Repetitive strain injury and workstation management

The following information is to be considered advice only. If you think you have RSI you should see a GP or a qualified Health Professional

This document contains information about:

• Your workstation
• What is RSI and are you at risk
• Identifying RSI
• What to do if you have RSI
• How is RSI treated
• What is required by your employer
• What is required by you
• A list of people to see
• Tips on remaining healthy and Kevin’s personal experience with a strain
• Exercises

Prevention is way better than cure.

Before explaining what RSI is and what to do about it, the first thing is to set your work station up, because sitting and working correctly is the most important part of not developing a strain. And the best way to cure a strain is to not get one.

Your work station

First off you should have anything you require to make sitting at your desk comfortable. The key things here are a 5 leg based adjustable chair and monitor risers (books, paper, anything to lift them up) also things like wrist supports and specific tools like keyboards and mice. Personally I have found a vertical mouse to be easier to use.

Usually when working at a computer we tend to lean forward as our concentration increases, and also as the day goes on we get tired in our back so we start to slouch. Pictured right is an example of how to sit at a desk correctly. If you are tall you will need your seat set high in order to get your knees aligned correctly.

Important things to note about the image…

• There are no arm rests, keep these low and away from your elbows

• The top of the screen should be level with the top of your head. In other words you shouldn’t be able to see over it easily.

• The feet remain flat, not crossed.

• The back is straight and the neck is long.

• The arms are level with the keyboard.

• The image is quite deceiving with the arm at the mouse, the arm shouldn’t be lay on the desk. You should always avoid resting your arms on the desk, especially at the elbow. If you rest your arm at the elbow you will be using just your arm and wrist to move the mouse, whereas if the arm is free to move you will use your back more.

• Keep your shoulders down and away from the ears.

Sitting like this isn’t easy and at first can feel strange, the reason for this is that you will be using different muscles in your back (the ones you should use). If we slouch forward we tend to use our shoulders more and that will slowly start to cause strains.Even if you can’t constantly sit like this, try to correct yourself into this position whenever you realise you are sitting bad and slowly it will become habit.

One screen

Similar to the image above the top of your screen should be a few centimetres above your head when you are sat up straight. It should face flat against you and you should be able to touch the monitor with the tips of your hand.

Two screens

The temptation with two screens is to work slightly towards one, this isn’t ideal as your trunk will be ever so slightly angled. There are two setups with two screens.

1. Have the monitors lined up so the vertical meeting of the two is directly in front of you, this will ensure you turn your neck and not your torso, it’s a good idea to move the program you’re on to the other screen every so often to keep balanced.

2. If you tend to use one a lot more than the other then pick a main monitor and set this one up directly in front of you as if you only had one, treat the other as a secondary and set it up of to one side but close enough so you can see it by turning your neck slightly.

Proper technique: typing, mousing, and writing

There are three keys to proper typing technique.

1. Keep your wrists straight: the straighter your wrists, the less strain you put on the tendons and nerves that run through your wrist. A split keyboard may aid you in keeping your wrists straight.

2. Let your hands float: This means don't rest your wrists on the desk, keyboard, or a wrist rest when you are typing. Let them hover over the keys. This has three advantages: (i) You allow the big muscles in your back to share some of the work; (ii) It allows you to keep your wrists straight, which is impossible if they're planted on a wrist rest; (iii) It's easier to reach the hard-to-reach keys (next item).

3. Don't strain your fingers: When you need to press a hard-to-reach key, like CTRL, SHIFT, BACKSPACE, etc., don't stretch out your pinky. Instead, move your whole hand and use your index or middle finger to press the key. Don't use one hand when you need to hit two keys simultaneously, e.g. CTRL-X, SHIFT-Y. Think before you type: unnecessary retyping/editing can add up. Use a light touch when typing: don't pound the keys.

