RSI: Little-Known Illness Is Big Hazard in the Workplace

Three years ago, the working lives of Jana Schumann and Anne Steinberg were worlds apart. Today, the two women have something in common--their pain.

Schumann took a meatpacking job at IBP Inc., the largest beef slaughterhouse in America, at the company’s sprawling Dakota City, Neb., plant. Schumman, 24 at the time, cut meat from bone in a rapid “disassembly line”--a moving-chain system that progressively transformed carcasses into halves, quarters, steaks, ribs and, finally, “kebab meat.” The rooms were refrigerated; workers often stood shoulder to shoulder; the “chain” never stopped.

About the same time, Steinberg, also 24, became an account executive at G.S. Schwartz & Co., a public relations company on New York’s Madison Avenue with an office several floors below the Metropolitan Life clock tower. Her days were spent calling clients and newspaper reporters in endless succession.

After working for about a year, Schumann found that her hands at times would inexplicably “turn numb and black.” She ignored the symptoms for months, but finally went to a doctor who told her she had severe carpal tunnel syndrome, a nerve disorder caused by inflamed tendons in her wrists.

Steinberg, after several months on the job, felt odd, increasing pains in her left hand; no one else in the office had them. One morning, she tried to turn on the water in her bathroom and couldn’t. The pain was unbearable. Her doctor said she had an inflamed nerve near her elbow--not from playing racquetball, as she suspected, but from leaning on her elbow while making phone calls all day.

Schumann and Steinberg are victims of what some experts say will be the major occupational disease of the 1990s. Tens of thousands of workers, ranging from factory workers to white-collar professionals, are being injured by repetitive, continually twisting motions on the job.

It is known in offices as repetitive strain injury, or RSI; in factories, they call it cumulative trauma disorder. By either name, three years ago it replaced skin diseases as the leading cause of occupational illness in the nation, according to the Bureau of Labor Statistics. Almost 73,000 RSI cases were reported in 1987, the most recent year for which data is available.

When compared with the total number of occupational injuries--more than 5.8 million a year--RSI accounts for a relatively small percentage of work-related ailments. But RSI cases are still greatly under-reported, experts say, and the numbers should continue to escalate.

Today, more than half of all U.S. workers have jobs with the potential for RSI, according to a recent report by the National Institute for Occupational Safety and Health. Most experts say RSI is widespread among assembly-line workers in factories, garment workers doing fast-paced piecework and construction workers operating vibrating power tools like drills and jackhammers.

It affects many performing artists--dancers, pianists, violinists and drummers--and professional athletes, particularly baseball pitchers who injure their elbows and shoulders from constant twisting and throwing motions.

Since the early 1980s, RSI also has been reported widely in many service-sector jobs. RSI now afflicts supermarket clerks who use price scanners at checkout lines, as well as airline flight attendants who constantly press the hand brakes of food carts used to serve passengers.

And it has struck thousands of office workers who use computers for a living, from telephone operators and data-entry clerks to newsroom reporters and editors. About half of the nation’s 40 million office workers use a computer terminal daily, according to the Computer and Business Equipment Manufacturers Assn., a trade group.

Still, RSI is frequently not linked to work-related motions because the symptoms--such as pain, numbness or tingling--are usually most severe at night, hours after the suffering worker has left the job, experts say. Furthermore, RSI may take years to develop--there are few consistent patterns--and such disorders are often confused with arthritis or simply the “wear-and-tear” of getting old.

RSI is actually an illness, not an injury, said Vern Putz-Anderson, chief of psychophysiology and biomechanics at the Institute for Occupational Safety and Health. “It’s caused by constant exposure over time,” Anderson said. “It’s a cumulative condition, not a single traumatic injury.”

Although overall awareness of RSI has increased significantly in the last five years, much controversy remains about what causes it and who is responsible.

Many employers are still suspicious of RSI, unable to distinguish between cases of discomfort and disease. Some question whether their employees are malingerers; they are startled by the sudden, seemingly “contagious” spread of RSI.

And many companies frequently dispute RSI-related worker-compensation claims, even when safety experts cite poor workstations, lack of worker training and medical mismanagement as causes for such injuries.

Even companies that admit RSI problems among their workers say the solutions are not always clear.

“There are many details we don’t understand yet,” said Ron Goodrich, vice president of ergonomic research at IBP. “Why does one person get it, and another person--who does the same thing for years--doesn’t seem to get it?”

Employees too are often confused about the causes of RSI and what to do about it. Office workers, who do not expect to be injured in the modern, computerized workplace, often do not associate their pain with work. Many wait too long to get treatment, and when they finally seek help, they find the road to recovery long and fraught with missteps. Sometimes, they find their careers at a crossroads, with little option but to change jobs or retire.

