International Journal of Industrial Ergonomics 31 (2003) 179–184

Low-cost work improvements that can reduce the risk of

musculoskeletal disorders
Kazutaka Kogia,*, Tsuyoshi Kawakamia, Toru Itanib, Jose Maria Batinoc
a
Institute for Science of Labour, Kawasaki 216-8501, Japan
b
Nagoya City University Medical School, Kawasumi, Mizuho-ku, Nagoya 467, Japan
c
Bureau of Working Conditions, Department of Labor and Employment, Intramuros, Manila, The Philippines

Received 1 July 1999; received in revised form 26 September 2000; accepted 18 October 2001

Abstract

Types of low-cost improvements that could reduce work-related musculoskeletal disorders were reviewed by
examining simple improvements in materials handling and workstations undertaken within a Work Improvement in
Small Enterprises (WISE) project in the Philippines. Serial WISE action-training courses in four regions of the
Philippines yielded many improvements relying on local resources. Over 2000 improvements resulted from participatory
activities in small groups, and many of them were found to relate to actual reduction of musculoskeletal loads.
Typically, these improvements, mostly implemented at low cost during the course period of about 2 weeks, concerned
the use of push carts or lifting devices, better worksite layout, worktables and chairs of appropriate height, fixing
handtools, better lighting, job rotation and inserting breaks. The effects of such improvements on reducing workloads
were investigated by case study measurements applying electromyography, heart rate recording and posture study
methods. Reduced muscular activities were found after work changes associated with improved materials transport,
avoiding deep bending postures, fixing handtools or better work organization. Productivity increase was also confirmed
in some cases. There was thus a variety of work improvements undertaken by managers and workers of small
enterprises through voluntary training steps, often with combined effects on reducing musculoskeletal loads and
improving other aspects of working conditions. This flexibility in work re-design seemed necessary in promoting
multiple changes linked with a reduced musculoskeletal risk. Such examples collected from WISE training courses
proved useful for various training programmes and advisory inspections. These results demonstrated the importance of
undertaking multiple work improvements on voluntary basis in reducing the risk of musculoskeletal disorders in a large
number of small enterprises.
Relevance to industry
There is a perception in industry that improvements to reduce the risk of musculoskeletal disorders are too costly.
This paper demonstrates that a participatory approach can be successful in making work improvements with very little
cost. Further, the work improvements reduced the risk of musculoskeletal disorder and increase productivity.
r 2003 Elsevier Science B.V. All rights reserved.

Keywords: Low-cost improvement; Work improvement; Musculoskeletal disorders; Participatory approach

*Corresponding author.
E-mail address: k.kogi@isl.or.jp (K. Kogi).

