The many forms of RSI

Speedcubing - a potential cause for RSIIn this blog, I have focused substantially on RSIs associated with computer and mobile device usage, specifically wrist and arm injuries. Of course, there are many other types of injury that can result from occupational overuse, whether you are a programmer, a checkout assistant or a chainsaw operator. Injuries are not confined to work of course, but can also result from leisure pursuits such as piano playing, golf, tennis, running or even Rubik’s cubing! Examples of the types of conditions that can be caused by such activities are: tennis and golfer’s elbow, thoracic outlet syndrome, De Quervain syndrome, as well as the more classic carpal tunnel syndrome and cubital tunnel syndrome.

Repetitive activities, including computer use, can adversely affect more than just the wrist, hands and arms, but also the neck and shoulders. Some years ago, my wife developed a constant and debilitating shoulder problem on her right side. At the end of each day in the office, her shoulder would ache such that the muscles would feel as if they were exhausted. Being right-handed, the most obvious association was with her computer mouse, yet it was apparent that this type of large-muscle ache would most probably not be addressed by using a different, more ergonomic mouse. It wasn’t until she moved jobs and her new desk included a drop down keyboard and mouse tray that the shoulder injury disappeared. Simply lowering the mouse pad had solved the problem. Even today, should she momentarily use a laptop and external mouse on a table top, for example, the shoulder issue will recur.

In addition, the range of occupations potentially affected by RSIs is wide. On several occasions now, I have encountered checkout cashiers wearing tell-tale arm braces which I instantly recognise  as probably indicating an RSI. I have chatted to such individuals and, indeed, they inform me that the repetitive motion of swiping products in front of the barcode scanner has caused their injury. I have recently heard of a tree surgeon having to scale back workload due to pain in his arms from the constant overhead operation of a chainsaw.

Examples of occupations at high risk of RSIs include:

  • Journalists, programmers, software engineers – anyone using a computer to do their job
  • Construction workers
  • Checkout cashiers
  • Production assembly line workers
  • Machine operators
  • Postal sorting workers

Sometimes it is not necessarily repetitive motion that is at fault, but holding the same position for hours on end. For example, many neck problems develop after possibly years of bad posture and/or inadequate breaks whilst staring at a computer screen, or performing any occupation that involves looking downwards (eg a jeweller). Even sleeping is not without hazard, if you are in the habit of lying on your front with your head to one side for example.

Of course, the key words here include “repetitive”, “overuse” and “habit”. The same principles apply in addressing these conditions:

  • Awareness
  • Good ergonomics
  • Adaptive software or hardware (this can include anything from computer mice to chairs to running shoes!)
  • Adequate breaks
  • Improvement of posture
  • Therapeutic exercise such as yoga, pilates etc
  • Avoidance, if necessary

So, regardless of whether you are at work or play, upon experiencing the first twinges of pain, it is time to become aware of the cause and to address them accordingly. The choice is yours – you can make the necessary adjustments to your work or leisure habits now, or be forced to give them up entirely later.

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The rise and fall of a promising career

I have touched on many of the practical dos and don’ts about RSI, but what about its associated stigma and how it has the potential to change your employer’s perception of you?

Usually RSI sneaks up on you and hits you when you are most under pressure and least able to cope with or, indeed, rest from its causes. Often it seems RSI hits conscientious hard workers. In my case, I went from being a top performer to a problem employee in the space of  less than 10 years. This steady decline was not something that I wished for, wanted or felt happy about, but there was very little option, later at least, to change course. I could make management happy by working harder and thus continue to hurt my arms and hands, and I knew that backing off work would mean less throughput, less visibility and fewer financial rewards. It’s a vicious cycle.

I can remember how it ultimately felt when I quit. In one respect, there was the relief of being free from the cause of pain but, on the other hand, there was the bitter feeling of how the injury had made me fall from being a top rated performer to simply a problem employee in the space of 10 years. In truth, the injury had led me from loving my job to becoming almost disillusioned with it when I realised that I just couldn’t perform my role any more due to the pain. It’s a nightmare journey with a lot of frustration along the way.

It was also a sad day to finally say goodbye to my engineering position, in which I was qualified and had spent the best part of 20 years doing, in a career that I really had enjoyed. And, of course, the future lay before me with a very large question mark over it. There were a lot of mixed emotions.

