February /March 2004

Volume 44, Number 4

It's your health: Surviving work-related pain and injuries

by Martha Cowley

Notes from the RMC listserv

A recent RMC mailing list question:

I have recently experienced muscle tendonitis and shoulder problems. Someone suggested that I might switch from using a mouse to a trackball. I have less problem when I use the touch pad on my laptop than a traditional mouse, so I think there might be something to the suggestion. Does anyone have experience with trackballs and do they make a difference?

And a response:

Sorry to hear of your problems. I'm a 10+ year survivor of what used to be called carpal tunnel syndrome and is now classified a repetitive stress injury (RSI). I declined recommendations for surgery and for finding a new career that did not require use of my hands. I still work in technical writing full time, and play after work writing novels, fixing and playing with my digital photographs, and playing mouse-click computer games with my 4-year-old. I manage my body's needs carefully. Yes I have days when I predict weather better than network weather stations, and I have broken a few coffee cups. And frankly it makes economic sense to buy Advil and Tylenol and Motrin in bulk. But I also have days where I'm no different then any other non-injured key-whacker.

So yes, a trackball will help alleviate your symptoms because it will force you to change your posture and how you hold your hand, your elbow, your shoulder. It will help you until you develop bad habits with a trackball mouse and different hand muscles protest and you need to switch to something else. Like anything, you will have a learning curve on handling expertise, an expert mode, and, if you don't change the underlying cause, perhaps an injured mode.

Sometimes one change is all it takes to break the habit and you may never know what the underlying factors are that caused the injury. However, the same habits and environment that contributed to the initial injury will be there and you may find yourself in a worsening situation. The real fix is to take a look at your situation and address the cause rather than the symptoms.

I suggest taking a look at your work surroundings and evaluating them ergonomically with a need to make changes. There are several aspects to identify in your evaluation: the physical contributors, the emotional contributors, and your own behavior patterns.

As you start looking at this in an analytical fashion you need to remember that your body did not arrive suddenly injured all at once one morning—though it may have felt that way. You probably had lots of warning signs that you ignored or were unable to perceive: fatigue, tense shoulders and arms, stiff neck, trigger finger, mouse-hand cramps. We mostly choose to ignore the body's built-in early warning systems. So get in touch with those warning systems again by being aware of them. These signs will help you recover quickly if you pay attention.

It's easy for everyone to ignore these simple warnings because we work hard and we reward ourselves for feeling tired at the end of the day instead of thinking "Yikes, what did I do to myself and how am I going to fix it?"

To remedy an overuse injury, you may need to make many changes. The best advice is to be patient. Instead of trying lots of changes all at once, try a couple for a few weeks. This will give your body time to adjust, and if other issues arise you can identify exactly what you were doing that caused the new thing to surface. Initially things will feel different and it takes time for your body to adjust.

If it's the work scenario that is causing stress both physically and emotionally, you need to find ways to adapt your body's response to one that is less stressful and harmful. Maybe you need headphones to drown out the loud discussions irritating you, earlier lunches to combat low blood sugar and fatigue, more frequent breaks to move the body around. Maybe you are clicking with too much force out of irritation for a situation or application or project. If there are emotional factors, identify them and how your body responds. And then think about changing some of those responses if they are factors in your problem.

The biggest area of needed change is usually the physical configuration of your workstation. Is your desk at the right height, and your keyboard in easy reach? Is your mouse habit forcing you to lean on that elbow, or are you able to hold your hand easily and move the mouse? OSHA has guidelines for healthy posture and workstation configurations that you can review. And it's important that you are honest with yourself when reviewing your physical work situation.

Here are some simple changes that can make a big difference: adjust your chair height, get a foot rest, adjust the arm rests, get a keyboard and mouse tray lower than your desktop surface so your arm floats instead of rests on the surface, move the mouse to the other side (if it works for you), and relocate your phone to the other side. Speaking of phones, get a headset if you find yourself pinching the receiver between chin and shoulder. Get a glare protector for your screen, raise or lower your monitor, bring it closer, get better lighting.

And finally really take time to identify the areas of your body that are tense or injured. Sore fingers are not the entirety of it; they are more likely the end of the road. Usually you can follow that up to tenseness in the forearm and tendons, a big callous on your elbow from resting weight on it, stiffness in your shoulder, a pinching sensation in the mid-back between shoulder blades, stiff neck, etc. When the injury is really bothering you, take a look at how you are sitting, and all that is impacted by the workstation and how you work at it.

