actively engaged in pertinent research and diversity of participants, representing a wide range of scientific disciplines, perspectives, beliefs, and approaches.

The workshop took place at the National Academy of Sciences on August 20-21, 1998. Several participants were commissioned to prepare and present papers; others provided written and oral responses to the papers. This report summarizes the papers and workshop discussions. (See Appendices A and B for the list of participants and the agenda.)

In designing the workshop and commissioning papers, the steering committee chose not to focus on specific parts of the body and associated musculoskeletal disorders. Instead, the steering committee sought to examine the many biological, biomechanical, non-biomechanical, and physical and psychological differences among individuals that might play a role in the development of musculoskeletal disorders. The steering committee believed this approach would provide a framework for reviewing the science base in each area, as well as the overlaps among them.

The steering committee organized the workshop around five major topics: (1) biological responses of tissues, specifically muscles, tendons, and nerves, to biomechanical stressors;1 (2) work factors, individual factors, and internal loads—that is, the biomechanics of work stressors; (3) the epidemiology of physical factors; (4) non-biomechanical factors that may affect musculoskeletal disorders; and (5) interventions to prevent or mitigate musculoskeletal disorders. For four of these topics, discussions at the workshop centered on a paper (or papers) commissioned for the workshop, followed by the comments of invited discussants. For the epidemiology of physical factors, the steering committee used a panel format to take advantage of a recent review of this literature (Bernard et al., 1997).

Organizing Framework

The steering committee developed a conceptual framework integrating the factors thought to be related to the occurrence of musculoskeletal disorders. This framework was used to organize the workshop topics and was presented to all participants at the outset of the workshop.

Figure 1 presents that framework. It diagrams the work-related and other factors most frequently involved in the development of musculoskeletal disorders. It is a useful framework for examining the diverse literatures associated with musculoskeletal disorders, each reflecting the roles that work-related biomechanical, psychosocial, organizational, and individual factors can play in the development of musculoskeletal disorders. The framework also suggests the pathways by which musculoskeletal disorders can occur and be avoided.

The central musculoskeletal disorder mechanism appears within the load-response box of Figure 1. It shows the load-response relationship that expresses the biomechanical


Two papers were commissioned for this topic—one focusing on muscles and tendons and the other on nerves.

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