An employee searches for items in one of the corridors of an Amazon warehouse.

Carlos Jasso | Reuters

In his last letter to shareholders, Jeff Bezos, CEO of Amazon, called for a deep dive into musculoskeletal disorders, which account for approximately 40% of work-related injuries across the company and affect millions of workers worldwide in various sectors. It is often synonymous with jobs in manufacturing and places like warehouses.

Of course, from the recent union battle at an Alabama warehouse to the conditions for key employees during the pandemic, Amazon’s treatment of its employees has become a major issue. And it has been cited for a high incidence of work-related accidents in recent years, although the company has stated in the past that it also reports more work-related accidents than its peers due to a more proactive safety culture.

“If you read some of the news, you might think we don’t care about employees,” wrote Bezos in his letter released earlier this month. “In these reports, our employees are sometimes accused of being distressed souls and being treated as robots. This is incorrect. They are sophisticated and thoughtful people who have options for the workplace.”

But they also suffer from MSDs that occur on jobs that can be described as robot-like repetition. Bezos’ in-depth remarks on this workplace injury were one of the first announcements by a large company to bring wider attention to the problem, according to several experts consulted by CNBC. It is estimated that MSDs cost US companies over $ 50 billion each year, resulting in an average of 21 to 32 days of work interruption between 1997 and 2010. In addition to warehouse work at Amazon, MSD issues in meat processing and poultry factories have recently drawn attention.

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MSDs, often referred to as “ergonomic injuries,” are typically strains and sprains caused by repetitive movement, overexertion, or performing tasks in awkward positions, and include problems such as carpal tunnel syndrome and tendinitis. According to the Bureau of Labor Statistics, retail, manufacturing, and welfare jobs accounted for 50% of all MSD cases in the private sector. While they are common in factory workplaces and with first-time workers, they can also occur through exercise, desk work, and everyday use.

“MSDs are common in the type of work we do and are more likely to occur in the first six months of an employee,” wrote Bezos, adding that the company had started a program to target small groups of employees on body mechanics and safety coaching, which helped a 32% decrease in injuries between 2019 and 2020, while time as a result of injuries “decreased by more than half,” Bezos said in the latest letter. “We need to invent solutions to reduce MSDs for new hires, many of whom may be working in a physical role for the first time.”

Amazon declined to provide additional information to CNBC about its ongoing MSD efforts.

While MSD cases in the US workplace have declined over the past decade, approximately 1.71 billion people worldwide have musculoskeletal disorders, with lower back pain being the most common, the World Health Organization reported. This number is expected to increase as the population ages and grows.

“Many of these injuries are actually preventable, they’re not accidents, we can work to prevent them and make a big difference for patients,” said Anna Miller, vice chairwoman of the orthopedic surgery department and director of the orthopedic trauma department Washington University School of Medicine.

The dangers of repetitive work

While it is common for manufacturing workers to work on the repetitive assembly line, they can also occur while sitting in a home office doing remote work.

One of the biggest problems with MSDs is that there is no specific reason why they are occurring, and they can arise on the fly from a seemingly minor task like climbing stairs, says John Dony, senior director of the National Safety Council. There is little research into how they occur, why they occur, and who is most susceptible. While older workers often suffer from wear and tear, younger workers often try to overcome the risks or fail to understand the risks, Dony said.

Some studies suggest obesity, genetics, or smoking may increase the risk of MSD, but the causal link data isn’t very clear, says Andrew N. Pollak, senior vice president of clinical transformation and chief of orthopedics at the university’s medical system of Maryland.

Very limited federal funding is allocated to this research, but large companies like Amazon, which now employs over a million people, are better able to gather information to share with other companies.

“This type of research has been difficult to do in smaller companies because you just don’t have the same number of people doing the same jobs as you would with a giant like Amazon,” says Pollak.

MSDs can also lead to mental health problems for many frontline workers, and many people keep working after exposure because they need the money, Miller says.

In many service-oriented professions, workers are under pressure to keep working to make the customer happy and deal with injuries to meet the goals, says Jaimo Ahn, professor and chair of education in the Department of Orthopedic Surgery at the Health System University of Michigan.

“If you are not getting there, or if you feel that you are not where you need to be, then move on,” said Ahn.

Solving the MSD Problem

In addition to the WorkingWell coaching program, which was introduced as part of Amazon’s workplace safety efforts last year for 859,000 employees in 250 locations, Amazon is also developing automated workforce plans that use “sophisticated algorithms for rotating employees” across jobs to prevent overuse of certain muscle groups and injuries, and that started rolling out this year.

Rotation schedules are one of the easiest precautionary solutions to preventing continued use of a particular muscle, as well as teaching workers how to lift from their legs instead of their arms or back. It also helps construct a job that involves excessive bending, requires non-slip shoes, or requires workers to lift heavy objects with a partner. Some companies have already put these guidelines in place, but they are sometimes ignored or not well communicated, Dony said.

Other alternatives include automating and implementing robots or machines that can minimize hand use and help with lifting, or handheld devices that show the environment and detail the span and range of motion. Robots have historically been a point of contention for workplace injuries, in some cases because of increasing risks to human workers, including requiring workers to move too fast to keep up ergonomically. However, the company’s executives have rejected this argument.

Solving MSDs outside of Amazon, across the world of work, and for many smaller, less deep-pocketed employers, begins with assessing the risk and walking through the workspaces.

“If you don’t even assess the risk or hazard you’re exposing someone to, you’re already behind the game,” says Dony.