Dr. Deepak Sharan repetitive strain injuries
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Current Research


The following research projects are under way at RECOUP and are scheduled to be completed by the end of March 2008


    Topic Type of Paper           Main Resource Person 
Thoracic Outlet Syndrome associated with Shoulder Instability: A Clinical Protocol    Original Research      Anu       Ebenezer
 2 Outcome of Treatment of Myofascial Lumbo-Pelvic Pain  Original Research  Sasikala V
 3 Thoracic Outlet Syndrome associated with Temporomandibular Joint Dysfunction  Original Research (brief report)  Chetan Parasar
 4 Physical Therapy of Thoracic Outlet Syndrome: A Clinical Protocol  Original Research  Mohan Babu
 5 Prevalence of Musculoskeletal Symptoms in Indian Computer Professionals, Risk Factors, and Clinical Features  Original Research  Praveen TJ
 6 CRPS as a complication of SEMLARASS  Case Report  Pallavi Sharma
 7 Non operative Management of Cubital Tunnel Syndrome in Computer Professionals  Original Research (brief report)  Jaba Prabu
 8 Physical Therapy of Patello Femoral Pain Syndrome: A Clinical Protocol  Original Research  Anoop P
 9 RSI in Indian Musicians Original Research (brief report)  Habeeb Rahman
 10 Osteoporosis in IT professionals younger than 40 years  Original Research (brief report)  Jeena Jose
 11 Treatment of Fibromyalgia using an integrated approach  Original Research  Dr. Satish VR
 12 Back pack injuries in Indian School Children  Original Research (brief report)  Shelza Gupta
 13 Thoracic Outlet Syndrome associated with Complex Regional Pain Syndrome Type 1  Original Research  Muniyandi P
 14 Outcome of SEMLARASS for Spastic Diplegia   Original Research  Pallavi Sharma
 15 Outcome of SEMLARASS for Spastic Athetoid Quadriplegia  Original Research (brief report)  Karthikeyan M
 16 Outcome of OSSCS for Spastic Hemiplegia  Original Research (brief report)  Karthikeyan M
 17 Role of Psychosocial Risk Factors in Pathogenesis of Work Related Musculoskeletal Disorders  Original Research  Pushpalatha
 18 Management of Thoracic Outlet Syndrome  associated with Cervical radiculopathy  Original Research (brief report)  Jeena Jose
 19 Physical Therapy of heel pain: A Clinical Protocol  Original Research (brief report)  Balaji G
 20 Myofascial Pain Syndrome in Children  Original Research (brief report)  Shanmugha Priya
 21 Lumbar Radiculopathy associated with Myofascial Pain  Original Research (brief report)  Sajin Dev
 22 Physical Therapy for Failed Back Surgery Syndrome : A Clinical Protocol  Original  Jayashree J
 23 Physical therapy for Iliotibial Band Friction Syndrome  Original Research (brief report)  Priyavadhana V
 24 Text Message Injuries including Blackberry thumb  Original Research (brief report)  Balaji G
 25 Effectiveness of stretch break software in RSI  Original Research (brief report)  Sasikala V
 26 Kinesio Trial for Thoracic Outlet Syndrome  Randomised Controlled Trial Deepa K
 27 Kinesio trial after SEMLARASS  Randomised Controlled Trial  Caroline Jothi
 28 Cost Effectiveness of Ergonomics and RSI Programme in IT Companies  Original Research  Nithin Suresh
 29 INTREX CRPS  Randomised Controlled Trial  Biju Nirmal Jacob
 30 INTREX FMS  Randomised Controlled Trial  Dr. Satish VR
 31 INTREX Post SEMLARASS  Randomised Controlled Trial  Shanmugha Priya
 32 INTREX MPS  Randomised Controlled Trial  Biju Nirmal Jacob
 33 Osteoarthritis of Knee: Comparison of efficacy of EFAC and Diacerin  Randomised Controlled Trial (Sponsored by Cymbiotics)  Biju Nirmal Jacob
 34 Physical therapy for wrist tendinitis: a clinical protocol  Original Research (brief report)  Jerrish A Jose
 35 Physical therapy for lateral epicondylitis: a clinical protocol Original Research (brief report) Reshmi Priya 
 36 Physical therapy for adhesive capsulitis: a clinical protocol  Original Research (brief report)  Reshmi Priya
 37 Physical therapy for coccydynia: a clinical protocol  Original Research (brief report)  Bieju K Balan




