March 31, 1996

Growing Problems with Repetitive Stress Injuries

CAREERS / By SABRA CHARTRAND

A couple of years ago, Ben & Jerry's Homemade, Inc. stopped selling its popular brownie ice-cream sandwich because the technique for making the goodie was giving its workers repetitive stress injuries.

Aches, pains and injuries to the hands, wrists, arms, neck and back from doing the same task over and over again afflict people doing many kinds of work -- cashiers manning checkout scanners, seamstresses turning spooling cranks, concert pianists practicing music, even sign-language translators gesturing to theater audiences. But it is computers and their keyboards that have turned repetitive stress injuries like tendinitis and carpal tunnel syndrome from little known ailments into the No. 1 job-related illness in the country in the last decade.

The Occupational Safety and Health Administration estimates that 100 million people suffer from varying degrees of repetitive stress injury, or RSI. With 40 million people working at computers -- that's 40 percent of the American workforce -- injuries from typing, clicking mice and striking command keys have skyrocketed.

In 1994, the National Council on Compensation Insurance Inc. said that workers' compensation claims from RSI had increased 770 percent since 1984, with each claim costing an average of $43,000. One primary cause seems to be sitting motionless at a desk, shoulders and arms at awkward angles, fingers flying over and over again across the same keys.

Now, with more people spending time on line, browsing the World Wide Web, working from home, creating consulting careers and entering jobs with titles like webmaster and content developer, there is added reason for everyone who uses a computer to be aware of RSI.

Does that mean the Internet is hazardous to your health? Only if you don't know what can cause RSI and how to avoid it, or how to recognize and respond to its signs are if you already feel its twinges.

In the 1960's, when the concert pianist Leon Fleisher first felt crippling pain in his right hand during eight-hour practice sessions, he drove himself to practice harder in an attempt to overcome it. That was probably the worst thing he could have done, and as a result he was forced to give up playing for years.

Fortunately, the Web itself is a resource for information about RSI. Institutions devoted to studying the disorder and a number of people who suffer from it have set up sites loaded with advice and information.

Just what is RSI?

For many people who work at keyboards, it often begins with a dull ache in the wrists or forearms. Pain, stiffening and numbing can spread to their hands and fingers. Suddenly, they find themselves stopping work to massage their wrists or arms.

Many are people who work with the latest in keyboard designs -- flat panels with light-touch keys that allow users to type at dizzying speeds with the greatest of ease. At the same time, they may be using a keyboard that is too high or too low, or they might be sitting in a chair that offers inadequate support. Finally, they don't take enough breaks during the work day.

So what might at first seem to be simple fatigue or temporary strain may actually be damage to tendons, nerves or muscles from repeated physical movements. Loss of strength and dexterity can set in. Pain can become debilitating and persist long after work is finished.

The Bureau of Labor Statistics places such injuries in a category called workplace illnesses, that is, afflictions brought on by continuous exposure to workplace hazards. In 1993, 482,000 such illnesses were reported, and 302,000 were repetitive motion or strain disorders. That's 60 percent of such illnesses.

At the same time, there were 6.3 million job-related injuries in 1993 -- accidents and the like. So RSI amounts to only about 4 percent of the overall number. But it continues to increase dramatically.

There is no established scientific link between RSI and computers or keyboards In fact, in 1995, IBM was cleared in a lawsuit brought by a secretary who charged that the company's keyboard had contributed to her RSI. IBM argued that regular rest breaks and careful placement of the keyboard can prevent RSI, and that no one could prove that the secretary's injuries did not result from other of her habits.

But, in fact, there is no ideal office set-up, either. Each person's desk, chair and computer has to be adaptable to their body needs and work requirements. Employees have to know how to adjust chairs and keyboard heights, to assess small traumas to their wrists or fingers and, above all, to arrange their work so they can move around easily and frequently.

The discipline covering all these factors is ergonomics, the science of assessing the anatomic, physiological and mechanical principles affecting the use of human energy at work. Within the field, designers are working to create desks, chairs, computers, keyboards and office systems to best suit workers' physical needs.

Many large corporations now have "ergonomists" on staff. Insurance companies have ergonomic services departments, and universities have ergonomics laboratories. Yet while "ergonomically correct" is a term heard frequently in offices these days, there is no universal standard of what it means.

So companies require employees to complete RSI prevention courses, they hire physical medicine and rehabilitation specialists, and they examine a dizzying array of split keyboards, wrist supports or pads, computer foot pedals and weirdly configured chairs.

Though it takes some experimentation to get chair heights adjusted properly, to configure monitors and keyboards, and to correct posture and movement, there are basic principles involved:

Adjust chair height so thighs are parallel to the floor.

Adjust keyboard height so forearms are parallel to the floor.

Don't rest wrists on the desk. Keep them parallel to the floor and in a straight line with elbows. Don't bend wrists.

Use arms to move hands around to reach keys instead of reaching around with fingers.

Sit straight and avoid leaning forward to reach the keyboard.

Treatment for RSI runs the gamut from rest and exercise to braces, anti-inflammatory drugs, cortisone and surgery. In the end, however, the recommended steps for preventing RSI are pretty straightforward: take frequent breaks from the keyboard, stretch and move around, and avoid repeating the same tasks for hours at a time.

More information is available at the following Web sites. Just be careful not to bring on a bout of RSI while doing your research:

Computer Related Repetitive Strain Injury. Put together by Paul Marxhausen, an engineering electronics technician at the University of Nebraska-Lincoln who suffers from RSI, this page is a good starting place for anyone seeking basic information about RSI. It defines different kinds of RSI, gives details of symptoms and offers tips for treatment with diagrams of proper posture and wrist placement. It also suggests books to read for further information and has links to other RSI-related sites.

Typing Injury FAQ. A home page constructed and maintained by a Princeton graduate student, Dan Wallach, who offers general information about typing injuries, an archive of medical documents, alternatives to keyboards and mice, and suggestions about office furniture.

Stretch Breaks. Part of the University of Virginia site, this page offers stretches you can do for hands, shoulders, forearms and wrists to break up work sessions and prevent RSI. Pictures accompany the instructions.

Carpal Tunnel Syndrome Home Page. Maintained by Metro Smallwares, the creator of a prevention system for carpal tunnel syndrome, one form of RSI, this site offers a useful patient's guide to the anatomy of the wrist and hand, and to the diagnosis, treatment and prevention of the syndrome.

Index of Occupational Safety and Health Resources. A clearinghouse for sites that deal with workplace safety. Click on "ergonomics/human factors" to get links to RSI home pages, corporate ergonomic sites, ergonomic societies and sites like Occupational Overuse, Office Working Postures and Computer-Related Repetitive Strain Injuries.

Seton On-Line Workplace Safety Maintained by Seton Identification Products, this site offers information about identifying and preventing RSI, as well as research being conducted on carpal tunnel syndrome. It also provides links to other RSI-related sites.

ErgoWeb. The University of Utah's offering of ergonomic standards and guidelines, case studies, worksite analysis and information resources.