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Wear and Tear.

How can you prevent repetitive stress injury in the workplace?

Repetitive stress injury (RSI) has been called the workplace epidemic of the modern age. A disabling ailment whose symptoms range from minor pain to loss of function in the affected body part, RSI affects millions of people who spend long hours at computers, switchboards and other worksites where repetitive motions are performed--typically hand-intensive exercises such as keyboarding or cutting. Two of the most common RSIs are carpal tunnel syndrome and "mouse elbow."

Carpal Tunnel Syndrome

More than 5 million Americans suffer from carpal tunnel syndrome, one of the most common conditions affecting the hand and wrist. The ailment occurs when the median nerve (the major nerve that carries the impulses from the brain to the hand) becomes compressed. The median nerve begins in the neck and runs underneath the collarbone, across the armpit and down the full length of the arm before it passes through a narrow passageway in the wrist called the carpal tunnel. The tendons that enable the hand to close also pass through this passageway. When these tendons are stressed due to repetitive motions, they swell inside the tunnel and compress the median nerve. This results in numbness, tingling, pain and burning sensations in the hand, often accompanied by clumsiness. Symptoms often begin in the wrist and move down into the thumb, index and middle fingers or back toward the elbow. Sometimes there is associated pain in the arm and shoulder. Frequently, sufferers awaken in the middle of the night with discomfort or a "pins and needles" feeling in the hand.

Other conditions associated with swelling and compression of the median nerve include pregnancy, diabetes, kidney problems, hypothyroidism, rheumatoid arthritis and obesity. Women are more likely than men to get carpal tunnel syndrome; they may be more vulnerable because they have smaller wrists than men but tendons that are the same size. Also, hormonal fluctuations of the menstrual cycle can result in fluid retention, which can cause wrists to swell.

Mild cases of carpal tunnel syndrome may be treated by wearing a brace or splint at night to allow the wrist to rest and, in turn, shrink the swollen membranes and relieve pressure on the nerve. However, wearing splints by day is controversial, because some physicians believe this can cause the muscles to atrophy and lead to further problems. Medications may also be prescribed to help reduce swelling. Since specific motions can help relieve pressure on the median nerve, exercises can also be essential in preventing and treating carpal tunnel syndrome.

Severe cases of carpal tunnel syndrome may require surgery to release the pressure on the median nerve by cutting the ligament that forms the roof of the carpal tunnel. An estimated 240,000 such surgical procedures are performed each year, but they are controversial and considered by many to be a last resort procedure since many people continue to have some symptoms, such as pain or loss of grip strength, after the operation.

Mouse Elbow

"Mouse elbow" is an increasingly common RSI in which elbow pain is experienced after long hours of clicking the computer mouse. Like its sport counterpart tennis elbow, mouse elbow is an inflammation of tendons in the elbow--specifically the lateral epicondyle of the humerus, which forms the origin of several muscles in the forearm and hand. Typically caused by low-grade, repetitive overuse, mouse elbow can also result when a single trauma initiates a small tear to the tendons. The ailment is associated with motions that combine rotating the wrist with applying force, such as in using a screwdriver, golf club or tennis racquet.

Mouse elbow can take a long time to heal since tendons don't get much time off to rest and have a modest blood supply. Treatment includes medication and ice massage to reduce inflammation, wearing a tennis elbow band for support, and doing exercises to stretch and strengthen the muscles of the forearm.

Preventive Measures

Badly designed computer workstations heighten the risk of RSI. Since prevention is the best cure, be sure to:

* Keep the monitor straight ahead of you, about an arm's length away, with the center of the screen positioned where your gaze naturally falls (typically a few inches below eye level).

* Adjust keyboard height so the forearms, wrists and hands are aligned parallel to the floor or bent slightly down from elbow to hand. Don't let the hands bend back.

* Position your mouse within easy reach, directly next to and on the same level as your keyboard.

