What is RSI?

Repetitive Strain Injury (RSI) is a potentially debilitating condition resulting from overusing the hands to perform a repetitive task, such as typing, writing, or clicking a mouse. Anyone who uses a computer regularly is at risk and should know about RSI. Unfortunately, most people are uninformed and do not understand what RSI is or how serious it can be. This webpage is intended to educate computer users about RSI, and to provide useful suggestions for prevention and treatment. The page also contains a few specific pieces of advice for students.

This webpage was written and is maintained by Clay Scott. I have formatted the site as a single page in order to minimize clicking, and so that you can easily print the page if you prefer. You may feel free to contact me if you have questions that I might be able to answer. I have been living with RSI since 1997, so you will find a sympathetic ear with me.

In simple medical terms, repetitive strain injury (RSI) is defined as a cumulative trauma disorder (CTD) stemming from prolonged repetitive, forceful, or awkward hand movements. The result is damage to muscles, tendons, and nerves of the neck, shoulder, forearm, and hand, which can cause pain, weakness, numbness, or impairment of motor control.

You may wonder how seemingly innocuous activities such as typing and clicking a mouse button could possibly be harmful. Fine hand movements, repeated hour after hour, day after day, thousands upon thousands of times, eventually strain the muscles and tendons of the forearms, wrists, and fingers, causing microscopic tears. Injured muscles tend to contract, decreasing the range of motion necessary for stress free work. The sheaths that cover delicate tendons run out of lubrication because they aren't given time to rest, so tendon and sheath chafe, resulting in pain. Due to this abrasion, tendons become inflamed, and begin to pinch neighboring nerves. This can result in numbness, tingling, or hypersensitivity to touch. Unless this cycle is interrupted, it repeats itself over and over, and a long-term, chronic problem results.

Repetitive strain injury can affect more than just your hands and wrists. Poor posture can lead to severe neck and back injuries. Staring at a computer screen can lead to eye strain. Repetitive reaching for a mouse can lead to arm and neck strain as well as spinal asymmetry.

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.

Who is at risk?

The three primary risk factors are poor posture, poor technique, and overuse. These topics are discussed in depth in the section on prevention. In addition to these, there are several other risk factors to be aware of. While they may not cause RSI on their own, they can increase your risk if you already possess one of the three primary risk factors. The following list (adapted from Pascarelli and Quilter) lists several risk factors. You may be at risk for developing an RSI if you:

• 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
• Are shy, and afraid to ask for better accommodations
• Are macho, and don't believe you are at risk when you really are

Consult Pascarelli and Quilter for further information.

What are the symptoms of RSI?

The primary warning sign of RSI is pain in the upper extremities (fingers, palms, wrists, forearms, shoulders). The pain may be burning, aching, or shooting. It could be local (e.g., fingertips) or diffuse (e.g., the entire forearm). The pain will typically be increased after a long session of computer use. Keep in mind, however, you can have severe RSI without experiencing pain. The following checklist (adapted from Pascarelli and Quilter), can help you determine whether you have RSI:

Do you experience:

• Fatigue or lack of endurance?
• Weakness in the hands or forearms?
• Tingling, numbness, or loss of sensation?
• Heaviness: Do your hands feel like dead weight?
• Clumsiness: Do you keep dropping things?
• Lack of strength in your hands? Is it harder to open jars? Cut vegetables?
• Lack of control or coordination?
• Chronically cold hands?
• Heightened awareness? Just being slightly more aware of a body part can be a clue that something is wrong.
• Hypersensitivity?
• Frequent self-massage (subconsciously)?
• Sympathy pains? Do your hands hurt when someone else talks about their hand pain?

In addition to these symptoms, RSI can also lead to behavioral changes. You may not even be aware of these changes. For example, do you:

• Avoid using the injured hand?
• Use your nondominant hand more frequently?
• Use your forearm, feet, or shoulder to open doors?
• Avoid wearing or buying certain kinds of clothing because it is too difficult to put them on?
• Change shopping habits because you can't carry as much as he wants could?
• Keep dropping things?
• Find you can't chop food?
• Not play sports you once enjoyed?
• Have trouble hooking bras or putting on jewelry?
• Not wear bracelets because your wrists are tender?
• Have trouble with keys or brushing teeth?
• Feel overly protective of your hands?

Repercusions of RSI

If you develop RSI, and do not take steps to correct the problem, there may be serious repercussions. When my RSI was at its worst, I was unable to open doors, prepare my own food, do laundry, drive, write, type, and shake hands. This lasted for half a year. I was unable to type regularly for about three years. Many RSI sufferers complain of similar problems. In addition to limiting your day-to-day functionality, this decreased independence can cause a significant emotional burden.

RSI can limit your ability to perform at work. Recent Supreme Court rulings do not view RSI as a disability, and hence, RSI is not covered under the Americans With Disabilities Act. (Apparently typing is not a "major life activity," according to a recent opinion authored by Sandra Day O'Connor, for those whose job requires significant amounts of typing.) Therefore your employer may fire you if you are unable to perform your job because of your RSI. The prospect of changing (radically, in many cases) your profession is obviously a daunting thought. For students, most Universities are willing to make accommodations, but lost productivity due to RSI could still delay your graduation one or two years. And once you graduate, your next employer may not be as accomidating.

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