WebWord.com > Interviews > The Facts About Repetitive Strain Injuries (22-March-99)

 

The Facts About Repetitive Strain Injuries
An interview with Scott Wright, Webmaster and Primary Caretaker of the Typing Injury FAQ


Introduction

What is the Typing Injury FAQ? What is your role?

The Typing Injury FAQ (TIFAQ) was created by Dan Wallach, an undergraduate computer sciences major that started to experience repetitive strain injury (RSI) symptoms in the early 1990s. He collected information and posted it online as a newsgroup FAQ (frequently asked questions)--until the Web became popular and it was converted to a website. Since then, the TIFAQ has evolved into a repository of information about RSIs, resources for dealing with these ailments, and assistive products to reduce injury risk and symptoms. While its primary focus is on computer users at risk of injury, there is lots of information of general interest that relates to other life activities as well.

My role with the TIFAQ website is what I'd call content development and webmastering. I became actively involved with the TIFAQ after I had completed my masters thesis on alternative keyboards and offered to help update some of its old information. As Dan was working to complete his Ph.D. in computer sciences, he was looking for someone to take over maintenance of the TIFAQ--which I eventually ended up doing. Currently the TIFAQ has become a publication of the CTD Resource Network, Inc.--a new California nonprofit organization formed to provide educational and charitable services to the RSI community.


What are Repetitive Strain Injuries (RSIs)?

The term "repetitive strain injury (RSI)" is a general, umbrella term covering a host of injuries that all have a similar cause: excessive wear and tear on the soft tissues of the body (tendons, nerves, circulatory system, etc.). While descriptive of its suspected cause, RSI tells little about what is damaged and the corrective measures needed to heal the injury. Specific examples of injuries typically considered RSIs include tendonitis, tenosynovitis, epicondylitis, carpal tunnel syndrome, thoracic outlet syndrome, etc. Other similar terms to RSI that you might see include:

  • CTD - Cumulative Trauma Disorder

  • MSD-Musculoskeletal Disorders

  • OOS - Occupational Overuse Syndrome

  • RMI - Repetitive Motion Injury

  • UEMSD - Upper Extremity Musculoskeletal Disorder

  • WRULD - Work-Related Upper Limb Disorders.


What are the symptoms or signs of injury?

Symptoms and locations vary as much as the disorders represented. Typical injury symptoms include tightness, general soreness, dull ache, throbbing, sharp pain, numbness, tingling. burning, swelling, and loss of strength in your upper extremities (hands, arms, shoulders, and neck). While some of these can be descriptive of general fatigue, it is always best to see your physician if you experience any of these symptoms for several days in a row.


What are the common causes or injury risks of RSIs?

RSIs are a response to excessive and repetitive demands placed on the body. From the typical engineering/biomechanical viewpoint, identified physical
causes have been:

  • Repetition of a single movement or motion pattern

  • Postures that place joints towards their extreme end of movement

  • Applying excessive muscular exertion/force

  • Pressing the body against hard objects

  • Vibration from vehicles or tools

  • Cold working temperatures.

It is important to note that our bodies are designed to perform all of these activities, however, as they are done in combination, and for extended periods of time, risk of injury increases. This is true whether the activities are performed at work or play.

Personal, medical conditions may increase the risk of injury. For CTS, these conditions include:

  • Diabetes

  • Rheumatoid arthritis

  • Thyroid disease

  • Gout

  • Being overweight or sudden weight gain

  • Hormone conditions (pregnancy, hysterectomy or removal of both ovaries)

  • Fluid retention (pregnancy, birth control, and sudden weight gain)

  • Previous injuries

  • Smoking may also increase the risk

Environmental/Psychosocial issues that have been identified to contribute to
injury risk are:

  • Low levels of job satisfaction

  • Infrequent or inflexible breaks

  • Monotonous work (low activity variety and fast pace)

  • Limited autonomy (lack of control over the work performed)

  • Perception of intensified workload and work pressure (deadlines, monitoring, bad management)

  • Limited support from supervisors and co-workers


How can injuries be avoided? What are the best preventative measures?

The general key is to avoid the above mentioned risk factors - move around and vary the physical activities that you do throughout the day. Below are some avenues that companies and individuals are following in the attempt to stay healthy and safe.

Workstation Ergonomics - The physical design of the workplace (workstations, tools, job design) has a large influence on how we work. Proper placement and design of computer equipment and other office items, so as to avoid injury risk factors, is an aim of ergonomics.

