Work 34 (2009) 239–248 239

DOI 10.3233/WOR-2009-0821
IOS Press

Work related psychosocial risks and

musculoskeletal disorders: Potential risk
factors, causation and evaluation methods
Colin Deeney and Leonard O’Sullivan ∗
Ergonomics Research Group, University of Limerick, Castletroy, Limerick, Ireland

Received 13 February 2008

Accepted 13 March 2009

Abstract. Musculo Skeletal Disorders (MSDs) are the focus of considerable attention and research in occupational health, which
is in part due to high prevalence rates and associated costs. In the United States, the total cost associated with MSDs increased
from $81 billion in 1986 to $215 billion in 2005 [3]. Epidemiological studies have repeatedly shown associations between
work-related psychosocial factors and MSDs, and the role of psychosocial factors and stress in these disorders has received
increased attention. Several reviews have reported associations between MSDs and work-related psychosocial factors such as
high workload/demands, high perceived stress levels, low social support, low job control, low job satisfaction and monotonous
work. Several theories have been proposed to explain the apparent relationship between stress and MSDs in the workplace
from a biological perspective. These include the biopsychosocial model of job stress, the hyperventilation theory, the migraine
theory, the muscle spindle theory and the Cinderella hypothesis. Within the literature, a vast array of questionnaires have been
developed in an attempt to measure the psychosocial factors that occur within the workplace. This article presents a discussion
of existing knowledge of the psychosocial risk factors potentially linked to MSDs and potential pathways to injury. A discussion
of evaluation approaches used to estimate psychosocial risk exposures in workplaces is also presented.

1. Background they estimated that the total cost of workers’ inability

In 2006, The European Community Risk Observa-
tory forecasted that the combined exposure to Musculo
Skeletal Disorders (MSDs) and psychosocial risk fac-
tors are amongst the top ten emerging risks to occu-
pational health and safety [17]. The Health and Safe-
ty Executive (HSE) in the United Kingdom conducted
several worker health surveys between 2002 and 2007
and consistently found MSDs to be the largest single
contributor to work related illnesses, accounting for be-
tween 42% and 58% of all work related illnesses [35–
39]. The HSE also reported on the costs of MSDS;
∗ Address
for correspondence: Dr. Leonard O’Sullivan, Er-
gonomics Research Group, University of Limerick, Castletroy, Lim-
erick, Ireland. Tel: +353 61 234249; E-mail: Leonard.osullivan@ul.
ie.
to work (adding costs for short term and long absen-
teeism as well as medical costs) due to MSDs was £2.2
billion [27]. The Small Firms Association in Ireland
conducted a survey of its members, and reported that
back injury and stress were the most commonly cited
reasons for absenteeism on medical certificates [71]. A
HSE survey on work related injuries also reported work
related stress as the second largest contributor to occu-
pational ill health with a estimated loss of 13.8 million
working days in 2006 [38].
MSDs include a wide range of inflammatory and de-
generative conditions affecting the muscles, tendons,
ligaments, joints, peripheral nerves, and supporting
blood vessels. The pathology has long been associat-
ed with exposure to physical risks, namely performing
work of high repetition, exerting high forces, working
in deviated postures and exposure to vibration [60].
Psychosocial risks have emerged as important risk fac-

1051-9815/09/$17.00  2009 – IOS Press and the authors. All rights reserved
240 C. Deeney and L. O’Sullivan / Work related psychosocial risks and musculoskeletal disorders
tors [6,7,58,60,63] but the pathology of the relationship
with MSDs, especially when combined with physical
risk factors remains unclear. This is due to the com-
plex linkages between psychosocial factors and MSDs
which are often influenced by a large number of con-
ditions [65]. The complexity of the underlying phe-
nomenon is evident in the evolution of the term “psy-
chosocial” as a non-specific term used as a catch-all
phrase to describe all non-physical elements associated
with the job/work environment [60]. The range of risk
factors that can be described as psychosocial ranges
from job demands, job control, social support and job
satisfaction, to characteristics of the worker (including
personality, family/work balance, mental well being).
