Managing musculoskeletal disorders — Bulgaria

  • Observatory: EurWORK
  • Topic:
  • Published on: 07 October 2007

Rumiana Gladicheva, PhD and Emilia Chengelova, PhD

Disclaimer: This information is made available as a service to the public but has not been edited or approved by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.

This is the Bulgarian contribution to the report on work-related musculoskeletal diseases .


The Community strategy on health and safety at work (2002 – 06) calls for working towards a healthier occupational environment. It sets three prerequisites for a high quality working environment:

  • a global approach to wellbeing at work taking into account of changes in the nature of work and the emergence of new risks;

  • consolidating a culture of risk prevention by combining a variety of political instruments and building partnership;

  • better application of existing laws, pointing out the costs of non-policy.

There are many definitions of Musculoskeletal disorders (MSDs). The most common are:

  • Repetitive strain injuries (RSIs)

  • Musculoskeletal disorders, or Musculoskeletal diseases (MSDs)

  • Work related Upper Limb Disorders (WRULD)

  • Work related musculoskeletal diseases

  • Cumulative trauma disorders (CTDs)

  • Over Use Disorders (OUD)

Some of them restrict the domain of observation to some part of the body (for instance WRULD) or to the causes of such diseases (RSI, CTD). Both “disorders” and “diseases” are used. This depends on the historical insurgence of such diseases: some of them stress “repetition” (RSI), others (CTD, OUD) the fact that “work demands habitually exceed a worker’s capacity to respond to these demands” (Putz-Anderson, 1988).

The 2002 Scoreboard on implementing the Social Policy Agenda draws the attention to new types of risks emerging giving rise to new health problems involving musculoskeletal disorders.

The 2002 Council resolution includes in its goals the prevention of work-related diseases, especially those most widespread amongst European workers, such as those related to exposure to toxic substances, the hearing loss and MSDs, taking into account changes in working population according to gender, aging, demographic dynamics, disabled worker conditions, ethnic and cultural diversities, and transformations in labour regimes, working times and work organization

Figures available show that Musculoskeletal disorders (MSDs) are the main occupational disease suffered by European workers. The LFS 1999 additional module by Eurostat shows that MDSs are more than 50% of serious work-related diseases, with a prevalence rate over 2,5%, i.e. more than 4 millions of employees. Some industries show higher prevalence rates: Health and social work (over 4%), construction, transport and communication (over 3%).

According to the 3rd EWCS, one worker over 3 (32,2%) alleges backache, 22.8% of workers allege muscular shoulders and neck pain, 12.9% muscular upper limb pain, 11.5% muscular lower limb pain. Gender differences are not very significant, although job characteristics differ significantly. They show an increase over the 90s. However, a number of epidemiological studies have found that women are at higher risk for WR-ULDs, although workplace risk factors are generally found stronger than gender effects.

Such upwards trends show that MSDs are no more “traditional” ones, linked mainly to some manual tasks (repetitive movements, carrying heavy loads, vibrations) but are increasingly widespread in services sectors (care, hotels and restaurants) and amongst working with PCs and ICT devices.

Cost of MSDs have been estimated by some countries. There are direct costs (absence days, rehabilitation) and indirect costs (production losses, quality losses, mistakes and errors, gap in productivity of the substitute, etc.). Netherlands estimates are 1.7% of GNP, both direct and indirect, while UK estimates of direct costs are around .8% of GNP in 1995-1996. In Finland, socio-economic costs of MSDs were estimated as 1% of GNP and in Germany as .61% of GNP (European Agency for Safety and Health at Work, 2000, first-phase consultation paper ).

1. MSDs and working conditions

Work-related MSDs were usually associated to repetitive tasks or to those implying carrying of heavy loads, vibrations, inadequate postures such as in construction, transport, agriculture sectors and, more recently, by caregivers. According to ergonomists, they are “multifactorial in nature. In work environment, these are problems attributable to repetitive work under strict spatio-temporal constraints” (Bourgeois, 2000). The expert forecast on emerging physical risks related to occupational health and safety strongly agree on the lack of physical activity and on the combined effect of exposure to MSDs risk factors and psychosocial risk factors (such as job insecurity and fear of the future), thus enlarging the target of such diseases.

MSDs affect all parts of the body allowing the individual to move and work, with strong interrelations between nervous and muscular systems: back, neck, shoulders, upper and lower limbs. They result from an accumulation of mechanic constraints, repetitive movements, short production cycle, heavy lifting, poorly designed work stations..., PC...

Epidemiological studies show that “work densification” due to time pressure and imperative deadlines, following the introduction of just-in-time methodologies, increased the influence of organizational factors over MSDs: “even more than risk factors, work organization “determines” the characteristics of work situations and may potentiate pathogenic effects” (Douillet, Schweitzer, 2002).

Brenner, Fairis and Ruser (2004) show similar findings in USA: cumulative trauma disorders increased impressively along 80s and early 90s. “Despite the importance of this trend in CTDs and the link posited with workplace transformation, surprisingly little research has been undertaken to explore this relationship”.

According to the ACSHH opinion adopted in May 2001, the risk of MSDs are to be taken into account especially when changes are made to the work organisation requires comprehensive information and awareness-raising policies.

Unlike the so-called “traditional” risk, MSDs arise as the result of a “singular combination of multiple personal and collective, material and psychological factors bound up with the practical way work is organised” (Douillet, Schweitzer, 2002). Amongst the latter, there is increasing evidence that stress and MSDs have significant interplays (see for instance HSE report in the oil industry) with causal direction in both senses.

Buckle and Woods (2002) summarise workplace factors affecting MSDs occurrence in 5 areas:

  • social support received by colleagues, supervisors or management, tends to reduce their occurrence because of their impact on mental and physical health and stress;

  • access to health information, have a similar impact because of its role in implementing improvement strategies;

  • job insecurity, temporary and piecework: less skilled manual workers at the lower end of labour market are affected the most, including part-time workers, with poor job-specific experience and/or confinement to worst jobs;

  • low status work, i.e. low paid, unskilled, paced and repetitive work, where no training is required and poor control on the job, show higher occurrence rates;

  • income show a negative relation with MSDs occurrence because of its impact on living conditions, esp. housing, education, clothing and fuel.

They can be modified by organizational and ergonomic interventions, while individual factors do not. Amongst the latter, education, age, gender, ethnicity are seen as significant. The Foundation papers discussed below (see section 4.) explore in depth their impact.

From this brief discussion, three structural changes can explain the resurgence of MSDs: a) changes in organizations, increasing time-based competition with lean supervision staff and without an increase in work autonomy, b) changes in work status and labour regimes, with higher weight of non-standard workers, c) changes in the workforce composition according to gender, age, and ethnicity, having different social habits with respect the traditional male breadwinner reference model. a) and b) affect the quality of work by itself, while c) affects the reference workforce on which jobs are designed and therefore the perceived quality of work.

