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You've been warned!

Nikita Agarwal | February 28, 2003 11:18 IST

Computer Related Injuries are on the rise and, chances are, you may have them too

Today is International
RSI Awareness Day and following our earlier story on Computer Related Injuries (CRI) Rediff Guide to the Net presents an in-depth interview with Dr. Deepak Sharan, Consultant Orthopaedic Surgeon and Rehabilitation Specialist, based in Bangalore.

Computer related injuries on the riseDr. Sharan has undergone specialised training in the UK and USA for five years, in Hand/Upper Limb Surgery, Biomechanics, Medical Ergonomics, Pain Management, Orthopaedic Engineering and Rehabilitation Technology.

He conducts bi-weekly, on-site CRI Clinics and ergonomic consulting for Hewlett Packard at Bangalore, where he has already treated over 250 IT professionals. This is the first and only clinic of its kind in India. He has successfully treated over 700 CRI patients and over 700 IT professionals from Compaq, Infosys, IBM, and ISRO have attended his training programs on CRI prevention.

Dr. Sharan presented his latest research in the field of CRI in November, 2002, during the AA Mehta Gold Medal Session of the 47th Annual Conference of the Indian Orthopaedic Association, at Patna. This research was part of one of the largest CRI-studies in the world. Here are the findings, from the expert himself.

What is CRI?

is defined as a constellation of work-related symptoms in computer users. It is a diffuse disorder of muscle, fascia, tendon and/or neurovascular structures, which typically involves the neck and upper limb; but any part of the body may be affected. It is also known as Repetitive Strain Injury (RSI), Cumulative Trauma Disorder (CTD), Work Related Upper Limb Disorder (WRULD), Musculoskeletal Disorder (MSD), or Occupational Overuse Syndrome (OOS). It is primarily a physical problem, not a psychosomatic one, though stress may aggravate symptoms. Unfortunately, Indian medical professionals in general are not trained to diagnose or treat these injuries, as they are a relatively recent phenomenon here.

Why should a normal healthy person bother about CRI?
For a start, CRI accounted for 66 per cent of work-related illnesses in the US, in 1999. Then, the estimated costs in lost productivity and compensation due to it are in the region of $60-100 billion annually. Most importantly, no one is immune to CRI, and it can seriously disrupt work and domestic life. 20-25 per cent of all computer users worldwide are estimated to have it, which is why it is essential to raise public awareness as quickly as possible before a new generation of computer users is exposed to the risks.

Could you tell us about causes and symptoms?
The causes include a lack of appropriate breaks, improper monitor height, resting the arm or wrist on a hard surface while typing, keyboard or mouse placed too high, bizarre leg positioning and bad posture. As for symptoms, they include pains in the back, neck, shoulder, hand/wrist, arm or anterior knee. There may also be some visual strain, numbness or weakness of the hand, and ‘Pilot Seat Syndrome'.

What is the scenario in India?
The pattern and nature of CRI in India is significantly different from that in the West. What may work there may be a disaster here. There may be significant anthropological differences in body shape and dimensions, work practices and furniture design that only a comprehensive study can unearth. As these problems are unique to our country, so should the solutions.

Could you tell us more about your research and its results?
My research was conducted on 650 subjects in computer-dependent careers. The median age was 27 years, while the ratio of males to females was 4:1. It revealed that 55 per cent of subjects developed symptoms within a year of starting computer dependent careers. 76 per cent reported having at least one symptom, while 60 per cent of those with severe injuries recalled having chronic neck and shoulder pain or stiffness that they had considered ‘normal' for computer users. Six software engineers between 25 and 35 had to give up their careers due to CRI symptoms. Also, it was found that the best-known CRI,
Carpal Tunnel Syndrome, is actually very rare in India.

What is the core problem area?
Indian computer users, in general, work on a keyboard and mouse a lot, and their workstations do not permit adequate adjustability, leading to secondary postural distortions and neurovascular compression in the neck. Indian office tables are fixed at a height of 2.5 feet, irrespective of body dimensions. Also, no Indian chair fulfils all
ergonomic criteria for adjustability, exacerbating the problem. Most importantly, only ‘genuine' patients report symptoms in India. Most professionals are reluctant to admit having CRI for fear of retrenchment or being labelled ‘psychotic'.

How have those affected been treated?
Due to low awareness, 65 per cent of all cases were (mis)diagnosed as spondilitis, arthritis, slipped disc, tennis elbow or Carpal Tunnel Syndrome. 20 per cent were diagnosed as RSI, but were told that it was incurable or given steroids (cortisone), Vitamin B12 injections or Antidepressants. 15 per cent had MRIs, all essentially normal! 10 per cent had Nerve Conduction Studies, all abnormal! The point to be noted is that 0 per cent had a workstation evaluation and 100 per cent had failed conventional physiotherapy.

What is the appropriate treatment?
No fancy investigation will help. Skilful physical examination by an expert is all that is required. Ergonomics, Postural Correction, Breaks, Trigger Point Therapy, Bodywork (Hellerwork, Rolfing), Myofascial release, Strengthening, Yoga during recovery stage, and multi-disciplinary teams will heal CRI.

The ‘ostrich mentality' of HR Managers in IT companies needs to change at once. The time to make a difference is when new offices are being set up. Truly ergonomic furniture, coupled with practical training, seems to be the only way forward. If HR managers are using any Ergonomic Consultants, the performance and suitability of such consultants demands a second look. Most companies select chairs by asking a few ‘senior' employees to sit on 8-10 chairs and take a vote for the most ‘comfortable' one. The cost factor scares many, but sensible ergonomics does not necessarily mean big money.

However, total reliance on fancy ergonomic gadgetry, with no understanding of the ‘human' factors involved is also wrong. Long-term recovery is possible only if significant changes are made in workstation arrangement, ability to pace work, computing techniques, and devoting up to 1-2 hours daily for various prescribed stretches and trigger point therapies. Medicines, in general, are a waste of time and effort, and may actually be damaging.

How can CRI be prevented?
It has to be a coordinated effort by NASSCOM, IT companies, individual computer users, doctors, parents and teachers. A reasonable start would be for
NASSCOM to fund a study to estimate the magnitude of the problem, predisposing factors, and steps necessary for prevention. Secondly, employees need to be more proactive in seeking safer workplaces.

There need to be active support groups for injured computer users to exchange notes about the recovery process, therapies and ergonomic modifications that work in the Indian scenario. Litigation against employers who deny them safe workplaces is only a matter of time. Employers must realise that having healthy employees spells greater productivity, morale and staff-retention. However, setting up an effective ergonomic system should be seen as much more than just a means of maximising profits!

Dr Sharan has a plea. Please do not:
-- Prescribe steroids, multivitamin injections or antidepressants.
-- Say “It's all in your mind” and “the only way you will get better is if you stop thinking about it”.
-- Advise splints while working.
-- Encourage attempts to ‘mask' the pain, using strong painkillers, enabling a rapid return to work.
-- Doctors should either get trained, set up multidisciplinary teams or refer patients to centres with proven expertise in treating these disorders.

Contact Dr Sharan. Tel: +91-80-8436736/7. Email:

More Links:
The Alexander technique 
10 steps for good ergonomics 
The Miracle Drug 
CRI: The full story 


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