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 * Repetitive Strain Injury**

**Definition**
//“RSI is not a specific medical diagnosis, but rather a family of disorders. Many people mistakenly equate RSI with carpal tunnel syndrome, even though CTS is only one particular form of RSI. One recent study even reported that frequent computer users are no more likely to develop CTS than non-computer users. Don't let this mislead you, though. Many other forms of RSI do come on as a result of frequent computer use”// (1)

Repetitive Strain Injury is an ailment that results in mostly musculoskeletal disorders (well known as MSD) like back ache, ceased hand movements, joint aches and injured muscles. This happens due to excessive strain applied onto muscles by heavy work hours without taking breaks or sitting in a similar posture for too long, hence resulting in MSD. This usually occurs to people who work a lot on keyboard or mouse.


 * **Contents**


 * 1) Definition
 * 2) Related Legislation
 * 3) How is it Related to Computing?
 * 4) Manage RSI
 * 5) Advice
 * 6) RSI Hazards
 * 7) Minimising risks
 * 8) Ergonomics
 * 9) Case Studies
 * 10) 'Questions for further thought'
 * 11) References ||

**Related Legislation:**
RSI has a legislation on it by countries in the European Community that an EC directive regulates. There are quite many acts that can be applied regarding RSI in the UK.


 * The Health and Safety (Display Screen Equipment) Regulations (1992) apply to the employees who work at a firm, with constant luring at a display screen equipment, and accessories like modems, printers, other peripheral display screens. According to this legislative regulation, the firm or employer must provide periodic breaks, safety training to work on the equipment to the employee with him or her meeting the minimum ergonomic requirements for the work environment. It also states that the employer must provide free eye sight tests and assess & reduce the risk of health hazards to the employee. (2)


 * The Health and Safety at Work Act (1974) talks about protecting employees other than people at work against risks related to health. (3) For example, keeping dangerous goods that be result in harming the employees inside at work; this may be employees being harmed by illegal possessions that a company holds. This way an employer must always ensure safety of employees & avoid risks by possessing legal equipments.


 * The Disability Discrimination Act (1995) is applied to physically impaired employees. (4) This legislative act stops the discrimination of disabled employees against the others. It ensures no physically challenged employee faces thwarting and humiliation. This is related to RSI; the employer must provide workplace adjustments to the disabled as he or she would end up with a strain injury, which is thereby unlawful. The adjustments could be provided based on the individual requirements, like one could be uncomfortable sitting on a chair rather than a lazy bag.


 * The Provision & Use of Work Equipment Regulations(1998) needs any equipment to be non hazardous and must not cause injuries to the employees.(5) This by basis, is mainly used in production line equipments.

//“New research by Dr Foster for Metro has revealed that ten per cent of sick notes written in London are for repetitive strain injury.”// (6)

**How is it Related to Computing?**
Computing has an adverse affect on the muscles that are strain prone, as it could include heavy programming, which results in muscular pains or RSI. Though a speech recognition software could be used to type out a letter, it is practically not very useful when it comes to programming as it includes symbols and nonstandard word spellings that cannot be dictated. UNIX as contrast to Windows has a much complex computing platform that seems more difficult to use a Speech recognition software. However, a program approach (a2x) has been made for that too. (7) Information technology marks repetitive stress injuries as an illness related to health risks involved with it. It is therefore an expensive compensation that companies may provide for such incidents, that may occur to their employees. It is also unethical and unlawful if it is carried so by the employer intentionally towards it’s employee.

**Manage** **RSI**
Most people always heal from the trauma with dual solution of following a solid treatment and adjusting to a new ways of doings things in their lives. It is necessary to know that every injury responds differently to treatment and the cure may fluctuate for each case, additionally there is individuality in physiology. Treatment would eventually ease the pain but people are asked to make further adjustments to their routines: (stepping the job, having frequent breaks to relax, using comfortable made workstations). (8)

Adjustments should be taken place as well in individual’s every day’s routine with introduction to positivity, chill, fitness and healthy diet. There are several methods to cure RSI but avoidance is recommended because staying in good health would minimize the dangers of contacting injuries. It is important for employees to participate in fun activities in their spare time to relieve pressure and minimise risk of bad health or posture to aggravate.

There are basic five steps to recovery: 1. Avoid to aggravate the danger of additional hurt 2. Complete and correct analysis on the trauma suffered by the patient 3. Suitable cure to clear the suffering 4. Exercises to recover the normal blood flow 5. Return to work promptly (9)

Suitable actions must be considered by employers to promote a safe environment for workers and prevent any repetitive RSI therefore many details need to be overviewed carefully to match health and safety standards (noise levels, visual, colour, and chairs). Depending on how serious an injury can be, some workers would look into changing careers because of inability or lack of confidence but there are always optional choices to make before reaching that conclusion.


