EHS Administration, Injuries and Illness

Ergonomics: Controlling the Costs of Musculoskeletal Disorders

Do you have effective ergonomics interventions in place at your facilities or worksites? How much are musculoskeletal disorders (MSDs) costing you?

Ergonomic hazards are among the costliest workplace hazards, according to Liberty Mutual’s latest Workplace Safety Index (WSI). “Overexertion involving outside sources” (lifting heavy loads) tops the insurer’s WSI­. Overexertion injuries collectively cost employers $12.84 billion a year in medical costs and lost wages. Awkward postures, or “other exertions or bodily reactions,” cost employers $3.67 billion a year.

The National Safety Council (NSC) has called MSDs the most common workplace injury. Some 30 percent of unwanted days away from work are due to MSDs, according to the NSC. How much are MSDs burdening you with lost productivity and medical costs?

While the NSC has focused efforts on research into and the application of interventions, the group released a white paper last year concluding that “there is no silver bullet” for MSD hazards. The group’s MSD Solutions Lab acknowledged it can be challenging to eliminate workers’ exposures to all risk factors.

The safety council’s MSD Solutions Lab is supported by corporate contributions from Inc., which has faced public criticism and Occupational Safety and Health Administration (OSHA) enforcement efforts for MSD hazards in its warehouses.

Workplace MSD risks include repetitive motions, along with bending, lifting heavy items, power tool vibration, pulling and pushing heavy loads, reaching overhead, and working in awkward body postures. According to OSHA, examples of MSDs include carpal tunnel syndrome, injuries to the elbow (epicondylitis, or “tennis elbow”), low-back injuries, muscle strains, rotator cuff injuries, tendinitis, and trigger finger.

MSD hazards remain a focus of enforcement efforts at OSHA despite the 2001 removal of a federal ergonomics standard. Because there’s no federal ergonomics or MSD standard, MSDs in the workplace are cited under OSHA’s authority established by the General Duty Clause of the Occupational Safety and Health Act of 1970.

Penalties for MSD violations can be low. Under OSHA’s current penalty policy, the maximum penalty per health or safety violation is $15,625. General Duty Clause violations don’t fall under the agency’s new “instance-by-instance” citation and penalty policy, which only applies to serious violations of the fall protection, lockout/tagout, machine guarding, permit-required confined space, respiratory protection, and trenching standards, or other-than-serious violations of the agency’s recordkeeping requirements.

The agency also sometimes issues ergonomic hazard alert letters (EHALs) that carry no penalty for MSD hazards identified during a workplace health inspection.

To address ergonomic and heat hazards in warehouses and distribution centers, OSHA launched a National Emphasis Program (NEP) this past summer. During an inspection, an agency compliance safety and health officer (CSHO) will review an employer’s injury and illness log to assess workers’ exposure to ergonomic hazards and open a health inspection if necessary.

OSHA citations, warnings at Amazon warehouses

In January, OSHA cited workplace safety and health violations at three Amazon warehouses in Deltona, Florida; Waukegan, Illinois; and New Windsor, New York. The agency determined that workers at the three warehouses were at high risk for lower-back injuries and other MDSs related to the following:

  • High frequency with which workers are required to lift packages and other items;
  • Heavy weight of items;
  • Awkward postures, such as bending, long reaches, or twisting while lifting; and
  • Long hours required to complete assigned tasks.

This summer, OSHA cited Amazon’s Logan Township, New Jersey, warehouse for exposing workers to ergonomic hazards. OSHA also has cited violations this year at Amazon’s warehouses in Aurora and Colorado Springs, Colorado; Nampa, Idaho; and Bayonne, New Jersey.

OSHA also has issued a series of hazard alert letters to Amazon warehouses across the country this year about MSD hazards and delays in receiving medical care.

While hazard alert letters impose no penalties, they can lead to further inspection and enforcement.

OSHA has had a policy for following up on EHALs since 2007. Under the policy, a year after issuing a hazard alert letter, agency personnel will contact employers that received a letter to assess their hazard abatement efforts. If an employer doesn’t respond or provides an inadequate response following two rounds of contact, a regional office may schedule an unannounced inspection.

Jeff Bezos, former president and CEO of Amazon, expressed concerns about MSDs in his final letter to shareholders before making the transition to executive chairman: “… about 40% of work-related injuries at Amazon are related to musculoskeletal disorders (MSDs), things like sprains or strains that can be caused by repetitive motions.”

Amazon’s collaborations with the NSC to address MSD hazards have included developing an MSD Pledge, sponsoring a small business ergonomics summit, and supporting grants for research into promising safety solutions to reduce the instances of work-related MSDs.

What is ergonomics?

The National Institute for Occupational Safety and Health (NIOSH) defines ergonomics as “the scientific study of people at work … to prevent soft-tissue injuries.” The causes of MSDs include awkward postures, repetitive motion, sudden or sustained exposure to force, and vibration. MSDs can show up in workers across a wide swath of industries, such as agriculture, construction, health care, manufacturing, mining, transportation, and the wholesale and retail trades.

