Dr. Deepak Sharan repetitive strain injuries
 
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Definition of RSI

  • In the last decade, hundreds of thousands of otherwise healthy individuals have developed a painful, debilitating and sometimes disabling condition known as Repetitive Strain Injury (RSI).

  • RSI is a multifactorial complaints syndrome affecting the neck, upper back, shoulder, upper and lower arm, elbow, wrist or hand, or a combination of these areas, which leads either to impairment or to participation problems. The syndrome is characterized by disturbance in the balance between load and physical capacity, preceded by activities that involve repeated movements or prolonged periods spent with one or more of the relevant body parts in a fixed position as one of the presumed etiological factors. (Health Council of the Netherlands, The Hague, 2000: Publication No. 2000/22E, p. 18).

  • RSI is a diffuse disorder of muscle, fascia, tendon and/or neurovascular structures. Some sources include disorders of the lower back and lower extremeties in the definition of RSI.

  • RSI is also known as Work Related Musculoskeletal Disorder (WRMSD), Cumulative Trauma Disorder (CTD), Computer Related Injury (CRI), Work Related Upper Limb Disorder (WRULD), and Occupational Overuse Syndrome (OOS).

High Risk Groups

  • Computer Users
  • Musicians
  • Health Professionals: Surgeons, Dentists, Nurses, Massage Therapists
  • Laboratory workers
  • Teachers
  • Manual Labourers, Assembly Line Workers
  • Check out clerks
  • Hairdressers
  • Butchers
  • Sportspersons
  • Children
  • Housewives

Prevalence

  1. 15-25% of all computer users worldwide (both vocational and recreational) are estimated to have RSI. By this estimate, over 5 million Indian computer users (out of an estimated 28 million) may already be having RSI.
  2. RSI accounted for 66% of all work-related illnesses in USA (1999).
  3. A survey of 500 software professionals at Hyderabad in 2000 revealed that over 50% had symptoms of established RSI.
  4. Preliminary results of our ongoing prospective study among over 35,000 Indian computer professionals (2001-2008) found that over 75% reported musculoskeletal symptoms. This is the largest study ever undertaken to identify the prevalence, causes and results of treatment of Computer Related RSI. READ MORE

Why should you bother about RSI?

  1. If you are reading this, even YOU could be at risk! NO ONE is immune to RSI: whether you are a week old in the industry or whether you are the C.E.O.
  2. RSI can seriously disrupt work and domestic life. We know of 70 young Indian computer professionals who have lost their jobs due to advanced, neglected RSI, since 2001.
  3. RSI is not a compensable occupational illness in India, even though over $250 billion are spent every year in USA as a consequence of RSI. There are no protective laws once workers get injured and are unable to work productively. The onus of RSI prevention is entirely on Indian workers.
  4. If RSI is not diagnosed and treated correctly and at an early stage, it can lead to a dreaded and crippling complication called Reflex Sympathetic Dystrophy.

 

Social costs of RSI Economic costs of RSI
Diminished health Decreased productivity & quality
Psychosocial consequences, e.g., anxiety, stress and depression Lost wages
Diminished community involvement Absenteeism
Diminished ability to participate in recreational activities Doctor visits, cost of medical procedures and ergonomic modifications
Overall diminished quality of life Employee turnover
  Recruiting and training new staff
 

Retraining injured workers

  Decreased employee morale
  Compensation expenditures

Current scenario in India

  • Early identification of RSI and competent medical intervention is critical to arrest and reverse the injury in its early stages
  • Unfortunately, Indian medical professionals (in general) are not equipped to diagnose or treat RSI's, since it is a relatively recent phenomenon here. Ergonomics, RSI and Myofascial Disorders do not even find a passing mention in the Indian Medical Curriculum and it is not unusual to find Indian doctors (even specialists) and physiotherapists who have not even heard of RSI, let alone have the ability to treat it.

Top pitfalls in RSI Treatment in India

  1. Misdiagnosis as "Spondylitis, "Arthritis," "Slipped Disc," or "Muscle Sprain" seems to be the rule rather than an exception. Diagnosis of RSI is entirely based on a skilled musculoskeletal examination by an expert, and no "special" tests including MRI scans or nerve conduction studies can reliably diagnose it.

  2. Inappropriate medications, e.g., corticosteroids (or Cortisone), antidepressants, Vitamin B12 and multi-vitamins, Unspecified Health Pills and Oils, etc. Medicines and potions (whether Allopathic or Alternative) make little difference in the long term.

  3. Conventional physiotherapy is usually ineffective (Ultrasound, Short Wave Diathermy, etc.) and sometimes dangerous (traction and isometric/resistive neck exercises).

  4. Inappropriate surgery for a presumed diagnosis of Carpal Tunnel Syndrome or Slipped Disc, with disastrous consequences.

  5. Total reliance on fancy ergonomic gadgetry, special chairs, wrist rests, split keyboards, anti-glare screens, etc. to prevent RSI, while ignoring human factors (e.g., practical training in posture, body awareness, typing technique, breaks)

  6. Often, RSI sufferers are told "it's all in your mind" and the only way to recover is to get "it out of your mind!" No further clues are usually provided as to how to achieve this laudable goal. Worse, others are condemned to referral to a psychiatrist because the "specialist" could not find anything wrong on examination or investigations.

  7. No significant attempts at identifying and correcting predisposing factors for RSI, e.g., ergonomic or postural problems.

  8. Alternative medicine practitioners who practice a single technique often have a single-track approach to diagnosis and treatment ("when the only tool you have is a hammer, everything looks like a nail!"). Most have no knowledge whatsoever of RSI and can severely aggravate an existing RSI and prolong the recovery period. However, some modalities like Yoga, Tai Chi and Alexander Technique, when used appropriately and in a holistic environment, are beneficial in RSI. READ MORE

RSI victims, on the lookout for a quick-fix requiring minimum effort and time off work, usually run from pillar to post seeking effective treatment and often fall victims to quacks. Inaccurate and unmoderated information abundantly available on the Internet and in RSI Support Groups/Mailing Lists is often swallowed up by the gullible victims, adding to their plight.

 

Useful Links

Our Treatment Approach

Alexander Technique in Bangalore

RSI Yoga Course in Bangalore

Training Programmes in Ergonomics/RSI Prevention

My RSI/MSD Articles in the World's Largest English Newspaper

Press Coverage of our work in RSI

Training Opportunities in RSI/MSD for Physicians/Therapists