"Pain Blocker" by Barbara Galuszka-Parsons
	Mouse Mauls Man! A dose of education is the best medicine to prevent injury at the hands of your workstation. Here are insights into an age old but growing problem, repetitive strain injury. By Jonathan Luskin

	I live in fear of pain from the most ordinary things: Car doors, large drinking glasses, exuberant handshakes, and my neighbor’s twelve pound cat, which begs to leap into my arms for a rough massage that would light my wrists on fire. Fear of even my toys - my violin, surfboard, bicycle, and skis - now lying under a three year film of dust. Three years of denial, depression, anger, and ultimately, acceptance and a vast reordering of my life. I write these words by voice, one-word-at-a-time, enunciated with a lifeless precision that only a computer could love. This works well enough, but I wouldn't do it if I didn't have to. Ironically, it was a computer that caused the crippling pain in my wrists and forearms, and it is a computer that now gives me the freedom to write painlessly.
	A name for every pain `Repetitive strain injury' is the general name for a huge variety of muscle, tendon and nerve disorders. I have a repetitive strain injury (RSI) known as tenosynovitis. This is quite different from the much-publicized carpal tunnel syndrome, but derived from the same root causes - computer work that involved high repetition, forceful and awkward postures, and insufficient rest. Most symptoms of RSI are invisible, which can lead to confusion and conflict between managers, insurance agents and the injured. A correct diagnosis is essential for proper treatment, and that, in my experience, requires a specialist in repetitive strain injuries. Why the sudden epidemic? RSI was first described by an Italian physician more than two hundred years ago. Over the last decade, the number of RSI related work injuries has increased tenfold to 300,000 annually. Although not all of these injuries are related to computing, the proportion is growing, and this estimate is widely regarded as understated. Many factors are to blame for the sudden increase in injuries, including a rise in service industry and high-tech jobs, an aging workforce, decline in the general health of the population, greater overall stress, the replacement of typewriters with computers, high typing speeds and fewer breaks, and the mass use of computers by people who previously didn't type at all. The complex causes and the prevention of RSI are topics of ongoing research at major hospitals. In addition to the human toll, the dollar impact of this epidemic is huge. Medical treatment for a single case of carpal tunnel syndrome can total about $29,000. The true cost to business is many times that, given the ripple effect of having to replace and train new workers. Preventing injury The good news is that most injuries can be prevented and at low cost. Prevention pays for itself through lower medical, insurance and sick pay expenses, maintaining the health of older, more skilled employees, and higher employee morale and productivity. Monkey in a suit As the name suggests, a primary cause of RSI is repetition. Although your computer keyboard may appear harmless, striking even a small plastic key a thousand times each day is hazardous. The human body evolved a few million years ago, apparently optimized for strolling about the African savanna, picking berries, munching insects, and fleeing from the occasional predator. This is utterly different from crouching over a flickering monitor and banging on a keyboard for many hours a day. Some workers, however, ignore their pain and maintain their automobiles better than their bodies. When they are injured, they assume doctors can heal them as easily as mechanics heal cars. Your body needs respect, rest, and maintenance. It can't be contorted into a limitlessly pliable machine interface. RSI injuries often take a very long time to heal - some are permanent. Couch potatoes Sufficient exercise is a strong deterrent to RSI. Exercise allows muscles to stretch and work more efficiently. It also improves blood circulation, which supplies soft tissue with essential nutrients and removes waste products. I have found regular exercise to be more effective than any antiinflammatory drug. One caveat: Hitting a punching bag at the gym on your lunch break is probably not wise. Find a sport that won't add to the stress on your limbs. Stretching muscles and tendons is prescribed by many physical therapists - the medical professionals who spend the most hands-on time with RSI patients. See the listed resources to learn safe stretches designed specifically for computer users. Many can be performed without leaving your workstation. A drink, a smoke, and a cup of joe Many of the legal drugs we use to get us through the working day are aggravating factors in RSI. Alcohol causes dehydration, which exacerbates soft tissue injury. It also interferes with sleep. Caffeine allows us to work longer