* Don't rest your wrists on anything while you're typing and don't bend them up, down or to the side.

* Adjust chair height so your thighs are parallel to the floor. If your feet don't touch the floor, place them on a footstool. An ergonomically designed chair with good back support may also be helpful.

* Sit with good posture, keeping your spine against the back of your chair and upper body in a relaxed, comfortable position-without slouching.

* Vary your tasks. Avoid long sessions of seated activities by breaking up typing with filing, phone calls or visits to the copy machine.

* Don't use excessive force when typing or clicking the mouse.

* Keep your fingernails short and your fingers curved so that you don't see the nails while typing.

Computer Athletes

In recent years, the tendency to spend our days sitting in a fixed position--coupled with improper posture, low fitness, stress and poorly designed work stations--has contributed to the current epidemic of RSIs. While many people focus on changing the workplace to improve ergonomics, that approach only addresses one component of the problem. It's also critical to change bad physical habits--such as being out of shape and having poor posture--to completely resolve these injuries.

That's why more and more companies and healthcare practitioners are encouraging employees to think of themselves as "computer athletes" who must be in shape to tackle the physically demanding job of sitting at a desk all day. Like any athlete, computer athletes must train for their event: the eight-hour desk marathon. Their training should include frequent "microbreaks" throughout the workday to stretch their arms, wrists, shoulders and neck.

How Exercise Helps

Being fit can help reduce the risk of RSIs. People with strong and supple muscles can better maintain good body mechanics and proper posture, which can minimize stress on tendons and nerves. Fit people are also more likely to have improved circulation, which enhances the body's ability to repair itself. Moreover, lower levels of body fat may lessen the impingement of nerves, which can alleviate symptoms of carpal tunnel syndrome.

Since stress is also a major contributor to RSIs, exercises that promote relaxation can also help people avoid overuse injuries. For example, people under stress tend to hike up their shoulders, which can cause pressure on the nerves in the neck. Neck and shoulder stretches can relax these muscles and relieve this pressure. Frequent stretching and walk breaks also give muscles, tendons and ligaments a chance to relax and change position. This enhances oxygenation, which encourages repair of overused muscles, tendons and ligaments.

If injuries do occur, therapeutic exercises can help tendons heal properly so they don't become shortened or weakened. It's important that people who have an RSI consult a healthcare practitioner, since the first stage in treatment is typically rest for the injured body part. People with painful injuries who exercise too soon or do too much may cause further damage. However, once the healing process has begun, exercises under the guidance of a health professional can play an essential role in recovery.

Exercise Recommendations

* Stretching. Just as athletes must stretch before their event, people in hand-intensive occupations--such as computer operators or grocery clerks--should do a few minutes of warm-up stretches for the hands, wrists, neck, shoulders and arms before starting their shift and another few minutes of cool-down stretches at the end of work.

Stretches should also be done frequently throughout the day, particularly for any body parts that experience tension. Shoulder shrugs, neck rolls, wrist curls and other simple stretches can be performed at regular intervals, such as while waiting for the computer to boot up, download files or print out documents. People who keyboard all day might grasp the fingers of one hand with the other hand and gently pull backward until they feel an easy stretch in their wrist. And if you tend to hunch over while sitting, raise your arms up and stretch back over your chair every half-hour, looking up at the ceiling. Editor's Note: For more information on stretching techniques, see "Computer Cramp Blues" by Lynn Difley (May/June 1999).

* Walking breaks. Getting up and moving around boosts circulation and gives overused muscles a chance to rejuvenate. Shorter, more frequent breaks (such as two or three minutes each hour) are more effective than longer, less frequent ones (such as 15 minutes every two to three hours). In jobs that don't permit frequent walk breaks, standing up and stretching at the desk can be helpful.

* Strengthening exercises. Computer operators need to recognize that they're upper-body athletes and they need the entire upper body, including the back and abdominals. A strong torso is essential to correct posture, so exercises such as crunches for the abdominals and extensions for the back muscles can be extremely helpful.

