WATERLOO, Ontario — For decades, the professional safety community has categorized musculoskeletal disorders (MSDs)—conditions affecting the muscles, nerves, blood vessels, ligaments, and tendons—as the exclusive domain of physical ergonomics. Experts typically focus on repetitive motions, heavy lifting, awkward postures, and workstation design. However, a groundbreaking position paper released by the University of Waterloo’s Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD) and the National Safety Council (NSC) is challenging this siloed perspective.
The study asserts that workplace violence, an issue traditionally viewed through the lens of security and mental health, is a "significant but preventable contributor" to the global epidemic of work-related musculoskeletal disorders. By identifying violence as an "underrecognized" risk factor, researchers are calling for a fundamental shift in how organizations design safety protocols, arguing that physical injury is often the final manifestation of systemic organizational failures.
The Core Thesis: A New Paradigm in Occupational Health
The position paper, co-authored by Paige DeBaylo, director of the NSC MSD Solutions Lab, and NSC research manager Kenna Stanley, dismantles the artificial barrier between physical safety and behavioral security.
"Workplace violence is not merely a threat to emotional well-being or a security concern; it is a mechanical and physiological stressor," the authors note. The research highlights that when an employee is subjected to aggression—whether verbal, physical, or psychological—the body undergoes a cascade of responses that directly correlate with the development or exacerbation of MSDs.
The Mechanics of Injury
The link between violence and MSDs is threefold:
- Acute Physical Strain: Direct physical altercations or the act of restraining a combative individual can cause immediate sprains, fractures, and musculoskeletal trauma.
- Psychological Stress: Chronic exposure to violent or hostile environments elevates cortisol levels, which can lead to muscle tension, reduced recovery rates, and systemic inflammation—key precursors to chronic pain conditions.
- Physical Fatigue: Heightened vigilance and the "fight-or-flight" response in a hostile work environment lead to physical exhaustion, which in turn degrades an employee’s biomechanical efficiency, making them more prone to ergonomic injury.
Chronology of a Safety Crisis
To understand why this connection has remained obscured for so long, one must examine the evolution of workplace safety regulations.
- 1970s–1990s: The Ergonomics Era: Occupational safety focused almost exclusively on the "human-machine interface." The primary goal was to prevent back injuries and carpal tunnel syndrome through equipment adjustments.
- Early 2000s: The Rise of Occupational Stress: Organizations began to acknowledge that burnout and stress could impact physical health, yet safety managers and human resources departments remained distinct, often uncoordinated entities.
- 2015–2020: The Convergence: As healthcare and service industries reported skyrocketing rates of violence against staff, researchers began noticing that these incidents were frequently occurring in environments where MSDs were also prevalent.
- 2024–2025: The Integrated Approach: The collaboration between the NSC and the University of Waterloo marks a formal acknowledgement that safety culture is monolithic. The recent position paper serves as a roadmap for integrating violence prevention into the broader ergonomics framework.
Supporting Data: The Shared Root Causes
One of the most compelling aspects of the NSC-Waterloo study is the identification of shared root causes. The researchers argue that if an organization has a high rate of MSDs, it likely has an underlying cultural issue that also fosters workplace violence.
1. Staffing Levels and Resource Allocation
Understaffing is the "force multiplier" for both risks. When staff are stretched thin, they are forced to perform tasks in a rush, leading to poor ergonomic practices (lifting heavy objects alone, moving too quickly). Simultaneously, understaffing creates environments where patients, clients, or customers become frustrated, increasing the likelihood of aggressive outbursts.
2. Job Design and Workflow
Poorly designed workflows often force employees into "high-demand, low-control" situations. When workers feel they have no agency over their environment, their physical bodies tense up, and their ability to de-escalate volatile situations diminishes. The study suggests that "job control" is a protective factor against both violence and MSDs.
3. Organizational Safety Culture
A culture that ignores "near-misses" or blames victims for injuries is a common denominator. When safety is treated as a compliance checklist rather than a core value, both physical hazards (like a wet floor) and behavioral hazards (like verbal abuse) go unreported until a catastrophic incident occurs.
Official Responses and Expert Commentary
The release of this paper has sent ripples through the occupational health community. Industry leaders are reacting to the findings with a mixture of validation and a call to action.
"We have been looking at the pieces of the puzzle, but we haven’t been looking at the whole picture," said a representative from a leading industrial hygiene firm. "By linking violence to musculoskeletal health, the NSC and the University of Waterloo have provided the data necessary for safety directors to justify budget allocations for anti-violence programs under the guise of ergonomics and productivity."
However, the authors of the paper emphasize that this is not a "quick fix." DeBaylo and Stanley argue that organizations must move beyond generic security training. "You cannot train your way out of a broken system," they write. "If the job design is inherently stressful and physically demanding, no amount of de-escalation training will protect the employee’s muscles or their mental health."
Implications: The Path Forward
The implications of this research are profound. If workplace violence is a risk factor for MSDs, then preventing violence must become a standard component of ergonomic risk assessments.
Integrated Risk Identification
Organizations are being urged to merge their data streams. Instead of keeping "Incident Reports" (violence) and "Workers’ Compensation Claims" (ergonomic injuries) in separate silos, safety managers should look for correlations. Do departments with high verbal abuse reports also show higher rates of back pain?
Enhanced Intervention Effectiveness
Interventions must be dual-purpose. For instance:
- Environmental Design: Installing security cameras and panic buttons, but also ensuring that workstations are adjustable to reduce the physical toll of the job.
- Policy Reform: Implementing "Zero Tolerance" policies for violence, coupled with "Zero Hurriedness" policies that empower staff to take the time necessary to move patients or materials safely.
Building Healthier Work Systems
The ultimate goal, according to the researchers, is the creation of "healthier, safer work systems." This requires a top-down approach where leadership recognizes that the safety of the individual is inextricably linked to the design of the environment.
The integration of violence prevention into MSD frameworks represents a maturation of the safety industry. It acknowledges that the human worker is not just a biological machine susceptible to repetitive stress, but a social being whose physiological state is fundamentally shaped by the safety and respect afforded to them in the workplace.
Conclusion: A Holistic Future
The collaboration between the University of Waterloo and the National Safety Council serves as a wake-up call for employers across all sectors, from healthcare and retail to manufacturing and public service. The "significant but preventable" nature of these risks places the burden of proof squarely on management.
As we look toward the future of work, it is clear that physical safety cannot be divorced from behavioral safety. By acknowledging the link between the violence an employee experiences and the musculoskeletal disorders they suffer, we move closer to a standard of care that protects the whole person. The era of treating the "back" and the "mind" as separate entities is ending; in its place, a more holistic, integrated approach to occupational health must emerge—one that recognizes that a truly safe workplace is one where both the body and the psyche are protected from the outset.
For safety professionals, the directive is clear: expand the scope of the risk assessment, engage with the reality of workplace culture, and recognize that in the modern workplace, the most dangerous hazard might just be the one we’ve been ignoring.