Some companies--spurred by active unions and growing RSI-related medical costs--are beginning to question the way modern work is organized.

Safety officials at IBP and Ford Motor Co., for example, acknowledge that the mounting costs of RSI have prompted them to take action. Experts estimate that costs for carpal tunnel cases--in lost time, turnover, medical expenses, legal fees and consulting--often range from $20,000 to $100,000 per case. In the auto industry, RSI costs are equivalent to adding 50 cents an hour to each worker’s wages, according to Frank Mirer, health and safety director for the United Auto Workers union.

IBP and Ford recently instituted joint company-union programs to train workers, redesign tools and re-evaluate workstations and tasks that pose particular RSI risks. Such cooperative programs are especially remarkable, experts say, given the longstanding bitterness between labor and management in these industries.

Nevertheless, many workers say such cooperation is not coming soon enough.

One electronic graphics engineer, for example, developed carpal tunnel syndrome four years ago while doing electronic lettering at a computer keyboard--an “unbelievably repetitive” task--for a major television network in Manhattan.

“When you say you hurt, (your supervisors) say, ‘Oh, c’mon,’ ” said the engineer, who asked to remain anonymous. After denying the pain for months, she took medical leave for a month. She was able to return to work, but within six months, the pain returned.

She tried various therapies: hot and cold baths, wrist splints, chiropractic treatments and, finally, surgery. They didn’t help.

Eventually, she quit and became a radio reporter.

She still feels sharp pain that travels, unpredictably, up and down her arm each day. And she continues the 2 1/2-year fight with her former employer, who is challenging her worker’s compensation claim that would require the company to pay for a second carpal tunnel operation.

“I’m not going to quit,” she said, “until they fix my hand.”

RSI is not a new occupational hazard. More than 200 years ago, an Italian physician, Bernadino Ramazinni, reported that serious occupational diseases could develop from “irregular motions and unnatural postures of the body.”

For years, craftsmen have experienced a variety of musculoskeletal disorders associated with their trades: ailments with colloquial labels like fruit-packer’s hand, carpenter’s elbow, bricklayer’s shoulder and stitcher’s wrist. In the early 1900s, telegraph operators reported cases of painful arms and “glass elbow,” similar to many data-processing ailments today.

One reason RSI’s rapid spread into the computerized workplace has stunned employees and employers alike is that people do not expect to be hurt in an office environment, Anderson said. How, after all, could you get hurt sitting down all day, typing at a computer keyboard?

But experts say the shock of computer-related RSI should come as no surprise. Even in the sedentary service sector, they say, the organization of work has followed the traditional industrial model that uses technology to create smaller, repetitive tasks as a means of increasing pace and, ultimately, productivity.

“The increased rate of work is a major cause of these disorders,” Anderson said. Many repetitive work tasks, such as gripping, twisting and reaching, are perfectly normal activities, he said, but what makes them hazardous is “excessive repetition, without giving the body enough time to recover.”

Manufacturers of video display terminals acknowledge RSI problems but say employee postures and work habits are the primary cause, not equipment.

“There are key things people have to be taught about how to adjust their workstation,” said Linden Heck, executive director of the Center for Office Technology, a New York-based association of computer manufacturers and users.

Although figures from the Bureau of Labor Statistics establish the overall incidence rate of cumulative trauma at 10 cases per 10,000 workers, the rates may be much higher in several industries and occupations.

For instance:

* In a recent study of New York City garment workers, one-sixth of 1,000 respondents reported RSI symptoms. That estimate may be low, because language barriers still prevent many Latino and Chinese garment workers from reporting RSI problems, said Becky Plattus, health and safety director for the International Ladies’ Garment Workers Union.

* Although accurate figures are not available, RSI incidence rates for computer operators have reached epidemic levels in many companies, experts say. For example, at the Denver office of U.S. West Communications (formerly Mountain Bell), 187 of the company’s 500 directory assistance operators filed RSI claims in the last three years.

* In meatpacking plants, the RSI incidence rate is 804.5 cases per 10,000 workers, the highest for all industries. Recently, John Morrell & Co. was found to have more than 800 RSI cases among 2,000 workers in one plant alone.

Many experts attribute the growth of RSI cases to an increased awareness and reporting of such cases.

For years, most factory workers never heard of repetitive strain injuries; they simply accepted aches and pains as a part of the job.

“Every morning, I used to pry my fingers apart,” said Frank Casaday, a meatpacker at IBP for more than 20 years and now president of United Food and Commercial Workers International Local 222. “I just considered it part of my morning exercises,” Casaday said.

But many employers continue to view RSI with skepticism.

