Musculoskeletal Disorder (MSD)

MSDs can be painful and debilitating injuries that can become chronic if left unresolved.
The best approach is to prevent them before they happen.

The following resources are available to assist you with your MSD prevention initiatives:

Office Ergonomics Reference Guide

Updated for the modern office, new technologies and home office situation

Now available online and as a downloadable PDF

Info Pages

The following MSD Info Pages are available as downloadable pdfs.

Download a PDF of OHCOW’s Info Sheet on Back To School: Ergonomics for Students and Educators

Back to School: Ergonomics for Students and Educators

It’s not necessarily growing pains!

Students are being exposed to ergonomic risk factors during key periods of physical growth which may lead to the development of musculoskeletal disorders (MSDs).   The range of body sizes, strength capabilities, and cognitive characteristics among students need to be considered when purchasing equipment and designing workstations.


Factors contributing to MSDs from backpacks include weight, transport duration, and additional items carried.

school napsackWhat to look for when purchasing a backpack?

  • Appropriate Size
  • Padded and adjustable shoulder straps
  • Waist and chest straps
  • Multiple compartments to position weight evenly

Proper Use:

  • Use both straps when carrying
  • Ensure straps are tight
  • Pack only essential items
  • Load heaviest items first


Musculoskeletal pain and discomfort among youth has been associated with the use of smartphones, tablets, and laptops. Students are being exposed more frequently to these forms of technology both inside the classroom and out. When using these items, it is important to:

Keep in mind neutral postures by assessing working heights and positioning tablets and phones accordingly


Increased use of technology may lead to eyestrain, headaches, blurred vision, dry or red eyes, double vision, and light sensitivity.

20 second rule imagesWhat can caregivers and educators do?

  • Teach children to not sit too close to the monitor and take frequent rest breaks.
  • Get regular eye tests
  • 20-20-20 Rule


Students have the most fluctuating body dimensions which makes accommodating each child’s growth needs extremely difficult.  Adjustable furniture is preferred but often it is not feasible.

child at deskFlexible seating arrangements promote movement and help students focus

  • Alternative seating – stools, floor, etc
  • Create stand up work area


  • Use pillows to provide support, comfort, and increase the working height to allow for neutral postures
  • Uses boxes or stools as a footrest

Encourage Movement

  • Movement aids both physical and mental components of learning
  • Everyone should move a minimum of once per hour
  • Incorporate movement into lessons


  • Wear supportive footwear and use anti-fatigue matting while standing
  • Use fully adjustable chair and set up desk area Ergonomically correct


• We can’t always control the setup and use of equipment at school but we can at home

• Teaching students proper setup at home may transfer over to the school

Download a PDF of OHCOW’s Info Sheet on Psychosocial Risk Factors & Musculoskeletal Disorders

Psychosocial Risk Factors & Musculoskeletal Disorders

Psychosocial Risk FactorsPsychosocial Risk Factors

Non-physical aspects of the workplace developed through workplace culture, policies, expectations, and the social attitude of an organization (CCOHS, 2017).

Includes both objective demands and subjective assessment of a worker’s ability to perform the demands. When workplace psychosocial risk factors place demands on workers that are greater than their ability to cope, they will experience stress. Stress can contribute to poor mental and physical health which can contribute to the development of musculoskeletal disorders (MSDs) (CCOHS, 2017).

Examples of Psychosocial Risk Factors

  • Job Demands: mental and physical requirements of the job (i.e., time pressures)
  • Job Control: the amount of perceived input a worker has over the way their work is performed (i.e., limited opportunity to make their own decisions).
  • Job Satisfaction: task variety, monotonous work
  • Support: workers perception of the support they are receiving from co-workers, employer, and family.
  • Work/Rest Cycle: adequate physical and mental recuperation time.

The Body’s Reaction to Stress 

The body has a “fight or flight” reaction in response to the stressors placed upon it.  Stress can be positive or negative and the body undergoes three different responses to stress:

Physical factors at work1.Behavioural Response
Responses produced by an individual that they are unaware of. For example, an individual may avoid the workplace (increased sick days); use excessive force when performing tasks, etc. These responses can increase the risk of developing MSDs.

