musculoskeletal disorders

Cecilia Van Cauwenberghe from Frost & Sullivan’s TechVision Group provides a comprehensive overview of work-related musculoskeletal disorders, including impact reduction

Most commonly musculoskeletal disorders (MSDs) are associated with a repeated exposure to occupational ergonomic hazards, including frequent exertion, repetitive bending, twisting movements, or recurrent standing. According to the announcements made at the XXI World Congress on Safety and Health at Work held in Singapore on September 2017 by the European Agency for Safety and Health at Work (EU-OSHA) and the International Labour Organization, worldwide work-related MSDs (WRMSDs) result in the loss of 3.9% of GDP, at an annual direct and indirect cost of €2,680 billion ($3,325 billion) and comprising more than 120 million disability-adjusted life years (DALY) lost. In the European Union, WMSDs are costing 3.3% of GDP, which implies an annual cost of €476 billion ($591 billion) and around 7 million DALY.

A recent article published by Sultan-Taïeb et al., 2017, highlights that WMSDs embody a major public health problem and economic burden to employers, workers and health insurance systems. The authors performed a systematic review to investigate the cost-benefit results of organisational-level ergonomic workplace-based interventions aimed at preventing WMSD, as well as, to analyse factors influencing the deployment of these interventions to effectively correlate economic results.

Industry/occupation prevalence rates and adverse health correlations

Shockey et al., 2018, published a comprehensive study attempting to determine which industry and occupation groups presently have the highest prevalence rates of frequent exertion at work and frequent standing at work, also including analysed data from the 2015 US National Health Interview Survey (NHIS) Occupational Health Supplement (OHS) regarding currently employed adults in the United States published by the US Centers for Disease and Control Prevention (CDC) and the National Center for Health Statistics.

According to the study, the highest prevalence of both frequent exertion and frequent standing at work evidenced by industry was associated with agriculture, forestry, fishing and hunting with 70.9%. Regarding occupation, the highest prevalence indicated more relevant were construction and extraction with 76.9%. The study also enabled to establish important differences among industry and occupation in terms of ergonomic hazards, suggesting the design of targeted interventions to reduce workplace exposure. Indeed, combined together industry and occupation, higher prevalence rates of frequent exertion, generally involving bending, pushing, pulling and lifting co-occurring with standing, were associated with farming, construction and food services, whereas, a high prevalence of frequent standing at work with a low prevalence of frequent exertion was related to education, laboratory testing and office-based services.

It is important to highlight that health risks associated with excessive sitting during the workday involving muscular atrophy are as relevant as repeated exertion. In fact, excessive standing has been linked to adverse health outcomes and unbalanced dietary habits. Coenen et al., 2016, carried out meta-analysis studies on peer-reviewed articles to correlate occupational standing with musculoskeletal symptoms.

Although the authors conclude that more research is needed to effectively advice about how to balance time spent sitting and standing while at work, the report allows associating numerous variables that may help to reduce WRMSDs. In agreement with these observations, a literature review performed by Waters and Dick, 2015, allows matching prolonged standing at work with adverse health outcomes, such as back pain, physical fatigue, muscular pain and even muscular atrophy. Corroborating these findings, Parry et al., 2017, investigating the potential workplace interventions for preventing musculoskeletal symptoms in sedentary workers, reported a high prevalence of musculoskeletal symptoms amongst sedentary workers. According to the study, near 92% of office workers worldwide reported musculoskeletal symptoms, related to persistent postures, prolonged keyboard, mouse use, high workload and distress.

Musculoskeletal symptoms and conditions

Accurate diagnostics and physical assessment WMSDs symptoms are derived from injuries or disorders of the muscles, nerves, tendons, joints, cartilage and spinal discs. Indeed, low back pain, neck pain and osteoarthritis are among the largest cause of loss of work productivity and work disability. Most WRMSDs can neither be diagnosed specifically nor associated with a strict pathology via physical examination. However, pain, discomfort, numbness and tingling in the affected areas are generally evidenced.

More exacerbated symptoms may involve swelling in the joints, decreased mobility, grip strength, skin colour changes, especially accentuated when work activities imply the long-term exposure to harsh environments such as excessive cold, vibrational tools, excessive levels of humidity or dryness, etc. These complaints can lead to physical impairment and even disability. Symptoms may take weeks, months or in some cases years to develop, so it is important to detect them and act at an early stage.

Early prevention and smart solutions

During the past decade, a vast number of technology innovations have significantly impacted work tasks and habits. Some of these technologies have resulted in an abrupt change in the workforce from less physically demanding employment toward more sitting standing workload. Most accentuated in developing countries, a sharp rise in physical inactivity and sedentary occupations is being evidenced.

According to Parry et al., 2017, office workers are sedentary for 77% to 82% of working hours. This fact means that an increasing proportion of the population faces a higher potential risk of not only musculoskeletal symptoms, but also additional health risks related to sedentary exposure. Therefore, early prevention is crucial to guarantee a good health for employees.

A global managerial approach involving time permanence, tasks readjustment and employee rotation and integration, constitute an essential part of any labour healthcare programme, along with the interaction of the corporation management with medical specialists and health and safety professionals. Emphasised by Van Cauwenberghe, 2016, in a Frost & Sullivan Research Service, ‘smart healthcare’ solutions in the context of ‘smart cities’ are starting to introduce eHealth/mHealth intelligent systems and connected medical devices, along with the implementation of online health monitoring and diagnostic systems at work, thereby encouraging health, wellness and well-being in the workplace. These smart solutions constitute a paradigm shift from treatment to prevention even at work.


I would like to thank all contributors from industry involved with the development and delivery of this article and Frost & Sullivan’s staff from the TechVision Group.

Further reading

1 Coenen, P., Willenberg, L., Parry, S., Shi, J.W., Romero, L., Blackwood, D.M., Maher, C.G., Healy, G.N., Dunstan, D.W. and Straker, L.M., 2016. Associations of occupational standing with musculoskeletal symptoms: a systematic review with meta-analysis. Br J Sports Med, pp.bjsports-2016.

2 European Agency for Safety and Health at Work, 2017. Work-related accidents and injuries cost EU €476 billion a year according to new global estimates.

3 Parry, S.P., Coenen, P., O’Sullivan, P.B., Maher, C.G. and Straker, L.M., 2017. Workplace interventions for increasing standing or walking for preventing musculoskeletal symptoms in sedentary workers. The Cochrane Library.

4 Shockey, T.M., Luckhaupt, S.E., Groenewold, M.R. and Lu, M.L., 2018. Frequent Exertion and Frequent Standing at Work, by Industry and Occupation Group—United States, 2015. Morbidity and Mortality Weekly Report, 67(1), p.1.

5 Sultan-Taïeb, H., Parent-Lamarche, A., Gaillard, A., Stock, S., Nicolakakis, N., Hong, Q.N., Vezina, M., Coulibaly, Y., Vézina, N. and Berthelette, D., 2017. Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders: a systematic review of organizational-level interventions. BMC public health, 17(1), p.935.

6 Van Cauwenberghe, C., 2016. Technologies Empowering Smart Healthcare: The Optimal Synergy Between Leading-edge Hi-Tech and Digital Innovation. Frost & Sullivan Research Service.

7 Waters, T.R. and Dick, R.B., 2015. Evidence of health risks associated with prolonged standing at work and intervention effectiveness. Rehabilitation Nursing, 40(3), pp.148-165.


Cecilia Van Cauwenberghe, PhD, MSc, BA

Associate fellow and senior industry analyst

TechVision Group, Frost & Sullivan


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