Dr. Deepak Sharan repetitive strain injuries
 
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RSI Prevention Programme

Introduction

Our aim is to provide the most up-to-date assessment, treatment, and research of Work Related Musculoskeletal Disorders (WRMSD) or Repetitive Strain Injuries (RSI) in India. We recommend a comprehensive, multi-disciplinary approach to prevent WRMSD, since a piece meal approach, e.g., sporadic lectures or sessions on stress management, wellness, yoga, or ergonomics is considered sub-optimal. This involves working as a team with representatives from human resources, facilities, health and safety, chair and workstation manufacturers. I am supported, in this venture, by a multidisciplinary team of trained Doctors and Rehabilitation Personnel, working closely together in a holistic environment. Through education, training and treatment, we help our clients' to regain control over their physical and mental well-being. We are also in close collaboration with eminent WRMSD and Ergonomics experts in North America, Asia, Australia and Europe.

What is Ergonomics?

Ergonomics is the science that studies the relationship between work and human abilities, limitations and characteristics. An ergonomic intervention involves the application of this knowledge in selecting or designing tools, machines, systems, tasks, jobs and work environments to maximize human performance without causing injuries or detrimentally affecting performance.

Why an Ergonomics programme makes good business sense?

There is a solid body of evidence to suggest that sound ergonomic interventions prevent pain, suffering and a range of other social costs directly associated with WRMSDs. Research from USA and elsewhere has consistenty shown that for every $1 (USD) spent on appropriate ergonomic intervention there is a return of as much as $17.80 (USD). However, setting up an effective ergonomics programme in an organisation (including early reporting of symptoms) should be seen as much more than just a means of maximizing profits!

Recently, several scientific studies have emphasized the cost effectiveness of establishing an effective WRMSD Prevention Programme in organisations by:

  1. Reduction in work related injuries and illnesses
  2. Reduction in absenteeism
  3. Reduction in errors
  4. Increased productivity and quality
  5. Maintaining high employee retention and morale

An ergonomic intervention plan must include a core set of elements, including:

  1. Worker involvement
  2. Management commitment
  3. Identification of risk factors
  4. Development of solutions
  5. Implementation of solutions
  6. Ongoing review for effectiveness
  7. Training and education for workers
  8. Early reporting of symptoms
  9. Appropriate medical management

Good ergonomics programs are ALWAYS cost-effective - they save more than they cost. Many studies have shown this. A basic programme of educating workers in Ergonomics and the prevention of musculoskeletal disorders are in your company's best interests and will result in more effective work practices.

(Reference: Cornell University Ergonomics Site: http://ergo.human.cornell.edu/)

There are no shortcuts in RSI Prevention

Many IT Companies approach us for conducting a "quickie" lecture on RSI ("no more than 30 minutes, since our boys are busy and would not concentrate on anything longer") followed by a screening session to see how many are suffering from RSI. Our humble opinion is that this activity is a complete waste of time. We are aware that many private hospitals are eager to send physiotherapists and junior doctors free of cost (essentially to get referrals for their hospitals), to give lectures on ergonomics, carry out workstation assessments and advise people about what general exercises to do for various ailments like back pain or neck pain.

We choose to steer clear of this approach for the following reasons:

  1. It takes at least 20 minutes to assess an individual regarding RSI, give advice about ergonomics and workstation arrangement, and prescribe tailor made exercises and other therapy. Anything less than that is of no value to the employee and remains a useless shortcut.
  2. An important component of recovery from RSI is an ergonomic assessment and correction of the employees' workstation and posture. This is obviously not possible in a group setting.
  3. RSI usually takes weeks or months to recover and requires a close follow up of treatment and modification of therapy occasionally.
We have documented advanced, debilitating RSI's in several Indian IT Professionals who had already received "training" in ergonomics, exercises from physiotherapists and doctors, and whose workstations had already been "cleared by experts"!

Why have Ergonomic Innovations failed to control RSI's in India?

"Ergonomic" chairs have been around since 1976, split keyboards since 1926, and Indian office workstations have become more sophisticated and flexible than ever. But Indian workers seem to be getting stiffer all the time. Not only has the incidence of RSI shown no signs of abatement, we are increasingly encountering more and more advanced RSI's due to which people are unable to work at all.

So, why are Indian IT companies not benefiting from investments in ergonomics?