The one thing that still rankles me is how the transition from a star employee to a problem one can happen. An injured worker isn’t very useful to a company and there is a breakdown in relationship between employer and employee when you get injured, which I guess relates to the business ethos. It’s a fact of life that, if you are limited in learning new things because you are injured, then you are becoming less and less useful. The only contribution for a long term employee is knowledge of the job. This can be tapped into in an advisory role for a while, but once that knowledge is imparted or becomes dated, your usefulness rapidly diminishes and you become a problem that needs to be addressed. Should I have done more? Should my employer have done more?  There are many open ended questions that linger with me to this day, ones that I know will never have an answer.

If I could change one thing, I’d have taken the injury more seriously a lot earlier. I can’t over-stress this point to anyone reading this who has just developed an RSI. It is very important to break free from the underlying causes before you too end up going from star employee to company problem.

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It’s the little movements that hurt with RSI

I came across an article on the Dorset Echo’s website that referenced an employee who had been sacked by her employer for an alleged attempt to defraud them over an RSI claim. As part of their legal challenge to her claim, her employer produced over 60 hours worth of surveillance footage of her outside her home, shopping and going to the gym, and relied on around five minutes of this in her disciplinary hearing to disprove that she had a computer induced RSI ailment.

Civil liberty infringements aside, this example shows how ignorant some employers are to RSI and how it manifests itself. RSI is pain induced by micro movements of a repetitive nature, which ‘flares up’ and produces painful symptoms when doing many small micro movements over long periods of time eg typing on a keyboard or clicking a mouse. In bad cases, it can cause pain and weakness, for example in wrists, which may affect other activities, or other repetitive everyday tasks. The condition does not, however, generally affect the muscles groups associated with doing many tasks requiring larger motion, including most motions involved in working out at the gym.

The irony is that with RSI, activity that is based on large non-repetitive motions and especially cardio based activity should be encouraged since movement of the larger muscular groups will enhance blood flow to injured areas and promote natural healing. It should not be criticised and brought up as evidence against an RSI claim. To do so just shows the complete ignorance of the individuals and organisations involved.

It is a travesty that the perception is that someone with an RSI condition should be effectively seen to be in a wheelchair and/or doing nothing before they look like they have RSI to an employer. If they were observed continually texting on their phone or playing video games all day that would be a different story! However, being criticised for living a normal macro movement life whilst trying to keep fit and healthy is an outrage.

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When is the last time you really listened to music?

A good few years ago, whilst visiting a Biofeedback practitioner (in the US), before they got a chance to attach electrodes onto my shoulders arms etc and do the technical task that is part of biofeedback, they did a talk through to find out my background, and observe what stresses may be involved in my life. It was part of a holistic approach to dealing with RSI before the technical measurements.

One question they asked that has stuck in my mind to this day was, “When was the last time you listened to music?”, to which I replied well, “In the car driving here”. Their response was, “No, when was the last time you listened to music just to enjoy the music, not as part of something else?”. I really had to rack my brain to think that one through. I couldn’t remember. Not for many years and probably when I was a lot younger, had a lot more time on my hands and a lot less to worry about – probably in my teens! I had to be honest and say, “I really don’t remember”.

The lesson she was trying to impart was that we rarely take the time in life any more to just enjoy simple things that once were a source of relaxation. Music should have been there to enjoy and relax to on its own. By then my life was so busy that music had been demoted to something less.

It may be a part of the reason we hanker after music during our childhood to teen years. Back then, we had more time to listen to music with fewer worries and distractions in our lives. Not only that, but we spent time listening to whole albums from start to finish (which back in my day were on vinyl) and playing them to death whilst memorising the lyrics. This changed in my busier twenties, demoting music to be something listened to when I was driving about, at my desk whilst working or when I went for a workout at the gym. It just wasn’t something I had time for any more on it’s own, yet it was still an important part of my life, just not for relaxing to. In other words I always added something else into the mix with music without obtaining any of the mental relaxation that could be found from listening to an entire album and doing nothing else.

Move forward a couple of decades, and we find ourselves in a completely different situation. The invention of home computers, MP3 files and players have completely revolutionised music and the way we listen to it. We now have thousands of files on our players that are very easily mixed and are frequently listened to in random order, which can be great, and really allows you to find stuff in  your collection that you’d forgotten about. However it has led to being spoiled for choice, and we tend to flick through music tracks at the push of a button, not listening to albums in the way they were intended to be appreciated. Many artists spend a lot of time sequencing an album into a specific order which ‘flows’ or tells a story, and is really part of the overall experience of that music. This sequencing is more often than not completely wasted with shuffle plays of MP3 players, and really adds to the sense that music is just a cheap commodity in our already over commoditised life.

