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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The article indicates that RSI is part of an ever increasing phenomena affecting 115,000 workers last year a staggering 34% increase from the previous year. If ever we needed evidence that RSI is reaching epidemic levels, then this is it.

It also contains a quote from Pauline Cole (a spokesperson for the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE))

“A lot of people are using computers more, even in jobs you wouldn’t traditionally expect it”.

This is the trouble with RSI conditions. Just about every job these days requires interaction with computers, and this can present major challenges when a worker is affected with RSI, there are few options out there to allow them to work whilst avoiding computer use and allowing their bodies to recover, except for perhaps manual labour.

In another revealing quote from the article, this time from Bunny Martin (who runs charity Body Action Campaign)

“schools tend to have a single standard computer set-up for nine and 15-year-olds alike.”, and alarmingly she notes that “around 60% of children she meets have first symptoms of RSI, including strain-related pain in the neck and shoulders.”

This is a staggering fact and if RSI is impacting children years before they start looking for employment then we truly are sitting on a RSI health time bomb.

All in all an excellent summary article on where we are at with RSI.

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In a nutshell, it combines a fairly physical activity encompassing muscle and tendon stretches from your head to your toes, with core conditioning and balance practices. This is coupled with controlled breathing techniques to allow the participant to focus their mind on the present moment. As well as the physical practice, yoga teaches techniques to promote deep relaxation and the ability to clear everyday thoughts from the mind with meditation. This powerful combination really can address a lot of the factors that lead to conditions like RSI (primarily driven by the overused micro-movements of muscles and tendons coupled with bad ergonomics and stressful working conditions).

Yoga practice can

• stretch out abused and injured arm muscles and tendons that have been used in a very poor/restrictive motion for numerous hours
• stretch out your neck, spine, and shoulders which most likely will have also been in a bad posture for hours at work, and can be the sources of a lot of RSI conditions
• enhance the blood flow to fatigued muscles
• enhance overall strength and flexibility
• stretch out tight tendons
• promote relaxation
• promote calmness through meditation
• make the participant feel good about their health
• make the participant decidedly fitter

I have only relatively recently delved into yoga. For those of you who think it’s an activity for girls and hippies, I can assure you it isn’t! It’s really a great practice for everyone and there truly are no age or gender barriers. It can be quite physically involved, which I didn’t realise before I tried it out! I really wish I had started practising at an earlier stage in life while my RSI was not as bad as it is now, when it could perhaps have helped me to address my RSI condition during its early stages.

There are many different types of yoga class out there. The class I currently attend is based on Ashtanga Yoga, and is fairly physical. It involves many stretches (some quite challenging) interspersed with vinyasas* which are physical sequences or “flows” between each Yoga pose. A typical class goes for 1 to 1.5 hrs, and follows a sequence of

• Controlled breathing practice (relaxation, focus of breath and readying self for practice
• Sun salutations (sequences of vinyasas to warm body up with)
• Standing stretch/posture sequences interspersed with vinyasas
• Seated stretch/posture sequences with vinyasas
• Reclined stretch/posture sequences with vinyasas
• Relaxation/meditation.

I can honestly say the time goes by in a flash, and I always leave way more relaxed than before I arrived. It’s a great way to switch off from the working day. The Ashtanga class is fairly physical, and it may be a good idea for you to try to experience yoga at an easier pace first of all, and there are many classes to suit. You can also get many great yoga DVDs these days so you can try it out at home if you prefer (all you need is a yoga mat and motivation!), before jumping straight into a class. I do however recommend trying to aim for a physical version of yoga, since this is what will help you achieve core strength and conditioning, giving your muscles a helpful intensive stretch based workout, coupled with relaxation and the ability to refocus your mind.

It is perhaps the idea of channelling the hyperactivity of the mind into more useful positive energy and thoughts that is one of the key aspects of yoga. If we can control the over activity of our minds, we can achieve a positive state of mind and can face day to day stresses on a more even keel, ie. it can be adapted to many areas of your life. For example, are you perhaps over stressing a lot in the office? Then maybe a 20 min break away from your desk and a bit of controlled breathing and meditation can bring your mind back to a less stressful place, and begin to bring things into perspective, which can’t be a bad thing in these crazy busy lives we now lead now can it?

*”Vinyasa has since been thought of as a physically demanding practice, which can be successful at channelling the hyperactivity of … minds. This system can also be used as a vessel for helping calm ongoing chatter of the mind, reducing stress and teaching extroverted personalities to redirect their attention to their internal experience.” wikipedia

An article from the San Francisco Chronicle highlights the benefits of Yoga practice in the high tech industry.

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Whether this form of computer input technology will ever see serious light of day or not, or whether it will replace the keyboard and mouse, is anyone’s guess, but it is interesting to see trends in technology moving away from using the standard devices (although it is hinted that currently there is no good replacement for a keyboard for text entry).

