Construction Chart Book

Chart Book (6th edition): Hazards and Exposures – Exposure Risks for Work-Related Musculoskeletal Disorders and Other Illnesses in Construction

33. Exposure Risks for Work-Related Musculoskeletal Disorders and Other Illnesses in Construction

Work-related musculoskeletal disorders (WMSDs; see MSDs in Glossary) are very common in the construction industry (see pages 48 and 49). They are injuries of the muscles, tendons, joints, and nerve tissues that are caused or aggravated by work activities. Examples of WMSDs include joint sprains; muscle strains, such as back or neck strain; inflamed tendons (called “tendonitis”), such as tennis elbow or rotator cuff syndrome; and nerve compression, such as carpal tunnel syndrome and spinal cord compression from herniated discs of the neck or lower back. Awkward postures, repetitive motions, and forceful exertions contribute to adverse musculoskeletal outcomes. Work-related back disorders are often caused by repeated exposures to activities such as lifting and carrying materials, sudden jerky movements, whole body vibration (WBV), bending or twisting motions of the back, and working in a cramped space for long periods of time.1-3

According to O*NET exposure scores (see page 32), many construction occupations require bending or twisting of the body and repetitive motions in work performance. Brickmasons are more likely to use bending, twisting, and repetitive motions during most of their work than other occupations, followed closely by painters and drywall installers (chart 33a). Many construction jobs also involve kneeling, crouching, stooping, and crawling, which increase the risk of WMSDs as well. Concrete workers, heating and air conditioning mechanics, roofers, and painters have to work in such postures for at least 60% of their working time (chart 33b). Overall, about three-quarters (75%) of workers in construction production occupations need to kneel, crouch, stoop, or crawl for at least half of their work time.4

In addition, nearly 77% of workers in construction production occupations are required to work in confined spaces or awkward positions at least once a month.4 Plumbers and elevator installers have to work in such spaces or positions more than once a week (chart 33c). Some construction jobs entail exposure to WBV; operating engineers are exposed the most often, with exposure occurring multiple times a week (chart 33d).

Most construction workers use their hands to handle, control, and feel objects, tools, and controls at work. About 90% of construction production jobs require manual handling activities for more than half of their work time (chart 33e). Brickmasons, painters, and cement workers typically spend more time physically handling work objects than other production occupations in construction.4 Such exposure can cause hand injuries as well as increase the risk of skin conditions like dermatitis when hands are exposed to various types of chemicals or construction materials.5,6

Construction jobs often require regular outdoor work. Workers exposed to sunlight on the job have an increased risk of skin cancer.7 In addition, nearly all production occupations in construction require working in very hot or very cold temperatures at least once a month, with about one-third (34%) exposed weekly (chart 33f). Ironworkers, operating engineers, and cement workers are exposed to extreme temperatures more frequently than other construction occupations.4 High temperatures are a serious hazard for construction workers and can lead to decreased job performance and increased risk of injury, as well as a range of heat-related illnesses, including potentially fatal heat stroke.8,9


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Musculoskeletal disorders – Musculoskeletal disorders (MSDs) – From the U.S. Bureau of Labor Statistics (2011 onward): in the category of Nature, MSDs include an injury or illness from pinched nerve; herniated disc; meniscus tear; sprains, strains, and tears; hernia (traumatic and non-traumatic); pain, swelling, and numbness; carpal or tarsal tunnel syndrome; Raynaud’s syndrome or phenomenon; and musculoskeletal system and con­nective tissue diseases and disorders. In the category of Event or exposure, MSDs include an injury or illness due to overexertion and bodily reaction; over­exertion involving outside sources; repetitive motion involving microtasks; other and multiple exertions or bodily reactions; and being rubbed, abraded, or jarred by vibration;


1. Dale AM, Ryan D, Welch L, Olsen MA, Buchholz B, Evanoff B. 2015. Comparison of musculoskeletal disorder health claims between construction floor layers and a general working population. Occupational and Environmental Medicine, 72(1): 15-20.

2. Wang X, Dong XS, Choi SD, Dement J. 2017. Work-related musculoskeletal disorders among construction workers in the United States from 1992 to 2014. Occupational and Environmental Medicine, 74(5): 374-380.

3. West GH, Dawson J, Teitelbaum C, Novello R, Hunting K, Welch LS. 2016. An analysis of permanent work disability among construction sheet metal workers. American Journal of Industrial Medicine, 59(3): 186-195.

4. U.S. Department of Labor, Employment and Training Administration. O*NET OnLine, (Accessed April 2017). All data on this page are from O*NET unless otherwise specified. Exposure percentages were estimated by the CPWR Data Center using O*NET exposure scores for detailed occupations combined with data from the U.S. Bureau of Labor Statistics. 2014-2024 Employment Projections (Table 1.9. 2010-2024 Industry-occupation matrix data, by industry), (Accessed April 2017). Some occupations were grouped together and average scores for their work contexts were cited.

5. Centers for Disease Control and Prevention. 2013. Workplace safety & health topics: Skin exposures & effects, (Accessed April 2017).

6. Coman G, Zinsmeister C, Norris P. 2015. Occupational contact dermatitis: Workers’ compensation patch test results of Portland, Oregon, 2005-2014. Dermatitis, 26(6): 276-283.

7. Schmitt J et al. 2018. Occupational UV-exposure is a major risk factor for basal cell carcinoma: Results of the population-based case-control study FB-181. Journal of Occupational and Environmental Medicine, Jan;60(1):36-43.

8. Zink A, Wurstbauer D, Rotter M, Wildner M, Biedermann T. 2017. Do outdoor workers know their risk of NMSC? Perceptions, beliefs and preventive behaviour among farmers, roofers and gardeners. Journal of the European Academy of Dermatology and Venereology, 31(10): 1649-54.

9. Occupational Safety and Health Administration. Occupational heat exposure, (Accessed April 2017).



Charts 33a and 33b – Exposure scores: 0 = Never; 25 = Less than half the time; 50 = About half the time; 75 = More than half the time; and 100 = Continually or almost continually.

Charts 33c and 33d – Exposure scores: 0 = Never; 25 = Once a year or more but not every month; 50 = Once a month or more but not every week; 75 = Once a week or more but not every day; and 100 = Every day.

“Concrete” here refers to the occupation titled, “Cement masons and concrete finishers”.


Charts 33a-33d – O*NET OnLine. 2015. Work context: Physical work conditions, (Accessed April 2017).

Charts 33e and 33f – O*NET OnLine. 2015. Work context: Physical work conditions, (Accessed April 2017). U.S. Bureau of Labor Statistics, 2014-2024 Employment Projections (Table 1.9. 2014-2024 Industry-occupation matrix data, by industry), (Accessed April 2017). Calculations by the CPWR Data Center.