Furthermore, the role of psychosocial risk factors is
quite different pre and post injury. For example, Keogh
and Fisher [46] note that occupational psychosocial
perceptions are much more complex during a return to
work after injury than they are before the injury.
Evaluation of MSD risks necessitates measurement
of the magnitudes and comparison with acceptable ex-
posures. For physical risks many methods have been
developed and incorporated into international stan-
dards, for example, the NIOSH lifting equation for
manual handling work and the Strain Index [56] for as-
sessment of upper limb repetitive work. But evaluation
of psychosocial risks has been dominated by methods
emanating from research in occupational psychology,
and so the suitability of these for measuring the risks
based on the pathological link of MSDs due to psy-
chosocial risks (either alone or combined with physical
risks), remains largely undefended. A small number
of theories on the pathology have been proposed but
few have been universally accepted. Hence prevention
strategies based on scientifically derived acceptable ex-
posures have not yet been developed.
2. Psychosocial risk factors in the workplace:
Stress(ors) and strain
Modelling and understanding MSDs involves study
of the stressors, which are normally physical attributes
such as force and posture, and the resultant strain, such
as muscle fatigue. Psychosocial risk factors are con-
ventionally termed stress rather than stressors, but in
studying injury causation the term stressors would be
more accurate. We could then focus on the nature of
strain in the individual and how this interacts with oth-
er physical risks in the work environment to increase
frequency and severity of MSDs. Cox [13] describes
stress based on the physiological responses due to per-
ception of an imbalance between job demands and abil-
ity to cope, but the response is actually a strain while
the perception of imbalance is the stressor. The HSE
(UK) also describes stress as the adverse reaction (again
a strain) people experience due to excessive pressure
or other types of demand placed on them. It is wide-
ly accepted that excessive exposure to work environ-
ment stressors have detrimental strains on the human
body, contributing to cardiovascular disease [21,59],
high blood pressure [11] and anxiety/depression [62,
75], amongst other conditions. In recent years the pic-
ture of the effects of stressors on MSDs has become
more apparent, mainly from epidemiological data and
case studies [60].
Like any other risk, psychosocial risk factors ele-
vating loads on the worker must be assessed and con-
trolled. The core objective in Ergonomics is to match
the fit between the person and the task. One of the
earlier more important contributions to this area was
the Karasek [42] demand/control model which focused
on the balance between job demands and job control.
This was later extended to include the importance of
support in the workplace [53]. Since then a number of
other important work-related factors have been identi-
fied. Kristensen et al. [48] proposed an extensive list of
risk factors, including cognitive demands, commitment
to the workplace, degree of freedom at work, demands
for hiding emotions, emotional demands, feedback at
work, influence at work, insecurity at work, job sat-
isfaction, meaning of work, possibilities for develop-
ment, predictability, quality of leadership, quantitative
demands, role clarity, role conflicts, sense of commu-
nity, sensorial demands, social relations and social sup-
port. The Health and Safety Executive in the UK [53]
conducted a number of projects on work stress with a
view to developing a management standard that com-
panies could use to monitor their exposures. They pro-
posed a taxonomy of risk factors that is more concise;
the risk factors include demands, control, support, re-
lationships at work, role and change. The following
sections summarise evidence for a subset of risk fac-
tors for which there is evidence of an association with
MSDs.
2.1. Job demands and MSDs
High job demands have been consistently linked
with upper extremity disorders, especially for work de-
scribed as intensive and performed under time pressure,
high work pressure and low workload variability [60].
 C. Deeney and L. O’Sullivan / Work related psychosocial risks and musculoskeletal disorders
Van den Heuvel et al. [74] in a study of a working
population in the Netherlands identified high job de-
mands as a risk factor for MSDs of the upper limb and
shoulder/neck. High work pressure was also found to
be a risk factor for MSDs of the neck and shoulder for
nurses in Japan [72]. A cross-sectional study of upper
extremity MSDs among 1050 employees using video
display terminals at a large metropolitan newspaper
found that variables corresponding to increased work-
load demands (e.g. increased amount of time working
under deadline and increased job pressure) were as-
sociated with increased neck, shoulder, and hand or
wrist disorders [5]. We found few contradictions and
generally good agreement across a number of studies
demonstrating the strong role of high job demands as a
psychosocial risk factor with MSDs.
