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Preventing musculoskeletal disorders: Are new technologies the answer?

Industrial exoskeleton
For some, exoskeletons are a potential gamechanger in efforts to reduce worker injury and fatigue. Others question if these devices are effective or even ergonomic.

Finding and implementing safe and effective solutions to reduce the burden of musculoskeletal disorders (MSD’s) is a priority for many. Do emerging technologies offer a solution?
These questions and more were top of mind for participants in a recent webinar, hosted by the Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD) in partnership with Toyota Motor Manufacturing Canada.  

Shouldering the burden of MSDs

Workplaces are looking increasingly to technologies such as exoskeletons to manage hard-to-control musculoskeletal disorders (MSD) risk factors. Exoskeletons are wearable, assistive devices, a form of personal protective equipment. They are intended to enhance or support the strength of the user and make it easier to perform difficult work.
MSDs comprise more than 40 per cent of allowed lost-time claims in Ontario. A range of factors can contribute to work-related MSD’s. In auto manufacturing, overhead work is a prevalent and known risk factor and is strongly associated with shoulder injury and pain.
Preventing these kinds of injuries drives the work of Clark Dickerson, Professor, Department of Kinesiology, University of Waterloo, Associate Director, Research, CRE-MSD and head of the Digital Industrial Ergonomics and Shoulder Evaluation Laboratory (DIESEL).
Calling it an “intricate symphony” of structures, Dickerson explained how the shoulder’s high mobility makes it more sensitive to increased and changing demands and loads and also more susceptible to injury. CRE-MSD’s position paper on overhead work, co-authored by Dickerson, calls for overhead work to be eliminated from a job task, when possible. When it can’t, the work must be subject to careful job design and evaluation to reduce the risk of injury — why the interest in exoskeletons.

Industrial exoskeletons. Early lessons.  

Active exoskeletons use motors, hydraulics or other means to power human action, for example to assist individuals with spinal cord injuries. Passive exoskeletons use energy stored in springs to assist human motion and include back, shoulder-and-arm, and leg-assist devices. Passive devices are found in industrial settings including at Toyota Motor Manufacturing Canada (TMMC). Seth Burt, ergonomist and TMMC Health & Safety Specialist explained in the recent CRE-MSD webinar how exoskeletons are among the controls used to address MSDs of the shoulder and upper body in assembly jobs.  
TMMC analyzed various controls which could eliminate or reduce shoulder posture risks. For one assembly line task, the use of robots and robotic arms or the installation of rotating carriers and height adjustable platforms each hold the potential to eliminate these MSD risk factors. With the challenges of technology, implementation time and cost, these controls were not considered viable and exoskeletons became the chosen intervention.  

Burt acknowledges however that exoskeletons are a form of personal protective equipment, whose use can be mandated by the employer, and notes such devices should be considered a last line of defense in controlling hazards.
The company’s exoskeleton pilot testing data offers rich but somewhat mixed findings: injury rates improved initially but have since tapered of; muscle activation in shoulder and large back muscles decreased; there was no evidence of strength conditioning loss; there was greater success in the weld shop where worker movement is less dynamic and the pace of work slower than in assembly work; workers experienced increased discomfort as the rate of production increased; and the straps of the device were ill-fitting.  

TMMC and CRE-MSD are partnering to explore the challenges of dynamic work and ways to improve the exoskeleton process selection tool.

Research evidence is mixed too

While research on exoskeletons has grown in recent years, few studies examine their specific use in workplace environments. Researchers have however identified unintended consequences associated with the use of these devices.  
A recent systematic review examining industrial back support exoskeletons found their use can lessen demands on back muscles and reduce spinal compression, but were also associated with increased abdominal and lower limb muscle activity. In other words, the load and hence musculoskeletal stress may be redistributed to other parts of the body. Other research found the weight and design of the devices reduced user’s balance and mobility, increased chest pressure and the risk of skin abrasions.

With conflicting research findings and little known about the long-term health impacts of exoskeleton use, some are advocating for a more holistic approach to evaluating exoskeletons before expanding their use.  

Like many emerging technologies, there is no uniform international regulation and certification for exoskeletons. While an evolving voluntary consensus standard exists, Toyota North America has developed its own Exoskeleton Usage Standard.

CRE-MSD receives funding through the Ontario Ministry of Labour, Training and Skills Development with support from the University of Waterloo. The Centre led the multi-stakeholder redevelopment of the MSD Prevention Guideline for Ontario and provides valuable guidance and information to workplaces seeking to prevent MDSs which are available at

Training for participation and prevention

Fully-trained joint health and safety committees can identify and help control workplace hazards, including factors which contribute to the development of MSDs. Despite the ongoing COVID-19 crisis safe access to Workers Health & Safety Centre’s (WHSC) essential programs, including mandatory JHSC Certification training has never stopped. This we achieved with WHSC virtual classroom training offering live, real-time learning. Participants and instructors engage remotely from their homes or workplaces, thus providing the benefits of traditional in-person training while also assuring safety.
Fortunately, most workplace hazards that give rise to MSDs can be identified and eliminated. With this in mind, WHSC offers supporting information resources and a range of ergonomics training programs, some available in our virtual classrooms, designed to prepare workplace representatives for MSD prevention work. Many WHSC information and training resources benefit from excellent tools developed by the Occupational Health Clinics for Ontario Workers (OHCOW). Many of these tools are available on the OHCOW website.
Beyond scheduled classes we can work with you, where participant numbers warrant, to coordinate almost any of our training courses, including ergonomics training, in a virtual classroom.

Other related resources:
European Agency for Safety and Health at Work: The impact of using exoskeletons on occupational safety and health
INRS Guide to Using Exoskeletons at Work
NIOSH Science Blog: Industrial Exoskeletons
Call: 1-888-896-7950
or contact a WHSC training services representative near you.
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