Posture Added to RSI Equation
Like many of my colleagues and millions of others who work at a keyboard, I have repetitive stress injury, or RSI. The accumulation of thousands of keystrokes and minuscule mouse moves made under the stress of deadlines over the years, sometimes at less-than-perfect work stations, can wreak havoc on the nerves, tendons and muscles in the hands, arms and back.
Computer users aren’t the only ones who suffer from RSI. Musicians and workers in places such as meat-and poultry-processing factories--any work that requires small, repetitive movements--are also susceptible.
For me this means an almost constant pain in my right arm and hand (my mouse hand) and pain and muscle spasms in my upper back and shoulders. For others, the symptoms are numbness or tingling in the fingers, cold hands, weakness or loss of coordination in the hands or arms. Untreated, some people develop permanent damage and are in constant pain or have a permanent weakness that makes it hard for them to perform simple daily tasks.
There is no firm number of how many people suffer from RSI, but the Institute of Medicine’s recently published report “Musculoskeletal Disorders at the Workplace” (National Academy Press, 2001) cites three 1997 studies by the same authors that give an indication: One study says that 1.87 million people report having carpal tunnel syndrome, inflammation of the median nerve where it passes through a gap--the carpal tunnel--under a ligament at the front of the wrist.
Carpal tunnel syndrome, associated with tingling and numbness in the hands and fingers, has come to be almost synonymous with RSI. Another study found that 588,000 report having tendinitis or related syndromes, and a third reported almost 2 million workers have hand-wrist arthritis.
The problem for many RSI sufferers has been that there are not that many qualified doctors who can diagnose RSI, and there is no simple treatment. Ensuring that your work station is ergonomically correct and holding your hands and arms in natural positions certainly help. Taking breaks and lowering your stress level are also key.
But for me, results from a study in the March issue of the Journal of Occupational Rehabilitation have changed the way I see this condition and, I believe, could lead to a better chance for recovery. In the study, Dr. Emil Pascarelli, a professor emeritus of clinical medicine at Columbia Medical School in Manhattan and a leading authority on RSI, did a thorough hands-on examination of 485 people with RSI symptoms, 70% of whom were computer users, 28% of whom were musicians.
Looking at the entire upper torso of these patients, Pascarelli found that nearly 80% had posture problems, including shoulder misalignments, rounded shoulders and holding the head thrust forward. Only 8% were found to have carpal tunnel syndrome.
Dr. Craig Rosenberg, director of physical rehabilitation at St. Charles Hospital and Rehabilitation Center in Port Jefferson, N.Y., agrees with the findings.
“The majority of patients I have seen over the last 15 years have upper back and upper shoulder problems, and posture is a major issue,” Rosenberg said.
“The real emphasis should be on a complete exam, looking at the posture and what is going on in the neck and shoulders,” he said.
Lisa Sattler, a physical therapist in Manhattan who specializes in RSI, says that first-line treatment should be therapy that is tailored to the postural and other misalignments of that person. The emphasis should be on exercises that help to increase flexibility and strength over time.
Yoga, Pilates and the Alexander Technique, approaches that focus on increasing strength and flexibility, can be good “second-line treatments,” Sattler and Rosenberg said.
