Exercise may be the Rx for RSI
The tendinitis in Mike Estrada’s right arm was getting worse. He couldn’t write up work orders for his construction company, carry a briefcase or even staple together papers. But although the pain was aggravated by the repetitive stresses of his job, the ergonomic changes -- getting a new office chair, using a track ball instead of a mouse -- didn’t help.
Finally, he sought help from doctors at USC. They prescribed not additional work changes, but painkillers and -- exercise.
For the past two months, the 51-year-old Northridge resident has been hitting the 360 Health Club in nearby Reseda, going to spinning classes three times a week, a yoga session on Sunday mornings and doing a daily 20-minute routine of stretching and weight lifting to strengthen the muscles around his injury. “I’ve seen a real improvement,” he says, “and I can even use a stapler again.”
A new report suggests that this approach may be the best medicine for many repetitive stress injuries. Although ergonomic adjustments are often used to treat work-related complaints of the arm, neck or shoulder, there’s scant scientific evidence that these costly interventions help, according to a review of recent research published in July. The weight of data suggests that old-fashioned exercise does.
Repetitive motion injuries, such as headaches, tendinitis, carpal tunnel syndrome, and chronic pain in the back, neck and shoulders, have become endemic in computerized offices across the nation.
The costs associated with these disorders is high -- as much as $100 billion annually in the U.S. alone, in direct and indirect costs, such as lost productivity and absenteeism. To reduce this toll, corporations have spent billions in the past decade outfitting workstations with ergonomic equipment such as specially designed keyboards, desks and chairs.
But are companies getting enough bang for their buck? Available evidence is decidedly mixed.
The recent review of 21 studies, which encompassed 2,110 volunteers, appears in the current issue of the Cochrane Library, published by the Cochrane Collaboration, an international nonprofit consortium that promotes evidence-based medicine.
Seven of the studies looked at various ergonomic strategies -- such as using alternative keyboards or educating workers about sound ergonomic practice -- to improve function and reduce pain in people with carpal tunnel syndrome.
There, evidence of efficacy was limited, the review found, and no studies were done on the use of these adjustments to relieve other repetitive stress conditions, which afflict 80% of people with work-related disorders.
The other 14 studies in the review examined the benefits of different types of exercise, including strength, weight and endurance training and, in contrast, the majority showed positive results.
“It amazes me that no one has ever evaluated the effectiveness of these expensive ergonomic interventions for most conditions,” says Arianne Verhagen, the lead author of the review and a physical therapist and epidemiologist at Erasmus University Medical Center in Rotterdam, the Netherlands. “While we can’t draw any firm conclusions, because some of the data is inconclusive, I put my money on exercise: It’s cheap and everyone can do it in their own time and their own way.”
Experts such as Yogi Matharu, director of the USC physical therapy clinic, agree.
“Once someone is injured, ergonomics can help, but that can’t be the only treatment,” he says. “Any kind of exercise increases endurance, which prevents the breakdown of different body parts, and people don’t get fatigued as easily. And targeted exercise can strengthen weakened areas.”
Ergonomic adjustments do help with prevention, easing the physical and mental stresses of a workstation setup, experts say. Substantial anecdotal evidence suggests these changes reduce the incidence of common workplace injuries.
“Industry started doing it because it was saving them money -- workers’ comp costs and absenteeism went down,” says Dr. Linda Rosenstock, dean of the UCLA School of Public Health and former director of the National Institute for Occupational Safety and Health. “And prevention is still the No. 1 goal.”
Once someone has a repetitive motion injury, however, “a systematic holistic approach that combines ergonomics and exercise is best,” says Jack Tigh Dennerlein, a biomechanist and ergonomics expert at the Harvard School of Public Health in Boston, “because they’re synergistic.”
Ergonomic changes can generally reduce the magnitude of the exposure, which is defined as the biomechanical load that unnatural stresses put on the body. Spreading the burden over other muscle groups and joints -- using a keyboard tray with a mouse shelf extension to relieve repeated strain to the wrists and forearms, for example -- cuts down on the wear and tear in just one spot so injuries aren’t exacerbated, USC’s Matharu says.
Ergonomic adjustments can also be made to ensure that someone is sitting or standing comfortably.
Workers who do repetitive motions can also relieve the strain of working intensely over long periods by taking regular three- to five-minute breaks every 20 to 40 minutes, and frequent 10- to 15-second micro-breaks.
“You must get out of that chair a couple of times an hour -- go to the bathroom, get a drink, answer the phone standing up,” says Jonathan Bailin, a West Los Angeles ergonomics expert and industry consultant. Otherwise, muscles become locked in the unnatural and stressful positions that cause these types of injuries.
Finally, exercise regularly, whether it’s hiking, cycling, walking, swimming or yoga, to get in better condition, which increases energy and endurance. “This way, you’ll have a higher capacity,” Matharu says, “and be better able to withstand stresses on the job.”