2. Psychological Response
General response based upon how the stress is perceived by the individual (positive or negative). In the workplace negative stresses may be linked to the psychosocial factors.

3. Physiological Response
How the body naturally reacts to stress. These responses include increased blood pressure; muscle tension; decreased sensitivity to pain; and increased release of cortisol (the body’s primary stress hormone).  The body’s physiological response may cause people to lift heavier material, work quickly, and work beyond their body’s physical capacity.

How do Psychosocial Risk Factors Contribute to MSDs

When workplace psychosocial factors place demands on workers that are greater than the worker’s ability to cope with them, they experience stress. 

 1.High mental load and work demands may: 

  • Increase muscle tension 
  • Decrease the frequency of breaks leading to muscle fatigue.
  • Change the immune response so recovery is affected
  • Directly impact force applied and postures assumed (i.e., striking keys harder, gripping tighter).

2.  Muscle Activity

  • High work stress may increase muscle activity and load on the musculoskeletal system.  It may also reduce an individual’s ability to relax which may lessen muscle recuperation during breaks and after work.

3. Stress responses may:

  • Cause physiological changes that may lead to musculoskeletal problems.
  • Lead to different perceptions of the work situation and musculoskeletal symptoms.
  • May result in acute or short-term pain becoming long lasting musculoskeletal pain.

4. Increased sensitivity

  • High work stress may lead to changes in the central nervous system causing increase sensitivity to pain.

5. Sleep 

  • Sleep disturbances leading to inadequate mental and physical recovery can result.

How to Assess Psychosocial Risk Factors

OHCOW has resources and tools to assist workplaces in assessing and preventing workplace mental harm. Find them here.

A survey of the psychosocial factors in your workplace

Stress Assess

OHCOW also offers StressAssess, a free evidence-based online survey tool, designed to assist workplaces in identifying psychosocial hazards that can lead to stress and mental injury.

Strategies to Help Control Psychosocial Risk Factors in the Workplace

  • Encourage employee participation and decision making
  • Clearly define employees’ duties and responsibilities
  • Promote work-life balance
  • Encourage respectful behaviour
  • Manage workloads
  • Provide training and learning opportunities
  • Promote conflict resolution practices
  • Recognize employees’ contributions 

When Workplaces Manage Psychosocial Risk Factors and Support Employee Mental Health the Following Generally Occurs:

  • Improved employee morale
  • Reduced absenteeism
  • Reduced injury costs
  • Increased productivity

Download a pdf of “Quick Workstation Setup” info Sheet.

Quick Workstation Setup Guide

Correct Seated Posture

workstation details ergonomics

Additional Setup Information


Seat Pan

Adjust to allow ~3 finger widths of space between backs of legs and edge of seat pan


Adjust height of backrest to provide lumbar support 


Adjust position and height to provide support for elbows while in a typing posture

Work surface

Should allow the user to work in neutral postures while sitting/standing with their shoulders relaxed, arms at sides, forearms horizontal with elbows at 90 degrees, and without having to reach upwards or downwards

Mouse & Keyboard

Centre keyboard to centre line of body with mouse directly adjacent on the same level

Computer Monitor/Screen

When positioning and adjusting a monitor consider:

desk screen economics 2, screen height, viewing angle, horizontal placementdesk screen economics 2, viewing distance, number of monitors

For more information:

OHCOW Office Ergonomics

Download a pdf of Ergonomics of Fall Yard/Garden Chores: Preparation for Winter below. Listen to the podcast on this topic here.

Ergonomics of Fall Yard/Garden Chores: Preparation for Winter

Yard waste cleanup; fall gardening tasks; gutter/eavestrough cleanup; and the storage of summer furniture, work, and leisure equipment requires substantial physical effort. Manual material handling activities (lifting, lowering, carrying, pushing, and pulling) may lead to the development of musculoskeletal disorders (MSDs). 

