Proceedings of the Human Factors and Ergonomics Society 58th Annual Meeting - 2014
1633
Critical Analyses of Work-related Musculoskeletal Disorders and
Practical Solutions in Construction
Sang D. Choi, Ph.D., CPE, CSP
Professor of Occupational and Environmental Safety & Health
University of Wisconsin - Whitewater
Lu Yuan, Sc.D., CSP
Occupational Safety, Health & Environment Program Coordinator
Southeastern Louisiana University
James G. Borchardt, CPE, CSP, CRIS
Bettendorf, IA
This study reviews and synthesizes the findings in recent literature addressing work-related
musculoskeletal injuries and disorders (MSDs) and practical solutions in the construction industry. Seven
construction occupations (carpenters, masons, electricians, sheet metal workers, roofers, ironworkers,
plumbers) are included to identify trade-related MSD risk factors. Effective intervention requirements are
identified to meet the challenges that construction contractors face in the field. Typical intervention
strategies include site-specific ergonomics programs, engineering controls, ergonomic hand tools
selection/design, and worksite stretching program. The “good practices” presented in this paper could be a
valuable approach to reducing common MSDs including sprains and strains, pain and discomfort at back,
neck/shoulders, wrists/hands, and knees, improving worker morale, lowering workers’ compensation costs,
while increasing productivity and profitability in the construction industry.
Copyright 2014 Human Factors and Ergonomics Society. DOI 10.1177/1541931214581341
INTRODUCTION
Construction remains one of the largest industries in the
United States and is an essential part of the nation’s economy.
Construction work involves physically demanding activity
from its workforce (Albers & Estill, 2007). Working in the
building and construction trades has been linked to serious and
costly health risks, especially those of work-related
musculoskeletal injuries and disorders (MSDs), a condition
involving the soft tissues of the body, including muscles,
tendons, nerves, cartilage, and other supporting structures
(Albers & Estill, 2007; CPWR, 2005). Construction work
often involves forceful exertions that are excessive or
prolonged, such as heavy lifting or prolonged grasping;
awkward postures that are maintained for extended periods;
pressure from hard surfaces or sharp edges on body tissues;
vibration from tools and machinery; and environmental factors
such as extreme temperatures and humidity (The Eastman
Kodak Company, 2004).
PRACTICE INNOVATION
The Laborers’ Health & Safety Fund of North America
(LHSFNA) points out that 40% of construction workers in a
survey said “working hurt” reduces productivity and results in
disabling injuries. Many MSDs that occur in the construction
industry include sprains and strains, low back pain, and
neck/shoulder and knee injuries. Contractors and workers are
searching for effective ways to address them. Contractors seek
hard data showing potential, cost-effective solutions. Solutions
that slow the job or reduce productivity are not considered
acceptable by contractors or workers (Schneider, 2012).
There is growing interest in the U.S. to protect workers
from the ergonomic hazards that contribute to work-related
MSDs in the construction industry. The word ergonomics was
coined by a Polish scholar, Wojciech Jastrzębowski, in 1857.
His book “An outline of Ergonomics, or the Science of Work”
defined ergonomics for the first time. According to National
Institute for Occupational Safety and Health (NIOSH),
“ergonomics” is still a new topic for the construction industry
(Albers & Estill, 2007). The first nationally recognized,
voluntary standard on MSD problems in construction was
published in 2007 (ANSI/ASSE A10-40-2007 (2013)). Each
construction trade utilizes different skills and completes
different tasks. Some jobs require employees to work close to
the ground or floor, while others require working in overhead
positions. The nature of work and characteristics of specific
jobsites or trades can expose workers to various ergonomic
hazards which could result in different work-related MSDs.
METHODS
Using a systematic approach to searching literature, keywords
were defined to guide the identification of relevant studies.
Electronic search of keywords included: musculoskeletal,
injury, illness, disorder, MSDs, ergonomics, construction,
trade, occupation, worker, workplace, safety, health.