* Aerobic activity. Walking, running, group fitness classes and other aerobic exercises are essential to improving circulation, boosting oxygenation of tissues, enhancing "stress hardiness" and maintaining a healthy weight. Do an aerobic activity, such as walking, cycling or swimming, at a pace you consider moderate or somewhat hard, three to six days a week for 20 to 60 minutes. If you don't have time to exercise continuously, you can still get benefits by accumulating exercise in 10-minute bouts.


While exercise is essential to preventing and treating RSIs, it should be performed under the guidance of a healthcare professional. If you experience painful symptoms, consult your physician immediately. Early diagnosis is essential to limiting the damage, while ignoring the pain could result in further injury and possibly permanent impairment. There are no quick fixes for RSIs and healing typically takes months. Gentle stretching is usually helpful, although some strengthening should be done only after the injury has healed, which is usually marked by the absence of sharp pain or numbness.

Follow commonsense wisdom: If an exercise hurts, don't do it. If you have a diagnosed RSI, consult your physician about specific exercises and consider working with a physical therapist to learn stretching, strengthening and range of motion activities.

RELATED ARTICLE: Telltale Signs of RSI

* Stiffness, tingling, burning or numbness in the hands, wrists, fingers, forearms or elbows

* Recurring pain in the neck or shoulders

* Clumsiness or loss of strength and coordination in the hands

* Waking at night with a disturbing numbness and tingling in the hands


RELATED ARTICLE: Additional Resources

* Stretching at Your Computer or Desk by Bob Anderson (Shelter Publications, 1997), and Bob Anderson's Stretchware software are available by calling (800) 333-I 307 or visiting

* The American Academy of Orthopedic Surgeons offers materials about a variety of musculoskeletal concerns, including carpal tunnel syndrome. Call (800) 824-BONES or visit

* The Feldenkrais Guild can refer you to a practitioner certified in the Feldenkrais Method of techniques to improve posture and breathing as well as

reduce stress. Write to P.O. Box 489, Albany, OR 97321, call (800) 775-2118 or visit

* The Alexander Technique teaches people proper posture and movement habits to reduce strain on the body. For referral to a certified practitioner, contact the North American Society of Teachers of the Alexander Technique at (473-0620 or visit


Consult AFAA

To read more on this topic, refer to the following AFAA's Fitness Gets Personal[R] cards, which are available by calling (800) 446-2322:

* H8: Skills for Managing Stress

* H21: Managing Low Back Pain

* E17: Exercises for Low Back Pain

* E18: Importance of Functional Strength

From Healing Moves by Carol Krucoff and Mitchell Krucoff M.D. Copyright c2000 Carol[C] Krucoff and Mitchell Krucoff, M.D. Reprinted with permission of Harmony Books, a division of Random House, Inc.

Carol Krucoff is an award-winning health columnist for the Washington Post and the founding editor of the Post's Health Section. Her Bodyworks column appears in numerous newspapers across the country and she is a frequent contributor to national magazines, including Reader's Digest, Self and the Saturday Evening Post.

Mitchell Krucoff, M.D., is a senior staff interventional cardiologist at Duke University Medical Center and a member of the Executive Faculty of the Duke Clinical Research Institute, where he serves as the Director of the Ischemia Monitoring Laboratory. Dr. Krucoff is internationally recognized for his pioneering research in computer-assisted electrocardiographic monitors, new modalities of coronary revascularization and applications of alternative and complementary therapies in patients with heart disease. He has authored more than 100 publications in the cardiology literature and book chapters in medical texts. In addition, he is Editor-in-Chief of Alternative Therapies in Health and Medicine, the most widely circulated peer-reviewed medical journal in the field of alternative medicine.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:preventing repetitive stress injury in the workplace
Author:Krucoff, Carol; Krucoff, Michell
Publication:American Fitness
Date:Jan 1, 2001
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