What is a musculoskeletal disorder, or MSD? You may also have heard them called soft-tissue injuries, musculoskeletal injuries (MSI’s) and repetitive motion injuries (RMI’s). Is there a difference?

For all intents and purposes, no. At Vivecorp, we like to use the terminology musculoskeletal disorder or MSD, a disorder affecting the body’s movement or musculoskeletal system. This more fully encompasses the entire range of disorders and their causes.



A musculoskeletal disorder is an injury of tendons, ligaments or muscles, nerves, discs and blood vessels. They include, but are not limited to the following:

  • Carpal tunnel syndrome
  • Tendinitis
  • Rotator cuff injuries (affects the shoulder)
  • Epicondylitis (affects the elbow)
  • Trigger finger
  • Muscle strains and low back injuries

MSD causes can be put into two basic categories:

Acute: Acute injuries are caused by a sudden trauma, like a twist, fall or blow to the body.

Overuse: Overuse injuries occur over time. They are often caused by repetitive movements repeated so often the body doesn’t have time to recover or heal. Other causes include static postures or poor movement patterns. Overuse injuries include tendonitis and bursitis and are the type of soft tissue injury more easily prevented through specific workplace interventions like the Industrial Athlete Training Program.



Work-related MSDs are among the most frequently reported causes of lost or restricted work time. According to the Bureau of Labor Statistics (BLS) in 2013, MSD1 cases accounted for 33% of all worker injury and illness cases.

Direct Costs

Just one MSD carries with it huge costs. The cost of a back injury, one of the most common injuries, can range between $40,000 and $80,000. According to the World Health Organization:


“The lifetime prevalence of non-specific (common) back pain is estimated at 60% to 70% in industrialized countries.”


It gets worse.

Startling Statistics

  • OSHA estimates work-related musculoskeletal disorders in the United States account for over 600,000 injuries and illnesses.
  • MSD’s account for 34 percent of all lost workdays reported to the Bureau of Labor Statistics (BLS) and one out of every three dollars spent on workers' compensation.
  • It is estimated employers spend as much as $20 billion a year on direct costs for MSD-related workers' compensation, and up to five times that much for indirect costs, such as those associated with hiring and training replacement workers.

Injury Prevention Stat (1)


Indirect Costs

While calculating direct costs of MSD’s is fairly straightforward, indirect costs are harder to pin down but often much more damaging. Indirect costs do more long-term, insidious damage to a company's workforce.

MSDs also often impose a substantial personal toll on affected workers who can no longer work or perform simple personal tasks like buttoning their clothes or brushing their hair.

Here are a few examples of indirect costs from a musculoskeletal disorder.

  • Days Away From Work: Employers pay $15-20 billion per year in Worker's Compensation costs for lost workdays.
  • Productivity Loss: For every 10% increase in on-the-job limitations, total employee work productivity declined 4 to 5%.
  • Rehire Costs: the median cost of employee turnover to an employer was about 21% of an employee’s annual salary. The cost of replacing an employee with salaries between $75,000 and $50,000 a year rises to around 22% of the annual salary.


READ MORE: Not Having an Injury Prevention Program is Costing You Money


It’s clear injuries are expensive, both directly and indirectly. But committing to and paying for a customized injury prevention program goes beyond the costs. A thoughtful musculoskeletal injury prevention program shows employees the company cares about their wellbeing. Not only is the company willing to spend money on the health and safety of its employees, it’s also willing to spend precious time to incorporate the program into its day-to-day functions. Employees notice this investment. The increase in engagement, productivity and staff retention more than pays for itself.



The good news is the majority of MSD’s can be prevented. MSD’s happen when a job function does not fit with how the human body functions. Repetitive motions, static posture, excessive reaching, twisting, bending and lifting can all take a toll on the body.

OSHA transition_pyramid                                                               (Source:

Engineering Controls

Ideally, first you want to out-engineer any working condition that could lead to an MSD. This would be called an engineering control. These controls are methods built into the design, equipment or process to minimize hazards.

Engineering controls are often costly or not possible within the constraints of the location or process.

