This brochure is one of a series on human resources practices and workplace accommodations for persons with disabilities edited by Susanne M. Bruyère, Ph.D., CRC, Director, Employment and Disability Institute, Cornell University ILR School. The original was written by Frank N. Morosky, M.S., P.T., the coordinator of the Cornell University Back Injury Prevention Program, Ithaca, NY. It was revised and updated in 2000, and again in 2010, by Sheryl Ulin, Ph.D., CPE, Research Investigator, The University of Michigan Center for Ergonomics. It recieved legal review in 2011 by Beth Reiter, an independent legal consultant from Ithaca, N.Y., with assistance from Sara Furguson, a Cornell University Employment and Disability Institute student research assistant

Morosky, Frank N.

Ulin, Sheryl

English

DigitalCommons@ILR

	 W W W . H R T I P S . O R G 	 1A D V A N C I N G 	 T H E 	 W O R L D 	 O F 	 W O R K w w w . h r t i p s . o r g
Any disease, injury, or significant impairment to muscles, bones, joints, and sup-
porting connective (soft) tissues is considered to be a musculoskeletal disorder 
(MSD).  Approximately 33 percent of U.S. adults are affected by musculoskeletal 
signs or symptoms, including limitation of motion or pain in a joint or extremity 
which are the leading cause of disability among individuals of working age (18 
to 64 years of age).  Annual costs of MSDs are estimated to be:
• $15-$20 billion in workers compensation costs alone
• $45-$50 billion total when including other expenses
Many people with musculoskeletal disorders are considered individuals with 
disabilities under the Americans with Disabilities Act (ADA).  An individual 
with a disability is a person who: has a physical or mental impairment that sub-
stantially limits one or more major life activities, has a record of such an impair-
ment, or is regarded as having such an impairment.  Major life activities include 
functions such as caring for oneself, performing manual tasks, walking, seeing, 
hearing, speaking, breathing, bending, communicating, and working.  Whether 
a person's impairment substantially limits a major life activity depends on its 
nature, severity, and its expected permanent or long-term impact.  If the impair-
ment is episodic in nature, it may nevertheless be classified as a disability pro-
vided that it substantially limits a major life activity when active.
Musculoskeletal disorders vary greatly in severity and degree of permanence.  
The provisions of the Americans with Disabilities Act of 1990 (ADA) do not ap-
Workplace Accommodations 
for People with 
Musculoskeletal Disorders
2 	 Workplace	Accommodations	for	People	Living	with	Musculoskeletal	Disorders
ply to every musculoskeletal disorder.  The 
ADA does not cover physical problems that 
are relatively minimal in nature and severity 
(e.g., a sprained toe or pulled muscle) or will 
heal in a short time.  
Implications of the ADA for Individuals 
with Musculoskeletal Disorders
Before the passage of the ADA, some employ-
ers attempted to screen out persons with dis-
abilities during the hiring process out of fear 
that these people represented an undue safety 
and workers' compensation risk.  Employers 
used pre-placement medical examinations to 
identify the particular disability the applicant 
had and then used this information to make 
a hiring decision.  The trouble with this ap-
proach was that the candidate had no chance 
to show the employer whether he could actu-
ally perform the job. 
 
