Computer Advocacy Computer Advocacy[Ed: Links to web pages and/or e-mail addresses which have become inactive since the publication of this article have been enclosed in curly brackets { }. Replacement links have been provided where possible.]
Although Repetitive Strain Injuries (RSIs) are the fastest growing industrial injury in America, they are commonly misunderstood. Carpal tunnel syndrome, relatively easy to describe and illustrate, is often the only RSI clearly described in media reports about these injuries. As a result, many people believe that RSI and carpal tunnel syndrome are interchangeable. However, repetitive strain injury is an umbrella term that covers many musculoskeletal injuries caused by repetitive stress or cumulative trauma; carpal tunnel syndrome is but one possible diagnosis. Other injuries include cubital and radial tunnel syndromes, tendonitis, thoracic outlet syndrome (vascular or neurogenic), DeQuervain's syndrome, tenosynivitis and vision problems, to name a few.
The media has done a disservice by emphasizing carpal tunnel syndrome to the near exclusion of other injuries. When other symptoms are not recognized as a sign of RSI, accurate diagnosis and medical treatment are often not sought until problems become acute. Many doctors prefer the term Cumulative Trauma Disorder (CTD), since repetitive stress may not be the only cause of the injury, whereas all are cumulative over time.
These injuries are notable in that they are counterintuitive. In the early stages, when discomfort subsides with rest, the injury has not healed, as the victim may assume, but is simply lurking below the threshold of pain. The injury may seem to be caused by an incident that triggers pain. However, the causes are multifactorial and pain is not always the first indication of their presence. Early, often unidentified symptoms may include generalized or specific fatigue (such as if your arms feel heavy), clumsiness due to loss of grip sensation, and headaches. Numbness, tingling and intermittent pain may follow. Avoiding or denying symptoms is dangerous, since injuries left untreated may progress to chronic pain and permanent damage. Early intervention, treatment and changes in working conditions and processes can minimize or prevent disability.
The importance of furniture arrangement is often discounted or not even considered. A properly sized, adjustable and well-designed chair is essential in maintaining proper posture and alignment. Bad chairs may also contribute to lower back problems and poor circulation in the legs, if a poorly angled seat pan is causing pressure. Computers are often placed on desks designed for writing, which are too high for keyboard use and sometimes too narrow to put the monitor far enough away.
The monitor should be approximately an arm's length (18 to 20 inches) away and directly in front of the keyboard to prevent neck problems. The keyboard and mouse should be at the same level. It is important when purchasing a keyboard tray to get one wide enough for the mouse, with height and tilt adjustments. Research indicates that arms should be at an angle of 90 to 110 degrees, with forearms parallel to the floor or slightly angled down. A keyboard tray with a negative tilt can assist in maintaining a neutral position of arm, wrist and hand in alignment during typing. This prevents pressure and uses the larger muscles of the arm rather than smaller hand muscles. Avoid resting wrists on a pad or desk edge while typing; use a wrist rest only when resting. If hands and arms are so tired that they cannot hold position, it is an indication of a problem.
Laptops are often used in awkward positions in makeshift spaces—on trains, planes and tabletops meant for other purposes, adding to the injury rate.
Lighting, glare and temperature can also contribute to injuries when the workplace is poorly designed. Most overhead lighting, including fluorescent, is designed for writing on paper, not working with a computer screen, and is often too bright. Overhead lights should be adjustable, using a full range slider. An alternative is to use dimmer overhead lights with adjustable workstation lamps. Reflection and glare on the screen contribute to vision problems. Temperature comfort is also important; muscles tighten and tense in the cold, encouraging stress and injury.
One size does not fit all, and equipment that is not adjusted for the individual can contribute to injury. Badly designed workstations can contribute to poor or awkward posture, which increases static load on the body. Take frequent breaks, drink plenty of water to prevent dehydration and vary work tasks to help prevent physical stress and contribute to overall improved productivity. Injury is more likely to occur when you are fatigued. When evaluating tools or equipment labeled "ergonomic," it is essential to be an informed consumer. There are no legal guidelines for using this term, and simply labeling a product ergonomic doesn't make it so.
Anyone interested in using voice recognition—natural voice programs or discrete speech—should consult with a qualified speech therapist familiar with computers and voice recognition. Evaluation and training, including proper breathing and warm-up exercises, can prevent vocal strain or damage.
When seeking medical evaluation and treatment, it is essential to find a physician with both training and experience in diagnosing and treating RSI. Never assume all doctors understand these complex injuries. Many know no more than the average person and misdiagnose other injuries as carpal tunnel syndrome.
Doctors not trained in occupational medicine rarely include questions about work and work-related tasks as part of a routine medical history, and they may not recognize the source of the injuries. Conservative courses of treatment are preferred. If a doctor insists upon surgery without first trying other treatments, seek a second opinion.
Physical and occupational therapies are essential in effective treatment. Here, too, a practitioner with knowledge of RSI is necessary. Look for myofascial release training in a physical therapist. Occupational therapists may assist in evaluating work practices and activities of daily living to develop ways to minimize stress and limit the chance of reinjury.
Ergonomists, a relatively new (and still evolving) profession, assist in fitting tasks and tools to the person, both to prevent injuries and to help those already injured to work safely. Again, it is important to seek an ergonomist with experience working with computer users.
Complementary and alternative treatments have been found to be very helpful to many. Alexander and Feldenkrais techniques teach body awareness and postural alignment. Biofeedback, acupressure and acupuncture can help with muscle relaxation and stress reduction.
With repetitive strain injuries, as with any health-related condition, prevention and awareness are essential. ComputerAdvocacy maintains a basic RSI bibliography, a list of selected Internet resources and a general resources lists. These are available at {www.nyu.edu/pages/advocacy/committee/health/}. ![[ C ]](../icons/CSmFall98.gif){kind=icon}
Posted October 5,1998. Last reviewed December 6, 2006.
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