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1 Repetitive Strain Injury: A Programmer s Worst Enemy By Tony Hagerty

2 Hagerty 2 Introduction Repetitive Strain Injury (R.S.I.) is an injury to the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained or awkward positions. (Wikipedia) Being in the computer science field often leads to quite a few of these situations becoming a reality, especially concerning repetitive tasks and sustained or awkward positions. These constant, repetitive tasks will slowly cause wear and tear on a person s set of muscles and joints. This wear and tear is a serious issue that needs to be considered by users who exhibit aggressive usage of computers. Employers need to be aware of their employee s work habits and allow for breaks, potentially even having a small meeting about proper computer posture and typing positions. History While R.S.I. seems to be something that has only recently started to occur with the advent of the computing age, R.S.I. has actually been well-documented as far back as 1700 A.D. In his article De Morbis Artificum Diatriba (Disease of Workers), Bernardino Ramazzini, essentially the father of occupational medicine, describes the condition of workers who have succumb to the lure of repetitive craftsmanship. (Ramazzini) He refers to workers whose morbid affections gradually arise from... some particular posture of the limbs or unnatural movements of the body called for while they work. Carpal tunnel syndrome is a fairly well known form of RSI which was first identified by the British surgeon James Paget in (Pearce) James described carpal tunnel in depth while

3 Hagerty 3 at St. Bartholomew s Hospital in London. He says that carpal tunnel is a result of a fracture on the wrist which causes a compression of the median nerve. Later on in 1880 a man named James Jackson Putnam discussed Paget s description, a median compression at the wrist, and the symptoms associated with it became known as Putnam s acroparaesthesia. Causes When it comes to causes of RSI, the reasons are amazingly varied and cover a wide range of jobs environments. Ramazzini has some valid points on why he believes that RSI can become an issue. Most of these, if not all of them, can be directly applied to the modern day computer enthusiast/worker. He believes that the causes of this ailment are directly related to three things. (Ramazzini) First, he believes that constant sitting can cause a form of RSI because of poor posture. Constantly being bent over can cause workers to become hump-backed. He says that they hold their heads down like people looking for something on the ground. He goes on to say that this is caused by their sedentary life style, which promotes a hunched posture. This hunched posture can possibly tear the outermost vertebral ligaments and cause calluses which prevent the person from returning to a normal state of posture. This relates directly to the modern work environment, especially that of the stereotypical, computer cubicle. With computer and desk workers working for eight or more hours every day, a person in that situation can become very tired and lackadaisical. Second, Ramazzini believes that incessant movement of the hand and always in the same direction can also cause forms of RSI. In his article he discusses a printer, or someone who works at a newspaper type of job, and how they are constantly laying ink down and

4 Hagerty 4 spreading it. This process repeats infinitum until they have enough copies of whatever is being reproduced. He describes this event as being quite detrimental to the individual s health. Not only is it putting an enormous strain on the person s hands, it is also putting an equal strain on the person s eyes as well. This is quite evident in the computing world as that is almost exactly what most computer users do. Sitting at a desk, cranking out code, all while never shifting one s focus from the computer screen; hours and hours of this day in and day out cannot be healthy. Ramazzini says that this in course of time results in failure of power in the [ ] hand. The final cause that Ramazzini mentions is that of the mental strain that workers have placed on them by their employers. He says that from the effort not to disfigure the books by errors or cause loss to their employers when they add, subtract, or do other sums in arithmetic that this will cause them to put even more stress on themselves which could lead to further injury. RepetiveStrainInjury.org.uk list of general causes: -overuse of muscles on a continued repetitive basis -cold temperatures -vibrating equipment -forceful activities -poor posture or a badly organized work area that is not ergonomically sound -holding the same posture on a continuous basis -prolonged periods of work without a break -stress has been proven to increase the incidence of repetitive strain injuries -direct pressure or a blow to the body -carrying heavy loads on a repeated basis -fatigue

