IT HAPPENED TO Ola Bullock, a 44-year-old data reviewer at the Watts branch of the Social Security Administration. It happened to Silvia Perez, a 39-year-old service representative for Pacific Bell in Orange. It happened to a contracts administrator for a Los Angeles-area entertainment company, an airline reservations clerk from the San Fernando Valley, a discount stockbroker in San Francisco. It has crept up on secretaries, screenwriters, accounting clerks, broadcast graphics engineers. And it sneaked up on me--a 32-year-old reporter for the Los Angeles Times.
At first, each of us occasionally felt minor aches so subtle that we barely realized we hurt. Over time, we developed an invisible affliction that made the simplest hand movement a major effort filled with pain. It hurt to wash, to eat, to open doors, to pick up a baby. It meant losing independence, and it threatened our jobs. Bullock couldn’t fill out her income tax forms. I could barely brush my teeth. “When I tried to apply pressure,” Perez says, “it was like putting your hand on a nail. I mean it hurt .”
Researchers call it the industrial injury of the Information Age. Doctors call it cumulative trauma disorder or overuse syndrome or repetitive strain injury. I call it computeritis.
IN THE PAST decade, computers have become as common in the office as telephones. They do it all: researching, filing, calculating, editing, mailing. Along with efficiency and speed and ease, though, the high-tech revolution also has generated complaints of crippling side effects. Questions have been raised about problems such as blurred vision and an increased risk of miscarriage or birth defects. Most clearly linked to computer work, however, is damage to tendons, muscles and nerves, apparently caused by punching keys as often as 18,000 times an hour, for hours at a time.
Cumulative trauma disorder is not a new phenomenon, but until recently it appeared to be confined to manufacturing work. It has shown up in meatpacking plants, textile mills, auto assembly lines--anyplace where hand and arm motions are repeated continuously. Over the past 10 years, as automation has reduced jobs to simpler tasks and the race to increase productivity has cut into rest periods, these problems are affecting more and more workers.
Last October, the U.S. Labor Department levied a fine of $4.3 million, the largest in its 17-year history, against John Morrell & Co. for “willfully ignoring” cumulative trauma disorder that struck more than 40% of the 2,000 employees in a South Dakota meatpacking plant. In December, a $1.4 million fine was proposed for cumulative trauma disorder at a Pepperidge Farms Inc. cookie factory in Pennsylvania. Both companies are currently negotiating settlements with the Labor Department.
Some employers question the connection of cumulative trauma disorder to computer work. In workers’ compensation cases, they have argued that the problems may result from aging or hobbies, such as knitting, sewing or playing musical instruments. And two social scientists from Carnegie Mellon University argued in the December issue of American Psychologist that the injuries are being used by some Australian clerical workers as an excuse to get disability pensions and escape their boring jobs.
But the National Institute for Occupational Safety and Health, a research arm of the Department of Health and Human Services that advises the Labor Department, is convinced that repetitive strain injuries have a cause-and-effect relationship to computer work. “It’s not unique to computers,” says Vern Anderson, a NIOSH ergonomist (an expert in adapting workplaces for workers), “but we are seeing more cases of it because the proportion of the work force using computers is increasing.”
Currently, 20 million people in the United States use computers daily to make a living, according to the Computer and Business Equipment Manufacturers Assn. By the year 2000, the association predicts, 75% of all jobs will involve computers.
Laurie Fraser studied cumulative trauma disorder as an ergonomist for the California health department. “It’s valid to assume,” she says, “that millions of Americans have computer-related (cumulative trauma) disorder now.”
MY FIRST BOUT with computeritis began in late 1986. Very early one December morning, I opened my eyes to the predawn gray and wondered why I was awake. I moved slightly. Then all I saw was a haze brought on by sudden agony.
The next day, after I took a painkiller prescribed by a doctor, my neck was much better. While typing a story later, however, my hands went numb. My fingers tingled as if they were being pricked by pins and needles.
The doctor thought that I had a pinched nerve in my neck, caused by cradling a phone on my shoulder while I took notes on my computer. The pinched nerve ran down my arm, said a chiropractor I started seeing. The hands would heal, he predicted, as pressure eased off the nerve. I exchanged my telephone receiver for a telephone headset and waited for improvement.
Instead, everything got worse. My forearms felt heavy and sore. Nothing eased the pain. My chiropractor, Bradley Frederick, theorized that the pinched nerve was not my only problem. He had seen something like this a few times before, in people who worked with computers.