Combinations of keywords and terms such as intervention or
prevention were also used in the search. The search was
conducted primarily using electronic data bases, supplemented
by books and other printed materials retrieved from a network
of libraries. Studies published in English were drawn from
peer-reviewed journals, conference proceedings, edited books,
and a variety of web-based sources. Electronic resources
searched included ABI/Inform, Academic Search, ACM
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Proceedings of the Human Factors and Ergonomics Society 58th Annual Meeting - 2014
Digital Library, Applied Science Full Text, Business Full
Text, CINAHL, Emerald, Google Scholar, NetLibrary,
ProQuest, PsycINFO, PubMed, ScienceDirect, WilsonWeb,
and Web of Science. During a preliminary review,
duplications and studies considered less relevant were
discarded. The musculoskeletal injury and illness data were
also reviewed from the U.S. Bureau of Labor Statistics (BLS),
U.S. Department of Labor (DOL), and U.S. Department of
Health and Human Services (DHHS). Searches identified
three categories of articles: (1) documentation of the problems,
(2) research on work-related musculoskeletal injuries in
construction, and (3) research and evaluation of ergonomic
work practice interventions.
FINDINGS
The paper discusses practical and simple solutions to mitigate
work-related MSDs at construction worksites. A summary of
risk factors for seven selected construction trades are
presented i.e. carpenters, masons, electricians, sheet metal
workers, roofers, ironworkers, plumbers. These trades
represent types of construction work with well documented
high risk of MSDs.
Construction trade-related MSDs
Carpenters make up the largest number of construction
workers (NIOSH, 2004). Major risk factors for MSDs include
static and/or awkward postures for extended periods of time,
heavy manual material handling, excessive and repetitive
motions of tool usage, and extreme weather conditions (Albers
et al., 1997; Cheung et al., 2009a). Among carpenters, drywall
installers are involved in handling of heavy and bulky
materials, repetitive screwdriving motions, and awkward
postures. The body parts most commonly injured are the axial
skeleton and shoulder, where back sprains, simultaneous
sprains to the back and neck, and shoulder strains occur
frequently (Chiou et al., 2000; Lipscomb et al., 2000). Another
subgroup of carpenters are carpet installers who spent a great
part of their working time in knee-straining positions,
including kneeling, knee-supporting (weight-bearing on the
knees), and squatting (Bhattacharya et al., 1985; Ekström et
al., 1983; Jensen et al., 2000a). In addition to these awkward
knee postures, the carpet installers use their knee as a power
source for the knee-kicker to stretch and fit the carpet on the
floor and against walls and door thresholds. Kicking the kneekicker is physically demanding and is repeated frequently
during a typical installation (Bhattacharya et al., 1985; Village
et al., 1993). Several studies have discussed knee injuries and
disorders among carpet installers (Kivimaki et al., 1992;
Tanaka et al., 1982; Holmström et al., 1995). A questionnaire
study on Danish floor layers showed a significant relationship
between the prevalence of self-reported knee-complaints and
the amount of knee-straining work (Jensen et al., 2000a).
Their clinical study found a positive association between floor
laying work and hyperkeratosis and bursitis. Radiological
investigations have found an increased frequency of knee
osteoarthritis for floor layers, especially in those over 50 years
of age (Jensen et al., 2000b).
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Masons often bend and kneel because most finishing is
done at floor level. Injuries include chemical burns from
uncured concrete and sore knees from frequent kneeling and
crouching. Concrete and terrazzo work is fast paced, strenuous
and often involves kneeling, bending, and reaching. Work is
generally outdoors and stops in wet weather (BLS, 2014a).
Lifting heavy materials while spreading, levelling and
smoothing concrete, mortar or terrazzo mixtures can also
cause injury to muscles, nerves, discs and ligaments of the
lower back. Additionally, repetitive lifting can lead to low
back muscle strain, ligament sprain, a bulging or herniated
disc, or other low back pain (Cheung et al, 2009b;
Goldsheyder, et al., 2004).