Even in many white-collar workplaces, the management response to RSI complaints is “often a lot of scoffing,” said David Eisen, research director of the Newspaper Guild.

Over the last four years, cases of RSI have been reported at more than a dozen major newspapers and news services, including Reuters, the Fresno Bee, the Buffalo Evening News, the Manchester Union Leader, Newsday and the Los Angeles Times, where more than 200 of The Times’ 1,100 editorial employees have sought medical help.

The American Newspaper Publishers Assn., a trade group, has issued a set of ergonomic guidelines for VDTs to its 1,400 members. But the association “hasn’t gotten any indication there’s a need for a survey (of RSI problems),” said Ernest King, senior industrial hygienist.

In many workplaces, employees tend to report RSI “only when they feel they have a little bit of support,” said Louis Slesin, editor of VDT News, which monitors health and safety issues related to computer terminals. “People are proud; they don’t want to admit (that they have RSI).”

Although experts acknowledge that there is greater employee awareness of RSI, they add that changes in production methods have increased the actual number of RSI cases.

For example, in the meatpacking industry, butchers used to carve whole carcasses, using many different knife strokes in the course of a day, said Deborah Berkowitz, safety and health director of the Food and Commercial Workers Union. But over the last two decades, the industry transformed the process of butchering beef and hogs into a high-speed conveyor system, where unskilled workers stand side by side, each worker making only one type of cut as many as 8,000 times a day.

The move to small, repetitive tasks helped large meatpackers to dramatically increase production, but also led to “an incredible rise” in RSI cases, Berkowitz said.

Some studies show that women appear to get RSI more often than men. But most experts say that where there are more cases among women, it’s usually because the work force is primarily female, such as in information processing or light assembly of electronics, said Morse, who has been handling RSI cases for 10 years. One exception to this trend, she said, is pregnant women, who seem temporarily more susceptible to carpal tunnel syndrome because of hormonal changes--but pregnancy-related carpal tunnel syndrome will generally disappear within two weeks after childbirth.

Although the use of assembly-line methods partly explains RSI in the workplace, many managers and workers still question why such ailments seem to afflict word processors more than typists years ago. “After all,” said one old-line editor, “I used to bang on a typewriter all the time. How come I didn’t get it?”

Because, experts say, typewriters just didn’t allow typists to type as fast as computer operators can today.

“Typewriters were originally designed to slow people down,” said Richard Littlehailes, president of Keyboard Productivity Inc., a Culver City, Calif.-based consulting firm.

The traditional “QWERTY” keyboard, designed more than 100 years ago, placed mechanical keys in positions that would minimize their chances of striking one another, Littlehailes said. Although typewriters required more force to pound the keys, these actions actually may have been less damaging because they spread the force over a person’s shoulders and arms instead of overworking a small group of tendons in the hands and wrists, he said.

Today’s computer keyboards enable workers to type faster than ever. Beginning secretaries, for example, can type 40% faster than they did a few years ago, “and employers expect it,” said Michael Maki, education director for the New York-based Katherine Gibbs School.

The seductive ease of computers also has enabled employees to spend more time in front of their VDT than they ever did at their typewriters.

“When you’re working on a computer, you never have to get up,” said Sonia Stone, a New York-based consultant specializing in office-automation issues. “You don’t get the mini-breaks you got when typing, like changing paper or moving the advance bar.”

Furthermore, the physical construction of some keyboards may have increased the risk of RSI among many users, said Lillian Malt, president of SkAn Training Services in Surrey, England, and trainer of keyboard operators for 30 years.

Around 1982, several Asian manufacturers introduced keyboards using a cheaper “membrane technology”--that is, circuitry where keys did not “spring back” when touched, Malt said. Computer operators who use membrane keyboards tend to press keys “right down until they hit bottom, sending a shock wave back into the wrist” and thus increasing the potential for RSI, she said.

Although workstation improvements have helped reduce RSI problems for many workers, those who have been forced to stop working are finding recovery to be a long process.

Los Angeles Times reporter Laurie Becklund, for example, has had various problems in her neck, shoulder, forearm and back since she first got RSI five years ago from constant note-taking and typing. Her doctor told her she might never recover; she might have to change careers.

But after her most recent RSI bout--when she was on leave for 10 months--she decided to return to work.

“I try to forget it, do the best I can,” Becklund said. Her twice-weekly therapy keeps her going--”like a boxer,” she said, “getting a rubdown after being in the ring.”

Becklund said she is improving, slowly. But now she sees a subtler, dark side to RSI: “It changes the way you do things,” she said. “It forces you to set out quotas of activities one can handle each day. You have to decide, ‘Do I do the dishes or take notes?’ ”