Back to Basics is a weekly feature that highlights important but possibly overlooked information that any EHS professional should know. This week, we examine how to deal with common workplace injuries.
Some workplace injuries can be tragic, like amputations, severe burns, and fatal falls, and more frequent or common worker injuries can result in costly workers’ compensation claims for medical treatment and missed wages.
According to the National Safety Council (NSC), the most common workplace injuries are overexertion (from lifting or carrying) and bodily reactions (from repetitive motions or working in awkward positions), followed by falls, slips, and trips, then exposure to harmful substances or environments. Harmful substances or environments in the workplace include electricity, heat, noise and radiation, air or water pressure changes, and other harmful substances (including contagious and infectious diseases). We recently examined heat exposures and heat injury and illness prevention programs in depth.
The NSC findings closely align with employer costs reported by workers’ compensation insurer Liberty Mutual. In the insurer’s most recent “Workplace Safety Index,” the three types of workplace injuries that cost employers the most are:
- Overexertion involving outside sources (carrying, holding, lifting, pulling, pushing, or throwing objects), costing employers $12.49 billion;
- Falls on the same level (slips and trips), costing employers $9.99 billion; and
- Falls to a lower level, costing employers $5.68 billion.
“Struck by object or equipment” and “other exertions or bodily reactions” (awkward postures) round out the top five. Injuries from “repetitive motions involving microtasks” cost $1.54 billion.
The most common workplace injury: MSDs
The NSC describes musculoskeletal disorders (MSDs) as “the most common workplace injury in America.” The group continues to focus on preventing MSDs, devoting resources to research and pilot projects. It also just announced $300,000 in new grants to its 2025–2026 Research to Solutions (R2S) and MSD Solutions Pilot Grant recipients. The group also recently released a guide to MSD surveillance. The new resource, developed by the group’s MSD Solutions Lab, draws on 50 academic sources to provide practical guidance on preventing MSDs through effective injury surveillance systems.
Key features of the approach developed by the MSD Solutions Lab include the following:
- Standardized recordkeeping—guidelines for consistent injury classification and data collection, helping employers better identify risks and target prevention efforts;
- System implementation—best practices for designing and maintaining effective injury surveillance frameworks that adapt to an employer’s size and capabilities;
- Technology integration—guidance on leveraging Internet of Things (IoT) devices, artificial intelligence (AI) analytics, and automated systems to enhance workplace monitoring and early intervention, with practical considerations for implementation; and
- Real-world application—use cases and interactive exercises to help employers effectively implement strategies in their own workplaces.
An appendix to the guide contains sample data dashboards and injury recordkeeping forms employers can refer to when developing or refining their injury surveillance methods.
The MSD Solutions Lab was launched in 2021 with funding from Amazon to address work-related MSDs. The NSC estimates that MSDs cost private sector U.S. businesses nearly $18 billion annually.
Along with the Workplace Safety Index, Liberty Mutual analyzed the top causes of injuries in eight industries: construction, health care and social services, leisure and hospitality, manufacturing, professional and business services, retail, transportation and warehousing, and wholesale trade.
Overexertion involving outside sources (lifting, carrying, etc.) was the top cause of serious, nonfatal injuries in manufacturing and wholesale trade, and it was the second-leading cause of injuries in business and professional services.
The NSC has recommended that employers use a “hierarchy of controls” to address MSD hazards, including:
- Elimination: Whenever possible, eliminate tasks that require high exertions, awkward or sustained postures, or a fast pace.
- Substitution: Adapt workplace design, and provide ergonomic accommodations for employees.
- Engineering: Provide assistive devices and technology, such as carts, co-bots (semiautonomous machines that work alongside workers to perform hazardous work tasks), conveyors, counterbalances, hoists, lifts, ramps, and turntables, to minimize strain and repetitive motions.
- Administrative: Seek worker feedback on job tasks and risk factors, and implement solutions that prove helpful to everyone.
Patient handling in health care and manual materials handling across industries can lead to back injuries. The National Institute for Occupational Safety and Health (NIOSH) has developed employer guidance for manual materials handling, safe patient handling and mobility, and ergonomic interventions for soft drink beverage delivery.
NIOSH also has a Revised NIOSH Lifting Equation (RNLE) for calculating the risk of work-related MSDs.
Factors in the institute’s RNLE include:
- Weight of the object being lifted,
- Horizontal location of the hands away from the midpoint between the ankles,
- Vertical location of the hands above the floor,
- Vertical travel distance of the hands between the origin and destination of the lift,
- Angle of how far the object is displaced from the front of the body,
- Frequency of the lifting task,
- Duration of all lifting tasks and rest time in an 8-hour workday, and
- Coupling the quality of gripping or grasping the object while lifting.
The American Industrial Hygiene Association (AIHA) considers the overexertion hazards of manual materials handling a top health concern in construction work, along with air contaminants, high temperatures, and high noise levels. According to the AIHA, manual materials handling accounts for about half of the industry’s workers’ compensation costs due to work-related MSDs from overexertion during carrying, lifting, pulling, and pushing.