Administrative Controls

When an engineering control is not possible, an administrative control is advised. These types of controls establish efficient processes or procedures. Ergonomics, an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely, is often used to modify existing job functions or tools to decrease hazards.


READ MORE: Learn How One Safety Manager Champions Ergonomics


And finally we have PPE, or personal protective equipment. This is the last line of defense when mitigating hazards that could lead to an MSD. PPE might include bump caps or hard hats, reflective gear, eye and ear protection and gloves.

Let’s say all of those controls have been applied. That leaves us with the human body. There’s one more control to help prevent MSD’s. Exercise interventions.

Exercise Interventions

An exercise intervention for MSD prevention would fall in between administrative controls and PPE.

They are programs that administer, educate and support frequent healthy movement, often customized to the workload and/or job function.

Exercise interventions like workplace stretching include pre-shift warmups (stretch and flex), post-break warmups and micro break stretches. Exercise interventions should be used as a tool in the injury prevention toolbox and should not be used as a substitute for a comprehensive worksite ergonomics program using the controls mentioned above.

But do these stretching programs even work?

While there is plenty of research showing workplace stretching improves flexibility, mobility, and range of motion, it’s hard to quantify the direct correlation between exercise intervention programs and a decrease in MSD’s.

However, the impacts of a stretching program can go beyond the physical. Author Donald Graham, M.S., WSO-CSE, noted as much in an article entitled "Workplace Stretching Programs: Do They Work and Are They Worth The Cost?":


"There also may be a psychological benefit at work in a stretching program. Company managers and workers together in space doing a common activity can create bonding and increase workplace morale. This semi-social grouping or bonding in the workplace creates the perception of caring and support felt by employees from management."


Although anecdotal, perception matters. Just moving at the start of the day can increase an employee’s awareness around how their body feels, leading to improved movement patterns.

If your employees perceive exercises as making them feel better and showing them the company cares about their health and wellbeing, it might be well worth the time to implement a stretching program.


musculoskeletal injury prevention download



Don’t get stretching programs confused with “Fit for Duty”. Fit for Duty is a pre-work conditioning program meant to prepare employees to work in highly physical jobs. It’s usually completed 4-6 weeks prior to employment.

Fit for Duty programs are also comprised of a range of physical tests used to determine an employee’s readiness or ability to do the job along with what interventions are needed to properly condition the employee for work.

Unlike Fit for Duty programs, workplace stretching programs like pre-shift exercises are performed daily, usually at the beginning of every shift. Where Fit for Duty is more of a work-readiness program, a pre-shift warm-up is just that, a warm-up. Warm-ups increase the body’s temperature and help move joints through a full range of motion, preparing the body for the physical activity ahead.


READ MORE: Injury Prevention Programs Beyond Fit for Duty 


ppex graphic




Pre-Shift Warm-ups

Workplace stretching programs with pre-shifts warm-ups are not a new concept. Athletes have been warming up in some form or fashion for decades, although the type of warm-up has changed as we continue to learn more about human movement and how to best prepare the body for physical activity.

Pre-shift warm-ups generally consist of 5-10 exercises or stretches focusing on multiple body parts. Traditional stretching programs used static stretching, or taking a joint to its end range and holding for :30 - :60 seconds. Recent research has shown this type of stretching, while beneficial in certain circumstances, can actually decrease power output and is more suited to a post-exercise flexibility and mobility routine.

Dynamic stretching, on the other hand, takes a joint through its full range of motion. It helps increase joint fluid, overall circulation, improves performance and enhances muscular performance and power.


READ MORE: Improve Your Stretch and Flex Program With This One Simple Change


Keep it Fresh

Just like any fitness program, consistent change must be made in order to see improvements. A pre-shift stretching program is no different. There are several reasons warm-ups must occasionally change in order to retain their effectiveness. The first is to keep engagement high. The same warm-up completed over a long period of time will become routine for employees. They’ll begin to “go through the motions”, decreasing warm-up effectiveness.

A progressive warm-up that builds on the last one can also be effective in improving range of motion, balance and muscular endurance.

