Why have we not solved the MSD problem?

Despite worldwide attention for more than four decades, musculoskeletal disorders (MSDs) remain a substantial concern at work and result in considerable personal and societal burden. This slow progress is not for want of trying. Prevention of MSDs has been emphasized in multiple jurisdictions. For example, in 2007 the European Agency for Safety and Health at Work organized a major campaign, “Lighten the Load – How to prevent Musculoskeletal Disorders (MSDs)” and NIOSH in the USA specifically identified MSDs as a major focus in their National Occupational Research Agenda. However, the results from surveys, published sick leave, and lost time data indicate we have a way to go in preventing MSDs. Which leaves us with a question: Why have we not solved the MSD problem? The initiatives mentioned above (and others) have uncovered multiple research questions including: the effects of new forms of work, the interaction of psychosocial and mechanical exposures, changing demographics, risk assessment, identification of best practice, and the implementation of interventions in companies. While all these are clearly relevant questions, we still need to know which of the answers to these – or any other question – will drive us forward in the prevention of work-related MSDs. In order to help refine the research agenda for the Centre of Research Expertise for the Prevention of Musculoskeletal Disorders, as director, I have begun to view the prevention of MSDs around six questions. I see these six questions as a flow of logic that can be used as a heuristic. The answers to each question can help identify weak links, and prioritize where the Centre’s researchers need to put their energies, skills and experience. The chain of linked questions could have been framed as areas of research, but when written as questions, I believe they are more thought provoking, and can help us stand back and reflect on each stage of inquiry and its key contributions to the prevention of MSDs. Asking each of these six questions helps us identify where our knowledge and practice may be wanting and the key factors that are limiting our ability to prevent MSDs at work. The intent of posing these questions is to judge whether our efforts are being derailed by not addressing key issues; workplace prevention of MSDs can only be as effective as its “weakest link”. The six questions are: