About Repetitive Strain Injury

 When it comes to computer injuries, ignorance is agony. Many people get hurt simply because they hadn't heard of repetitive strain injury (RSI) until they were diagnosed in the doctor's office. Others get into trouble because they don't know how to set up their workstations properly, neglect to take breaks, or habitually slouch. Still others deny their injuries and continue aggravating activities despite experiencing chronic soreness, dropping things constantly, or finding it difficult to perform simple activities such as writing, opening doors, or shaking hands when they should be seeking help. A little education can help you protect your hands. Here are some common misconceptions people have about RSI.

I don't type much, so I won't get injured. People who use computers for as little as two hours a day can become severely injured. A lot of typing is only one risk factor for RSI; others include holding still for long periods, awkward positioning, poorly designed input devices, ill-fitting workstations, and poor posture. Using a mouse causes overuse of one hand and can be far more injurious than the keyboard.

RSI is the same as carpal tunnel syndrome. Repetitive strain injury and carpal tunnel syndrome are not synonymous. RSI is an umbrella term for many cumulative trauma disorders, such as De Quervain's disease, tendinitis, epicondylitis, cubital tunnel syndrome, and carpal tunnel syndrome. This distinction is important. People may not know about the other common forms of RSI, and if they don't have symptoms of carpal tunnel syndrome which they might read about in the news, like wrist pain, they may put off seeking treatment because they don't realize anything serious is wrong.

RSI is all in your head. While symptoms can certainly be triggered by stress, RSI is not an imaginary malady. If it were, physical ailments would disappear after people worked through psychological stumbling blocks with a therapist. If your doctor suggests your symptoms are psychosomatic, you should seek a second opinion. However, once you've seen a doctor about your bodily ailments, you may wish to enter psychotherapy to help you deal with frightening anxieties brought on by the all-too-real financial, physical, and job-related RSI problems.

My injuries will go away when I stop using a computer. If you receive proper treatment (not just rest) at the first hint of injury, your chances of recovery are better. But many people ignore early warning signs, such as fatigue or weakness. If you wait until you experience severe, incessant pain before seeking treatment, permanent damage may be done and you may develop a chronic disability. At this stage, it may take many months of arduous rehabilitation simply to reach a pain-free state at rest.

If I start having problems using a computer, I'll stop so I can save my hands for playing guitar (or whatever else you enjoy doing). Protect your hands now, because once they're injured, any activity that uses them can exacerbate the problem.

Why should I see a doctor? This goes away by itself. In the earliest stages of injury, RSI frequently manifests itself with episodic bouts of soreness or other symptoms that come and go. In later stages, symptoms are present all the time. Chronic RSI does not get better by itself. It can get worse if left untreated.

I'll just get some splints (or magnets, wrist rests, vitamin supplements) and that will take care of it. Attempts to self-treat RSI can have tragic results when the injury worsens. For example, splinting is a medical procedure that can lead to atrophy and even more extensive injury, and should be done only under the supervision of a physician. If you're in so much discomfort or have so little strength that you can't use a computer without wrist support, you probably shouldn't be working. You should take an active role in your healing, but let a professional guide your progress.

I'll just take some time off and things will go back to normal when I come back to work. It astonishes many people that although they felt fine when they weren't using their computers, their symptoms return within moments of going back to the mouse or keyboard. Once injured, the tissue becomes fragile and prone to reinjury.

I'll get one of those new ergonomic keyboards. New equipment won't make a disability go away, nor will it necessarily prevent injury. New gadgets don't address risk factors such as speed, repetition, poor posture, awkward positioning, weak muscles, and sedentary behavior. More often, new tools could simply shift the focal point of injury from one part of the body to another. There are no substitutes for rest, good posture, regular breaks, self-pacing, maintaining a reasonable workload, and heeding your body's warning signals that you've done enough for today. Savvy athletes understand that overtraining can lead to overuse injuries, and that proper conditioning, technique, pacing, and alignment can help prevent problems. Computer users must embrace the same principles to stay out of trouble.

