Work 51 (2015) 645–656 645

DOI 10.3233/WOR-152027
IOS Press

Review Article

Comparative study of the relevance of

musculoskeletal disorders between the
Spanish and the European working population
José Maria Rivas Moara,∗ , José Maria Alvarez-Campanab, José Luis Míguezc and D.G. Ramosd
a
Safety and Health Department, RMCI, A Coruña, Spain
b
Health Care and Rehabilitation, Mutua Gallega de Accidentes Rehabilitation Society, Spain
c
Industrial Engineering School, University of Vigo, Spain
d
Polytechnic Institute of Cávado and Ave, Technology School, Barcelos, Portugal

Received 18 May 2013

Accepted 24 November 2014

Abstract.
BACKGROUND: Musculoskeletal disorders (MSDs) are diseases of high prevalence. The extent to which our work is causing
or aggravating them is still questioned because their causes are heterogeneous and usually combined in the same person, and can
be attributed to any of them.
OBJECTIVE: The objective of this paper is to compare Spain with the rest of Europe concerning MSDs.
METHODS: The study is based on a comparison between Spanish and European data. The difficulty is that the lists of occupa-
tional diseases in the various States of the European Union (EU) are different, and therefore it is difficult to compare data.
The study compares two types of data: the views of workers, and the official results of workplace accidents. In the first case,
the results of the VII Spanish National Survey of Working Conditions were compared to the V European Working Conditions
Survey. In the second case, we compare accident data, published by the Spanish Labour Authorities, to data provided by Eurostat
(Statistical Office of the European Communities).
RESULTS: During the development of this study, we have proved the importance and significance of MSDs on the Spanish
working population in relation to the European one.
First, we have discovered a great difference between Spanish and European workers views about the relationship between work
and heath.
Then, we detected some more important ergonomics risk factors within the Spanish workforces’ opinions. These are repetitive
movements, tiring positions, and exposure to vibrations. However concerning heavy loads, lifting or moving people, the views of
Spanish workers are more carefree than European ones.
If we only consider the official results of workplace accidents and diseases, we find Spanish rates higher than the European
average.
CONCLUSIONS: The incidence of MSDs on the Spanish working population significantly exceeds European records in this
matter. MSDs account for between 35–40% of Work Accidents and between 70–88% of Occupational Diseases in Spain so, we
can see why Spain has one of the top Occupational Accidents rates in Europe.
Spain should try to improve this issue by concentrating only on three factors: repetitive work of upper extremities, tiring positions
and exposure to vibrations.

Keywords: Work-related diseases, Labour Statistics and Health and Safety Survey

∗ Corresponding author: José Maria Rivas Moar, Safety and

Health Department, RMCI, Ada. Alfonso Molina, 6 1◦ D 15006, A Coruña, Spain. E-mail: josem.rivas.moar@gmail.com.