What is RSI and are you at risk

At most risk are those who:

• Have poor posture

• Have poor technique

• Use a computer more than two to four hours a day

• Have a job that requires constant computer use, especially heavy input

• Don't take frequent breaks

• Are loose-jointed

• Don't exercise regularly

• Work in a high-pressure environment

• Have arthritis, diabetes, or another serious medical condition

• Keep your fingernails long

• Have an unhealthy, stressful, or sedentary lifestyle

• Weigh more than you should

• Don't sleep well

Those most at risk from RSI are those whose work involves small repetitive movements. For example, using a mouse or keyboard. Try and think what you would feel like if you painted a ceiling all day, you would be switching arms and taking constant breaks as it would be tiring and your arms and back, this is because it’s not a normal position for us to stand in. This is also true of sitting at a computer and clicking a mouse all day. Sure you are only using your fingers to click a mouse but you are using muscles to do it, it just feels easy because you’re sat down.

Things that can put you at risk of RSI include:

• repetitive activities

• doing a high-intensity activity for a long time without rest

• poor posture or activities that require you to work in an awkward position

Cold temperatures and vibrating equipment are also thought to increase the risk of getting RSI and can make the symptoms worse. Stress can also be a contributing factor.

RSI is most commonly caused by a repeated action carried out on a daily basis. A variety of jobs can lead to RSI, such as working at an assembly line, at a supermarket checkout or typing at a computer.

It is important that your working environment, for example your desk space, is laid out so that you can work comfortably. Your employer is under a legal duty to try to prevent work-related RSI and ensure that anyone who already has the condition does not get any worse.

Identifying a strain

My strain started with my little finger in right hand becoming a bit numb down the outside, it wasn’t like the ache you get in your wrist from using a raised mouse mat pad or a sharp stabbing pain, it was more like a tingling down the side.

The symptoms initially can be quite mild twinges with a bit of numbness or tingling like mine. However as the condition develops the pain increases until it is with you for 24 hours, leading to weeks on end of pain and disability, reality sets in, usually confirmed by doctor’s diagnosis.

In time you can start to feel it everywhere, your neck, you back, even your legs and feet.

If you have a pain that isn’t going awaygo to your gp immediately.It’s possible your pain could relate to the following types of RSI.

• Carpal tunnel syndrome (a relatively common condition that causes a tingling sensation, numbness and sometimes pain in the hand, fingers and or arms.)

• De Quervain Tenosynovitis (a painful condition affecting the tendons on the thumb side of your wrist.)

• Shoulders aches

• Back and Neck aches

• Strained eyes leading to migraines

How RSI is treated

The first step in treating RSI is usually to identify and modify the task or activity that is causing the symptoms. If necessary, you may need to stop doing the activity altogether.

To relieve symptoms, your GP may advise taking a course of anti-inflammatory painkillers (such as aspirin oribuprofen), or using a heat or cold pack, elastic support or splint.

You may also be referred to a physiotherapist for advice on posture and how to strengthen or relax your muscles. Some people find that other types of therapy help to relieve symptoms, including massage,yogaandosteopathy.

RSI can be divided into two types. Type I is when the pain is the result of a specific medical condition, such ascarpal tunnel syndromeortennis elbow. Type II is when no specific cause can be found and is often referred to as non-specific upper limb pain.

What to do if you have RSI

If you have a pain that isn’t going awaygo to your gp immediately and inform your employer.If you leave it, it will get so bad you won’t be able to stroke a kitten without noticing it.

What is required by your employer

NDP is obliged to provide you with everything you need to carry out your work with the minimum risk possible. Correct chairs, keyboards and also information about RSI. NDP will also monitor your strain after it’s been reported and it’s likely they will ask for updates as your treatment progresses.

What is required by you

• Maintain fit and healthy enough to be able to work at a computer for 8h a day

• Be responsible with your time and don’t overwork.

• Request any extra equipment you may need.

• Notify your employer regarding any pain you suspect to be a strain.

• Schedule in any appointments as soon as possible to help deal with studio timings.

• Keep your employer informed on and treatment, improvements or regressions

List of people to see

I have been usingSix Physiofor anything I have needed to do

• Massage - Jackie or Gary (Senior) - Six Physio (~£50/ph)

• Desk assessment - Rebecca - Six Physio (£95)

• Yoga places - I got toYoga HavenThey have places all over london. AlsoSohot yoga is good for Bikram. AlsoThe Shalain South London has great Yoga.

• Pilates - Laura at Six Physio is great and just round the corner. Also your gym will have pilates classes.

*Info credits: Six Physio and NHS online.

Exercises