It hurts so bad

Like other victims of repetitive stress injury, I was in agony while typing, but still I tapped out posts to an e-mail list of fellow miracle cure-seekers.

Published February 29, 2000 5:00PM (EST)

I had just started wearing an attractive pair of beige velcro splints on my forearms to combat repetitive strain injury (RSI) when I learned of the ironic existence of Sorehand, an e-mail discussion list on which typing victims type out tales of typing-induced misery.

I was new to the world of "cumulative trauma disorder," an umbrella term for a condition where muscles and tendons in the upper body -- the neck, shoulders, chest, arms, wrists and hands -- can become strained, irritated or pinched. And like many keyboard junkies diagnosed with RSI, my doctor said my traumatized limbs also showed signs of early carpal tunnel, a constriction of the nerve as it passes through the wrist.

As an online news reporter, my title could just as easily have been "thinking typist." I was terrified that the excruciating pain in my shoulders and wrists would end my career, not to mention my life; sometimes I couldn't even use a fork without a jolt of agony ricocheting up my arm.

But no one seemed to have a solution. My employer, like thousands of Net companies, handed out photocopied line drawings of rigidly proper typing postures that would help us avoid RSI -- but once I had it, they didn't have much advice. Doctors suggested everything from massage to glucosamine sulfate, a seashell derivative sometimes used to treat arthritis, to crying more (release the tension, you know) -- none of which soothed the stabbing pain. Soon, I was taking time off work, learning voice recognition software and asking strangers to open my Odwalla bottles to avoid the wrist pain.

Around 1.8 million workers each year experience musculoskeletal disorders, according to the Labor Department's Occupational Safety and Health Administration (OSHA); but those numbers are from 1997, eons ago in Internet time. And the category includes a ton of back problems, says Gary Orr, ergonomist at OSHA. Orr counted 250,000 cases of "repeated trauma," which includes the sound and vibration-induced. Of that there are 90,000 cases that involved time off from work. Carpal tunnel sucks away the most workdays -- 25 on average -- even more than amputations and fractures. The government doesn't have great records on how many of those injuries are related to computer use; many employers don't report the cause of injury or even the occupation of the injured worker, says Orr.

But OSHA is getting more serious about RSI. In November it proposed a national ergonomic standard -- basically a guideline for properly aligning workstations to workers -- that it says will each year spare 300,000 workers from injuries and save the U.S. economy $9 billion. OSHA is receiving public comments on the standard until Thursday.

This is music to the ears of the folks on Sorehand, many of whom not only commiserate about pain management, but are actively working to increase awareness of RSI. Since the summer of 1998, a group of about 100 people who originally met on Sorehand have been preparing for this Tuesday: International RSI Awareness Day. Under the slogan "Because work shouldn't hurt!" organizers in cities stretching from Brazil to Canada and from Spain to New Zealand chose Feb. 29 -- the only nonregular day of the year -- to speak to local legislators and hold panel discussions and press conferences about RSI.

"It began with a desire to increase awareness about this injury," says International RSI Awareness Day chairwoman Catherine Fenech, who runs an RSI support group in Toronto and describes herself as an "injured worker activist." She got tendinitis working on a cash register that was too high for her and now has a permanent disability. "I want to keep people from making the same mistakes I made," she says.

I didn't turn to Sorehand for activism, but for comfort and, of course, that miracle cure that had to be out there. On the list I found 800 people from around the world who have been conversing since 1994 about possible remedies. About a dozen people a day post suggestions and questions: Would a foot mouse solve the problem? What about rolfing? Or arnica gel under the tongue? Giving up driving?

But between the hopeful healing aids and worker's comp advice, there are disquieting posts about lost jobs, two-pencil typing, multiple failed surgeries, toxic levels of supposedly helpful herbal supplements and people who can't even comb their hair. It terrified me. Would this be my future?

A Sorehand member, who asked not to be identified, recalls a four-month period in which he "worked 10- to 12-hour days for six and seven days per week" learning a software product for which he was writing technical training materials. "The stress was intense," he says, and enough to bring on a life-changing repetitive strain injury. "I don't work in technology at all anymore," he says now. He limits his time online to less than an hour a day and uses the phone instead of e-mail whenever he can. "I received retraining in sales," he adds. "I'm looking for a job in the ergonomics and workplace wellness industry."

Deanna McHugh, a programmer at the University of California at San Francisco who maintains the list, somehow remains upbeat. Even though there is a steady stream of newcomers detailing their deteriorating conditions, she says, "Every time there's a success story on list, I get hope."

Reading through the posts, it's clear that not all repetitive strain injuries and carpal tunnel cases are caused by computer use; a wide range of assembly-line workers, cashiers, stock clerks, cooks and teachers are affected. Injuries can even be caused by sports, playing instruments or recreational Net surfing, says Dr. Robert Markison, a hand surgeon and RSI guru at the University of California at San Francisco. "Greater than 61 percent of work-related injuries appear to be upper limb strain. A high percentage of that -- we don't know how high -- is from computing," says Markison. "[But] not all of it is work-related strain. People have made nonessential computing a growing part of their life with the Internet."

Markison thinks the more recent surge in RSI and carpal tunnel cases is at least "partly brought on by our undue fascination with the computer interface ... We are the blind consumers of ill-fitting goods," he says. Today's visual-centric computers require a head-forward user position, which Markison says might be OK for a pig -- but humans aren't built to handle that posture for extended periods of time. He argues that designers of everything from PCs to PDAs to cell phones should have to study human anatomy, and that just as clothes come in different sizes, and glasses come in different prescriptions, technology devices should be fitted by body type.