Whether this technology can save us from RSI related injuries is open to debate; it may well transpire that they just mean we are susceptible to different types of injuries, but it is a good sign that developers are at least rethinking the now traditional methods of interacting with computers. It could lead to opportunities in computer use for people with all kinds of different disabilities, and not just RSI.

Is this the start of a new age in ergonomics, or is it just the latest phase of hi-tech gimmickry ?

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The following is relevant if you have been experiencing RSI symptoms for a few months and they are now persistent in nature.

The rate of success in dealing with RSI symptoms is proportional to the speed that a sufferer can diagnose the causes of those symptoms, and their understanding of the corrective actions required to avoid further injury.

The onset time for RSI injuries can be fairly rapid (in my own case I went from having initial symptoms to intermediate symptoms within 3 to 4 months. It is therefore vital that sufferers glean RSI knowledge as fast as possible, try to understand the causes of their symptoms, and make the necessary adjustments to their working practices.

So the scenario for this article is of a worker who has had RSI symptoms for a few months, and is experiencing any of the following -

• wrist, arm, hand, finger, wrists, shoulders, neck pain
• numbness of fingers, back of hands, wrists, thumbs
• swelling of arm, hand tissues

on a regular basis and predominantly after working with computers. Typically, you may be regularly coming home after a day at work, with one or more of the above symptoms. You may or may not have reported the injury to your employer, and you may or may not have consulted a your doctor about your symptoms. You may also have decided to keep the injury to yourself in the hope that it would go away, and that you would not have to disclose it to your employer.

The danger to you at this stage is that by letting the condition(s) go unchecked for a few months you have made the RSI injury more difficult to get rid of. However there is still hope that your condition can be diagnosed, addressed, relieved, and ultimately cured. It may however involve making several radical adjustments in your life.

You have to continue to believe that there is still a lot you can do to help yourself.

Progressive Symptoms of a computer (over)use RSI condition

Progressive RSI symptoms can be varied, this is because RSI is a collective term for a number of different musculoskeletal conditions.

Progressive symptoms will be similar to those described in the Initial Symptoms Article but will be more persistent in nature ie. you may be coming home every night after work and experiencing some of the following -

• tingling/numbness in back of fingers, thumb, hands
• sore (fatigued) arm muscles including upper forearm
• sharp pains in joints or wrists
• sore shoulder /neck
• coldness of hands
• loss of strength in hands/arms
• abnormal swelling on parts of the arms and hands

What to do?

Since you have been experiencing RSI symptoms for a while, you need to try to urgently diagnose the mechanisms causing your pain to occur before they get more permanent, and try to make the adjustments to your working practice to reduce or eliminate the factors that are causing you pain. You still have a great chance to get rid of these symptoms with a little research and modifications to lifestyle, but it will take a more dedicated effort on your part to make those changes happen.

The following are some general recommendations to counteract progressing RSI symptoms -

• Follow through on the recommendations in my Initial Symptoms Article
• If you havn’t done so already , alert your own doctor, employer and company doctor about your symptoms,
  take on board any recommendations and if they advise you to take time off work to rest, do so.
• If you havn’t done so already, get an ergonomic consultation (it’s never too late for one of these), and listen to everything that the Ergonomist recommends and try to adjust your practices accordingly. This may mean changes to your desk, chair, keyboard, mouse/input device, or adjustments of your posture or other working practices.
• read up on some common causes of RSI conditions such as my articles on typing with clawed hands, and lateral wrist deviation, and work had to eliminate these bad habits from your working practice.
• consider using different input devices. At this stage, you need to be trying out a variety of them to find out which ones are less uncomfortable for you to use.
• Try click generating software (if your injury is mouse use related)
• Cut down on mouse usage by learning keyboard shortcuts for your O/S or software package
• Try voice recognition software if you type a lot of text documents.
• You need to eliminate all non-essential interaction with computers and computer like devices including organisers and mobile phone messaging.
• Eliminate or severely restrict use of home computers.
• Eliminate all video game use including games consoles.
• If you have a hobby that aggrivates an RSI eg Piano playing, reduce practice for a while to help your RSI heal.
• You must take up a physical pastime that exercises your musculoskeletal structure in a fluid, healthy way. I would recommend anything that gets you away from a desk/chair and doing non-stress movements. Swimming is an ideal low impact fluid motion activity. Try looking into Yoga, it has a very good fluid movements/methods for stretching muscles and tendons in a healthy way, whilst promoting relaxation (it also actually can get you fit, and no, it’s not just for girls!). Physical pastimes are also very good for getting your mind ‘into the moment’ of what you are doing (the physical exercise) and away from stressful every day factors (work, injury symptoms, other problems in life etc), and can help break the negative thought cycle that can accompany persistent injuries. Other sporting activities can be good, but they should be avoided if they worsen your symptoms. Physical pastimes are also good for getting blood circulating around your body, and blood circulation helps heal fatigued muscle tissue.
• If you are still working on a computer you should be taking a minimum of 5 minutes rest and stretch breaks every 30 minutes, even if your symptoms start to feel better. Install a take a break reminder to remind yourself to take breaks. Get up and walk around for a break, don’t take a break surfing the web!
• Take all company allowed breaks including tea and lunch breaks. If you work in an office, leave your desk. If you have hour long lunch breaks, get away from the office environment completely.
• Research and obtain a good stretching routine, to stretch out muscles of the forearms, upper arms, shoulder and neck, as well as the wrist and hand tendons. Consult a Physiotherapist for the best stretches for your condition.
• Use pain reduction techniques, like hot/cold contrast baths, physical therapy (ultrasound, massage etc), TENS machine, or a hand held heat massager.
• Keep hydrated.
• Adopt a healthy diet.
• Take measures to de-stress your life
• Consider getting your back structure analysed by a Chiropractor or Osteopath for potential problems.
• Research your problem extensively, learn as much as you can, and consult as many doctors, physiotherapists and specialists as you can. Knowledge about these conditions can vary widely in the medical community.
• Find out fellow sufferers though internet forums, or even your own workplace to share learnings. It is often very beneficial to learn from what other sufferers have gone through.
• Don’t take painkillers and continue to work as before. Painkillers will just mask the symptoms (pain) whilst allowing you to continue to worsen the problem and can lead to further worsening of your injury!