2. The normative frame: the EU level

The Health and Safety at work Framework Council Directive 89/391 directive, introduces general prevention principles applicable to all occupational risks, aimed to ensure a higher degree of protection of workers at work through the implementation of preventive measures to guard against accidents at work and occupational diseases, and through the information, consultation, balanced participation and training of workers and their representatives. Article 6.2d states that the employer should take measures necessary for “adapting the work to the individual, especially as regards the design of work places, the choice of work equipment and the choice of working and production method, with the view, in particular, to alleviating monotonous work an work at a predetermined work-rate and to reducing their effect to health”

Other individual health and safety directives address risk factors for MSDs:

  • the Council Directive 89/665/EEC, as amended by the Council Directive 95/63/EC on minimum safety and health requirements for the use of work equipments by workers at work. Article 5a, under the heading “Ergonomics and occupational health”, states “the working posture and position of workers while using work equipment and ergonomic principles must be taken fully into account by the employer when applying minimum health and safety requirements”

  • the Council Directive 89/656/EEC on minimum safety and heath requirements for the use of personal protective equipments (PPE) by workers states at article 4 that all personal protective equipment must “correspond to existing conditions at the workplace” and they must “take account of ergonomic requirements and the worker's state of health”

  • the Council Directive 89/686/EEC on the approximation of implementation of the PPE directive in National States legislation, states that “any impediment caused by PPE to movements to be made, postures to be adopted and sensory perception must be minimized; nor must PPE cause movements which endanger the user or other persons” (Article Annex II)

  • the Council Directive 90/269/EEC on the minimum safety and health requirements for the manual handling of loads where there is a risk particularly of back injury to workers, states that the “employer should take appropriate organizational measures, or shall use the appropriate means, in particular mechanical equipments, in order to avoid the need for the manual handling of loads by workers”. (article 3.1)

  • the Council Directive 90/270/EEC on the minimum safety and health requirements for work with display screen equipments states that “employers shall take appropriate measures to remedy the risks found, on the basis of the evaluation (…….) taking account of the additional and/or combined effects of the risks so found” (article 3.2) , with specific references to risks to eyesights, physical problems and problems of mental stress.

  • Specific provisions are provided by the Council Directive 92/57/EEC on the minimum safety and health requirements for work in temporary and mobile construction sites, which constitute an area of activity that exposes workers to particularly high levels of risk, with specific reference to the conditions under which various materials are handled (article 8.c);

  • The Council Directive 98/37/EC on the approximation of the laws of the Member States relating to machinery, states that “Under the intended conditions of use, the discomfort, fatigue and psychological stress faced by the operator must be reduced to the minimum possible taking ergonomic principles into account” (article, Annex II)

  • The annex of the Council Directive 2001/45/EU concerning the use of work equipment provided for temporary work at a height on work at height, states that “if (it) cannot be carried out safely and under appropriate ergonomic conditions from a suitable surface, the work equipment most suitable to ensure and maintain safe working conditions must be selected” (article 4.1.1, Annex)

  • The Council Directive 2002/44/EC on the minimum safety and health requirements regarding the exposure of workers to the risks arising from physical agents, such as vibrations, states “it is considered necessary to introduce measures protecting workers from the risks arising from vibrations owing to their effects on the health and safety of workers, in particular muscular/bone structure, neurological and vascular disorders” (point 3).

  • The Council Directive 93/104/EC concerning certain aspects of the organization on working time, in stating the minimum standards for weekly working time, rests, breaks and annual leaves, relies on “the general principle of adapting work to the worker, with a view, in particular, to alleviating monotonous work and work at a predetermined work-rate, depending on the type of activity, and of safety and health requirements”, (article 15) including therefore MSDs.

Impact of the MSD reports by the EU-OSHA on work-related neck and upper limb disorders and on work-related low back disorders concluded that the existing knowledge could be used in the development of practical, preventive strategies and that there is limited but convincing evidence of the effectiveness of work system interventions that have incorporated ergonomics. However, after the 2000 European Week for the Safety and Health at Work devoted to MSDs, only the reports based on the 3rd EWCS provided further comparative evidence.

A first-phase consultation process of the social partners on musculoskeletal disorders at work is acting to come eventually to an agreement A preliminary step in this direction is the agreement in agriculture signed by GEOPA-COPA (Committee of Professional Agricultural Organisations in the European Union, the employers’ association in agriculture) and EFFAT (European Federation of Food, Agriculture Tourism trade unions), the 21th November 2005.

3. Some secondary analyses of the 3.rd European Working Conditions Survey

The report “Work organisation and health at work in the European Union” show that the share of employed women affected by occupational diseases sharply fall after 30 years of service, while men do so only for stress. This means that women more likely drop out the labour market. Authors draw up four typologies of worker: “autonomous”, mainly associated with clerical tasks, “flexible” especially for work schedules, mainly associated with hotel&catering and health services, “constrained”, mainly associated with services and hotel& catering again, and “automated” workers, associated with repetitiveness and lack of autonomy, mainly concentrated in manufacturing industries. MSDs are concentrated amongst workers performing heavy tasks, typically in construction, agriculture, and those performing repetitive tasks, typically manufacturing. They are significant also between “autonomous” workers, with figures not so far from more physically demanding jobs: more than one woman over four report suffering backache, more than 20% MSDs at neck and shoulders. Similar figures are shown by men, although their tasks in physically demanding jobs require more heavy tasks, while women perform more repetitive jobs.

According to the report Time and work: work intensity, work intensity is on the increase in Europe: from 1995 to 2000, employees experienced an intensification of their jobs and that increase time pressures at work affect workers’ state of health. In the majority of cases, “there is a positive link between the physical problems recorded and the work intensity factors”. This link is significant for most or all MSDs listed in the case of automatic constraints, dependence on colleagues activities, direct supervision by the boss and presence of customer for at least ¾ of working time, while commercial constraints do not show such relations.

The report Employment status and working conditions shows that non-permanent and self employed workers are significantly more exposed to unfavourable ergonomic conditions, which can give rise to “classical” MSDs, while part-time workers do not display significant differences. Their impact over health is discussed by the report Type of employment and health in the European Union: backache are more likely among self employed, while muscular pains are more likely among self-employed and full-time fix term employee with respect to full-time permanent workers. Extreme temperatures, repetitive movements and vapours are the unfavourable working conditions which increase the most the occurrence of both backache and muscular pain. Absence of social support is weakly significant for the former and not significant for the latter, while both job control and job demand have a strong impact on both diseases above mentioned.