1051-9815/15/$35.00 
c 2015 – IOS Press and the authors. All rights reserved
646 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population
1. Introduction
The World Health Organisation [1], defines “Mus-
culoskeletal disorders” (MSDS) as a locomotor system
health problem, that is, tendons, skeleton, ligaments,
nerves, cartilage, etc. It is a broad definition which in-
cludes heterogenic diseases. This increases the diffi-
culty of the study, investigation or statistical analysis
of their impact.
There has never been international consensus when
defining this group of diseases, nor uniformity when
defining exactly what diseases make it up. Different
terms have often appeared in literature and each term
captures the group of pathologies selected by a country
in its statistical controls.
The interest in this group of injuries, from a work
perspective, was probably not very relevant 30 years
ago, but as government health and safety organisa-
tions (EU-OSHA in the European Union, NIOSH and
OSHA in the U.S., INSHT in Spain, HSE in Britain,
CCOHS in Canada, SWA in Australia, etc.) have begun
to discriminate and classify health damage, we have
also begun to discover the true extent of the problem,
increasing the interest in this matter.
The real cost of MSDs is difficult to calculate,
mainly because of the lack of their standardization.
Some reports [2] from the European Agency for Health
and Safety at Work, have published the rating 0.5–2%
of GNP. Therefore, in any case, it is a priority health
problem in the Euro Zone.
In recent years there have been numerous arti-
cles [2–9] and research on MSDs with very heteroge-
neous methodologies on differentiated groups of peo-
ple. For this reason, it is difficult to get an overall re-
sult. There are still doubts on key issues.
What diseases are included in MSDs? What is the
weight of work factors regarding personal factors?
What are the risk factors associated with the pathol-
ogy of each joint? Which diseases should be consid-
ered work related and which not?
The MSDs classified as professional contingencies
make up a group of diseases that can be processed as
work accidents (WA) or occupational diseases (OD).
Generally, when there is an immediate cause-effect re-
lationship we consider it a work accident, and, if the
disorder comes from prolonged exposure over time,
it is called occupational disease. For a disorder to be
considered a work related disease, we need a diagno-
sis and identification of the working conditions or its
causative agent, which is included in the list of Occu-
pational Diseases. Therefore, any analysis of the MSDs
has its limitations, since the comparison between coun-
tries with different laws is difficult.
Particularly in the European Union, the lists of Oc-
cupational Diseases are not organized in the same way.
Some states define, very precisely, the various MSDs
that are recognized, while others have a list with major
groups, without going into great detail.
To make matters worse, most states have an open
system of recognition in which the physician, by his
sole discretion, has authority to classify the disorder.
In Spain, given the difficulty in the actual count
of MSDs, i.e., the coexistence of the two profes-
sional contingencies, the Spanish Social Security sys-
tem has recently created a data file called “Pan-
otrass [10]”, which corresponds to Non-Traumatic
Pathologies caused by work. The aim is to facilitate
knowledge of those non-traumatic pathologies, which
have no place on the list of occupational diseases, and
yet are receiving protection as work accidents when
it’s proven that the cause is exclusively work related.
Many MSDs are in this situation, thus it is understood
that their cataloging and detection will be easier in the
future.
The aim of this paper is to make a sufficiently rigor-
ous comparison between Spanish and European data,
whilst trying to overcome the difficulties described.
2. Materials and methods
It is often said that there are two categories of re-
search and analysis of work conditions [11], the first
of which considers that valuation must be made by the
workers themselves and, therefore, can only be carried
out by asking them (via survey). The second category
disregards any subjective assessments to focus on ob-
jective findings.
Regarding MSDs, the data source must be selected
conveniently and we must make sure that there is no
group bias. Differences between the trade unions and
business organizations are not uncommon, and the se-
lected samples in the commissioned studies are not al-
ways representative.
2.1. Considered databases
The data considered have the following origin:
a) Data provided by Spanish workers through the
Spanish National Survey of Working Conditions
(ENCT) [12].
 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population
Carried out by INSHT (Spanish National Insti-
tute of Health and Safety at Work), with a sam-
ple of 8,892 workers by personal interview in the
workers’ home and a questionnaire of 62 ques-
tions. From this group, 95% of people working
on the day of the interview, 80% were actively
registered with the Spanish social security system
and 73.9% had a permanent contract.
b) Data provided by the European workers via the
European Working Conditions Survey
(EWCS) [13].
The EWCS of the European Foundation for the
Improvement of Living and Working Conditions
(EFILWC) has a similar goal to the ENCT, i.e.
to obtain the views of workers, on the various
factors that influence their working conditions.
The present study uses the fifth edition of the sur-
vey, which has 44,000 workers from 34 European
Countries (the EU-27, Norway, Croatia, Macedo-
nia, Turkey, Albania, Montenegro and Kosovo).
Gallup Europe, addressed the issue of data col-
lection in 2010, by interviews in the worker’s
home, outside the workplace, with an average du-
ration of 44 minutes per interview.
The EWCS use the terms EU-12, EU-15 and EU-
27, which means:
– The EU-12 is formed by, Belgium, Denmark,
France, Germany, Greece, Ireland, Italy, Lux-
embourg, the Netherlands, Portugal, Spain,
and the United Kingdom.
– The EU-15 is EU-12 plus Austria, Finland and
Sweden.
– And the EU-27 is EU-15 plus Bulgaria,
Cyprus, Czech Republic, Estonia, Hungary,
Latvia, Lithuania, Malta, Poland, Romania,
Slovakia and Slovenia.
c) Data on WA in Spain obtained from official in-
dexes developed by the INSHT [14].
