Could your injured neck be a result of performing routine work without any decision making capabilities or a fear of being replaced by computers? How about that shoulder injury? Is pressure on the job mounting? Does an increase in workload coupled with uncertainty about your future make your elbows hurt? Maybe your hands and wrist hurt because you lack supervisor support. It sounds strange that these upper body repetitive strain injuries may be linked to performance at work, job uncertainty and pressure. However, according to Moon and Sauter’s 1996 book, Beyond Biomechanics: Psychosocial Aspects of Muscoskeletal Disorders in Office Work, repetitive strain injuries or RSI (also known as cumulative trauma disorder or CTD), may be the result of a combination of physical factors as well as psychosocial factors at play.
A RSI is caused by repetitive movements coupled with poor posture that can lead to muscle fatigue and damage. A RSI, closely resembling tendinitis, is marked by pain, numbness and muscle weakness and can lead to pain or injury of any compensating structures. For example, pain lifting your arm to the side and over your head may begin as a muscular injury to the deltoid muscle but because of abnormal recruitment of other muscles to compensate for deltoid weakness and pain, other muscles of the shoulder and beyond may experience overuse or misuse and suffer injury as well.
RSI risk factors can be separated into physical factors and psychosocial factors. First the physical risk factors are separated by intrinsic and extrinsic factors. Joint hypermobility or the ability for a joint to exceed range of motion limitations is an intrinsic risk factor. Lack of exercise and increased muscle tension are other intrinsic risk factors to developing a RSI. Not to be discounted from this list of factors is poor posture and body movements. Specifically non-neutral postures of the wrist, arm and neck! According to Jens Wahstrom’s review of Ergonomics, musculoskeletal disorders and computer work [Occupational Medicine 2005; 55:168-176], sitting at work for the vast majority of working time is correlated with neck pain. Shoulder flexion and abduction, the same posture we exhibit while gripping a computer mouse and typing at a keyboard, have been found to be “associated with muscoskeletal symptoms of the neck and upper limbs”. While gripping a computer mouse and placing the wrist in an abnormally deviated position is considered a non-neutral postural risk factor for disorders of the hand and wrist.
Extrinsic risk factors include the type of work environment, repetition of movements, rapid movement of the neck and shoulders while performing job duties as well as the polar opposite lack of movement of the neck and shoulder while performing job duties. Such at risk occupations include computer operators and telephone operators or employees who spend a great deal of their work day with their arms in a continuous raised manner like assembly line workers. The risk is greater for older employees who are already suffering or experiencing tendon degeneration.
Lastly, there are psychosocial risk factors at play in the occurrence of a RSI. Among them are job satisfaction and dissatisfaction, individual or personal drive and work ethic. When employees suffer a lack of support from both peers and superiors or feel like that they are always being closely watched and monitored by “Big Brother”, they have a tendency to experience mental stress which may be a factor in the development of musculoskeletal disorders and symptoms. Therefore it has been hypothesized by Mr. Wahstrom, that the demands of office work, powerlessness of position or decreased decision latitude, and managerial and peer support are “different elements in the work system thought to affect psychosocial factors” of RSI risk.
Regardless of whether RSI is real or in your head or both, there are things that everyday workers can do to treat RSI. It has been suggested that rest and maintained strength and flexibility combined with a gradual return to work is the best treatment with a recommendation of a massage therapy, physical therapy, and occupational therapy regimen. (Rattray). Several preventative measures can also be undertaken. Employees should assess work station ergonomics. It has been suggested that a lower computer screen is better than a higher screen. Standing rather than sitting may be helpful. In fact according to a recent CNN report, many companies are not only installing standing work stations for those who ask and are in need but are also setting up treadmills for employees to use while performing mundane tasks such as answering emails. Once you get past the image of a hamster in a wheel visual, you can recognize the benefits of being able to move while on the job. Varying work tasks and working postures paired with shorter durations have been scientifically proven to improve RSI conditions (Rattray). Another preventative measure to decrease risk of developing a RSI to the neck and shoulders is to support the forearms and wrists while working at the computer. One last thing, for all of you supervisors out there, a little support and patience goes a long way to decreasing risk factors. Remember a happy employee is a healthy employee is a productive employee.
Kip Yates, LMT was trained at the Swedish Institute in New York City and is New York State and Texas State licensed. He is owner and operator of Massage Refresh in New York City where he provides Swedish wellness and recuperative Deep Tissue massage that encompasses myofascial release and trigger point therapy. Kip lives in Brooklyn with his wife and three children and also practices at Physiofitness Physical Therapy in Soho.