I am leading the largest prospective study in the world on Computer Related Repetitive Strain Injury (RSI). This comprehensive, prospective study started on February 8, 2001 and will be completed in 2008. Our aim is to study over 35,000 computer professionals to determine the prevalence, predisposing factors, presenting features and outcome of treatment of RSI.

The following material is a part of my paper titled "Computer Related Injuries: The Indian Experience", presented on November 15, 2002, during the AA Mehta Gold Medal Session of the 47th Annual Conference of the Indian Orthopaedic Association. The number of computer users studied has since extended to over 30,000 and over 75 IT/ITES Professionals have now lost their jobs.

Study Population

  • 650 subjects in computer-dependent careers
  • Recreational users were excluded from this particular study, though our youngest RSI patient was aged 5.

Presenting Symptoms

Back pain (47%), Neck pain (35%), Shoulder pain (34%), Hand/wrist pain (26%), Arm pain (22%), Visual strain (20%), Anterior knee pain (20%), Tingling/numbness of hand (16%), Weakness of hand (10%), Pilot Seat Syndrome (10%)

  • 76% of those surveyed reported having at least one musculoskeletal symptom
  • Median age 27 years (range: 18 to 52). In most studies reported from the west the commonest age group is 40-50 years.
  • 55% developed symptoms within 1 year of starting computer dependent careers, clearly demonstrating that most Indian Computer Users are unaware of safe computing techniques.
  • 60% of those with severe disorders (neurovascular compression or tendinitis) recalled having chronic neck and shoulder pain or stiffness that they had considered "normal" for computer users and ignored

Predisposing Ergonomic Factors

Lack of appropriate breaks (86%), Improper monitor height (60%), Mouse too high (54%), Resting the arm or wrist on a hard surface while typing (42%), Keyboard too high (40%), Bizarre leg positioning (25%)

Predisposing Postural Factors

Head forward (92%), Rounded back (75%), Protracted shoulders (55%)

Specific Physical Findings

  • Scalenus anterior MTrP's (70%)
  • Thoracic Outlet Syndrome (68%)
  • Pectoralis major/minor MTrP's (66%)
  • Trapezius MTrP's (66%)
  • Rhomboids/Levator Scapulae MTrP's (66%)
  • Forearm MTrP's (62%)
  • Erector Spinae MTrP's (40%)
  • Psoas major MTrP's (40%)
  • Supraspinatus tendinitis (35%)
  • Acromioclavicular degeneration (33%)
  • Cubital Tunnel Syndrome (32%)
  • Short hamstrings (32%)
  • Patellofemoral pain syndrome (18%)
  • Hand weakness (15%)
  • Lateral Epicondylitis (12%)
  • Medial Epicondylitis (8%)
  • Reflex Sympathetic Dystrophy (5%)
  • Hyperlaxity of elbow/fingers (5%)

MTrP's = Myofascial Trigger Points

Past Treatment (n = 353)

  • 65% (mis)diagnosed as "spondylitis", "arthritis", "slipped disc", "tennis elbow", "muscle sprain" or "Carpal Tunnel Syndrome"
  • 20% diagnosed as RSI but told "RSI is incurable" or given steroids (cortisone), Vitamin B12 injections or Antidepressants
  • 30% had x-rays/bloods (useless in establishing diagnosis)
  • 15% had MRI's (all essentially normal!)
  • 10% had Nerve Conduction Studies (all abnormal!, but non-contributory in management)
  • 0% had an on-site workstation evaluation
  • 100% had failed conventional Physiotherapy (e.g., traction, short-wave diathermy, infra-red, ultrasound, IFT, isometric exercises)

Predisposing Medical Disorders

  • 10 (0.02%) had a pre-existing medical condition or surgical history.
  • 5 (0.01%) had an anatomical predisposition (e.g., Cervical Ribs)
  • 32% admitted significant stress at home/work
  • 80% led sedentary lifestyles

Speed of Recovery

  • Related to the stage at presentation, with little correlation to duration of symptoms
  • Stages of RSI (Damany & Bellis, 2001): Patients who presented at an earlier stage (stage 1: pain during work, that eased off as soon as you stopped working) almost always got better within a few days or weeks. Stage 2 (pain that went home with you, and interfered with your regular activities, but disappeared by morning) usually took a few months to improve. Stage 3 (pain that woke you up, and stayed with you all day and night) was much more difficult to treat and took several months.