 * Rational amendments in technology,
 * modifying working hours, changing workloads,
 * redistributing tasks within a team,
 * leave for rehabilitation,
 * training for new equipment
 * Change structure within organisations. (10)

**Advice**
Most individuals affected by the trauma are unsure where to look for guidance or assistance but they have ignored the fact that their contracts offer


 * Health and Safety legislation: health & safety at work act 1974, health & safety SE regulations 1992, manual handling operations regulations 1992, workplace regulations 1992, reporting of injuries /diseases and dangerous occurrences regulations 1995
 * Employments rights: there are good or bad reasons why individuals tend not to reveal details about their current or repetitive RSI but mainly it is the threat to secure a job because nowadays job safety is rare in the market
 * Benefits: council tax reduction scheme, income support, incapacity benefit, disability living allowance, industrial injuries disability benefits

Many individuals such as Adam Ward, Bruce Lynn and Jane Greening are running research in order to prevent these injuries to occur to vulnerable people and some institutions such as EU-OSHA, Robens Institute for Ergonomic have for goal to promote health & safety within organisation. (11)

**RSI Hazards**
RSI does not normally have a main reason and in many cases these trauma occur from a poor environment, there are other details to consider when referring to hazards but injuries may occur also due to routine or habits. (12)

The main hazards include


 * An uncomfortable workstation
 * Long working hours with no break
 * Poor posture
 * A large workload
 * Cold or hot working conditions

RSI prone individuals also should take some responsibility for putting themselves at risk that lead to individual respective habits. This is also affected by factors including age, strength and general health of a person. (13)

**Minimising risks**
Ergonomics: it is essential to perform actions that you can support, readable displays for H & S, make sure that well-matched systems are in use and prevent overusing of technology for a lengthy period which results to uneasiness. It is important to evaluate the similarities and differences that individuals respond to the use of each system. Being at ease and comfort would be a major key in minimising risks of RSI.
 * General lifestyle**: there is a say in French://”mieux vaut guerrir que prevenir”//, in other words prevention is the best method to apply rather than going throughout a cure or healing process. A good lifestyle with healthy diet and exercise can contribute to minimising the risk.

Better more ergonomic technology can also lead to risk reduction, this includes more ergonomic designed keyboard and autocorrect technology for spelling mistakes. Abilitynet provides information on RSI in computing. (14)

Employers also hold some of the responsibility to provide a good safe environment for its employees to perform daily tasks without fear of any form of strain or injury. Obligations from Health and Safety at work act 1974 and Health and Safety regulations 1992. (15)

Employers has the responsibility to provide a safe environment for its employees to perform daily tasks without fearing any type of strain or injury, there are obligations that can be read from H & S at work act 1974 and H & S regulations 1992, Provision and use of work equipment. The whole purpose of these acts is promoting diminished or eradicated risks for RSI at work or by work equipment. (16)
 * Alternate Technology**: the less use of keyboard is a help to the present danger of RSI, modifying control panel settings with a stable speed for the mouse. The autocorrect is another option to substitute usual used sentences and improved keyboards are available than the conventional one and now some organisations employ voice recognition software. Organisations such AbilityNet have for goal to provide information about to employees about RSI in computing.

**Ergonomics**
//“Ergonomics, also known as human factors, is the scientific discipline that seeks to understand and improve human interactions with products, equipment, environments and systems. Drawing upon human biology, psychology, engineering and design, ergonomics aims to develop and apply knowledge and techniques to optimise system performance, whilst protecting the health, safety and well-being of individuals involved. The attention of ergonomics extends across work, leisure and other aspects of our daily lives.”// (The Official Journal of the Institute for Ergonomics and Human factors, 2009) [|(17)]

//The Figure above describes the correct postures so as to avoid developing an RSI [|(18)] //

RSI Court Case
Between 2003 through 2004, about 4.7m work days were lost to RSI, with workers taking and average of 18 sick days leave. (19) A journalist received an out of court settlement after taking 6 months sick leave. The journalist Ms Munson, whom worked with an electronic keyboard, was diagnosed as suffering from RSI in 1991 and the condition was confirmed by the company doctor. The Portsmouth and Sunderland Newspapers agreed to pay Ms Munson £10,000 and £1,371 to cover the benefit she has received since the dismissal. Another RSI case is Rafiq Mughal whom worked for the Reuters news agency, and was the journalist involved in Thursday's High Court verdict after turning down a pounds 20,000 out-of-court settlement. (20) These RSI cases highlight the importance for companies to incorporate RSI into their health and safety practices, and corporate responsibility for companies to ensure employees use prevention methods to ensure RSI doesn’t develop in employees or face repercussions such as the court cases above.

