Author: Stephen David
Bangalore, India Today, September 8, 2003
Till last year, R. Rashmi was the epitome of success: the Bangalore-based financial analyst with a software company earned a six-figure salary and travelled abroad frequently. Today, she is virtually immobilised by a searing backache. The eight long years of hunching over a computer and banging away at bad keyboards have taken their toll. She is a victim of computer-related injury (CRI), a professional health hazard that threatens to reach epidemic proportions in this infotech-driven city. It isn't just Bangalore. With computers now ubiquitous, a majority of the country's 20 million computer users, including schoolchildren, call-centre employees and it professionals, are at risk. Yet, CRI is barely heard of in the medical community or by the computing public. Injury (CRI). She has been undergoing trigger point therapy for about eight months now and is already feeling better.
It could begin with a slight pain in the wrist. Or a recurring backache. Or dry, red eyes and headaches. Minor symptoms initially, all of these can be traced to erratic movements and unnatural postures adopted by people while using computers for long durations. Often untreated, and generally misdiagnosed in the early stages, CRI could lead to incapacitation. Worse, there are no easy cures, only preventive measures.
None of these illnesses is new or unique to computer users. They can arise from any awkwardly positioned, physically strenuous movement repeated over a prolonged period. In fact, repetitive strain injury (RSI), a pain in the wrist which is a common symptom of CRI, was first documented by the 17th century Italian physician Bernardino Ramazinni. The first CRI "epidemic", however, was noticed in New South Wales, Australia, 15 years ago. Since then, several studies across the world have shown that up to a quarter of people who use computers regularly for work or fun suffer from CRI.
Proper body postures, stretch exercises and computer placement can reduce afflictions
DRY EYES: Afflict 20 per cent of workers.
MONITOR ANGLE: The correct angle is very important to prevent both eye and back problems. The monitor should be just below eye level, tilted up a little.
KNEE PAIN: Common in 20 per cent of workers. Caused by
strain to muscles around knee joints.
WRIST PAIN: In 26 per cent of workers, tendons around
the wrist get inflammed, affecting the nerves.
NECK PAIN: Nearly 35 per cent of workers suffer from
it. Is caused by constantly looking up or down at the monitor.
BACK PAIN: Affects half of computer users. Slouching
changes the spinal position, causing lower back pain.
FOREARM PAIN: Forearm and elbow pain affects 10 per cent
of users. Repetitive movement causes tiny ruptures in forearm and elbow
For a fairly recent phenomenon-the epidemic struck India about five years ago coinciding with the IT boom-CRI is causing much damage in the country. According to a study conducted by Deepak Sharan, an orthopaedic surgeon who runs a CRI clinic in Bangalore, involving 1,200 computer professionals in the city, as many as three out of four people had at least one symptom of established CRI. Another study by the Apollo School of Physiotherapy, Hyderabad, found that more than half of the 500 people scanned suffered from CRI.
"CRI is a serious cause for worry. Computers cause a lot of problems for the neck, back, elbows, knees, even ankles," says S. Marya, senior consultant orthopaedic surgeon at Delhi's Indraprastha Apollo Hospital. The malaise also appears to hit the Indians at a younger age. The median age of injury in the Bangalore study was found to be 27 years. In the West in contrast, it is the 40- and 50-year-olds who are most likely to be affected. More alarming is the fact that 55 per cent of CRI sufferers in Bangalore developed symptoms within a year of starting computer-related careers. "This reflects a lack of awareness about using computers safely," says Sharan. Worse, the ignorance about CRI extends to the medical fraternity, with doctors failing to associate ailments with computers.
The most common symptoms of CRI is pain in the back, neck and shoulders, the result of sitting uncomfortably, hunched over the keyboard while typing, or constantly craning the neck to look up at the monitor which should ideally be just below eye level. Bad keyboards lead to hand or wrist pain, tingling and even numbness in hand. The repeated tensing of the tendons causes inflammation. Eventually, the tendon fibres start separating and can even break, leaving debris which induces more friction, swelling and pain. Staring at a screen can lead to a drop in blink rate, causing dry eyes, while the constant glare from the monitor can also cause headaches. All CRI symptoms are exacerbated when appropriate breaks are not taken or if the patient has low fitness levels.