I had heard vague tales about others at The Times stricken by something called “computer disease.” When I casually mentioned to a Times computer-systems expert that I seemed to have a touch of it, he stared at me, hard. You better take it seriously, he snapped. It can ruin you. He gave me the name of a reporter who had been forced to take a non-reporting job for nine months because of the pain.
Nine months! I called. The man was reporting again, but he still hurt. Stop typing now, he ordered me. Otherwise, it gets much worse.
As we talked, I sat facing the glowing green letters of a half-finished story on my computer screen. I hung up and kept staring, wondering if I had drifted into a cheap horror flick: The Revenge of the Office Machines.
I knew there was always a chance of getting hurt on the job, but the risks of journalism had seemed kind of glamorous. I had wandered into the middle of a heroin bust in a Baltimore ghetto, driven through a Florida hurricane and investigated a thug who relayed threats to me. The newsroom, removed from the rush and rumble of the real world, was not supposed to pose any danger.
I refocused on the screen. I wanted to change a sentence, but I didn’t dare touch the keys.
WHEN you work on a computer, shoulder muscles are tight, constrained to support the arms. Eye muscles remain rigidly focused on the screen, usually 15 to 20 inches away. Each time you punch a key, a muscle running from the elbow through the forearm contracts. The muscle is attached to tendons that slide back in lubricated sheaths through the wrist to lift the fingers. The muscle relaxes, the tendons slide forward, the finger pushes down.
When Ola Bullock enters Social Security information into her computer, she doesn’t have to pause as she would with a typewriter. She doesn’t have to roll out a finished form or insert a new one. Contract, slide, relax. Silvia Perez types phone orders into a computer almost continuously. Contract, slide, relax. I can move paragraphs at will, so I rewrite endlessly. To chat with colleagues, I tap out a message and dispatch it electronically. Contract, slide, relax. Contract, slide, relax.
Cumulative trauma disorder encompasses problems ranging from swollen tendons and muscle spasms to severe nerve damage, or any combination thereof. It usually starts when excessive friction scars tissues that then stick to tendons, muscle or bone. The tendon sheaths tighten, changing the lubrication inside from the normal egg-white consistency to a gluey texture. Body parts go from slipping easily to a constant tug-and-pull.
In response, the tendon sheaths may become inflamed, a condition known as tenosynovitis. Or the tendons themselves may swell, an injury called tendinitis. My doctor said I had both.
Swollen tendons can push into the wrist, compressing the median nerve, which runs through a passage in the wrist--the carpal tunnel--to the fingers. The disorder can also surface along the ulnar nerve running from the elbow to the little finger.
Carpal tunnel syndrome is a potentially crippling injury that may require surgery to widen the tunnel and relieve pressure on the nerve. That’s what happened to Perez. Her hands deteriorated for a year, from cramps to numbness to shoulder pain. Finally, she lost her grip. Perez had an operation performed on her right wrist. Within six weeks, before she could return to work, her doctor ordered similar surgery on the left wrist.
“You can also get muscle-pain-spasm syndrome,” says Linda H. Morse, chief of occupational medicine at Valley Health Center in the Silicon Valley. “That term covers about 20 different situations. . . . Usually we see it in the muscles of the neck and upper back and sometimes in the shoulder.” Bullock is a case in point. Her pain appeared in her neck, shoulder and shoulder blades. Such spasms can become permanent if allowed to progress.
Computeritis researchers are not certain why some people have some symptoms and others have different ones. Nor are they sure why some people manage to hold up under the strain with no problems at all. But they suspect that the most likely victims are those whose efficiency of movement is hampered by conditions ranging from my pinched nerve to someone else’s lower back trouble or old shoulder injury. Prolonged computer work, Morse says, is so harsh that there is little tolerance for imperfections. The pain, she says, tends to show up where the imperfections are.
The most common factor is bad posture--not only of the neck and spine, but also of the arms and hands. Bad posture can create the last bit of extra pressure, that marginal defect, that leaves computer users vulnerable.
Design of furniture and of the computer itself can affect posture. If keyboards are too high or too thick, or if chairs are too low, operators may be forced to work with hands bent upward. Try it and feel the tendons behind the wrist bunching together; it makes that slide movement tough.
Screens can also be too high, or too low, or too far away, prompting operators to crane their necks for hours. The keys can be so stiff that it takes a mighty effort to push them.
Computer users may not even realize when their bodies are compromised. “It’s amazing how much difference an inch or two can make,” says Mark S. Sanders, an ergonomics consultant on the faculty at California State University, Northridge.
