Repetitive Strain Injuries—What You Should Know
BY AWAKE! CORRESPONDENT IN BRAZIL
MARCELO, a 24-year-old housepainter living in Brazil, had done it almost every morning without thinking. He put his watch on his wrist and maneuvered the two ends of the leather strap around it. But this time he had trouble fastening the straps. Then he looked at his wrist and noticed the problem. It was so swollen that the watchband no longer fit.
In time, even holding a comb or a toothbrush caused pain in his hand. So Marcelo went to see a doctor. After examining Marcelo and learning that for two years he had been scraping, plastering, and painting walls, the doctor told him: “The pain you’re feeling is job related. You have repetitive strain injury [RSI].”
A New Disease?
Many factory and office workers are given the same diagnosis as Marcelo was. RSI is spreading so fast that the newspaper Folha de S. Paulo called it “the foremost work-related sickness of the end of this century.” No wonder many people have concluded that RSI must be another one of those modern-day diseases! Is it?
Actually, if Marcelo had lived in Europe early in the 18th century, a doctor may have recognized his symptoms. Of course, the problem was not known by the same name then. The Italian doctor Bernardino Ramazzini described the problem as wrist tenosynovitis (inflammation of the tendons and surrounding sheaths) and called it the illness “of scribes and notaries.” The repetitive movements required in those professions had given clerks the 18th-century version of RSI. But by the end of that same century, the number of workers suffering from RSI had gone down. Why?
The Fall and Rise of RSI
Office clerks in the days of Ramazzini lived in the so-called preindustrial age. In those days, people worked long hours without the help of machines. Their work demanded repetitive movements and constant mental attention. This resulted in RSI-type afflictions.
By the end of the 18th century, however, Europe had moved into the industrial age and man power was being replaced by machine power. Man now became the master who let the machine do the repetitive jobs. That change, concludes a doctor who studied the history of RSI, may have reduced the occurrence of RSI among laborers.
Granted, during the industrial age, the number of work accidents rose and occupational illnesses among factory workers increased. Nevertheless, medical literature covering that period makes mention of RSI cases only among specific groups. For instance, 19th-century pianists and violinists suffered from tendinitis in the upper arms, and tennis players contracted tennis elbow, or inflammation of the tendons in the elbow.
In our century, however, job-related RSI has returned. Why? For one thing, increasingly efficient machines often tell man what to do and how fast to do it. This turnabout has led to workers’ dissatisfaction and to health problems. Workers put in long hours at jobs that often force them to make repetitive movements and that demand constant mental attention. The result? RSI has become a health problem that now accounts for more than 50 percent of all work-related illnesses among workers in the United States and in Brazil—to name just two countries.
The Causes, and the Professions Affected
The major cause of RSI is the rapid repetitive movements required in many work assignments. Sadly, workers are often left with little choice but to cling to jobs that may damage their health. Many workers can sympathize with the Brazilian woman who worked in an automobile plant and had to assemble radios in less than one minute each. Another worker, reports the newspaper Folha de S. Paulo, had to perform tests that required her to hit 63 appliances with a rubber hammer each hour. Both women began to suffer pains in their upper arms and were later laid off their jobs because of disability caused by RSI.
Efforts that overtax one’s muscles and joints (such as carrying heavy sacks) and static efforts (that is, efforts by the muscles to keep parts of the body in a fixed position) are also causes of RSI. Such actions may especially cause injuries when one works in an uncomfortable position.
Some whom researchers list as particularly RSI-prone are metallurgists, bank clerks, keyboard operators, telephone operators, supermarket cashiers, waiters, housepainters, toy assemblers, seamstresses, hairdressers, knitters, sugarcane cutters, and other manual laborers.
More Than Movements
Although most people think that RSI is solely caused by work that requires repetitive movements, experts attending the First National Seminar on RSI, held in Brasília, Brazil’s capital, stressed that more than repetitive movement is involved.
Dr. Wanderley Codo, a mental-health and work consultant at the University of Brasília, explained: “The way work is organized—the tasks, the management-worker relationships, the actual climate of the business, the level of worker participation, and the work routine—is one of the factors strongly linked to the illness.”
Other medical experts at the RSI seminar also underlined the link between the illness and the organization of the workplace. One downside of new technologies, they said, is that these have led to forms of work organization in which the worker loses all control over his job—a contributing factor in getting RSI.
Since the way work is organized and carried out is closely linked to RSI, certain workers in previous decades were able to perform repetitive movements without contracting RSI. Such is the conclusion of some experts.
