The Times, September 14 1999
A significant court decision and new research have helped to legitimize claims of repetitive strain injury. Val Sampson reports “At last recognition for RSI sufferers” When accounts clerk Julie Baggott was transferred to the wages department of the large corporation where she worked, she had no idea that she would pay a terrible price. The move at the end of 1995 wrecked her health and signaled the end of her working life. It was while she was typing on a keyboard under constant pressure that Julie, 47, from Bude in Cornwall, developed RSI (repetitive strain injury). It affected her arms, shoulders and spine. Four years on she is in constant pain, living on disability benefit and unable to shop or shower on her own. “I have got no life,” she says. “I can walk a little on grass but I can’t walk on pavements because that affects my spine too much. I can’t reach up to the shelves in the shops and I’ve broken every glass in the house. I can’t shower alone in case I lose my balance. I have to have someone with me.”
Bill Fine, a senior consultant with Ability Net, a charitable consultancy that aims to make the benefits of computers available to disabled people, estimates that up to 10 per cent of the British population experience a degree of discomfort while using computers or working in jobs that require similar repetitive hand movements, such as at supermarket checkouts. RSI is not a new phenomenon. It was rife in Victorian times when Civil Service clerks were introduced to new technology – the steel nib. Signers for the deaf are also susceptible to disorders of the upper limbs, as are violinists, potters and can-stackers. But the advent of computers triggered the latest cases. According to Bill Fine, “The QWERTY standard computer keyboard layout was designed in 1873 to slow down keying enough so that the mechanisms would not jam”.
“There is a number pad on the right-hand side which most people never use and which occupies the most comfortable and usable piece of desk for right-handed people. Keys are flat and straight; hands and fingers are not. This forces an angle in the wrists, which constricts the carpal tunnel and requires the hands to be held flat when they are naturally held at an angle, with the thumb higher than the little finger.” When patients first started turning up in GP and hospital waiting-rooms with pains in their upper limbs, necks and shoulders, few of their complaints fitted textbook diagnoses. As a result many were informed by medical professionals that their discomfort was psychological, not physical. “The vast majority of people who contact the RSI Association have been humiliated by doctors and members of the legal profession and told that their suffering is all in the mind,” says Andrew Chadwick. “It is very distressing. All they want is for people to acknowledge that they are not mad.”
The tide turned in their favour in July with the Court of Appeal’s ruling in favour of five former part-time Midland Bank staff who suffered disabling pains working as keyboard operators. “This judgment shows that RSI is a very real industrial injury and employers are liable for the damage they cause to their staff,” said Linda Gregory, a negotiator for UNiFI, the financial industry union which backed the women. The Midland Bank case coincided with the publication of new scientific research in The Lancet showing physical evidence that RSI exists. Jane Greening, a research physiotherapist at University College London, was prompted to examine issues around upper-limb pain more than a decade ago when she noticed increasing numbers of patients arriving in clinics complaining of arm pain that did not seem to have any obvious physical reason. “Orthopedic surgeons didn’t want to use the term RSI so they put them in such categories as writer’s cramp or tendinitis,” she says. “When patients don’t fulfill criteria it is tempting to suggest that it is all in
Greening’s initial research focused on how sensitive nerves were to vibration. She discovered that the vibration thresholds of RSI patients were significantly raised. She and her team recently used an MRI scanner to identify that in RSI patients the median nerve in the wrist’s carpal tunnel can become trapped when people use a lot of repetitive hand movements in a confined and static posture. “There is something physically wrong with these people,” she said. “You can measure it.” In February 1997 the Government’s Health and Safety Executive (HSE) organised a conference of health professionals including rheumatologists, physiotherapists, neurologists and orthopedic surgeons to try to establish a consensus on RSI. The result was a broad agreement on the existence of a condition they chose to call “non-specific diffuse forearm pain”. It is a diagnosis that is made by excluding other conditions, according to Dr Ron McCaig, of the HSE. “The difficulty is that some people use RSI for anything in the upper limb. We would prefer people to use the term non-specific diffuse forearm pain.” Semantics play a significant role in RSI. A Confederation of British Industry official describes RSI as a very emotive word. “We do not specifically recognise RSI,” she says. “What we recognise is Work Related upper limb disorders.”
But for Philip Hayden, 37, a marketing analyst with British Telecom, RSI is a purely medical problem. “I had been working with a keyboard for years and then in January 1994 I began to get cramps in my right elbow as I worked with the mouse. After a couple of weeks I saw my GP, who diagnosed tennis elbow, or inflammation of the tendons, and told me to rest it. I started using the mouse with my left hand and then problems began to develop in my left arm.” By June 1994 Philip was in constant pain, which lasted for two years. Then a friend recommended a physiotherapist who had some experience treating RSI patients. “Her approach made it possible for me to go back to work. I began with a three-day week and gradually worked back up to five days.”
BT paid for Ability Net to assess Philip at work and the company put into place its recommendations. This included a relatively cheap voice-recognition package which meant that Philip no longer needed to use a keyboard or mouse. “The voice-recognition software was only a few hundred pounds,” says Philip. “And it has enabled me to continue to do my job. I still can’t drive for more than half an hour or so, but with a combination of physiotherapy and massage I have seen a steady improvement. And I have taken up sports that don’t require finger work, and I go to the gym. Overall, my level of fitness has increased.”
“The vast majority of people who use keyboards have never been trained to do so,” says Caroline Blaazer, a health and safety consultant with the Industrial Society. “A lot of companies acknowledge good practice on paper and recognise that people should take sensible work breaks, but it does not materialise in the workplace. But these companies don’t realise that when they take steps to prevent RSI there are other benefits too. “One merchant bank I have come across became aware that some of their staff was risking RSI by working 14 to 16-hour shifts on keyboards. They put a stop to it, but that was unpopular because it meant staff lost overtime payments. So the company analysed who was doing what job, and who was most likely to suffer from RSI and stress. Working patterns were altered, people did repetitive jobs for shorter times, and there was a dramatic reduction in absenteeism and illness. As a result of which, BUPA subscriptions were cut.”
Ten tips to avoid RSI
- Avoid any twist in the spine while seated so that your head faces in the same direction as your hips.
- Don’t have papers between you and the keyboard that make you reach or stretch over them and don’t rest your wrists on the desk while typing.
- Take short breaks. To relax stressed muscles and tendons, try 30 seconds of well-chosen stretches and movements at your desk.
- Adjust your chair so that hands are no higher than your elbows and your back is well supported.
- Remove the arm rests on chairs if they force arms and shoulders into an unnatural position.
- Learn to touch-type.
- Remember that you can generally use the keyboard instead of the mouse, and it often turns out to be quicker once you know the rules.
- Don’t throw devices that claim to be ergonomic at a problem unless they address a real cause. Ergonomic keyboards can be worse than standard ones if you are not a touch-typist. Chairs can be expensive and may not address your problem.
- Act immediately if you experience discomfort. Rest and treatment of symptoms alone can never solve the problem if the causes remain the same.
- Contact Ability Net on 0800 269545 or 01926 312847 for advice; The RSI Association, 380-384 Harrow Road, London W9 2HU, 0171-266 2000.