Musculoskeletal injuries, often called MSIs, are among the most common injuries in long-term care and home support. They include soft tissue injuries such as sprains and strains that can affect muscles, tendons, ligaments, joints, nerves, and blood vessels.
In continuing care, MSIs often happen during the work that defines the job: helping residents and clients transfer, reposition, toilet, bathe, dress, and move safely. They can also affect workers in other roles, including laundry, food services, housekeeping, maintenance, and janitorial services.
Preventing MSIs takes more than careful body mechanics. It depends on safe work practices, appropriate equipment, effective care planning, risk assessment, training, reporting, and organizational support.
Why MSIs happen in continuing care
Care work can involve repeated physical demands throughout a shift. Workers may need to support a resident or client who has limited mobility, respond to a sudden change in behaviour or strength, work in a tight space, or adjust quickly when a task does not go as planned.
Common MSI risk factors include:
- Bending, twisting, reaching, pushing, and pulling
- Limited space to move or use equipment safely
- Equipment that is not available, not working, or not the right fit for the person or task
- Time pressure, high workload, or limited staffing support
- Limited training or unclear procedures
- Changes in a resident’s or client’s mobility, cognition, strength, or behaviour
- Hesitation to report hazards, near misses, discomfort, or early symptoms
Some MSIs happen suddenly. Others build over time when physical stress is repeated without enough control, support, or recovery.
Tasks that can increase MSI risk
MSI risk can show up in many parts of the workday. Common high-risk tasks include:
- Repositioning residents or clients in bed
- Helping a resident or client move from bed to wheelchair
- Chair-to-toilet transfers
- Providing peri-care or personal care in bed
- Repositioning residents or clients in wheelchairs
- Bathing and showering support
- Assisting someone who is losing balance or beginning to fall
- Pushing and pulling laundry carts, meal carts, supply carts, and equipment
- Handling supplies, linens, food service items, or waste
- Working in rooms, bathrooms, hallways, or homes where space is limited
These tasks are not risky because workers are careless. They are risky because the physical demands are real, repeated, and often affected by the environment, equipment, staffing, and the resident or client’s condition.
MSI prevention is a shared responsibility
MSI prevention works best when employers, leaders, workers, and Joint Occupational Health and Safety Committees work together.
Employers are responsible for identifying tasks and activities that may put workers at risk of an MSI, assessing those risks, and putting controls in place to eliminate or reduce the risk. Our hierarchy of controls resources for long-term care and home care both highlight the need to assess resident or client handling tasks, involve workers and the JOHS Committee, and apply the most effective controls first.
Workers play an important role by following care plans and safe work procedures, using available equipment, completing point of care risk assessments, reporting hazards, and speaking up when a task becomes unsafe.
A strong prevention program needs both: systems that make safe work possible, and daily practices that help workers respond to real conditions at the point of care.
What employers and leaders can do
Employers and leaders can help prevent MSIs by building prevention into how work is planned, staffed, equipped, taught, and followed up.
Practical actions include:
- Identify tasks and activities that may expose workers to MSI risk.
- Complete MSI risk assessments for tasks and work areas.
- Consult workers who do the work, workers who report MSI signs or symptoms, and the JOHS Committee.
- Use the hierarchy of controls to select the most effective controls available.
- Make sure safe handling policies and procedures are clear and current.
- Provide access to appropriate mechanical lifts, sit-to-stand devices, transfer belts, slide sheets, and other assistive devices.
- Make sure equipment is inspected, maintained, available, and appropriate for the task.
- Support point of care risk assessments before transfers, repositioning, bathing, and other handling tasks.
- Provide practical education and refresher training.
- Make it easy to report hazards, near misses, discomfort, and early symptoms.
- Review incident and near-miss reports to identify patterns.
- Support rest breaks, task variation, and recovery where possible.
- Follow up when workers raise concerns about equipment, staffing, space, workload, or unsafe conditions.
Controls should not rely only on workers “being careful.” Safer systems reduce the need for force, awkward posture, manual lifting, and repeated strain.
Use the hierarchy of controls
The hierarchy of controls helps workplaces choose stronger prevention measures first. In safe resident and client handling, controls may include eliminating unnecessary transfers, using equipment to reduce manual handling, changing the layout of a space, improving procedures, and providing training.