According to the report “Gender, jobs and working conditions in the European Union” gender differences in ergonomic working conditions “are largely a result of men’s greater involvement blue-collars (manual) jobs” and these differences are negligible in professional jobs: men report more frequently “carrying heavy loads” and hazardous ergonomic conditions, while women report more frequently “monotonous work”. However women report slightly higher muscle-related problems.

The Foundation report “Quality of work and employment in Europe. Issues and challenges” summarizes these results ad follows: “organizational change do not always meet expectation” and “the development of “new” forms of work organization … is not necessarily resulting in improved working conditions….. lean organizations are often associated with more intensive working. This in turn leads to higher stress and MSDs, and accident rates”(p. 16). Finally, gender differences could be explained by the double workload and other psychosocial factors attaining working conditions and job status.

4. The questionnaire

1. Definitions

The various terms listed above in describing MSDs all put the accent on repetitive and cumulative motions.

The Eurostat description of EODS methodology provides some useful comparative insight about disease statistics and the general functioning of national work-insurance systems, e.g. who compensate occupational diseases, in particular MSDs included and at what degree of seriousness are listed: only some of the MSDs are recognized as such by National Insurance Agencies (NIAs) and other agencies entitled by government and/or social partners in playing such a role. There are two main obstacles to their recognition: certain activities outside work expose people to similar risks, especially women (see question 3 below); and the nature of the contract does not help to point to the occupational origin of the disease.

Note of the National correspondent:

By this symbol (►) questions and answers will be separated.

1. Please, report the official definition of WR-MSDs, if any, or the most widespread one. Please specify whether it includes backaches.

There is no official definition of WR-MSDs. The most widespread one is: 'musculoskeletal diseases (MSDs) include impairment/injuries of muscles, bones, joints, ligaments and bursas, caused by occupational factors, such as static work, heavy loads, monotonous work, and vibration'. It includes backaches. This definition is given by an expert opinion group of the University Clinic of Occupational Diseases and the national consultant to the Ministry of Healthcare on the problems of Occupational Diseases.

2. Please check whether criteria illustrated in the above EODS paper have been updated in the meantime. Are recognition criteria by NIAs taking into account gender differences? Have there been any changes in last years both in general and with respect to gender issues in particular?

The mentioned criteria have not been updated. Gender differences are not taken into account in the recognition criteria. No changes in last years.

2. Reporting

Reporting is another key preliminary issue. Two orders of problems can be identified.

Clinical reporting, statistical sources (mainly based on self-reporting), working conditions surveys and administrative sources from NIAs and Health Systems tend to differ. The latter heavily depend on the institutional definitions (both legal and administrative settings) both about their causes and their nature. Figures are often collected and classified according non-homogeneous criteria, and at different analytical level in terms of part of the body affected and causes. For instance, the LFS 1999 additional module reported MSDs in an aggregated way (Q217), while the 2007 LFS ad hoc module questionnaire distinguish (Q215/216) MSDs according three regions affected: neck, shoulder, arms and hands (WR-ULD); hips, legs, feet; back.

According to Eurostat, this make difficulties to collect comprehensive European level data on recognized MSDs. Also in the EU-15, it is not granted that the European standards (EODS in our case) are employed. This causes a further problem of comparability.

Working conditions survey are probably the least dependent on institutional (legal) framework, but cultural/social habits could affect reporting work related MSDs. However, an UK study shows significant consistencies amongst self-reported and clinical results (see the Foundation report “Quality of work and employment in Europe. Issues and challenges”.)

This very short overview, far from being complete, outlines some of the main questions related to reporting.

2.1. Please list the main sources of information about WR-MSDs (NIAs and other insurance agencies empowered by government and/or social partners, WCS, public health, statistical bureaux). Please describe the way WR-MSDs are categorized by public authorities and NIAs according to the part of the body affected (upper/lower limb, bone, joint or muscle problem, hips, legs, feet, knees, back, neck, shoulders, arms, etc. ...), causes (repetitive work, vibrations, heavy loads, postures, PCs, etc…..) and occupational and demographic characteristics (labour contracts, occupation, age, gender).

National Centre of Health Information 2) National Centre of Public Health Protection;

3) National Statistical Institute;

4) National Social Security Institute;

5) First Candidate countries survey on working conditions, 2001;

6) National working conditions survey, 2005.

The National Centre of Health Information (NCHI) to the Ministry of Healthcare collects information about the hospitalised cases and diseases, and those with permanent disability. The data collected is categorised by:

  • localisation (upper/lower limb, bone, joint or muscle problem, hips, legs, feet, knees, back, neck, shoulders, arms, etc.);

  • causes (repetitive work, vibrations, heavy loads, postures, PCs, etc.);

  • occupational and demographic characteristics (sector, occupation, age, gender, region).

However, the collected data is not processed in such a detailed way in the official reports and publications. It may be processed further by them upon legitimate request only.

The National Centre of Public Health Protection and its National Register of Occupational Diseases collect similar information about the confirmed WR Diseases on annual base but the database is limited as it covers only insured workers and confirmed cases.

The National Statistical Institute and the National Social Security Institute share the data from the abovementioned sources and sometimes may request additional calculations that serve their particular needs.

In fact, there are 2 official sources of raw data - the National Centre of Health Information and the National Centre of Public Health Protection.

On the whole, the relevant information sources probably lack resources for maintaining of a comprehensive and satisfying database. They may also lack efficient co-operation. In a document of the Ministry of Labour and Social Policy ('National strategy for equal opportunities of disabled people', 2001-2005) is written that 'it can't be claimed that the existing statistics is real and concrete in regard to disabled people and related characteristics'.

3. 2.2. Please describe the number, type and variety of questions advanced in MSDs. Please report the exact formulation of questions advanced in working conditions surveys. What is the evolution over time of question formulation?

There is only one multi-facet question dealing with WR health outcomes including MSDs (Q31 in 2001 and in A45 2005). The question wording in both cases is: 'Does your job affect your health? (Yes/No)'. If yes, many different ways health is affected are listed to choose from. The scales are also identical in both surveys. The relevant answers are:

  • yes, backache;

  • yes, muscular pain in shoulders and neck;

  • yes, muscular pain in upper limbs;

  • yes, muscular pain in lower limbs.

2.3. Is there any research of analyses of causes available?

► No.

3. Trends of MSDs and their social impact

MSDs complaints show a growth across the editions of the EWCS, supporting the argument of “work densification” and that actual prevention instruments are not fully adequate in order to cope with them. As discussed above, organizational changes, which reflect both changes in competition and HRM practices (see for all Oesterman, 2000), play a key role in such a trend. Such trends can differ significantly across sectors, occupations, firm size and gender.

