Musculoskeletal Injuries: Evaluation, Assessment and Control

Inspect, Investigate, Identify, Evaluate, Assess and Control.

Do these health and safety program concepts bring a sense of apprehension or difficulty when they are used in an ergonomics program or musculoskeletal injury context? How many workplaces have the skills and knowledge to address these issues? What about tackling the issue of psychosocial hazards as they relate to sprains and strains?

Musculoskeletal Injuries (MSIs) in the workplace are a significant concern globally and in Manitoba[i]. They can become disabling to the worker with long-term pain and dysfunction[ii]. In 2019, over 4,200 lost-time claims were reported to the WCB of Manitoba, totalling 206,140 lost days[iii]. Those injuries include pain and dysfunction in muscles, tendons, nerves, ligaments, blood vessels and other soft tissues of the body. Workers, management and health and safety committees must be educated to identify jobs with ergonomics hazards, assess the level of risk, and find a safer way to perform the job in order to minimize the number and severity of MSIs. An effective ergonomics program must include strategies and methods to inspect tasks for MSI risk, investigate MSI injuries and complaints, identify problem jobs, assess the risk, evaluate control options and assist in accommodating workers with musculoskeletal restrictions.

In 2007, a new Manitoba Workplace Safety and Health regulation was assented: Part 8: Musculoskeletal Injury Prevention Regulation[iv]. This regulation provided a framework to educate, identify, assess, control and monitor the hazards that cause or aggravate MSIs. When an employer has been made aware of an MSI risk, they must ensure an assessment is conducted by a competent person. Based on that assessment, controls must be put in place. Those controls include providing, positioning or maintaining equipment, developing and implementing safe work procedures (training), making changes to the work schedules that incorporate rest and recovery periods or changes to workload, and or providing personal protective equipment. The employer must also monitor the controls to determine the effectiveness to eliminate or reduce the risk of injury. Further controls that are reasonably practicable must be implemented if warranted. Furthermore, workers exposed to a risk of injury must be informed of the risk and signs of common symptoms and receive instruction and training regarding the control measures implemented by the employer.

Two important points to discuss in the regulation involve ‘informing an employer of a risk’ and the definition of an MSI. There is no standard document to fill out and inform an employer of a risk of injury. Workplaces have different safety procedures, programs, and overall safety cultures. The regulation identifies these differences and therefore allows for multiple ways an employer can be informed of a risk. Informing an employer of a risk of injury can be reactive or proactive. From a reactive approach, injury reports, worker complaints, near misses, or investigations are all valid ways to inform an employer. From a proactive approach, inspections, job hazard assessments, worker surveys, or safe work procedure reviews are valid ways to identify a potential problem or risk before an injury occurs.

What about tackling the issue of psychosocial hazards as they relate to sprains and strains? Can the regulation be used to focus efforts on psychosocial hazards?  The definition of a musculoskeletal injury in MB Regulation 217/2006 “means an injury or disorder of the muscles, tendons, ligaments, joints, nerves, blood vessels or related soft tissues, including sprain and strain or inflammation that may occur to a worker in a workplace and that is caused or aggravated by any of the following; a repetitive motion, a forceful exertion, vibration, mechanical compression, a sustained or awkward posture, a limitation on motion or action, or any other factor that creates a risk of musculoskeletal injury”. It has been shown that psychosocial hazards create a risk for musculoskeletal injury. Therefore, health and safety committees can use the ‘any other factor that creates a risk’ point to address psychosocial issues as much as physical risks such as excessive force, high repetition, and awkward postures. From these two regulation points, it can be shown that through various procedures to inform an employer of a risk and understanding the definition of hazards and risk, a health and safety committee can reduce their apprehension or sense of difficulty to address musculoskeletal issues in their workplaces.

Several workplace surveys and resources have been developed to assist health and safety committees to identify both physical and psychosocial risks and provide a framework to guide them to a better and safer environment. Occupational Health Centre has been providing education and awareness training on some of these surveys and methods. OHC has hosted virtual RSI Day events for the past two years on the topic of ergonomics and psychosocial issues and the link to MSIs. This February 28th, the OHC will again be hosting a virtual RSI Day event in which our Certified Professional Ergonomist will be presenting two different MSI assessment and evaluation tools for both physical and psychosocial hazards: MERET (Manufacturing Ergonomic Risk Evaluation Tool) and the APHIRM (a participative hazard identification and risk management toolkit). Case studies involving these methods will highlight their use and potential to help health and safety committees inspect, investigate, assess, evaluate and control the risk of musculoskeletal injuries from a physical and psychosocial perspective. Register here!

For more information on MSIs and ergonomics, check out OHC’s Ergonomics page with webinars and other resources to support workers.

[i] Vos, T., Lim, S.S., Abbafati, C., Abbas, K.M., Abbasi, M., Abbasifard, M., Abdelalim, A., 2020. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396 (10258), 1204–1222.

[ii] Crawford, J.O., Berkovic, D., Erwin, J., Copsey, S.M., Davis, A., Giagloglou, E., Woolf, A., 2020. Musculoskeletal Health in the Workplace. Best Practice & Research Clinical Rheumatology, p. 101558.

[iii] WCB Business Intelligence 2021

[iv] Workplace Safety and Health Regulation