Similar to the RNLE, the AIHA created the acronym “W-H-A-T PACE” to remind employers of the risk factors affecting materials-handling hazards:
- Weight: The heavier the object, the higher the risk of overexertion.
- Handling ease: Loads with contents likely to move, loads that can’t be carried close to the body, or loads without handles all increase the risk of MSDs.
- Awkward postures, such as bending, kneeling, reaching, stooping, and twisting, all increase risk.
- Time/distance: Loads that must be carried a greater distance or for a longer time are higher risk.
- Pace: The number of loads that must be moved per shift.
- In 2023, the NSC released a white paper examining emerging technologies that could help employers control MSD hazards, including the following:
- Computer vision, a potentially helpful tool for larger organizations seeking to aggregate data and analyze ergonomic risks. (The NSC’s “Work to Zero” initiative released an earlier white paper on applications of computer vision to mitigate fatal workplace injury risks.)
- Wearable sensors as a supplement to engineering controls.
- Passive exoskeleton use for manual materials handling. Studies show a reduction in muscle activity up to 40 percent with exoskeletons.
Repetitive motion in poultry processing work can lead to MSDs like carpal tunnel syndrome, tendonitis, and “trigger finger” (when a finger bends, gets stuck, and then snaps straight). The Occupational Safety and Health Administration (OSHA) released Prevention of Musculoskeletal Injuries in Poultry Processing, an employer guide that recommends the use of engineering controls, including tool handle and workstation designs. A wraparound handle or strap allows users to maintain control of the tool while relaxing their fingers on the handle. A handle guard can prevent the hand from slipping onto the tool’s blade.
Slips, trips, and falls
Given the billions of dollars in employers’ costs associated with slips, trips, and falls (including falls on the same level or to a lower level), Liberty Mutual has called for renewed vigilance regarding slip, trip, and fall hazards.
NIOSH encourages employers to make young workers aware that slips, trips, and falls are common causes of workplace injuries, and it suggests that employers remind young workers to clean up spills and remove any slippery materials, check with supervisors about the safe use of cleaning products, and avoid using cleaners that could make floors slippery.
NIOSH also provides guidance on slip, trip, and fall prevention for healthcare employers. According to NIOSH, the top slip, trip, and fall hazards in health care include:
- Contaminants (fluids, food, grease, oil, and water) on the floor;
- Improper use of floor mats and runners;
- Inadequate lighting;
- Poor drainage of drains and pipes;
- Stairs and handrails;
- Step stools and ladders;
- Tripping hazards like clutter, hoses, loose cords, medical tubing, and wires;
- Walking surface irregularities both indoors and outdoors, like uneven flooring or ground and holes, protrusions, and rocks; and
- Weather conditions like ice and snow.
NIOSH’s guidance provides employers with an extensive checklist of slip, trip, and fall hazards that should be addressed in healthcare facilities.
NIOSH also offers a fact sheet for wholesale and retail employers. Like the institute’s advice for healthcare employers and those that employ young workers, the fact sheet points to risk factors in the wholesale and retail trades that include boxes and containers; ice, rain, and snow; loose mats and rugs; poor lighting; spills on walking surfaces; and walking surfaces in disrepair. NIOSH has specific recommendations for employers on footwear, planning and workplace design, and training, as well as advice for wholesale and retail workers concerning housekeeping and materials handling.
Specific recommendations for the industry include:
- Selecting flooring material according to the work performed in an area.
- Using mats that absorb liquid and remove dirt, debris, and liquid from shoes to provide slip-resistant walking surfaces. Mats should be large enough to allow several footsteps to fall on the mat and clean contaminants off shoes.
- Providing umbrella bags to prevent rainwater from dripping onto the floor and cleanup supplies, including paper towels or absorbent material and “wet floor” signs, at convenient locations in the facility.
- Ensuring all indoor and outdoor areas have proper lighting to reduce shadows, dark areas, and glare so tripping hazards or surface irregularities are visible.
NIOSH has also researched the effectiveness and value of wearing slip-resistant shoes.
Researchers looked at workers’ compensation injury claims for accidents caused by slipping on wet or greasy surfaces to evaluate the effectiveness of the shoes worn.
A group of workers provided with highly rated slip-resistant shoes saw a 67 percent reduction in claims for slip injuries. The baseline was 3.54 slipping injuries per 10,000 months worked among the intervention group, which was reduced to 1.18 slipping injuries per 10,000 months worked after the slip-resistant shoes were provided.
Workplace housekeeping is also crucial in preventing slip, trip, and fall hazards while controlling fire hazards, as well as preventing objects from falling. Housekeeping interventions recommended by the Canadian Centre for Occupational Safety and Health (CCOSH) include the following:
- Cleaning all spills immediately;
- Mopping or sweeping debris from floors;
- Marking spills and wet areas;
- Removing obstacles from walkways and keeping walkways free of clutter; and
- Keeping working areas and walkways well lit and replacing faulty light switches and used light bulbs.
Controlling MSD risks and slip, trip, and fall hazards can protect your employees from the most common workplace injuries and help contain costs associated with these injuries.