Repetitive stress injuries in industrial workers, their effects & management

By Debadutta Mishra

The incidence of occupationally induced upper and lower extremity disorders, often referred to as Repetitive Strain Injury (RSI), has increased dramatically in the last decade, which may be because of a technology and industry driven life style. A number of prospective studies which conceptualize RSI as a complex biopsychosocial phenomenon framed within a chronic pain model offer some insights into the importance of a multidisciplinary, multifactorial approach to its treatment. Occupational therapists play a major role in contributing significantly in enhancing the health of the worker in the workplace through participation in a team approach to treatment and in health promotion through workplace education with a view to prevention.

What is RSI?
The term “repetitive strain injury” is most commonly used to refer to patients in whom there is no discrete, objective, patho-physiology that corresponds with the pain complaints. It may also be used as an umbrella term incorporating other discrete diagnoses that have been associated with activity-related arm pain such as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, DeQuervain’s syndrome, stenosing tenosynovitis/trigger finger/thumb, intersection syndrome, Golfer’s elbow (medial epicondylosis), Tennis elbow (lateral epicondylosis), and focal dystonia.

Although tendinitis and tenosynovitis are discrete pathophysiological processes, they are also terms that doctors often use to refer to non-specific or medically unexplained pain, which they theorize may be caused due to unknown reason.

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In a research carried out by Dr. Saran a Repetitive Strain Injury Specialist the following results were obtained;

1. Factory workers, Office workers, especially IT professionals are highly predisposed to RSI.
2. Nurses, teachers, housewives, musicians and students are also highly prone to RSI.
3. 75% of 5000 Indian Computer Users studied by our team reported pain/numbness.
4. Over 30 young Indian IT/ITES Professionals have lost their jobs because of advanced Repetitive Strain Injury (RSI).
5. 55% of Indian Computer Users got injured within a year of starting their first job.

6. Some types of RSI are responsible for up to 85% of all instances of musculoskeletal pain in all age groups.

Rationale

1. Early identification of RSI and competent medical intervention is critical to arrest and reverse the injury in its early stages.

2. Unfortunately, Indian medical professionals (in general) are not equipped to diagnose or treat RSI’s, since it is a relatively recent phenomenon in India and no training courses for doctors and physiotherapists exist. Ergonomics, RSI and Myofascial Disorders do not even find a passing mention in the Indian Medical Curriculum.

3. As things stand in India at the moment, Physical/Occupational Therapists are just trained to be technicians to operate Ultrasound, IFT or Diathermy machines, and advise a few perfunctory exercises. There is an acute need for rehabilitation professionals who can offer effective (hands on or manual) therapy other than the run of the mill physiotherapy abundantly available.

4. Currently no other clinic in India offers such a comprehensive prevention and treatment package for RSI and other soft tissue disorders.

Work in an industrial set-up includes not just piecework on an assembly line but also product inspection and packaging, operation of heavy machinery, and activities like commercial baking, cabinet making, and building tires. Manual handling covers everything from bagging groceries and delivering packages to lifting and caring Injury is often the result of a mismatch between the demands of the work tasks and the worker’s ability to meet those demands. A worker may be physically overloaded by the necessity of repeating one motion thousands of times during a shift. Occupational health care of industrial workers is no longer a matter of welfare, but has been proved to be related to growth, productivity and national prosperity.

General causes of repetitive strain injuries
A non-exhaustive list of contributory factors towards the emergence of repetitive strain injuries is as follows:

1. An overuse of the muscles on a continued repetitive basis
2. Cold temperatures
3. Vibrating equipment
4. Forceful activities
5. Poor posture or a badly organised work area that is not ergonomically sound
6. Holding the same posture on a continuous basis
7. Prolonged periods of work without a break
8. Stress has been proven to increase the incidence of repetitive strain injuries
9. Direct pressure or a blow to the body
10. Carrying heavy loads on a repeated basis
11.Fatigue

Types of repetitive strain injuries
Each type of RSI will be caused by the breakdown in a specific bodily function, which has been caused by one (or many) of the factors that have been listed above. Here is a list of variety of conditions arising due to repetitive strain injuries.

1. Bursitis
2. Cubital tunnel syndrome
3. DeQuervain’s syndrome
4. Diffuse RSI
5. Dupuytren’s contracture
6. Dystonia (writers cramp)
7. Epicondylitis
8. Gamekeeper’s thumb
9. Ganglion
10. Raynauds disease
11. Tendinitis
12. Tenosynovitis
13. Thoracic outlet syndrome

Effects
1. Pain, tingling, sensory deficits or loss of function
2. Loss of strength or loss of mobility in the arms, legs or trunk
3. Loss of balance or other problems with walking and general mobility skills
4. Speech or memory difficulties following a stroke or other medical problem
5. Difficulty with dressing, bathing, cooking or other activities of daily living
6. Loss of confidence in returning back to work after even medical treatment id over
7. Loss of attention/concentration from a particular job/task.

Management
Repetitive Stress Injuries can be prevented and managed by Occupational Therapy interventions in which a regular check up and assessment of Individual Musculoskeletal consultation shall be carried out at individual workstations and the ergonomics and workplace design is also assessed and modified if necessary. Along with occupational therapy procedures other musculoskeletal treatment such as myotherapy, neuromuscular therapy, trigger point therapy, myofascial release, muscle energy techniques, positional release techniques, soft tissue mobilization, taping and adjunctive techniques are also applied. Ergonomic assessment at work places and ergonomic modifications of furnitures, training of postural correction etc. plays important role. Occupational therapists can help patients with these disorders practice “joint protection.” Patients can learn to use their hands in non-deforming positions. RSI may be avoidable through proper work habits – including posture, wrist position and regular work breaks – as well as ergonomically designed workstations and keyboards. Group training and education of contributory and perpetuating factors for RSI (posture, diet, stress, habits, etc.) is required to be given separately for factory workers, computer users, office workers, and all staff. A RSI treatment/management centre adjacent to the work place of employees of a firm/factory is of much help which will prevent loss of work hours in going to hospitals frequently for undergoing treatment. Training of other doctors & therapists and research to identify the causes and results of treatment of RSI is also equally important to management of this disabling condition.

(Debadutta Mishra, Rehabilitation Consultant, Jindal Steel & Power Limited, Raigarh (C.G.)