2.2. Job control and MSDs
Job control can be broadly defined as the level of
control a worker has over the way they schedule their
work, perform their job, undertake their tasks, and how
they undertake their tasks. If such facets of the job are
rigid, job control is low. In the literature, a lack of job
control has been associated with MSDs in a number of
instances. In a study of 973 newspaper workers, em-
ployees who perceived themselves as having a low lev-
el of participation in job decision making where more
likely to report MSDs symptoms for the shoulder [5].
A study of 518 telecommunication employees reported
that those who had low job control where more likely
(OR 1.6) to report MSD symptoms of the elbow [23].
Other studies have also identified a relationship be-
tween low job control and MSDs complaints, particu-
larly in the upper extremities [2(OR 1.1), 49 (p < 0.05),
51 (OR 1.9)]. There is general concordance in the liter-
ature that job control is an important psychosocial risk
factor and that this has a strong association with MSDs,
especially in the upper extremity and neck.
2.3. Monotonous work and MSDs
Monotonous work can be described as tasks requir-
ing tedious repetition or lacks variety, and this type
of work has been positively linked to MSD symptoms
in several studies. In a two year prospective study of
newly employed workers from 12 diverse occupational
settings, participants who perceived their work to be
monotonous or boring were found to be at increased risk
of developing shoulder pain, and this risk was found
to be independent of other work related factors [25].
241
Similarly, in a study of 143 data processors, their self
reports of “being bored most of the time” were high-
ly associated with neck symptoms [64]. Other studies
have found associations between shoulder pain and a
lack of stimulus from work; for example, in nursing [8]
and truck assembly [34]. Monotonous work has not
received as much attention as other psychosocial risks
and the majority of the positive evidence linking it with
MDSs is based primarily on associations. There was
no epidemiological survey found including a statistical
analysis of the strength of the effects. On this basis it
is our impression that monotonous work contributes to
the risk of MSDs but effect magnitudes are not as high
as for high job demands and low job control.
2.4. Social support and MSDs
Social support is a rather broad term used to describe
a complex process of how an individual draws sup-
port from interpersonal relationships, thereby enhanc-
ing their ability to cope with problematic situations and
to enhance their general happiness derived from feel-
ings of belonging to a community. In occupational set-
tings House [31] suggested that social support can be
grouped under four headings,
1. Emotional support: providing empathy, care,
love, trust, esteem, concern and listening
2. Instrumental Support: providing aid in terms of
money, labour, time or any direct help
3. Informational Support: providing advice, sug-
gestions, directives and information for use in
coping with personal and environmental prob-
lems
4. Appraisal support: providing affirmation, feed-
back, social comparison and self evaluation
Studies indicate that limited social support from su-
pervisors and co-workers has an association with mus-
culskeletal symptoms. A lack of social support was
significantly associated with neck-shoulder complaints
in ambulance workers (OR1.86) [1], and sewing ma-
chine operators (OR 3.72) [41], whilst other studies
have found an association with back pain [32,70]. Oth-
ers found low social support to be a predictor of absen-
teeism at work [30,57]. But there are contradictions in
the literature on this. In a study of 144 tank terminal
workers, low support was found not to be significantly
associated (OR < 1) with self reported musculoskeletal
pain in the shoulder, elbow or in the wrist [9]. A similar
study of assembly operators at Volvo (n = 67) also re-
ported lack of evidence of an association between low
social support and self reported musculoskeletal pain
in the upper extremities [15].