Keep in mind that very rarely is there a ‘magic bullet’ fix for RSI type conditions. Usually, a combination of factors have lead you to experience RSI pain, and it is up to you use every resource that you can to identify as many of these as possible, make changes to your lifestyle and work practices that can reduce and ultimately eliminate your RSI symptoms.

By this time you should need no further motivation to address your RSI symptoms. The main driving factor now being to avoid your injury worsening and potentially becoming a permanent disability (like mine has), which can ultimately have disastrous consequences to your career!

In Part 3 I discuss dealing with a long term (2 years or more) RSI condition.

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The danger with this is that, if symptoms are left unchecked, it can lead to their rapid worsening and the long march to a more debilitating (and difficult to treat) condition.

This need not be the case. There is a lot you can do at this early stage of RSI symptoms to help yourself.

Initial Symptoms of a computer (over)use RSI condition

Initial RSI symptoms can be varied, this is because RSI is a collective term for a number of different musculoskeletal conditions.

Symptoms can include (but are not limited to) the following -

• tingling/numbness in back of fingers, thumb, hands
• sore (fatigued) arm muscles including upper forearm
• sharp pains in joints or wrists
• sore shoulder /neck
• coldness of hands
• loss of strength in hands/arms
• abnormal swelling on parts of the arms and hands

What to do?

The first thing to remember is don’t panic. The fact that you have diagnosed a problem at this early stage is a good thing. You have a great chance, with a little research and modifications to lifestyle, to get rid of these symptoms. The following are general recommendations to counteract initial RSI symptoms -

• Stop doing the task that is causing you to experience the symptoms (remember, the symptoms you are experiencing are your body’s way of sending a signal that something that you are doing is wrong and letting you know that you need to do the task differently or make adjustments to your working practice)
• Research and analyse specifically what is causing the symptoms to occur
• Go on a ergonomics awareness course
• Obtain an assessment by a professional ergonomist who will advise you about posture, techniques of correcting bad posture, and the possibility of a change in equipment (eg chair, desk, keyboard height etc)
• Listen to what the ergonomist says and try to implement any changes they recommend
• Maximise rest time away from the keyboard (avoid surfing during break time, eliminate home computer use etc)
• Keep in mind that this period of time is the best stage to stop the injury worsening, so it’s also the best time to rest too!
• Consult your doctor or company doctor about the symptoms
• Try to make changes to your working practice or daily life to reduce exposure to other computer/keypad/mouse devices including laptops, organisers and texting on mobile phones etc
• Take frequent rest breaks when you have to use a computer
• Keep well hydrated
• Consider physical therapy
• Develop a habit of doing stretching exercises on the affected limbs (consult a physiotherapist for recommendations)
• Consider a low impact physical fitness program like swimming, yoga, tai chi
• Don’t take painkillers and continue to work as before. Painkillers will just mask the symptoms (pain) whilst allowing you to continue to worsen the problem and can lead to further injury!

The key to dealing with initial RSI symptoms is don’t ignore them however slight they are. Even slight pain is your body’s way of telling you that you are not doing something correctly, and that you urgently need to make changes to your working practice before the symptoms get worse.

In Part 2 I discuss dealing with progressive, lingering RSI symptoms.

