NEW YORK (AP) - Can a workplace epidemic be cured?
With the personal computing boom of the 1990s came thousands of "repetitive
stress injuries" or "repetitive strain injuries." RSI became the hip medical
acronym of the keyboard era, with subset carpal tunnel syndrome the diagnosis of
the day.
"At its height of diagnosis, anybody showing up at a doctor's office with
wrist pain or hand pain was being diagnosed with carpal tunnel," said Carol
Harnett, vice president of insurer Hartford Financial Services Group Inc.'s
group benefits division.
Since then, carpal tunnel cases have plummeted, declining 21 percent in 2006
alone, according to the Bureau of Labor Statistics. Among workers in
professional and business services, the number of carpal tunnel syndrome cases
fell by half between 2005 and 2006.
What changed?
First, it may not have been the white-collar epidemic it appeared to be.
A 2001 study by the Mayo Clinic found heavy computer users (up to seven
hours a day) had the same rate of carpal tunnel as the general population.
Harvard University headlined a 2005 press release "Computer use deleted as
carpal tunnel syndrome cause."
"Clearly, if keyboarding activities were a significant risk for carpal
tunnel, we should have seen, over the last ten to 15 years, an explosion of
cases," said Dr. Kurt Hegmann, director, the Rocky Mountain Center for
Occupational & Environmental Health. "If keyboarding were a risk, it cannot be a
strong factor."
Blue-collar workers, especially those doing assembly-line work such as
sewing, cleaning and meat or poultry packing, have a far greater incidence of
carpal tunnel than white-collar workers, according to Bureau of Labor Statistics
data.
That doesn't mean white-collar workers don't get carpal tunnel and related
disorders. But it may mean such disorders were overdiagnosed when they were most
in the news, resulting in an artificially high number of cases by the late
1990s. Most doctors have dropped the term RSI, calling them "musculoskeletal
disorders" while government agencies like "cumulative trauma disorders."
Now, some experts think some of those patients had "referred pain" from
trouble elsewhere, such as the neck. Other theories claim attention to
ergonomics has prevented injuries or that they have become underreported because
they lack the immediacy of a broken bone.
At the height of RSI-fever, it was hard to avoid. The National Institute for
Occupational Safety and Health received three times as many requests for health
and hazard evaluations related to wrist pain in 1992 than it did in 1982. During
1998, an estimated three of every 10,000 workers lost time from work because of
carpal tunnel syndrome, according to the National Institutes of Health.
People who've had a cumulative trauma disorder say it can be debilitating.
Clay Scott, now an assistant professor of electrical engineering and computer
science at the University of Michigan, developed severe wrist pain during
college at Harvard University. By the end of his senior year, he said he was
incapable of doing daily tasks like cutting food and opening doors.
His recovery started with physical therapy a few times a week and a home
exercise program to stretch and strengthen his back and neck muscles. It took
three or four years for him to recover, he said.
"I was hurting myself for about two years before figuring it out and
realizing I needed to change my work habits," he said.
Some businesses have been focusing on prevention, part of a growing effort
by employers to keep their workers healthy.
Outdoor clothing company L.L. Bean, Inc. shuts down its manufacturing line
three times a day for mandatory five-minute stretches. Retailer Replacements
Ltd. also runs on-the-clock group stretches as well as a fitness-walking
program.
Blue Cross Blue Shield of Kansas started a program in 1991, when costs of
the injuries to its employees passed $500,000. It bought ergonomic chairs and
desks, introduced ergonomic assessments for new employees during their first two
weeks of work and hired two full-time registered nurses to work with employees.
Since the program started, the company's workers' compensation costs have
fallen by 62 percent, said Terri Janda, a nurse who leads the Blue Cross
program.
As companies worked on interventions, ergonomics became cool. Auto companies
advertised their cars' ergonomic features. Salons installed ergonomic hair
washing stations. Everyone with a desk got a keyboard tray.
The Federal Occupational Safety and Health Administration introduced
ergonomic standards in 2000, which were assailed by businesses claiming the
standards would cost them somewhere between $20 billion and $100 billion to
implement. The standard was overturned by Congress in 2001.
The loud politics around the standards got businesses interested in starting
their own ergonomic programs. The standards were "a huge marketing campaign for
us," said Mike Wynn, vice president at Humantech, an ergonomics consultant based
in Ann Arbor, Mich.
"Since the standard was rescinded, companies have approached ergonomics as a
business improvement, not a regulatory compliance issue," he said. "Companies
are much more ambitious about improving ergonomics than they ever would have
been with OSHA breathing down their necks."
Said Barbara Silverstein, research director at the Washington State
Department of Labor and Industries, "People have gotten the message about how to
design work, so people aren't as at risk as in the past." California is the only
state with a state ergonomic standard, according to OSHA.
But Dr. Hegmann, sounds a note of caution. While it's possible that
improvements in factories and offices may be behind the decrease in cases,
another possibility is that existing cases aren't always reported, he said.
As carpal tunnel is strongly linked with aging, obesity and diabetes, "it
means we should have more cases than we have." Some of the reduction in cases,
he said, "may be due to the realization that it's a common situation; there's no
rush to do anything about it."
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