Examples include:
- Encouraging resident or client self-mobilization when it is safe and appropriate
- Using dual-purpose equipment to reduce the number of transfers
- Using mechanical lifts, sit-to-stand lifts, ceiling lifts, and floor lifts
- Using non-mechanical aids such as slide sheets, transfer boards, bed ladders, or trapeze ladders
- Installing height-adjustable beds, grab bars, railings, or other lift-assist devices
- Removing obstacles so equipment can be used safely
- Developing safe handling policies and procedures
- Providing training and refreshers
- Using buddy systems or team-based approaches when tasks require more than one worker
- Reporting and investigating incidents and near misses
Personal protective equipment may be needed for infection prevention or other hazards, but it is the least effective control for MSI risk. MSI prevention should focus first on eliminating or reducing the physical demands of the task.
What workers can do before and during care
Before starting a task, take a moment to check the care plan, the person’s current condition, the space, and the equipment needed. A point of care risk assessment is a quick check that helps workers decide whether it is safe to proceed, whether the task needs to be changed, or whether help is needed.
Check out our transfer huddle to learn how to apply the steps of a point of care risk assessment, decide if it is safe to transfer the person in care, and know what to do if it is not safe.
Workers can reduce MSI risk by:
- Reviewing the resident’s or client’s care plan and mobility status.
- Checking for changes in strength, balance, alertness, cognition, pain, or behaviour.
- Looking for hazards in the environment, such as clutter, poor lighting, wet floors, limited space, or equipment in the wrong place.
- Gathering the right equipment before starting.
- Making sure enough help is available when the task requires more than one worker.
- Using mechanical lifts, ceiling lifts, sit-to-stand devices, transfer belts, slide sheets, and other assistive devices when required.
- Inspecting equipment before use and reporting defects.
- Avoiding manual lifting when mechanical assistance is available and appropriate.
- Adjusting bed, chair, and work surface heights to reduce bending and reaching.
- Keeping loads close to the body.
- Avoiding twisting while lifting, pushing, pulling, or carrying.
- Following approved transfer and repositioning techniques.
- Asking for help when a task exceeds their capability or becomes unsafe.
- Stopping and seeking assistance if conditions change.
- Reporting equipment issues, environmental hazards, and unsafe conditions.
- Reporting discomfort or early symptoms before they become more serious.
Point of care risk assessment: pause, check, decide
A point of care risk assessment does not replace the care plan. It helps confirm whether the care plan still matches what is happening in the moment.
Before a transfer, repositioning task, shower, or other handling activity, consider:
- Has the resident’s or client’s mobility changed?
- Are they more tired, weak, dizzy, drowsy, anxious, or unsteady than usual?
- Is the space ready for the task?
- Is the right equipment available and working?
- Is the equipment positioned correctly?
- Is another worker needed?
- Could the task be delayed, changed, or done another way?
If it is not safe, stop and follow your workplace procedure. That may mean asking for help, using different equipment, updating the care team, reporting a hazard, or reassessing the care approach.
Our showering huddle also reinforces the value of point of care assessments before care tasks, especially when the environment may create added risk, such as limited space, awkward reach, or difficult equipment positioning.
Reporting early helps prevent more serious injury
Early signs of an MSI can include soreness, stiffness, numbness, tingling, weakness, swelling, reduced range of motion, or pain that continues after work. These symptoms should not be ignored.
Reporting early helps workers get support sooner. It also helps employers identify hazards before more workers are injured.
Workers should report:
- Pain, discomfort, or early symptoms
- Equipment that is missing, damaged, poorly fitted, or hard to access
- Tasks that regularly require awkward posture or force
- Spaces that make safe handling difficult
- Changes in resident or client mobility or behaviour that affect safe handling
- Near misses and unsafe conditions
Leaders can support early reporting by responding without blame, following up quickly, and using reports to improve equipment, procedures, training, staffing, and care planning.
MSIs affect workers, teams, and quality of care
An MSI can affect a worker’s health, income, mobility, home life, and ability to keep doing the work they care about. It can also affect the whole workplace.
When MSI injuries increase, organizations may face higher claims costs, higher WorkSafeBC premiums, staffing shortages, increased workload, fatigue, and stress among remaining workers. These pressures can create conditions where further injuries are more likely and where care quality may be affected.
Prevention helps protect workers and supports safer, more stable care for residents and clients.
