Repetitive Strain Injury: A Handbook on Prevention and Recovery Repetitive Strain Injury A HANDBOOK ON PREVENTION AND RECOVERY David Ruegg Copyright (c) 1999 by David Ruegg All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the express permission of the publisher. Published by Largo c/o 7, Belvedere Close, Weybridge, Surrey KT13 8XQ rsi_site @ hotmail.com Printed and bound by Biddles Ltd, Guildford ISBN 0 9534718 0 2 Disclaimer: This book is not intended to take the place of proper legal or medical advice. Please consult your doctor before undertaking any of the treatments reviewed. Contents Acknowledgements Foreword Preface 1 - The repetitive strain injury phenomenon What is RSI? Some commonly asked questions about RSI Acute and chronic pain Types of RSI Carpal tunnel syndrome Tendinitis/tenosynovitis Adverse mechanical tension/adverse neural tension Trigger points Research into RSI How do you tell whether you have RSI or not? What you should do if you think you are affected by RSI 2 - Treating repetitive strain injury Treatments Physical treatments Physiotherapy Chiropractic and osteopathy Dietary supplements RICE Alternate hot and cold Splints Postural improvement methods Alexander technique Feldenkrais Energy treatments Acupuncture Healing Relaxation techniques Biofeedback Massage Yoga Floatation tanks Sauna Exercise Walking Swimming Running Gym Stretching Cognitive behavioural therapy Food intolerance 3 - Living and working with RSI Changes to the working environment The sitting position Work habits Take regular breaks Organise your workload better Equipment Keyboards Mice Wrist rests Software Break reminders Voice recognition software Changes to the home environment Seating Sleeping Driving Other dangers Computer games Dealing with other peoples' attitudes 4 - Legal aspects Litigation Social security benefits Statutory Sick Pay (SSP) and Incapacity Benefit Jobseeker's Allowance (JSA) How RSI sufferers are affected by the system Placement, Assessment and Counselling Team (PACT) Access to work Job Introduction Scheme (JIS) Alternative employment 5 - The next step The way ahead 94 Sources of information The Internet Further reading Useful addresses Select bibliography 102 Index Acknowledgements My special thanks go out to the following for their help in the preparation of this book: Dr R A Hughes, Consultant Rheumatologist at St Peters Hospital, Chertsey, Surrey. Graham Ross for providing feedback on the legal aspects chapter. Graham is a solicitor for Ross & Co, Hinderton Hall, Hinderton, near Neston, South Wirral, Cheshire, UK, L64 7TS; telephone 0151 336 3000. All the RSI sufferers who have provided me with advice and information along the way. This book is dedicated to you. I would also like to thank the following for their assistance in providing material or granting permissions: Prion Books, Professor Howard Bird, Professor Robert D Helme, Jane Greening, Maltron keyboards. Equipment photographs supplied by Safe Computing at www.safecomputing.com and AnimaX at www.animax.no. And anyone else who has been inadvertently missed. Finally my parents for their support. Foreword Repetitive strain injury represents an increasing problem in our society and causes both pain and anxiety, interfering in working and social capabilities. With the ever-increasing emphasis on keyboard-orientated working practices and the need to strive for greater success and job security, the RSI problems will only increase unless the level of awareness is raised. Individuals, those suffering from RSI, their near relatives and partners, parents, employers and occupational health departments will all find the information provided in this book to be of help. Here is RSI described from the perspective of the patient. The book contains a description of the clinical entity, treatments both conventional and complementary, together with a section on adapting life to cope with the difficulties imposed by repetitive strain injury. It represents a valuable guide and fills an information void that currently increases the anxieties and stresses of RSI. Dr Rod Hughes Consultant Rheumatologist Preface Most people have heard of the term RSI, or Repetitive Strain Injury. Many will have read about it in newspapers, or sat through talks on it at work. Few people really understand exactly what it means. RSI is a blanket term commonly used to describe a wide range of musculoskeletal disorders that usually affect the hands, arms and upper body. These disorders can result in pain severe enough to leave a person unable to work, and impinge on almost every single aspect of their daily lives. Very often there are no visible signs that anything is wrong, and this has led to a great deal of scepticism from doctors and employers alike. Anyone who engages in repetitive tasks for more than a few hours a day, whether at work or leisure, is at risk from RSI. It affects healthy people of all ages and both sexes. It may not be a life threatening injury, but RSI has the potential to cause crippling disability and pain. Estimates put the cost of these injuries in Britain at around £1 billion a year (TUC figures 1995). It is also believed that over 200,000 new cases are coming to light annually, which indicates a worrying scenario. The story is similar in many other countries too. Although it has affected people in many lines of work over the years, it is now becoming clear that new technology is presenting problems of its own. Millions of people use computers every day, and yet they don't always realise that they may be putting themselves at risk of serious injury. The evidence is growing that we are facing a major increase in cases, across all sections