To investigate the long term effect of heavy construction work on the back the occurrence of postures, lifting, carrying, and accidents in concrete reinforcement work and in maintenance house painting were measured. The 32 620 observations covering 272 work hours showed that reinforcement work necessitated stooped postures and heavy lifting more often than did painting. Reported minor back accidents were more than ten times as common in reinforcement work than in painting (1.3 compared with 0.11 accidents per man-year, p less than 0.001). Accidents of the musculoskeletal system, registered by the insurance companies, were also several times more common in reinforcement work (81 compared with 25 per 1000 man-years, p less than 0.001). The premature development of lumbar degeneration detected in the clinical study of the reinforcement workers was evidently due to the occupational strain on the back. The different types of hazardous back loads probably potentiate the effects of each other.