Work-related upper extremity and back injury claims across Canada from 2000–2019

Abstract

Aim: With technological advancements and altered work environments, it has been thought that the risk of low back injuries would decrease while the risk for upper extremity injuries would increase. This construct has not been investigated, with little information available on possible trade-offs in injury rates across body parts over recent decades. The objective of our work was to perform a time series analysis on low back and upper extremity workplace musculoskeletal disorders through the injury compensation claim system across Canadian provinces from 2000 to 2019.

Methods: Injury claim data across all Canadian provinces from 2000–2019 were analyzed by grouping injuries based on the nature of injury, body part, and normalized to number of workers in each province.

Results: Normalized injury claims for both low back and upper extremity injuries have decreased from 2000 to 2015 across Canada (p < 0.001), with faster declines in low back injuries (p < 0.001 to p = 0.0295 depending on nature of injury). Some Canadian provinces have seen a stagnation or slight increase in injuries since 2015. Sprains and strain injuries had the most claims for both the low back (84.8% of all claims) and upper extremity (55.6% of all claims). Tendinitis was the most common specific upper extremity injury (18.2%), followed by epicondylitis (5.3%), carpal tunnel syndrome (3.3%), and rotator cuff injury (3.1%) across all of Canada with the order varying by province.

Conclusions: This study provides a comprehensive and updated look of the most prevalent musculoskeletal disorders as revealed by compensation data affecting Canadian workers over the last two decades.

Keywords

ergonomics / workplace / epidemiology / workers’ compensation / occupational injuries / musculoskeletal disorders

References

[1] International Labour Organization. Creating safe and healthy workplaces for all [Internet]. [cited 2026 Feb 18]. Available from: https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---publ/documents/publication/wcms_305423.pdf

[2] International Labour Office. Estimating the Economic Costs of Occupational Injuries and Illnesses in Developing Countries: Essential Information for Decision-Makers [Internet]. International Labour Organization; c2012 [cited 2026 Feb 4]. Available from: https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---safework/documents/publication/wcms_207690.pdf

[3] Crawford JO, Berkovic D, Erwin J, Copsey SM, Davis A, Giagloglou E, et al. Musculoskeletal health in the workplace. Best Pract Res Clin Rheumatol. 2020; 34: 101558.

[4] Keir PJ, Zuniga AF, Mulla DM, Somasundram KG. Relationships and Mechanisms Between Occupational Risk Factors and Distal Upper Extremity Disorders. Hum Factors. 2021; 63: 5-31.

[5] Gilks J, Logan R. Occupational Injuries and Diseases in Canada, 1996-2008 [Internet]. [cited 2026 Feb 27]. Available from: https://publications.gc.ca/collections/collection_2011/rhdcc-hrsdc/HS21-4-2008-eng.pdf

[6] WSIB Ontario. Healthy and safety statistics. Summary-Schedule 1 and 2 [Internet]. Workplace Safety and Insurance Board; c2026 [cited 2026 Feb 16]. Available from: https://safetycheck.onlineservices.wsib.on.ca/safetycheck/explore/provincial/SH_12?lang=en

[7] Breslin FC, Smith PM, Moore I. Examining the decline in lost-time claim rates across age groups in Ontario between 1991 and 2007. Occup Environ Med. 2011; 68: 813-7.

[8] Nowrouzi-Kia B, Baig A, Li A, Casole J, Chai E. Occupational injury trends in the Canadian workforce: An examination of the Canadian community health survey. Int J Crit Illn Inj Sci. 2019; 9: 29-35.

[9] Smith PM, Mustard CA. Examining the associations between physical work demands and work injury rates between men and women in Ontario, 1990-2000. Occup Environ Med. 2004; 61: 750-6.

[10] Tilley PM, Mulla DM, Keir PJ. Effects of sex and age on work-related upper extremity musculoskeletal disorders in Ontario, Canada. Work. 2023; 75: 1009-20.

[11] Macpherson RA, Lane TJ, Collie A, McLeod CB. Age, sex, and the changing disability burden of compensated work-related musculoskeletal disorders in Canada and Australia. BMC Public Health. 2018; 18: 758.

[12] Smith P, Hogg-Johnson S, Mustard C, Chen C, Tompa E. Comparing the risk factors associated with serious versus and less serious work-related injuries in Ontario between 1991 and 2006. Am J Ind Med. 2012; 55: 84-91.