The increasing participation of women to labour market make the need of engendered prevention policies for the following reasons:

a. According to Pèze (2002), “women are massively hit by MSD not only because of their morphology and hormonal factors, but because work organisation keep them out massively from conception and decision-making”: therefore, workplace design is based on the prevailing occupational group, i.e. men;

b. horizontal and vertical segregation literature show that some industries are significantly engendered (for all Hakim, 1992)

c. women still cope with more domestic tasks than men, facing thus larger risk exposure outside work.

The report “Work organisation and health at work in the European Union” investigates the relationship between health according three broad classes of organizational factors, an engendered approach from the 3rd EWCS:

  • temporal framework, according to the two sub-dimensions of internal flexibility (shifts, long hours, night work, sundays working, no fixed times) and industrial type of the pace of work (depending on the automatic speed of the machine, depending on quantitative standards)

  • scope of manoevre, according to the two sub-dimensions of autonomy (no possibility to choose or modify the pace of work; no possibility to choose or modify the methods of work, no possibility to choose or modify the sequence of tasks, not allowed to take a break) and of control (respect of precise quality standards, personal evaluation of the quality of their work);

social relationships, according to the three sub-dimensions of the commercial constraints (the pace depends on the current demands from customers etc.) discussions (no possibility of discussing work organization when changes occur, no possibility of discussing your working conditions in general) and continuing training.3.1 Please report figures on absence days caused by MSDs (from NIAs and other Agencies, or WCS where the former are not available) according to parts of the body affected and causal agent, and their trends over last 10 years, disaggregated by labour contracts, occupation, age, if it were possible in a engendered way, accordingly to the sources available described in Q2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communication.

MSDs are quite common in Bulgaria as only Respiratory diseases supply more frequent cases per 100 insured persons. By frequency of absence days per 100 insured persons MSDs rank 3rd after Respiratory diseases and Poisoning, accidents/traumas and violence.

Note: indicators are calculated for a sample (24%) of insured by the employer persons

Table 1: Absence days due to temporary disability caused by MSDs in 2004
  Total Men Women
Frequency of cases per 100 insured persons 9.4 9.8 9.0
Frequency of lost days per 100 insured persons 124.1 129.9 121.2
Average length per 1 case (days) 13.2 13.0 13.5

Source: National Centre of Health Information (NCHI), 2005

Table 2: Disabled persons and loss of capacity due to MSDs
Level of disability ► Above 90% 71-90% 50-70% Up to 50% Total
2004 24.2 39.3 26.2 10.3 100%
2003 25.4 38.5 26.9 9.2 100%
2002 21.9 37.6 26.2 14.3 100%

Sources: 1) National Centre of Health Information (NCHI), 2005 webpublication

2) National Centre of Health Information (NCHI), Public Health statistics. Annuals 2004, 2003, 2002 (hard copies)

Working Conditions Surveys can't be of help here because they ask only about the total number of absence days without dividing cases by categories of diseases.

4. 3.2 Please report figures from WCSs on MSDs suffered according to parts of the body affected and causal agent, and their trends over last 10 years, disaggregated by labour contracts, occupation, and age in an engendered way by gender, accordingly to the sources available described in Q2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communication.


All data provided under the headings 3.2. and 3.3. are derived from the following sources:

1) First Candidate countries survey on working conditions, 2001;

2) National working conditions survey, 2005.

General notes:

1. There are serious limitations of representativeness because the working conditions surveys are not designed to address particularly the working population suffering MSDs. In fact, trying to focus on MSDs complaints we work only with a sub-sample of about 20-25% (the share of MSDs) and the representativeness may be deteriorated by default. In addition, this sub-sample must be kept permanently divided into 4 groups according to the part of body affected as requested. Even at this stage of breakdown the representativeness may be totally lost. Any further breakdowns affect deeper the reliability of correlates, particularly those by occupation and age. It is definitely true for the analysis at sectoral level;

2. By these reasons (1) we would advice to perceive data as tentative only; (2) we don't feel inclined to draw conclusions and to offer extended analyses for the prevailing number of tables.

3. 'Don't know' answers are not shown in the tables and graphs for a better graphical appearance and easier perception. Usually they have relatively small values (1-2%) but complement the totals up to 100%.


In general, the reported levels of MSDs have not changed between 2001 and 2005, except for a slight increase in the rate for lower limbs (which difference is, however, in the interval of the sampling error). All the national percentages (for BG) are around or below the averages for the 12 Candidate Countries (CC-12) in 2001. Most of the respondents gave 3 out of 4 possible answers regarding MSDs.

Figure 1: Comparisons and trends of reported MSDs (%, total)

Gender and MSDs

On the whole, women are more affected by MSDs than men are. The biggest gender difference was observed in relation to backaches: women's contribution is higher by 20 and 10 percentage points (in 2001 and 2005, respectively). The gender difference reported for lower limbs also decreased: from 15 to 10 percentage points. The men slightly prevail only regarding the pain in upper limbs according to both surveys. In the period 2001-2005 the women's complaints decreased by 2-4 percentage points, whereas those of men increased by the same rate. As a result the gender difference decreased on total except for upper limbs.

Table 3: MSDs by gender (%)
  2001 2005
Parts of the body affected women men women men
Back 59.4 40.6 55.6 44.4
Shoulders and neck 52.3 47.7 50.8 49.2
Upper limbs 49.6 50.4 47.1 52.9
Lower limbs 57.4 42.6 54.3 45.7

Employment status

The type of the labour contract shows significant divergences. It may be explained by at least few facts:

1) permanent contracts are more spread in traditional industrial sectors. In these sectors serious WR-MSDs are more possible and also an aging working population is observed;

2) on fixed-term contracts usually work young people, who have not been yet much affected by occupational diseases and who are more oriented to jobs in services.

The significant increase in MSDs reported by people on permanent contracts also may be explained. In general, the proportion of permanent contracts increased in the period and at the same time the control over work process (autonomy) decreased.

Table 4: MSDs by labour contract (%)
  Permanent contract Fixed-term contract
Parts of the body affected 2001 2005 2001 2005
Back 72.5 78.7 23.4 21.3
Shoulders and neck 69.3 80.3 25.0 19.7
Upper limbs 69.7 80.9 24.6 19.1
Lower limbs 73.3 81.7 19.0 19.3

Note: in 2001 more options were listed - like temp work agency contract etc. The percentages for these options are about 4-6% and complement the totals for 2001 up to 100%.

