Originally created 07/05/99

Repetitive-strain guide a must-read

Over the past few decades, putting out a newspaper has become increasingly computer-intensive. So have plenty of other industries; in fact, a new breed of company existing entirely in the datastream emerged in this decade.

Computers create a sky's-the-limit mindset about productivity, but as computer-dependent industries age, their workers are learning there's a price to pay.

For everyone from the humblest keyboard jockeys to the highest executive offices of such businesses, I recommend Repetitive Strain Injury: A Computer User's Guide, by Emil Pascarelli, M.D., and Deborah Quilter. Published in 1994 and now in its eighth printing, it remains the one to beat.

I believe there is no excuse in the latter half of the 1990s for not knowing the risks of consistent daily computer use or the precautions necessary to minimize damage: not if you're the computer user, the user's supervisor, the office manager, floor plan designer or the home office executive drafting the company's position on worker's compensation claims for repetitive stress damage.

Dr. Pascarelli is an occupational health specialist, and since the 1985 opening of the Miller Institute for Performing Artists at St. Luke's/Roosevelt Hospital in New York, he has made repetitive strain injury a subspecialty.

Journalist Deborah Quilter, who has covered health issues for The New York Daily News, Woman's World and San Francisco Focus, among others, was diagnosed with RSI in 1991. Like many RSI sufferers, she had ignored the occasional twinges, aches and tinglings in her hands and arms for nearly a year before the episodes became dramatic enough to scare her into seeking treatment at the Miller Institute.

"When I compared notes with injured friends, I was puzzled. They didn't have their muscles carefully tested for an hour and a half by their doctors. They weren't videotaped at a simulated workstation. They weren't getting technique retraining," she writes in her preface. "Their doctors were seeing them for 10 minutes and giving them the standard treatment -- EMGs, splints and anti-inflammatories. They didn't seem to be getting better. I was."

The first thing to get straight: RSI is not a synonym for Carpal Tunnel Syndrome. This is a common misconception thanks to confusion of the two in the early press coverage of RSI.

Carpal tunnel is a subset of RSI affecting the wrist and base of the hand, and actually is fairly rare; the most common form of RSI is called DeQuervain's disease, which affects the thumb from the wrist up, and can be caused or aggravated by hitting a keyboard's space bar too hard and often. (You can cut back on using the space bar, can't you? Exactly.)

Also coming under the umbrella of RSI are muscle injuries such as flexor tenosynovitis (trigger finger), cervical radiculopathy ("phone shoulder" -- go ahead, make that `shrug-and-clench' motion while you're reading this) and epicondylitis (plain old tennis elbow). Then there's the ulnar nerve disorders like sulcus ulnaris syndrome. (That's a groove in the part of the elbow usually called the funny bone, and it's caused by leaning on your elbows -- you can cut back on leaning on your elbows, can't you? Exactly.)

Just to confuse the issue, there are associated disorders that aren't primary forms of RSI but may occur with, be complicated by or be confused for RSI.

These include focal dystonia (writer's cramp), osteoarthritis and fibromyalgia. The real killer of an RSI-associated disorder, though, the one anyone diagnosed with RSI would like to tell you about but can't quite, is reflex sympathetic dysfunction, which to you and me, is known as pain.

RSD starts as a burning pain in the early stages; later it goes into chills, weakness, spasms, tremors and tics in the hands. It constricts circulation, turning hands mottled or blue, and sufferers have trouble initiating movement. (Ever hear anyone say, `my hands won't do what I tell them to?' Exactly.)

Not only do traditional RSI treatments like splints, massage, some drugs and surgery (surgery!) not help RSD, they may actually make it worse. The thing about RSD that knocks sufferers for a loop, though, is that RSD pain leads to more pain.

This is the associated disorder that causes some RSIs to flare up worse than before if you start abusing your hands again; this is the one that makes you afraid to risk another attack, and by neglecting to exercise at all instead trigger more pain.

One of the best aspects of the book is that it demystifies the diagnostic process. Dr. Pascarelli takes you step-by-step through what an RSI-qualified doctor will look for and tests they'll run, and most remarkably, a simulation they should put you through: videotaping you in a typical work session at a mockup of your workstation.

Playing back their actual postures and bad habits for them often astonishes RSI patients into breaking them like nothing else would, and it tells the doctor more than you could with just words what you actually do at work.

If your doctor's giving you 10 minutes and telling you to take aspirin and take it easy, Dr. Pascarelli tells you how to find a doctor who'll give you more concentrated attention, and there's an appendix of support groups, newsletters and programs that can help as well. The book goes through how to do everyday things without triggering attacks -- did you know there's a right way to hold a book open? Neither did I, but apparently there are wrong ways aplenty, and if you read like your humble reviewer does, you've probably done 'em all.

The back half of the book is devoted to exercises, changes in work habits and lifestyle, physical workstation setup, prevention and best of all, legal issues involved in RSI treatment. A major part of the problem with RSI treatment has been the response of corporate America to its emergence, ranging from fear to defensiveness to outright hostility.

The legal chapter covers worker's compensation, the applicable passages of the Americans with Disabilities Act, when and if you need a lawyer (employers, please let's not make it necessary to bring lawyers into this, the RSI patient is in enough pain already), and bringing the unions into the dialogue. (Note to human resources types: efforts have been under way for several years now to revise the ADA, and if you're not already conversant with actual or potential changes to it, it's back-to-school time).

A better option would be for businesses to work with their employees to get treatment instead of taking an adversarial stance, but yes, I know, I'm going to get some more high-octane coffee right now.

Book details


By Emil Pascarelli, M.D., and Deborah Quilter

John Wiley & Sons Inc., 1994 $16.95

ISBN # 0-471-59532-2

Suzanne R. Stone writes book reviews for the Augusta Business Chronicle. She can be reached at 724-0851.


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