Estimated costs associated with lost days and compensation claims related to musculoskeletal disorders-including back pains and repetitive motion injuries-range from $13 billion to $20 billion annually. This is a serious national problem that has spurred considerable debate about the causal links between such disorders and risk factors in the workplace.

This book presents a preliminary assessment of what is known about the relationship between musculoskeletal disorders and what may cause them. It includes papers and a workshop summary of findings from orthopedic surgery, public health, occupational medicine, epidemiology, risk analysis, ergonomics, and human factors. Topics covered include the biological responses of tissues to stress, the biomechanics of work stressors, the epidemiology of physical work factors, and the contributions of individual, recreational, and social factors to such disorders. The book also considers the relative success of various workplace interventions for prevention and rehabilitation.

Contents

• STEERING COMMITTEE FOR THE WORKSHOP ON WORK-RELATED MUSCULOSKELETAL INJURIES: THE RESEARCH BASE
• COMMITTEE ON HUMAN FACTORS
• PREFACE
• I. STEERING COMMITTEE REPORT
  • 1. Introduction
    • Background
    • Framework of Contributors to Musculoskeletal Disorders
  • 2. State of the Evidence
    • Criteria to Determine Causality
    • Soft Tissue Responses to Physical Stressors
    • Work Factors and Biomechanics
    • Epidemiological Evidence that Physical Factors Can Cause Musculoskeletal Disorders
    • Epidemiological Evidence That Non-Biomechanical Factors Can Cause Musculoskeletal Disorders
    • Interventions
    • Future Research
  • 3. Seven Questions Posed by Congressman Robert Livingston
  • 4. Conclusions
  • References
• II. WORKSHOP SUMMARY
  • Introduction
  • Organizing Framework
  • Biological Responses of Tissues to Stressors
    • Presentations
    • Discussion
  • Work Factors, Individual Host Factors, and Internal Loads: Biomechanics of Work Stressors
    • Presentation
    • Discussion
  • Epidemiology: Physical Factors
    • Panel Discussion
    • Workshop Discussion
  • Non-Biomechanical Factors That Can Affect Musculoskeletal Disorders
    • Presentation
    • Discussion
  • Intervention to Control Musculoskeletal Disorders
    • Presentation
    • Discussion
  • Conclusion: Integration and Overview
    • Panel Comments
    • General Discussion
  • References
  • Appendix A Invitees and Participants, Workshop on Work-Related Musculoskeletal Injuries: Examining the Research Base
  • Appendix B
• III. WORKSHOP PAPERS
  • Response of Muscle and Tendon to Injury and Overuse
    • Introduction
    • Muscle
    • Passive Tensile Structures:
    • Brief Discussion—The site of injury.
    • Conclusions
    • Future Directions
    • References
  • Biological Response of Peripheral Nerves to Loading: Pathophysiology of Nerve Compression Syndromes and Vibration Induced Neuropathy
    • Introduction
    • Structure and Function of Peripheral Nerves
    • Purpose of this Report—Database Search
    • Experimental devices for nerve compression in animals
    • Nerve Compression—Acute Effects (Hours)
    • Nerve Compression—Short-Term Effects (Days)
    • Nerve Compression—Long-Term Effects (Weeks)
    • Histology of Human Nerve Compression
    • Vibration and Nerve—Short-Term Effects (Days)
    • Histology of Human Vibration Induced Neuropathy
    • Extraneural Pressure in Nerve Compression Syndromes
    • Effects of Joint Posture and Hand Loading on Extraneural Pressure in Normal Subjects
    • Conclusions
  • Work Factors, Personal Factors, and Internal Loads: Biomechanics of Work Stressors
    • 1. Introduction
    • 2. Internal Tissue Loading
    • 3. External Loading Factors
    • 4. Assessment of Workplace Factors
    • 5. Workplace Design Factors and Physical Stress Exposure
    • 6. Discussion
    • 7. Summary
    • 8. References
  • Work-Related Musculoskeletal Disorders: Examining the Research Base Epidemiology: Physical Factors
    • Summary:
  • The Epidemiology of Workplace Factors and Musculoskeletal Disorders: an Assessment of the NIOSH Review
  • Workshop on Work-Related Musculoskeletal Injuries: Examining the Research Base Panel on Epidemiology: Risk Factors
  • Epidemiologic Studies of Physical Ergonomic Stressors and Musculoskeletal Disorders
    • References Note: Citations are listed below only if they did not appear in the NIOSH review itself.
  • Analysis of The Scientific Approach in Assessing Epidemiological Evidence for the Relationship Between Work and Musculoskeletal Disorders
    • Introduction
    • Methodology for Causal Determination of Work and Msds
    • SUMMARY
  • Summary Comments
  • Non-Biomechanical Factors Potentially Affecting Musculoskeletal Disorders
    • Section One: Personal Factors
    • Section Two: Work-Related Factors
    • References
  • A Review of Research on Interventions to Control Musculoskeletal Disorders
    • A. Introduction
    • B. The Nature of Interventions to Control Musculoskeletal Disorders
    • C. Methods Used to Review the Literature
    • D. General Discussion of the Strengths and Limitations of Research on the Effects of Interventions on Musculoskeletal Disorders
    • E. Review of Select Research
    • B. General Conclusions about the Findings from the Laboratory Intervention Research Studies:
    • B. General Conclusions about the Findings from the Field Intervention Research Studies using Injured Subjects:
    • B. General Conclusions about the Findings from the Field Intervention Research Studies using Healthy Subjects:
    • F. Global Assessment of the Literature
    • G. References

This project was supported by an award between the National Academy of Sciences and the Department of Health and Human Services; the project, N01-IOD-4-2139, Task Order No. 47, received support from the evaluation set-aside Section 513, Public Health Service Act. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.