Workplace MSD prevention: acting on work before pain sets in

MSDs affect the musculoskeletal system: the muscles, tendons and nerves of the upper and lower limbs, as well as the back. They show up as discomfort, pain, stiffness, or loss of strength or sensation, mostly in the neck, shoulders, elbows and wrists. They can become irreversible, which is why early diagnosis and care matter.

Their causes are multiple. INRS identifies several families of risk factors that never occur in isolation:

• biomechanical: physical effort, awkward postures, repetitive movements;
• psychosocial: work intensity and complexity, working hours, low autonomy;
• environmental: vibration, cold, noise, poor lighting.

Stress, for instance, increases muscle tension and grip force, and lengthens recovery time. EU-OSHA likewise calls for a holistic risk assessment that addresses the full range of causes. The answer cannot rest on each employee’s physical fitness alone.

INRS structures its MSD prevention approach in four successive steps, supported by three continuous actions: mobilizing, communicating and evaluating.

Commit

Senior management commits, appoints a coordinator and sets up a steering group. Involve line managers, employee representatives and occupational health services from the start. In France, the regional occupational risk funds of the national health insurance can also be called on.

Take stock

This is a snapshot of the current situation, used to share what is at stake and to choose which work situations to analyze first. To prioritize, weigh how often and how intensely people are exposed, how many are concerned, the opportunities for recovery, how feasible a change is and the collective signals: incidents, work restrictions, feedback from teams. It is also when you choose the indicators you will use to evaluate.

Do not ask managers to single out “at-risk” employees based on their appearance or medical guesswork: it is neither their role nor a method.

Procedures describe work as prescribed; observation shows what operators actually do to meet their targets. The in-depth analysis INRS recommends takes into account the variety of tasks, the sequence of actions and the different ways of working, combining observation, interviews and measurements.

Observe several situations, teams and shifts. Document movements, distances, loads, heights, interruptions, unexpected events, tools and mutual help. Ask employees when the strain increases and which workarounds they have already found.

Room for maneuver and root factors

Two ideas guide the analysis. Room for maneuver means the organizational, material, time and collective resources that allow an employee to find a way of working that is both effective and not harmful to their health. Root factors are the features of the situation that shape that room: work organization, workstation design, tools, production demands, instructions, staffing, management, pay structure.

A posture sensor or an app can complement this analysis within a defined protocol. It replaces neither ergonomic observation nor listening to the team. And if it tracks the activity of identifiable employees, data protection rules apply. In France, the CNIL, the data protection authority, sets three cumulative conditions for any monitoring system: it must be justified and proportionate, submitted to the works council (CSE) beforehand in companies with 50 or more employees, and disclosed to employees before it is introduced.

Transformation aims to remove or reduce exposure by acting on root factors, and to give employees back room for maneuver. In France it follows the general principles of prevention set out in the Labor Code. Action is most effective upstream, when premises and work situations are designed; it remains possible as a correction to what already exists.

Options include how tasks and working time are organized, how workstations are designed and laid out, which tools and equipment are chosen, and then information and training. Changing packaging, a layout, a pace or how tasks are shared acts on the cause, whereas a reminder about good posture only acts on the person.

Before rolling anything out, assess each solution in advance, discuss it with the employees concerned and test it. A lifting aid can reduce effort but lengthen a movement; an adjustable workstation achieves nothing if the adjustment is hard to reach or incompatible with the pace of work.

When an employee is in pain, the employer should not try to make a diagnosis. They refer the employee to occupational health services and the relevant professionals; any workplace adjustments follow the applicable rules and respect medical confidentiality. In France, the CNIL states that employers and HR departments have no right to hold medical information about staff. How to reconcile this rule with personalized prevention is covered in our article on employee health privacy.

With MyTwin for employers, a company can offer musculoskeletal health among its prevention modules. Employees who choose to take part follow a personal program whose results stay between them and authorized professionals; the employer only sees aggregated indicators. This individual program complements action on work situations; it does not replace it.

Evaluation checks that the actions actually reduce exposure and do not create new difficulties. Compare observed effects with expected ones, using the indicators chosen when taking stock:

• work situations analyzed, then transformed;
• reduction in a measured exposure;
• actual use of equipment;
• reported difficulties and time to fix them;
• team participation;
• accidents and occupational diseases, read over a long enough period.

A drop in reported pain does not prove success on its own: it may reflect under-reporting. Combine observation, qualitative feedback and organizational data. For a broader framework, see our method to measure a workplace health program. The lessons then feed into the company’s risk assessment (in France, the single occupational risk assessment document) and into future projects.

Support programs: the French example of TMS Pros

Some insurers and public bodies support companies in this work. In France, the occupational risk branch of the national health insurance runs TMS Pros, a four-step support program for companies selected because of their claims record and contacted by their regional fund. Financial aid may be available, subject to conditions.