During Joan’s professional career at AXZ Company, she noticed a pain in her hands, which she initially she ignored. A short while later the pain was radiating up to her elbow and she resorted to off the counter painkillers for the time being, which helped her for an interim. As time passed, the pain gradually started building up and spread to her elbow, neck and shoulder, which she again ignored and continued working, till it became unbearable and she had to approach her supervisor who suggested her to see a doctor. After an appointment with the doctor, she was advised that she may have tendonitis or carpal tunnel syndrome, due to the nature of the work she did which involved much typing – he tells her to file a workers’ compensation claim with her employer because her symptoms appear to be work related. The next day Joan tells her manager that she may have carpal tunnel syndrome based on the evaluation completed by her primary doctor. The manager reviews the paperwork from Joan’s primary doctor and completes the Notice of Injury. The manager contacts the workers’ compensation insurance carrier and reports the claim to them. Joan is told to make an appointment with the occupational clinic that treats the employees who work for AXZ //Joan has her first appointment at the walk-in clinic on January 23, 2008. The physician evaluates her and concurs with the primary doctor that Joan may have tendonitis or possible carpal tunnel syndrome. He prescribes a conservative treatment plan – brace for both wrist, physical therapy two times per week for 2 weeks and a prescription for anti-inflammatory medication. Joan is schedule for a follow up appointment in 3 weeks.// //Three weeks later Joan return to the walk-in clinic, she relays that she is feeling a little better but her hands are still a bit stiff. Her employer has reduced the amount of typing she has to do and they have reassigned the hole punching job to someone else. The doctor orders two more weeks of physical therapy and advises Joan to continue using her brace. She is schedule to return to the clinic in three weeks.// //Joan returns to the walk in clinic on March 11, 2008 – she tells the doctor that she is feeling much better, in fact she is almost back to normal. The doctor discontinues her therapy and advises her to wear the brace if she has any symptoms. She is discharged – Full Duty with a 0% permanent impairment rating.// //Joan returns to work – she is back to her regular job and she is back to making training manuals for her manager. Gradually her symptoms return, again Joan ignores the warning signs and continues to type and hole punch. Two months after her last appointment at the walk-in clinic, Joan is back with significant deterioration in both arms, tenderness and pain radiating from her shoulder to her wrist.// //Joan is immediately referred to an orthopedic hand specialist for an evaluation. The hand specialist orders a nerve conduction study and confirms that Joan has carpal tunnel and ulnar neuropathy. She is schedule for surgery.// //Yes, based on her original symptoms the nerve conduction study could have been order earlier to rule out the carpal tunnel syndrome or confirm her diagnosis.// //This employee reported an injury that is repetitive, reporting the claim to the insurance carrier is only half of the process. It is imperative that the employer evaluate the employees job tasks to determine the root cause of the employees problem.// //70% of all claims are related to productivity and workplace conditions. The Notice of Injury does not capture the daily routines that can be contributing to the employees symptoms.// //Carpal tunnel claims are 34% more likely to transition from medical only to lost time increasing the cost by 300%.” (21) //
 * //“Joan Enters the Workers’ Comp System://**
 * //Was there a delay in her diagnosis?//**
 * //What did the employer do wrong?//**

**'Questions for further thought'**

 * Should better ergonomic equipment be provided by employer to their employees?
 * Who is to be blamed if an employee is injured at his workplace as a result of long working hours?
 * What could be portrayed as a balanced working environment regarding issues related to RSI kept in mind?
 * Could the RSI and Carpal Tunnel Syndrome issues be curbed or eradicated by introducing ergonomics?
 * If a UK based firm has it’s branch in a nation that does not have an RSI Legislation act, will the act still hold good in that nation?
 * Is there a necessity to include RSI illness for job application forms?
 * What are the regulations pertaining RSI in other regional countries such as Asia or Africa?
 * Is RSI a significant sign of disability for individuals to be entitled for income support for instance?
 * Computing is not always the only reason for RSI to occur. What are the others?
 * Should government implement a policy for RSI since early ages for citizens?
 * As technologies grow, as RSI figures grow; do manufactures regulate their products with health bodies before releasing them?
 * Are there surplus funds invested for the improvement in prevention from RSI?
 * What are the measures that companies should take to ensure that better ergonomics are to be provided?
 * are the lean practices an advantage or disadvantage for RSI at work?
 * Why doesn't media portray enough evidence about RSI?
 * Although RSI may lead to a disability for life, why do A & E departments in hospitals not prioritise their treatment?
 * Should we retain ourselves from new technologies because they brought RSI to life?