Post-Break Warm-ups

Warm-ups should not be limited to pre-shift. Post-break warm-ups are also a valuable tool in an injury prevention toolbox. Employees who work 10-12 hour shifts with a 30-minute break should be performing a post-break warmup.

Coming to a complete stop for 30 minutes and then jumping back into physical work leaves employees susceptible to injury. A short, 3-4 exercise post-break warm up helps prepare workers both physically and mentally for the last half of their shift.

Micro break Stretching


"Muscles need a break - not only from strenuous work, but also from continuous, low-level activity."


Micro break stretching and exercises are an underutilized, but highly effective tool in the fight against musculoskeletal disorders.

Muscles need a break - not only from strenuous work, but also from continuous, low-level activity. Without breaks, muscles will begin to break down creating imbalances and overcompensation of other muscles, increasing the possibility of injury.

Multiple studies across a variety of occupations show taking short breaks (micro breaks) multiple times throughout the day improves physical performance and focus and decreases the occurrence of soft-tissue injuries.

Micro breaks are short—30 seconds to one minute—and help alleviate static positions or repetitive motions.

The key to microbreaks is taking them before pain and fatigue set in. If possible, employees should be encouraged to schedule microbreaks on the hour. They can stand if they’ve been sitting, walk around if standing in place, or reverse the motion if the job function has repetitive tasks.

Even if micro breaks can’t be scheduled because of the variable nature of the work, help employees determine areas of the day or within their workflow that have natural pauses. Use those pauses to perform the activities mentioned above. Even taking a few micro breaks throughout the day will help.



Deciding to implement an exercise intervention like a stretching program is only the beginning. The hard work is just beginning.

Depending on the median age of your population and how long employees have worked for your company, you might be met with resistance. Luckily, pre-shift stretching programs are much more commonplace than even five years ago, so chances are most of your employees are familiar with the concept or have worked for a company with a similar program.

Communicate Early and Often

Begin the process of building program buy-in and excitement two to three months before implementing the program. Have your vendor participate in a company health and wellness fair to introduce your employees to any staff who might be involved with program coordination. This allows employees to ask questions, get to know their coordinator and maybe even experience a warm-up. Consider handing out program-related swag to increase awareness.

Talk to employees during shift start-ups and town hall meetings. Better yet, go on the floor or in the field and talk one on one with employees. Explain the program and its benefits. Make it clear leadership will participate. This isn’t a time to say “I’ll be watching you.” It’s a time to say “I’ll be joining you!”

No Silos

Engage members of your safety, benefits and employee engagement teams to ensure everyone understands the program’s purpose and goals and how each of these departments will work together to ensure its success.

Too often, companies have their injury prevention programs in one department, say Benefits, without using the expertise and point of view of another equally invested department like Safety. Both departments have similar goals - or should. All departments should want a reduction in claims costs, a decrease in absentee and presenteeism and a decrease in injuries leading to healthier, happier and more productive employees.

“Marketing” Your Stretching Program


"Don’t make the mistake of relying on one form of communication, like emails. You’ll need to hit multiple avenues of communication on multiple occasions to reach everyone."


Think about how you might brand your stretching program. This helps employees to instantly recognize program components and creates message continuity. You will use this brand to create a communication strategy.

This strategy might include a visual message using posters or flyers, or emails, presentations, etc. Use the same look, feel and tone throughout.

Don’t make the mistake of relying on one form of communication, like emails. You’ll need to hit multiple avenues of communication on multiple occasions to reach everyone. Think about your messaging from a monthly and quarterly perspective. Consistent communications tells employees this isn’t a short-term program, but leaders are fully invested in seeing it succeed.

Kick off the program with a fun, all-company event. Have leaders speak about program goals and expectations and then take everyone through the warm-up. Save time for questions or allow your program coordinator to talk to small groups. Branded program swag can be used as giveaways during the event.

Now that you’ve launched the program, how do you keep participation and engagement high for the long haul?



Leadership buy-in can mean many things. It can mean leaders sign off on the purchase of an injury prevention program like pre-shift stretching but are not involved in the day-to-day. We like to call this “checking the box”. It means a leader outwardly supports the program by providing financial support but isn’t interested in the hard work of supporting the program on a daily basis.