The employment provisions of the ADA (Title 
I) protect all qualified individuals with dis-
abilities from discrimination in all employ-
ment decisions.  Specifically, employers may 
not inquire about an applicant's medical 
history before making a conditional offer of 
employment.  After a job offer is made, an 
employer may make disability-related inqui-
ries or require medical examinations as long as 
this policy is applied consistently to all enter-
ing employees in a particular job category, 
is job-related and is consistent with business 
necessity.  All medical information collected 
is confidential and must be kept in a separate 
locked file.  The employer cannot assume that 
the applicant is limited in performing the job's 
essential functions merely because he or she 
has a disability.  If the post-offer inquiry shows 
that the prospective employee will be unable 
to perform the job without posing a significant 
risk of harm to oneself or others, the employer 
cannot refuse to hire such individual unless it 
first determines that no reasonable accommo-
dation would reduce or eliminate the risk.  
What Is Reasonable Accommodation?
Reasonable accommodation is the critical 
concept in the employment provisions (Title I) 
of the ADA.  It is any modification or adjust-
ment to a job, employment practice, or work 
environment that enables a qualified indi-
vidual with a disability to participate in and 
enjoy equal employment opportunity.  The 
employer's obligation to provide a reasonable 
accommodation applies to all aspects of em-
ployment. This duty is ongoing and may arise 
any time a person's disability or job changes.  
A qualified applicant or employee cannot be 
denied an employment opportunity because of 
the need for reasonable accommodation. 
In order to determine what accommodations 
may be necessary, the employer must identify 
the essential functions of the job.  Job functions 
may be considered essential for several rea-
sons: 
1. the position exists so that the function can 
be performed;
2. a limited number of employees are avail-
able among whom the performance of the 
job function can be distributed; or
3. the function is highly specialized so that 
the incumbent in the position is hired for 
her expertise or ability to perform it.  
If the employee is otherwise qualified to per-
form a job but requires a reasonable accommo-
dation to accomplish an essential job function, 
she cannot be discriminated against in any 
aspect of the employment process.  Employers 
are not required to hire or retain any individ-
ual who poses a direct threat to the health and 
safety of himself or others, however.  Any em-
ployer who believes this to be the case bears 
the burden of proving it and also of showing 
that no reasonable accommodation can either 
eliminate that threat or reduce it to an accept-
able level.
	 W W W . H R T I P S . O R G 	 3
Employers are also not required to provide 
any accommodation that would impose an 
undue burden on their business.  The ADA 
requires that employers consider all sources 
of outside funding when assessing whether a 
particular accommodation is too costly.  This 
could include funding from outside organiza-
tions, tax credits or tax deductions.  Moreover, 
if the cost of an accommodation would im-
pose an undue burden on the employer, the 
employer must give the individual with the 
disability the opportunity to provide his or her 
own accommodation or to pay that portion 
of the cost that would otherwise constitute an 
undue burden for the employer.
What Types of Accommodations Should 
Be Considered?
Workplace changes for people with muscu-
loskeletal disabilities fall into two general 
categories: engineering accommodations and 
administrative accommodations.
Engineering accommodations include changes 
to the physical work environment and equip-
ment such as:
• Selecting the right tool for a given job.  
Tools come in many different sizes, shapes 
and capacities.  Tools should be selected 
that minimize physical stress so that 
workers don’t have to reach or bend their 
wrists; the tools don’t produce high pres-
sure on workers’ hands; and the worker 
does not become fatigued as a result of 
holding or operating the tool.  In addition 
to selecting the best tool, many accessories 
are now available to help support the tool 
and resist reaction forces.
• Providing adjustable workstations (e.g. 
work tables, keyboard trays, monitor hold-
ers and seating).  Remember that people 
differ in size and the way they do things.  
We do not expect all workers to wear the 
same size or style shoes and we should not 
expect them to all use the same size work-
station or tools.
• Utilizing lift devices such as lift tables, tilt 
tables and mechanized lift assists.  Lift 
tables bring items up off the floor and tilt 
tables reduce the horizontal reach. Both 
pieces of equipment decrease the amount 
of forward torso bending to load or unload 
work objects.
Administrative accommodations include changes 
in the manner in which work is performed 
such as:
• Periodic breaks (including micro-breaks, 
i.e. small recovery periods each work cycle 
or short breaks each hour).
• Avoiding incentive systems that discour-
age breaks.
• Education by a health care provider for 
injured workers that explains their condi-
tion and how to pace themselves to avoid 
re-injury.
• Education by supervisors and engineers 
for all workers on how to adjust work 
equipment, what to do if equipment is 
not working correctly and where to go for 
medical services.
• Worker rotation.  It is important to make 
sure that workloads on the different jobs 
vary enough to provide recovery from 
high work demands.
• Providing sufficient time for new work-