  1. The word "ergonomics" has become a mere marketing gimmick. There is hardly any chair or computer hardware manufacturer in India who fails to call his product "ergonomic". However, there is no such thing as an "ergonomic" workstation, chair, keyboard, etc. What will make the product ergonomic is if it is selected and adjusted according to the user's body dimensions and nature of work, and the user is trained to use it and is willing to use it correctly.

  2. Out-of-date or incorrect ergonomic information provided by untrained "trainers" or worse, salesmen of furniture and ergonomic equipment! Ergonomics is a rapidly changing and controversial field and it needs special training and experience to sort out what is relevant to Indian workers.

  3. Many Indian IT/ITES organisations rely on a "company doctor" (usually a general practitioner or a physician with no training/qualifications in Ergonomics/RSI treatment) to provide ergonomic advice or to select office furniture. The result is that most RSI's remain undiagnosed and untreated till a stage comes when the employee is unable to work at all.

  4. It is difficult to make asymptomatic computer users accept and implement sane advice about safe computing techniques; people start listening to you only after they become vulnerable (read injured)! But grade 2 or more advanced RSI does not respond to ergonomic modifications alone and specialised medical intervention is required to reverse chronic muscle inflammation or tethering of nerves.

  5. Blind adherence to American or European Standards/Policies on Ergonomics, especially by multi-national companies in India, ignoring research specific to Indian workers. Indian office tables are usually fixed at a height of 2 feet irrespective of the body dimensions of the user. Most chairs do not permit adequate adjustability of armrests and back rests, and are too large for shorter individuals and females, due to which workers are unable to support their backs while typing. READ MORE

  6. Hazardous design and arrangement of furniture: M0st Indian IT professionals sit in corners of L-shaped workstations (in order to accomodate more workers in offices), with either no tray or only a small tray for the keyboard with the mouse placed on the table top. Often, computer users are provided with a hard wrist rest, fixed to the tray. This set up constrains arm movements of computer users and encourages hunching up of shoulders and placing wrists/forearms on the edge of the table, putting an enormous amount of strain on the neck and shoulder muscles. Offices employing this set up have a disproportionately high incidence of Thoracic Outlet Syndrome: one of the most dangerous and severe forms of RSI.

  7. Many Indian HR/Facilities Managers are known to obdurately deny an Ergonomics/RSI problem in their organisations. Their usual claim is that since the company has spent an astronomical amount of money in "ergonomic" furnishing and design, and since every single employee is not complaining vociferously, there must be something wrong with the individuals who are reporting pain. The problem is that most companies have no reporting mechanisms for musculoskeletal symptoms and there are huge disincentives to report ergonomic issues, especially for junior workers. With this Ostrich-like attitude, there are losers all around. Studies have shown that employees who continue working in pain lead to hidden Corporate losses amounting to thousands of dollars every year, even in companies employing only 25 workers.

  8. Major IT Companies in India are often found to be insensitive to injured employees and it is often impossible to obtain even relatively inexpensive workstation modifications (e.g., keyboard tray, footrests), time off work to recover from an injury, etc.

  9. In our experience, putting up ergonomic check lists on company web sites or using software to make mass ergonomic recommendations is a waste of time and money.

The Bottomline with Ergonomics

  • Ergonomics has primarily a preventive role.
  • Ergonomics will not compensate for inefficient management or ineffective practical training.
  • Once workers develop RSI, Ergonomics will not relieve pain: Specific Therapy will!
  • Western ergonomic recommendations are not always appropriate for Indian office workers.
  • Ergonomic recommendations vary wildly from source to source, indicating several controversial areas. Listen only to qualified experts with a proven track record, otherwise your ergonomic intervention might turn out very costly (and painful) indeed.

It is essential to raise public awareness about risks of RSI, to prevent the next generation of workers (i.e., today's children and adolescents) from entering the industry while already injured. The computer and classroom furniture in schools is usually inappropriate, and worse, children, teachers and parents have little or no knowledge of ergonomics, RSI prevention and warning signs.

How can you help?

  1. Organise RSI Awareness lectures at your child's school or college, or at your social club. We would be happy to provide you the necessary training material.
  2. Sponsor RSI Awareness Posters/Pamphlets for School and College students.
  3. Ask your HR Manager to organise training programmes in Ergonomics/RSI Prevention and have your workstation assessed.
  4. Share your experience or knowledge of RSI with other injured workers and help others recover. Details
  5. If you come across an injured co-worker, urge him/her to seek early, competent medical care.

Please email me if you wish to help in spreading awareness about RSI in the community.

 

Useful Links

Our Treatment Approach

Alexander Technique in Bangalore

RSI Yoga Course in Bangalore

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