WASHINGTON, DC, December 16 -- The U.S. Department of Labor recently proposed regulations that would require many employers to provide equipment designed to prevent repetitive stress injuries. Such injuries currently account for something like 40% of all Workers' Compensation insurance claims. The regulations, if adopted, would be enforced by the Occupational Safety and Health Administration (OSHA).
The most common repetitive stress injury is carpal tunnel syndrome (CTS), which has become an epidemic among office/information workers in recent years. CTS probably needs no introduction to most computer users -- it's the wrist pain and numbness that result from median nerve compression. I've had recurring wrist problems myself, as a result of the fact that I've spent my entire career (14 years and counting) sitting at a keyboard all day.
I'd be the first to agree that something needs to be done about the problem. However, I'm not sure that government regulation -- such as that proposed by the Department of Labor -- is the answer.
It happened all of a sudden -- within about three days, the pain became so severe that I could barely type.
The problem is that repetitive stress injuries come in many types, from many causes. What's more, what fixes the problem for one person doesn't necessarily fix the same problem for another.
Would you like some cheese with that whine?
Back in the summer of 1992, I was working part-time doing e-mail customer support for a company that published several on-line information database products. My job involved answering support "whines" from users who were having trouble getting what they wanted from the databases. Typically, this meant answering some 50-60 e-mails a day -- not a full-time job, but one that kept me busy three or four hours a day.
Shortly after I started the customer-support gig, I got a call from a small software company that needed a contract technical writer to produce a couple of manuals. I interviewed, they liked me, and they offered me a reasonable hourly rate -- so I signed up. Like most software companies, they had a pretty tight development schedule, which meant that I had to do a lot of writing in a short time.
Having two jobs at once meant that I was working a lot -- around 60 hours a week. This was OK with me, because it meant I was making a lot of cash. However, after a couple of months of the heavy workload, I started to have some pain in my hands and wrists.
It happened all of a sudden. Within about three days after I first started noticing it, the pain became so severe that I could barely type -- I had to take a break every 15 minutes or so, and rest my hands until they felt better. Obviously, I wasn't going to be able to keep doing both jobs unless I found a remedy.
I wasn't inclined to drop either job. If there's one thing a consultant simply has to be, it's reliable; a consultant who starts a job and drops it before it's finished isn't going to stay in business very long. And as for the customer-support, it was (and still is) a good gig -- work at home, flexible hours, decent pay, easy job. Not something I wanted to give up.
I went to see my internist, who took a look at my hands and wrists, bent them in various directions, and diagnosed me with carpal tunnel syndrome. He was all set to send me to a surgeon, but I said, "Let's try something more conservative first -- if that doesn't work, I'll go under the knife, but let's not do that unless we have to."
No magic bullet
My doctor put me on prescription-strength ibuprofen and had me get a couple of wrist braces from the drugstore. And I started doing my own research, to try to find out what others with the same problem had done.
I quickly discovered that many types of work can cause carpal tunnel syndrome. The most widely publicized is, of course, computer work -- but meatpackers have a high incidence of similar injuries, as do musicians, dentists and their assistants, and even sign-language interpreters. (Often, "terps" like to work in pairs, so that one of them can "sign" while the other rests.) Two guys on my bowling team are sufferers -- one of them installs and repairs carpet; the other is a driver and tends to position his hands on the bottom of the steering wheel for long periods.
Anyhow, so in the summer of '92, I started to have some hand/wrist pain. After seeing my doctor and talking to a lot of people (mostly on-line, which of course involved typing -- but I managed), I started making adjustments, both in my desk/keyboard setup and in my work habits.
For awhile, I had to slow down my typing speed enormously. I'm normally a fast typist, but I found that typing fast made the pain much worse. If I typed one character at a time -- not beginning each keystroke until the previous one was complete and my finger had released the key -- the pain subsided. I also found that a rubber wrist pad, placed in front of the keyboard, helped a lot. Some people had suggested that upper body and leg posture was also important -- sitting upright with their feet flat on the floor was helpful.
Over the next few weeks and months, my wrists improved a lot. I was able to keep both jobs, because typing no longer caused as much pain. However, the problem never went away entirely. Several months later, I began to have a lot of pain again.
(Incidentally, I've found that heavy use of a conventional mouse -- the kind you drag around, with a cable attached to it -- really does a number on my wrists. Oddly enough, my symptoms have always been bilateral -- when I have pain in one hand or wrist, I always have the same pain in the other. How the mouse could cause pain in both wrists is something I don't quite understand -- but that's what I've experienced. At home, I use a touchpad or, on Meg's machine, a trackball. I find these devices easier on the wrists than a regular mouse. When I'm working at a client site and have to use a drag-around mouse, I switch hands with it every couple of weeks or so. This also seems to help)
I went to see a neurologist at Massachusetts General Hospital, who'd been recommended by a musician friend the doctor had treated for tendinitis. This guy took a look at my arms and back, and informed me that he felt the problem was largely a result of the large muscles in my back being too weak. He explained that without enough support from the large muscles, I ended up putting too much weight on my hands, wrists, and lower arms.