hours without fatigue, straining our limbs beyond safety. It is also a diuretic; that's a good thing if it means you take more frequent rest breaks to visit the bathroom and a bad thing if you don't replenish the fluids in your body by drinking water. Nicotine interferes with blood circulation, necessary to remove waste products from the bloodstream. Smoking also replaces oxygen, needed by your muscles, with carbon monoxide. Free will or fate? Your own genetic heritage may predispose you for RSI. Both obesity and extreme slenderness are associated with higher risk for injury. Women are more susceptible to RSI than men. This may be due, in part, to the higher proportion of women doing repetitive tasks. Women, however, have smaller muscles with which to do the heavy keyboard work. Pregnant women are particularly at risk for carpal tunnel syndrome. Patients with cool hands heal more slowly, which may indicate poor circulation. I wear elbow length, fingerless, wool gloves to keep my wrists toasty warm. Ergonomics, the Holy Grail? A poorly designed workstation can cause injury. Poor design, however is not the only culprit - repetitive work itself is hazardous. Without redesigning your work and health habits, you remain at risk. Even the best ergonomic furniture in the world won’t prevent injury if you don't know you use it. Some manufacturers promote ergonomic products that are useless or even dangerous. Consult the books listed in the reference section, a local ergonomics expert, or a qualified physician, when buying furniture for your workstation. Keyboards, mice, and other vermin The human body is nonlinear and comes in many shapes and sizes. Computer interfaces which lack adjustments and do not account for the body's natural curves are therefore inherently suspect. Standard keyboards force your wrists into three unnatural positions: pronation (rotation of the palms to face downward at the keyboard), extension (tilting the wrists upward to reach the keyboard), and ulnar deviation (rotating the wrists outward to face the keys). A wide variety of new designs address these problems through splitting the keyboard in the middle, wrist pads, and numerous adjustments for proper height and position. Mice, trackballs, tablets, touchpads, and other pointing devices pose their own special problems. Often they are placed off to one side of the keyboard, forcing an awkward extension of the arm and twist of the spine to reach them. Graphic artists and others who spend the majority of their computer time drawing and clicking should place their pointing hardware close to their bodies, centered, and down low. An adjustable keyboard tray, large enough to accommodate both the keyboard and a pointing device, allows the shoulders to remain relaxed and pointing without excessive reaching. Some users prefer pointing devices that do not require pronation. I often use a small touchpad, strapped with Velcro to the side of my thigh. The art of sitting The human body did not evolve to sit in a chair, which is the source of many injuries, particularly in the back and neck. A proper chair for intensive computer use must adjust to support your body. The seat pan should adjust both in height, to allow your feet to rest flat on the floor, and in tilt, to allow your pelvis to rotate forward and your spine to straighten. The backrest should tilt forward and backward to allow different working positions and adjust vertically to fit the lumbar support to your lower spine. Armrests must not prevent you from rolling your chair close to your keyboard and monitor. Some doctors believe that while you type, your arms and wrists should not rest on anything, including armrests, the edge of your desk, or even wrist rests. See the chapters on chairs in the Pascarelli and Sellers books listed under resources for a more compete discussion of chair design and adjustment. The standard office desk, without modification, is minimally functional for computing. Most desks are designed for writing and are too high for typing. They also lack sufficient depth to accommodate a large monitor without placing it at an angle, forcing you to twist your spine to face the computer. A keyboard tray, monitor stand, and ergonomic chair can assist in overcoming these limitations. Many ergonomic solutions are as simple and inexpensive as using a telephone book to raise your monitor or buying a separate lumbar support pad for your existing chair. Software soreness Software ergonomics is often overlooked. Software macros and "hot" keys can reduce the strain on your limbs. New software should be designed and evaluated to minimize strain. All about you Ultimately, only you are responsible for your own safety. Prevention is the only sure cure for RSI. The best RSI prevention plan for your workplace is one that emphasizes personal awareness and education as well as ergonomics, is developed in partnership with your employer, and is implemented without delay. Resources to Learn More About RSI