What are clues or tip-offs to WMSDs as a real or possible workplace problem? Some signs are obvious while others are more subtle. The first step is to look for these signs or clues.

Recognizing Signs That May Indicate a Problem

Company OSHA Form 200 logs or workers compensation claims show cases of WMSDs such as carpal tunnel syndrome, tendinitis, tenosynovitis, epicondylitis, and low back pain. Sometimes these records contain nonspecific entries like "hand pain," which (while not a specific diagnosis) may be an indicator of a significant health problem if severe or persistent.

• Certain jobs or work conditions cause worker complaints of undue strain, localized fatigue, discomfort, or pain that does not go away after overnight rest.
  
  
• Workers visiting the clinic make frequent references to physical aches and pains related to certain types of work assignments.
  
  
• Job tasks involve activities such as repetitive and forceful exertions; frequent, heavy, or overhead lifts; awkward work positions; or use of vibrating equipment.

Signs like these have triggered requests for NIOSH evaluations of possible ergonomic problems and risks of WMSDs. Some examples of reasons that have been given for requesting NIOSH ergonomic evaluations are described in Exhibit 1. These examples show that WMSDs can occur in a variety of workplaces.

Other signals that could alert employers to potential problems include the following:

• Trade publications, employers insurance communications, or references in popular literature indicating risks of WMSDs connected with job operations in the employer's business
  
  
• Cases of WMSDs found among competitors or in similar businesses
  
  
• Proposals for increasing line speed, retooling, or modifying jobs to increase individual worker output and overall productivity

Table 1 illustrates a variety of industries and job tasks in which NIOSH evaluations found evidence of WMSDs. A table listing NIOSH findings for an even larger sample of workplaces is provided in the Toolbox section of this primer (Tray 1-A).

Table 1: Selected work settings from NIOSH investigations showing evidence of WMSDs

Determining a Level of Effort

Clues that indicate ergonomic problems may also suggest the scope of the effort required to correct them. For example, signs implicating multiple jobs in various departments and involving a large percentage of the workforce would indicate the need for a full-scale, company-wide program. Alternatively, signs that the suspected problems are confined to isolated tasks and relatively few workers may suggest starting with a more limited, focused activity.

The program elements offered in this primer describe the development of a full-scale ergonomics program for use in a company-wide approach. All companies may benefit from such an approach. However, the intensity of the program may need to be calibrated to the magnitude of the problem. For smaller-scale efforts that are directed at specific problems or situations in which problem jobs or affected workers are quite limited, selected elements of the overall program may be useful. Exhibits in this primer cover a range of efforts and will clarify aspects of both full-scale and more limited approaches. Understandably, a company s initial efforts in ergonomics will be directed toward fixing the most obvious problem jobs. The program elements described here offer a framework for an orderly undertaking of such activities. Moreover, even if the evidence for WMSDs is not clear, implementing the program can have value by enabling early detection of (and more timely interventions in) potential ergonomic problems. Also, an ergonomics program can influence the design of future changes in work processes to reduce the possibility of WMSDs. In these instances, the envisioned efforts have proactive benefits that will help prevent WMSDs.