Electricians work indoors and outside, at construction
sites. Work may be strenuous and include bending conduit,
lifting heavy objects and standing, stooping or kneeling for
long periods. Workers may be subject to inclement weather
conditions, cramped spaces, and tasks requiring standing or
kneeling for long periods (BLS, 2014b). Most common MSDs
are associated with the back, neck, fingers/hands and knees
(Cheung et al., 2009c). Working overhead or at/above
shoulder level is an essential component of electrical work and
is a risk factor for shoulder injury. Additional risk factors for
shoulder injuries are inadequate rest, static loads, vibration
and awkward postures. Electricians most frequently
experienced musculoskeletal symptoms of the back, hands and
wrists (Hunting et al 1994).
Sheet metal workers stand for long periods, lifting heavy
raw materials and finished pieces. Different production
stations reduce the repetitiveness of the work. Installation
work results in considerable bending, lifting, standing,
climbing or squatting sometimes in close quarters or awkward
positions. Sheet metal workers install duct systems and
kitchen equipment indoors but encounter a variety of weather
conditions when working outdoors installing siding, roofs and
gutters (BLS, 2009a). Common MSDs of sheet metal workers
affect the back, wrists/hands, knees, and neck/shoulders
(Cheung et al., 2009d). Welch et al. (1995) stated that MSD
symptoms of neck, arm, and hand pain are common in sheet
metal workers in the shop, and that shoulder injuries are
associated with work overhead (hanging duct). Merlino et al.
(2003) studied union apprentice sheet metal workers,
electricians, plumbers, and operating engineers in Iowa,
Illinois, Oregon, and Washington and found the lower back
musculoskeletal symptoms were reported most often. Number
of years worked in the construction trade was significantly
associated with knee and wrist/hand MSD symptoms and was
suggestive of an association with low back pain. “Working in
the same position for long periods” was rated by construction
apprentices as a moderate/major problem contributing to
musculoskeletal symptoms.
Roofers do heavy lifting, climbing, bending, and kneeling.
They work outdoors in all types of weather, particularly when
making repairs. Workers risk slips or falls from scaffolds,
ladders, or roofs or burns from hot bitumen. Roofs can also
become extremely hot during the summer, causing heatrelated illnesses (BLS, 2009b). Musculoskeletal symptoms
among roofers are strongly associated with work limitation,
missed work, and reduced physical functioning (Welch et al.,
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Proceedings of the Human Factors and Ergonomics Society 58th Annual Meeting - 2014
2009). Common MSDs involve back, shoulders,
hands/fingers, knees, and feet/ankles (Welch et al., 2009;
Fredericks et al., 2005). Roof work is physically demanding
because of manual materials handling activity at different roof
inclinations. Roofers experienced greater feet/ankles
discomfort and pain with an increase in slope (Choi, 2008a).
Ironworkers place and install iron or steel girders,
columns, and other construction materials to form buildings,
bridges, and other structures. They also position and secure
steel bars or mesh in concrete forms to reinforce the concrete
used in highways, buildings, bridges, tunnels, and other
structures. Ironworkers usually work outside in hot/cold
weather conditions (BLS, 2009c). Reinforcing iron and rebar
workers, sometimes called rod busters, set reinforcing bars
(often called rebar) in concrete forms following blueprints
showing the location, size, and number of bars. They then
fasten the bars together by tying wire around them with pliers
(BLS, 2009c). Ironworkers usually lift and carry heavy loads,
work in severely awkward positions in confined spaces or
from kneeling positions. They use heavy vibrating pneumatic
tools overhead requiring them to apply high force in static
positions. Common MSDs associated the ironworkers are in
back, shoulders, elbows, hands/fingers, and knees (Buchholz
et al., 2003; Choi, 2007; Forde et al., 2005; Hunting et al.,
1999).
Plumbers, pipefitters, and steamfitters install, maintain,
and repair many different types of pipe systems, and have a
higher rate of injuries and illnesses than the national average.