The bad news

  • 6 Software Engineers (25-35 year old) had to give up Computer-dependent careers due to advanced RSI symptoms
  • 85% of the respondents were from the so-called blue-chip IT Companies. One shudders to think what would be the situation in lesser equipped IT Companies, banks, newspaper offices, and colleges/training institutes.


  1. The high incidence of RSI in India is remarkable because no financial gain is involved, unlike in the west. Only "genuine" patients* would report symptoms here. In fact, there are huge disincentives to report symptoms (lack of support from management, possibility of retrenchment, etc.)
  2. RSI is a diffuse neuromuscular disorder: a physical problem, not a psychosomatic one (though stress may aggravate symptoms)
  3. There are significant proximal upper body findings that affect distal function. In other words, pain or numbness in the hand may signify a neuro-vascular compression in the neck.
  4. The best-known RSI, Carpal Tunnel Syndrome, is actually very rare in India
  5. Splints, Conventional Physiotherapy, Medicines of all systems, and Surgery frequently made matters worse
  6. All affected individuals had significant postural and/or ergonomic abnormailities that needed correction

* This is not to say that RSI patients in other countries are malingerers!

Causes of RSI?

RSI arises due to the following factors:

  • Prolonged repetitive, forceful, or awkward hand movements
  • Poor posture
  • "Static loading" or holding a posture which promotes muscle tension for a long period
  • Poor conditioning of the heart and lungs, and poor muscle endurance
  • Direct mechanical pressure on tissues
  • Cold work environment
  • Poorly fitting furniture
  • Basic inadequacies of keyboard, monitor and workstation design
  • Work organisational and psychosocial issues
Our findings are identical to that of similar research being carried out by Dr. Emil Pascarelli at Columbia University in USA, who is considered one of the foremost expert in the world on RSI. Double Crush Syndrome is common in RSI: there may be compression or injury at multiple points during the course of a nerve, from the neck down to the hand. What was earlier passed off as Carpal Tunnel Syndrome (nerve compression in the wrist) is now increasingly recognised as being due to neurovascular compression in the neck. This finding has far-reaching consequences on the treatment of RSI. Nerve surgery at wrist or elbow would be a disaster in such cases and no amount of physiotherapy at the wrist/hand would help because the problem usually lies higher up.



  1. Awareness programmes for employees, employers, school and college teachers, and medical professionals
  2. Mandatory practical training and certification on safe computing techniques, body awareness and posture for all computer users
  3. Early Intervention for RSI symptoms. Neck and shoulder discomfort should never be ignored.
  4. Reporting, referral (for treatment) and workplace accomodation procedures in organisations

Food for thought

What will be the prevalence of RSI in India when the present lot of children who have been ab(using) computers and suffering backpack and postural injuries since the age of 3 grow up to be IT Professionals?

Who'll bell the cat?

NASSCOM?, IT Companies?, Individual Computer Users?, Doctors?, Parents?, Teachers?, Government?

Significant effort needs to be made by each group, in a coordinated manner. A reasonable start would be for NASSCOM to fund a comprehensive multi-centre study to estimate the magnitude of the problem, predisposing factors, with an eye on the steps necessary for prevention. I have emailed Mr. Kiran Karnik, President, NASSCOM, in 2003 about the seriousness of the problem, without eliciting as much as an acknowledgement from him.

The pattern and nature of RSI in India is significantly different from that in the western countries. There are significant anthropological differences in the body shape and dimensions, work practices, and furniture design. These problems are unique to our country and so should be the solutions.


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