Keyboards, power tools, material- and patient-handling, and postures can all pose risks.

Repetitive motion poses MSD risks for workers in meat and poultry processing. Recommended engineering controls in meatpacking and poultry processing involve tool-handle and workstation designs.

OSHA recommends that poultry processing employers look for tools such as knives, pliers, and scissors that are designed to minimize the bending of the wrist either side to side or up and down and minimize the finger force and contact stress to fingers and the palm. Proper tool handles should help prevent the transmission of cold or vibration to the user. Appropriately sized tool handles should allow users with small hands to maintain the “C” shape of a power grip between the fingers and thumb.

A wraparound handle or strap allows a tool user to maintain control of the tool while relaxing the fingers on the handle. A handle guard can be added to some tools to prevent a worker’s hand from slipping onto the tool’s blade. Powered hand tools can reduce the finger force necessary to operate tools.

NIOSH has several industry-specific guidelines for ergonomic interventions, such as its Ergonomic Guidelines for Manual Material Handling, covering ergonomic interventions that can lower the physical demands of manual material-handling tasks.

In retail grocery stores, workers performing manual material-handling duties—moving merchandise to the sales floor, unloading trucks, and unloading merchandise from storage onto store shelves—may benefit from the assistance of conveyors, hand trucks, pallet jacks, powered pallet jacks, and “u-boats” (carts with inverted-u-shaped handles on either end).

Storewide manual solutions in retail grocery stores include pinch grasps, power grips, and power lifts. While some ergonomic interventions involve engineering controls like assistive equipment or tools, many rely on recommended motions or postures, such as proper lifting techniques and recommended working postures to eliminate or limit exertion or pressure on joints.

Engineering controls recommended in NIOSH’s ergonomic interventions for soft drink beverage delivery include external handles and pullout steps on beverage delivery trucks, two-wheeled hand trucks with counterbalancing devices, improved carton design to ease product handling, and the use of plastic instead of glass containers to reduce product weight. Biomechanical monitoring of manual material handling, psychophysical discomfort assessment surveys, and videotaping can help employers identify risk factors.

NIOSH also has researched MSDs among employees in health clinic pharmacies who repeatedly open and close child-resistant medication bottles. Repetitive-motion injuries were the most common recordable injury among pharmacy department employees. Investigators noted that hand and neck symptoms and conditions were consistent with pharmacy work-related MSDs.

The institute’s recommendations include:

  • Using adjustable-height workstations,
  • Alternating between computer work and repetitive-motion pharmacy tasks, and
  • Increasing employee and supervisor training on ergonomics and MSDs.

Like NIOSH, OSHA has developed voluntary ergonomic guidelines for a number of workplaces, including beverage distribution, foundries, meatpacking and poultry processing, nursing homes, and shipyards.

In its employer guidance for foundries, OSHA recommends ergonomic interventions that include:

  • Cutouts in worktables to reduce reaching distances;
  • Devices that allow parts to be easily turned in multiple directions during production to reduce awkward postures or reaching;
  • “Ergonomic” handles on tools to reduce the use of forceful pinch grips;
  • Floor mats in areas where workers stand for long periods of time to reduce discomfort and fatigue and “sit-stand” stools that reduce fatigue and the need for extended reaches;
  • Hoists or balancers to transfer heavy loads to reduce lifting, pulling, and pushing forces;
  • Height-appropriate work surfaces or the modification of work heights to reduce reaching motions, as well as permanently raised standing surfaces that reduce awkward body postures;
  • Lift tables to reduce bending, reaching, and walking; platforms or stacks of pallets to increase the height at which items are handled to reduce bending and reaching motions; and “tilters,” mechanical devices that lift and tilt to adjust materials for easier handling;
  • Mechanical grabbers and powered dollies to reduce physical exertion; and
  • Powered trolleys or roller conveyors to reduce the need to manually push loads.


Industrial exoskeletons have often been said to reduce the risk of work-related MSDs because they may reduce spinal muscle loading and muscle fatigue during dynamic lifting tasks. Upper-extremity exoskeletons, along with an appropriate ergonomics program, may also help prevent shoulder injuries. However, NIOSH has pointed out a lack of research to confirm the benefits of exoskeletons.

Industrial exoskeletons can also pose risks that include:

  • Compressed nerves and pressure wounds from prolonged use;
  • An increase in the length of time a worker holds a tool, increasing exposure to hand-transmitted vibration; and
  • Increased load to the spine while using heavy tools, as well as a shifting of loads from the shoulders to the legs and lower back.

NIOSH has supported many research projects on industrial exoskeleton use in health care, manufacturing, mining, and the wholesale and retail trade sector. The institute has looked into exoskeleton systems’ potential for reducing hand-transmitted vibration, the feasibility of using exoskeletons for safe patient handling, and the health effects of passive shoulder exoskeletons.

While there may be no “silver bullet” for MSD hazards, an effective ergonomics program must weigh the benefits of engineering controls, work practices, and training to reduce worker risk.

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