Accurate, reliable, and cost-effective quantification of real-time biomechanical exposures in occupational settings remains an enduring pursuit in ergonomics. Miniaturized, wireless, body-worn inertial sensors offer opportunities to directly measure vast and personalized kinematics data in both laboratory and applied settings. This review investigated the contemporary and emerging uses of wearable inertial sensing technology in occupational ergonomics research related to biomechanical exposure assessment in physical work. A review and narrative synthesis of 78 peer-reviewed studies was conducted. A conceptual framework was used for scoping and synthesizing the reviewed scientific literature. Review findings help to contextualize contributions of this emerging technology to the broader goals of reducing work-relevant musculoskeletal trauma disorders. The review made evident that despite the growing interest in wearable inertial sensing technologies for ergonomics research, its use in applied settings still lags. The review also identified differences in sensor attachment locations and methods and measures for calibration and validation, and inconsistent criteria for reporting and assessing biomechanical exposures even across studies with similar objectives. Emerging applications include combining inertial sensing with predictive modeling for obtaining cumulative exposure data, and providing real-time feedback about biomechanical work demands. The manuscript concludes with research directions for enabling inertial sensing technologies as a tool for online biomechanical exposure assessment and feedback, which has particular appeal in non-repetitive work settings.