Data from MSDs listed as WA within the Span-
ish working population have been estimated from
the Spanish Labour Statistics Yearbooks. This in-
formation comes from the content of the offi-
cial reports of occupational accidents with time
off work. We used an INSHT publication, “Acci-
dents at work by overexertion 2011”, which be-
longs to the Department of Research and Infor-
mation.
d) Information concerning WA within the European
Union is obtained directly from Eurostat.
Information has been obtained at the web address
http://epp.eurostat.ec.europa.eu/portal/page/port
647
al/eurostat/home/ dated 02/14/2013 with the last
update of the data on 04-02-2013.
e) Data on OD [15] in Spain are obtained from offi-
cial indexes developed by the INSHT.
The MSDs data classified as OD within the Span-
ish working population have been estimated from
data provided by the CEPROSS, General Direc-
torate of Spanish System of Social Security. The
INSHT has collected these results in its publica-
tion, “The musculoskeletal disorders in the work-
place in numbers” that has been used for this pur-
pose.
f) At a European level, the information on OD
comes from two different sources:
– For the 2002–2005 period, we have used
data from the European Occupational Diseases
Statistics (EODS), collected in the publication
of European Agency for Health and Safety
at Work (EU-OSHA): OSH in figures, Work-
related musculoskeletal disorders in the EU.
Data come from across the EU except Ger-
many, Greece and Ireland.
– For the 2006–2010 period, we have used
records from four countries: France, Denmark,
Great Britain and Germany. The source of
these records can be found in EUROGIP pub-
lications, in the annual statistics of Health and
Safety Executive and in DGUV publications.
We must point out that studies and research conducted
by social agencies and NGOs involved in the matter
have been left out because of possible biases that may
occur (unions, prevention services, accident insurance,
business associations, etc.).
2.2. Procedure
The methodology involved the direct comparison of
the different results obtained in Spain by ENCT or the
accident statistics published by the INSHT, compared
to data from the European or the ECWS, Eurostat
statistics, EUROGIP, SHE or DGUV. In some cases
where a correspondence between ENCT and EWCS
does not exist, we have compared the Spanish results
against the average European results in the EWCS sur-
vey.
With regard to working conditions, we have anal-
ysed:
– Views of workers on the relationship between
health and work.
– The incidence of major ergonomics hazards in
their work place, namely:
648 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population
∗ Repeated movements
∗ Tiring positions
∗ The handling of weights (loads and/or people)
∗ Vibrations
Meanwhile, in terms of accidents, we used the fol-
lowing variables for comparison: Percentage share of
MSDs of total WA (% MSDs-WA) and on total OD (%
MSDs-OD).
For WA, the Spanish data used are those occupa-
tional accidents with sick leave that have been classi-
fied as code type 71 (physical overexertion-on muscu-
loskeletal system).
For the selection of European data, due to the mis-
match of the different laws, it was necessary to filter
the WA published by Eurostat. Of the various existing
fields in the description of the accident, we will use
“type of injury”, with only the following codes being
recorded:
– 031 Dislocations and subluxations
– 032 Sprains and strains
– 039 Other types of dislocations, sprains and
strains
The period analysed was 2008–2010, and all records
are used for total activities and total accidents i.e. no
more filters than those given to “the type of injury.”
For the OD, we compare the results of % MSDs
Spanish OD with the results provided by the European
Statistics on Occupational Diseases (EODS) over a pe-
riod of four years. Later a second comparison, in a
more current period, with four EU countries: France,
UK, Germany and Britain. In the latter case, we have
used the following criteria.
The figures for France include the following dis-
eases as MSDs:
– Joint diseases
– Chronic lumbar conditions
– Chronic meniscal injuries
– Diseases induced by vibrations of machines.
For Britain, the total number of cases recorded in the
last 12 months. The British statistical system does not
match calendar years in other countries, therefore, we
have used the equivalence 2006 to 2006/2007, 2007 to
2007/2008, etc. . .
In the case of Denmark, the following diseases have
been recorded as MSDs:
– Lumbar affections
– Motricity diseases and other articular diseases
– Nerve inflammation including carpal tunnel syn-
drome.
Your work affect your health
32.9%
EU-27
22.4%
EU-15
EU-12
22.1%
0.0% 10.0% 20.0% 30.0% 40.0%
Fig. 1. Relationship between work and health. (Colours are visible
in the online version of the article; http://dx.doi.org/10.3233/WOR-
152027)
We have selected data from diseases recognized af-
ter the diagnosis process (regardless of the initial data).
The results of Germany recorded only confirmed
cases of occupational diseases and, between them, we
have selected Subsection 2.1 of its list of professional
diseases, corresponding to mechanical agents: Muscle
diseases, meniscal injuries, back injuries, nerve pres-
sure injuries, etc.
Finally, the approach followed in the case of MSDs
in Spain is the one used by INSHT in their reports
“Work Accidents by overexertion 2011” and “muscu-
loskeletal disorder in the workplace in numbers”.
3. Results and analysis
3.1. Results of workers surveys
3.1.1. Relationship between work and health
The content of the labor surveys should begin with
the workers’ views on the relationship between work
and health. In the EWCS, the question ”Does your
work affect your health?” has been answered “yes” in
the following percentages: 22.1% in EU-12, 22.4% in
EU-15 and 32.9% in EU-27 (Fig. 1).
Meanwhile the ENCT makes reference to this is-
sue by asking the workers, primarily, about perceived
health problems and secondly, if they think their prob-
lems are aggravated by work.
The main health problems identified include: back-
ache, neck, upper extremities, lower extremities, tired-
ness, stress and headache (Fig. 2).
The results show that the 27.8% of workers had no
problem whatsoever, which means that 72.2% of the
working population suffers health problems.
 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population 649

