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Repetitive stress injuries: 5 steps to prevent and even reverse damage

Being a fed — whether in an office or in the field — often means hour after hour of sitting at a keyboard or at another repetitious task, and that spells danger of repetitive stress injury. Here are some ways to avoid and relieve RSI.


Being a fed—in an office or in the field—often means hour after hour of sitting at a keyboard or at another repetitious task, and that spells danger of repetitive stress injury (RSI). Tweaking your posture and your work routine just a little now will save a lot of trouble later.
 
RSI describes a range of painful conditions — including carpal tunnel syndrome, epicondylitis, tendinitis, bursitis, and others — from damaged muscles, tendons and nerves following their repetitive and improper overuse.

Feds and other high-intensity keyboard users frequently develop RSI in their hands, wrists, shoulders and neck — and, if not addressed quickly, early warnings can become permanent injuries that can cripple.

RSI is a whopping problem. The cost in lost work capacity and treatments to the U.S. economy comes in well north of $100 billion per year, according to the Occupational Safety and Health Administration.

Big-picture economy aside, to preserve health and career, each sufferer of early RSI must take steps to stop the typical painful spiral of injury, re-injury and increasingly ineffective pain-pill popping — which can add up to a derailed career.

Worsening dangers: the mobile web and uninformed doctors

“Things have gotten a little better with office equipment in recent years,” Dr. Emil Pascarelli — a leading RSI specialist and professor emeritus at Columbia University — tells HealthyFed. “For instance, more people use keyboards with a downward slant, which can be very helpful in avoiding an upward tilting of the wrist.”

While office workstations may be better equipped to prevent the disorder, the remote typing and reading feds do these days is on far smaller keyboards and screens found on smart phones and iPads — raising renewed dangers.

“The situation has really gotten worse overall,” warns Deborah Quilter, a physical therapist who co-authored with Pascarelli the standard text on RSI, Repetitive Strain Injury: A Computer User's Guide. “With every new device that comes along with keys, there’s a new problem. Like a new one we’re calling ‘text-neck,’ which comes from looking down at those tiny screens all the time.”

Quilter reports more bad news — greater numbers of very young clients. “They’re much more badly injured than when I started in this field 20 years ago,” she adds. “Back then, most office workers had started their careers on far less dangerous typewriters. Not these young people — and when it’s severe damage, it’s not reversible.”

Among the greatest dangers cited by many RSI experts who span several medical and occupational disciplines, is a puzzling lack of awareness of a disorder that OSHA has long listed as responsible for the greatest sweep of workplace injuries.

“Many doctors are still not informed about RSI—and that’s something for workers to be aware of,” Pascarelli confirms. “Sometimes, you’ll get a doctor who says, generically, ‘OK, that’s it you have ‘carpal tunnel syndrome’ so I’m sending you to a surgeon who’s got a 10-minute surgery to correct the problem. “But if you don’t correct your workspace and habits, the problem will return — a very serious musculoskeletal problem that won’t reverse itself.”
 
If you do find yourself suffering telltale regular pains in your fingers, hands, wrists, elbows, shoulders, or elsewhere in your upper body, take “positive action,” as Pascarelli calls it—immediately. Back off from overwork, and follow the basic avoidance plan he, Quilter and other experts recommend. If that does not provide relief, consider seeing a doctor or physical therapist, one who has specialized knowledge in this area—rather than your family doctor.

Reversible early signs?

Can you really reverse at least early damage? “In my experience, you can,” Pascarelli told HealthyFed. “First, back down on the number of hours you put in, and, second, if you’re a real desk jockey, curtail that level of intensity — you may need complete rest or you may need partial rest. It depends on the level of damage. The degree of damage is very important to determining your outcome — if it’s bad, it can be irreversible.”

Qulter agrees with Pascarelli you can get improvement from early injury, but she is more insistent that if a sufferer lets RSI progress "you'll never be the same because of deep tissue scarring. It’s not like a broken bone that mends; the soft tissue is subjected to micro-tearing, and the tissue that replaces it is scarred and more susceptible to injury. So, often, people fall into a viscous cycle of injury and re-injury.”

“You need to be sure you are keeping your posture straight, that your head is not tilted too far forward—and that you maintain upper body strength,” Quilter tells HealthyFed. “I’m not talking about tight pecs, but rather strong romboids and latismus dorsi. Those muscles, from the back, should be doing the real work and pressures — not the tiny little muscles in your forearms and fingers. You have to stay fit at the athletic work you do on the computer. Really, we’re computer athletes.”

Steps to Preventing RSI:

1) Maintain a ‘Neutral Wrist.’ “Keep a ‘neutral wrist’ when you type—that is keep your wrist positioned in a straight line with the forearm,” Pascarelli explains. Neutral wrist also means not placing weight or pressure on the bottom of the wrist. “Never rest your wrists on the desk, wrist pad or armrests while you are typing or using a mouse or trackball,” Quilter admonishes. Yes, those rubber rectangles are popular, but many doctors think they are just an invitation to squeeze your wrist.

2) Adjust your workstation, keyboard and screen. “Keep a straight line of sight,” Pascarelli warns. “You want to look straight at the screen—that screen should have no more than a 15- to 20-degree tilt either direction, so your neck is not stretched upward or downward, or sideways.”

3) Sit up straight. Make sure your chair is adjustable, and it supports an erect posture. This keeps your weight in line, on your back and seat and not on other joints and muscles.

4) Take regular breaks from typing and mouse use. Give yourself “five- to 10-minute breaks every 20 minutes,” advises Quilter. The Harvard RSI page says that as little as one minute off every 10 working can help.

5) Reduce unnecessary computer use. Keying at a computer all day? Instead of playing video games to relax, take a walk or do other physical exercise. Give your hands and fingers a rest. RSI actually involves inflammation of the muscles, tendons and joints. If you persist you actually cause permanent changes, including scarring of tissue, that are increasingly painful and irreversible over time.

See more here on making your workstation more ergonomic.

Reader comments

Sun, Apr 12, 2015 Clemens Germany

Thank you for sharing your information about RSI! I had been in a similar situation and found strength to not give up in websites like yours! I am currently assembling a Google map with physicians and physical therapists who have substantial knowledge of RSI (Repetitive Strain Injury). I was wondering if you know any good medical people I could additionally recommend on my map? http://www.rsipain.com/physical-therapists.php I created the website after I had been suffering from RSI for over 3 years. It's my personal story (22,000+ words) combined with advice on prevention, self-treatment, ergonomic equipment, TMS and I hope that it will help fellow sufferers overcome their pain. Thank you for your help! Clemens

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