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Dangerous Work - Repetitive Strain Injury at MIT

By Thomas R. Karlo
Contributing Editor

It can start with a stiff feeling in your fingers, or maybe a loss of strength in one hand. Subtle as they may be, these symptoms often signal the onset of a serious medical problem. If ignored, that problem can eventually lead to loss of the ability to type, or even of use of a hand at all. The subtle progression from a chronic ache to a serious permanent injury is only one of the factors that make repetitive strain injuries such a danger at MIT.

"The first thing I noticed was kind of a tingling; it didn't really hurt me. It was like my hands were falling asleep," recalled Catherine G. Preston G, a senior studying urban studies and planning. She first experienced RSI in the spring of her junior year.

The problem subsided temporarily over the summer, but in the fall, "the number of pages I had to write in a term increased significantly," Preston said. "It started out bad and only got worse," she said. She finally sought help in the winter of 1994 after watching a presentation about RSI given to MITnet employees.

Holly L. Grabowski '97, an electrical engineering and computer science major, had a similar introduction to RSI. "My wrists had gotten tired before," she said, but it didn't get really troublesome until Independent Activities Period, when she worked 12-hour days at an Undergraduate Research Opportunities Program project and another job. "My wrists got really bad, and I just felt like I should leave."

The next day, Grabowski found herself unable to type, her fingers numb. She made a doctor's appointment and waited a week for her visit. "Every day I'd try to check my e-mail and I would feel pain my hands felt so weak," she said.

The problem became critical for Grabowski this spring while she was doing work for a software design class required of EECS majors. She spent 15 hours a day programming and writing documentation for the project. "About nine hours before the problem set was due, I couldn't type any more," Grabowski said.

Experiencing pain, she e-mailed her teaching assistant. "I've done my coding," she wrote. "I've just got some documentation left to do, I'm going to hand it in late, and if I get penalized, fine, I can't type any more right now."

RSI is a major problem at MIT

RSIis most commonly associated with prolonged work at computer keyboards, but it is a risk for anyone who performs highly repetitive manual tasks. Both musicians and athletes fall prey to RSI, as do people who work with vibrating machinery like sewing machines and power tools, said David V. Diamond, the medical department physician who sees most of MIT's RSI patients.

RSI is a class of injuries to the muscles, tendons, and nerves that result from chronic overuse or misuse. Repetitive actions, especially small rapid movements like typing, poor working posture, strenuous movements, and working without taking regular breaks all contribute to the problem.

Unlike many injuries, RSI builds up slowly over time as thousands of tiny microtraumas that wear away gradually at the body. "I think it poses a major - probably the major - risk to students' health," Diamond said.

"I've seen several hundred people in the last few years; students, staff, faculty - [people] who use computers in large amounts," Diamond said. "In terms of injuries, there's nothing else that comes close to what these computers are doing to people at MIT."

The stress RSI puts on students differs from other injuries because it directly interferes with the most common of tasks, like writing and typing. "It was really scary, especially because I'm kind of a workaholic," Grabowski explained. "It's driving me crazy to be near computers and not be able to type. Even now, after resting a few weeks, just typing a few keys really sets it off."

"They tell you type slower, take more breaks' and you think I can't, I have to get this done, I have to do it this fast," Preston said. "I don't want to type slower. If anything, I want to type faster, because I'm thinking even faster. When you've gone to doing all your work by typing as you think, it just feels like there's this wall in front of you; you can't do the think you want to do. It's extremely frustrating."

Computer users most often experience RSI in the arms, wrists, and hands, which bear most of the stress of typing on a keyboard. Other people, like architecture students building models in studio, are more likely to stress their upper arms, shoulders and neck. Damage to the back from poor posture or lack of support is also a significant problem, Diamond said.

RSI is of particular concern to students in majors that depend heavily on computer use. An extremely serious case of RSI can even set back a career. "I'm in computer science; this is my life," Grabowski said. "I have so much typing to do here I am in pain, and the implications aren't just for this term."

Bad cases of RSI have forced a handful of employees and graduate students to leave MIT, Diamond said. "I don't know of any other condition that has led to more people having to modify their careers than this," he said.

Taking pain killers or working through minor pain might seem like an acceptable way to deal with the aches many people see as simply part of long-term computer work. But ignoring the warning signs of RSI can lead to serious - and sometime irreparable - damage. "People tend to type until it hurts, and then they take a break. But by the time it hurts, the damage is done," Diamond said.

Prevention's the best defense

Although many products on the market promise to end RSIproblems, Diamond recommends examining work habits first. Pacing computer work is especially important, and something MIT students often neglect.

"You want to [take a] break before the damage is done, otherwise the damage comes back quicker and easier. So we recommend a short microbreak of a minute or so every fifteen minutes, and a minibreak every hour of a few minutes," Diamond said.

Diamond also recommended getting up from the computer and stretching for awhile every few hours, to allow the muscles and tendons to restore circulation and relieve pressure on nerves.

In a June 1994 memorandum, the ad hoc Task Group on RSI recommended that people spend no longer than six hours per day working at a computer, particularly if that work involves steady typing. The guidelines also recommended taking five-minute breaks every 40 minutes or so.

While a six-hour max may seem unrealistic given students' regular work habits, it does provide a realistic goal and a good benchmark beyond which people should be especially mindful of the risk of RSI, Diamond said.

Changing work habits is not easy, especially when people are under deadline pressure, Diamond said.

But it can be crucial. "The problem comes in for workaholics who work like crazy and feel guilty for taking a break," Grabowski said. "Some people really have that mentality. People really need to not feel guilty for taking time off from typing if their wrists are tired. Or telling a professor that they really have a problem, they need to protect their wrists, and have another day on an assignment. But people are afraid to do that."