ers to learn and become accustomed to the 
physical demands of new jobs.
Utilization of these measures will not only 
make it possible for employers to meet the 
requirements of the ADA, but will also help 
prevent future injuries and disabilities and sat-
isfy present and future OSHA requirements.
Maximizing Employee Potential for 
Success
4 	 Workplace	Accommodations	for	People	Living	with	Musculoskeletal	Disorders
As with any significant change in the work 
environment, making job site accommodations 
for a disabled employee may have implica-
tions for effective labor relations.  For example, 
an assembly-line worker with a low-back 
disability is reintroduced into the workplace 
following a job-related injury.  He is able to 
return to his job because of modifications to 
his workstation that decrease the physical de-
mands of the job and help to control his symp-
toms.  Other employees with the same job title 
or union seniority, however, may want similar 
changes to their workstations to make their 
jobs less physically demanding.
The employer may feel this is a no-win situ-
ation.  Not only does she have to pay for the 
disabled employee's accommodation, she also 
faces the backlash from other workers who 
consider the accommodations a form of favor-
itism.   Employee education about the ADA 
may be helpful in this situation.  
An employer may not disclose that a particu-
lar employee has a disability or needs a rea-
sonable accommodation.  However, employees 
who have been informed about the ADA's pro-
tections in a general manner will understand 
that an employer must provide a reasonable 
accommodation that will enable an employee 
with a disability to perform the essential func-
tions of his job and thus remain a productive 
member of the workforce.  If accommodations 
are viewed in this way, there is a distinction 
between accommodating a disabled worker 
and making adjustments for able-bodied 
workers that make their jobs less physically 
demanding.  While an employer may always 
choose to make ergonomic changes that help 
to prevent worker injuries, the ADA's require-
ments extend only to qualified individuals 
with disabilities.   
If the dialogue between labor and manage-
ment concerning the obligation to accommo-
date the individual with a disability is handled 
cooperatively, other employees will come to 
understand that different people can perform 
the same job in different ways and that the 
ADA will also protect them in the event of a 
future disability.  By working closely with la-
bor to ease the assimilation of individuals with 
disabilities back into the workplace, employ-
ers can achieve a result that is beneficial to all 
involved and can create an atmosphere that 
facilitates the resolution of future conflicts.  
Employers may wish to consult experts in the 
field of labor relations and the ADA for addi-
tional guidance.
Beyond the ADA
Understandably, employers worry about the 
impact of the ADA on the cost of doing busi-
ness.  In most cases, however, accommodating 
a worker costs less than disability compensa-
tion does.  Employers, in fact, have much to 
gain by investing in ergonomic redesigns for 
the entire workplace that go beyond the intent 
of the ADA.  It has been estimated, for exam-
ple, that the proper design of manual handling 
tasks can reduce the incidence of industrial 
back disorders by up to one-third.  
Matching individuals to jobs, emphasiz-
ing employee skills and abilities rather than 
limitations, and designing work stations and 
environments that minimize the likelihood of 
injury will lead to positive outcomes benefit-
ing both employers and employees.  In ad-
dition, jobs incorporating ergonomic design 
principles will often have positive impacts on 
product quality and employee productivity.  
Joint labor-management ergonomics programs 
are effective at identifying workplace risk fac-
tors and interventions.
Resources
	 W W W . H R T I P S . O R G 	 5
If you have more specific questions about the 
ADA or musculoskeletal disorders, please con-
sult the resources listed below.
ADA Disability and Business Technical 
Assistance Center 
800.949.4232 (voice/TTY); web: www.adata.org
Equal Employment Opportunity Commission 
131 M Street, NE, Washington, D.C. 20507, 
800.669.4000 (voice) or 800.669.6820 (TTY) to 
reach EEOC field offices; for publications call 
800.669.3302 (TTY) or 800.669.3362 (voice); 
web: www.eeoc.gov
Job Accommodation Network (JAN) 
West Virginia University, P.O. Box 6080, 
Morgantown, West Virginia 26506-6080, 
telephone 800.526.7234 or 877.781.9403 (TTY); 
web: www.jan.wvu.edu
The University of Michigan Center for Ergo-
nomics: 1205 Beal Ave., IOE Building, Ann 
Arbor, MI  48109-2117, 734.763.2243 (voice); 
web: www.engin.umich.edu/dept/ioe/C4E/ 
Other Web-Based Resources
American Board of Industrial Hygiene (ABIH): 
www.abih.org
American Conference of Governmental 
Industrial Hygienist (ACGIH):
www.ACGIH.org
American Industrial Hygiene Association 
(AIHA):
www.aiha.org/index.html
Americans with Disabilities Act:
www.usdoj.gov/crt/ada/adahom1.htm
ANSI accredited Z365 Committee on Work 
Related Cumulative Trauma Disorders:
www.nsc.org/z365.htm
Board of Certification of Professional 
Ergonomics (BCPE): www.bcpe.org
Board of Certification of Safety Professionals 
(BCSP):  http://www.bcsp.org/bcsp/index.php
Ergonomics Society: www.ergonomics.org.uk
ErgoWeb Inc.: www.ergoweb.com/
FAA Human Factors Design Guide: 
www.hf.faa.gov
Human Factors and Ergonomics Society: 
www.hfes.org/
I Can Online: www.icanonline.net/
International Commission on Occupational 
Health (ICOH):  http://www.icohweb.org/
International Ergonomics Association:  
http://www.iea.cc/
Microsoft Accessibility Support: 
