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RSI — Don't live with it!

Note:
This article appeared in the ITI Japanese Network's Bulletin no. 24, issued October 2001.

I mentioned RSI (repetitive strain injury, but better known as neck-shoulder-arm disorder in Japan) in my previous article (NB: written in Japanese) about voice recognition. I have done a bit of homework on this condition since and, since everyone who writes or uses a computer all day, everyday runs a high risk of developing it, I thought I would share the information here.

WWW resources on RSI:

What is it that I've got?

Paul Marxhausen explains: "Repetitive Strain Injuries occur from repeated physical movements doing damage to tendons, nerves, muscles, and other soft body tissues. Occupations ranging from meatpackers to musicians have characteristic RSIs that can result from the typical tasks they perform. The rise of computer use and flat, light-touch keyboards that permit high speed typing have resulted in an epidemic of injuries of the hands, arms, and shoulders."

The term RSI is now well known, but doctors do not usually tell you that that's what you've got. RSI is a blanket term that explains how you got the condition rather than what it is, and your doctor is more likely to give you the name of the specific condition you have. Mine was diagnosed as "tennis elbow", and a colleague of mine was told by her doctor that she had an onset of "golfer's elbow". Apparently these are two different forms of epicondylitis, and you can get them even if you do not play tennis or golf. Carpal Tunnel Syndrome (CTS), tenosynovitis and tendinitis are also common diagnoses for RSI.

The best cure is prevention

Whatever the name of your condition, the problem is the same: once you've got it, it is very difficult to get rid of it unless you stop doing whatever has caused the problem in the first place (typing, using a mouse, writing...). This may well mean a complete change of career, which is not a realistic option for most of us, so look after your hands, arms and shoulders even if you have no pain now. If you suspect you may be developing some of the symptoms of RSI, remember that RSI is a progressive condition; if you keep doing the things you have been doing in the same way, you can be sure that your condition will get worse.

Assess your workstation

If you work for a company, your employer is required by law to make sure your workstation is set up correctly (ergonomically). If you are a freelancer, I'm afraid that is your own responsibility. Paul Marxhausen's R.S.I. Page shows how your computer should be positioned (top of the monitor at eye level and your wrists straight and level, not bent up or out). I find it more comfortable when the top of the monitor is lower than eye level and the keyboard also positioned very low and tilting away from me. These alternative positions are also explained in a page linked from the above.

If you are not sure if things are at the right height/position, ask someone to check or take photos of you while you work.

Invest in a good, adjustable chair

Desks are not usually height adjustable, so having a height-adjustable chair is essential to achieving a correct workstation setup. A few years ago, my employer bought every PC user a new, ergonomic chair following the introduction of a new health & safety regulation. It has a well-cushioned contoured seat with a high back, again contoured to support the small of your back. You can adjust everything — seat height, seat angle, back height, back angle and even the height of the arm rests. This type of chair is not cheap, but it does make a big difference to your comfort level.

Also, make sure you do adjust your seat. Did you know that most people require their seat to be at different heights for writing (low) and computing (high)? If adjusting the height of your chair correctly relative to your monitor and keyboard results in your feet not resting on the floor, you need a footrest.

Are your keyboard and mouse good for you?

Not all keyboards are the same, and the one that came with your computer may not be the best one for you. Some keyboards have really clicky, well-sprung keys which have to be struck with some force to register the inputs. This problem is also seen with some mice. Getting a keyboard and a mouse with light-touch keys can make a lot of difference. The aforementioned colleague of mine with golfer's elbow was a typical example - the keys on her keyboard were a bit too well sprung for her pinkies, and she saw an immediate improvement when she replaced the keyboard.

You can go one step further and try one of the ergonomic input devices such as angled keyboards and trackball mice. They seem to work for some but not for everyone, so you may have to experiment a bit.

Take breaks

To avoid RSI, it is important that you take frequent breaks. My doctor recommends a couple of minutes' break every quarter of an hour, in addition to normal tea and lunch breaks. By "break", I mean not using your hands. Writing things up between computer work is not a break as you are still using the same muscles in a similar way. The RSI resource pages listed above also recommend "micro-breaks": a few seconds' break every few minutes.

If you find it difficult to remember to take breaks, you can install a break reminder on your computer. There is a wide variety to choose from, from a simple timer to a sophisticated RSI prevention package including animated stretch exercise instructions and a computer usage analyser that monitors keyboard/mouse inputs and tells you about your bad habits! For a more low-tech solution, here is a tip from RSI-UK FAQ:

" If you find it difficult to take your breaks put an alarm clock across the far side of your office, set it to go off in 20 minutes. When it goes off walk across the office and re-set it. "

Another important thing is to stop working if you feel any discomfort, tingling or pain in hand, arm, shoulder, neck or back and let your body rest and recover before you start again.

Fidget!

Sitting in the same position for hours is bad for your body even if your workstation is set up perfectly. Shift your position. Fidget in your seat. Stretch your hands and arms during micro-breaks. Leave your seat for a couple of minutes. Paul's page has lots of stretch exercises (GIF animations).

There are also some yoga-based exercises designed to prevent/relieve RSI at http://www.mydailyyoga.com/yoga/rsi_excercises.html.

Use your applications efficiently

It's quite surprising that many people never customise the applications they use daily. Most Windows applications come with customisable tool bars. If you regularly go through layers of menus to get to something you use for every job (such as word count and find/replace), you can save yourself a couple of mouse clicks by putting the command on your tool bar. Some shortcut keystrokes are also handy. For example, I now almost always use shortcut keys for cut, copy, paste and undo (ctrl+x, ctrl+c, ctrl+v and ctrl+z respectively on Windows) rather than clicking on the icons as they can be keyed in with my left (better) hand.

Keep warm

Cold hands may mean a warm heart, but they also mean an increased risk of RSI. People with cold hands seem to be more prone to RSI because poor circulation in arms/hands makes soft tissues more susceptible to damage. If you, like me, notice your hands getting colder and colder as you work, do two things:

  1. Stop working as soon as you notice your hands are cold. Your arms are probably overworked and need to rest anyway.
  2. Warm your hands thoroughly — wear gloves, wrap your hands around a hot mug of tea or hold your hands against a radiator. Once your hands feel warm, stretch your fingers, hands and arms before you go back to work.

Consider voice recognition

Even seasoned VR users find it difficult to do everything by voice, but it is a good alternative to a keyboard and mouse and can help prevent RSI as well as let you continue working if you have RSI. Get used to using VR before you find yourself unable to type. All VR applications require spot training, and it's a lot easier to train it when you can type words in the correction box. It also takes a bit of time to learn all the voice commands you need for hands-free computing.

I mentioned in the last bulletin that my Dragon had a problem hearing me over the noisy fan in my laptop. Since then I have bought a USB microphone, and I am pleased to report that it works a treat. It bypasses the sound chip completely and is not affected by noise inside your computer.

And lastly...

If you experience any of the symptoms of RSI (see http://www.rsihelp.com/warning.shtml) in your hand, arm, shoulder, neck or back, and especially if they do not go away after a night's rest, see your doctor as soon as possible. And, more importantly, reassess the way you work. Make sure you are comfortable when you are working, and stop working when you are not. Think of ways to reduce key typing and mouse work. Not convinced? Read the "Or else..." warning linked from Paul's website (a message posted on SOREHAND, a US-based RSI mailing list) and think how important having the use of your hands is to you.

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Last updated: 30 December 2002