Prévention of MSDs and the development of empowerment
Résumé
The prevention of work-related musculoskeletal disorders' (MSDs) is a classieal object for ergonomies. Itis also, perhaps, one of the most internationalized topies in the field of occupational health and safety. Since the 1990s, the world of work has undergone sorne major evolutions. The various forms of intensification of work, widely described in the literature, have led to an 'explosion' of MSDs. What may be termed 'industrialization of services' or 'tertiarization of the industrial world' refers to a multiplication of constraints in an fields of human activity. The proportion of French workers performing their job under constraints of work rate is increasing (Arnaudo et al., 2010).Inaddition to the usual constraints of the indus trial world, one can also find constraints from the service world (quality, relations with customers and providers, audits, tailored services with low delays, etc.). In the world of services, the individualized evaluation of work imposes growing quantitative requirements that mistreat the service relation itself - and consequently mistreat its agents. MSDs today represent more than 80 per cent of occupational diseases in terms of compensations received.
In the 1980s and 1990s in France, as in other parts of the world, the dominant approaches to the prevention of MSDs focused on the biomechanics of movement, underlying pathogenic conditions in the solicitation of the body at work in terms of intensity of posture, duration, frequency and vibration.
Although these approaches are essential, they have proven to be incapable of ensuring prevention on their own, for two crucial reasons.
On the one hand, because these approaches focus on the pathogenic mobilization of the body, the possibilities they afford for transforming work situations have been restricted to designing the 'proximal means' of work (workstations and work tools) and to training workers to achieve correct gestures and postures.
On the other hand, these approaches have underestimated the multifactorial character of the pathology. Relations of the pathology with the other dimensions of mobilization at work have, since then, been noted by both practitioners and researchers (Bongers et al., 2006; National Research Council, 2001; Kausto et al., 2010; Krause et al., 2010;Van Rijn et al., 2010).Work in epidemiology has also led to a complexification of the models of MSD aetiology. These models gradually integrated other factors, which were termed psychosocial and organizational (autonomy, collective support, organization, workload, etc.). Today, the literature acknowledges the importance of driving forces for transformation, located at the level of the organization and of the design of work systems (including the design of the design process itself)