Occupation and MSDs

The spread of MSDs by occupational groups was initially examined using the standard ISCO categories (9 occupational groups). There are no changes in the 1st category (Legislators, senior officials and managers) and last category (elementary occupations), i.e. those employees who are least and most affected by MSDs by default. Yet, these 9 occupational groups disperse cases too much and representativeness is seriously deteriorated. Therefore, we aggregated ISCO categories and used the dichotomy 'white-blue collars'. We considered the ISCO categories from 1st to 5th as white collars and categories from 6th to 9th - as blue collars, although 3rd and 5th categories may include miscellaneous occupations. Despite all the difficulties to transform the ISCO groups into the dichotomy “white collars/blue collars”, it is sure that this dichotomy provides better representativeness.

Table 5: MSDs by occupation (%)
Parts of the body affected ► Back Shoulders and neck Upper limbs Lower limbs
  2001 2005 2001 2005 2001 2005 2001 2005
White collars 45.1 55.8 38.8 51.5 30.1 49.7 40.9 62.5
Blue collars 51.8 44.2 57.2 48.5 67.0 50.2 54.8 37.5
DK 3.1 0.0 4.0 0.0 2.9 0.1 4.3 0.0
total 100 100 100 100 100 100 100 100

There are big changes between 2001 and 2005: MSDs complaints increased in the group of white collars, respectively:

  • by about 10 pp regarding back and shoulders & neck;

  • by about 20 pp regarding upper and lower limbs.

By contrast, complaints among blue collars decreased. It is due mainly to the input of the groups of Technicians and associated professionals, and Service workers, shop and market sales workers. These significant changes in the distribution of MSDs complaints between blue and white collars may be explained by structural economic changes. In the period 2001-2005 the share of services increased significantly in parallel to employment there, mostly composed of white collars. Some differences may be caused also by the different response rate of the compared surveys (2001: 87% of the planned sample=870 respondents; 2005: 100%=1002 respondents).


On the whole, the distribution of MSDs complaints by age has not changed from 2001 to 2005. There are no changes at all in the oldest group (55+).The figures show some increase in the youngest group, but it may be due to the fact that this group was defined in a different way in both surveys (2001, from 15-24 ages and in 2005, from 18-25). In other words, the grouping of 2005 includes 'more serious' workers who may have had more tiresome jobs. There is also some increase in the group of those aged 25-35 regarding backaches (from 19 to 23%) at the expense of pain in lower limbs (drop from 24 to 18.5%). Yet, the differences are close to the sampling error (4%). Thus, it may be concluded that significant changes by age have not happened and the most affected age groups remained those of 35-55 years of age.

Table 6: MSDs by age groups (%)
  2001 2005
Parts of the body affected 15-24 25-34 35-44 45-54 55+ 18-25 26-35 36-45 46-55 56+
Back 3.9 18.9 33.3 33.9 10.0 6.3 23.4 31.0 30.2 9.1
Shoulders and neck 4.6 19.1 34.9 30.3 11.2 11.1 20.1 32.2 26.1 10.6
Upper limbs 3.1 21.5 34.6 28.5 12.3 7.9 17.3 34.0 28.0 12.0
Lower limbs 5.2 24.3 32.2 28.7 9.6 6.7 18.5 35.9 28.2 10.8

Note: surveys in 2001 and 2005 used different age classes.


Preliminary notes:

1) the sectoral data need even more careful interpretation because the breakdown by sectors disperses broadly the cases once again and thus in some cells only few cases remain, which may affect the reliability of correlates at sectoral level;

2) the data from 2001 are in general less reliable because of the lower response rate as compared to the survey from 2005. Therefore, the signs of deteriorated representativeness for 2001 emerge at an earlier stage of breakdown;

3) that is why some data from 2001 are skipped because it is very risky to draw conclusions and any attempts to trace trends may be misleading;

4) the most unreliable breakdowns are by occupation (9 groups) and by age (5-6 age groups); therefore we offer aggregated figures;

5) By (*) are marked figures that are insignificant and should not be taken into account by the reader.


The data about manufacturing and mining are processed together in 2001 and separately in 2005. Unfortunately, we can't provide sectoral breakdown for 2001 because of technical problems with the SPSS file.

Table 7: MSDs reported in manufacturing and mining (%)
Parts of the body affected 2005
  manufacturing mining
Back 33.7 28.3
Shoulders and neck 29.3 30.4
Upper limbs 26.6 28.3
Lower limbs 23.9 19.6

Obviously, there are no significant differences between these two sectors; moreover the distribution of complaints by parts of the body affected is relatively even in both sectors. An exception is observed regarding Lower limbs being less reported in both sectors. In general, we can conclude that these sectors affect in a similar way all the considered body parts.

In order to prevent representativeness in next tables we will provide aggregated data about the sectors of manufacturing and mining and quarrying.

Table 8: MSDs by labour contract in manufacturing and mining and quarrying (%, 2005)
  Permanent FTC
Parts of the body affected Manufacturing, and mining and quarrying Manufacturing, and mining and quarrying
Back 29.4 18.2
Shoulders and neck 29.4 18.2
Upper limbs 29.4 18.2
Lower limbs 21.6 27.3
Table 9: MSDs by sex in manufacturing and mining and quarrying (%, 2005)
Parts of the body affected Male Female
Back 29.8 13.6
Shoulders and neck 28.1 36.4
Upper limbs 26.3 27.3
Lower limbs 22.8 9.1

Complaints are more evenly distributed among men as compared with women. The prevailing complaints of women refer to Shoulders & neck and the share is higher than that of men. All other proportions for women are lower or equal (upper limbs) to those of men.

We prefer to skip the requested breakdowns by occupation and age at sectoral level because of the inevitable deterioration of the representativeness.


In 2001 Health and education are processed together with some other sectors united in a bigger group entitled 'other services'. Because of that the requested cross tabulations can be provided only for 2005. Health and Education are smaller than Manufacturing and Mining and reliability of data here is lower; moreover they are women-dominated sectors and males comprise a small number in the sub-sample. That is why the female distribution is close to the average. In this case we advise not to consider male proportions.

Table 10: MSDs in health and education (%, total and by sex)
Parts of the body affected 2005
  Health Education
  Total Male* Female Total Male* Female
Back 21.1 21.7 20.8 21.0 21.1 20.9
Shoulders and neck 17.1 21.7 15.1 13.3 21.1 11.6
Upper limbs 15.8 13.0 17.0 11.4 21.1 9.3
Lower limbs 19.7 13.0 22.6 24.8 21.1 25.6


Table 11: MSDs by labour contract in health and education (%)
Parts of the body affected Permanent FTC*
  Health Education Health Education
Back 22.1 21.9 0.0 42.9
Shoulders and neck 17.6 12.5 0.0 28.6
Upper limbs 16.2 12.5 0.0 42.9
Lower limbs 19.1 27.1 20.0 28.6

*non-significant as FTC are not spread in the sectors

The consideration of representativeness holds at most for the age breakdown at sectoral level. To avoid this we packed the original age groups for the purposes of the sectoral analysis.

