Value stream mapping (VSM) is a Lean tool aiming at waste reduction. Previous research suggests that the use of VSM may result in work intensification and thus an increased risk for the workers of developing work-related musculoskeletal disorders (MSD). In the current study, VSM has been developed to also consider physical exposure in the analyzed production system (ErgoVSM). As the VSM, ErgoVSM is based on a participatory approach. ErgoVSM was tested in Swedish manufacturing industry. The results suggest that ErgoVSM catalyzes change processes that include intervention proposals emphasizing ergonomics in addition to waste reduction. Thus, it seems to be usable for the intended target group of engineers. The suggested performance improvements obtained by VSM seem not to be hampered by adding the ergonomics complement. However, the use of ErgoVSM is somewhat more time-consuming than the use of VSM. In conclusion, ErgoVSM may be suggested as a feasible tool to be used by production planners for including ergonomics considerations in the rationalization process.