THE FIRST STEP in my treatment was to change the way I worked. The Times’ safety director suggested a new chair and a wrist rest--a black leather pad that sits in front of the keyboard to assure that wrists stay in a level position. He raised my screen so that I could keep my neck straight instead of stretching to peer down at it.
With the acquiescence of my editor, I cut back on how often I wrote. At the International Sports Medicine Institute in West Los Angeles, Bradley Frederick worked on the pinched nerve in my neck. In the institute’s clinic, I received ultrasound and electronic stimulation to ease the inflammation in my forearms and wrists.
By June, 1987, I was feeling much better and turning out more copy. Then, on Oct. 1 that year, the Whittier earthquake struck. I had one hour to report and write a story for a special edition of the paper. My fingers skittered across my computer keyboard; I was pumped up, concentrating, composing as fast as I could.
I noticed a tiny circle of pain lodged under my right shoulder. The deadline passed; another loomed. As I pounded at the keys, the pinpoint of pain started glowing hot.
That night, the fire in my shoulder wouldn’t let me sleep. Within two weeks, the pain spread to my neck. I could barely lift my head. Frequent lightning-bolt sensations struck my elbows. The pads on my palms swelled to twice their normal size. My wrists felt as if barbed wire were strung inside.
This was worse than the first time. Driving, writing longhand and typing shot sparks up and down my arm. Once again, I reduced my workload. I started seeing Frederick three times a week. Reluctantly, he recommended that I wear a wrist splint. Although it would offer support, prolonged use might also lead to muscle atrophy. Even these efforts failed to halt my slide.
A month later, I consulted an orthopedic surgeon, Robert W. Chandler, at the Kerlan-Jobe Orthopaedic Clinic in Inglewood. I had heard about him from other Times computeritis victims. He recommended physical therapy.
“You were fairly debilitated,” recalls Betsy Fleisher Terry, the physical therapist I started visiting at Schlink, Nadel & Associates in West Los Angeles. Strength, she told me, is rated by therapists on a 0-to-5 scale. My wrist muscles were “about a 3, in some cases a 3-plus,” she says. “You can be fairly functional at a 3-plus, but that tends to lead to more problems because you’re so weak. It sort of becomes a cycle. You overused it, so it hurts, so you don’t use it, so it becomes weak, so it’s easier to overuse it again and then it hurts.
“You see this 3-plus in older people,” she says, “people in their 80s.” I was 31.
Like Frederick, Terry had treated others with computeritis. All had resumed their normal lives within several months, she said. Because I was on my second episode, she calculated that my recovery would take at least a year.
Wisely, she kept her estimate to herself. I would have been stunned. I was already reeling from the realization that an “episode” could happen again and again.
I was by turns stoic and hysterical, determined to fight my way back to health and frightened that my life as a reporter--my identity since high school--must be over. I railed at the fates, and at my husband and my friends.
In the Times cafeteria one day, I chose beef stew for lunch because I didn’t think it would require any cutting--cutting hurt too much. The potatoes, however, were too big. My companion noticed that I wasn’t eating them, and sighed. She reached over to slice the chunks into tiny pieces. She was visibly pregnant at the time; it made a nice domestic scene.
At home, my husband, Steve, found me standing helplessly in front of the dryer. It hurt so much to fold the laundry that I had to stop.
When Steve and I took a vacation, I made up my mind to avoid talking about my condition. We both needed to forget about it.
We stayed with friends in New York City. Before 7 the first morning, I crept out of the guest bed--a mattress in the living room--and reached for a jump rope I had packed and a towel I had laid out the night before. I crept through the darkened apartment to the special place I had scouted out earlier. I had a ritual to perform in solitude.
What I hadn’t planned on was our hosts’ waking up so early and going out for breakfast. The two of them came down the hall, bundled in coats and scarves, and found their exit blocked.
There I was, prone on the floor, my head in a noose that I had fashioned from the towel. The rope secured the noose to the knob of the front door.
I had hoped to keep my need for daily traction a secret. They thought I was trying to hang myself.
EVERY MONDAY, Wednesday and Friday, Ola Bullock stops typing at noon and travels to Inglewood for physical therapy. Her supervisor is sympathetic but occasionally asks how much longer she’s going to need the treatments. “There’ve been budget cutbacks. There’s no one else to do my work,” Bullock says.
Before Silvia Perez had her surgery, “I was doing maybe 30% of my job,” she says. “I tried taking calls and writing out orders, but then someone else had to type it in,” she says. She worried about the added pressure on her co-workers: “What I couldn’t do, they were doing.”
