The following article was published in The Independent (London, UK) on the 17th September 1993, on its Computer Page. Copyright (c) Richard Donkin, 1993. Electronic reproduction permitted, print rights reserved. May not be published for commercial purposes in electronic or print form without consulting the author. COPING WITH NIRVANA'S DARK SIDE Computer technology is converging with television and telephone networks to create a seamless digital fabric with which we can interact at any time. There is, however, a darker side to this electronic nirvana: people sometimes break down before the computer does, experiencing Repetitive Strain Injury (RSI), an umbrella term for disorders causing pain and weakness in the hands and arms. RSI is not just a computer-aided disease: it has affected people ranging from Leonardo da Vinci to eighteenth century clerks and modern day biscuit packers. Anyone who performs precise repetitive movements for long hours and with few breaks can succumb, especially when working under stress in a poor, fixed posture. Although Bernardini Ramazzini, the father of occupational medicine, recognised these essential elements of RSI in 1713, they are still present in the way most people use computer keyboards and mice. The recent growth in RSI cases largely involves computer usage. In the US, there were 185,400 reported computer related occupational injuries in 1990, an increase of over 300 per cent since 1986. A recent survey of over 13,000 UK computer users by the Union of Communication Workers found a 900 per cent increase in computer-related health problems. RSI and associated poor ergonomics not only affect the health of computer users - they hit the finances of their employers as well. One direct cost is a productivity loss of 20 per cent in keying at an unergonomic workstation, according to one study. A Norwegian company discovered the indirect costs by redesigning assembly workers' workstations, reducing RSI - it made an 840 per cent return on its investment, simply by reducing the cost of sick leave and staff turnover. Preventing RSI need not be expensive. Guidelines are available from the RSI Association and the Health and Safety Executive to help employers fulfil their legal obligation to assess and reduce any risks. Trade unions provide similar information for employees. This may involve simple measures such as re-arranging furniture and providing foot rests. Consultancy on prevention is available, while manufacturers are producing new types of mouse and keyboard that reduce hand and arm strain. Programs are available to remind users to take breaks, which improve their overall productivity as well as safeguarding their health. RSI can be prevented by taking action as soon as the warning signs appear - these can include one or more of aching, pain, weakness, swelling, tenderness, numbness and pins and needles in the hands or arms, though every case of RSI is different. A common precursor is a stiff or aching neck or shoulders, though this does not necessarily lead to RSI. Symptoms that persist after work or over several days are especially serious, but users should stop whatever is causing any symptoms and see a doctor as soon as possible. Unfortunately, although RSI is completely preventable, there is little agreement on effective treatments. Many GPs are aware of RSI, but there are still some that do not believe that RSI exists, while the few specialists in RSI have long waiting lists. Unsympathetic employers can lead to sufferers avoiding time off work, thereby worsening their condition. These factors may explain why up to 40 per cent of RSI sufferers lose their jobs. The causes of RSI are controversial. While every RSI sufferer knows that a stressful day will worsen their symptoms, simply by increasing muscle tension and thereby pain, RSI is definitely not "all in the mind". The spread of RSI within a workplace may even be exacerbated by anxiety once a few people have RSI, but anxiety is not sufficient to cause RSI. Rather, RSI is caused by many shared and individual factors, including physical fitness, muscle tension, individual work habits, stress, long hours, lack of breaks, bad ergonomics, and poor, static posture. Without treatment or prevention, RSI tends to progress gradually from occasional aching and tiredness in the hands or arms to intense pain and weakness, even with nonrepetitive movements. Early action improves the chance of complete recovery, but some degree of recovery is usually possible even at later stages. Lack of knowledge about and access to the best treatments can be a barrier to recovery. Frequently, combining conventional and complementary therapies provides the best results, as my own experiences confirm, although perhaps not everyone can expect to make a complete recovery as I did. A few years ago, my hands began occasionally to ache from typing, but since this quickly disappeared each time and did not reappear or a year or more, I ignored it. At the beginning of last year, however, the pain resurfaced and became persistent, and my GP diagnosed RSI. After three weeks off work, having intensive physiotherapy, I was able to resume working, with limited keyboard use. Although I could not afford frequent treatments, some therapies lend themselves to self treatment, as a supplement to treatment by a skilled practitioner. This vastly increases the amount of treatment possible and enables you to control any pain or muscle tightness as soon as it occurs. The following therapies and disciplines all include self treatment and were extremely helpful to me - however, they may not apply to individual cases of RSI and should be undertaken only after consulting your doctor: + Physiotherapy: this involves mobilising the neck and upper back, which are usually stiff in cases of RSI, together with 'neural stretches' to lengthen contracted nerves, which appear to cause pain in some forms of RSI. + Trigger point therapy: this is superficially similar to acupressure or shiatsu but also employs stretching and exercise. It immediately relaxes muscles that are in spasm, and can also help back ache and migraine. Some physiotherapists practise this in the UK, but a comprehensive book and self treatment tools are also available from the US. + Alexander technique: this concentrates on improving the use we make of our bodies. Alexander teachers can help RSI sufferers correct the habits that result in poor posture and muscle tension in computer work and other activities. + Relaxation techniques: there are many approaches to relaxation, often based on deep breathing using the diaphragm, that help to soften tense muscles and reduce fatigue. + Chi Kung: this Chinese discipline, which is related to Tai Chi Chuan, involves standing in certain positions that enhance the 'chi' or energy. It is very useful for short term pain relief and long term healing, and can also be used to prevent work-related health problems. + Ba Duan Jin: these Chinese exercises were invented several thousand years ago and used by monks and soldiers to improve their strength and health. Ba Duan Jin employs gentle stretching to stimulate the blood circulation and relieve any aches or pains. While these therapies and techniques mostly pre-date the computer, their usefulness in treating and preventing RSI remains largely unknown. Finding them was not easy or quick, but the RSI Association was an essential information resource, providing general guidance and a list of RSI support groups. I also discovered several online RSI discussion groups and resources on the Internet and CompuServe. In the process, I set up an RSI discussion forum on CIX, the UK computer conferencing service. It is somehow appropriate to use computers to beat a computer-related disease. Such online resources are a useful antidote to the lack of self help books for RSI and may even help to ensure that RSI, like telegraphist's finger, will become a thing of the past. -------------- Richard Donkin is a computer consultant. His Internet mail address is richardd@cix.compulink.co.uk. Bonnie Prudden, Inc. (trigger point therapy books and tools): +1 (602) 529 3979 Chartered Society of Physiotherapy: +44 (0)71 242 1941 Compulink Information Exchange (CIX): +44 (0)81 390 8446 (voice) Health and Safety Executive: +44 (0)742 892 346 RSI Association: +44 (0)895 431 134 Society of Teachers of the Alexander Technique: +44 (0)71 351 0828 The Lam Clinic (Chi Kung and Ba Duan Jin): +44 (0)831 802 598 Notes for non-UK readers: GP means general practitioner; drop the (0) from phone numbers when dialling from outside the UK.