Occupational Medicine 2005;55:164–167

doi:10.1093/occmed/kqi081

IN-DEPTH REVIEWS
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Ergonomics and musculoskeletal disorders:

overview
Peter Buckle
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Abstract Musculoskeletal disorders continue to be a major source of disability and lost work time.
Understanding their causes, and especially those that are work-related, remains the key to primary

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prevention. This set of in-depth reviews considers the problem from a number of systems needs and
viewpoints. Assessing the exposure of workers to known risk factors is essential and appropriate
methods are reviewed. Similarly, a consideration of psychosocial factors thought to contribute
indirectly to the problem has also been explored. Contemporary ergonomics stresses the importance of
a participatory approach to prevention and solution finding, and evidence in support of this is
presented. The final review considers the application of ergonomics knowledge to understanding
musculoskeletal disorders amongst those using computer technology.

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Key words Ergonomics; musculoskeletal disorders.

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Introduction The size of the problem

There has been an increasing effort in recent years to
investigate the causes of musculoskeletal disorders
(MSDs) and to take action to prevent them. This has
led to increasing recognition from workers, employers
and government agencies that a strong relationship exists
between factors within the working environment and the
development of MSDs, and that these conditions result in
significant sickness absence and reduced productivity [1].
Action to prevent these disorders within the UK has
been based upon the current European Union directive
framework. Key directives, introduced in 1992, such as
those relating to the management of health and safety at
work, manual handling and the use of display screen
equipment have played an appreciable role in increasing
public awareness and in introducing measures for
prevention across a wide range of industrial sectors.
The papers that follow in this in-depth review consider
the problems from a number of perspectives, including
problems specific to computer users, the wider social and
psychological factors associated with these disorders,
methods for assessing risks in the workplace and
contemporary approaches for establishing effective
ergonomics interventions.
Robens Centre for Health Ergonomics, EIHMS, University of Surrey, Guildford
GU2 7TE, UK.
Correspondence to: Peter Buckle, Robens Centre for Health Ergonomics,
EIHMS, University of Surrey, Guildford GU2 7TE, UK.
Tel: þ44 01483 689213; e-mail: p.buckle@surrey.ac.uk
It is now generally acknowledged within the UK that
MSDs affect large numbers of people across most
industries and occupations, have the potential to lead to
long and serious disability, and impose heavy costs on
employers and on society.
The UK Health and Safety Commission have made
prevention of MSDs a priority programme as part of their
‘Securing Health Together’ agenda. This strategy aims
to: (a) reduce ill-health in employees and public caused or
made worse by work, (b) to help people who have been ill
to return to work, (c) to improve work opportunities for
those excluded from work on health-related grounds and
(d) to use the work environment to help people maintain
or improve their health. Further, there is a vision, as part
of a 10-year plan, that ‘No individuals should be made ill
by work’.
These important goals were based on an extensive
consultation process that brought together a wide range
of key stakeholders, including government departments,
professional groups and industry. In delivering this
agenda, targets have been set to reduce working days
lost from work-related ill-health by 30% by 2010, and to
reduce the incidence rate of cases of work-related
ill-health by 20% by 2010.
Added priority has been given to reducing MSDs by
setting interim targets to achieve at least half of these
improvements (for each target) by 2004. This means that
to achieve the 2004 targets, the number of new cases
must be reduced by 29 000 and the number of working
days lost by 1.8 million.

