What happened to the epidemic? Was it just panic? That depends on whether you were referred to a rheumatologist, occupational therapist, musculoskeletal surgeon or psychiatrist!

Some injuries described as Repetitive Strain Injury (RSI) encompass real, long-term physical injuries wrapped in psychosocial issues. Unfortunately, the industrial climate in the 1980s and personal circumstances fueled anxiety and resistance to ameliorative measures, by both employers and employees (Reid and Reynolds 1990). Reports of RSI dropped drastically when compensation rules became less supportive (Tyrer 1998). Clinicians have to discriminate between physical symptomatology and psychiatric phenomena (Bell 2000).

Alleged risk factors include genetic factors, mental disposition, specific movement patterns, obesity, smoking and inactivity (Quilter 2003). The genetic aspect is out of our control. People have difficulty managing stress, especially when their symptomology is not respected. The easiest thing to do is to alter behaviours.

• We break up highly repetitious movement and confined exertion patterns by varying people’s tasks in the course of the day.
• We design equipment, furniture and tasks to avoid static loads (habitual hunching, twisting and tension, etc) and reduce inflammatory triggers (ulnar deviation, etc).
• We remind users to avoid pain. (Duh!)

Fortunately, teachers and students have a great deal of autonomy (mental disposition) and variation (physical behaviours) in their physical work, which should reduce their risk compared to, say, data-key operators.

Remarkably, Canadian metanalysis of RSI treatment studies found:

• “Moderate evidence … that workplace adjustments as implemented in the studies reviewed have NO effect on musculoskeletal or visual outcomes.”
• “Moderate evidence … that rest breaks together with exercise during the breaks have NO effect on musculoskeletal outcomes.”
• “Evidence was insufficient to conclude that exercise training, stress management training together with workplace adjustment, new chairs, lighting plus VDT glasses, new office lens type or VDT glasses had effects on musculoskeletal outcomes.” (Strauss 2007)

Take away messages for teachers

• Avoid obviously unsafe work practices, perhaps using use guidelines for teachers from RSI/OOS ACT.
• Teach about lifestyle risk factors (smoking, exercise, stress, etc).
• Feeling bad increases your risk of injury, and makes symptoms seem worse. Address psychosocial issues.
• On symptoms, see a doctor. Diagnosis requires medical expertise.
• There is no universal or guaranteed treatment.
• Respond to the present circumstances of each individual, continuously.

I thank Martin for pointing out these guidelines for kids:

• http://www.healthycomputing.com/kids
• http://cehd.umn.edu/kls/ecee/ (University of Minnesota)
• http://ergo.human.cornell.edu (Cornell University)
• http://itkids.curtin.edu.au/papers/IJIEchildlap2000.pdf (Straker 2000)

References:

1. Awerbuch, M. 2004, Repetitive strain injuries: has the Australian epidemic burnt out? Internal Medicine Journal 2004; 34: 416–419
2. Bell, DS, 2000, Epidemic Occupational Pseudo-Illness: The Plague of Acronyms, Current Review of Pain 2000, 4:324–330
3. Quilter, D. 2003, Risk factors for repetitive strain injury, RSIHelp.com, http://www.rsihelp.com/risk_factors.shtml
4. Reid, J. and  Reynolds, L. 1990, Requiem for RSI: The Explanation and Control of an Occupational Epidemic, Medical Anthropology Quarterly, New Series, Vol. 4, No. 2, Medical Anthropology and the Construction of the Medical Conditions (Jun., 1990), pp. 162-190
5. RSI and Overuse Injury Association of the ACT 2006, Frequently asked questions about RSI/OOS, RSI/OOS, http://www.rsi.org.au/faqs.htm
6. Strauss, VP 2007, Whatever happened to the crippling RSI epidemic? CBC News, February 23, http://www.cbc.ca/news/viewpoint/vp_strauss/20070223.html
7. Tyrer, SP, Repetitive Strain Injury, in Manu, P. 1998 Functional Somatic Syndromes: Etiology, Diagnosis and Treatment, Cambridge University Press.