My fingers tingle, but my doctor and physical therapist say the problem is in my neck. They must not know what they're doing. Your doctor and therapist sound smart. Such symptoms can result from compression of the brachial plexus, an important network of nerves that leads to the hand. Tight neck muscles can cause this pressure.

My co-worker claims he's injured, but he and I do the same job and have identical workstations, so he must be faking it. The roots of RSI are for more complex than jobs and workstations, and it's impossible to generalize about who will become injured. You and your co-worker may be of different age or gender, and everyone has unique anatomical structure, body composition, posture, and work habits. While some people do seem immune to injury, their poor habits may catch up with them eventually, and they may develop RSI.

People just don’t want to work, so they claim to be injured. Actually no. The most common question I get is “What job can I do now that I can’t use my hands anymore?” People really want to work. They go to all lengths to keep their jobs – sometimes making their injury much worse in the process.

 Repetitive Strain Injury (RSI) is an umbrella term for several cumulative trauma disorders caused by overuse of the hand and arm. The injury can happen to the fingers, wrists, forearms, upper arms, shoulder and neck.

RSI includes many different ailments: de Quervain's disease, tendinitis, tenosynovitis, epicondylitis and carpal tunnel syndrome, to name a few. Many RSI sufferers have more than one of these diagnoses, so it can be a complicated medical problem.

And while RSI sufferers can share many common complaints, no two cases are exactly alike. RSI varies according to individual physical weaknesses or areas vulnerable to faulty work habits or workstations. Some people get pain in their shoulders and necks. Other people feel pain in their wrists. And then there are people who don't have much pain, but instead experience extreme weakness or clumsiness.

One thing you need to know is that Repetitive Strain Injury is not the same thing as Carpal Tunnel Syndrome. Carpal Tunnel Syndrome is one form of RSI, but the terms are not synonymous. 

Repetitive Strain Injury is serious. If left untreated, it can lead to unemployment and severe disability.You need proper diagnosis and treatment right away in order to prevent further damage. See the Repetitive Strain Injury Recovery Book for more information. 

  
There are many risk factors for repetitive strain injury (RSI). Some are well-known, such as spending long hours working with a mouse or sitting in a poorly configured workstation. Others are not readily apparent. For example, having long fingernails leads you to type with flat rather than curved fingers. But if you don't know the major risk factors then you add another: ignorance. You can't take preventive measures if you aren't aware of the dangers.  

1. Ignorance of the warning signs or risk factors for injury
2. Over two hours of computer use and/or other repetitive hand movement per day
3. Binge or marathon computer use (i.e., video games, deadlines, quarterly reports)
4. Lack of frequent, regular breaks
5. High stress work
6. Lack of control over pacing or workload (rush work, deadlines, quotas)
7. Boredom, anger or lack of assertiveness
8. Poor posture
9. Sitting for long periods
10. Static loading (holding still for long periods, as in holding a mouse while staring at a computer monitor)
11. Keeping elbows bent for long periods
12. Poor technique (twisting or resting wrists, forearms or elbows while using a keyboard or mouse)
13. Improper workstation setup (i.e., keyboard too high, monitor too high, low or off to one side)
14. Inadequate seating (i.e., chair too high, low, or lacking lumbar support)
15. Awkward positions (i.e., typing while using the telephone, reaching for the mouse)
16. Long fingernails
17. Smoking
18. Obesity
19. Overly flexible joints
20. Weak or tight muscles
21. Lack of regular exercise
22. Cold hands
23. Improper eyeglass prescription or undiagnosed vision problem
24. Arthritis, diabetes, thyroid disease, pregnancy, menopause, and other medical conditions
25. Hand-intensive hobbies, such as playing a musical instrument, gardening, carpentry, needle crafts, bowling, throwing or racquet sports and playing video games

This list is not all-inclusive, nor do the risk factors appear in any particular order. If you experience any warning signs of RSI, see a competent physician immediately. For more information about the risk factors for injury, warning signs of RSI, how to select a doctor and various treatment options, read The Repetitive Strain Injury Recovery Book and the following article, which is even more relevant today than it was when first published in 1998.
 

