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Repetitive Strain Injury (RSI)
….insidiously creeps in through the back door whilst we are busy guarding the front
Work related aches and pains which can affect hand, wrist, arms, shoulders and neck as well as the back, resulting in pain, tenderness, swelling, feeling of heat, numbness, loss of strength – to name but a few – are estimated to hit over a million people a year in Great Britain. Known to experts as World Related Musculoskeletal Disorders (WRMSDs) or World Related Upper Limb Disorders (WRULDs) they are, according to the Health and Safety Executive, costing society billions of pounds.
I prefer to use the term RSI instead of WRMSD or WRULD because I want to emphasise that these are injuries, which can be avoided and, if caught early, treated successfully. The key is prevention, that is, never allowing the condition to become chronic because should it do so, it can take a very long time to become manageable and may even lead to long term disability.
Both prevention and treatment of RSI requires a multifaceted approach and both employers and employees need to take equal responsibility towards preventing it. Most employers provide some semblance of ergonomically designed workstations, some better and more, than others. Ergonomically designed workstations are those that optimize human well being whilst ensuring overall system performance. Employer responsibility does not end there – they should actively ensure that their employees use these workstations correctly, because no matter how well the workstation is designed, if the operator does not use it in the appropriate manner, then RSI still remains a distinct possibility. In my opinion, having an inadequately informed user in front of an ergonomically designed workstation is the equivalent of giving a novice driver with little driving experience the use of a Ferrari – he will end up injuring himself. For their part, employees cannot look to blame the employers if they behave irresponsibly whist using the workstation – it is to their benefit to comply with the instructions provided by the employer and remain vigilant to the early signs of RSI, otherwise the loss of earnings, the inability to work and unrelenting pain are very real possibilities.
So what causes RSI in users of workstations?
Broadly speaking, long uninterrupted stints of repetitive work, bad posture, extended periods in sedentary positions and on-going stress are the main contributors to RSI. A typical scenario would be an individual who sits at the workstation with prolonged static posture of the back, neck and head coupled with awkward positioning of the hands and wrists, slumped shoulders and forward jutting head, and working with high workloads to tight deadlines. This is not an uncommon occurrence and tends to be the norm rather than the exception.
Why is RSI insidious?
It is an irony that whilst we are now more aware of what constitutes good health – we are eating better food, taking more exercise – the incidence of RSI continues to rise. This is because it creeps up on us without our realising its seriousness. It may start with only an ache in the arm, or a bit of tightness in the neck. People ignore these ‘niggles’, paying more attention to their deadlines, and putting these minor aches and pains down to "stress", a widely used term that is unquantifiable and somewhat ambiguous. RSI can also be camouflaged when there are other more demanding musculoskeletal problems e.g. back pain (chances are the back pain may be a part of the RSI syndrome).
Herein lies the problem – as these ‘minor’ upper body aches & pains are ignored, their cause remains unidentified, leading to more chronic problems, which do not lend themselves to easy rectification, and can lead to long term disability. Seeing the postings on RSI forums confirms this sorry state.
So what is the solution?
Companies, big and small, need to take a much more proactive role in the prevention of RSI. Measures can be introduced at every operational stage to provide a cohesive and consistent programme. Such measures can range from encouraging attendees at meetings to get up, walk about and do some stretches after 30mins or so, to having a formal and well established Workstation Protocol© that every employee is familiar with and encouraged to use. The Protocol cannot be onerous if high compliance is desired – long lists and complicated instructions are an immediate put-off. It should contain simple to follow instructions and be visible all the time.
Included in this protocol should be instructions on
Ø setting up workstations correctly
Ø appropriate use of keyboard & mouse
Ø importance of taking breaks, drinking water, looking after eyes
Ø maintaining correct posture
Ø stretches to be done regularly during the day
Ø recognising the early signs of RSI
It is not enough to give paper/electronic instructions to employees and expect them to dutifully comply – this is simply the Employer discharging his minimum responsibility. In order to keep RSI in constant focus, specialist Trainers/Practitioners should be invited to give regular presentations and workshops. Different approaches to RSI are refreshing and help to consolidate the message. For example, Healthcare Practitioners, Alexander Technique teachers, Stress Management Personnel and Counsellors should all work together to raise the awareness and impact of RSI. After all, one wouldn’t give a learner driver a manual and expect him/her to pass the driving test with no instruction, so why should Workstation Protocol© be any different? The computer is a piece of machinery – forgive the obvious statement – and to use it safely, people need proper instructions. A lot of people have no idea how to stretch correctly and the benefits of stretching.
Treatment for RSI
As discussed above, RSI often gets ignored until the symptoms become chronic. Users of workstations should be vigilant about early warning signs and act to deal with them. Early intervention is an absolute imperative for recovery to have a chance. Workstations need to be reassessed to ensure they are compliant with HSE guidelines. Aspects of the workload and workstation habits need to be evaluated to assess their impact on the worker, and changed to accommodate the worker.
Should these simple measures not be sufficient, employers should know of practitioners in their area specialising in the treatment of RSI. Unfortunately, RSI still does not merit a specialism in main stream medicine in the UK, so its diagnosis and treatment by the various teams remains piecemeal. Sufferers are going to India and the USA for treatment of their RSI.
Prescribing analgesics does little to correct the cause and can often lead to the condition worsening, as the sufferer is lulled into a false sense of recovery. Just because a patient does not test positive on the nerve and muscle tests does not mean they are clear of RSI: this is a multifaceted beast whose presentation is diffuse and illusive, a little like Lupus and ME to mention two. But unlike these conditions, a thorough investigation of the individual’s condition to include provision of alternative keyboards and mice; body areas affected, posture, diet & stress, followed by appropriate treatment consisting of deep tissue massage, myofascial release, realignment, mobilisation, postural correction, stretching and strengthening of the muscles involved could lead to substantial abatement of the symptoms. This recovery can be further enhanced and consolidated by equipping the sufferer with tools to manage their workload, stress and workstations.
To conclude, RSI is an insidious and dangerous condition. To keep it at bay we need to change our mindsets. We need to recognise the dangers of misusing our workstations and the benefits of having a Workstation Protocol©. Both employers and employees must take responsibility and work to reduce the risks, and specialist practitioners need to work as a team in the prevention and treatment of RSI.
No one is immune to the dangers of RSI – MDs and CEOs should lead the way by recognising the dangers of ignoring this beast and work to raise awareness within their organisations. Otherwise, the cost, financially as well as in terms of human suffering, is set to increase greatly.
About Diksha Chakravarti
Diksha Chakravarti is the Director of Fixme Ltd (www.fixme.org.uk), based in Reading, Berkshire. She has been a Massage Practitioner & Bodyworker for 10years with qualifications in Deep Tissue, Sports, No Hands & Holistic Medical Massage; Myofascial Release; McTimoney Chiropractic & Reiki. Recently Diksha has seen an increase in the number of RSI related disorders. Her current initiative is to raise the awareness to the dangers of unattended RSI and improve the quality of treatment available for sufferers. She has a Certificate of Competence in Essential Ergonomics (M203) from the British Occupational Hygiene Society
Diksha can be contacted on (0118) 9261464 / 07878 148 229
Email: diksha@fixme.org.uk
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