242 C. Deeney and L. O’Sullivan / Work related psychosocial risks and musculoskeletal disorders
3. Theories linking psychosocial risks and MSDs
The causation of MSDs with physical risk factors is
only partly understood, while the causation, specifical-
ly the pathology, with psychosocial risk factors is even
less well known. A small number of scientific theories
have been widely cited. These propose explanations for
the interplay between psychophysiological responses
and physical stressors and MSDs. But many are based
on assumptions which are in some cases impossible to
test due to measurement limitations. Technological ad-
vancements in practical psychophysiology and cogni-
tive activity measurement techniques are necessary to
make substantial ground in this respect.
3.1. The Biopsychosocial model
Engel [14] proposed the Biopsychosocial model
which states that psychological stress may result from
both overload (demands that can exceed an individual’s
ability to deal with them), and under load (demands
that are too low including monotonous work situations
that do not sufficiently challenge the individual). Melin
and Lundberg [55] applied this model to explain the
relationship among mental and physical stressors, and
hormonal stress responses and muscle tension. The
Melin and Lundberg model proposed that mental and
physical stressors related to workloads produce physi-
ological responses while at work. A special feature of
this model is that it also addresses post work activity
when it is generally assumed that the stress response
associated with exposure to work tasks and/or the work
environment subsides. The model proposes that a full
recovery of the stress response to levels prior to the
exposure to workplace stressors may not occur quickly.
That is, after work the stress response may continue
in the form of sustained muscle tension and/or secre-
tion of stress hormones such as adrenaline and cortisol.
Furthermore, should the individual be exposed to other
workloads such as household work or child-care, the
recovery may be further affected. As the physiolog-
ical stress response persists over time, a worker may
be placed at greater risk of a musculoskeletal disorder.
This model is unique in considering the potential con-
tribution of family-related factors (work life balance)
to MSD symptoms and draws attention to how stress
responses from work may be maintained and/or exacer-
bated when an individual is away from the workplace.
3.2. The hyperventilation theory
Schleifer and Ley [67] proposed the hyperventilation
theory based on the principle that there is a possible re-
lationship between stress-induced hyperventilation and
the development of MSDs. The theory proposed that
psychosocial risks can cause emotional strain that re-
sult in hyperventilation. The outcome is a disruption of
the acid-base equilibrium resulting from a decrease in
arterial CO2 levels and a rise in blood pH levels. The
disruption of the acid-base equilibrium initiates various
physiological responses that have adverse affects on the
musculoskeletal system, such as muscle tension and
muscle ischemia and hypoxia. The change also affects
the potassium ions in the blood which may result in
a disturbed muscle function. During hyperventilation
a persons breathing pattern is often altered from ab-
dominal (diaphragmatic) breathing to chest (thoracic)
breathing, which increases the biomechanical load on
the ancillary muscles (i.e. trapezius) [66]. It is inter-
esting to note that clinicians associated musculoskele-
tal symptoms with hyperventilation many decades be-
fore this model was proposed, and at present breathing
therapy is assumed to have a positive effect on muscle
tension [20].
3.3. The migraine theory
Knardahl [47] proposed the migraine theory based
on long duration static loading and the arousal of mus-
culoskeletal pain disorders. According to the hypoth-
esis, the interaction between sensory nerves and blood
vessels, which in turn dilate the blood vessels affecting
the muscles, cause pain similar to attacks of migraine.
Knardahl suggested a reciprocal action between senso-
ry nerves and blood vessels without any direct involve-
ment of muscle fibres. Knardahl outlined 3 possible
mechanisms for this mutual activity: (1) Arterial va-
sodilatation resulting in an extension of the blood ves-
sels stretching the actual tissues including nerve end-
ings, (2) an increase of pain inducing substances result-
ing in pain and irritability, and (3) that these contribute
to an inflammatory process with an increase permeabil-
ity of the vessels.