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 P. BUCKLE: ERGONOMICS AND MUSCULOSKELETAL DISORDERS 165
Figure 1. A model of systems in ergonomics [5].
How many people are affected?
The UK Health and Safety Executive (HSE) have
estimated that 5.7 million working days (full-day equiv-
alent) were lost in 2001/02 mainly as a result of back pain
that was caused or made worse by work. On average, each
person suffering took an estimated 18.9 days off in that
12-month period. Additionally, they estimate that 4.1
million working days (full-day equivalent) were lost in
2001/02 through MSDs that mainly affected the upper
limbs or neck that were caused or made worse by work.
On average, each person suffering took an estimated 17.8
days off in that 12-month period.
The economic costs to individuals, industries and
society are also excessive. The HSE estimate the cost to
the economy to be £5.7 billion per year.
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Are effective prevention measures
available?
MSDs affect all industries and workplaces, and there is
general recognition that a systems ergonomics approach
based on a participatory model that engages key
stakeholders is important. This is demonstrated by the
key elements identified for ergonomic intervention that
include: commitment from senior management, worker
involvement, risk assessment, control measures and
instruction and training. A recent publication by the
HSE [2] provides a good basis for developing a
preventative strategy at a local level.
An extensive range of guidance materials are available
from government agencies and these have been
supplemented by advice for specific industries
166 OCCUPATIONAL MEDICINE
and organizations. In addition, case studies have been
developed and critically reviewed [3] that demonstrate
the success of ergonomics interventions.
Hitherto, the major focus has been on primary
prevention. The setting of targets to reduce work-days
lost has shifted the emphasis of the strategy to develop a
more holistic approach that embraces guidance on
assessment, treatment and the prevention of acute
episodes becoming chronic.
System failure, ergonomics and MSDs
A number of leading organizations within the UK
recognize that a high prevalence of MSDs is a symptom
of ‘system failure’ that should be addressed to improve
overall quality and productivity. Thus, programmes for
the prevention of MSDs are incorporated within a wider
ergonomics approach to the continuous improvement of
work systems, organizational design, use of technology
and the work environment. This requirement is best
described as an ergonomics approach.
In August 2000, the International Ergonomics Associ-
ation (IEA) Council adopted an official definition of the
discipline of ergonomics. This states that ‘ergonomics (or
human factors) is the scientific discipline concerned with
the understanding of interactions among humans and
other elements of a system, and the profession that
applies theory, principles, data and methods to design in
order to optimize human well-being and overall system
performance.’
Those engaged in ergonomics and human engineering
have long since recognized that the preferred route for
preventing problems and enhancing performance in
systems is through a design or redesign process. This
may require a consideration of a range of issues. These
include:
† the system goals,
† the task allocation,
† the equipment design,
† interactions between sets of equipment and groups of
people,
† the work organization,
† and the job design.
Whilst methods [4] exist for the analysis of each of these
components of the system, the complexity of such an
approach is, at first sight, daunting. A recent model, shown
in Figure 1, attempts to draw together the components of
systems that need to be considered if we are to take the
systems design or systems engineering approach [5].
This model enables the various levels of the system to
be conceptualized for the purpose of understanding,
interpreting, evaluating, information collection, and
design purposes. Such an approach and understanding
is required for successful systems analysis and design [6].
Earlier models of the causation of MSDs characterized
worker activity as movements and exerted forces that lead
to the generation of internal forces within the body [7].
These models recognized the role of psychological and
social factors but the importance of these factors has been
explored more thoroughly recently [8].
The working situation derives from the organization of
work (work organization factors) and the perceptions or
beliefs held by workers regarding the way the work is
organized (psychosocial work factors). This has led to
models and scientific evidence indicating that work
organization and psychosocial work factors are associated
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with the development of work-related MSDs [9– 12].
These psychosocial work factors may also influence the
biomechanical load and/or the reactions to workplace
stress [13,14]. Finally, individual psychological factors,
perhaps pertaining to coping strategies are emerging as
additional factors requiring further research [15].
In this set of in-depth reviews, the importance of
taking consideration of factors at every level of the system
is evident.
Conclusions
The science of ergonomics and its application to MSDs
associated with the modern workplace provide both an
important perspective and a preventative approach. The
breadth and impact of ergonomics extends well beyond
what is often presented in the lay literature.
This set of review papers provides insight into how
ergonomics has enhanced our understanding of the
nature of the disorders, their work-relatedness and their
potential prevention. Greater adherence to the ergo-
nomics process in design and assessment of work systems
would seem the most likely strategy for securing long-
term primary prevention of these disorders within the UK
and elsewhere.
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