Repetitive Stress Injury (RSI)

If you’ve ever developed a burning, aching pain in your elbow after playing too many rounds of tennis, or shooting pains and weakness in your hands after spending weeks glued to the computer while crashing on a project, you’ve probably experienced the early stages of repetitive stress injury (RSI).

A form of overuse injury caused by repeating the same motions for hours on end over extended periods of time, RSI is often associated with computer keyboard work. It’s not a new disease, however. Hand and arm problems associated with repetitive tasks first appeared in world medical literature in the 17th century with reports of “milkmaids’ arm.”

In the United States, blue-collar workers reported the first cases of RSI in 1912, when telegraph operators developed a mysterious ailment known as “telegraphists’ cramp.” Other workers reported such diseases as “washerwoman’s thumb” and “glass arm,” the latter a painful condition afflicting Morse Code operators during World War I. Assembly line workers, seamstresses, meat packers, and construction workers were later diagnosed with repetitive motion injuries as well.

Manufacturing workers, in fact, make up the lion’s share of RSI or “repeated trauma” cases reported to the Bureau of Labor Statistics. But over the last 25 years, as computer use has exploded, there’s been a flood of such injuries among computer users as well.

In many offices across the country, employees are donning arm splints, missing work because of crippling pain, and even undergoing surgery due to injuries linked to repetitive keyboard work. Ironically, the very technology that made typing so much faster and easier also made it easier to be injured.

Alan Hedge, PhD, the director of ergonomic research at Cornell University, says that modern keyboards have actually made the work more risky because they don’t allow for the occasional respites from typing that you once got from using a typewriter.

“The problem is that people using computers are transfixed on the work they’re doing,” Hedge says. “They will sit there, and they will key like crazy, and they don’t need to worry about carriage returns. They don’t have to load or unload paper. They don’t have to make page breaks at the end of the page. It’s very easy to sit there and let time pass by.”

The epidemic of RSI among computer users definitely caught many companies by surprise. “We had no warning about RSI,” recalls Noel Greenwood, deputy managing editor of the Los Angeles Times in the 1980s and ’90s. “When we first got [computers], everyone just saw them as spiffy electronic typewriters. We found out the hard way that if you don’t treat your computer right, it’ll bite you.”

Tips for preventing RSI

If you work in an office:

  • Make sure your work station is set up to put the minimum amount of stress on your hands and back. Adjust it so that you can sit comfortably while typing.
  • Try to use a soft touch while keying in information.
  • Set up your monitor so it is directly in front of you, with the top of the screen at or slightly below eye level.
  • Be sure your keyboard and mouse are low enough to allow you to relax your shoulders; install a keyboard tray if necessary. When you’re typing, make sure your wrists are straight (and level with your elbows). Never rest your wrists on the desk or armrests while you are typing or using a mouse or trackball.
  • Don’t bend your hands up at the wrists, even if you’re using a wrist rest.
  • Sit up straight and make sure your chair supports your spine.
  • Keep your feet flat on the floor.
  • Stretch frequently while at the computer. If you’re not suffering hand pain, make circles with your wrists and stretch your fingers back to ease up on pinched nerves and increase microcirculation. If your office is too cold, try to keep your hands warm by using gloves with the fingertips cut off.
  • Take frequent breaks. Take a “minute break” every 15 minutes and a five-minute break every 20 to 30 minutes.
  • If you have symptoms of RSI, cut down on your computer use. Try leaving a voicemail message instead of sending e-mails, and take notes by hand instead of using the computer.

If you do manual labor:

  • Make sure the tools you use absorb shock and are easy to grip. Look for tools with soft rubber handles or extensions that allow you to work without reaching or bending over. If you use writing tools, grip them as loosely as possible.
  • If the belt or table you sit at is too high, ask your employer to adjust its height. If you’re doing the same task over and over, try to vary your duties so that you’re not doing the same repetitive motion over and over again. Discuss implementing work rotation with your union or employee/management team.
  • Take at least one break an hour.