27.8% 6%

14.0% 15% Liing or moving people

Health problems idenfied

Ergonomic hazards
Never
17.2% Headache Thrust and drag forces
18%
Stress Heavy loads
18.9% 30%
Tiredness Sing posture

22.9% 31% Standing

Lower Extremies
Tiring posions
Upper Extremies
26.6% 36% Repeve movements
Neck
32.0% Backache 5 9%

50.3%
0% 20% 40% 60% 80%

0.0% 10.0% 20.0% 30.0%
Fig. 2. Health problems. (Colours are visible in the online version of
the article; http://dx.doi.org/10.3233/WOR-152027)
70.0%
60.0%
50.0%
40.0%
30.0%
22.1%
20.0%
10.0%
0.0%
EWCS EU-12
Fig. 3. Comparative relationship between work and health.
In the second question, 86.4% of workers believed
that the health problem is produced or made worse
by work, yielding different percentages depending on
the different pathologies. This means that 62.4% of re-
spondents understood that work affects their health, a
much higher percentage share when compared to data
obtained at a European level (Fig. 3).
From the analysis we can observe that the Spanish
working population believes that their work will affect
their health in a much higher percentage than the Eu-
ropean average: 40.2% more than the EU-12, 39.9%
more than in the EU-15 and 29.4% than the EU-27.
3.1.2. Ergonomics risk
The etiology of MSDs related ergonomics risk fac-
tors, such as repetitive work, painful and tiring pos-
tures, carrying/moving heavy loads and exposure to vi-
bration as their main cause [16].
The ENCT analyses the opinion of the workers on
these factors. The result obtained is shown in the Fig. 4.
40.0% 50.0% 60.0% Fig. 4. Ergonomics hazards identified. (Colours are visible in the on-
line version of the article; http://dx.doi.org/10.3233/WOR-152027)
Using these risk factors and taking into account ex-
posure to vibration (physical hazard with evidence of
62.4%
its influence on MSDs of the back), then we will make
a comparison of the difference of opinion between Eu-
ropean and Spanish workers in the key ergonomics fac-
32,9% tors identified.
22.4%
3.1.2.1. Repetitive work of upper extremities
This is a group of continuous movements of the up-
per limbs, kept up at work, which damage the same
musculoskeletal group. Repetitive work aggravates fa-
Your work affect your health
EWCS EU-15 EWCS EU-27 ENCT
tigue, overload, and, ultimately, pain. This problem
usually appears with work cycles with similar patterns
in terms of forces and displacements.
The following repeatability values are considered
harmful in different body segments [17]:
– Shoulder: More than 2.5 repeats per minute
– Arm/Elbow: More than 10 repetitions per minute
– Forearm/Wrist: More than 10 repetitions per
minute
– Fingers: Over 200 repetitions per minute
On the other hand, generally, Silverstein [18–20]
stated that “work is considered repetitive when the du-
ration of the work cycle is less than 30 seconds.”
The perception, in terms of exposure to repetitive
movements, of the Spanish workforce in the EWCS
(Fig. 5), is 40.9%, well above the European average:
8.2% more than the EU-12, 8% more than the EU-15
and EU-27.
3.1.2.2. Tiring positions
These are positions adopted at work which generate
one or more anatomical regions to abandon a natural
position of comfort to move to another position that
650 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population

Table 1
Joint limits
Joint Positions RULA ISO 11226 OSHA Keyserling Drury Occhipinti-Colombini
Shoulder Flexion > 90◦ > 60◦ Without support Without support 94◦ 80◦
Extension > 20◦ If there 31◦ 20◦
Abduction If there > 60◦ 67◦ 45◦
Elbow Flexion > 100◦ At the end 71◦ 60◦
Supination Maximum value At the end Fast movement If there 39–57◦ 60◦
Wrist Flexion > 15◦ At the end > 20◦ If there 45◦ 45◦
Extension > 100◦ At the end > 30◦ 50◦ 45◦
Radial Deviation If there At the end − 14◦ 15◦
Ulnar deviation If there At the end − 24◦ 20◦

Table 2 70.0%
Limit values of neck and trunk 59.0%
60.0%
Segment Position Intervals Assessment
Head Flexion > 20◦ Limit exposure time 50.0%
40.9%
Turn > 15◦ Limit exposure time 40.0%
< 45◦ 32.7% 32.9% 32.9%

< 45◦ Remove 30.0%

Lateral tilt Remove great inclinations 20.0%

Extension Remove
Trunk Flexion > 20◦ Reduce the angle 10.0%
< 60◦
> 60◦
0.0%
Remove Repeve movements
Lateral tilt > 15◦ Reduce the angle
> 15◦
EWCS Only Spain EWCS EU-12 EWCS EU-15 EWCS EU-27 ENCT
Turn Reduce the angle
< 45◦
Fig. 5. Comparative repetitive movements exposure.
> 45◦ Remove
Extension If there Remove
40.0%
35.8%
generates hyper flexion and/or osteoarticular hyper ro- 35.0%
tations.
30.0%
Usual results are muscle, tendon and joint fatigue,
25.0%
and usually occur when recommended limits are con-
20.0% 18.4%
tinuously exceeded. Conventional valuation methods 15.5% 15.3% 15.7%
identify the following values [21]: (Tables 1 and 2). 15.0%

The perception of Spanish workers, in terms of ex- 10.0%

posure to tiring positions, is 18.4%, against 15.5%, 5.0%
15.3% and 15.7% from EU-12, EU-15 and EU-27 0.0%
(Fig. 6). Tiring posions
The results show that the Spanish workforce is EWCS Only Spain EWCS EU-12 EWCS EU-15 EWCS EU-27 ENCT

higher than the European average on 2.9% 3.1% and

Fig. 6. Comparative tiring positions exposure.
2.7% respectively.

