I am very concerned that I could be developing RSI. What can I do, and what treatments either conventional or alternative have proven to be of use? EB, Swindon.....
Repetitive Strain Injury (RSI) has become an epidemic. The National Institute of Occupational Safety and Health in the US estimates that the problem has increased from 18 per cent to 56 per cent of all workplace maladies in less than 10 years. RSI now accounts for over half of all worker compensation claims.
This increase is pretty much down to the use of the computer. "Without stepped up keys to reach, paper to change or a carriage to push, computer typists get no breaks from activity that is drastically confined to the wrist and forearms," explains Dr Alan Hedge, director of ergonomic research at Cornell University, New York.
Despite its prevalence, there still remains a hard core of GPs who refuse to recognise RSI as anything more than yet another psychosomatic disorder, mainly because there is little supportive epidemiological or pathological evidence.
They can also be a bit sniffy about the language. RSI is not a medical definition; it is a layman's term for a range of symptoms affecting the muscles, nerves and tendons of the upper limbs which is collectively known by your doctor as carpal tunnel syndrome (CTS), bursitis or tendonitis, to name but three.
Your other problem is political. Doctors and, it's rumoured, UK government health agencies are reticent to recognise and diagnose a condition that can lead to expensive, and sometimes disputed, claims against employers.
Assuming you overcome all this and can find yourself a sympathetic doctor, there is a limited amount he can offer. Depending on the severity of the condition, he might prescribe an anti inflammatory, a diuretic or steroids.
Of the three, steroids seem to be the most effective, according to one double blind placebo study (Neurology, 1998; 51: 390-3).
In another study, the steroid prednisone offered rapid and effective relief for the first eight weeks only (Neurology, 1995; 45: 1923-5). This finding was also observed in another study involving 32 carpal-tunnel-syndrome patients, which found that the benefits of steroids were "transient" (J Neurol, 1993; 240: 187-90).
Your GP might also tell you to stop whatever's causing the RSI. Good advice, in fact, and by far the best thing to do is to stop it before it really starts. Once it takes hold, full recovery is uncertain and may go on for a very long time, irrespective of the treatment, conventional or alternative.
If you're getting early warning signals, such as numbness or tingling around the thumb or fingers, you must find a way to curb the activity. Even if you can't take time off work, learn to break up the day and walk away from the keyboards once an hour or so, or vary the workload so that you are not constantly keying in.
You also need to get advice about posture and the positioning of the keyboard and screen. The desk should be at an appropriate height without a sharp leading edge, and the keyboard should be spaced 8 to 10 cm away from the desk's leading edge.
Finally, try and use an ergonomically designed chair that makes your back do more of the work and prevents slouching. A good source is Back in Action (3 Quoiting Square, Oxford Road, Marlow, Bucks SL7 2NH; tel: 01628 477177).
There might also be a method of early detection, even before the tingling begins. Dr Bruce Lynn of University College Hospital in London and physiotherapist Jane Greening have used a machine called a vibrametre, produced by Somedic in Stockholm, Sweden, which detects a change in the nerve vibrations among typists who may go on to suffer RSI (Int Arch Occup Environ Health, 1998; 71: 29-34).