3.4. The muscle spindle theory
The Johansson and Sojka [33] theory is centred
around the muscle spindle system, i.e. sensory organs
embedded in the muscles that are important for the
proprioception, coordination of movements and reflex-
 C. Deeney and L. O’Sullivan / Work related psychosocial risks and musculoskeletal disorders
mediated muscle stiffness. This theory assumes that
the body’s defence system against monotonous move-
ments is linked to the stress management system. In
this case static and/or repetitive work causes an accu-
mulation of metabolites (e.g. lactic acid) and inflam-
matory substances (e.g. bradykinin) in the muscles,
which results in increased activity in the muscle spin-
dle system, which in turn causes an increase in reflex-
mediated muscle stiffness and an increase in metabo-
lites in the muscle. A vicious circle ensues, a process
that could spread to other muscles. Of particular con-
cern is the potential effect on proprioception, coordi-
nation of movements by the spindle system’s altered
activity, and accumulation of metabolites which may
affect the sympathetic nervous system.
3.5. The Cinderella hypothesis
The Cinderella hypothesis has been widely refer-
enced in ergonomics circles as it offers a lot to our
understanding of the development of muscle damage
for low level intensity tasks [22]. The theory is named
after a fairy tale of the same name, in which Cinderel-
la was the first to rise and the last to go to bed. The
analogy hypothesises that motor units are recruited and
de-recruited in the same order, resulting in some units
being recruited for the full duration of the contraction
while others are only recruited for short durations. Over
activation and exhaustion of individual motor units with
insufficient recovery time may then result in damage to
the muscle with associated muscle-related pain. The
Cinderella hypothesis draws upon several assumptions;
that muscular force generated at below maximal levels
only engages a small fraction of the motor units avail-
able, that motor unit recruitment is predictable, and that
small type I fibres are continuously active during sus-
tained tasks. These assumptions were based on work
previously conducted by Henneman et al. [29]. How-
ever other studies found that for some individuals, de-
recruitment of motor units can occur [54], and that mo-
tor unit substitution can take place [18]. However, stud-
ies finding agreement with the hypothesis are far more
plentiful. For the upper trapezius muscle Forsman et
al. [19] concluded that stereotypic recruitment patterns
exist in the trapezius muscle not only in static work,
but also in work situations involving arm and shoulder
movements. Other studies have reported similar find-
ings [40,76]. Based on the literature we concluded that
the Cinderella theory remains a valuable hypothesis.
243
3.6. The nitric oxide/oxygen ratio hypothesis
According to the nitric oxide/oxygen ratio hypothe-
sis proposed by Eriksen [16], pain can be invoked in
the neck region in work situations involving low level
contractions in the trapezius muscle, when combined
with psychological stress or prolonged head-down neck
flexion. Both can increase sympathetic nerve activity,
thereby causing constriction of blood vessels (vasocon-
striction). This is followed by a sequence of physi-
ological reactions leading to an increase in the nitric
oxide/oxygen concentration ratio in the muscle fibres
and a depletion of adenosine triphosphate (the intracel-
lular substance that provides the energy for almost all
cellular functions). This would elicit production of lac-
tic acid into connective tissue where nociceptive fibres
would be activated, causing muscle pain [16].
4. Screening psychosocial risk factors related to
MSDs
The practitioner needs methods for screening tasks in
order to evaluate exposures relative to acceptable levels.
Unlike, for example, occupational hygiene where cau-
sation between exposures and disease is often well un-
derstood, for psychosocial risks the biological respons-
es remain understudied and vague in many respects.
This is demonstrated by the numerous open theories on
causation detailed in Section 3. This section reviews
approachs that could be used to measure psychosocial
risk factors, specifically with respect to the risk factors
linked to MSDs.
Questionnaires are the most common instruments
used to measure psychosocial work environment risk
factors and there are general structure and content com-
monalities between the frequently cited methods; in the
most they include standardised questionnaires on pres-
ence or absence of risk factors including job demands,
job control, and social support in the work environment.
In some cases methods also include scales to measure
health status. Mackay et al. [53] report that in the de-
velopment of the HSE Stress Management Standards,
consensus by experts in organisational psychology and
associated domains was the basis for setting limits. For
the control of ergonomics risks inducing MSDs it is
preferable that biological data is used, at least in part
for setting limits used to protect against injury. But
these methods are normally developed in the context
of the objectives in organisational psychology and not
specifically for ergonomics studies.