3.1.2.3. Carrying/moving heavy loads The result of the comparison of the perception of the
This risk factor encompasses acts of transporting or workers is:
handling of loads by workers, such as lifting, pushing, – Spanish workforce said that their job involves car-
positioning, traction or displacement, which generate rying or moving heavy loads in a 30.7%
the ergonomics risks of back injury.
– Workers from EU-12 answered in the same terms
With regards to this factor, there are different val-
in 32.5%
uation methodologies, the NIOSH equation being the
– Workers from EU-15 in 32.8%
most used. Using this equation, one can calculate the
– Workers from EU-27 in 33.5%
RWL (Recommended Weight Limit) for a particular
transport operation based on the weight of the load, the Apart from tiring positions and repetitive move-
relative position thereof, the vertical distance of ma- ments, the Spanish results are better than the European
nipulation, handling height and frequency surveys. average.
 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population 651

40.0%

35.0% 32.5% 32.8% 33.5%

30.7% 14.0%
30.0%

25.0% 17.2%

Health problems idenfied ENCT

20.0% 17.8% Sleep problems

15.0% Stress
18.9%
10.0% Tiredness
5.0% 22.9% Muscular pain at Lower
0.0% extremies
Heavy loads Headache/Visual problems
32,9%
EWCS Only Spain EWCS EU-12 EWCS EU-15 EWCS EU-27 ENCT Backache

50.3% Muscular pain, neck, shoulders

Fig. 7. Comparative heavy loads exposure. and upper extremies

10.0% 9.4% 9.5% 58.6%

8.9%
9.0%
8.0%
7.0% 6.5% Fig. 10. Health problems at ENCT. (Colours are visible in the online
6.0% 5.5% version of the article; http://dx.doi.org/10.3233/WOR-152027)
5.0%
4.0%
3.0%
2.0% 8.8%
1.0%
Health problems idenfied EWCS

0.0% Injuries
13.4%
Liing or moving people Stomach problems
EWCS Only Spain EWCS EU-122 EWCS EU-15 EWCS EU-27 ENCT
18.3% Sleep problems
Muscular pain at lower
Fig. 8. Comparative lifting or moving people exposure. extremies
30.0%
Headache/Visual problems
30.0% 32,9% Muscular pain, neck, shoulders
and upper extremies
25.0% 24.0%
21.8% 22.5% Backache
21.6% 42.8%
20.0%

14.0% 46.4%
15.0%

10.0%

5.0% Fig. 11. Health problems at EWCS. (Colours are visible in the online
version of the article; http://dx.doi.org/10.3233/WOR-152027)
0.0%
Vibraons

EWCS Only Spain EWCS EU-122 EWCS EU-15
Fig. 9. Comparative vibrations exposure.
3.1.2.4. Lifting and moving people
MSDs are a serious problem in the health sector, par-
ticularly for personnel who move patients, their trans-
fer being the most common mechanism of injury.
The difficulty of using traditional methods (Niosh
equation, etc.) is that the load is the human body and
manipulated weight calculation is extremely difficult
despite knowing very precise estimates of the differ-
ent body segments. Furthermore, the manipulations are
performed in positions with high angles of flexion of
the spine and/or neck.
At present there is a specific method, the MAPO in-
dex [22], a methodology which allows mobility risk
EWCS EU-27 ENCT assessment in different hospital areas (wards, surgi-
cal areas and outpatient care), taking into account fac-
tors such as: number of patients per worker, number
of elevators, proportion of valid patients, provision of
wheelchairs, adjustable beds and specific training for
workers in the field.
The comparison is similar to the above, the result
of the Spanish workers (Fig. 8) within the European
survey was 6.5% against 9.4%, 9.5% and 8.9% corre-
sponding to the European averages. It seems accept-
able to think that the Spanish workers are carrying
loads less than the European average, which is the op-
posite to other risk factors.
3.1.2.5. Vibrations
Mechanical vibrations cause a number of diseases
when their occupational exposure is significant. There
652 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population

70.0%
59.0%
60.0%
50.3%
50.0% 46.5%
42.8%
40.0%
30.0%
30.0% 22.9%
20.0%
10.0%
0.0%
Muscular pains, Neck, Shoulders Backache Muscular pains at lower
and upper extremies extremies
EWCS EU27 ENCT

Fig. 12. Comparative health problems. (Colours are visible in the online version of the article; http://dx.doi.org/10.3233/WOR-152027)

