Computer-Related Repetitive Stress Injuries

About Repetitive Stress Injuries

Repetitive stress injuries (RSIs) are conditions caused by placing too much stress on a joint, and they vary in type and severity. Most RSIs are linked to the stress of repetitive motions at the computer or overuse injuries in sports. RSI in kids may occur from heavy computer or video game use, texting, playing musical instruments, or the repetitive motion of sports like tennis.

An RSI occurs when stress is placed on a joint, pulling on the tendons and muscles around the joint. When the stress occurs repeatedly, the body does not have time to recover and becomes irritated. The body reacts to the irritation by increasing the amount of fluid in that area to reduce the stress placed on the tendon or muscle.

Conditions that are the result of RSIs include:

• Carpal tunnel syndrome: swelling inside a narrow "tunnel" formed by bone and ligament in the wrist; the tunnel surrounds nerves that conduct sensory and motor impulses to and from the hand, leading to pain, tingling, and numbness
• Cervical radiculopathy: disk compression in the neck, often caused by repetitive cradling of a phone on the shoulder
• Epicondylitis: elbow soreness often called "tennis elbow"
• Ganglion cyst: swelling or lump in the wrist resulting from jelly-like substance that has leaked from a joint or tendon sheath
• Reflex sympathetic dystrophy: a condition characterized by dry, swollen hands and loss of muscle control; consistently painful
• Tendonitis: tearing and inflammation of tendons connecting bones to muscles

Fortunately, only a small percentage of kids have RSI. You can help prevent RSI by taking preventive measures and redesigning your home computer environment.

Preventing RSIs

Preventive measures can help kids avoid RSIs altogether:

• Always remind kids to sit up straight. Slouching or crouching over the keyboard can place undue stress upon the neck, back, or spine and lead to an RSI.
• Tell kids to avoid tensing their shoulders.
• Legs should be positioned comfortably and feet should be flat on the floor or on a footrest with the legs and hips perpendicular (between 90-100 degrees) relative to the spine.

Remind kids that pounding on the keyboard is unnecessary and can hurt both them and the keyboard! Using a light touch to type is best. Also, be sure that they don't reach for the keys; if so, the keyboard should be moved closer. Kids should maintain a 90-degree angle between the wrists and elbows and the upper part of the arms. Fingers and wrists should remain level while typing.

Taking frequent breaks is also a important to preventing RSIs. Kids can lose track of time and forget to take breaks, so make sure they rest their eyes, back, wrists, and neck every half hour or so.

Stretching, getting a snack or a drink, or walking or taking a bike ride can help kids avoid future pain. Eye twitching; sore, tired, burning, itching, or dry eyes; blurred or double vision; and increased sensitivity to light are all symptoms of eyestrain, so tell kids to look away from the computer and focus on something far away every once in a while. Proper lighting of the workspace will also help to prevent eyestrain.

Finally, set a good example yourself. If you stare at a computer screen in dim lighting for hours without taking a break, kids will get the message that it's OK.

Many times, RSIs are caused by using the wrong tool for the job. Because most computer systems are designed for the body of a 25-year-old man, be sure to get chairs, monitors, input devices, and keyboards that are suitable for your kids' size.

Getting Ergonomic

Proper computer placement, correct typing and sitting positions, and well-designed furniture will make your computer environment ergonomic (which means to make equipment use less fatiguing and uncomfortable) and prevent RSIs.

In computer usage — as with other equipment — the goal is to decrease both force and repetition, to ensure adequate rest breaks, and to achieve good positioning and good support.

Computer furniture can prove to be an ergonomic hazard if it does not adjust to promote good posture and hand positions. Don't put your new computer on a discarded desk with an old kitchen chair pulled up to it because these products don't give proper support.

Go for maximum adjustability in the set-up — from the desk and chair height to the position of the keyboard relative to the elbows and trunk to the height of the monitor — because kids come in all different heights and sizes.

These guidelines will help you make your family's workplace ergonomically correct:

• Leg position: legs should be positioned comfortably, feet should be flat on the floor or on a footrest, with the legs and hips perpendicular (between 90 and 100 degrees) relative to the spine.
• Chair position: if the computer is used by more than one person, a chair that's comfortable is not the only consideration — you should be able to adjust its height, back angle, and armrest.
• Back position: the small of the back should be supported with an adjustable lumbar support.
• Wrist angle: wrists should be in a neutral position for typing or using the mouse, not overly flexed or extended. A wrist rest can keep the hands in the neutral position.
• Elbow angle: the angle of the elbows should be 90 degrees relative to the upper arms. The elbows should be close to the side of the body so kids won't bend their wrists to the side when typing.
• Monitor position: the top of the monitor screen should be aligned with the computer user's forehead. Kids should sit about 2 feet from the screen. If the monitor is used by the entire family, get one that is easily adjustable.
• Keyboard height: the keyboard should be about 27 to 29 inches above the floor, and adjustable so it can be higher for taller people and lower for shorter people.
• Foot position: feet should rest comfortably on the floor. A raised footrest can help smaller people attain an ergonomically correct position.

Some keyboards feature function keys arranged in a convenient circular format, rather than on the side or top of the keyboard in rows or columns. Many have a "curved" or split design that promotes what ergonomists believe is a more natural position for hands and wrists, with the palms turned slightly toward each other (a position knows as pronation), rather than flat relative to the keyboard. In addition, a trackball can be substituted for a mouse.

Also, sitting on a therapy/gym ball can help encourage good posture.

Treatment of RSIs

Repetitive strain (also called cumulative trauma) symptoms include tingling, numbness, and searing pain, which indicate the presence of progressive nerve and muscle damage. If your child complains of excessive fatigue or stiffness in the neck or back or any of these other symptoms, a visit to the doctor is in order.

Treatments for RSI vary; your doctor may prescribe cold treatments to reduce swelling and pain and rest to reduce irritation and speed up healing. Once the swelling and pain has gone away, the doctor may suggest a rehabilitation program to exercise the muscles slowly and prevent loss of movement in the joint. Another part of treatment might be anti-inflammatory medication to reduce the pain.

Parents can install keyboard trays, pads, or alternative curved keyboards; change the location or position of seating, and the height of desks and keyboards; or adjust the height of computer screens and video monitors to create an ergonomically correct work station for the whole family.

Given the importance of computers in our everyday lives, parents and kids should strive to make adjustments to their computer environments to keep themselves healthy.

Reviewed by: Wendy Harron, BS, OTR/L
Date reviewed: November 2011
Originally reviewed by: Kimberly S. Pierson, OTR/L