The more people affected at any given office, the more devastating the loss in productivity. Over the past four years, more than 200 of The Times’ 1,100 editorial employees have sought medical help for computeritis. Similar symptoms have cropped up at newspapers across the country, but not to such a startling degree. The evidence is all over the newsroom. One editor keeps ice packs within reach. His inflamed tendons etch angry red lines on the top of his right hand. Several reporters have gone on disability leave for as long as 10 months. Still another stopped reporting altogether, transferring to another position at The Times that requires less typing. There are other costs as well. The Times has estimated that it will require at least $500,000 in workers’ compensation funds to treat the existing cases.
Computer disease has cut wide swaths across other workplaces, too. At an Oklahoma City office of The Hertz Corp., about 20% of the data processors who feed car-rental contract information into computers came down with tendinitis. They type all day, except during lunch and two 15-minute breaks. Speed counts.
Last year, Hertz bought new computer tables, adjustable seats and wrist rests for that department. The jobs remained the same. Brenda Rigby, a company spokeswoman, says Hertz will not disclose the cost of the makeover or the number of employees affected. She says that the incidence of injury is down sharply but that about 10% of the processors are still troubled by pain and swelling.
In at least two instances, federal safety inspectors have directed companies to redesign jobs and computer equipment. At a phone company in Denver, U.S. West Communications, union officials maintain that since 1986, 182 of 461 directory-assistance operators developed wrist and hand troubles from rapid keying to retrieve phone numbers from computer files. The number has been reduced to 15 active cases.
The other complaint was leveled against the U.S. Postal Service Bulk Mail Center in Pittsburgh. Back and wrist disorders affected six of the 72 clerks there who direct packages along a conveyor belt by typing ZIP codes into computers, according to Gary Griess, who heads the Pittsburgh office of the U.S. Occupational Safety and Health Administration. At one time, employees had alternated half an hour of typing with half an hour of another task. In the two years after workers began to type continuously, the health problems appeared, Griess says.
Both the Postal Service and the Denver phone company challenged the inspectors’ conclusions, although both eventually negotiated settlements, agreeing to provide employee education and, possibly, new equipment.
Nobody knows exactly how many people have computeritis. “There’s a need to collect better data,” says Louis Slesin, editor of the VDT News, a New York-based computer newsletter. He believes that the incidence of computeritis has been underreported. “If it’s a small office, you may never hear about it,” he says. “If it’s not unionized, you may never hear about it.”
Some victims may not even know why they hurt. An Indiana journalist remembers thinking her wrist hurt because she popped the tops off seven cans of Diet Coke a day. She cut back on soda, but it didn’t help. A former San Francisco discount stockbroker says she thought her sore neck and tingling arms were a result of aging. “I was starting to think I was too old to do the job,” she says.
As for Perez, “I had fallen down a couple of times and (doctors) suspected a fracture in my right hand.” She filed for workers’ compensation after an orthopedist diagnosed carpal tunnel syndrome and told her it was work-related.
MEASURES HAVE been passed in at least nine states to regulate computer work. In California, purchasing guidelines for workstations have been adopted for state government, university and community college employees. The state Division of Occupational Safety and Health is studying whether to impose computer work rules on all workers.
At the same time, Assemblyman Tom Hayden says he and colleague Tom Bates will try this year to get computeritis laws passed statewide.
Such a law was enacted last June in Suffolk County, N.Y. It requires a 15-minute break for employees every three hours, employee education and specifications for new work furniture.
Those solutions sound simple, but they involve fundamental changes in the way employees approach their work--and they can be expensive. Consequently, says Laura Stock, of the Labor Occupational Health Program at the University of California, Berkeley: “It’s a political battle more than a scientific one. It’s a labor-management struggle. Will companies do what’s needed on their own?”
She doesn’t think so. “That gap between what we know and agree upon, and what’s actually in practice in the workplace is still there,” Stock says.
On the other hand, Columbia University professor Alan F. Westin believes that most offices are trying voluntarily to defuse the potential for harm. Westin studied the way 110 companies dealt with computer technology, surveying each firm between 1982 and summer, 1985, and between fall, 1985, and 1986. The first time, 75% failed to display much interest in the potential health hazards posed by computer work. The second time, more than 60% were taking steps to minimize the problems, steps “that might not satisfy the critics,” Westin says, but that included distributing literature about computeritis and education about exercises and stretching.
In some cases, however, the changes have come too late. Westin tells of a bank he surveyed, but chooses not to name, where half a dozen data processors in a department of 35 or 40 started blaming their computers and workstations for a range of aches and pains. Officials at the bank, “which had a reputation for having good employee relations,” Westin says, “drew the conclusion that it was the attitude or malingering of those six.”
