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Repetitive Strain Injury, RSI, results when repeated physical movement inflames or damages tendons, nerves, or muscles. One of the main causes is computer work. The sitting position stresses the neck, shoulders, and back, and the tiredness leads to a lower productivity. And then there's headaches and sight problems.

Current advice is to get up every twenty minutes or so and move around - even if it's just to the photocopier. Take a lunch break. Sit with your eyes opposite the centre of the screen. Avoid coloured fonts or small font sizes that make you lean forward to read. If you can't work hands-free with speech recognition software, make sure the keyboard is just below your elbow level. And get an adjustable chair.

The following notes are based on comments from a wide range of sources. We plainly cannot check everything to make sure it is correct.

Alternative keyboards have not had a long design history. Although they have been widely advertised, there has been almost no research to show that they prevent or cure RSI, and not one manufacturer says that they will guarantee that the product involves no risk. In fact many ergonomic keyboards carry a warning sticker.

Some claim a slight reduction in pain, but often the whole workplace layout was changed, along with the keyboard, so productivity and injury reduction claims are hard to quantify.

RSI appears to have other causes than just prolonged typing. It is not clear why some people get it in their mid-twenties whilst others never suffer. It may be that work stress, the sitting position, commitment, enthusiasm, long hours, and independence, are all contributory factors.

A recent TUC survey suggested that backstrain and upper limb disorders are a hidden epidemic and employers generally do little to understand RSI, provide treatment, or make future work safer. RSI and backstrain cost about 10 000 000 days off work every year and, although the burden falls on individuals, it has been estimated that the cost to business and industry is around £2 billion a year. The survey highlighted other factors:

only 17% of businesses had assessed the cost impact of backstrain injuries
only 11% of businesses had assessed the cost impact of RSI
only 22% provided any sort of treatment or rehabilitation
RSI is increasing faster in North West England

Recent research shows that non-specific forearm pain (NSAP) sufferers have reduced nerve activity in the wrist, particularly in the carpal tunnel where nerves can become compressed.

In the US, during four legal cases against IBM, no scientific evidence could be produced to prove that normal keyboards cause RSI, temporarily halting the thousands of pending claims.

In the UK, the recent successful claim by miners who developed 'white knuckle' may result in a different perception of workplace injuries.

In January 1996, there was also a successful RSI claim, one that may set a precedent, resulting in a record damages payment of £82 000 to a typist. She was classed as 30% disabled.

More recently, £175 000 (reduced to £155 000 on appeal) was awarded to cover loss of earnings and loss of future earnings.

The Inland Revenue and the Public Services, Taxation, and Commerce Union now have a compensation scheme. The agreement was signed after high-profile actions by sufferers were lost, largely because of conflicting medical evidence. It ensures that future RSI cases will be settled without expensive court action.

In the US, the OSHA failed in its attempt to draft a standard to help prevent RSI in the workplace, something the UK might have mirrored, so, at the moment, its up to you.

In the UK, the Health and Safety Executive now lists work-related upper limb disorders as the main health problem associated with using computers.

Boots The Chemists recently agreed to an out-of-court settlement with packers represented by the Union of Shop, Distributive, and Allied Workers. However, Boots did not accept liability.

Bowater Scott was sued by a worker through the Graphical Paper and Media Union. After a four day case she was awarded damages, although the company denied that her RSI was caused by work. The union said the company did nothing to assess her work environment, making the condition worse.

To summarise, the TUC General Secretary said 'The time for excuses is over. We are left with a legacy of wasted years when RSI sufferers were negelected and ignored. Cases should now be settled urgently, with fair levels of compensation and proper rehabilitation. Employers have to realise that the emphasis must shift from compensation to prevention.'

RSI, in one form or another, accounted for more than half of workers' compensation claims in the US last year, costing around $20 billion.

Chronic tendinitis may be eased by using an ergonomic keyboard but, because other changes such as including breaks, doing hand and arm exercises, adjusting the sitting position, reducing the work load, and sometimes taking anti-inflammatory drugs, were implemented, individual case histories may not be typical.

Most people over-grip the mouse, so there should be some relief in using the palm of the hand to roll a much larger trackerball. However, with a mouse or a trackerball, users can develop an asymmetric posture, causing muscle imbalance, joint stresses, and ligament problems. The arm leverage on the shoulder, the extended arm, the wrist angle, and the finger pressure, all add to the risk of injury.

Sitting posture is usually poor. Watching visitors to this office shows how easily the spine curves, the shoulders fall, the wrist angle is incorrect, the eyes get nearer the sreen, and the neck and shoulders become tense.
Piano stools adjust to ensure the correct wrist placement, a luxury missing from many office chairs. However, musicians still get RSI.

Computer monitors are usually too low, causing a forward posture which is often held for hours and hours. Many could easily by 300mm higher and angled to face the user.

Journalists, one of the highest risks groups, are often unwilling to talk about the adoption of alternative technologies in case their employers consider them to be less able than before.

The Chartered Society of Physiotherapy has warned that RSI sufferers should not assume that it is their fault, or their employer's, or blame the keyboard. The human body is very complex and trying to find out why it suddenly goes wrong can take some time, and professional experience.

For many users, voice recognition software has proved a solution. However, although most things can be done by voice, our own experience shows that some tasks are very fiddlesome and, if you can use a trackerball as well, many become very much easier.

No matter what you choose to believe, RSI is a very real cause of suffering that lasts for years, maybe for ever. If you are an employee you should talk to your Health and Safety Officer, or an RSI support group, the moment your hands or arms feel uncomfortable.

Litigation generally requires a medical diagnosis, proof of causation, and evidence of employer negligence. The Disability Discrimination Act has proved invaluable, but requires medical evidence that RSI has seriously affected everyday activities. If you feel you have been discriminated against, you have three months to initiate a claim.

Copyright and Permission: Talking Technologies 2002

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