Injury and Somatic Awareness - Knowing about RSI injury risk factors and being able to recognize symptoms when they occur is an important step in avoiding injury, as well as being able to take care of the injury and it's likely cause, when it does occur. Beyond these items are individual workstyle issues, such as how hard we strike the keyboard keys or squeeze the mouse, how we position our fingers, wrists, arms, and shoulders while we work; and where we place items frequently used throughout the day. We don't generally pay a lot of attention of how we go about doing our daily activities until our body starts telling us something is wrong by hurting. Many people ignore what their body is telling them and work through the pain to get the job done--that is a big mistake. The main issue here is to listen to your body and take a break, vary your activities throughout the day, change how you are doing the activity that hurts, or get help.

General Health - Taking care of ourselves through good nutrition and stretching/exercise helps our body be ready for the daily exertions we place on it. Several personal/medical risk factors can be addressed through spending the time to take care of ourselves, so our body can take care of us.


Special Web Considerations

Are there special RSI considerations for Web users?

Typical issues with RSIs focus on the physical setup and user behavior. Depending upon the speed of internet connections--and web page sizes--there can be significant pauses when downloading new pages. User behavioral issues I've heard discussed from past observational studies include a "freezing" in place, holding of one's breath, or continuing to grasp the mouse while waiting for the next page or option to appear to the user. These display "down" times are perfect opportunities for users to disconnect from the computer, look away from the monitor to rest the eyes, and stand and stretch.


How is Web design related to RSIs? For example, can Web sites be better designed to prevent RSIs?

Software designs that focus only mouse use, or require holding down a button during a given function, force a lot more activity into a limited set of body motions. Allowing keyboard short-cuts and multiple alternative means of executing commands facilitates a broader set of physical movements and variety. As this relates to RSIs, I feel that it is important to provide well-designed tables of contents, site maps, and search capabilities to reduce the need of excessive scrolling and clicking to find the information of interest. While shorter pages reduce the need to scroll, more clicking is required. For longer pages there are several different methods to scroll--scroll bar use with the mouse; keyboard space, arrow, and page up/down keys--and pages can usually be printed out as well. Page length should be tailored to the information being presented. If the pages get too long, then a table of contents can be placed on a primary page with a brief introduction and the contents broken up in logical divisions of information.

Where users are already injured or disabled, they may use Web browsers that don't recognize graphics or need additional descriptions for the use of screen readers, speech recognition applications, etc.

In a recent issue of the Internet Technical Group's (ITG) Internetworking newsletter, Lila Laux published an article on Designing Accessible Web Pages and Web Applications.

Below are some of her thoughts:

  • The goal of Human Factors in Web design is to design Web sites to make them accessible to the largest number of potential users, including those with disabilities.

  • The largest groups of users with handicapping conditions who want to use the WWW are users who 1) are blind / visually impaired, 2) are deaf / hard-of-hearing, or, 3) have motor problems relating to input/output devices.

  • Some general guidelines to make pages accessible to the broadest range of users with disabling conditions include:

  1. Ensure that your pages are compatible with screen-reading software and other adaptive technology like screen magnification.

  2. Use a consistent, simple layout across all pages of the site.

  3. Ensure that contrast between the background and foreground (especially text or other symbols) is high.

  4. Provide a text alternative to all graphics/image maps (alt-text or D-tag.)

  5. Provide descriptive captions for all pictures.

  6. Use tables and frames sparingly or offer alternative pages for screen readers.

  7. Use large, clearly identifiable buttons/controls.

  8. Caption video and transcribe audio displays.

  9. Do not require that users be able to use a mouse to navigate through your pages/site.

Excellent sites providing "how-to" information for designing accessible Web sites are supported by the Trace Research & Development Center at the University of Wisconsin and the Web Accessibility Initiative of the World Wide Web Consortium (W3C).

Assess the accessibility of your web page for all disabilities by using Bobby. Also check out WebABLE, an authoritative Web site for disability-related internet resources.


What are the best books available about RSIs?