Manual Material Handling

  1. Plan 
  • Organize – tasks, equipment required, storage options, help required
  • Clothing – lightweight, closed toed shoes or boots, Personal Protective Equipment (PPE) – safety glasses, gloves, etc.
  • Physical Preparation – warmup and stretch

Lifting,from knees2. Lifting/lowering and carrying 

  • Test weight – lift within personal limits; use lifting aid or partner; and use correct lifting techniques (BACK)
  • Ensure adequate grip and stable base 

3. Push/pull

  • Push rather than pull
  • Use correct equipment (wheelbarrows, buggies, wagons)
  • Ensure equipment is properly maintained (lubrication, tire inflation, handles, etc.)
  • Ensure load is stable, evenly distributed, and appropriate weight

4. Climbing – ladder, scaffolding, etc.

  • Ensure it is in good repair with no loose hinges, rungs, or screws
  • Place on a firm, level surface, and be sure it is erected correctly 
  • Always ascend and descend facing toward the ladder or scaffolding
  • Abide by manufactures recommended work heights
  • Always work with a partner for additional stability and safety

Raking and yard waste 

Select the right rake: 

  • Handle length that allows the user to stand upright 
  • Rake head that is correct for material to be moved: bow or fork head for garden, thatch, or heavier material (dirt, gravel, etc.); fan head for leaves or light grass
  • Correct rake head width – wider heads require increased forces
  • Correct rake weight  and construction –  steel/metal rakes are heavier than plastic or fiberglass

different kinds of rakes


Raking technique

  • Reach arms directly forward ahead of the leaves, etc. and pull back – avoid twisting
  • Step to the side to move onto a new debris pile – avoid twisting 
  • Use “scissors” stance: one foot forward and one foot back for a few minutes, then reverse position
  • When picking up the debris use correct lifting techniques 
  • Make smaller piles to decrease weight and lateral reach requirements
  • Take regular breaks or change tasks frequently 
  • Consider using a leaf blower or a mulching lawn mower to negate the need to rake at all.

Gardening, harvesting, flower beds

  • Kneel or use a small chair/stool to decrease bending or stooping when in one spot for extended periods
  • Align torso directly with task to avoid twisting
  • Alternate hands to reduce strain and prevent imbalances
  • Utilize appropriate tools or aids to assist – gardening shovels, hoes, etc.
  • Take regular breaks or change tasks frequently 

Garden Set, kneelinggarden seat, pos 1

Cleaning gutters and eavestrough

  • Always follow all recommended safety guidelines set out for ladder use. More info here.
  • Always perform this with a partner – one person holds ladder while upright and helps with its relocation
  • Move ladder frequently to avoid overreaching – always keep body centred on the rungs of the ladder, do not lean to the side or reach more than an elbows distance away  
  • Remove small amounts of debris at one time – use a rope and small bucket to lower waste
  • Use a hose or pressure washer to push waste towards one end to decrease the number of times the ladder needs to be relocated

Storage: Lawn/garden equipment; Patio/lawn furniture; etc.

  • Use correct lifting techniques; have a partner or a lifting aid to help move larger, heavier items 
  • Store at appropriate height (preferably chest level) to avoid excess bending, stooping, or reaching overhead
  • Place items in a different location than winter equipment to avoid moving them again when requiring winter tools
  • Organize and plan when moving and storing items

Listen to the Oh-Cow podcast on this topic here.

Download a pdf of the Info Sheet, Ergonomics of Sleep.  Listen to the OHCOW podcast (Oh-Pods) on the Ergonomics of Sleep here.

Ergonomics and Sleep

Sleep is essential for total repair. It helps the body recharge physically and mentally.

When we sleepAge/Hours of Sleep Diagram

  • The brain is eliminating waste products
  • The muscles, bones, and organs are repairing and rebuilding
  • The immune system is strengthening
  • Most people do not get enough sleep
  • 25 – 40% of people do not get enough quality sleep 
  • Recommendations for sleep are generally based upon age 

Sleep deprivation (lack of quality sleep) may lead to

  • Decreased mental and physical alertness 
  • Poor decision making
  • Decreased coordination and reaction time
  • Increased stress levels
  • Increased illness
  • Increased injury – musculoskeletal disorders (MSDs) 
  • Increased sensitivity to pain


Sleeping posture is essential to decrease chances of sleep induced MSDs.

