A Royal Pain in the Wrist

By Philip Elmer-DeWitt

Bonnie Halper was banging out advertising and publicity copy for RCA Records 2 1/2 years ago when she felt a tingling in her right pinky. Not knowing what caused it, Halper kept right on typing. Within half an hour her right hand and arm were numb. In less than a month, she was effectively disabled on both sides -- unable to turn a doorknob, tie her shoelaces, button her clothes or brush her teeth without excruciating pain.

At first Halper didn't want to accept her doctor's diagnosis: repetitive strain injury (RSI) caused by too many long hours at the word processor. Neither did the company, which she says accused her of exaggerating her symptoms to get out of work. According to Halper, RCA managers demanded that she withdraw a workers' compensation claim and tell her caseworker that the injury wasn't job related after all. When she refused, says Halper, they began a campaign of intimidation and harassment. They moved her into a smaller office. They excluded her from meetings. They asked her to take a 40% salary cut. "You have 24 hours to decide on this offer," Halper quotes a supervisor as telling her, "If you don't accept, you're fired."

Instead, Halper hired an attorney and sued RCA Records and its parent company, Bertelsmann Music Group, for $50 million. (A spokesperson for Bertelsmann would not comment on the case.) Halper also filed a claim against her employer under the federal Americans with Disabilities Act -- one of the first such claims filed by an RSI victim in New York.

But it won't be the last. Hundreds of thousands of workers have been gripped by RSI, and many of them are furious. In the U.S. alone, more than 2,000 have filed lawsuits against the makers of computer equipment. Two big cases -- a multimillion-dollar suit by four newspaper reporters who developed RSI while using the Atex word-processing system, and a similar challenge to IBM -- are expected to go to court this fall. "It's not just typists, it's artists, blacksmiths, hairdressers, massage therapists and people in dozens of other professions," says Stephanie Barnes, a former secretary and RSI victim who went on to found the Association for Repetitive Motion Syndromes, based in Santa Rosa, California. "It's an epidemic."

Companies could soon find themselves even more vulnerable to RSI suits. The U.S. Occupational Safety and Health Administration is about to unveil for public comment steps the agency proposes that companies should follow in order to reduce the danger of RSI in offices, factories and retail outlets. Not only will the rules make it harder for employers to claim they didn't know about the problem, but they could be forced to change the way they do business. One of the measures OSHA plans to propose, for example, would require employers to redesign jobs associated with a high risk for RSI -- which could include any task that involves typing at a computer for four or more hours a day.

That could slow down the light-speed pace of the information revolution. There is hardly a company in the industrialized world that hasn't tried to boost productivity by moving work onto computers. Some 70 million Americans -- including more and more schoolchildren -- already spend part of their workday at a keyboard. When the so-called information highway gets built, they could spend even more of their days and nights hunched over glowing screens, bodies perfectly still except for their fingers flying over the keys.

Such a lifestyle is an invitation to RSI. Repetitive strain injury has long been associated with blue-collar jobs that required excessive force, awkward posture and repetitive actions -- like driving the same kind of screw hour after hour in an assembly line or slicing carcasses all day in a meat- processing plant. For the delicate muscles and tendons in the fingers and wrists, rapidly pushing buttons thousands of times an hour can be just as stressful. "When you're working eight hours a day at the same task, you're essentially an athlete," says Dr. Emil Pascarelli, director of ambulatory care at St. Luke's/Roosevelt Hospital and co-author of Repetitive Strain Injury: A Computer User's Guide (John Wiley & Sons; $14.95). "Unfortunately, too many people are trying to run the Olympics when they're not in shape for it."

Doctors now know that RSI is not a single disease, but a cluster of syndromes. In computer users, the problem often starts in the muscles or tendons (the long pulley-like bundles of fiber that direct the movement of the fingers) and in the sheaths surrounding the tendons. Keyboards tend to force the upper body into unnatural positions -- hands bent, arms akimbo, wrists cocked -- straining the tendons and muscles and reducing circulation. Computer "mice" can be just as troublesome; users tend to grip the devices too hard, often with the wrist extended up, creating more work for the hands.