69.4%

38.0% 68.7%
2010
74.7%
%MSDs-WA

2009
2010
37.6% 79.1% 2008
2009
%MSDs-OD

2007
2008 86.6%
2006
36.4% 87.4% 2005
2004
86.2%
2003

35.5% 36.0% 36.5% 37.0% 37.5%
Fig. 13. Percentage share of MSDs over total WA in Spain. (Colours
are visible in the online version of the article; http://dx.doi.org/
10.3233/WOR-152027)
are two categories in terms of their effects: vibrations
transmitted to “hand-arm”, which generate vascular,
bone or joint, neurological or muscular problems; and
vibrations transmitted to the “full body” which usually
cause back pain and spinal injuries.
In this physical factor, the technical criteria of eval-
uation is defined by the UNE-EN ISO 5,349-1 (2002)
and UNE-EN ISO 2,631-1 (1997) regulations. The ex-
posure limit for the “hand-arm” system is 5 m/s2 and
“full body” 1.1 m/s2 . They are limits that correspond
to the most efficient values of accelerations according
to the three orthogonal axes defined in the rules.
The comparison of this ergonomics risk factor is as
follows (Fig. 9): the results show that 24% of Span-
ish workers said that they are exposed to vibrations, at
work, against 21.8%, 21.6% and 22.5% corresponding
to the European averages.
The end result shows that Spanish workers are more
conscious concerning ergonomics hazards from repet-
itive movements, tiring positions and vibrations expo-
sure, than European workers. Only in terms of carrying
loads and lifting people, do European workers show
greater sensitivity.
85.3% 2002
38.0% 38.5%
82.5%
0% 20% 40% 60% 80% 100%
Fig. 16. %MSDs-OD in Spain. (Colours are visible in the online ver-
sion of the article; http://dx.doi.org/10.3233/WOR-152027)
3.1.3. Disorders
Another consideration to determine the views of
workers on the incidence of MSDs is to analyze the
discomfort that they suffer. ENCT results show the fol-
lowing conditions as the main ones (Fig. 10): Muscular
pain, neck, shoulders and upper extremities were suf-
fered by 59% of the workers and backache by 50.3%.
For their part, the EWCS results (Fig. 11), were:
Backache 46.4% and muscular pain, neck, shoulders
and upper extremities 42.8%.
The comparison of the results of both surveys shows
the following results (Fig. 12).
As we can see, disorders reported by Spanish work-
ers in the ENCT outweigh the findings of the EU aver-
age in EWCS so that:
– Spanish workers show a 16.2% higher than the
EU-27 average, in neck, shoulder and upper ex-
tremity MSDs
– 3.8% more on MSDS on Back
– 7.1% less on lower extremity MSDs (to a lesser
extent from a labor perspective)
 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population 653

%MSDs -WA

29.3%
EU-27 29.6%
29.5%

30.3% 2010
EU-15 30.6%
2009
30.9%
2008
30.4%
EU-12 30.8%
31.2%

28.0% 28.5% 29.0% 29.5% 30.0% 30.5% 31.0% 31.5%

Fig. 14. Percentage share of MSDS over total WA in Europe. (Colours are visible in the online version of the article; http://dx.doi.org/
10.3233/WOR-152027)

%MSDs-WA
40.0% 37.6% 38.0%
36.4%
35.0% 31.2% 30.8% 30.4% 30.9% 30.6% 30.3%
29.5% 29.6% 29.3%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
EU-12 EU-15 EU-27 Spain

2008 2009 2010

Fig. 15. Comparative %MSDS-WA between Spain and EU. (Colours are visible in the online version of the article; http://dx.doi.org/10.3233/
WOR-152027)

3.2.1. Work accident

58.9% Official data of accidents are published by the Span-
ish National Observatory for Working Conditions.
2005 These are statistics that come from the public system
%MSDs-OD

55.2%
2004 to report accidents and therefore are always based on
2003
52.9% the diagnosis made by a physician.
2002
There is clear evidence that the accident rate in
52.8%
Spain is decreasing gradually, and, within this frame-
work, MSDs results continue to show a slight upward
48% 50% 52% 54% 56% 58% 60% trend while maintaining a level of about 36–38% of
WA (Fig. 13).
Fig. 17. %MSDs-OD in EU. (Colours are visible in the online ver- Meanwhile, in Europe, Eurostat estimates (no data
sion of the article; http://dx.doi.org/10.3233/WOR-152027)
from Holland and Portugal in 2008 or Greece) for these
three periods are (Fig. 14) somewhat lower.
The comparative between European and Spanish
3.2. Results of official accident statistics data is: (Fig. 15). As the graph shows, in Spain, the
percentage share of MSDs within WA is between 5%
and 8% higher than the European average.
In this chapter, we will use the results of occupa-
tional diseases diagnosed and legally notified by the 3.2.2. Occupational Diseases
Spanish national health system and the different esti- This type of data is more difficult to obtain because
mates made by Eurostat in this area. the Occupational Diseases lists are difficult to com-
654 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population

%MSDs-OD
100.0%
85.3% 86.2% 87.4%
90.0% 82.5%
80.0%
70.0%
58.9%
60.0% 52.8% 52.9% 55.2%

50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
2002 2003 2004 2005
Europe Spain

Fig. 18. Comparative %MSDs-OD 02-05.