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When you actually analyse what position your arms , wrists and hands are in when you wake up, you will more often than not, find them in all kinds of contorted positions. Quite often the wrist can be bent or twisted, causing blood flow restrictions, pinched nerves, and RSI symptoms can be worse when you least expect them to be.

I can quite frequently wake up in the mornings with pain , numbness and tingling in my hands. It is an impossibility during sleep to keep a track of what position you put your arms and hands into, but there is one solution that can help.

If you have been prescribed by your doctor or physiotherapist a wrist brace, it can be more important to wear the brace in bed while sleeping than it is at most other times of the day. The wrist brace (depending on type) will force the wrist into neutral position for the whole night, and give the RSI much needed rest. I personally find the Bauer & Black carpel tunnel wrist brace to be the most comfortable brace for this purpose. Sadly it would seem that this excellent brace has been discontinued by the manufacturer.

Whichever brace you end up using, be sure not to over tighten it before going to sleep, blood flow restriction is not the aim here! Be especially careful if you use a snug fitting neoprene style brace, since they may not be best suited for these purposes. If in doubt, ask your doctor or physiotherapist for their recommendations.

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A very common bad ergonomic practice is wrist deviation when using a keyboard. Keyboards have never been the most ergonomically designed devices, and users tend to hold their wrists very central to the keyboard whilst inducing a lateral deviation in their wrist angle.

Lateral (ulnar) deviation can eventually lead to wrist pain, both centrally and at the outer edges of the wrist. This can occur due to nerve pinching and tendon compression which can ultimately lead to RSI like conditions.

The image on the left shows lateral deviation in both wrists. This deviation can be further worsened by the user reaching for keys at the more extreme end of the keyboard, most commonly by little lateral wrist ‘flicks’.

This is a very common ergonomic problem, and can be easily rectified by the user once they know what to look for. The biggest problem being that most
users don’t start paying attention to wrist deviation this until pain develops.

Keyboard Position

Keyboard position can become critical too.

An off-centre keyboard can cause one wrist to laterally deviate more than the other. Keyboards should have the centre of the spacebar (as opposed to the centre of the keyboard) aligned to the user’s centre. This will push the numberpad (if you have one) way out to the right, but will reduce the lateral wrist deviation.

Alternatively keyboards with removed numberpads (which are not always used) are available.

Good neutral wrist angle

It is very important to have your wrists in a neutral position when using a keyboard. Compare the wrist deviation angle in the image to the left. The wrists are held in a neutrally straight angle.

This is the best angle to hold them in to minimise potential injuries. This may feel a little strange at first, but keyboard users can get used to this style of typing posture. The hands should be lifted by the forearms and shoulders and no pivoted by the wrists. Keep in mind at all times to avoid clawed hands.

Keyboard solutions

Alternatively, there are a wide array of ergonomic ‘natural’ type keyboards, which present the keyboard to the user at the optimal wrist angle.
Some, like the GoldTouch keyboard (pictured below) have a fully adjustable split that can be adapted to the user’s posture.

This keyboard has the right hand number entry pad removed, but if required, a detached separate one is available

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• computers (mice/keyboards) for our work, gaming, web surfing, emailing, blogging, socialising
• organisers to plan our lives
• mobile phones for text messaging, web surfing etc
• other hand held email devices
• mp3 players
• digital cameras
• laptops
• game consoles
• TV remotes and 100’s of channels to hop

What do all these devices have in common?

We spend an ever increasing portion of our daily lives interacting with them, often in a very unergonomic and repetitive manner (small repetitive motions with our arms, wrists, fingers and thumbs). Many of the gadgets themselves require computer interaction.

By interacting with these gadgets, we are maximising our exposure to the causes of RSI-type conditions, when we really should be minimising it. This is especially true if you are one of the many people who uses a computer in your daily job. Using a computer for 6-8 hours a day may already be putting your body at risk from RSI. If you add in interaction with some of the above gadgets, you will be increasing that risk. RSI (or cumulative stress disorder) conditions are indeed cumulative in nature, meaning they worsen over time.

Our bodies have never had to intensively utilise devices in such a way ever before in history, and therefore, day after day, they are not functioning as they were designed to do. We maximise our risk of injury by choosing to interact with the above devices on top of work related computer use. While technology has brought amazing benefits, there is a down-side if we are not careful. To compound matters, we may well be maximising our stress levels if we allow ourselves to become enslaved by it 24/7.
It is sometimes difficult to remember a time when these gadgets didn’t exist in our lives, and how we existed without them, but our future ergonomic health may depend on how we manage our exposure to not just computers, but anything that requires repetitive interaction. Every click can add up over time, and the health consequences can, in the worst cases, be severe. Only time will tell, but unless the human body evolves rapidly to cope with the new demands placed upon it, we may be on the verge of a massive RSI epidemic.

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