  • Maintain neutral neck, back, and shoulder postures as often as possible

Back Sleeping on back

  • The head/neck pillow should fill and support the natural curvature of the neck to ensure neutral posture and spinal alignment 
  • If forehead tilts up the pillow is too high; if chin tilts up the pillow is too low
  • Place a pillow under knees and low back to help maintain natural curvature of the lower back 

Side sleeping on side

  • The head/neck pillow should fill the natural space between the shoulder and neck to ensure neutral posture and spinal alignment 
  • Place a pillow between knees 
  •  Avoid lifting arm overhead or resting head upon arm
  • An additional pillow beneath the top arm may help maintain correct alignment 

Front sleeping on front

  • Not ideal – should be avoided if possible
  • Does not allow proper spinal alignment (increases low back sway) and may lead to neck and back pain
  • Requires excessive neck rotation
  • Place small pillow beneath abdomen to reduce excessive low back arch
  • Place thin pillow beneath head to help reduce neck rotation
  • Avoid resting head on arms


Bigger beds are generally better 

  • To adjust posture
  • To support the limbs
  • When more than one person – less disturbance while altering postures

Height Bed Height

  • Feet should be flat while sitting on edge of bed
  • Higher beds are easier to get out of but harder to get on to
  • Lower beds are easier to get on to but more difficult to get up from
  • Low beds are worse for individuals with hip or back issues



The best mattresses are designed to conform to the spine’s natural curves and keep the body in neutral posture. The following should be considered when selecting a mattress:  

  • Personal – preference, body type, sleep postures, etc.
  • Firm enough to support the body adequately, soft enough to be comfortable 
  • Too firm may create pressure points and too soft may create uneven support — both can cause deviations from neutral postures 

The Right Firmness (Contour to body shape)

  • Excellent body support
  • Natural Spinal alignment
  • Optimal pressure distribution
  • Good blood circulation

Too Firm

  • Distorts your back
  • Pressure concentrated in two areas: shoulders and pelvic area

Too Soft

  • Sagging
  • No proper back support
  • May cause back pain

Proper Firmness Based on Sleeping Posture

Back sleeper

  • While lying on back – slide hand between low back and mattress
  • Hand slides through easily with no gap – mattress has proper firmness
  • Hand slides through with clear gap – mattress is too firm 
  • Hand must be forced through – mattress is too soft 

Side sleeper 

  • If the mattress touches the body all the way from the ribs to the pelvis with similar pressure — firmness is alright
  • If there are gaps or areas of substantially less pressure – mattress is too firm
  • If there are areas with substantially more pressure or one or more body areas are lower — mattress is too soft 

Two sleepers

  • If both are not similar build and weight – firmness is difficult to individualize
  • Compromise or accommodate for only one
  • Some mattresses allow for different firmness ratings on each side – ideal

Mattress Construction and Maintenance

Composition and quality of the mattress is very important

Memory foam mattressmattress firmness/softness

  • Full memory foam mattress (not a topper) will conform to the body as it reacts to both pressure and temperature
  • Returns to its original shape after use
  • Helpful when more than one person on same bed 
  • “Turning” or “rotating” newer models may not be recommended 
  • Lifespan = 5-8 years

Improving Sleep

  • Develop a sleep routine
  • Avoid caffeine & alcohol
  • Avoid using technology in bed
  • Eat well throughout the day: don’t go to bed on an empty or full stomach
  • Be active during the day
  • Reduce fluid intake directly before bed
  • Keep the bedroom dark and noise free
  • Choose the ccorrect bed and mattress
  • Utilize internal clock opposed to alarm clock
  • Utilize relaxation techniques 

Listen to the OHCOW podcast (Oh-Pods) on the Ergonomics of Sleep here.


Prevent Musculoskeletal Disorders (MSD) at Work

Sample screen shots from the PainPoint app

This helpful app delivers a very basic ergonomic assessment by running through a series of diagrams and questions to:

•  pinpoint musculoskeletal pain

•  identify possible sources

 • discover practical solutions

The results are depicted on a body map, with recommendations to address work-related MSD hazards that could be contributing to your discomfort.