Table 12: MSDs by age groups in health and education (%)
  Health Education
Parts of the body affected 18-35 36-55 56+* 18-35* 36-55 56+
Back 8.7 27.1 16.7 8.7 27.5 8.3
Shoulders and neck 17.4 16.7 16.7 8.7 14.5 16.7
Upper limbs 8.7 16.7 33.3 4.3 11.6 25.0
Lower limbs 21.7 18.8 16.7 8.7 29.0 33.3



Table 13: MSDs in transport and communication (%, total and by sex)
Parts of the body affected total Male Female
Back 30.0 30.5 28.6
Shoulders and neck 23.8 25.4 19.0
Upper limbs 20.0 23.7 9.5
Lower limbs 20.0 20.3 25.6
Table 14: MSDs by labour contract in transport and communication (%)
Parts of the body affected Permanent FTC*
Back 27.0 50.0
Shoulders and neck 25.4 25.0
Upper limbs 22.2 12.5
Lower limbs 20.6 25.0

* non- significant

Table: 15 MSDs by age groups in transport and communication (%)
Parts of the body affected 18-35 36-55 56+*
Back 21.7 37.8 16.7
Shoulders and neck 8.7 33.3 16.7
Upper limbs 8.7 26.7 16.7
Lower limbs 4.3 26.7 25.0



Among the sectors examined the highest spread of MSDs is found in Manufacturing and Mining&quarrying. In general, there are no big differences between these two sectors. Backaches and pain in Lower limbs slightly prevail in Manufacturing as compared to Mining&quarrying, while upper limbs are a bit more affected in Mining&quarrying. Pain in shoulders and neck are evenly distributed.

Health and Education manifest similarities, too. Pain in shoulders&neck and upper limbs are slightly higher (by 4pp) in Healthcare, whereas employees in Education suffer more discomfort/pain in lower limbs (by 5pp). Backaches are equally spread.

Transport and communication stands close to both Manufacturing and Mining&quarrying regarding backaches and closer to Mining&quarrying and Healthcare regarding Lower limbs. Pain in shoulders and neck is less common as compared to Manufacturing and Mining&quarrying but more common than in Health and Education. The same holds for upper limbs complaints.

Table 16 (comparative): MSDs by 5 selected sectors (%, 2005)
  Manufacturing Mining and quarrying Transport and communication Health Education
Parts of the body affected          
Back 33.7 28.3 30.0 21.1 21.0
Shoulders and neck 29.3 30.4 23.8 17.1 13.3
Upper limbs 26.6 28.3 20.0 15.8 11.4
Lower limbs 23.9 19.6 20.0 19.7 24.8

3.3. Please provide some crosstables of MSDs according to part of the body affected and, if possible, causal agent, with the following organizational factors in an engendered way, showing trends from the 90s and taking into account the questions included in WCS for each country:

  • pace of work (speed or repetitiveness, tight deadlines)

  • autonomy (in general and where possible breaks opportunities, scope on pace of work, scope on methods);

  • use of PCs and other ICTs devices;

  • scope of discussion over work organization and/or organizational changes;

► The following crosstabs address only the recent survey (2005) because (1) its response rate is higher; (2) of the limited volume of the present topic report; (3) the 2005 survey provides the most recent data.

All the data about organizational factors and workers participation (tables 17-27) may be unreliable because of the detailed answer categories and the requested additional breakdown by gender, which deepens the problem. Therefore, we also provide the incidence rate (frequencies) of complaints, which is more reliable measurement in this case.

In general, the influence of organisational factors (control over work process and workers' participation in decision making) have significant impact on MSDs complaints. The duration of exposure to painful working postures, work at tight deadlines etc. definitely influence the incidence of complaints (a longer exposure causes more complaints). In almost all cases percentages do not show gender differences. However, frequencies evidence some gender differences, observed in relation to suffering backache and pain in lower limbs: women appear more vulnerable and more affected by the organisational factors than men are. This gender difference is particularly obvious with regard to ability to take breaks, to change/chose order of tasks and methods of work. Regarding shoulders & neck and upper limbs gender differences are weak or are lacking.

Note: for the following analysis are mainly considered totals respectively for men and women, because further breakdowns are less reliable (for example, intensive work all of the time, 3/4 and 1/2 of the time etc.; the latter breakdowns are given but should be perceived as tentative only).

Table 17: MSDs and high work intensity (2005, frequencies and %)
  Men Women
Parts of the body affected Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never
Back 112 24.2 6658.9 3531.3 119.8 140 26.5 8963.6 4230.0 96.4
Shoulders and neck 98 21.2 6768.4 2424.5 77.1 101 19.1 7372.3 2625.7 22.0
Upper limbs 101 21.9 6564.4 3231.7 44.0 90 17.0 6572.2 2022.2 55.6
Lower limbs 90 19.5 5561.1 3033.3 55.6 107 20.2 7368.2 2422.4 109.3

Work with high intensity equally affects all the body parts of men, except for backache, which is reported a bit more frequent. Women suffer backache and pain in lower limbs more often than men.

Table 18: MSDs and work at tight deadlines (2005, frequencies and %)
  Men Women
Parts of the body affected Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never
Back 11124.1 5549.5 2926.1 2724.3 14026.5 7150.7 2517.9 4431.4
Shoulders and neck 9821.3 5354.1 2424.5 2121.4 101 19.1 5958.4 1817.8 2423.8
Upper limbs 10121.9 5857.4 2322.8 2019.8 9017.0 4954.4 1718.9 2426.7
Lower limbs 9019.5 5257.8 1921.1 1921.1 10720.2 4844.9 1514.0 4441.1

There are no significant gender differences except for a more frequent backache of women.

Table 19: MSDs and painful or tiring working postures/movements (2005, frequencies and %)
  Men Women
Parts of the body affected Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never
Back 11124.1 5145.9 3430.6 2623.4 14026.5 4230.0 3525.0 6345.0
Shoulders and neck 9721.0 4748.5 2929.9 2121.6 101 19.1 4241.6 2322.8 3635.6
Upper limbs 10021.7 5252.0 3535.0 1313.0 9017.0 4347.8 1617.8 3134.4
Lower limbs 8919.3 3842.7 3337.1 1820.2 10720.2 3835.5 3028.0 3936.4

Percentages do not show gender differences but incidence rate shows that women report more frequently backache and pain in lower limbs.

