Musculoskeletal symptoms were reported by 215 fishermen followed at 6-month intervals over 18 months. Exposure information was collected through field observation and in-depth ethnographic interviews allowing potential ergonomic stressors to be identified and catalogued by task and stage of work. Symptoms causing work interference in the last 12 months were reported by 38.5% of the cohort at baseline. Low back symptoms were the most common cause of work impairment (17.7%), followed equally by pain in the hands or wrists and shoulders (7%). Symptoms in any body region were more likely to have been reported among individuals who did not fish full-time and those who worked other jobs part or all year had significantly lower symptom prevalence; both likely reflect a healthy worker effect. A number of ergonomic stressors were identified in all stages of fishing with exposure variability dictated by some unpredictable factors such as weather; but also by type of boat, gear, crew size, and level of experience. Reducing ergonomic exposures associated with work among these traditional workers is important, regardless of whether they directly cause or contribute to their musculoskeletal symptoms, or aggravate existing pathology.