Only after 12 of the data processors were disabled did the bank replace its rigid furniture with adjustable desks and chairs, spending $2.5 million.
The Times, too, is trying to quell its outbreak of computeritis. Newsroom employees are now required to watch a videotape demonstrating good workstation posture. They are given a brochure that urges them to take frequent breaks and describes equipment that can help prevent strain. The paper accommodates requests for adjustable chairs, shelves that lower keyboard height and personal computers with a lighter touch than the standard issue terminals. The Times is also experimenting with new keyboards and adjustable computer tables.
Michael G. Manfro, The Times’ safety director, says the pace has been slow because “it took a long time before everybody believed this was real.”
“They’ve been kind of inching along,” says Sanders, the ergonomist who serves as a Times consultant. “It’s unfortunate for the people that are in there, caught during the process.”
FOR MONTHS after the Whittier earthquake, I focused only on the majority of my colleagues going about their business--my business. For the first time in my life, I was jealous of my friends when they did good work. I’m being left behind, I thought.
I learned ways to conserve my capacity to use my hands. Steve washed dishes and did my other chores to leave me energy for work. I taped phone interviews and sent the cassettes to be transcribed.
At some point, though, I had to type. I was used to hitting the keys at the same speed as the voice in my head that put the words together. Now I had to think about stopping periodically to rest; I had to remember to hold my neck straight and keep my shoulders from hunching; I had to stay alert for signs of fatigue that warned me to knock off for a few hours or even the rest of the day.
At my physical therapy sessions, I lay on a treatment table in a hospital gown while Betsy Fleisher Terry pressed hard on my shoulder, arms and hands to loosen knotted tissue, relax muscles in spasm and firm up spots that she described as “boggy.” To a healthy person, the rubbing would have felt like deep massage. For me, it was torture. I left feeling as if I had been beat up.
A few months later, Terry told me it was time to regain my lost strength. Do wrist curls, she said, while you hold a 12-ounce can of tomato paste. Later, she suggested moving on to a 1-pound bag of spaghetti. Unfortunately, the next step was not garlic, but a 2-pound bag of dried beans. My exercise also included squeezing an orange sponge ball or Silly Putty.
Slowly my endurance increased. From typing two or three minutes, then stopping for an hour until the pain died down, I got to the point where I could type for 20 minutes straight. In a few months, I often could type for 45 minutes and break for 20 minutes.
I charted my progress with domestic triumphs, too. I could wash the dishes again.
But I seldom felt like an achiever. Instead of listening to my understanding husband, parents and friends, I chose to pay attention to the sneers of those who thought I must be faking or crazy or a wimp. I stuffed myself with candy and cookies, gaining 7 pounds. I drove aimlessly around the city, giving myself pep talks.
David Rosenzweig, then The Times’ Metro editor, noticed my misery. He took me aside. What can you do that would help the paper but would not involve typing? he asked. And so I spent seven weeks in April and May speaking Spanish with a tutor, courtesy of The Times. I acquired a new reporting tool, and my healing sped along.
I dropped down to two therapy sessions a week. I needed traction only a few times a month. I abandoned the splint, the despised symbol of my weakened state.
Still, I’m a long way from normalcy.
I’ve been typing for nearly half an hour now. If I don’t stop, the puffiness in my elbows and forearms will give way to pain. The front of my right shoulder seems tender. The base of my right thumb is stiff; my wrist is aching too. If I don’t stop . . .
THERAPY OFFERS relief for Ola Bullock, but the pain always comes back. “My doctor told me not to give up,” she says. “I would just hate to just stop working completely.”
Silvia Perez is back at full speed. Her right hand is much better now, but her left is sometimes numb. “Should this recur, what do I do?” she worries. “I’m a single mom. I have to have a job. Where do I go now where there’s no typing and no computers?”
As for me, Chandler says I have every reason to believe that someday I’ll be working as much as I did before. I’ll have to do it differently, that’s all. I’ll continue to exercise, to take frequent short breaks, to make sure my workstation doesn’t force me into contortions that add to the pressure.
“What you are looking at,” he says, “is adaptation.”
I’ll have setbacks, he has told me. But I have to test my limits.
So I didn’t panic when the pain intensified after I worked four hours straight on a deadline in late May. I simply stopped punching keys for three weeks until the soreness faded.
In the middle of writing this story, I managed five six-day workweeks before I overdid it again. The result was another flare-up. This time, though, I rebounded even faster.
For six days, I rested. And on the seventh day, I typed.