Some general information and preventative books for the general public include:

Repetitive Strain Injury, a Computer User's Guide
Emil Pascarelli and Deborah Quilter
John Wiley & Sons (ISBN 0-471-59533-0)
[check it out on Amazon]

The Computer User's Survival Guide
Joan Stigliani
O'Reilly & Associates, Inc (ISBN 1-56592-030-9) http://www.ora.com/www/item/cusg.html

Conquering Carpal Tunnel Syndrome and other Repetitive Strain Injuries: A Self-Care Program
Sharon J. Butler (Author's e-mail: SButler100@aol.com )
New Harbinger Publications (ISBN 1-57224-039-3)
[check it out on Amazon

Preventing Computer Injury: The Hand Book
Stephanie Brown
Ergonome Press (ISBN 1-884388-01-9)

ComputerFit: Staying Healthy in a Computer-Based Workforce
Randall Helm
Lifelong Health Systems (ISBN 0-9682652-0-0)
$18.95 Can. and $14.95 U.S.A, released October 1997
Phone: Randall Helm (519) 579-9926
Email: Randall Helm helm@computerfit.com.
http://www.computerfit.com

And for those interested in the politics around RSIs:

Wounded Workers: The Politics of Musculoskeletal Injuries
Penney Kome
University of Toronto Press (ISBN 0-8020-7795-1)
http://www.utpress.utoronto.ca/publishing/catalogue/kome_wounded.htm
[check it out on Amazon]

Office Politics: Computers, Labor, and the Fight for Safety and Health
Vernon L. Mogensen
Rutgers University Press (ISBN paperback, 0-8135-2287-0) Phone: Rutgers University Press (800)446-9323

Occupation and Disease: How Social Factors Affect the Conception of Work-Related Disorders
Allard E. Dembe
Yale University Press (ISBN 0-300-06436-5)
http://www.yale.edu/yup/books/dembe96.html
[check it out on Amazon]


What products are available to help prevent RSIs?

There are a wide variety of accessories, devices, software, etc. available on the market that have a diverse range of claims and research behind them. Some products are very useful in positioning computer input devices (keyboards, mice, etc.) and monitors to improve user postures during use. The same can be said about the design of newer keyboards, mice, etc. Some ergonomists de-emphasize product-based approaches when dealing with RSIs and move their focus onto behavioral issues of the users and how they use their existing equipment. Both the physical work environment and our own behaviors in that environment interact in our efforts to prevent RSIs. The better the user is educated about RSIs, the more likely they will be avoided or adequately addressed in their early stages to avoid the possible chronic pain and disability that can result from severe cases. 

For more information on products and related comments, I'd suggest users visit the Typing Injury FAQ. It is constantly being updated and contains a massive amount of products, information, and links to other resources.


What organizations, articles, and newsletters do you recommend?

The CTD Resource Network, Inc. publishes not only the TIFAQ website, but also The RSI Network newsletter. Both publications contain articles and related information of interest to the RSI community.

Some other RSI-related organizations with their own newsletters and informational packets are:

The Association for Repetitive Motion Syndromes (A.R.M.S.)
P.O. Box 471973, Aurora, CO 80047-1973
(303) 369-0803
Email: arms@lightspeed.net
Web site: http://www.certifiedpst.com/arms/
Description: The Association for Repetitive Motion Syndromes (ARMS) is a not-for-profit organization committed to assisting workers at-risk or injured by repetitive motion syndromes. ARMS also provides assistance to employers, workers compensation specialists, and health care professionals.

Americans With Work Related Injuries
Description: Originally founded as a Political Action/Injured Worker help organization to increase the awareness of computer related injuries and help the injured worker through the Workers' Compensation process.

Coalition on New Office Technology (CNOT)
650 Beacon St., 5th Floor, Boston in Kenmore Square
Boston, MA 02215
Phone: (617) 247-6827
Fax: (617) 262-6414
Description: CNOT organizes and trains clerical workers to prevent repetitive strain injuries and advocates for safe workplaces.

Some organizations, newsletters, and resources on the Web issues, I'd recommend:


Scott, I am certain that many people will find this information invaluable. Indeed, this might save people from needless suffering and agony.

Thank you very much for your time and effort. Your work is greatly appreciated.

(This interview was conducted via email by John S. Rhodes)


Read another popular interview: Interaction Design: The Guru Speaks



Contact John S. Rhodes, WebWord.com Editor and Webmaster

URL: http://www.WebWord.com/interviews/wright.html

© 1999 by John S. Rhodes. All rights reserved.
Do not reproduce or redistribute any material from this document,
in whole or in part, without explicit written permission from John S. Rhodes.