Getting beyond 'ouch'

Does it hurt when you sit down at the computer? You're not alone. Occupational repetitive strain injury (RSI) is one of the fastest growing workplace injuries, according to the Occupational Safety and Health Administration (OSHA).

Laura Del RossoTravel industry personnel who are likely to suffer the most from RSI are corporate travel agents, who are often more tied to their CRSs than leisure agents, and supplier res agents. According to a speech given by an OSHA official, "one large airline's flight reservation facility, with 650 employees, had 250 cases of RSIs over a two-year period."

We at Travel Weekly do more than sympathize with the computer casualties of the travel industry. We share your pain. As journalists, we're also on the computer a good part of the day. That's why we're leading off this guide to treating RSIs with the story of one of our own who suffered through the syndrome, San Francisco bureau chief Laura Del Rosso.

"Listen to your body" may sound like touchy-feely mumbo jumbo, but it was the best advice I got in 1998. I was covering the ASTA Tourfest in Dallas last January, scribbling notes while ignoring a persistent pain in my right shoulder that shot down my arm and into my hand. As it worsened, I could no longer grip my pen; carrying my purse over my right shoulder became unbearable. I felt cranky and irritable.

I made an appointment to see my doctor, a general practitioner who, suspecting RSI, suggested a call to my workers' compensation insurance carrier, which referred me to an orthopedist. It was difficult to find an orthopedist who would take me immediately, but I finally found one who had a slot open. He gave me a perfunctory look, prescribed a heavy dose of ibuprofen and recommended a physical therapist, Bill Mattmiller, who specializes in office-work-related injuries.

Mattmiller was the best person who could have entered the scene at this point. He turned out to be warm, caring and an expert on RSIs. It was Mattmiller who told me to "listen to your body" and warned me at the start that RSI does not heal quickly. This was advice I did not want to hear, especially with a full travel and reporting assignment schedule ahead of me for the spring.

But Mattmiller was right. Even with strong doses of ibuprofen, a week off from work and then a part-time schedule for two more weeks, my pain was weaker but persistent. He believed the injury was a result of 20 years' work as a reporter, taking notes in longhand, telephone pressed to an ear, and long hours writing at a computer, all the time with poor posture and a maladjusted workstation.

A visit to my office proved him right about my work space. Mattmiller immediately saw the problem. My computer screen was positioned at an angle that required me to turn my head to the left, while the keyboard and the mousepad were placed too high on the desktop. That forced my elbows out, putting pressure on my shoulder and neck muscles.

I needed to install a pull-out drawer for my keyboard to bring it lower than the desktop, and the computer screen had to be adjusted so that I was looking directly at it. Within days, I had made all these changes. But the pain was still there and on some days it was just as bad as it had been, despite deep tissue massage two days a week and other forms of physical therapy that went on for nearly two months (fortunately for me, the cost was paid for by the workers' comp carrier).

On top of that, I followed Mattmiller's stretching and strengthening regimen, a variety of slow, repetitive exercises involving wide rubber bands and weights. I also stopped work for 10 minutes every hour to rest my shoulders, hands and arm. Other techniques I used to bring temporary relief included acupressure massage and soaks in whirlpool baths at my gym.

Meanwhile, I heard scary stories about others suffering from RSI. One neighbor, a computer programmer who was out of work for a year due to the syndrome, lent me some books that told of reporters who had not taken care of their injuries early on. They were permanently disabled, unable to use their hands or work again.

In May (five months after my initial diagnosis), feeling better but still hampered by pain that left me cranky and unable to work for some periods, I decided I simply needed a break from it all. The stress of the injury, compounded by the fear that I might have to give up the work I enjoy, had made me anxious. I took almost my entire vacation time at once -- three weeks- and headed to Europe.

The trip was a turning point. When I returned, feeling relaxed and having been away from phones, computers and even pens, I was free of much of the pain. In the weeks that followed I had one relapse (common occurrence, according to Mattmiller) and took it easy for another week.

Today, I'm relatively pain-free -- but I am careful to follow Mattmiller's advice, stopping work when tingling sensations start. I also take more breaks, faithfully perform stretching exercises, make sure my work area remains properly adjusted and use a speakerphone on long phone calls.