5 Hagerty 5 Most of these are relatively common instances within the professional computing world. It would be wise to take RSI seriously, considering how often these occur. The nature of RSI is that of a very gradual process; every little bit adds up to a much bigger problem. Symptoms and Effects Symptoms that patients may experience can vary from mild tenderness to complete loss of feeling in the hand. It is important to recognize these symptoms early on to prevent any permanent damage and halt the occurrence of bad habits. Medical News Today's list of potential symptoms: -tenderness in the affected muscle or joint -pain in the affected muscle or joint -a throbbing (pulsating) sensation in the affected area -pins and needles (tingling) in the affected area, especially the hand or arm -loss of sensation in the hand -loss of strength in the hand As mentioned earlier, RSI is a gradual process, so these symptoms would generally ramp up over time from a mild annoyance and end up potentially causing extreme pain or numbness. This only helps to compound the issue with diagnosing RSI. Just because a patient has one or more of these issues does not mean that they have RSI. This is especially dangerous when permanent damage could result from not taking care of a bad habit. As of now, there are no definite tests to determine whether a person has a RSI, however, a patient can help their orthopedist in discovering this by letting them know what actions a person takes on a regular basis that may or may not be stressful on the person's muscles and

6 Hagerty 6 joints. Actions such as regular computing, woodworking, guitar practice, office work, and even masturbation in some cases, can invoke these symptoms if the person performs them too often without breaks. There are currently two types of RSI: type one and type two. Type one RSI falls into the category of specific types of symptoms. Patients categorized by type one generally exhibit symptoms in line with common issues such as carpal tunnel syndrome, rotator cuff syndrome, a ganglion cyst, Raynaud's disease, writer's cramp, and many others. Type one conditions are often accompanied by inflammation and swelling. (RSI: Diagnosing) Type two is much harder to diagnose and can often go unnoticed as the symptoms are often too generalized to be of assistance. Type two RSI is categorized as "non-specific pain with no swelling or inflammation". Type two is also called "Diffuse RSI". (TIFAQ) To help diagnose type two, patients can be given a series of X-rays and blood tests to help determine what the problem could be. An interesting symptom that is mostly seen with type two is extreme sensitivity to vibrations and stimuli. Work Pressure Employers today ask quite a bit out of their employees; with ever-rising quality and far stricter time constraints, employers are looking for people that can deliver high quality output in a very short time. This is something that has and will always be expected, but with the advent of newer, more efficient technology, it can be tough to not only get your foot in an industry, but keep it there. With those expectations it is abundantly clear why todays computer user can get RSI so easily.

7 Hagerty 7 According to CanMyBossDoThat.com, in Kentucky, workers are entitled to a thirty minute meal break and two ten minute paid rest breaks within an eight hour period. This means that workers, especially workers in the computing fields, should take advantage of this opportunity and go for a walk or any exercise that will take their mind off of work and allow their hands to rest. If an employer refuses to acknowledge this, they can be prosecuted and fined a large sum of money. This is especially good to know if a person's manager is depriving them of necessary down time during work. While it is good to know, some people do not want to take a break and prefer to power through the daily routine of working in a professional setting. This is an unfortunate side of having a good work ethic and should be addressed promptly. Employers need to try to assist employees in finding an alternative for their workers to do when on a break. When I work, for example, I usually take a break and go for a small walk around the block or practice mixing music. Doing mindless work is helpful for allowing the mind to de-stress and promotes creativity when returning to work after doing so. This is also useful for the worker physically, as a healthy mind promotes a healthy body. Being relaxed in mind can help relax and relieve tension in the muscles and joints in the body as well. Treatment Once permanent damage has been done it cannot be undone, but before it comes to that point, there are steps that can be taken to ensure that it will not become worse. First and foremost, steps should be taken to alter the initial habit that caused the RSI. Without a change in