These stresses can create tiny tears in the muscles and tendons, which become inflamed. If the tissues aren't given time to heal properly, scarring can occur. Blood vessels that feed the arms and hands may become constricted, depriving tissues of vital nutrients and leaving toxins in place that would otherwise get washed away. In the late stages of RSI, the tendons and muscles can deteriorate and nerves become so hypersensitized that the slightest strain -- even opening a stubborn twist-off cap -- may set off a fresh round of pain.

Tension and stress can also play a role in RSI. People working under pressure tighten up; muscles cramp, shoulders hunch, necks get knotted -- further straining tendons and muscles. Deadlines, speedups and employee monitoring programs can exacerbate the trouble. RSI sufferers also must deal with the skepticism and resentment of co-workers (who may have to pick up the slack) and the knowledge that their productivity has been impaired. This can lead to a vicious cycle in which the victims are so worried about their jobs that they work even harder, making their hands and arms worse.

Given how much has been written about RSI in the past few years, employers are still surprisingly ill-prepared to deal with it. The Americans with Disabilities Act requires companies to make "reasonable accommodations" for disabled RSI victims. This means the burden is on the employers to prove they can't afford to take whatever measures are required -- from hiring typists to installing voice-activated computers -- to enable stricken employees to do what they were hired to do. But RSI sufferers complain that employers often make only token efforts to comply. "Corporations are extremely reluctant to spend even $100 for an employee with symptoms because they're frightened that if they do it for one person, they'll have to do it for everyone," says Neal Taslitz, president of BackCare Corp., a Chicago-based manufacturer of ergonomic equipment.

Employees may inadvertently allow their conditions to deteriorate. Some may not recognize the fatigue and minor aches that are the early signs of RSI. Others, knowing that jobs are scarce, may try to hide their symptoms. Or, worse still, they may try to work through the pain, causing further damage to their arms and wrists. "Employees get all wrapped up in keeping a good relationship with the employer," says Barnes. "They know that if they can't perform, there's always someone to take their job."

The tragedy of RSI is that it is relatively easy to prevent but hard to cure. Most people can avoid the ailment by taking a few precautions -- doing warm-up exercises, maintaining good posture (but not sitting too rigidly), keeping their arms loose, holding their hands properly, stretching occasionally and taking frequent rest breaks. On the other hand, once people get full-blown cases, they will be susceptible to reinjury for the rest of their lives. "You can control it," says Pascarelli, "but it's always there haunting you."

Whether out of concern for their staff or fear of legal reprisals, a number of firms are starting to apply an ounce of prevention. When two employees at Macworld magazine were sidelined with severe RSI, the San Francisco-based publisher tried to root out the problem. The company bought a lot of adjustable, modular equipment, and then hired a consultant to show the staff how to use it. "We took the approach that it was a partnership between the employees and the company," says Shelly Ginenthal, Macworld's director of human resources. "The employees have to do some things, like take breaks and take care of themselves, and we have to provide them with the tools, equipment and education."

After a year and an investment of more than $50,000, Macworld's offices are still not RSI-proof, but they are ergonomically correct. Much of the computer industry, by contrast, still seems to be in denial. Even in advance of the osha proposals, the Computer and Business Equipment Manufacturers Association -- which represents two dozen computer makers -- petitioned the agency to back off, arguing that guidelines are premature because the link between computer keyboards and RSI has not yet been proved. But the companies know better, according to a lawyer representing RSI victims in the IBM and Atex lawsuits. Internal documents uncovered in the suits show that both firms were alerted to the potential danger their keyboards posed years before. ibm began training its own employees in the proper use of computer equipment in the early 1980s, but still does not notify customers about the risks of RSI. Atex, for its part, insists that the claims made by RSI victims are not supported by science.

At least some members of the computer industry are taking the threat more seriously. Before the end of the year, Dallas-based Compaq will begin printing RSI warnings on all its keyboards. Other companies -- including Apple and Microsoft -- have started selling redesigned keyboards that they hope will cut the risk of RSI. The new equipment -- and the training necessary to use it - -- can be expensive. But the cost of doing nothing could be even higher, both for the employer, who may end up in court paying damages, and for the RSI sufferer, who may never type again.

With reporting by Dan Cray/Los Angeles and Janice M. Horowitz/New York