True leadership buy in is an involved and engaged leadership team. It means regular interaction with employees around the program. The following are a few ways leaders can show ongoing support for your injury prevention programs:

  • Lead weekly leadership meetings in warm-ups.
  • Participate in stretches with your employees. Get out on the floor or in the field. Do it often enough so employees know you might be stopping by at any time.
  • Provide regular positive feedback to supervisors and employees who are enthusiastic leaders of the warm-ups.
  • Promote the program in town-hall, all-plant or company-wide meetings. Better yet, lead these meetings with a warm-up.





In many companies, it is the supervisor who leads the team in shift safety start-up meetings. It’s up to the supervisor to initiate the stretching. It’s also up to the supervisor to make sure employees are doing the exercises to the best of their abilities, and aren’t doing anything unsafely.

While it’s always ideal to have several program champions across a variety of departments and shifts, it’s the supervisor who employees look to. Even the best employee program champion will not overcome an unengaged supervisor.

Often times a lack of supervisor engagement could mean a lack of education around the stretching program. Provide supervisors with information on the following:

  • How MSD’s affect the company - both directly and indirectly.
  • What the company goals are around the stretching program and how supervisors can help leadership to meet those goals.
  • Why the exercises were chosen and how they will benefit employees.
  • What’s “in it for them.” How they will benefit from being engaged program leaders.



Like any good safety initiative, it’s important to let employees know the reason behind the initiative along with expected outcomes and how they can play their part. Your company’s culture will also dictate how you present an injury prevention program like pre-shift exercise. We recommend the following ways:

  • Athlete comparison: Just like professional athletes warm-up prior to practice or competition, so should employees whose jobs are physical in nature.
  • PPE comparison: Required PPE like eye and ear protection, steel-toed shoes, safety vests and bump caps or hard hats protect employees on the outside. Pre-shift exercises protect employees on the inside. We like to call them “Personal Protective Exercise” or PPEx.
  • Machine maintenance comparison: The machines at your site require regular care and maintenance. Think of your body like a machine. It also requires regular care and maintenance.



While most workplace stretching programs are designed for the industrial environment, office workers are not immune to musculoskeletal disorders. The prevalence of MSD’s continues to rise, with back and neck disorders among the most common.

The challenge with providing office staff a workplace stretching program like pre-shift exercise is variable start times. Most office staff don’t have a daily safety stand-up meeting comparable to what many warehouse and off-site workers experience.

Computer programs with pop-up reminders might seem like the answer, but those have limitations as well. Most pop-up reminders are easily ignored, especially if there is no encouragement or accountability from supervisors or upper management.

Staff might also feel embarrassed to perform stretching at their desk, especially in a cubicle environment. However, office workers can perform plenty of subtle yet beneficial stretches and exercises without raising their neighbor’s eyebrows.

Office Staff Engagement Ideas

Use weekly staff meetings to reinforce the program by rotating staff who leads the group in stretches. Spend a moment to talk about work station setup and make sure everyone understands any ergonomics processes your company has in place like personalized workstation reviews, sit/stand desks, etc.

Managers should be champions of the program, discussing expectations in one on one meetings and review sessions. It’s important to note these discussions will only carry weight if the manager also takes part in any injury prevention, ergonomics or stretching program, actively modeling any behaviors she wants to see in her team.



While it might be tempting to let the same people lead the stretches every day, one of the best ways to get everyone involved is to rotate who leads the warm-up. Some sites even create a calendar and let each stretching lead pick out the music.


"Make it clear the pre-shift warm-up is a judgement-free zone."


To make this work, leaders must set the tone. Make it clear the pre-shift warm-up is a judgement-free zone. Everyone will perform the warm-ups a bit differently based on their own abilities. That’s ok. There is no “perfect”. Consistent messaging around performing the exercises to the best of each employees ability will ensure employees don’t overdo it but it also encourages employees of all fitness levels or coordination.



With the staggering direct and indirect costs of MSD’s, you can’t afford not to have an injury prevention program like pre-shift stretching. Like any company initiative, be prepared to nurture the program to ensure its long-term success.


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