244 C. Deeney and L. O’Sullivan / Work related psychosocial risks and musculoskeletal disorders
There is an abundance of questionnaires avail-
able to measure the psychosocial work environment.
NIOSH [61] have identified in excess of 40 and some of
the most commonly cited methods will be summarised
here. These were chosen based on frequency of citation
in the literature, number of psychosocial risk factors
measured and development of the methods based on
theories or scientific data.
4.1. Job Content Questionnaire
The Job Content Questionnaire (JCQ) was developed
by Karasek [45] as a method to specifically measure
the content of a work task. The method comprises of
49 questions measuring 5 aspects of the psychosocial
work environment (decision latitude, psychological de-
mands, social support, physical demands and job in-
security). Each question has four responses, strongly
disagree (score of 1), disagree (score of 2), agree (score
of 3) and strongly agree (score of 4). The overall score
for each scale is then calculated and the result com-
pared to national averages (US data) using z-scores to
identify hazardous risk. The JCQ has been shown to
predict coronary heart disease and jobs with higher risk
of stress [45].
The questionnaire was originally derived from the
job demand-control model [42], which has been one of
the most influential theories is this area. The model fo-
cuses on two specific risks; job demands and decision
latitude. During the 1980’s the model was further ex-
panded to include social support and became known as
the job demand-control-support model [44]. The theo-
ry states that the most adverse reactions occur when the
psychological demands are high and the worker’s deci-
sion latitude is low, and that this is further exacerbated
by low social support [45]. Extension of the model al-
so now incorporates the active behaviour hypothesises
which states that a certain level of “good stress” can
increase motivation under certain conditions of high
demands and high decision latitude. These conditions
are also thought to contribute to the learning of new
behaviours and aid coping pattern development. But
the active behaviour hypothesis is reliant on demands
not being excessive and there is no clear delineation
between exposure levels.
4.2. Effort reward imbalance questionnaire
The questionnaire was developed from the Effort-
Reward Imbalance (ERI) model [68], which postulates
that jobs are characterized as stressful based on a per-
ceived imbalance between high effort and low rewards,
particularly in persons with limited coping abilities.
An important construct of the model is the individual’s
need for control. According to the model, a person
with high need for control will respond in an inflexible
way to work situations of high effort and low reward.
The full version of the ERI questionnaire consists
of 23 questions divided into 3 scales: ‘extrinsic effort’
(6 questions), ‘reward’ (11 questions, including mon-
ey, esteem, and job security and promotion prospects),
and ‘over commitment’ (6 questions). Each question
has only 2 responses; disagree (score of 0) and agree
(score of 1). The sum of the scores for each scale is
used to determine if the person is regarded to have an
ERI. Extrinsic effort is defined as any score greater
than three, while low reward is considered to be any
score greater than seven. If both are present, the re-
spondent has an ERI. The validity of the instrument has
been demonstrated in several countries [10,24,50] and
it has been successfully used to predict sickness absen-
teeism [26]. In a review of the effort–reward imbal-
ance model Siegrist et al. concluded that is was a psy-
chometrically well-justified measure of work-related
stress [69].
4.3. General Nordic Questionnaire
In 1994, the Nordic Council of Ministers launched a
project with the aim to improve the scientific quality and
the comparability of measurement results on psycho-
logical and social factors at work. The resulting instru-
ment, the General Nordic Questionnaire, encompass-
es the basic psychological and social factors at work
and is suitable both for workplace interventions and
research purposes [52]. The long version of the ques-
tionnaire consists of 129 questions but a short version
is available. The scoring system for the questionnaire
is similar to that of the job content questionnaire as the
scores are compared to national averages. The main
content areas that the questionnaire measured include,
decision making processes, housekeeping, job content,
job demands, management style, organisational culture
or climate, social supports / relations, teamwork, role
strain and the work-family balance.