If we spent a dedicated hour a day to do nothing but listen to a favourite album the way it was intended to be listened to and for no other reason but to enjoy that album, we’d find that the music does a wonderful thing and takes us to a different place, where we can lose our worries and stresses for an hour and start to relax again, just as we did when we were younger. It may also help us to de-stress and unwind from tension induced conditions such as RSI.

So when was the last time that you really listened to music?

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Windows Speech Recognition

I have long been an owner of an earlier version of Nuance’s Dragon Naturally Speaking (version 7 I think) and have had much frustration in the past mainly due to the the software’s inability to recognise regional accents, well my accent anyway! Nuance appear to have a policy of no trial before buy with Naturally Speaking, which is a shame since I don’t feel like stumping up £80 to try out version 10 (once bitten etc etc), especially if it ends up that I find that it doesn’t meet my needs or expectations. I certainly don’t see why Nuance can’t make a time limited evaluation copy available for download. Maybe they think that potential buyers won’t be impressed with their software and won’t buy as a result, who knows …

Not being so much of a computer tech geek these days since succumbing to RSI, I have only just realised that both Windows Vista and Windows 7 ship with Microsoft Speech Recognition engine in them for free. Go to Windows Start menu and type in “Windows Speech Recognition” and hit ‘Enter’. You can use your computer’s inbuilt microphone, but may find much better results with purchasing a separate headset with microphone which sits approximately 3 cm from your mouth. The better quality the mic/headset, the better the results will potentially be.

The speech recognition engine from Microsoft appears to be reasonably usable. I quickly was able to enter the learning text. I was also quite surprised at how well it performed given the ultra quick learning cycle, and my low toned Scottish accent.

My trial in using this software is just beginning, and I’ll report back with a more detailed analysis later, but initial impressions are quite positive with certain reservations eg it works (or more accurately works with full features) only when using Microsoft applications, ie Internet Explorer, Word, Excel, Notepad, Wordpad etc, and only partially with some third party applications like Open Office and not at all with others eg Firefox (my usual browser, which it also appears to slow down). If I set Microsoft’s monopolistic tendencies aside, and try it out with their software, I find that it does a reasonable job of making Internet Explorer navigable with speech.  I would have preferred a little more help, however, with finding typical commands available to use with the browser. The windows help on the subject is reasonable, but not great. The few commands I did manage to find are as follows –

Windows 7/Vista Speech Recognition Commands for Internet Explorer 8. If anyone finds any more be sure to leave a comment and I’ll update this.

Speech Function
START LISTENING turns on speech recognition
STOP LISTENING turns off speech recognition
OPEN INTERNET EXPLORER opens internet explorer browser
MINIMISE INTERNET EXPLORER minimises internet explorer browser to the task bar
SWITCH TO INTERNET EXPLORER opens internet explorer browser from taskbar
CLOSE INTERNET EXPLORER closes internet explorer browser
BACK Back button
HOME Home button
FORWARD Forward button
STOP Stop button
REFRESH Refresh button
CLICK ‘link name’ Click on link with name ‘link name’
HOVER / HOVER OVER THAT Hover over menu to display contents
CLICK ADDRESS BAR Click on and select address bar
CLICK GOOGLE Click on Google search bar
SHOW NUMBERS generates numbers for every link on browser
TEN OK selects link number 10 displayed in SHOW NUMBERS above
PAGE UP scroll page up by one page
PAGE DOWN scroll page down by one page
SCROLL DOWN scroll page down by approx 1/2 page
SCROLL UP scroll page up by approx 1/2 page
bookmark name speak bookmark name to select your bookmark (or use numbers to select it)
PRESS CONTROL TAB navigates to next tabbed page
PRESS CONTROL SHIFT TAB navigates to previous tabbed page

Who knows whether speech recognition will ever be a complete replacement for a keyboard and mouse, but with a free copy embedded in Windows 7 and Vista it’s certainly well worth a try out.

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Men’s voices harder to understand for speech recognition

In a BBC news story recently titled “Computers find male voices ‘harder to recognise’” describes how Edinburgh University scientists found that computer speech recognition software finds male voices harder to understand than female voices.

This they attribute to the fact that men “make ‘umm’ and ‘err’ sounds more frequently.”

I can attest to this. It is a common problem in general, and I was guilty of doing this in presentations in between lines as I paused to catch a breath. It’s also common when pausing between words when using voice recognition. A bad habit? Perhaps, but a common habit nonetheless.

In addition, the scientists found that, “Variations in pitch, tone and speed can also cause the system to misunderstand voices” – which goes without saying. No two people talk in the same way or style. If we did, we’d be a very boring species! Dialects and regional variations also come into play, and as such I can certainly see why speech recognition software has its work cut out to achieve results.