%MSDs -OD

5.1%
26.7%
2010
44.1%
85.3%

4.7%
27.5%
2009
45.2%
83.3%

5.5% Germany
27.0% Denmark
2008
45.5%
81.3% Britain
France
5.3%
29.3%
2007
42.8%
78.2%

5.1%
23.5%
2006
46.4%
76.9%

0% 20% 40% 60% 80% 100%

Fig. 19. %MSDs-OD Germany, Denmark, Britain y France 06–10. (Colours are visible in the online version of the article; http://dx.doi.org/
10.3233/WOR-152027)

pare in Europe for its lack of homogeneity. First, we
compare the Spanish results with the latest official data
available at European level (2002–2005), and a second
more recent comparative will address data for four EU
countries (France, Germany, UK and Denmark).
First shown (Fig. 16), the percentage share of mus-
culoskeletal disorders in the whole of the Occupational
Diseases diagnosed in Spain. MSDS are the main prob-
lem in this area.
3.2.2.1. Period 2002–2005
The results at the European level over this period are
between 50% and 60% (Fig. 17).
The comparison (Fig. 18) regarding the relative
weight of MSDs in ODs declared in Spain leaves no
doubt.
The percentage share of MSDs within ODs cata-
loged in Spain by the health system is 30% higher than
the European average in the period 2002–2005.
3.2.2.2. Period 2006–2010
The results for France [23], Great Britain [24], Den-
mark [25] and Germany [26] are shown in Fig. 19.
Germany is about 5%, Denmark is between 25% and
30%, Britain is about 45% and France is between 75%
and 85%.
 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population 655

%MSDs-OD
100.0%
90.0% 86.6% 85.3%
81.3% 83.3%
78.2% 79.1%
80.0% 76.9%
74.7%
68.7% 69.4%
70.0%
60.0%
50.0% 46.4% 45.5% 45.2%
42.8% 44.1%

40.0%
29.3% 27.5%
27.0% 26.7%
30.0% 23.5%
20.0%
10.0% 5.1% 5.3% 5.5% 4.6% 5.1%

0.0%
2006 2007 2008 2009 2010

France Britain Denmark Germany Spain

Fig. 20. Comparative %MSDs-OD Spain, Germany, Denmark, Britain and France 06–10.