If you mandate changes in the design of keyboards, desks, and so on, you may end up helping some people while hurting others.
The neurologist recommended making several changes in my computer setup, to improve the ergonomics. He had me lay my keyboard flat on the desk, instead of having it tilted toward me. He suggested getting an adjustable office chair -- I got one that lets me move the seat, back rest, and arms up and down. He also had me raise my monitor, so I'm looking straight ahead instead of down.
And he sent me to a physical therapist, who prescribed several exercises to strengthen my shoulders and back. After doing the exercises for several months, I noticed a considerable improvement.
However, I still have some wrist pain from time to time. What that says to me is that there isn't one particular "cure" for a repetitive-stress injury -- the wrist braces, ergonomic adjustments, exercises, and what-have-you are all elements that help reduce the strain on my wrists, but there is no single step that "fixes" the problem. Probably the most important adjustment I've made is simply to be aware of the problem, and to take a break whenever my wrists tell me they need one.
That's why I'm not sure government regulations are appropriate -- or that they'll do much to solve the repetitive-stress-injury problem.
In talking to people who've wrestled with carpal tunnel problems, I found that there is no single remedy that works for everyone. In particular, the more drastic medical treatments tend to have decidedly mixed results. A lot of people who have surgery to relieve pressure on the median nerve (which is what causes the numbness and pain characteristic of CTS) find that the condition recurs after a few years -- especially if they haven't done enough to change the work habits, motions, or postures that caused the problem in the first place.
Another remedy, the injection of steroids into the wrists, is so unreliable that I rejected it out of hand (despite the fact that my internist suggested it as an alternative to surgery). First of all, it tends to cause a lot of pain initially. After that, pain and swelling subside, but they often reappear in a few months -- again, because the sufferer often fails to change the conditions that led to the initial injury.
Try this -- it'll fix you right up!
A recent Computerworld editorial lauded the Department of Labor's proposed regulations, stating that "[B]usinesses will find the cost of lost productivity, unfilled jobs, workers' compensation and mounting medical bills a lot more punitive than the cost of underwriting preventative [sic] measures. That comes to about $150 per year per workstation that's fixed, according to the Labor Department."
I'm a little skeptical that $150 per worker is going to "fix" anything. Because the same problem applies to ergonomics as to treatment methods -- what works for one person often doesn't work for another. For instance, I've heard doctors say that the keyboard-front wrist pad should not be used to rest the wrists while typing, because putting weight on the wrists actually increases nerve compression. The rests should only be used for taking short breaks from typing, say the "experts."
That may be true for some people, but I've found the wrist rest a lifesaver -- if I type more than a few minutes without it, my wrists hurt. On the other hand, some of the adjustments I've made, such as raising the height of my monitor, don't work for some people. I've heard of people having good results by doing just the opposite -- positioning the monitor so it's flat, at keyboard height, so that the user is looking down at the monitor. (I find it hard to imagine that being comfortable, but it was for the person who recommended it.)
Government-mandated equipment standards may be counterproductive -- if you legislate changes in the design of keyboards, desks, mice, monitors, and so on, you may end up helping some people while hurting others.
There's another factor that further clouds the issue: genetics. Some people, as far as I can tell, seem pre-disposed to get repetitive-stress injuries like CTS, while others don't, no matter how un-ergonomic their computing setups. Here again, a heavy-handed government ergo-mandate would be barking up the wrong tree -- because you'd be wasting a lot of money on ergonomic equipment for people unlikely to have problems in the first place. (And that's assuming you could establish standards for ergonomic equipment design, which I've just argued you can't, because what works for me might not work for you.)
Instead of thinking we can fix the problem by mandating certain equipment designs, it might make more sense simply to increase people's awareness of the hazards of continuous fast typing. As long as people know what the issues are, they can make up their own minds about what kinds of equipment they want to use -- most companies I've worked for, over the past 5-6 years or so, are already doing a pretty good job of offering different kinds of equipment to people who ask for them. At my last client site, they had a guy I called "Ergo Man," who used to go around knocking on people's doors, looking over their computing setups, and suggesting improvements. I think Ergo Man singlehandedly accomplished a lot more than any set of standards handed down from Washington could possibly do.
There are certain business practices that might be better targets for government standards. Keystroke counting (where temp workers are forced to crank out a certain number of keystrokes per hour or risk losing their jobs) is a good example. In my case, fast typing was what caused the problem in the first place.
As I say, though, repetitive-stress injuries have many causes and many remedies -- and there's no magic bullet. The most important thing is simply to be aware that it can happen. Don't type for too long without taking a break. When you start feeling pain or fatigue, take a break. It's mostly common sense.
Copyright © 1999 John J. Kafalas