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The modern office has left many employees with little variation in their daily tasks. "Instead of running to the file cabinet to pull out information or going to the library, workers can do everything they need to by just sitting at the keyboard," says Silverstein. "They don't even have to get up to talk to each other. Now they have electronic messaging." Even today's phones with push buttons instead of dials strain the same tired tendons.
Computer makers defend their machines vigorously. They stress that the problem lies not with their keyboards but with how they are used. They also point out that other office equipment, such as chairs and desks, must be designed ergonomically, which means that they fit the individual's body and specific job needs. Says IBM spokesperson Brian Doyle: "IBM's position is that aches and pains in the workplace can come from a number of sources, including posture, adjustment of equipment and the amount of time spent performing a given task. Applying good work habits and good ergonomic principles is a shared responsibility of both employers and employees."
But U.S. employers have so far done a poor job of shouldering this responsibility. Chairs, desks, lighting are chosen more on the basis of price or decorating schemes than ergonomics. "We're just not doing as much as we could," says Michael Smith, professor of industrial engineering at the University of Wisconisin. Several other countries are further along in protecting workers. Sweden, for example, has had a strict ergonomic standard since 1979, and in Germany insurance companies scale back benefits to companies that do not adequately guard against RSI.
Admittedly, personal traits and habits often influence who will develop RSI. A pioneer in treating the injuries, Dr. Emil Pascarelli, medical director of New York City's Miller Institute at St. Luke's-Roosevelt Hospital, points out how very heavy people can get into trouble. For their hands to reach the keyboard, they have to maneuver their arms around their own girth, and wind up contorting their wrists inward. Double-jointedness can also be a risk factor. Smokers may have fewer injuries, thanks to their periodic breaks away from the terminal to satisfy nicotine cravings. And what goes on outside the office can be just as damaging as what happens in it. Observes Katy Keller, a physical therapist at the Miller Institute: "Injured people go home and talk on the telephone, stir the supper and carry the baby all at the same time. All this does is add to the physical stress of the workday."
For many workers, physical stress is just part of the problem. A three-year study by the National Institute for Occupational Safety and Health of telephone workers at U.S. West Communications found that 111 out of 518 employees who used computers had RSI. The most revealing discovery was that all the sufferers reported high levels of psychological strain, such as job insecurity and pressures to work fast. Psychological stress probably does its mischief by creating muscle tension, which reduces blood flow to hard-working muscles and tendons; without enough oxygen, these tissues become fatigued and prone to injury.