NIOSH Issues Major Critical Review of Science on Job Related Musculoskeletal Disorders

Contact: Fred Blosser (202) 260-8519
July 1, 1997

The National Institute for Occupational Safety and Health (NIOSH), a part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services, today issued a major critical review of scientific literature pertaining to work related musculoskeletal disorders of the neck, upper extremities, and low back.

Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiological Evidence for Work Related Disorders of the Neck, Upper Extremities, and Low Back, is the most comprehensive review to date of the scientific data from epidemiologic studies that describe the prevalence and distribution of selected musculoskeletal disorders in worker populations, and factors associated with those cases.

The relation between musculoskeletal disorders and work related factors has generated considerable public debate. Based on a review of the science, the document concludes that compelling scientific evidence shows a consistent relationship between musculoskeletal disorders and certain work related physical factors, especially at higher exposure levels.

For the report, NIOSH reviewed more than 2,000 epidemiologic studies and then intensively analyzed more than 600 of those that addressed the relationship between musculoskeletal disorders of the neck, upper extremities, and low back, and workplace factors. The report was reviewed extensively within and outside of NIOSH.

Musculoskeletal disorders are common and costly conditions that occur in many different businesses. The greatest risk occurs in a small number of industries where workers are more likely to have high exposure to conditions associated with musculoskeletal disorders; in a larger number of industries, high exposures are less common. As a conservative estimate, work related musculoskeletal disorders of the neck, shoulder, elbow, hand, wrist, and back account for $13 billion in workers’ compensation costs every year.

“We know from the current science that musculoskeletal disorders can develop from or become exacerbated by factors associated with work,” said NIOSH Director Linda Rosenstock, M.D., M.P.H.. “This new report will help focus the ongoing studies and public dialogue critical for reducing these burdens on health and productivity.”

The report analyzes major potential workplace factors for musculoskeletal disorders of the neck, upper extremities, and low back. For each factor, NIOSH describes whether research shows strong, adequate, or inadequate evidence relating the potential risk factor to a specific disorder, such as carpel tunnel syndrome and low back injury. NIOSH’s conclusions were based on a careful examination of the data using key criteria. For example, were the findings in a particular study strong statistically? Were they consistent with the results of similar, independently conducted studies?

“Appropriately, we are releasing the new science document at our meeting today at the National Academy of Sciences with the many public and private sector partners who are working with us to implement the National Occupational Research Agenda (NORA),” said Rosenstock. “By providing compelling evidence that these types of disorders are a significant problem in U.S. workplaces, and by offering a foundation for future efforts to prevent such disorders, the science document will serve as a fundamental technical resource for research under NORA for years to come.”

The report is a companion document to NIOSH’s recent publication, Elements of Ergonomics Programs: A Primer Based on Workplace Evaluations of Musculoskeletal Disorders. Where the new document is intended as a reference for other scientists, the primer offers nontechnical audiences a set of practical approaches for protecting workers from job related musculoskeletal disorders, based on the current scientific knowledge. The new report also reflects the importance of upper extremity and low back musculoskeletal disorders under National Occupational Research Agenda as two of the 21 NORA priority areas for job health and safety research in the next decade.

Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiological Evidence for WorkRelated Disorders of the Neck, Upper Extremities, and Low Back, DHHS (NIOSH) Publication No. 97-141, is available by calling NIOSH toll free at