8 Hagerty 8 the foundation of the problem, it will always be there and will continue to comeback time and time again. One of the most basic examples of changing the habit is to slowly cut back on the amount of time spent doing the action in question. (RSI: Treatment) By eliminating time spent doing the action, less overall stress will be exerted on the wrist and arm. Even taking a small break for five minutes every hour can help to alleviate physical as well as mental stress and reduce the amount of discomfort felt from an already occurring RSI. Some more extreme examples of treatment can vary from regular medication to surgery. Medication is the most used as it is the least intrusive. (RSI: Treatment) Anti-inflammatory painkillers, muscles relaxants, and sleeping tablets are a few examples of medicine that can be used to help treat RSI. Physiotherapy can also be used to help alleviate the symptoms as well. Doing regular exercises that help workout the strained area can ease the pain over time if done correctly. Cold and hot packs are great for cases where movement is excessively painful. The last alternative that can be used to treat RSI is surgery. Surgery is usually a last resort and only occurs when the patient needs some form of reconstructive surgery for their tendons or nerves. Carpal tunnel syndrome would be a reason for surgery. Analysis RSI is a real issue that affects many people, especially those that are in the computing professions. From my research I have come to the conclusion that this is a very small concern in the workplace. Awareness needs to be raised about the subject and hopefully this paper will do just that.

9 Hagerty 9 Scouring the internet for various articles on the subject has lead me to believe that RSI is still a major problem in the work environment. This problem goes back to 1700 and probably much longer before that. With it being such a long standing problem, I assumed that more people would have more in depth and interesting info on the subject, but with RSI being such a hard problem to diagnose, there is not very much to do about it, outside of normal/obvious techniques. Dealing with RSI boils down to a few key points. One of the main points is to actually prevent it before it becomes an issue. This means getting into the habit of having correct posture, taking a few breaks in the middle of work, and even mixing up what you do while you work. Programmers tend to spend hours writing code at a time. The problem is that this time does not need to solely be used for writing the actual code. Trying to plan out how a section of code is going to work before hand can limit the amount of actual code that needs to be written or rewritten. Being creative with the time at hand can help in the long run in countless ways. The next point is to take it easy when you do receive a RSI. Doing what was mentioned before, along with using muscle/joint recovery techniques can go a long way in helping a person suffering from RSI feel better, faster. Pain medication and muscle relaxants are wonderful for helping with pain toleration, as well as helping the body to relax and recover faster. Hot and cold packs also help with symptoms such as swelling and inflammation. These are all things that can be done at home or from purchasing over-the-counter at a local drug store. The final point is that of discussing the subject with an employer. Employers always want hard workers, but more importantly, they want efficient workers. Efficiency is something that can be hard to come by in the computing industry. Nonetheless, it is seen as a necessity, so bringing up the topic of RSI can help employers to understand the employee's needs and give them a better work environment which would allow them to be much more productive.

10 Hagerty 10 While RSI can be an intimidating problem to deal with, it should never be taken lightly and should always be thought of in the back of the worker's mind. When it comes to personal health, sometimes the most crippling problems are the slowest to appear.

11 Hagerty 11 References "Causes of Repetitive Strain Injury." Causes of Repetitive Strain Injury. Web. 13 Apr < "Health A-Z." Repetitive Strain Injury (RSI). Web. 13 Apr < "James Paget's Median Nerve Compression (Putnam's Acroparaesthesia)." -- Pearce 9 (2): 96. Web. 13 Apr < "Meal & Rest Breaks." Can My Boss Do That? Web. 13 Apr < Medical News Today. MediLexicon International. Web. 13 Apr < Ramazzini, Bernardino. "De Morbis Artificum Diatriba [Diseases of Workers]." American Journal of Public Health. American Journal of Public Health Web. 13 Apr < PMC />. "Repetitive Strain Injury (RSI) - Causes." Repetitive Strain Injury (RSI). Web. 13 Apr < "Repetitive Strain Injury (RSI) - Treatment." Repetitive Strain Injury (RSI). Web. 13 Apr < "What Is a Repetitive Strain Injury." TIFAQ. Web. 13 Apr < type-1-and-2-rsi/>.

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