But while Markison points a finger at product designers, some folks on Sorehand point right back at Markison's medical community. Fenech, the RSI support group leader, says even when she was diagnosed with tendinitis, her doctor didn't explain that it could take years to heal, so she thought it was fine to work part-time. "I thought you had to be completely disabled to get workman's comp," she says.

Like a lot of my injured comrades, I found that my doctors weren't sure what to do. My pain had spread from my shoulders and neck down to my fingertips, while doctors prescribed all the usual treatments: physical therapy, anti-inflammatory drugs, acupuncture, massage, meditation and voice recognition software. I kept a "pain diary," recording the stabs and twinges between visits to the doctor, but no patterns emerged. (Some days when I didn't type I hurt more than on days when I did.) Then I took three months off my job as a Web site reporter.

Eventually, I stopped reading the Sorehand posts -- they were just depressing me more. I figured, like many suffering this malady, that I should renegotiate my relationship with technology. Do I have to e-mail when I can call? Do I need to work 10-hour days? Am I ever really too busy to take a two-minute break? Maybe, I thought, what we need is a cultural shift.

Neurologist Frank R. Wilson, author of "The Hand: How Its Use Shapes the Brain, Language, and Human Culture," says he visited a workplace where designers use computer-aided design (CAD) systems and were experiencing RSI problems. "They were young, talented, educated, motivated, healthy and physically active, vigilant and self-critical, etc. What was wrong?" he wrote via e-mail. "My answer: eaten up by the machine; complete loss of autonomy. They weren't artists and designers any more; as far as the company was concerned, they were computer operators. Death."

According to OSHA, fewer than 30 percent of general industry employers have effective ergonomics programs in place. The new standard proposed by the Clinton administration in November would make employers more responsible for ergonomics and training, but nothing will become final before the end of the year.

Will proper ergonomics prevent injuries like mine? "People get injured on ergonomically correct instruments all the time," says Dennis Ettare, a biofeedback practitioner at Biofeedback Associates of California, who eventually set me on the path to recovery. Ettare and others criticize typing alternatives like voice recognition software or a foot mouse, which he says can become just another device that triggers pain, and even cause repetitive strain-like symptoms in the voice or feet.

Ettare, who has treated patients from almost every major Silicon Valley company, thinks that ergonomics are only a sliver of the problem. He says that the speed of computers and the demands of the workplace are as responsible for many people's chronic pain as bad posture.

"We are overwhelmed by multitasking and the fact that we are now the slowest link among our tools," he says. Once you hit "enter," most computers are ready for more. There is almost no processing time between tasks, and that is something that can be "misinterpreted by the brain," says Ettare. "It assumes the worker is in danger" and the sympathetic nervous system starts firing impulses into their muscle spindles telling the diligent worker's body to get away, while they remain desk-bound.

I had heard about Ettare from other RSI sufferers at several dot-com parties, and thought I should give him a try. I sat in a chair in his office as he strapped a fanny pack around my waist that burst with wires leading to electrodes; these he attached to my neck, shoulders, arms, hands and back. I felt like a character out of a bad cyberpunk novel as the fanny pack transmitted signals to a computer, which showed live graphs of the amount of tension in my muscles. Of course, my tension level was off the charts.

Using his "muscle learning therapy," a technique based on biofeedback, he retrained me to sit, type, write and walk using only those muscles necessary to do the job. I started feeling better and soon I posted my own hopeful pain reliever to Sorehand -- but no one responded. Ettare was undoubtedly lost in the heap of remedies.

Deborah Quilter, author of the "Repetitive Strain Injury Recovery Book," cautioned that she has seen patients like me get better temporarily, but "as time goes on, more and more things start going wrong ... I'm not sure there's a universal method that will work for everybody."

I've left my keyboard-pounding job for part-time work, while I heal and incorporate Ettare's method into my work. And I'm careful: I never type more than half the day. I wear a bag around my waist instead of my shoulder. I hired a housecleaner and stopped cooking. And, of course, I still swap tips with RSI veterans, about difficulties shaking hands, opening jars or masturbating -- after all, what activity requires more wrist action? And though I'm slowly getting better, I certainly haven't found a miracle transformation back to full-time, pain-free typing.

Mine is a largely open-ended story -- and one that is undoubtedly similar to many that Fenech and the organizers of International RSI Awareness Day will broadcast around the world on Tuesday. It's crazy to think of all these pained typists e-mailing plans back and forth -- but maybe their efforts will educate a few people and perhaps even spare some from RSI.

"I wish that someone had told me [what I was risking], when I was 12 years old and sprawled across an overstuffed chair, typing on a too-small keyboard for hours on end," says another RSI victim wanting anonymity. She had hand surgery on both her wrists last year. "I make it a point, now, to educate people I see with bad typing habits. I honestly hope that someday soon, the study of proper ergonomics is included in middle school and high school health curricula; I'm nearly positive, and my doctor agrees, that it was the bad habits reinforced over so many years that caused such a terrible case of RSI so early in life."

By Jennifer Sullivan

Jennifer Sullivan is a consultant to the Electronic Frontier Foundation, a freelance writer and co-editor of Posemodern.

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