Doctor urges computer athletes to exercise good sense

Dana Greenlee discusses repetitive stress injuries and carpel tunnel syndrome with Dr. Emil Pascarelli.

Editor’s Note: Dana Greenlee’s technology column is appearing a day early this week in order to make room for a story in tomorrow’s paper.

Most computer users don’t think of themselves as athletes, but computing is strenuous activity.

One physician I know compares it to laying bricks.

You need to be in top condition to avoid injuries.

Approximately 2 million US workers suffer from repetitive strain injuries, including carpel tunnel syndrome.

In many businesses that demand long hours of banging at a keyboard and clicking a plastic mouse, victims of repetitive stress injuries bring more misery upon themselves with every keystroke.

And that pain brings a chilling fear that a career may be over sooner than desired.

Dr. Emil Pascarelli, author of “Repetitive Strain Injury: A Computer User’s Guide,” says to forget the weak geek generality for all us computer cowboys.

“We’re all computer athletes,” he says. Like all athletes, playing our game can result in wear and tear and strain. Work can hurt, if you don’t take care.

Pascarelli is also Emeritus Professor of Clinical Medicine at the College of Physicians and Surgeons of Columbia University and Associate Professor of Clinical Public Health at the New York Hospital Cornell Medical Center.

Pascarelli explains how to make work less of a strain on our aching compressed carpel tunnel nerves.

Q: How did you gain so much knowledge on repetitive strain injuries like carpel tunnel syndrome?

A: I started out as a hospital physician in ambulatory care.

I was asked to start a program for the treatment of musicians because we were right near Carnegie Hall.

And lo and behold we were swamped with people with computer injuries and that’s how I got into this since 1985.

Q: What have you learned from your studies and experience?

A: I wanted to clarify things about repetitive strain injuries (RSI) and wrote a recent article in the Journal of Occupational Rehabilitation on a study I conducted.

What I did was examine very thoroughly 485 computer users, musicians and others who engaged in repetitive activities.

This article focuses on the need for complete physical exam, which is rarely done.

Most of the early presenting symptoms are in the hands, hands and fingers so there’s a tendency to call it regional arm pain, but the origins are further up in the nervous system, in the neck and shoulders.

For time and cost savings purposes, workman’s comp usually doesn’t cover a complete exam.

Q: When do we start seeing these symptoms arise?

A: It appears the mean age is 38 years old.

Q: Does working all day at a computer cause the strain to be worse?

A: My posture will continue to deteriorate unless I do postural exercises and some athletic training – because I’m essentially a computer athlete.
If I’m spending 4-8 hours a day at a computer – well, very few athletes run 4-8 hours a day.

You have to do something to prevent the time-related deterioration of your posture and its effect on the nervous system.

Q: Can you give us some holistic tips to help?

A: Strengthening of the upper back is vital.

At the gym you tend to see people on bicycles and treadmills and very little upper body exercise takes place. If it does, it’s not in the scapula area.

You have to do a combination of strengthening the upper back, particularly the neck and shoulders, along with stretches because we tend to tighten up.

If we free up our muscles from constant repetitive motion, we allow the muscles in the arms to regenerate properly.

Q: What actually happens inside our bodies when we keyboard all day?

A: As we type, we burn up the type-2 muscle fiber, a fast-twitch fiber that is necessary of those rapid keying movements.

Carpel tunnel results from the forearm muscle tightening. I’ve never seen a carpel tunnel patient able to bend his wrist normally.

Stretching and massaging those muscles and releasing the pressure on the wrist can conservatively turn around a case of carpel tunnel syndrome.

Q: We can always opt for the operation, right?

A: Typically we don’t see them do particularly well after these operations in the long term.

Q: What are some symptoms to watch out for?

A: About 20 percent of the people with repetitive strain injuries have cold hands.

What it is the overactivity of the sympathetic nerves.

These people have more difficulty getting better because of poor circulation.

Q: Are splints a good idea to wear?

A: Splints make matters worse. Particularly do not wear splints while typing.

Q: What is the difference between carpel tunnel syndrome and repetitive strain injury?

A: Carpel tunnel syndrome is only a part of a whole series of symptoms occurring with people with accumulated trauma, but a small part – about 8 percent in this study.

For example, postural misalignment is 78 percent.

The nerve compression and traction problems are 70 percent.

A fairly common nerve impingement problem in the elbow occurs among 64 percent of the people with repetitive strain injury, due to the way arms are held or when you’re leaning on the nerve.

Q: Where would we feel pain?

A: Carpel tunnel syndrome is either a traction or compression of the median nerve supplying the thumb, the index finger and part of the middle finger and the base of the palm. You’d feel pain or tingling in those areas.

The muscles in the forearm shorten and a you experience a loss of wrist range motion.

Q: What can a person do to solve the problem?

A: First, get into a fitness program. Postural retraining is critical for the upper back.

Stretch the neck, shoulders, arms, and wrists. A 15-minute rest break every hour is great, as is a good diet.

A downward tilt of the keyboard is very desirable, keeping the wrists in the straight, neutral position.

The elbow should be in an open angle, not the 90-degree angle like we’re usually shown.

Look slightly downward, 20-degree angle at the computer screen and your visual acuity will increase, too.

Remember, you are really a computer athlete and to do this kind of work you need to keep in shape.

Dr. Emil Pascarelli’s book, “Repetitive Strain Injury: A Computer User’s Guide,” is available at bookstores and Amazon.com. You can listen to the full audio interview with Dr. Pascarelli online at www.webtalkguys.com.

Dana Greenlee is producer and co-host of the WebTalkGuys Radio Show. WebTalkGuys, a University Place-based talk show featuring technology news and interviews. It is broadcast on CNET Radio in San Francisco, on the Web at CNET Radio, WebTalkGuys Radio, Sonic Box and via the XM satellite network and the telephone via the Mobile Broadcast Network. Past show and interviews are also Webcast via the Internet at www.webtalkguys.com. PC World magazine names WebTalkGuys “Best of Today’s Web Hidden Gems” in their August 2002 issue.

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