It's Not Carpal Tunnel Syndrome! RSI Theory and Therapy for Computer Professionals.

It's Not Carpal Tunnel Syndrome! RSI Theory and Therapy for Computer Professionals Damany S, Bellis J. Allentown, PA 18103, Simax/Suparna Damany and Jack Bellis, 2000, paperback, 231 pp, illus, ISBN: 0-9655109-9-9, $19.95.

The purpose of this book is to provide information regarding the origin and management of repetitive stress injury (RSI). Its intended audience is people who work with computers. The basic terminology used throughout the book as well as the simplified explanations help to present the information to these readers effectively.

The text is divided into 5 major parts: "Introduction," "Theory," "Information," "Therapy," and "Organized Prevention." The various sections follow in a logical progression. Comments from patients and some references are interspersed throughout the book. The authors do not attempt to address all aspects of RSI but rather discuss their own theory of how RSI develops and how the computer professional can recognize and respond to the signs and symptoms of RSI.

Part 1 of the book is an introduction in which the authors provide their definition of RSI, the general purpose of the book, and the contributions they believe the book will make. A key concept in this section is the theory that RSI is caused by working for several years in a repetitive fashion while maintaining one posture. General descriptions of 5 patients are given, each includes their successful treatment by one of the authors.

Part 2 is devoted to theory. The authors explain how RSI can develop, and these explanations lead to a flow diagram summarizing the root causes of RSI and the resulting symptoms and common syndromes. The authors stress that treatment depends on identifying these causes, including long-term posture, repetitions, work intensity, tissue resilience, physiology and anatomy, ergonomics, and personality. Part 2 also describes the authors' views on prognosis and predisposing factors. An overview of the anatomy of the spine, thoracic outlet, brachial plexus, peripheral nerves, and joints is provided. Common syndromes--including thoracic outline syndrome, tendinitis, nerve entrapments, fibromyalgia, reflex sympathetic dystrophy, and arthritis--are described as the results of RSI and not the root causes. The final chapter deals with diagnosing RSI. A "Damany-Bellis RSI Scale" is presented with the categories of symptoms that are used to determine the degree of RSI. Brief descriptions of common diagnostic tests are also included.

Part 3 is a relatively short section outlining resources readers can access. These include Web sites related to mailing lists, articles, organizations, legal information, tools, supplies, and software. A short list of books is also provided.

Part 4 is devoted to therapy, and it stresses the patient's role in managing his or her condition. Techniques the authors recommend include deep and localized massage; alterations of work practices; improved posturing; strengthening, stretching, and endurance exercises; reduction of stress; and warm-ups. Various techniques for each of these interventions are described, many use a picture and instructions on the procedure and repetitions. Workstation modifications are included in a separate chapter that discusses chairs, desk surfaces, monitors, keyboards, the mouse, and the telephone.

Part 5 briefly describes an RSI prevention program. The basic plan for such a program begins with support from company management and continues with choosing appropriate participants and providing literature, training, and consultation.

The book, likely because of its targeted audience of computer professionals, makes little attempt to justify the effectiveness of this approach to RSI identification, prognosis, or treatment. Statistics regarding the success of these techniques are absent, and the book's evidence for the effectiveness of the techniques relies on the feedback from the 5 patients quoted throughout the book. References are minimal, and few appear to be from peer-reviewed journals. No outcome studies of this approach or comparison of its results with other approaches were included.

In summary, It's Not Carpal Tunnel Syndrome! RSI Therapy and Therapy for Computer Professionals describes one clinician's theory and approach to RSI. The book is clearly meant to be a guide to help these workers become familiar with RSI, to present one theory about RSI, and to offer suggestions regarding management of RSI. Physical therapists will find that the theory and techniques presented reflect traditional pain or spasm descriptions, common methods of differential diagnosis, and familiar interventions. The lack of references and simplification of material will limit its use by student physical therapists and clinicians. The book, however, can be a resource for computer professionals who want to explore the topic and theories of RSI.

Nancy R Talbott, PT University of Cincinnati Cincinnati, Ohio 

Ms Talbott is Assistant Professor in the Department of Rehabilitation Sciences where she serves as the Physical Therapy Program Director and Department Head. Her professional interests are in ergonomics and biomechanics, including posture, balance, and gait.