Table 20: MSDs and carrying heavy loads (2005, frequencies and %)
  Men Women
Parts of the body affected Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never
Back 11224.2 3228.6 4237.5 3833.9 13926.4 1510.8 2417.3 10071.9
Shoulders and neck 9821.2 2525.5 3636.7 3737.8 101 19.2 1514.9 1514.9 7170.3
Upper limbs 10121.9 2928.7 4140.6 3130.7 9017.1 1415.6 2022.2 5662.2
Lower limbs 9019.5 2730.0 3336.7 3033.3 10620.1 1514.2 2422.6 6763.2

Women report more frequently backache and pain in lower limbs caused by carrying heavy loads.

Table 21: MSDs and repetitive hand movements (2005, frequencies and %)
  Men Women
Parts of the body affected Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never
Back 11224.3 7264.3 2320.5 1715.2 13926.4 8359.7 3021.6 2618.7
Shoulders and neck 9821.3 6667.3 2222.4 1010.2 101 19.2 6665.3 2019.8 1514.9
Upper limbs 10121.9 7271.3 2019.8 98.9 9017.1 6976.7 1314.4 88.9
Lower limbs 9019.5 5561.1 2022.2 1516.7 10720.3 6560.7 2523.4 1715.9

Women report more often backache.

Table 22: MSDs and use of PCs and other ICTs devices (2005, frequencies and %)
  Men Women
Parts of the body affected Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never Total All of the time and 3/4 of time Around 1/2 of time and 1/4 of time Never
Back 11224.2 1210.7 98.0 9181.3 14026.5 3424.3 1913.6 8762.1
Shoulders and neck 9821.2 1111.2 55.1 8283.7 101 19.1 2322.8 109.9 6867.3
Upper limbs 10121.9 87.9 22.0 9190.1 9017.0 1516.7 88.9 6774.4
Lower limbs 9019.5 88.9 55.6 7785.6 10720.2 1110.3 1312.1 8377.6

Again, women's complaints prevail regarding backache.


Definitely the ability to control the work process has positive effect on the health and in particular on prevention of MSDs, because MSDs complaints are in times higher when/where the autonomy at work is restricted. Another point is that the ability to change different facets of the work process has a stronger positive influence on women than on men.

Table 23: MSDs and ability to change/choose order of tasks (2005, frequencies and %)
  Men Women
Parts of the body affected Total yes no Total yes no
Back 112 24.2 48 42.9 64 57.1 140 26.6 57 40.7 83 59.3
Shoulders and neck 98 21.2 40 40.8 58 59.2 101 19.2 36 35.6 65 64.4
Upper limbs 101 22.8 41 40.6 60 59.4 90 17.1 29 32.2 61 67.8
Lower limbs 90 19.4 40 44.4 50 55.6 107 20.3 43 40.6 63 59.4

Not only frequencies but also percentages show that women are more sensitive to this facet of autonomy.

Table 24: MSDs and ability to change/choose methods of work (2005, frequencies and %)
  Men Women
Parts of the body affected Total yes no Total yes no
Back 111 24.0 42 37.8 69 62.2 139 26.4 58 41.7 81 58.3
Shoulders and neck 97 21.0 32 33.0 65 67.0 101 19.2 35 34.7 66 65.3
Upper limbs 100 21.6 33 33.0 67 67.0 90 17.1 30 33.3 60 66.7
Lower limbs 89 19.3 36 40.4 53 59.6 106 20.2 45 42.5 61 57.5

Not only frequencies but also percentages show that women are more sensitive to this facet of autonomy.

Table 25: MSDs and ability to take breaks (2005, frequencies and %)
  Men Women
Parts of the body affected Total yes no Total yes no
Back 111 24.0 38 34.2 73 65.8 140 26.6 31 22.1 109 77.5
Shoulders and neck 97 21.0 31 32.0 66 68.0 101 19.2 19 18.8 82 81.2
Upper limbs 101 21.9 32 31.7 68 67.3 90 17.1 19 21.1 71 78.9
Lower limbs 90 19.5 26 28.9 64 71.1 107 20.3 22 20.6 85 79.4

Ability to take breaks diminishes men's MSDs complaints approx. 2 times for each body part (even stronger for lower limbs), while this influence on women is stronger: complaints decrease by approx. 3-4 times if there is opportunity to take breaks.

Table 26: MSDs and ability to discuss working conditions (2005, frequencies and %)
  Men Women
Parts of the body affected Total yes no Total yes no
Back 112 24.2 84 75.0 28 25.0 140 26.6 87 62.1 53 37.8
Shoulders and neck 97 21.0 68 70.1 29 29.9 101 19.2 62 61.4 38 37.6
Upper limbs 100 21.6 78 78.0 22 22.0 90 17.1 62 68.9 28 31.1
Lower limbs 89 19.6 66 74.2 23 25.8 107 20.3 75 70.1 32 29.9

Employees, who have ability to discuss working conditions suffer more often MSDs. The only significant gender difference concerns backache: there are much more women (53 cases, 38%) than men (28 cases, 25%), who do not have ability to discuss working conditions and suffer backache.

Table 27: MSDs and ability to discuss organisational changes at work (2005, frequencies and %)
  Men Women
Parts of the body affected Total yes no Total yes no
Back 112 24.4 64 57.1 48 42.9 140 26.6 67 47.9 73 52.2
Shoulders and neck 97 21.1 47 48.5 50 51.5 101 19.2 44 43.6 57 56.4
Upper limbs 99 21.6 55 55.6 44 44.4 90 17.1 45 50.0 45 50.0
Lower limbs 89 19.4 52 58.4 37 41.6 107 20.3 56 52.3 51 47.7

In general, the ability to discuss organisational changes at work has no correlation with MSDs and gender, although employees, who have opportunity to comment changes report MSDs more often than those lacking such opportunity.

4. Trends of MSDs and their economic impact

MSD has consequences both on health and work efficiency. This latter can be accounted in lower productivity of both the affected worker and his/her substitute.

Lower work efficiency is just part of the costs. They are both direct (compensation, treatment, medical care) and indirect (production lost, loss of quality in production, errors/mistakes in production, absenteeism, replacement). As we have seen in the introduction, estimates produced by some countries differ in included costs.

Just from these few cases, their amount is undoubtedly huge and calls for prevention policies and a careful evaluation of their impact in terms of costs and benefits.

  • Are there estimates of MSDs costs? If any, which direct and indirect costs are included? Who carry them? If not, what indicators are monitored by policy makers and Agencies in order to propose/draw new policies, esp. in prevention?

No such estimates available.

Policy makers and Agencies monitor mainly directs costs, i.e. those spent for treatment/medical care specifically in hospitals as they affect budgeting. The shares of registered people with recognised WR diseases are also monitored. Yet, there are no visible results from monitoring of these indicators because it has not led to establishment of efficient prevention policies up to now.