In short, I "listen to my body," which for so long had been giving me signals that I was not working in a healthy way.

Looking for Dr. Right

Once you've identified the pains you have as a possible repetitive strain, you face the next hurdle: finding a doctor who can diagnose your condition competently.

"A large number of my patients have expressed great exasperation in connection with seeking treatment for RSI," writes Dr. Emil Pascarelli in his book "Repetitive Strain Injury." "They tell me the [first] doctors [they saw] treated them like children; the exam was too short; the doctors were arrogant or cynical or told them to do something inappropriate, such as go back to work when they were in too much pain to touch a keyboard."

A doctor's prescription is a requirement before you can start receiving physical therapy, which is the usual treatment for RSI.

In your search for the right doctor, Dr. Pascarelli suggests looking to "knowledgeable friends, RSI support group members or recommendations from a facility that is known for interest in occupational medicine or one that treats musicians or athletes, who often have problems similar to computer users. "Keep asking. If the same name keeps coming up, chances are that person may be very good," he said.

Also remember that many different kinds of doctors are qualified to diagnose this condition, including orthopedists, hand surgeons, neurologists, occupational medicine doctors, physiatrists, rheumatologists, internists and family practitioners.

Ergonomic elements

Besides physical therapy, another important factor in treatment for RSI is setting up your work space so you don't have to strain while using the phone or computer. One good Web site to check out on this topic is www.pc.ibm.com/us/healthycomputing.

Two basic pieces of equipment for a healthy work space are a comfy chair with enough support for your back and a phone headset, essential if you often type while on the phone.

For more help, consider a consultation with an ergonomic specialist such as an occupational therapist to really fine-tune your work space.

Warning signs of RSI

RSI BookAccording to the book "Repetitive Strain Injury," the following are all signs that you could have a problem with RSI and should be checked out with a visit to the doctor's office:

l Chronic pain almost anywhere in the body's upper extremities.

This pain can be experienced as burning, aching or shooting, restricted to small sites, such as fingertips, or settled over a broad area, such as the forearms.

This pain can be there when you work or even when you're at rest; it can even wake you up at night.

  • Fatigue, lack of endurance and/or weakness in the hands or forearms.
  • These symptoms can make it difficult to do things most of us never think twice about, such as lifting wet laundry out of the washing machine or lugging a shopping bag.

  • Tingling, numbness or loss of sensation.
  • Clumsiness. If you find yourself continually dropping things, or find yourself having to concentrate actively on something that should be automatic, such as holding on to your coffee mug, you might have RSI.
  • Stiffness; difficulty opening and closing hands or using hands at all.
  • Lack of control or coordination of your hands or fingers; the feeling that your fingers aren't doing what you want them to, or that you've lost control of them could be a signal that you have RSI.
  • Hypersensitivity. Watch out for tenderness to the touch, the feeling that you're wearing a bracelet when you're not or a burning sensation.
  • Chronically cold hands -- especially in the fingertips -- can signal a distorted nerve function.
  • Published by John Wiley, "Repetitive Strain Injury" was written by Dr. Emil Pascarelli and Deborah Quilter and costs $16.95.

    Time for a name change?

    Here is another of Richard Turen's marketing minutes:

    Richard TurenSeveral years ago, I listened to a dynamic speaker address a huge agent gathering. He asked audience members to "close your eyes, reach into your wallet or purse and extract a single business card." I watched as 3,000 agents did this.

    "Now, I want you to hold the card between your right thumb and forefinger, then hold it two inches or so away from your eye," he said. What is this guy's point, I wondered. "Now, I want all of you to slowly open your eyes, read your card and look at the silly names you have picked for your businesses."

    The audience laughed, but the guy had a point. Go to any yellow pages in any U.S. city and you will see the same interchangeable names for the travel agencies listed. Is it time for you to think of a better name for your business?

    Richard Turen is managing director of the Churchill Group, a sales and marketing consulting firm, as well as president of the agency Churchill & Turen Ltd., both based in Naperville, Ill. Contact him at [email protected]

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