0169-8141/03/$ - see front matter r 2003 Elsevier Science B.V. All rights reserved.
PII: S 0 1 6 9 - 8 1 4 1 ( 0 2 ) 0 0 1 9 5 - 6
180 K. Kogi et al. / International Journal of Industrial Ergonomics 31 (2003) 179–184
1. Introduction
Prevention of musculoskeletal disorders is one
of the most important tasks of securing safety and
health at work. There is a growing recognition in
both industrialized and industrially developing
countries that simple improvements in materials
handling and workstations for preventing muscu-
loskeletal disorders have multiple impacts on
safety and health promotion and on productivity
enhancement (Kogi and Kawakami, 1997).
This recognition is based on numerous reports
showing the usefulness of simple and low-cost
improvements in improving multiple aspects of
existing workplace conditions. The need for
practical approaches, particularly for small en-
terprises, is commonly stressed in these reports
(Rantanen et al., 1994; International Labour
Conference, 1995; Kogi, 1996). It is of particular
interest that multiple improvements often have a
direct influence on reducing musculoskeletal work-
load (Kawakami et al., 1999). It seems important,
therefore, to look into the way such simple
improvements reduce musculoskeletal load and
the support required to promote their spread use
(Kogi, 1998).
Three background conditions that increase
awareness on preventing musculoskeletal disorders
can be mentioned. (a) Musculoskeletal disorders
such as neck, shoulder, arm and low-back pains
and discomfort are commonly seen in many
workplaces. Positive experiences have been accu-
mulated that simple and low-cost improvements
can develop a visible outcome. (b) Workers having
musculoskeletal problems are also faced with
many other risks. There is thus a need to address
multiple aspects of working conditions. (c) It has
been widely accepted that musculoskeletal dis-
orders are one of the major obstacles for
productive workplaces.
This paper discusses the types of simple
improvements, which were achieved in work
improvement action training activities in the
Philippines and known to have reduced musculo-
skeletal load. A typical emphasis was placed on
participatory steps and low-cost solutions (Thur-
man et al., 1988). The analysis of these improve-
ments and the results of follow-up studies suggest
the need to promote similar improvements in
various workplaces.
2. Methods
Improvements in materials handling and work-
stations undertaken within a Work Improvement
in Small Enterprises (WISE) project in the
Philippines were first reviewed (Batino, 1997).
Serial WISE action-training courses in four
regions of the Philippines yielded many improve-
ments relying on local resources (Kogi, 1996;
Conferido, 1997). The project activities were
undertaken by trainers from the Department of
Labor and Employment and employers and work-
ers organizations in four regions of the country
during 1994–1997. Most of the resultant improve-
ments concerned ergonomic improvements rele-
vant to the reduction in musculoskeletal load. The
types of improvements achieved by the intensive
courses were analyzed to know the relation
between the training approach and musculoskele-
tal problems.
The results of follow-up case studies that
involved small enterprises participating in the
WISE training courses of the project were then
discussed. The effects of such improvements on
reducing workloads were investigated by applying
electromyography, heart rate recording and pos-
ture study methods. The impact on productivity
gains was also examined.
Based on these results, the means of promoting
similar improvements in workplaces with relatively
high musculoskeletal load were discussed.
3. Results and discussion
3.1. Reduced risks of musculoskeletal disorders by
the WISE approach in the Philippines
The WISE project in the Philippines funded by
the UNDP and technically assisted by the ILO led
to many successful improvements. Of over 2000
improvements within the project, many related to
materials-handling tasks and simple workstation
changes. Each course started with a checklist
 K. Kogi et al. / International Journal of Industrial Ergonomics 31 (2003) 179–184 181

Table 1
The numbers of improvements undertaken by small enterprises at WISE action-training courses in four regions of the Philippines
during 1994–1996 and in a course at Cebu

Technical area Total in the four regions 1994–1996 Cebu course, 1994

Plan Done or in progress To be done Plan Done In progress To be done

Materials handling 409 364 (89%) 45 (11%) 19 12 3 4

Workstation design 167 134 (80%) 33 (20%) 20 6 6 8
Machine safety 166 142 (86%) 24 (14%) 7 6 1 0
Screening hazards 116 98 (84%) 18 (16%) 16 12 0 4
Lighting 260 225 (87%) 35 (13%) 11 6 1 4
Welfare facilities 239 196 (82%) 43 (18%) 21 12 4 5
Premises 482 373 (77%) 109 (23%) 8 4 1 3
Work organization 185 150 (81%) 35 (19%) 6 3 0 3
General environment 46 43 (93%) 3 (7%)

Total 2070 1725 (83%) 345 (17%) 108 61 16 31

exercise in one of the participants’ enterprises. An
action checklist listing low-cost actions was used
to identify potential improvements. In evening
workshops, the participants discussed in small
groups local good examples collected from their
own workplaces and learned ergonomic and
related principles. They focused on low-cost
methods and the link between better working
conditions and productivity. Then the groups
discussed action plans, and implemented chosen
improvements. In the final workshop, the groups
presented improvements done by them.
Since the emphasis of the courses was placed on
the practical nature and simple solutions, many
low-cost improvements were undertaken in all the
four regions. Participatory training tools adopted
in these courses included the use of action check-
lists, demonstration of locally available good
examples and group work dynamics. As a result,
many innovative solutions in multiple technical
areas were implemented.
Table 1 gives a summary of improvements
reported in 1994–1996 and those undertaken in a
course in Cebu in 1994 in which 20 enterprises
took part. Improvements done by participating
enterprises covered different technical areas. The
success rates of the planned improvements were as
high as 80% or more for almost all these technical
areas. The action-oriented nature of the courses
and the stress on low-cost improvements facili-
tated the high rates of implementation. Important
were (a) the emphasis on immediate action by
participatory group work, (b) the attention to
gains in both working conditions and productivity,
and (c) the focus on locally achievable low-cost
improvements.
The technical areas covered were materials
handling, workstation design, screening hazard
sources, lighting and ventilation, welfare facilities,
premises, work organization and environmental
protection. As the results of the Cebu course show,
each participating enterprise undertook improve-
ments in multiple areas. Many of the improve-
ments undertaken addressed the reduction in
postural loads and repetitive motions related to
the risk of musculoskeletal disorders (Batino,
1997). This was obviously because musculoskeletal
discomfort was commonly experienced by many
workers. Prevention of musculoskeletal disorders
was one of the motives for starting the wide-
ranging improvement actions. Active participation
of managers and workers or the young and senior
contributed to generating many workable ideas.
3.2. Action taken to reduce musculoskeletal loads
Examples of actions taken by participating
small enterprises in reducing musculoskeletal loads
are shown in Table 2. These examples represented
simple and inexpensive solutions with substantial
impact on upgrading safety and health. It is
encouraging that such improvements could be
182 K. Kogi et al. / International Journal of Industrial Ergonomics 31 (2003) 179–184

