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November 19, 1999
RSI: The Silent Debilitator
By Matt Villano

After 27 years as an interpreter for the deaf, Jane Margules can no longer grasp her morning cup of coffee. Ordinary tasks such as tying her sneakers or buttoning a blouse are difficult and frustrating. For Margules, 46, the work she loved resulted in a debilitating injury of the hands -- an injury she says has changed her life forever.

Margules is one of the thousands of Americans who suffer from repetitive strain injury (RSI), a collective term that refers to ailments that afflict the nerves, muscles, and tendons in a person's upper extremities. When a person contracts RSI, tissues that would normally be able to withstand the everyday stresses of work activity lose their ability to endure. Over time, repeated exposure to this work-related stress can cause the tissues to become scarred. The resulting pain can be excruciating, frustrating, and debilitating.

Because hands and arms are an essential part of most human labor, nearly everyone is at risk of contracting some form of RSI. Dr. Robin Herbert, occupational medicine physician and codirector of the Mount Sinai Center for Occupational Medicine, in New York, lists the specific risk factors associated with the illness as follows: repetitive work, keeping the body in the same position for prolonged periods, and performing forceful movements. "These disorders are preventable," says Dr. Herbert, "but by the time most people realize they are injured, irreversible damage has already occurred."

Illustration: RSI

Without treatment, RSI progresses with everyday movements. "Many sufferers continue to get worse until they find a physician with enough understanding about the complexities of the disease to diagnose and prescribe helpful treatment," notes author and RSI sufferer Deborah Quilter in her book The Repetitive Injury Strain Book (Walker and Co., 1998). In her book, Quilter has assembled resources and advice from leading RSI experts, including Robert E. Markison, M.D., a hand surgeon and professor of surgery at the University of California, San Francisco.

The best way to prevent RSI is to be aware of some of the telltale symptoms, in which Quilter includes the following:

  • Weakness in the hands or forearms
  • Fatigue
  • Lack of endurance
  • Tingling, numbness, or loss of sensation
  • A feeling of heaviness in the arms
  • Frequent clumsiness
  • Difficulty opening and closing hands
  • Stiffness in hands
  • Difficulty using hands (i.e., trouble turning pages of books or magazines, twisting doorknobs or faucets, holding a coffee mug, buttoning clothing, or putting on jewelry)
  • Hands falling asleep
  • Soreness or mild to excruciating pain, which can be dull, achy, electrical, or stabbing

According to the Bureau of Labor Statistics, more than 308,000 cases of RSI were reported in 1995 -- nearly twice the number of reported cases of lung cancer (169,000) in that same year. Annual RSI figures have fallen since then, but experts say that fewer employers are reporting claims now than ever before. Why the sudden drop in reports? These injuries can hurt employers, too, accounting for more than 60 percent of all workplace illnesses and millions of dollars in workers' compensation costs every year. According to the National Institute for Occupational Safety and Health, a single case of carpal tunnel syndrome, probably the most common work-related ailment, can cost an employer more than $100,000.

Just as there is no single cause of RSI, no treatment works for everyone. "The term RSI is used to describe a variety of medical conditions, including carpal tunnel syndrome, various tendon disorders of the arm, and various neck and shoulder disorders," Dr. Herbert says, "and treatment should be tailored to the specific diagnosis." Depending on the nature and extent of the injury, a physician may prescribe physical or occupational therapy, and an RSI sufferer should make sure he or she is not aggravating the condition at work. "A critical component of all treatment is modification of the workplace exposures that lead to the disorder," Dr. Herbert says. Many sufferers also find that treatments such as acupuncture, massage, and yoga help reduce pain.

Quilter, in Repetitive Strain , confirms that "healing a case of RSI takes time, but sufferers can make remarkable recoveries." She advises that the best way to avoid the disease altogether is to take the following precautions before you experience symptoms of any kind:

  • Avoid unnecessary computer use. To minimize risk, avoid using computer programs that mimic things you can do yourself, such as finance software and electronic address books. Try to use the Internet and email in moderation.
  • Avoid leisure activities that overstress your hands. While practicing tennis and playing video games are relaxing and fun, activities such as these subject your hands to a high degree of stress. Instead, try reading, walking, or listening to music. Remember, when you take time off, make sure your hands do too.
  • Keep your body strong and flexible with appropriate exercise. Warm up before you start working, and make sure your hands are warm while you type.
  • Sit at a proper workstation. If you must use a computer on a regular basis, always keep your keyboard surface low enough that you don't have to hunch you shoulders to type or use the mouse. Your monitor should be at eye level.
  • Give yourself a break. For uninjured people, a five- to ten-minute break is recommended for every twenty minutes of computer use. Stand up frequently during breaks.