of the population. Universities and colleges in America are now having to accommodate a huge rise in the number of students affected by RSI. Nevertheless there still exists a general myth that it only affects data entry clerks - middle age women in particular - who spend hour after hour pounding a computer keyboard. Some believe that these people are malingerers, bored with their work, or that they are only after compensation and time off. I certainly do not regard myself as fitting into that category. I am a male and I was 23 when I suffered my first symptoms. At the time I was working as a self-employed computer contractor. Despite the fact that I have a degree in Computer Science I can no longer work in my previous job, and have spent many years unemployed. Like every other sufferer I have spoken to, I never, for one moment, considered that RSI would affect me. Unfortunately though, it did. The tragedy is that RSI is entirely preventable, and nobody should suffer from it. It is clearly important for Government and businesses to take this problem seriously. Unfortunately, even amazingly, this is something that still does not seem to be happening at the present time. With the ever increasing dependence on computers in our everyday lives, the situation can really only get worse before it improves. RSI is not just another case of a media scare story, but an extremely serious occupational health issue that has not received the attention it deserves. This book has been written to help those who have RSI, and those who want to know more about its treatment and prevention. Its aims are basically four-fold: To educate people on the importance of safe working practices, so that they avoid injuries of this nature occurring in the first place. To enable anyone afflicted by RSI to take control of their own situation, and find effective ways to recover. To promote greater understanding, discussion and awareness of the condition to anyone who deals with RSI sufferers be they doctors, employers, colleagues, Social Security staff, or just family and friends. To act as a valuable resource for further information and treatment. Address and contact details of useful organisations are given in the back of this book. At the time of writing there still seems to be a lack of serious research or publicity on RSI, and this is something that really needs to be addressed urgently. There is a great deal of published material on avoiding RSI, but unfortunately very little on what to do about getting help and treatment. Preventing RSI, although vitally important, is of little use to anyone who is already suffering from it. Many people, either through ignorance or complacency, fail to take the necessary precautions, and consequently end up with RSI symptoms of one kind or another. My own experience was considerably worsened because I did not have enough information on what exactly was causing this extremely painful and debilitating condition. To begin with, I had very little idea about why this had happened to me, and what steps I could take to combat it. I was told that "there's nothing wrong with you" and "RSI doesn't exist", as well as "there's nothing that can be done to help anyway". This is simply not true, and is the reason why I decided to write this book. In order to overcome RSI, it is vital to understand the condition, what exactly caused it, and how it can best be treated. Finally, it is necessary to find ways in which you can stay free from any recurrence in the future, so as to live as near a normal life as possible. Remember that it is your body and your life. It is up to you to recover. I quickly discovered, like many others I have spoken to, that nobody else is going to do it for you, and it is unlikely that many people will help and support you either. The most important thing is that if you believe you have a problem, then you must stop doing whatever is causing the pain, and seek treatment as soon as possible; don't put it off. There is no point in saying that "I am unable to take time off now" or "I cannot afford to seek treatment". RSI is a very serious injury and has the potential to cause permanent disability. Some sufferers have been unable to return to work, any form of work, even after many years of treatment and recuperation. The good news is that if correct treatment is received at an early stage, then practically a full recovery is possible. However, a delay of a few days or weeks can put back the recuperation time by months or even years. This obviously results in loss of earnings through unemployment or a forced career change, not to mention all the stress and worry that goes along with it. As a general rule: the worse the condition is, the longer it will take to get better, and the longer a person has suffered, the less likely they are to make a good recovery. According to the RSI Association about 1 in 20 sufferers do not recover. However, on a more positive note, no matter how bad an individual's condition is, some improvement can always be realised. There are thousands of people out there who are living near normal lives that are a testament to this. This book will hopefully give advice and guidance to both new sufferers of this dreadful condition, as well as provide some useful ideas for those with long-term problems. It covers treatment options, work practices, as well as legal and social security aspects. RSI varies a great deal from person to person, and living with it is a challenge. There is no single cure and getting better requires a complete rethink of your lifestyle. Recovery takes a great deal of time, patience, perseverance and determination. Good luck. David Ruegg January 1999