**References**

 * 1) Repetitive Strain Injury, 2012 http://www.eecs.umich.edu/~cscott/rsi.html##book Accessed 20/02/2012
 * 2) Employee RSI from an Employer's Perspective. 2012. Employee RSI from an Employer's Perspective. [ONLINE] Available at: @http://www.rsiprevention.com/employer.php. [Accessed 29 February 2012].
 * 3) Legislation.gov.uk. Health and Safety at Work etc. Act 1974 . [ONLINE] Available at: @http://www.legislation.gov.uk/ukpga/1974/37/introduction. [Accessed 28 February 12].
 * 4) Unison.org.uk. Repetitive Strain Injury. [ONLINE] Available at: @http://www.unison.org.uk/file/179.pdf. [Accessed 28 February 12].
 * 5) rsi.org.uk. Workplace Health and Safety. [ONLINE] Available at: @http://www.rsi.org.uk/minimise/workplace_safety.html. [Accessed 28 February 12].
 * 6) The age of strain | News. 2012. The age of strain | News. [ONLINE] Available at: @http://www.thisislondon.co.uk/news/article-7638853-the-age-of-strain.do [Accessed 29 February 2012].
 * 7) Dealing With RSI. 2012. Dealing With RSI. [ONLINE] Available at: @http://www.stanford.edu/~ouster/cgi-bin/wrist.php. [Accessed 29 February 2012].
 * 8) Pascarelli, Emil. Dr (2004) Complete guide to Repetitive Strain injuries. John Wiley & Sons, Inc. Hoboken, New Jersey ISBN 0-471-38843-2 pg.163
 * 9) Pascarelli, Emil. Dr (2004) Complete guide to Repetitive Strain injuries. John Wiley & Sons, Inc. Hoboken, New Jersey ISBN 0-471-38843-2 pg. 209
 * 10) Pascarelli, Emil. Dr (2004) Complete guide to Repetitive Strain injuries. John Wiley & Sons, Inc. Hoboken, New Jersey ISBN 0-471-38843-2 pg. 171
 * 11) Jameson, Timothy. D.C. (1998) Repetitive Strain Injuries. McGraw-Hill Companies. ISBN-13: 9780879838027(p.50-67)
 * 12) Jameson, Timothy. D.C. (1998) Repetitive Strain Injuries. McGraw-Hill Companies. ISBN-13: 9780879838027(p.23-45)
 * 13) Jameson, Timothy. D.C. (1998) Repetitive Strain Injuries. McGraw-Hill Companies. ISBN-13: 9780879838027(p.80-102)
 * 14) Pascarelli, Emil. Dr (2004) Complete guide to Repetitive Strain injuries. John Wiley & Sons, Inc. Hoboken, New Jersey ISBN 0-471-38843-2 pg.111
 * 15) Pascarelli, Emil. Dr (2004) Complete guide to Repetitive Strain injuries. John Wiley & Sons, Inc. Hoboken, New Jersey ISBN 0-471-38843-2 pg.27-69
 * 16) Pascarelli, Emil. Dr (2004) Complete guide to Repetitive Strain injuries. John Wiley & Sons, Inc. Hoboken, New Jersey ISBN 0-471-38843-2 pg.27-69
 * 17) Taylor & Francis Journals: Welcome. 2012. Taylor & Francis Journals: Welcome. [ONLINE] Available at: @http://www.tandf.co.uk/journals/terg. [Accessed 04 March 2012].
 * 18) UCAR Ergonomics Web Site. 2012. UCAR Ergonomics Web Site. [ONLINE] Available at: @http://www.fin.ucar.edu/sass/hess/ergo/posture.html. [Accessed 04 March 2012].
 * 19) BBC NEWS | Health | Evidence on RSI 'urgently needed'. 2012. BBC NEWS | Health | Evidence on RSI 'urgently needed'. [ONLINE] Available at: __@http://news.bbc.co.uk/1/hi/health/6692683.stm__
 * 20) Journalist wins compensation for RSI: Out-of-court settlement of pounds 11,371 follows judge's ruling that strain injury does not exist - UK - News - The Independent . 2012. Journalist wins compensation for RSI: Out-of-court settlement of pounds 11,371 follows judge's ruling that strain injury does not exist - UK - News - The Independent . [ONLINE] Available at: @http://www.independent.co.uk/news/uk/journalist-wins-compensation-for-rsi-outofcourt-settlement-of-pounds-11371-follows-judges-ruling-that-strain-injury-does-not-exist-1501386.html. [Accessed 04 March 2012].
 * 21) Case Study: Impact of Delayed Carpal Tunnel Diagnosis | Workers' Comp Gazette. 2012. Case Study: Impact of Delayed Carpal Tunnel Diagnosis | Workers' Comp Gazette. [ONLINE] Available at: @http://workerscompgazette.com/case-study-impact-of-delayed-carpal-tunnel-diagnosis/. [Accessed 04 March 2012]