Repetitive Strain Injury:
The Saga Continues

by Thomas Caldwell

This makes fatal diseases simpler for a Japanese doctor to deal with than conditions that are merely crippling. For want of a better description: dying is easier than lingering. Crippling conditions don't get the same media splash as something that kills you, but they can prove to be much more heartbreaking and horrible.

The condition known as Repetitive Strain Injury (RSI) is an acquired workplace disease that could eventually bring the Information Age to a screeching halt but not before ruining the lives of millions in the process. RSI is brought on by performing the same task over and over again, day in and day out, under conditions your body finds unnatural. A common cause is typing at a computer keyboard under poor ergonomic conditions.

RSI isn't just a nuisance, although that's how it starts: Over time, RSI can lead to irreparable damage of muscles and bones. Some people who develop the condition eventually find themselves crippled for life. In particularly severe cases, suffers of RSI can no longer perform such simple tasks as driving a car, twisting a doorknob to open a door, or even picking up a sheet of paper without enduring terrible pain.

A history of RSI
Early symptoms of typing-related RSI include muscular pain, neck and arm disorders, and in the more severe cases mental fatigue and nervousness. Indeed, according to Japanese specialists in the field, the mental effects of the illness can be the most difficult to cure.

The condition first began to be diagnosed in Japan in 1960s, not only in data entry-related workers, such as typists and keypunch operators, but among people in a wide range of occupations. Cases of diagnosed RSI in Japan actually started to decrease about 1975, right after the first Oil Shock. Some experts suggest that this was due to less work being done by office staff after the blow to the economy brought on by the Arab oil embargo.

Throughout the 1960s and early 1970s, clerical workers commonly spent eight or more hours per day in front of a keyboard. Immediately after the Oil Shock, keyboard usage was said to average only two to three hours a day. Because of this, actual cases of advanced RSI decreased at least officially. RSI isn't new, even if the name is. Reports of the condition date back to 1700s, when craftsmen and artisans performed the same tasks hundreds of times a day. But with the massive increase of computer usage, the number of reported cases of RSI has been growing worldwide in recent years.

Repetitive Strain Injury has now become one of the top work-related injuries in the industrialized world. The current boom in using the Internet, and personal computer usage general, is apparently leading to the condition become a major health problem in Japan again.

RSI: A foreign import?
According to medical experts in Japan that I have been in touch with over the past couple of years, the best defense Japanese workers had against RSI was, believe it or not, the typical Japanese office. Here's why: The traditional Japanese office was, in most cases, a very messy and unorganized place. Papers were stacked everywhere, along with books, magazines, newspapers, and files scattered to and fro. This environment required Japanese workers to work in a non-repetitive manner. True, it often took forever to get anything done, but the workflow was inconsistent, and thus friendly to the human body's way of doing things.

Unfortunately, the boom of the '80s brought many foreign business practices to Japan. Among them was the increasing use of US-style office layouts and productivity goals. Japanese clerical workers began to be pushed to achieve higher and higher levels of productivity, just like their American counterparts. One result is an increased number of RSI cases.

But before you head off and start messing up your work space and buying old-style furniture, don't forget that pig pen-like offices can also contribute to the problem. The gray steel desks, uncomfortable chairs, poor lighting, and cramped working conditions common in Japan are also part of the problem. (On a side note, recently some experts have begun blaming the noise that comes from the fan on a PC's power supply as contributing to a lack of concentration on the part of office workers.) The best way to avoid developing RSI is to work inconsistently at least when it comes to using your PC.

The usual prescription for treating the advanced stage of the condition is to stay away from a keyboard for a period of several months. But this may not be possible, or even effective, for everybody. In addition to people who operate computers to earn there living, laboratory technicians, sign language interpreters, and even kindergarten teachers (who can develop back-related RSI because they spend much of their day bent over small children) are being diagnosed with the condition.

RSI in Japan
Few Japanese sufferers are willing to discuss their condition with others, in part due to fear of being edged out of their jobs. Since I began my study of the disease two years ago, I have been contacted by many people suffering from various stages of RSI. Most have said the fear of losing their jobs or their careers in the cases of writers, journalists, and computer programmers has forced them to suffer silently with the condition.

