There are aches that do not go away easily. Most often, people affected by a crick in the neck, a bad back or painful wrists, do not recognize these as symptoms of repetitive stress injury (RSI), the causative factors for which are embedded in a person’s profession or vocation.
Medical practitioners are now finding that those affected by RSI come from diverse backgrounds that include computer professionals, musicians, sportsmen, journalists and even dentists and surgeons.
What is RSI?
“When there is physical stress of a similar kind and repeatedly at the same area, it leads to RSI,” says V.B. Bhasin, honorary senior consultant at the department of orthopaedics, Maulana Azad Medical College, New Delhi. Dr Bhasin says cases of such disorders are largely unreported in India. Typically, RSI manifests itself in a pattern based on the patient’s profession. “A golfer could have RSI in the shoulder region. Other sportspersons could have foot related RSI, while IT (information technology) professionals and call centre employees typically suffer from a consistent pain in the neck, back or wrist,” says Dr Bhasin.
Who are most affected?
Computer-dependent professions exhibit the highest incidence of RSI. In an ongoing study on musculoskeletal disorders among computer professionals in India being conducted by RECOUP—Neuro Musculoskeletal Rehabilitation Centre based in Bangalore, more than three-fourths of the 35,000 persons surveyed showed symptoms of RSI. The areas affected most commonly include the neck, upper back, lower back and the upper extremity, says Deepak Sharan, medical director, RECOUP. A fifth of such patients also suffers from constant pain and numbness.
Also, unlike in the West, where RSI is usually an illness affecting middle-aged women with chronic health disorders, people affected here are mostly healthy men (with an average age of 27). Therefore, patients tend to be lulled into believing their symptoms are not serious. This has made RSI a progressive disorder that most Indians first hear of only after being severely afflicted by it, sometimes several months after losing their jobs because of it. The RECOUP study has identified 80 young people who are unable to independently bathe, dress, drive, open doors or even hold a cup of tea, due to Complex Regional Pain Syndrome, a condition that is the result of inadequately managed RSI. RECOUP started out on the systematic study of RSI in 2001 after the centre had an influx of six-year-olds who were all referred to it for bad handwriting. “We realized all of them had a similar problem of being unable to grip a pencil,” says Dr Sharan.
Further investigations pointed to RSI that was the result of unsupervised use of gadgets such as video game consoles, television remote and mobile phones. “Once these children were treated, I found a lot of referrals from parents and relatives of these children, most of whom happened to be IT professionals,” says Dr Sharan.
Since then RECOUP has set up six rehabilitation centres in Bangalore and one each in Hyderabad, Pune and New Delhi where over half of the patients treated are from the IT sector and have been injured within one year of taking on a computer-dependent job.
Typically, 30 out of 100 such patients seek specialized help after they have been misdiagnosed with ailments such as spondylitis, slipped disc, arthritis or stress.
“Any pain or discomfort while working is potentially serious and expert help must be sought as soon as possible, preferably at an on-site RSI clinic,” says Dr Sharan, adding that RSI injuries have to be treated in conjunction with modifications to workplace ergonomics.
What an employer could do
In developed markets in the West, every $1 invested in an effective ergonomics programme has provided a return on investment of $1, according to industry watchers. Employers who are cognizant of the potential loss in productivity from work-related RSI are ensuring that employees have facilities to alleviate the problem.
At Oracle India, a comprehensive ergonomic facility was set up for employees two years ago. “While there is no specific profile of employees affected by RSI, we look at proactively resolving any potential health hazard that an employee could face,” says Allen Matthew, vice-president, human resources (HR), Oracle India. Ergonomic facilities at Oracle include consultation and physiotherapy.
In addition, all offices are equipped with high-back chairs with adjustable elbow rests and seats for full back and elbow support. “Our HR practices are designed to help sensitize our employees about the possibility of RSI, right from the time they join us,” says Matthew.
Oracle India also works in tandem with RECOUP to provide employees non-surgical interventions to arrest problems associated with RSI.
Central to effective RSI prevention is workplace assessments for employees based on individual specifications.
RECOUP sends its workplace assessment personnel to more than 70 companies across the country. Once a patient’s work environment is evaluated, suitable changes are recommended to prevent further injury.
At Sterling Commerce, an AT&T company, the 540 employees across its two centres in Bangalore have fitness sessions orchestrated by an RSI consultant right within their work areas. Groups of 15–20 employees are encouraged to stretch, bend and tweak their muscles in short breaks from work. The full ergonomic package at Sterling Commerce includes both physiotherapy sessions as well as work station assessment. “Before we began offering a full ergonomic package, we would have employees who had to take a couple of weeks off due to RSI-related issues. The severity of the symptoms has reduced since then,” says Nisha Gopinath, senior manager, human resources, Sterling Commerce.
High incidence in India
It is also the long working hours at Indian workplaces that is a major causative factor for RSI, according to medical specialists. “Indians work 60-80 hours a week...while it is also a six-day week for most” compared with a five-day week in the West, says Dr Bhasin. The problem is exacerbated due to insufficient breaks from repetitive tasks, he adds.
Typically, an effective RSI programme is aimed at getting the affected muscles to relax, and mobilizing neighbouring muscles and joints to create room for the nerves and blood vessels to pass through unhindered. Then the postural muscles are strengthened so that they do not fall back to compress the nerves and blood vessels. “When the RSI programme is properly structured, complete recovery is possible,” says Dr Sharan.
• Burning sensation
• Skin discolouration
•Constant need to stretch or massage one’s arms
TIPS TO PREVENT RSI
• If you work on a laptop regularly, use an external keyboard and mouse, placed just above the lap level. Also use a laptop stand or place the computer or laptop on books so that the screen is at eye level
• Keep both the keyboard and the mouse above lap level. The elbow should be tucked close to body and should make an angle of around 100 degrees. You could use a tray
• Lower the armrests to thigh level and do not rest the elbow on it while typing. If that is not possible, throw the armrests away
• Sit with the back supported on the chair’s backrest with the thighs sloping down slightly so that the hips are higher than the knees
• Keep the wrist unsupported while typing and don’t use gel pads
• Keep the chin tucked in so that the ears, shoulders, elbows and hips meet an imaginary straight line
Deepak Sharan conducting a test on a Sterling Commerce employee.
Exercise sessions at the Sterling Commerce office in Bangalore.
A physiotherapist shows an employee correct arm positions and posture.
Photographs by Hemant Mishra / Mint
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