www.microsoft.com/enable
NAS Workshop on Musculoskeletal Injuries, 
August 20 & 21, 1998 Report: 
www.nap.edu/bookstore/index.html
National Center for Medical Rehabilitation 
Research:  
http://www.nichd.nih.gov/about/org/ncmrr/
National Institute for Occupational Safety and 
Health (NIOSH): 
www.cdc.gov/niosh/homepage.html
National Institute on Disability and 
Rehabilitation Research (NIDRR): 
www.ed.gov
National Rehabilitation Information Center:  
http://www.naric.com/
6 	 Workplace	Accommodations	for	People	Living	with	Musculoskeletal	Disorders
Occupational Safety and Health 
Administration (OSHA): www.osha.gov/
Orthopaedic Section, American Physical 
Therapy Association, Inc.:
www.orthopt.org
Rehabilitation Engineering and Assistive 
Technology Society of North America 
(RESNA): www.resna.org/
University of Michigan Rehabilitation 
Engineering Research Center, 
Ergonomic Solutions for Employment:  
http://www.med.umich.edu/rehabeng/
We Media: www.wemedia.com
	 W W W . H R T I P S . O R G 	 7
About this Brochure
This brochure is one of a series on human 
resources practices and workplace accommo-
dations for persons with disabilities edited by 
Susanne M. Bruyère, Ph.D., CRC,  Director, 
Employment and Disability Institute, Cornell 
University ILR School. 
The original was written by Frank N. Mo-
rosky, M.S., P.T., the coordinator of the Cornell 
University Back Injury Prevention Program, 
Ithaca, NY.   It was revised and updated in 
2000, and again in 2010, by Sheryl Ulin, Ph.D., 
CPE, Research Investigator, The University of 
Michigan Center for Ergonomics.
It recieved legal review in 2011 by Beth Reiter, 
an independent legal consultant from Ithaca, 
N.Y., with assistance from Sara Furguson, a 
Cornell University Employment and Disability 
Institute student research assistant.
These updates, and the development of new 
brochures, were funded by Cornell, the Na-
tional ADA Center Network, and other sup-
porters.
The full text of this brochure, and others in 
this series, can be found at www.hrtips.org. 
More information on accessibility and accom-
modation is available from the ADA National 
Network at 800.949.4232 (voice/ TTY), 
www.adata.org.
Disclaimer
This material was produced by the Employment 
and Disability Institute in the Cornell University ILR 
School.   Development of the original brochure series 
was funded by a grant from the National Institute on 
Disability and Rehabilitation Research (NIDRR) (grant 
#H133D10155).   Content updates were funded by 
NIDRR grant number H133 A110020.  However, those 
contents do not necessarily represent the policy of the 
Department of Education, and you should not assume 
endorsement by the Federal Government.  
The U.S. Equal Employment Opportunity Commission 
has reviewed it for accuracy.  However, opinions about 
the Americans with Disabilities Act (ADA) expressed 
in this material are those of the author, and do not 
necessarily reflect the viewpoint of the Commission or 
the publisher.  EEOC interpretations of the ADA are 
reflected in its ADA regulations (29 CFR Part 1630), 
Technical Assistance Manual for Title I of the Act, and 
Enforcement Guidance.  
Cornell University is authorized by NIDRR to provide 
information, materials, and technical assistance to indi-
viduals and entities that are covered by the Americans 
with Disabilities Act (ADA).  You should be aware that 
NIDRR is not responsible for enforcement of the ADA.  
The information, materials, and/or technical assistance 
are intended solely as informal guidance, and are 
neither a determination of your legal rights or responsi-
bilities under the Act, nor binding on any agency with 
enforcement responsibility under the ADA.
The Equal Employment Opportunity Commission has 
issued enforcement guidance which provides ad-
ditional clarification of various elements of the Title 
I provisions under the ADA.  Copies of the guidance 
documents are available for viewing and downloading 
from the EEOC web site at: 
http://www.eeoc.gov
	 Workplace	Accommodations	for	People	Living	with	Musculoskeletal	Disorders
Contact Information
Susanne M. Bruyère, Ph.D., CRC
Director, Employment and Disability Institute
Cornell University
ILR School
201 Dolgen Hall
Ithaca, New York 14853-3201
Voice: 607.255.7727
Fax: 607.255.2763
TTY: 607.255.2891
Email: smb23@cornell.edu
Web: www.edi.cornell.edu
To view all the brochures in this series, please visit:
www.hrtips.org


Workplace Accommodations for Persons with Musculoskeletal Disorders

This material was produced by the Employment and Disability Institute in the Cornell University ILR School. Development of the original brochure series was funded by a grant from the National Institute on Disability and Rehabilitation Research (NIDRR) (grant #H133D10155). Content updates were funded by NIDRR grant number H133 A110020. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.This brochure is one of a series on human resources practices and workplace accommodations for persons with disabilities edited by Susanne M. Bruyère, Ph.D., CRC, Director, Employment and Disability Institute, Cornell University ILR School. The original was written by Frank N. Morosky, M.S., P.T., the coordinator of the Cornell University Back Injury Prevention Program, Ithaca, NY. It was revised and updated in 2000, and again in 2010, by Sheryl Ulin, Ph.D., CPE, Research Investigator, The University of Michigan Center for Ergonomics. It recieved legal review in 2011 by Beth Reiter, an independent legal consultant from Ithaca, N.Y., with assistance from Sara Furguson, a Cornell University Employment and Disability Institute student research assistant.A93_PDF.pdf: 781 downloads, before Oct. 1, 2020

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