Repetitive stress injuries a continuing concern

Work-related repetitive stress injuries (RSI) are the most widespread occupational health hazard facing North America today. Nearly two million workers suffer work-related musculoskeletal disorders every year, and about 600,000 lose time from work as a result.

RSI: What is it?

Repetitive stress injuries, also known as repetitive strain injuries or musculoskeletal injuries (MSD), refers to work-related soft-tissue disorders that occur with increasing frequency in workers engaged in jobs involving static postures and repetitive motion (using the body’s smaller muscle groups for fine motor control activities like keyboarding, mousing, writing, scanning groceries, grasping tools or objects).

Discomfort in the low back often occurs as a result of such activities, as well as in industries where larger muscle groups are used in more strenuous activities, such as repetitive lifting or twisting.

Often patients will present to doctors or other health care providers with localized symptoms which may involve any body part from the neck, shoulders, upper back and upper limb extending all the way down to the fingertips.

The vast majority of cases involve a more extensive area than the presenting symptoms would suggest. A careful examination of both arms, shoulders, upper back and neck often reveals bands of muscle tightness, restricted range of motion and tenderness. There may also be weakness, hypersensitivity, poor circulation and puffiness of the overlying skin.

Poor posture has often developed by the time a worker with RSI is symptomatic. Since so many areas are often affected by these injuries, symptoms can actually move around depending on the activity pattern of the individual. This can be disconcerting to both the patient and the physician if the original extent of the injury was not adequately assessed.

When filling out workers’ compensation forms, a family physician should report all affected areas that are found on examination. This kind of comprehensive, detailed assessment is often neglected because of the pace and workload of a busy family practice office.

Magnitude of the problem

The U.S. Department of Labour’s Occupational Safety and Health Administration (OSHA) estimates that MSDs (the U. S. term for RSI) affects 1.8 million workers in that country, accounting for one-third of the most serious on-the-job injuries. The estimated direct costs in the U.S. are $15 to $20 billion (U.S.) per year; when indirect costs are included, the total increases to $45 to $54 billion.

Repetitive motion injuries result in more lost work days than other injuries. It takes longer for workers to recover from carpal tunnel injuries (one type of RSI) than from fractures or amputations.

OSHA estimates that $1 of every $3 spent on compensation costs is related to improper ergonomics. The agency’s Web site reports that one company introduced ergonomic footrests and adjustable-height tables and replaced chairs, reducing compensation costs from $96,000 to $4,500, while increasing employee satisfaction and production. Another company reduced workers’ compensation costs from $514,000 in 1991 to $176,000 in 1997 by instituting a program of educational seminars.

The injuries

Our bodies are designed to make thousands of different movements each day. People with sedentary jobs are doing thousands of repetitions of essentially similar movements each day. We need to think of sedentary workers as elite athletes — doing something very remarkable with their bodies. Like all athletes, they need to condition and train for the activity.

Training for repetitive activities involves working in a proper ergonomic position, and proper work habits. Examples include:

•taking frequent short breaks;

•stretching adequately;

•recognizing the early signs of injuries to muscles; and

•knowing how to take preventative action.

By the time people present to the doctor they are already injured and require treatment.

Most often the first time an injured worker presents to the doctor with a complaint, he or she will get a diagnosis that focuses on the area that hurts and the background of the injury and its connection to other body parts goes unacknowledged.

The most common response is to prescribe an anti-inflammatory drug. Unfortunately, these drugs are of only minimal benefit for symptom relief of chronic injuries, and do not address the underlying defect.

The most effective treatment is by a team of therapists with an understanding of chronic muscle injury and a multidisciplinary, comprehensive approach that could include assessment and correction of posture, muscle tightness, muscle compensation patterns, muscle imbalances and weakness. Very often the current model of rehabilitation dictates a schedule for recovery that is more appropriate to acute injury rather than chronically derived injuries in people who routinely perform tasks that cause a repetitive injury. This model puts people into strengthening programs before they are ready and often aggravates the original injuries.

Often people with RSI are very conscientious workers who have ignored early signs of injury because they had work to get done. But an ounce of prevention is truly worth a pound of cure, because the costs associated with injuries rises with the severity of the injury.

Heather Tick is director of the RSI Clinic in Toronto. For more information visit www.rsiclinic.com.

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