Table 2
Examples of action taken to reduce musculoskeletal loads in different industries

Industry Musculoskeletal loads Action taken

Shoes Frequent bending and stretching postures for Multi-level rack for storing semi-products within
taking raw materials from the cluttered worktable easy reach
surface
Foods (candy) Carrying heavy raw materials to the production Developing a simple manual hoist crane
are located on the second floor
Foods (fish Heavy and difficult tasks for carrying a bulk of Passive roller conveyors for moving cans easily
canning) small cans
Garments Repetitive monotonous job contents because Formulating autonomic group work system in
workers were engaged in their fragmented which workers can rotate jobs
assigned jobs only
Metalworking Manual carrying of long steel bars Push carts appropriately designed for carrying
long bar materials
Handicrafts Discomfort and pains in arm portions due to the Fixing the scissors at the corner of the worktable
heavy scissors for slicing hard shell materials

carried out by mobilizing locally available re-
sources and ideas.
Actions taken usually addressed either reduction
in repeated motions or that in physical work
intensity. Improved motions were made possible
by storing materials or semi-products within easy
reach or by using fixtures. Reduction in physical
work intensity was realized by lifting devices, roller
conveyors and push carts. Installing simple hoist
devices or roller conveyors provided for workers
the safer means of moving loads with less muscular
efforts. Often, workload of carrying heavy and
bulky materials could be eased by locally designed
push carts. For example, waste steel plates or
material containers found in the local workplaces
were often used to make such carts. Further,
layout changes were undertaken so as to reduce
the distance of carrying heavy loads. Autonomous
group work and associated rotation of jobs were
also found to reduce the amount of physical work
done by individual workers.
Many workstation changes were undertaken to
avoid strenuous work postures. Simple improve-
ments as a result of WISE courses could lower
postural loads associated with deep bending,
squatting, twisting or arm elevation postures.
Adjusting work height, sometimes combined with
the provision of suitable chairs, allowing workers
to work at their elbow height was a basic principle
frequently adopted for adjusting their work
postures. Wood pieces or steel pipes available at
the local workplaces were often used to develop
their worktables and chairs. Fixing or hanging
heavy hand tools relieved muscular discomfort.
Improved lighting conditions on the work surface
assisted workers in decreasing the bending degree
and avoiding neck and back strains.
Work organization changes also provided prac-
tical and low-cost means for reducing the risk of
musculoskeletal disorders. Job rotation avoiding
the repetitive tasks was useful for preventing the
overload of the particular muscles. Insertion of
frequent short breaks and the provision of
comfortable resting corners facilitated the recovery
from muscle fatigue. Many other unique ideas
developed in the local workplaces were seen to
accelerate the workplace improvement thereby
reducing the risk of musculoskeletal disorders.
Case studies done in selected enterprises that
had participated in WISE training courses re-
vealed that improved materials handling and
better workstation designs contributed to reducing
pains and discomfort of workers. Table 3 gives
typical results obtained by these case studies. In all
these cases, changes of the indicators were
compared between the working situation before
the particular improvement and that after the
improvement.
In the case of introducing push carts or hoist
cranes for carrying or lifting heavy loads, the
 K. Kogi et al. / International Journal of Industrial Ergonomics 31 (2003) 179–184 183

Table 3
Confirmed improvements of musculoskeletal loads in typical improvement examples

Improvement features Typical improvement examples Indicators applicable in field conditions

