Objectives: The aim of this study was to evaluate the potential association between occupational stress and musculoskeletal symptoms in firefighters. Material and Methods: Data were collected among Cypriot firefighters through a battery of adapted questionnaires completed anonymously. Results: A total of 430 firefighters (a response rate of 68%) completed the survey (the age range: 21–60 years). A total of 11% of firefighters reported moderate to extremely severe stress through the Copenhagen Psychosocial Questionnaire and Depression, Anxiety and Stress Scale. A total of 40% of firefighters reported musculoskeletal symptoms, the most frequent being back pain. Multivariable-adjusted logistic regression models showed that occupational stress was associated with a 50% higher risk of musculoskeletal symptoms in firefighters after adjusting for age, smoking and obesity (OR = 1.52, p = 0.04). In addition, a positive dose-response relationship was found between occupational stress and musculoskeletal symptoms. Conclusions: Occupational stress constitutes a significant risk for firefighters and is associated with higher prevalence of musculoskeletal symptoms at work. Int J Occup Med Environ Health. 2019;32(3):341–52