Although pushing and pulling is very common in occupational settings, this type of manual materials handling is less well studied than lifting and carrying. Several issues should be considered when obtaining exposure measures in epidemiological field studies on pushing and pulling. The purpose of this article is threefold: (i) to critically evaluate different methods to assess push and pull forces, (ii) to describe measures of exposure to pushing and pulling, and (iii) to consider measurement strategies for assessment of exposure to pushing and pulling.Firstly, information on the level of exerted forces with the accuracy needed for epidemiology can only be obtained from direct measurement methods. These methods are particularly required when push and pull tasks are biomechanically analysed, implying that also force direction and point of application relative to the worker have to be assessed. Secondly, to obtain a limited number of external exposure measures that reflect exposure to pushing and pulling over time, aggregation of various force measurements is suggested. Internal exposure measures and parameters corresponding to guidelines are also described. Thirdly, for truck drivers and refuse collectors a strategy of approximately five repeated measurements for each representative working situation is advised to obtain a reliable estimate of an individual's exposure to pushing and pulling.Relevance to industryAn overview is given of methods to assess forces accompanying pushing and pulling, which are very common activities in industry. Examples of exposure measures and measurement strategies in studies on adverse health effects of pushing and pulling are presented. Such studies should eventually stimulate prevention of work-related musculoskeletal disorders. Copyright (C) 1999 Elsevier Science B.V.