[13] Choi BC, Levitsky M, Lloyd RD, Stones IM. Patterns and risk factors for sprains and strains in Ontario, Canada 1990: an analysis of the Workplace Health and Safety Agency data base. J Occup Environ Med. 1996; 38: 379-89.

[14] Breslin FC, Smith P, Dunn JR. An ecological study of regional variation in work injuries among young workers. BMC Public Health. 2007; 7: 91.

[15] Morassaei S, Breslin FC, Ibrahim SA, Smith PM, Mustard CA, Amick BC 3rd, et al. Geographic variation in work injuries: a multilevel analysis of individual-level data and area-level factors within Canada. Ann Epidemiol. 2013; 23: 260-6.

[16] de Kok J, Vroohnhod P, Snijders J, Roullis G, Clarke M, Peereboom K, et al. Work-related MSDs: Prevalence, costs and demographics in the EU [Internet]. European Agency for Safety and Health at Work; c2019 [cited 2026 Jan 30]. Available from: https://www.gmtconsulting.net/_resources/files/GMT-Consulting-Work-related_MSDs_prevalence_costs_and_demographics_in_the_EU_report-.pdf

[17] Govaerts R, Tassignon B, Ghillebert J, Serrien B, Bock SD, Ampe T, et al. Prevalence and incidence of work-related musculoskeletal disorders in secondary industries of 21st century Europe: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021; 22: 751.

[18] Allan DB, Waddell G. An historical perspective on low back pain and disability. Acta Orthop Scand Suppl. 1989; 234: 1-23.

[19] Pransky G, Benjamin K, Hill-Fotouhi C, Himmelstein J, Fletcher KE, Katz JN, et al. Outcomes in work-related upper extremity and low back injuries: results of a retrospective study. Am J Ind Med. 2000; 37: 400-9.

[20] National Research Council (US) and Institute of Medicine (US) Panel on Musculoskeletal Disorders and the Workplace. Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. Washington (DC): National Academies Press (US); 2001.

[21] McInnes B, Sagmeister L. Musculoskeletal disorder coding harmonization [Internet]. [cited 2026 Jan 12]. Available from: https://irp.cdn-website.com/7641940d/files/uploaded/Article_-_MSD_Data_Mapping_final_%28codes%29.pdf

[22] Zakaria D, Robertson J, MacDermid JC, Hartford K, Koval J. Estimating the population at risk for Ontario Workplace Safety and Insurance Board-covered injuries or diseases. Chronic Dis Can. 2002; 23: 17-21.

[23] Statistics Canada. Guide to the labour force survey [Internet]. [cited 2025 Dec 18]. Available from: https://www150.statcan.gc.ca/n1/pub/71-543-g/71-543-g2020001-eng.htm

[24] Mustard CA, Chambers A, Ibrahim S, Etches J, Smith P. Time trends in musculoskeletal disorders attributed to work exposures in Ontario using three independent data sources, 2004-2011. Occup Environ Med. 2015; 72: 252-7.

[25] Sorensen G, McLellan DL, Sabbath EL, Dennerlein JT, Nagler EM, Hurtado DA, et al. Integrating worksite health protection and health promotion: A conceptual model for intervention and research. Prev Med. 2016; 91: 188-96.

[26] Yassi A, Gilbert M, Cvitkovich Y. Trends in injuries, illnesses, and policies in Canadian healthcare workplaces. Can J Public Health. 2005; 96: 333-9.

[27] Breslin FC, Smith P, Mustard C, Zhao R. Young people and work injuries: an examination of jurisdictional variation within Canada. Inj Prev. 2006; 12: 105-10.

[28] Armstrong P, Evans P. What are the most distinctive jobs in your province? [Internet]. CBC/Radio-Canada; c2026 [cited 2026 Jan 19]. Available from: https://www.cbc.ca/news/business/what-are-the-most-distinctive-jobs-in-your-province-1.3084325

[29] Marcum J, Adams D. Work-related musculoskeletal disorder surveillance using the Washington state workers’ compensation system: Recent declines and patterns by industry, 1999-2013. Am J Ind Med. 2017; 60: 457-71.

[30] Stock S, Nicolakakis N, Raïq H, Messing K, Lippel K, Turcot A. Underreporting work absences for nontraumatic work-related musculoskeletal disorders to workers’ compensation: results of a 2007-2008 survey of the Québec working population. Am J Public Health. 2014; 104: e94-101.

[31] Canadian Workers’ Compensation System - 2024 Year at a Glance [Internet]. [cited 2026 Jan 29]. Available from: https://awcbc.org/en/statistics/canadian-workers-compensation-system-year-at-a-glance/