Grabowski recommends against taking two programming courses at once so as to reduce exposure to stress from the strenuous coding and debugging those courses often demand.

End-of-term pressure can be especially dangerous, Diamond said. "People crashing into their thesis or writing a paper have a combination of psychological stress, physical stress, and lack of sleep, which tends to really flare," RSI, he said.

While prevention is the best way to avoid RSI, early attention to symptoms makes for an able second line of defense.

"If you think you're having problems, don't wait until you're sure [before you] seek out help, because it does take a couple weeks to see anyone at the Medical Center who deals with RSI," Preston said. "You want to look into it if you think there's a chance you have a problem, before you get to the point where you can't do anything."

Bad desk design contribute to RSI

Although conclusions aren't yet clear, work by doctors and other safety personnel suggests that an ergonomic work environment is very important in preventing . Adjusting a work station to help prevent RSI means more than simply adding a wrist rest in front of the keyboard.

Some Athena cluster workstations sit on adjustable work tables, but there are not enough of these especially towards the end of the term when cluster usage rises.

"The first thing is positioning yourself and your computer, mouse, and possibly telephone in a way to minimize angle and force, and to give good support," Diamond said. "Most people tend to have their keyboard a little too high, have their monitor off-center their mouse way out of reach. These contribute to the problem."

Although students have more control over the configuration of the setup in their dormitory room, they also start with a somewhat poorer set of equipment there. The standard dormitory desks are writing desks, generally too high for computer work as well as too narrow to allow proper monitor placement.

The standard-issue chairs are poor by ergonometric standards as well; they don't let students adjust the height or angle of the chair's back.

Following the completion of renovations this summer, Senior House will become the first dormitory with modern desks that better accommodate computer use. The desks were chosen after discussions between MIT, the architects behind the renovations, and Senior House residents.

"At least half the students have their own computers," explained Jagruti S. Patel '97, one of the students on the committee. "The current desks are very narrow. We explained how we need wider desks to accommodate 17-inch monitors," Patel said. Monitors of that size are fast becoming the industry standard.

MIT also consulted the student group about the problem of RSI, and as a result the new tables will also have keyboard trays designed to allow students to place their keyboard at a better height.

Although Senior House will be receiving ergonomic furniture, no upgrade is in the works for other campus dormitories, according to Carl A. Seagren, general manager of budgets and accounting in the housing office.

"I hadn't thought about it. We replace a certain amount of furniture in dormitories every year. That is something we should take into consideration," Seagren said.

The issue is further complicated by the individual structure of each dormitory. "Baker House has built-in furniture, and that's all being done over in the original," Seagren said. Also, with a working life of 15 to 20 years, the replacement cycle for the solid wood desks is extremely slow, he said.

Still, Seagren said he intends to examine the problem in the near future. "I would like to get some guidelines. We would like to put a program in place over time," he said.

Proper typing, exercise important

But furniture shouldn't be students' only concern. Diamond also suggests students be aware of typing technique, and even warns that the amount of exercise a person gets can be important to avoiding strain injuries while typing.

"Some people have typing techniques that are very awkward and very stressful to the hands,"he said. "They tend to plant the palms and move the fingers, which causes compression of nerves and weakening or straining of tendons. People hit the keys hard, thinking they're going to type faster."

Typing with wrists held approximately one-half inch above the wrist rest and moving the entire hand rather than stretching across, helps reduce this damage, Diamond said.

For its part, aerobic exercise helps blood circulation generally; good circulation can mean improved recovery time in the arms. "Weight lifting is not helpful," Diamond said. "Particularly in the symptomatic phase, it will tend to stress the tendons that need to rest."

Resources help injured students

Students injured so badly that they can no longer type or carry out tasks necessary for their schoolwork, are referred to Disability Services Coordinator Barbara A. Roberts. Roberts arranges the reconfiguration of computer setups and provides scribes and typists to students unable to write or type. Usually, students are referred to Roberts either by their doctor or academic advisor.

A major goal in helping someone recover from RSI is reducing stress on the affected area by avoiding painful tasks. For people who get RSI from typing, this means dictating to a typist assigned by Roberts. This arrangement allows students to keep pace with classes and continue their academic work with as little interruption as possible.

Other forms of assistance students can get include having extended-length examinations arranged for students unable to write at a normal pace. An additional resource available is the Access Technologies for Information and Computing Laboratory, where students can test-drive new ergonomic hardware.

Although having a typist allows students to return to doing basic computer work like word processing and e-mail, it is at best an awkward solution for those doing more complex work such as programming.

"It takes between two and five times as long to do my work through someone else," Grabowski said. "Coding through someone else, debugging through someone else - they don't know what I'm thinking. It's really, really hard and I can't be as productive as someone else in those areas."

Moreover, lecturers and teaching assistants can at times lack an understanding of the serious nature of this problem, especially because RSI often disables a student without the easily visible symptoms of some other handicaps.

Grabowski recently had a problem while working on a group project for her programming class. Following an oral presentation on her project, she left early to head to a class while the rest of her group continued to discuss the project with their TA. After she left, the TA asked her group if they felt she was pulling her weight despite "her wrist thing."

"That upset me so much," Grabowski recalled, "because I'm doing everything I can, and have been pulling my weight by doing everything possible not involving typing in the project and doing as much typing as I can through a typist."

"I'm trying hard and it really upset me that he did that," Grabowski said. "Maybe they're not as understanding as they could be."

Even with all the tips and resources available to students and staff, the problem of RSI is not about to disappear; if anything, it is growing as computer use on campus increases.

RSI "is an endemic problem," Diamond said. "Most of the people here are at risk. In some ways, MIT is not unique, but [here] it's right on the cutting edge."