When too much hurts: Repetitive stress injuries

During writing-intensive weeks such as midterm period, students often spend hours at their computers, fixed in their chairs, eyes steady at the screen, hands plucking at tiny key pads. Each motion, each minute spent at this task is effortless.

But it is the accumulation of hours or even years of this same motion that leads to health problems generally classified as repetitive strain injuries.

RSI is an umbrella term for numerous conditions caused by overuse of the hand and arm. The repetitive movements and strain-inducing positions damage delicate tendons, muscles, joints and nerves in the arm, elbow, wrist and fingers. The pain and discomfort associated with the injury is the body's plea to stop the abuse.

Tendinitis is the most common problem associated with computer overuse. Typing causes continuous friction, and tiny tears in tendon tissue may lead to inflammation, causing tendinitis, which manifests itself in localized pain in the elbow, arm, and wrist.

A more serious condition, carpal tunnel syndrome, occurs far less frequently among computer users. Excessive up-and-down wrist and finger movements in striking keyboard keys irritate the lining of the carpal tunnel, a tiny rigid corridor just below the wrist. The swelling of the lining exerts pressure on the median nerve that passes through the tunnel, causing numbness and tingling in the thumb and first three fingers of the hand.

Treatments of these and other related ailments may include anti-inflammatory medicine to relieve pain and swelling, as well as extensive physical therapy to regain strength and learn proper work techniques.

Above all, however, RSI is a lifestyle and occupational injury; complete treatment should aim to modify the habits that caused the problems in the first place. Proper posture, correct typing techniques and ergonomic work station setup are crucial in minimizing pain and decreasing the risk for further injury.

According to Dr. Emil Pascarelli's "Repetitive Strain Injury: A Computer User's Guide," good posture at the computer means finding a dynamic neutral position for all the muscle groups to prevent straining in an uncomfortable position.

"You've got to be loose," suggested Leslie Bridgen, director of occupational medicine at McCosh Health Services.

The proper work station setup is also crucial in reducing strain. The monitor should be slightly below eye level, and the keyboard height should allow elbows to bend at about 90 degrees. Legs should also be at a 90 degree angle, with the feet flat on the floor.

The traditional computer keyboard contains several design flaws. Ergonomic keyboards attempt to force the wrists in a more natural, neutral position. However, the jury is still out on their effectiveness.

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"The fundamental problem with ergonomics is that the science is not good," said Garth Walters, University environmental health and safety office director. "No one has done scientifically rigorous testing to determine the best product."

Stretching, exercising and taking frequent breaks also go a long way in relieving muscle tension build-up, preventing the body against locking up in an unhealthy position. Doctors recommend taking breaks every 20 minutes. "Stretch, move," Bridgen said. "Get your blood supply going."

Even so, the most stringent precautions may be ineffective. "If you set up everything properly, you minimize the risk, and the key word is minimize" said Greg Cantrell, a safety engineer with the environmental health and safety office.

All else equal, some people will get hurt, and others will escape injury under the most egregious ergonomic conditions.

"The person's anatomy is so important in this," Bridgen said, explaining that people's bones and muscles may be naturally built in a way that makes them particularly susceptible to injury.

At the University, computer-related injuries are not as widespread as in production-oriented environments, but do cause concern among employees and students.

For employees — who account for most of the cases of RSI at the University — the environmental health and safety office monitors the ergonomics of workstation setup and offers purchasing of ergonomically sound furniture. Educational programs are conducted throughout the year, and employees with complaints are referred to the occupational health office at McCosh.

The resources for students are limited, however, partially because of the relatively low number of occurrences among students. According to Steves, RSIs among students are uncommon, but account for "one of the top five reasons" students are referred to his office.

"Students' bodies are agile, they're exercising, they're healthy," said Bridgen. "These are problems that will begin to develop when you're 30," she added, underscoring the need for forming healthy habits early on.

Students do get hurt, however, especially during midterms and reading period. "I wish I'd known how serious the injury could be," said one injured student, who asked to remain anonymous. "I should have stopped typing as soon as I felt the pain."

Students are advised to go to McCosh if they feel pain in their arms or hands even after discontinuing use of a computer. Once hurt, RSI sufferers are extremely sensitive to flaws in the workstation setup. According to several injured students, the setup at computer clusters around campus is often inadequate, and there seem to be no readily available resources to address the students' concerns. Associate provost Joan Mitchell — who is responsible for dealing with students with disabilities — noted that a Firestone Library resource room contains computers equipped with dictation software for students with injuries such as RSI.

To increase awareness of the problem among students, Steves is initiating a series of information sessions. The first session, which was conducted last week at the Graduate College, was aimed at graduate students, who are more likely to experience RSI-related problems.

Steves plans to spread the program to residential colleges. "This is one of the easier problems to prevent if you're more educated," said Steves. He acknowledged the difficulty of correcting the problem, however. "You've got a habit, you've got a lot of work. These are things that are tough to change," he explained.

Steves urged students to take a break. "If you're injured playing a sport, that's random," he said. "But you have control over how much work you do at a time."