The focus of my previous story on RSI, a lady who wished only to be identified as Junko, is better. To recap, she is a former employee of a very large Japanese company. Her job required her to sit in front of a computer daily and key in information for long hours, often into the night.

One day, Junko felt a sudden twinge in her arm that, she says, felt like a jolt of electricity. At first, she thought nothing of it. But over the next several days, the pain gradually became more and more intense. Junko found it increasingly difficult to move her fingers and arms, and after several weeks she could not use her hands without feeling pain. She eventually found it difficult to sleep because of the constant ache.

Junko sought medical attention, and was advised to do some sort of other work in the office. Unfortunately, her employers were unsympathetic.

Although she had been good at her job, Junko was now branded as "lazy" and "childish" by her manager and coworkers. Eventually, she had no choice but to quit.

Today, after two years of treatment which consisted of a combination of therapy and a great deal of rest Junko is doing very well in her new career. She is still careful when if comes to using keyboards, and she spends as little time in front of a computer as she can get away with. Unfortunately, no everyone gets off so lucky.

It doesn't take much to find RSI-related horror stories, especially in the information business. Japanese universities, which abuse their faculty members mentally and physically perhaps more than any other educational system on the planet, have many cases of people developing chronic RSI.

Unlike in the private sector, where legal ramifications dictate making some effort to take care of your workers, academics in Japan have no such protection. Japanese professors tend to run their departments much the way daimyo once ran their fiefdoms. One usually doesn't usually have to produce anything of intellectual or scientific value in Japan's higher learning institutes just play the politics right. And being politically correct means not complaining or making any trouble for the powers that be. This draconian attitude that those who are further down the ladder should suffer becomes more horrible when the use of computers in concerned.

Gathering accurate statistics on RSI among computer users in Japan has proven illusive, mostly due to the fact that office workers are classified as "white collar," an area of the workforce that is virtually free of labor unions or any other organization that monitors working conditions. In Japan, the age old problem still continues: unless it is on paper, it isn't official and therefore doesn't exist.

What to do?
If you or someone you know is developing the symptoms mentioned of RSI, the first thing you must do is come to the immediate realization that your health, both physical and mental, is in danger. RSI does not just "go away" if you ignore it.

There are many, many exercises and training systems available to limit RSI dangers and alleviate the symptoms. However, the very best treatment I have discovered is not music to the ears of the computer industry: it is "just say no!" Internet or not, do not take up housekeeping in front of your computer.

Here are three simple steps you should follow:
First, strictly limit the amount of time you or your employees work in front of a computer without a break. Twenty minutes at a sitting is a good average a little more or less depending on the individual. If your place of work does not think this is a good idea, seriously consider finding another job. No amount of money is worth being crippled for.

Second, the furniture you use while parked in front of a terminal should be of the very best quality and design. Price is always a consideration but I have never heard people argue that commercial aircraft were too-well built. The principle is the same.One very important thing to keep in mind is that better furniture does not mean you should spend longer in front of the computer. Although some of the experts may claim otherwise, you must limit your time in front of the keyboard.

Third, exercise. There are many exercise programs available on the market. Some you can buy in book form, others are programs taught to companies by a professional consultant. Again, although many of these methods are effective, one must continue to limit time in front of a PC.

An old IBM mainframe expert once told me that the sign of a well-run computer system was when you saw nobody in front of a terminal. There is a limit to the amount of time any human should sit in front of a computer and use a keyboard and mouse, and the industry has now come to realize it. Almost all computers purchased these days have disclaimers advising the user against "prolonged use" so that the manufacturer does not fall victim to a liability claim. But, like the tobacco companies are now finding out, this might not be good enough. Repetitive Strain Injury is a ticking bomb, and unless it starts being taken very seriously we'll be back to quill pens in no time.

The opinions and advice expressed are those of the author and do not necessarily represent the views of Computing Japan or LINC Media, nor should they be construed as medical advice. Consult a physician, or speak about your concerns to your supervisor, if you suspect you may be developing symptoms of Repetitive Strain Injury.

For more information on RSI and CTD (cumulative trauma disorder), and links to other RSI-related sites, a good starting point is the "Typing Injury FAQ" at http://www.cs.princeton.edu/~dwallach/tifaq/general.html.