Despite the symptoms being well documented, Sharan's study reveals that 65 per cent of the incidents were wrongly diagnosed as spondylitis, arthritis or slipped disc. Tennis elbow and RSI were diagnosed correctly in 20 per cent of the cases, but the treatment was incorrect. Many were told that RSI was incurable or were given steroids, Vitamin B12 injections or anti-depressants. In nearly 30 per cent of the cases, X-rays and blood tests were done, all of which were irrelevant in diagnosing the problem.
"I would suddenly have such terrible bouts of pain while driving that I would need to stop the car," says Bangalore-based software engineer V.B. Mahesh. "The best doctors asked me to have MRI scans and other tests, but nothing helped because no one diagnosed it as CRI." The correct treatment, according to Sharan, varies from person to person and involves a range of therapies like neuromuscular therapy, trigger point therapy, myofascial release and bodywork techniques, but prevention is the best.
"The awareness levels are very low. People come to us because they have a pain or numbness, but don't realise it is because of computers," says Marya. Awareness is important because successful recovery hinges on early diagnosis. If diagnosed and treated properly in the first stage, when symptoms are only seen at work, the patient can recover within a few days. If symptoms persist at home but subside with rest, CRI is in the second stage, which takes some weeks for recovery. And if the symptoms are persistent and severe-numbness, tingling, weakness-it may take several months or the patient may never recover fully. Marya concurs: "If people exercise, they recover quickly. But mostly they do nothing and the resulting structural changes are more difficult to treat."
Sayesh Kumar, 16, should know. The ICSE Class X topper and computer junkie has spent over 10 hours a day on the computer in the past four years. That he would become a victim of severe, generalised CRI was a tragic inevitability. What is more unfortunate is that his injury worsened due to the incorrect ergonomic advice in a computer magazine. Determined to ensure that such misinformation does not affect others, K. Surya, a former software professional and CRI victim, launched RSI India Patients Support Group a year ago. The group's 40 members are trying to inform people about the dangers of CRI through e-mails. It is a humble beginning, but could be the trendsetter for campaigns to convince both the government and the industry that CRI is no laughing matter.
|S. JAMES, 25
PROBLEM: Pain in arm
For seven years, computers ruled the Bangalore-based software engineer's life. But the long hours took their toll. He ignored the pain till his arm was "practically dead, numb, without any feeling". He could no longer work. Diagnosed with CRI at a late stage, recovery is now taking time.
|R. RASHMI, 28
As a financial analyst for a software firm in Bangalore, Rashmi had a globe-trotting lifestyle. But she paid a heavy price for eight years of banging away at bad keyboards and sitting on unsuitable chairs. Today she has a searing backache, a severe case of CRI-and no job.
In the industry, the indifference exists at many levels. As far as policies are concerned, there is no protective legislation against CRI and there is very little large-scale, countrywide data on the problem. With no legal obligation, few employers provide furniture at the correct height, anti-glare screens for computers or any of the measures that would help prevent CRIs. Neither are they obliged to compensate the victims. According to a recent survey of 50 Chennai-based it companies, 60 per cent of the firms admitted they do not provide medical allowance or compensation. Only three companies have an hr policy in place for CRI, and only seven have CRI awareness programmes. In fact, most of the big it firms failed to respond to india today's queries on their hr policies on CRI.
In contrast, most developed countries recognise CRI as a serious occupational hazard and have legislations to protect computer operators from the inherent risks. According to the US Bureau of Statistics, CRI has accounted for 66 per cent of all related illnesses in the US since 1991. The cost in lost productivity and compensation: $20 billion (Rs 92,000 crore) a year. In India, most workers assume the initial pains to be "normal" for computer users and ignore them.
Awareness, however, is beginning to creep in. Hewlett Packard claims to have a premier ergonomic intervention programme, while others like Compaq, Analog Devices, IBM, Enercon Systems and Stylus Systems have also launched training programmes in Bangalore. Hari Hegde, general manager (infrastructure), Wipro Technologies, asserts the company not only has awareness programmes but also provides medical facilities and compensation. Adds Aseem Bhargava of HCL Technologies: "HCL Tech's BPO partner British Telecom has provided detailed environmental safety guidelines, and the call centre has been designed as per these."
A beginning may have been made, but for the thousands of suffering or potential CRI victims, it is a malady crying for a more focused attention.