 Repetitive strain injury (RSI) can affect the neck, shoulders, upper back, upper arm, elbows, forearms, wrists, thumbs or fingers. Warning signs of RSI can appear in any of those areas.

1. Weakness
2. Fatigue
3. Lack of endurance
4. Tingling, numbness or loss of sensation
5. A feeling of heaviness
6. Clumsiness, constantly dropping things
7. Difficulty opening and closing hands
8. Stiffness
9. Difficulty using hands (turning pages of books or magazines, turning doorknobs or faucets, holding a coffee mug)
10. Reluctance to shake hands
11. Difficulty carrying things or holding bus or subway poles
12. Hands fall asleep
13. Waking up with wrist pain or numb hands, especially during early morning hours
14. Lack of control or coordination
15. Cold hands
16. Frequent self-massage
17. Difficulty buttoning clothing or putting on jewelry
18. Tremors
19. Avoidance of activities or sports that were once enjoyable
20. Pain or soreness (RSI is not always painful, though)

If you experience any of these warning signs of RSI, see a competent physician immediately. For more information on how to select a doctor and various treatment options, see The Repetitive Strain Injury Recovery Book, by Deborah Quilter.

When I wrote Repetitive Strain Injury: A Computer User's Guide  in the 1990s, there was a lot of confusion about what to do about Repetitive Strain Injury (RSI). Many of the approaches were misguided: for example, people underwent unnecessary surgeries because their doctors didn't know how to properly diagnose their conditions; RSI was often treated with splinting as though it were a broken bone, which only made matters worse. Employers would upgrade an injured person's workstation and expect that to solve the problem, but  ergonomic equipment can't resolve a physical problem.

A few years after I had written my first book, it became apparent to me that people with RSI very often were forced to quit their jobs because they were so disabled they could not work. No amount of ergonomics or physical therapy could overcome the severity of their injury. Something was wrong. I wrote The Repetitive Strain Injury Recovery Book, hoping to bring this long-lasting damage to light.

Fast-forward to 2021. Although some things have improved, many people still have never heard of RSI. They go from doctor to doctor, seeking a proper diagnosis and guidance – often dismissed as having psychological problems or given a strong drug to mask the pain. Meanwhile, without expert advice on what's helpful, their condition can get considerably worse. Further, smartphones and other devices have increased the ways people can now become injured using technology.

Now, once again, I am questioning the prevailing advice about Repetitive Strain Injury. What good does it do to take breaks if you are repeatedly subjecting your hands to the same tools and workplace that injured you in the first place? The workplace set up recommended by the Occupational Safety and Health Administration is incorrect on many counts and actually puts people in a position likely to create strain.

The tools that most people work with on a daily basis also wreak havoc with the body. Input devices need to be designed to be safe for the human body. I am hopeful that eventually the public will demand safer equipment and that the public will be educated about Repetitive Strain Injury. You can't prevent an injury unless you have heard of it. This is why I have created a YouTube channel about RSI. The goal is to raise consciousness about RSI and bring the best thinking on this issue to the public, and help injure people continue to work and function. Please go to the channel, heed the expert advice – and subscribe! Let me know if you have any questions in the comment boxes below the videos.

Take care of your hands. You can't use your other pair of hands to do what you want to do.

After many years of studying the source of Repetitive Strain Injury, I believe that the only way to prevent RSI is to address the root causes: ignorance, because there is no mass educational campaign, tool design because the tools and the positions that people adopt to use them are inherently risk factors for Repetitive Strain Injury and the widespread lack of education about how to diagnose and treat RSI in the medical profession. To this end, I have written Repetitive Strain Injury Patient Bill of Rights and posted it on change.org. Please sign the petition and share it with everyone you know!