Plumbers and fitters often must lift heavy materials, climb
ladders, and work in tight spaces (BLS, 2014c). The study by
Hunting et al. (1999) found that eye falls from ladders were
more common for plumbers compared to carpenters,
electricians, and ironworkers. Merlino et al. (2003) reported
that plumbers and pipefitters had the highest percentage of
knee MSD symptoms in their study. This was similar to the
findings that were reported by Kirkeskov and Eenberg (1996)
and Rosecrance et al. (1996).
MSD prevention strategies and practical applications
Site-specific ergonomics programs. Ergonomic
interventions entail matching the task, tools, and environment
to the needs of the worker with the goal of achieving a
healthy, productive workplace. Ergonomic interventions to
reduce musculoskeletal risk factors range from very simple
tool modification to elaborate material handling devices or
automation of construction processes. Manual lifting hazards
vary from job site to job site; therefore, lifting programs
should be specific to the construction job site (Choi, 2008b).
The key to an effective lifting program is proper site setup at
the beginning of the project (LHSFNA, 2006). Making
mechanical material handling equipment readily available will
reduce the temptation to lift material manually (Choi et al.,
2007). Training is a key component to the ergonomics
program. Before attempting to develop the training program,
the foreman and/or company safety personnel should evaluate
the job site materials that will be used throughout the
construction project. Employees should be trained in the use
of the material handling equipment that is on-site. Training
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with the specific types of materials that will be used
throughout the job and the hazards associated with their use
are also needed (LHSFNA, 2006).Discussing the different
ergonomic hazards associated with the material handling will
benefit the employee and help keep them safe on their specific
jobsites (Choi, 2008b). As an alternative some construction
companies have created weight restrictions for employees.
According to a survey study, more than 50 percent of the
construction firms had a program that restricted the weight an
individual could lift at one time (Choi et al., 2007).
Ergonomic hand tools. Another way to reduce some
MSDs is the use of ergonomically designed hand tools. An
auto-feed screw gun with an extension allows the worker to
stand upright while maintaining spine and knees in a neutral
position to minimize muscle strain and fatigue (Albers &
Estill, 2007). These tools may be more expensive but they
may save money in the long run by reducing loss-time
incidents (Albers & Estill, 2007). For job tasks that require
repetitive work, a portable power tool can be used instead of a
manual hand tool (Albers & Hudock, 2007). Select a hand tool
that has a power grip or add a power grip to an existing tool
(Albers & Estill, 2007). This will help the employee perform a
job task with less stress on the employee’s hands and wrists. A
portable power tool with a larger trigger requiring the use of
multiple fingers to activate the tool, will reduce the stress on
one finger activator (Kroemer et al., 2001). Changing the
design of the tool’s handle can help prevent ergonomic
injuries on the job (Choi et al., 2007; LHSFNA, 2006). A
drywall worker can use an easy-hold glove attached to the
mud pan to reduce the hand strain from holding the pan
(Albers & Estill, 2007). Another type of glove is a full finger
anti-vibration glove used to absorb some of the vibrations that
are caused by a power tool. These gloves must meet the ISO
(International Organization for Standardization) 10819.
Gloves that do not meet this standard may not reduce the
vibrations from the power tool adequately, even for low
vibration tools (Albers & Estill, 2007).
Engineering controls. Engineering controls are work
processes that eliminate the risk factors present in specific
construction tasks. Changing the way the work process is done
to decrease the labor intensity may reduce the amount of time
it takes to get the job done and the amount of reaching or
overhead work that needs to be done (Albers & Estill, 2007).