My own experience with trying out speech recognition wasn’t great. I think my low toned Scottish accent with plentiful doses of ‘umm’ and ‘err’ didn’t help either, but I did feel a bit aggrieved at its inability to learn my accent. It was some time ago so the software may well have changed and improved a lot since then, but I remember feeling frustrated at the many hours I had sunk into the system hoping it would learn my voice, all for naught in the end. Voice recognition in my mind has always had great potential for relief of over-used arm and hand muscles, but the effort involved in learning how to use the software, ie teaching the software to recognise your voice, for was a soul destroying and futile task!

It’s a sad but true fact that for me there really is no comparable alternative to the keyboard in this day and age!

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RSI Pain Relief – Contrast Baths

Some temporary RSI forearm muscle pain relief is achievable using an easy to administer method called contrast baths. I was taught how to use this procedure by a hand/arm physical therapist while living and working in the US.

The idea is to have two waterproof (plastic storage boxes work fine) containers. Each one  should be just greater in length than the distance from your elbow to you finger tips. These should be filled with water to a depth enough to cover your arms when fully submerged.

One container should be ‘hot’ – not too hot.  ie. no greater than 40-45oC (104-113oF)

The other container should be ‘cold’ – cold tap water with a few ice cubes (or an ice cooler pack) in it to chill further to no lower than 10-15oC (50-60oF)

You will also need to have a clock or timer handy with seconds/minutes easily visible. A kitchen timer or stopwatch is good for this purpose.

The procedure is simple, and involves submerging your arms into the ‘hot’ bath for 1 minute, followed by submerging them for 1 minute in the ‘cold’ bath. Then repeat this switching between baths for 10 to 15 minutes (longer if desired).

You can repeat contrast baths a few times a day if necessary, but it may be impractical to do this at work. You could also increase the time from one minute in each bath to two minutes in each bath if found to be more effective.

This temperature cycling should help relax any stressed out muscles a bit, and give some immediate pain relief. At the peak of my RSI condition after coming home from work every night, I would do contrast baths to get some pain relief. Its a low cost and self administrable procedure that can help reduce RSI pain.

Please check with your health advisor first if you have diabetes, heart problems or Raynaud’s Syndrome before doing contrast baths so that they can determine whether it is advisable for you to proceed.

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Text input controlled by thought?

In an interesting article in Hplus Magazine entitled ‘By thought alone: Mind over keyboard’, the author describes studies into how we can use the brain’s thoughts to control a keyboard input. The findings indicate that people with electrodes implanted in their brains can learn to type by using thoughts alone. It’s also possible to achieve this without these electrodes by using  an EEG type interface, although speed rates for typing seem to be slow if we take the current findings –

“Tweeting by thought alone is a somewhat slow process using this prototype technology –- we speak at approximately 120 words per minute. But, as with texting, users can improve as they practice using the interface. “I’ve seen people do up to eight characters per minute,” Wilson says.”

Ouch.. that would be a significant downturn in workload!  I can see this form of input being a considerable benefit to people with severe disabilities, however I do wonder what the long term health impacts are of having an electrode implanted in your brain. My guess is that it must surely at this stage be a large unknown. It is, however, an interesting area of research.

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Computer thought control by 2020?

In an article titled “Intel: Chips in brains will control computers by 2020” in Computer Weekly a vision is painted of computers being controlled by an implanted sensor in the human brain.

The mind boggles at the mere though of this. It’s a very Orwellian concept. Imagine other sensors out there being able to read your thoughts – scary!

The assumption is that due to the ease of the technology, we as consumers will beg to have this implanted technology. I’m not convinced of this argument. I also tend to believe that new concepts in computer control are never going to be risk free in themselves. Eye motion controllers could cause eye strain. Thought controllers could cause brain strain!

The human brain is not a device that tends to tackle one sole task at hand. Out thoughts are random, parallel, and varying in nature. You may be thinking about the weekend holiday ahead or be excited about a forthcoming birthday etc. How would thought control devices differentiate these ‘human’ thoughts from ‘control’ thoughts? Would your employer be able to see when you were not thinking about the project you are working on each day? Would they be able to pay you per thought control hour rather than per 8 hour day?

Only time will tell whether this plan comes to fruition, but it seems to be no more than wishful thinking. I suspect that if it does come into existence it will be treated very cautiously by discerning workers.

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Ergomatters RSI Blog page on Facebook

facebooklogofreshErgomatters RSI Blog is reaching out with our RSI awareness effort with a presence now on Facebook, one of the world’s largest social networking web sites. Come and join us, become a fan and help spread the word!