While a professional ergonomic assessment is considered the most effective way to address work-related discomfort, this app is a good first step to help you recognize the signs of MSDs and take action for prevention.

…right from your smartphone!

Download PainPoint now using the follow links:


No personal data is collected, but summary results can be shared with others (at your discretion) in order to report hazards or foster solutions.

MSD Prevention and Small Business

Development and Evaluation of Quick Start Guideline for MICRO & Small Business

Developing Procedures for Musculoskeletal Disorders (MSD) Prevention

This presentation will discuss the important elements that should be included in a Musculoskeletal Disorders (MSD) Prevention Program including assigning responsibility, workstation design, manual material handling procedures, procurement of tools and equipment, the training required and evaluation.

MSD Prevention Guideline for Ontario

Developed by the Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD)

Providing Workplace Solutions to Prevent Musculoskeletal Disorders (MSD), because…

Work shouldn't hurt logo

A collage of images that represents the key steps from the website

MSD Quick Start Guide

A simple and useful guide for busy people in small businesses

Roadmap to Success

Overview of the Ontario MSD Prevention Guideline for larger organizations.

Animations & Videos

Introducing MSD, website feature highlights, demonstrations and more…

MSD Resource Filters

Search for Prevention Resources based on your needs.

Centralized MSD Risk Assessment Resources

Not sure what method to use? The Tool Picker will help you find a method best suited to your work.

Employer? Workers? JHSC member?

The stakeholder tab gives quick access to information of use to you!


Learn more about our Ergonomic Tools and Calculators


The following references were used in the creation of these tools:

McAtamney, L., & Corlett, E. N. (1993). RULA: a survey method for the investigation of work-related upper limb disorders. Applied ergonomics, 24(2), 91-99.

Waters, T. R., Putz-Anderson, V., Garg, A., & Fine, L. J. (1993). Revised NIOSH equation for the design and evaluation of manual lifting tasks. Ergonomics, 36(7), 749-776.

Steven Moore, J., & Garg, A. (1995). The strain index: a proposed method to analyze jobs for risk of distal upper extremity disorders. American Industrial Hygiene Association, 56(5), 443-458.

Potvin, J. R. (2012). Predicting maximum acceptable efforts for repetitive tasks an equation based on duty cycle. Human Factors: The Journal of the Human Factors and Ergonomics Society, 54(2), 175-188.

Rohmert, W. (1973). Problems of determination of rest allowances Part 2: Determining rest allowances in different human tasks. Applied Ergonomics, 4(3), 158-162.

Sonne, M., Villalta, D. L., & Andrews, D. M. (2012). Development and evaluation of an office ergonomic risk checklist: ROSA–Rapid office strain assessment. Applied ergonomics, 43(1), 98-108.


Given the new normal of businesses and government striving to maintain services while reinforcing critical physical distancing,
more and more Ontarians are working from home.

OHCOW ergonomists offer tips in the following resources on taking the time to set up a proper workstation
to improve health, safety, and even productivity, which is better for everyone.

Setting Up Your Home Workstation

Home workstations warrant as much care and attention as in an office, particularly if used more than occasionally ( 1 day/week).

View PDF button

Ergonomic Tips for Working From Home in Ontario
During COVID 19

Recent webinar, in partnership with the Workers Health and Safety Centre (WHSC)

Ergonomic Tips for Temporary Home Workstations…3 Months Later

Providing an abundance of information and guidance on fitting your workstation to you, instead of contorting yourself to fit it…or alternatively, roaming around with a laptop.

Virtual Home Office Ergonomic Assessments

Available to anyone in Ontario who is currently working from home, and is concerned about their workstation set-up,
or suffering from a Musculoskeletal Disorder (MSD) (or recent chronic pain). 

The service provides individual assessments performed 1:1 by an OHCOW Ergonomist via email, photos (or video), and telephone (or video conferencing).
It will focus on the use of available resources (eg. office equipment, furniture, household items, etc.) to improve workstation set-up (and use).
Recommendations will be in keeping with the current CSA Z412 Standard: “Office Ergonomics – An application standard for workplace ergonomics.”

Contact the Clinic nearest you to set up a phone or virtual assessment.