Physical workload reduction
Physical workload reduction
Local muscular loads reduction
Local muscular loads reduction
Higher job satisfaction and skill
development
Easier work procedures and higher
productivity
Push carts for carrying heavy
materials
Hoist cranes for lifting loads up to
the second floor
Prop-stools for allowing workers to
alternate standing and sitting while
working
Adjusting the height of worktables
to elbow levels of workers
Autonomic group work methods
for allowing workers to experience
different jobs
Easier work methods including
layout changes, placing materials
within easy reach and use of roller
devices
Heart rate reduction (5–10 bpm); decreased
oxygen consumption (2–5 ml/kg min)
Heart rate reduction (10–20 bpm); decreased
oxygen consumption (3–8 ml/kg min)
Lowered low-back muscle activities
monitored by electromyography; decreased
workers’ subjective fatigue feeling
Lowered trapezius muscle activities
monitored by electromyography (5–20 mV);
decreased workers’ subjective fatigue feeling
Workers’ own subjective evaluation; higher
production rates
Shortened cycle time and increased
productivity (9–15%)

average heart rate levels and oxygen consumption
decreased after these improvements. The work was
much easier after the improvements. Local mus-
cular loads in terms of muscle activities monitored
by electromyography reduced significantly after
allowing workers to alternate standing and sitting
or after adjusting the height of worktables to the
elbow levels of individual workers. The scores of
subjective fatigue feelings also decreased after
these improvements. In a handicraft factory
manufacturing shell products, the workers had
been engaged in cutting shell materials into pieces
by heavy scissors. The workers complained of
pains and discomfort of the forearm portions due
to holding the scissors for a long period of time.
After attending a WISE course, they fixed the
scissors at the edge of the worktable so as to
reduce the muscular strains. The electromyo-
graphic activities of the forearm muscles reduced
greatly after this improvement and the workers
reported less fatigue there.
Interestingly, autonomous group work methods
introduced in a factory for allowing workers to be
engaged in different jobs were evaluated as
effective in reducing fatigue feelings in the limbs
and the back. An increase in production rates was
often observed. In another case, easier work
methods including layout changes, placing materi-
als within easy reach and the use of roller devices
led to a shortened cycle time and increased
productivity.
Similar positive results were confirmed in other
improvement examples. It was encouraging to see
that improvements carried out by the initiative of
local people had led to various improvements with
sustained effects.
3.3. Promoting support for similar low-cost
improvements
In the course of the project activities, the
reported improvement examples were compiled
in a computerized database. A series of improve-
ment guides showing low-cost ways of making
improvement in multiple aspects, example leaflets
and success stories were produced and distributed.
We noted that the low-cost improvements related
to the reduction in musculoskeletal loads were
among the most popular examples. Slides and
video films produced to show the benefits of WISE
activities included many such examples. These
materials were used in various training activities.
They were used in ‘‘advisory inspections’’ started
by regional labor inspectors particularly for
184 K. Kogi et al. / International Journal of Industrial Ergonomics 31 (2003) 179–184
providing practical advice to local entrepreneurs
about upgrading safety and health at their work-
places. Generally, illustrations and photographs
showing good examples were powerful means for
clearly focusing on the improvement points.
There were thus a variety of work improvements
undertaken by managers and workers of small
enterprises, often with combined effects on redu-
cing musculoskeletal loads and improving the
other aspects of working conditions. This flex-
ibility in work redesign seemed necessary in
promoting multiple changes linked with a reduced
musculoskeletal risk. These results demonstrated
the importance of undertaking multiple work
improvements on voluntary basis in reducing the
risk of musculoskeletal disorders in a large number
of small enterprises. Encouraging stepwise and
participatory action with a broad scope and
learning from local good examples seemed parti-
cularly useful.
These results sugggest that similarly action-
oriented training approaches can be used widely
to reduce musculoskeletal loads in different
industrial settings. Various combinations of low-
cost work improvements may be applied to have
realistic impacts.
4. Conclusion
By examining simple improvements undertaken
within the WISE project for small enterprises in
the Philippines, many low-cost improvements were
shown to reduce the risk of work-related musculo-
skeletal disorders and discomfort. The case studies
of participating enterprises confirmed reduced
muscular activities associated with improved
materials transport, better work postures, fixing
handtools or better work organization.
These results demonstrated the importance of
undertaking multiple work improvements on
voluntary basis in reducing the risk of musculo-
skeletal disorders in small enterprises. Participa-
tory approaches adopted in WISE have provided a
useful means for strengthening the local improve-
ment initiative. Encouraging stepwise and partici-
patory action seemed particularly useful. Many
simple and low-cost solutions should be possible
even in smaller enterprises. Local and interna-
tional efforts should be strengthened in extending
such practical improvement experiences focusing
on low-cost solutions into a large number of
industries in different countries.
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