Identifying the Affliction
Keep in mind that RSI does not refer to one illness but to a group of illnesses. All ailments of this group affect muscles, tendons, joints, and ligaments, especially those of the upper limbs. Since RSI identifies a group of illnesses, it follows that various signs and symptoms are produced. The symptoms may be vague, and the connection between the causes and symptoms may not be immediately determined. Consider the following principal signs.
One sign is a feeling of heaviness and discomfort in the affected body part (the shoulder and⁄or the arm, for example) that develops into persistent pain and a tingling sensation. Also, nodules, or small lumps, may appear under the skin. In the more advanced stages of RSI, swelling and pain may become so severe that a person is unable to do such simple tasks as combing his hair and brushing his teeth. If left untreated, RSI may even result in deformities and disability.
Combating RSI
If your present work requires repetitive movements and you already notice signs of RSI, you might want to seek help from the medical service of your company. If that is not possible, you may be able to go to a health service where an orthopedist can assess your problem and take the necessary measures to help you. The chances of getting well will be much greater if you pay attention to RSI in the early stages of the illness.
Another important way to combat RSI is to give consideration to ergonomics. What is ergonomics? The term is defined as “an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely.”
Thus, ergonomics has to do with adapting the workplace to man as well as man to the workplace. However, it goes beyond improving the shape of a keyboard or a hammer. It also includes considering the worker’s mental and emotional needs. To achieve that, says ergonomist Dr. Ingeborg Sell, ergonomics “utilizes data, information, and knowledge from all participating disciplines [and] endeavors to arrive at new and comprehensive knowledge about man and his work.”
True, changing the ergonomics of the workplace may be beyond most workers’ sphere of influence. But medical experts at the RSI seminar in Brasília explained that “participative ergonomics” is not. What is meant by participative ergonomics?
An employer who encourages participative ergonomics in the workplace takes the worker’s opinion into consideration. He invites the worker to share in figuring out how to improve his workstation. Such an employer will also favor the presence of an in-house RSI committee made up of workers and management. This group will keep an attentive eye on maintaining a safe and comfortable work environment within the workplace. They tackle the causes of RSI, promote prevention, and define what the employer’s and employees’ responsibilities are in controlling or even abolishing cases of RSI within the firm.
Prevention at Home and at Work
Prevention of RSI starts at home. What can you do? When you wake up, imitate your dog or cat. Notice how your pet stretches its muscles before getting on with a new day. Do the same. And, while you’re at it, repeat those stretches a few times during the day. This is essential for keeping your bones and muscles healthy. Do some exercises to warm up your muscles. This will accelerate blood circulation and increase the amount of oxygen available for your muscles to do their work. Of course, during cold weather and also before participating in sports, taking this step is even more important. Do some exercises that will strengthen the specific muscles that you use most. Stronger muscles will help you to perform the necessary tasks at work.
Besides these measures at home, there is also need for a prevention program at your workplace. The employer may prevent RSI problems among workers by arranging for a work schedule that provides breaks or changes and that rotates the different types of jobs among the workers.
Another aspect of RSI prevention is providing the right type of tools for the worker. This might include, among other things, desks and chairs of the correct height, pads for elbows, drills and pliers that do not require excessive force applied by hand, user-friendly computer keyboards, or heavy equipment with shock absorbers to prevent excessive vibration.
Marcelo, mentioned in the introduction, put many of these suggestions into practice. This together with the medical treatment that he received has eliminated the RSI symptoms that he had. A complete cure is within his reach. Without a doubt, it takes personal effort and organizational changes to combat RSI, but since the number of RSI patients in the workplace is growing, the benefits of these changes may prove greater than the costs.
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RSI in Musicians
Repetitive strain injury (RSI) is common among professional musicians. According to a study published in 1986, half of all musicians in eight symphony orchestras in Europe suffered from RSI. In the 19th century, the illness was called musician’s cramp. One of the first reported cases was that of Robert Schumann. RSI forced him to give up piano playing and to concentrate on composing.
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Factors Contributing to RSI
1. Wrong posture
2. Working long hours
3. Stress at work
4. Previous injuries in muscles and tendons
5. Dissatisfaction with your job
6. Exposure to cold
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Preventing RSI
THINGS TO AVOID
1. Holding weighty objects for prolonged periods
2. Putting too great a burden on the joints
3. Using arms above heart level for prolonged periods
4. Working in uncomfortable positions
THINGS TO DO
1. Alternate arms when performing tasks—even light ones
2. Distribute various types of tasks throughout the day
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Pages 16 and 17: The Complete Encyclopedia of Illustration/J. G. Heck