Table 28: Patients discharged from hospitals (MSDs cases)
Time periods Hosp.discharges; dis.of musculoskeletal s./100000 %
1996 383.8 34
1997 299.2 34
1998 318.1 45
1999 301.9 38
2000 589.0 62
2001 738.4 68
2002 711.9 69
2003 807.5 69
2004 995.0 97

Source: National Centre of Health Information, webpublication 2005, English version

This trend may be explained by 2 factors:

  • The reform in the Healthcare system gradually leads to: improvement of the diagnostic capacities; more precise statistics by categories of hospitalised patients; possible preference given by GPs to MSDs in case of multi-complaints;

  • After the decisive phase of privatisation taken place in 1995/1996 probably MSDs complaints increased because of the deteriorated working conditions and breaches of OHS regulations particularly in SMEs.

Table 29: Registered people with WR diseases (three biggest groups, 2003)
Classes according to ICD-10, 1992 Geneva number %
1. Over Use WR MSDs (class XIII M00-M99) 222 23,37
2. Vegetative polyneuropathy 216 22,74
3. Vibration disease 142 14,95

Source: Focal Point, Statistics on the occupational diseases in Bulgaria, webpublication 2005 in Bulgarian

Obviously, the WR MSDs are the most spread ones but their contribution to mortality rate is negligible. Also the cost for treatment of a case is small as compared to neoplasms cases (cancerous diseases) and those of the circulatory system.

4.2 Are there “return to work policies” (by whom/ on what level/ whose initiative/ involvement of the actors) developed and implemented (in general and specifically for MSDs)?

Such practices are observed at company level being developed by both trade unions and employers (OHS are also involved). The measures include mainly dissemination of information and training of employees. The strategy involves rising awareness of employers and employees about MSDs, their causes, and means of reducing the risk.

Such information are collected just in order to have a flavour of the shared awareness of their social and economic impact, and as such we deal with them.

5. Prevention policies and room to manoeuvre

The figures/data so far available seem to suggest that we are not sure the EU is already the downward part of the slope of the reported graph form Brenner et al. (2002). The 2002 Scoreboard on implementing the Social Policy Agenda statement about the “insufficiency of current occupational health and safety practices and hence the cost of non-social policy to businesses and workers” could be applied to MSDs. As the Community strategy on health and safety at work (2002 – 06) points out, “the preventive approach set out in Community directives has not yet been fully understood”.

According to various studies, such as those summarized in Bourgeois et al. (2000) both MSDs and stress-related disorders arises out of work situations which limit workers’ discretion. Along these lines Coutarel (2003) suggests preventive strategies based on the notion of room to manoeuvre (“marge de manoeuvre”), i.e. the means and opportunities of action an employee has in a given production situation to influence and correct the work process. This gives the possibility for the individual to have control over the work situation and to use personal capacities.

According to Douillet, Schweitzer, 2002, “expanding workers’ discretion (…) becomes a key prevention priority: not just to reduce the physical and psychological stressors, but also as a way of recognizing the individual’s creativity at work”. The organizational changes in order to prevent MSDs must therefore include all the concerned stakeholders (Daniellou, 2005).

Therefore, the room to manoeuvre approach calls for prevention strategies based on interventions at an early stage at the design of the workplace according a participative method, which can be different labelled and stylized across countries. This calls for the opportunity in developing some quality indictors in order to set benchmarking policies, such as:

  • Good quality working conditions;

  • Possibilities of cooperation;

  • Mobility;

  • Rotation;

  • Organisation of work which allows to make maximum of benefit out of the workforce

  • Training

  • Stability in the workforce/low staff turnover

Limits of such a prevention approach are economic constraints (productivity/overall performance maintainance, further investments) and social constraints (population characteristics, level of experience, training, levels of exposure).

5. In general, plant-level prevention policies are “risk elimination oriented” or centered around “risk information”? What is the role of social partners?

Company policies are mostly focused on risk information. The social partners play an important role mainly in dissemination of information and training of employees. The “risk elimination oriented” policy is at a very early stage of development.

6. 5.2 Please illustrate some plant-level good practices (at least one in manufacturing and one in services) following (or showing significant similarities with) the “room to manoeuvre” approach above sketched, showing in particular the adopted approaches and the impact both in working conditions and firm performance. Is there any specific strategy of the kind towards small and medium enterprises?

Such good practices are not known at the moment. In general, autonomy at work is among the lowest in Europe. Moreover, the comparison of data from WCS shows that the “room to manoeuvre” got even more restricted in the period 2001-2005.

.5.3 Have been developed any quality indicators measuring “room to manoeuvre” preventive strategies?

► No.


Brenner, Fairis and Ruser, 2004, “”Flexible” work practices and occupational safety and health: exploring the relationship between cumulative trauma disorders and workplace transformations”, Industrial relations 43.

Bourgeois F. (ed.), 2000, TMS et travail: quand la santé interroge l’organisation. ANACT.

Clot Y., 2005, “Les TMS: hypersollicitation ou hyposollicitation”, communication presented at the “ congrés francophone sur les TMS du membre supèrieur”, Nancy, 30-21 may 2005.

Coutarel F., 2004, La prevention des troubles musculo-squelettiques en conception: quelles marges de manoeuvre pour le dèploiment de l’activitè?, Coll. Thèses et Mèmoires, Universitè Victor Segalen Bordeaux 2 – ISPED, Laboratoire d’Ergonomie des Systèmes Complexes.

Daniellou F., 2005, “TMS et modèles d’organisation du travail et de la produciont”, communication presented at the “ congrés francophone sur les TMS du membre supèrieur”, Nancy, 30-21 may 2005.

Hakim C. (1993), “Segregated and Integrated Occupations: A New Approach to Analysing Social Change”, European Sociological Review 4.

Oesterman P., 2002, “Organizing the US Labor Market: National Problems, Community Strategies”, in Trubek D., Zeitlin J. (eds.) Reconfiguring work and welfare in the New Economy, Oxford, Oxford University Press, 2002

Pèze M. (2002), Approche psychosomatique et psychodynamiques des TMS. Mimeo.

Putz-Anderson V. (2002), Cumulative trauma disorders – A manual for musculoskeletal diseases of the upper limbs. Taylor&Francis, London.

Authors: Rumiana Gladicheva, PhD and Emilia Chengelova, PhD

Expert consulted: Prof. Emilia Ivanovich, MD, PhD, D.Sc.; national consultant to the Ministry of Healthcare on the problems of Occupational Diseases; Department head at the National Centre of Public Health Protection.

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