Engineering controls are usually the most effective long-term
approach to reducing work-related MSD risk factors (The
Eastman Kodak Company, 2004). Examples include: (1)
install embedded concrete inserts in the ceiling forms to
eliminate prolonged overhead drilling needed to place allthread rods for a ceiling system (Albers & Estill, 2007); (2)
use a mechanical lift or hoist to raise the employees closer to
their work to prevent them from having to raise their arms
above their shoulders (Choi et al., 2007); (3) manufacturers
could modify the size or design of the packaging of materials;
(4) use a mechanics device to hold a heavy tool in place while
the worker is using the tool. Using such a device reduces the
physical burden for the worker (Albers & Estill, 2007). (5) In
the United Kingdom a study was done with workers who
installed and replaced concrete kerbs (aka curbs in US) along
the roadsides. It is common practice to manually carry the
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Proceedings of the Human Factors and Ergonomics Society 58th Annual Meeting - 2014
concrete kerbs to be installed along the roadsides because it is
cheaper than using equipment to move the kerbs. The kerb
design was altered by reducing the size, using a lighter
concrete, and adding hand holds for the employees (Bust et al.,
2005).
Worksite stretching program. Stretching has been
common for athletes before and after exercise in order to
reduce injury and increase performance, but it is now
becoming part of the work routine for construction workers
(Rajendran, 2013). Worksite exercise programs have been
suggested and implemented as a preventive measure against
musculoskeletal disorders of the upper extremities (McGorry
& Courtney, 2006). A study by Holmström and Ahlborg
(2005) evaluated the effects of morning warm-up exercise on
musculoskeletal fitness in construction workers (i.e., a 10-min
exercise every morning at the building site). Significant
increase of thoracic and lower back mobility, increase of
hamstring and thigh muscle stretchability were seen in the
morning warm-up exercise group (Holmström and Ahlborg,
2005). Ludewig and Borstad (2003) studied the effects of a
home exercise program on shoulder pain and functional status
in construction workers (i.e., five shoulder stretching exercise
with two stretches for 30s each repetition). The participants
who performed the stretching and strengthening exercises
showed significantly greater improvements in shoulder
function and satisfaction (Ludewig & Borstad, 2003).
Occupational Safety and Health Administration (OSHA, 2005)
recommended that when working in a bent over position,
workers take short and frequent breaks to stretch out the back
muscles. Construction companies are now taking this a step
further by having their workers stretch before beginning work
to loosen up the muscles (Cable, 2007). For the best results,
worksite stretching sessions along with pre-job
safety/ergonomics planning (e.g., pre-shift huddles, toolbox
safety talks) may be included as part of a comprehensive
ergonomics program to control work-related MSDs in the
construction workplace.
DISCUSSION
This study started with a review of recent literature on workrelated MSDs for seven major construction operations and
then discussed practical solutions to prevent those MSDs in
the workplace. The common job task conditions were
overhead, ground/floor level, hand-intensive, and manual
materials handling. Work-related MSD risk factors included
repetitive motion, excessive force, work in same (awkward)
position, and hand/arm vibration. The most affected body
parts were the back followed by neck/shoulders, wrists/hands
and knees. The industry-specific MSD injury prevention
strategies included ergonomics programs (e.g., worksite lifting
program, hand tool selection), work process improvement,
engineering controls, and worksite stretching/flex exercises. It
is recommended that employers and joint labor-management
groups develop their own ergonomics programs to analyze
ergonomic hazards at the worksite and implement site-specific
MSD prevention strategies and “good practices.” The
programs may operate as part of the construction site’s health
and safety program, or may be separate. It is imperative that
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more Research to Practice initiatives on effectiveness of
solutions (including productivity and cost savings) be
developed, including doing a pilot campaign in one trade,
developing contractor success stories, partnerships with
OSHA/NIOSH, and increasing education and awareness
(Schneider, 2012). The National Institute for Occupational
Safety and Health (NIOSH, 2014) currently leads a nationwide
initiative called “Prevention through Design” addressing
occupational safety and health needs by eliminating hazards
and minimizing risks. Similarly, building information
modeling (BIM) is a new communication tool which provides
safety practitioners the ability to share information and
collaborate on complex construction processes such as
mechanical, electrical and plumbing design models (Eastman
et al, 2011). Site-specific MSD injury prevention programs
can be a valuable way to improve ergonomics and worker
morale, lower workers’ compensation costs, and increase
productivity and profitability for the construction industry.
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