4.4. Copenhagen Psychosocial Questionnaire
The COpenhagen PSychOsocial Questionnaire
(COPSOQ) was developed with the aim of improving
the assessment of psychosocial risks [48]. We found the
COPSOQ amongst the most comprehensive tools avail-
 C. Deeney and L. O’Sullivan / Work related psychosocial risks and musculoskeletal disorders
able providing measurement of a considerable number
of risk factors. Unlike many of its counterparts it is
not based on one specific theory of job stress but rather
intelligence from a number of those widely cited [48].
The questions where largely derived from previously
well validated questionnaires including the JCQ and
ERI. Another unique feature of the questionnaire is that
it comes in 3 versions; a long version for research stud-
ies (141 questions), a medium size version to be used
by work environment professionals (91 questions), and
a short version for workplaces where access to workers
is of limited duration (44 questions). Scoring is simi-
lar to both the Job Content questionnaire and the Gen-
eral Nordic questionnaire; results from each scale are
measured as a percentage and then compared with na-
tional averages. Any score between 40–60% is consid-
ered average, while scores measured outside this range
highlights a need for further investigation. Since its
emergence, the tool has become popular and has been
used in many case studies [4,74].
4.5. HSE stress management standard and
work-positive
The HSE in the United Kingdom developed a Stress
Management Standard which comprises an evaluation
questionnaire and concisely expressed desirable tar-
gets [12,53]. The HSE website provides useful prac-
tical resources for the practitioner, including an Excel
file for uploading and evaluating the data. In this re-
spect the approach is well targeted towards application
in industry. Case studies are provided demonstrating
successful interventions in industries, but few scientific
studies in international journals validating the approach
were found. A variant on this method is the Work-
Positive approach [28] developed by NHS Health Scot-
land and the Health and Safety Authority Ireland. It
is also practical and straight forward to apply in the
occupational setting.
Both methods benefit from good usability and they
also assess psychosocial risk factors that have a rela-
tionship with MSDs. However, for both the HSE Stress
Management Standard and the Work-Positive tool no
studies were sourced that applied specific elements of
either methods for screening of psychosocial risk fac-
tors for MSDs.
5. Conclusions
MSDs remain a considerable financial burden to or-
ganisations, but prevention through risk management
245
strategies is confounded by a lack of detailed under-
standing of the risk factors relative to human tolerances.
Good scientific progress has been made in ergonomics
research on physical risk factors, such as posture, force
and repetition, culminating in quasi-quantitative risk
assessment methods. There is growing evidence that
psychosocial risk factors exacerbate the effects of phys-
ical risk factors thereby increasing the risk and severity
of MSDs. It remains unclear if the combined effects
on the body of psychosocial with physical risks are ad-
ditive or multiplicative in nature. Most research in this
area to date is based on epidemiological studies. In
order to develop more accurate holistic risk assessment
methods for prevention of MSDs it is necessary to ini-
tiate more quantitative studies of biological responses
based on exposures.
Industrial ergonomists, health and safety officers and
other occupational health related practitioners remain
somewhat in a vacuum. Risk assessment methods for
physical exposures have good acceptance, even though
they generally do not evaluate the psychosocial risks.
Consequently the strategy to protect workers against
MSDs involves applying physical and psychosocial
risk evaluation methods simultaneously, but separate to
each other. With respect to evaluating the psychoso-
cial risk factors associated with MSDs it is not pos-
sible to advocate any one psychosocial questionnaire
based on hard scientific data, but the authors are of the
opinion that the COPSOQ, the HSE Stress Manage-
ment Standard and the Work-Positive are well placed.
These methods were not developed to assess the effects
of such risk factors on MSDs, but they measure the
pertinent factors, notably job demands and control and
are therefore useful. But the strategy of controlling
psychosocial risk factors just related to MSDs is very
narrow. In fact a more comprehensive management of
all psychosocial risks within the organisation will have
many other benefits over and above reduced MSD risk
and this is to be strongly encouraged.
Acknowledgements
This work was completed on the Cybermans project,
funded under the FP6 Programme (IST-NMP 016712).
The authors would like to thank the anonymous
reviewers for their comments in the revision of this
manuscript.
246 C. Deeney and L. O’Sullivan / Work related psychosocial risks and musculoskeletal disorders
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