The comparison with Spanish results is shown in
Fig. 20.
When comparing data, we can see the importance
of MSDs on total ODs diagnosed in Spain, again con-
firmed in this analysis period. While Germany suffers
a percentage share of MSDs of about 5%, Denmark a
25–30% and Great Britain a 45% share; Spain is lo-
cated between 70 and 85%. This shows the importance
of such diseases within our workforce.
4. Conclusions
This study shows the importance of MSDS in Spain
in relation with Europe.
The results show curious issues:
a) The view of Spanish workers about the relation-
ship between work and health is worse than Eu-
ropean workers. The difference is marked (62.3%
against 22%, 22.4% and 32.9%).
b) If we talk about ergonomics risk factors, which
was the purpose of this study, the comparison
gives us interesting results. Habitual factors like
repetitive work of upper extremities, tiring posi-
tions and exposure of vibrations are identified by
Spanish workers with more emphasis than Euro-
pean ones. The opinion of the Spanish workforce
compared to the European one is only better in
the matter of carrying weights (loads or people).
This could be a symptom of the Spanish work
profile, which is more manual and repetitive but
not lifting as many weights as in Europe.
c) From official results of WA and OD, we obtain a
similar result. The rates in the Spanish workplace
are worse than the European average. In WA, the
difference is between 5–8% and in OD, the dif-
ference is about 30% compared with Europe.
The results are very clear although it would be more
precise to unify the accounting methods used by Euro-
pean countries. This would make it easier to compare
data. We also need more homogenization of official list
of OD.
The above suggests, that the incidence of MSDs in
the Spanish working population significantly exceeds
European records in this area.
The conclusion is that Spain should improve its
“safety and health at work”. MSDs account for about
35–40% of WA and between 70–88% of OD; for this
reason the first step should be to improve this issue.
Just by reducing MSDs, Spain would significantly
improve its “safety and health” ratios.
The correct strategy in order to reduce the incidence
of MSDs in Spain would be to work on three factors:
repetitive work of upper extremities, tiring positions
and exposure of vibrations. This means we have to
act on workplaces, reducing frequency of movements’,
eliminating tiring positions and absorbing vibrations.
On top of this, the management of break times and
“micro-pauses” should be changed to allow for recu-
peration.
References
[1] Alwin Luttmann, Matthias Jäger, Barbara Griefahn. Preven-
ción de los TME en el lugar de trabajo. 2004; ISBN 92 4
359100 2.
656 J.M.R. Moar et al. / Comparative study of the relevance of MSDS between the Spanish and the European working population
[2] Elke Schneider, Xabier Irastorza, Sarah Copsey. Work-related
musculoskeletal disorders in the EU – Facts and figures. (Page
100). European Agency for Safety and Health at Work, 2010;
ISBN 978-92-9191-261-2/. Profesor Peter Buckle and Dr. Ja-
son Deveroux. Work’-related neck and upper limb (Page 85).
European Agency for Safety and Health at Work, 1999; ISBN
92-828-8174-1.
[3] Ellen Bos, Boudien Krol, Lex van der Star, Johan Grootho
V. Risk factors and musculoskeletal complaints in non-
specialized nurses, IC nurses, operation room nurses, an X-
ray technologist, Int Arch Occup Environ Health. 2007; 80:
198-206.
[4] Evangelos C. Alexopoulos, Alex Burdorf, Athena Kalokeri-
nou. Risk factors for musculoskeletal disorders among nurs-
ing personnel in Greek hospitals. Int Arch Occup Environ
Health. 2003; 76: 289-294.
[5] Arezes, PM, Colim, AS, Miguel, AS. Manual materials han-
dling: Knowledge and practices among Portuguese Health and
Safety practitioners. 2011; Work: A Journal of Prevention,
Assessment and Rehabilitation, vol. 39, no. 4, pp. 385-395.
[6] Isabelle Leroux, Clermont E. Dionne, Rene’e Bourbonnais,
Chantal Brisson. Prevalence of musculoskeletal pain and as-
sociated factors in the Quebec working population. Int Arch
Occup Environ Health. 2005; 78: 379-386.
[7] Sara Holmberg, Anders Thelin, Eva-Lena Stiernström, Kurt
Svärdsudd. The impact of physical work exposure on mus-
culoskeletal symptoms among farmers and rural non-farmers.
Ann Agric Environ Med. 2003; 10: 179-184.
[8] John Rasmussen, Mark Boocock and Gunther Paul, Advanced
musculoskeletal simulation as an ergonomics design method.
Work 41. 2012; 6107-6111. DOI: 10.3233/WOR-2012-1069-
6107.
[9] Costa, N., Arezes, P., Melo, R. Effects of vibration exposure
on professional drivers: A field test for quantifying visual
and cognitive performance. 2012; Work: A Journal of Preven-
tion, Assessment and Rehabilitation, Volume 41, Supp. 1, pp.
3039-3042.
[10] Comunicación de Patologías no Traumáticas Causadas por
el Trabajo A.T. (Accidentes de Trabajo) PANOTRATSS
[Sede web]. Seguridad Social, Ministerio de empleo y Se-
guridad Social. [Access 7 de marzo de 2013]. Available in
https://sede.seg-Social.gob.es/Sede_1/Serviciose
nLinea/EmpresasyProfesionales/index.htm?ssUserText=1315
95.
[11] Juan José Castillo, Carlos Prieto. Una técnica subjetiva de in-
vestigación en condiciones de trabajo: las encuestas de sat-
isfacción. Revista Española de Investigaciones Sociológicas.
N◦ 13 1981, 49-63.
[12] Almodovar Molina Antonia, Galiana Blanco María Luz,
Hervás Rivero Pilar, Pinilla Garcia, Francisco Javier. VII En-
cuesta Nacional de Condiciones de Trabajo. Instituto Na-
cional de Seguridad e Higiene en el Trabajo. 2011; NIPO 272-
12-039-5.
[13] Agnès Parent-Thirion, Greet Vermeylen, Gijs van Houten,
Maija Lyly-Yrjänäinen, Isabella Biletta, Jorge Cabrita, with
the assistance of Isabelle Niedhammer. Fifth European Work-
ing Conditions Survey, Publications Office of the European
Union, Luxembourg. Eurofound. 2012; ISBN 978-92-897-
1062-6.
[14] Clara Díaz Aramburu. Accidentes de Trabajo por So-
breesfuerzos 2011. Departamento de Investigación e Informa-
ción. Instituto Nacional de Seguridad e Higiene en el Trabajo,
2012.
[15] Ángeles de Vicente, Clara Díaz, Marta Zimmermann, Luz
Galiana. El Trastorno Músculo Esquelético en al ámbito lab-
oral en cifras. Departamento de Investigación e Información.
Instituto Nacional de Seguridad e Higiene en el Trabajo, 2012.
[16] Musculoskeletal Disorders and Workplace Factors. U.S. De-
partment of Health and Human Services. Public Health Ser-
vice Centers for Disease Control and Prevention National
Institute for Occupational Safety and Health. 1997; DHHS
(NIOSH) Publication No. 97B141.
[17] Kilbom Å. Repetitive work of the upper extremity; Part II:
The scientific basis for the guide. Int J Ind Erg. 1994; 14: 59-
86.
[18] Silverstein B A, Fine L J, Armstrong T J. Hand wrist cumu-
lative trauma disorders in industry. Brit J Ind Med. 1986; 43:
779-784.
[19] Silverstein B A, Fine L J, Armstrong T J. Occupational factors
in carpal tunnel syndrome. Am J Ind Med. 1987; 11: 343-358.
[20] Silverstein B A. Cumulative Trauma Disorders of upper ex-
tremity: A preventive strategy is needed. J Occup Med. 1991;
33: 625-642.
[21] Silvia Nogareda Cuixart, Alfredo Álvarez Valdivia. Carga
postural: Técnica goniométrica. 2003; NTP 622, INSHT.
[22] Battevi, N., Menoni, O., Ricci, M., & Cairoli, S. MAPO in-
dex for risk assessment of patient manual handling in hospital
wards: A validation study. Ergonomics, 2006; 49(7): 671-687.
[23] Statistical review of occupational injuries France 2010; data.
Eurogip-76/E.
[24] Annual Statistics Report 2010/2011. 2011; Health and Safety
Executive.
[25] Statistical review of occupational injuries Denmark 2010,
2009, 2008, 2007, 2006, 2005, 2004 data. Eurogip – 67/E.
[26] DGUV Statistics 2010, 2009, 2008, 2007, 2006; Sicherheit
und Gesundheit bei der Arbeit.