Then start checking in with the troubled areas on a frequent basis and if you find they are hurting or tense, do something about it for 30 seconds: flex your fingers, rub your hands, do some finger and wrist stretches, roll your shoulders, try some gentle hand stretches, get up, gently roll your neck, breath deeply. Just pause a moment and check in, and if you find the warning signs, do something about it. A 30-second break is not going to kill a deadline, but it may keep you from expensive medical bills.

So now that you are injured you need to take better care of yourself. If you have a chronic case of granite shoulder lock, get some shoulder, upper back, and arm massages. Any school of massage will gladly let their students do clinic work on you for free or minimal charges. Call them and get on the schedule. These clinics are done under the instruction of professionals who know how to medically treat your areas of concern.

Get in the habit of building in mini-breaks to your routine so you can check in with yourself and be proactive about the muscles and nerve issues or needs you may discover.

Exercise regularly, even if it's just getting up at lunch and walking up and down four flights of stairs. Exercise keeps your circulation up, and helps move stagnation out of the body (good for reducing swelling). Swimming is fantastic for just about every part of your body. Or find something you like to do that involves getting up and moving your body and gets your heart rate up for 20 minutes 5 times a week. And no—screaming on a deadline is not considered exercise!

Yoga should be every computer user's friend. There are several simple yoga stretches that are especially helpful for injuries of shoulders, arms, and wrists. A personal favorite is (using the English translation) "downward-facing dog" or "chair-dog" or "desk-dog." You know how a dog or a cat stretches with its front paws parallel to the ground and hind-quarters up in the "come on, let's play" mode? That's the gist of the pose and it's part of my daily regimen.

Take heart: the worst of it is right now—you have an injury and it has hit your awareness level. Since you weren't listening to your body's warnings before, it had to yell to get your attention. As you've likely noticed, soft tissue and nerve injuries are especially sensitive at night when your circulation slows down and there are few distractions. You may have more swelling at the injury site as a result of fluids building up with the slowed circulation. Don't tough it out if it's enough to keep you from falling asleep normally. Take something to ease your discomfort and address the swelling. Pain doesn't build character-it just creates grumpy people. Keep your circulation going by light exercise 30-45 minutes before going to bed. Restorative yoga poses are ideal for light exercise.

So here are some operating instructions for recovery and survival.

• Talk to your doctor about pain management. There are no rewards or pay raises for sucking it up, and your friends, loved ones, and co-workers will appreciate your not being a pain about your pain. Take something for pain that has anti-inflammatory properties. And if the recommended dose isn't working and interrupts your ability to function during the day, keeps you from doing things that you love, and prevents you from getting your rest at night, talk to your medical professional. Occasionally I have a flare-up and it's tough to get some sleep. Tylenol PM is non-addictive and included on my list of things that are wonderful to have around—sometimes that one night of good sleep is all I need to get back on track. Your body needs rest to rebuild so make sure you get your rest.
• Drink plenty of clear fluids to help flush your vascular system of the residues of swollen and torn muscles and fibers. Reduce caffeine intake. Caffeine restricts your capillary system and holds on to fluids from inflammation. Magnesium tablets are a "natural" muscle relaxant often used after deep tissue massage because it helps flush the toxins from your system. Magnesium can help with overall muscle tension. Follow the dosage instructions and drink plenty of water. As always, take into consideration your own medical needs and discuss your medications with a medical professional.
• For comfort when you are feeling achy and sore, microwaveable heat packs are great and you can get them at any mall, especially this time of year. If heat doesn't make you feel good, you can freeze those same packs or try a bag of ice. If you don't have sensitive skin, Tiger Balm, Icy/Hot, and other sports creams and rubs are also effective, and it's an added bonus if you can persuade someone to spend several minutes rubbing them into your aching shoulders, neck, back, arms, and hands!

And now the bad news: Now that you have this type of injury, you are at a higher risk for repeat or other injuries to the area. It's like stubbing your little toe or biting the inside of your cheek. It's easy to bite that cheek again or stub another toe by overdoing it or not paying attention. So you are going to need to be more aware of your injury and make this a life change. No big deal really—it may actually help you have better health in the long run.

I hope I don't sound like gloom-and-doom or a know-it-all. I have had similar issues for many years and I maintain and manage it while continuing to do what I love. It's possible for you to do the same.

Wishing you a speedy recovery and no repeat injuries.
Martha Cowley, survivor

Here are some Web resources:

Ergonomics: www.osha.gov/SLTC/ergonomics/. Also www.osha.gov/SLTC/etools/computerworkstations/index.html for specifics related to computer workstations.

www.tifaq.com/ is an RSI FAQ site with information on injuries, devices, and support groups.

Yoga: www.yogajournal.com/poses/ - Yoga Journal is a great overall resource for most things related to yoga.