Saving money through good work design

Preventing RSI is a key goal of many employers — and for good reason. Musculoskeletal disorders, which include more than 100 different types of disorders, make up about 30 percent of all workplace injuries that result in lost workdays. They also account for a third of the money doled out in workers compensation claims. According to the Occupational Safety and Health Administration (OSHA), RSI affects some 1.8 million workers per year. One government study puts the cost of RSI between $17 billion and $20 billion a year.

Steven Sauter, a job-stress specialist with the National Institute for Occupational Safety and Health, says that one problem with many computer jobs is “little built-in variety.” Computer users often make thousands of keystrokes an hour, he explains, repeating nearly identical motions at a high rate of speed. While typing, each stroke requires muscles to contract and tendons to move. One of the many possible causes of RSI is that the tendons can become irritated as they slide around bones and against tissues. In such cases, Sauter warns, the wear and tear can cause painful inflammation of the tendons, which will not heal without rest.

Research shows that the more stress and pressure employees feel, the more they’re at risk for musculoskeletal injuries such as tendinitis, Sauter adds.

According to one survey, nearly 60 percent of computer office workers nationwide suffer from wrist pain while at the computer, and 51.2 percent say their keyboards are placed too high. But ergonomics are not the only problem: 49.7 percent of employees say they ignore recommendations to take breaks from their computers.

“Work-related musculoskeletal disorders are the most widespread occupational health hazard facing our nation today,” says Charles N. Jeffries, former assistant secretary for occupational safety and health at the U.S. Department of Labor. “The most severe injuries can put people out of work for months and even permanently disable them.”

Jeffries argues that better ergonomics will improve efficiency and productivity in business. “For years, many employers have known that good ergonomics is often good economics…Those employers have not only saved their workers from injury and potential misery, they’ve saved millions of dollars in the process,” he testified before Congress.

Indeed, many employers have voluntarily adjusted equipment and added ergonomics programs to help cut down on workplace injuries. Two Maine manufacturers of New Balance shoes, for example, overhauled their factory: improving ergonomics, eliminating piecework, and rotating work activities. The result: the factories cut their workers compensation costs from $1.2 million to $89,000 a year. Equally dramatic, the number of lost and restricted workdays dropped from 11,000 to 539, according to OSHA.

As for office workers, Hedge emphasizes the need to take frequent breaks and to work in a position that’s as relaxed as possible. In recent years, the use of laptops has created new problems, he says, because they’re made for mobility, not for ease of use. He warns that if you do use a laptop all the time, you should attach an external keyboard to work more comfortably.

Seek help at the first signs of RSI

Whether you work in a factory or at a desk, watch out for symptoms of repetitive strain injury.

If you regularly feel pain, numbness, or tingling in your arms and hands, you may have RSI. Left untreated, these aches that start out as relatively minor pains can eventually make it difficult for you to use your hands at all.

In some cases, RSI isn’t a localized pain, but a general feeling of heaviness or weariness in a particular limb. Your hands may feel numb or tingly, and you may have trouble completing formerly simple tasks. You may also wake up at night with a “pins and needles” sensation in your hands, the same one you feel when a limb falls asleep temporarily.

The pain may appear in your forearms, shoulders, or neck, making them ache or sensitive to touch. Shaking hands may hurt, and you may have problems using your fingers to button your jacket, twist a doorknob or jar lid, or even turn the pages of a book.

If you notice any of these symptoms, report the injury to your employer immediately so that you can get medical evaluation and treatment. Working together, you and your employer might also make changes in the workplace. If you have even early symptoms of RSI, it’s crucial to see a doctor right away. The sooner you get treatment, the more likely you are to heal quickly.

Further Resources

National Institute for Occupational Safety and Health (NIOSH)

CTD Resource Network Inc.
This group has compiled a list of Typing Injury Frequently Asked Questions (TIFAQ).


Repetitive Strain Injury: How to Recognize and Manage It. University of Michigan. 2010.

Bureau of Labor Statistics. Nonfatal Occupational Injuries and Illnesses Requiring Days Away from Work, 2007. November 20, 2008.

Bernard, BP. Musculoskeletal Disorders and Workplace Factors: A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. U.S. Dept. of Health and Human Services. Center for Disease Control and Prevention. National institute for Occupational safety and Health. Cincinnati, Ohio.

© HealthDay

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