Computer Ergonomics - Avoiding MSD and RSI

Introduction
In 2001, the Occupational Safety and Health Administration (OSHA) of the United States had scheduled a new safety regulation for computer workers to go into effect in the Fall of that year. This regulation addressed the risks of physical injuries associated with computer usage (see "What Is MSD/RSI?"). The regulation required employers to provide employees with information and training on how to avoid such injuries - specifically, OSHA directed employers to provide all employees with a printed booklet and classroom instruction on risks, symptoms, and prevention. A client company gave Matthew Harris the task of preparing a printed booklet and training curricula in compliance with the new OSHA regulation. This article is a revised version of the safety booklet prepared in accordance with the OSHA requirements.

What Is MSD & RSI?

Musculo-Skeletal Disorder (MSD) is a blanket term for illnesses and diseases of the muscles, tendons, skeleton, and connective tissues, such as tendonitis. Repetitive Stress Injury (RSI) is a type of MSD, and refers to injuries to the muscles, bones, or connective tissues caused by repetitive motions. Carpal Tunnel Syndrome is an example of a common RSI. MSD and RSI injuries can take many forms, and can affect any part of the human structure; typically in the hands, shoulders, neck, spine, knees, or ankles.
What Causes MSD/RSI?

Repetitive Stress Injury (RSI) occurs when a person performs the same motion over and over; especially if the motion is performed intensely over a long period of time and involves awkward body positions and/or application of force. Long periods of typing, improper workstation setup, incorrect work habits and/or problems in your personal health may be linked to MSD or RSI. When you work muscles intensely, the individual cells in your muscles produce waste products faster than your circulatory system can carry them away. The cell waste products, called fatigue poisons, build up in the muscle and other body tissues, and cause swelling. In turn, the swelling reduces circulation, and causes a further build-up of fatigue poisons, resulting in further swelling which reduces circulation even more, and so on in a vicious cycle. Swelling in muscles and connective tissues often puts pressure on nerve pathways, resulting in temporary or permanent damage to the nerves. As an example, a common type of RSI is Carpal Tunnel Syndrome. The tendons that move your fingers pass through small tunnels in the carpal bones at the back of your hands (hence the name carpal tunnel syndrome). When your hands are overworked, the tissues around the carpal tendons swell, and the tendons become too large to move freely through their bone tunnels; the tendons

Computer Ergonomics - Avoiding MSD and RSI

then scrape against the bone and pinch the nerves that share the carpal tunnel with the tendons. The result is a painful, crippling loss of mobility and control of the hands. Other types of MSD have similar causes, mostly related to a lack of circulation. For example, constant vibration can drive blood away from the part of the body experiencing the vibration, resulting in tissue and nerve damage. Some types of MSD, however, are caused by a lack of motion. The joints of the human body, like the moving parts of machinery, must be lubricated for the joint to move freely. Although the human body produces its own internal lubrication for the skeleton's joints, movement of the joint is necessary for the lubrication to be spread over the bearing surfaces. If you don't move the various joints in your body through their full range of motion, the available range of motion tends to become less.
Who gets MSD/RSI?

Young or old, anyone in any occupation can get MSD or RSI. Although we currently most hear about RSI related to computer work, you can get RSI or other MSD from any sort of work, and even from your hobby and recreational activities. For example, RSI has been a problem afflicting assembly-line workers for over a century now. Piano players have been known to get Carpal Tunnel Syndrome, and there is an MSD known as "bassoon finger" caused by the fact that bassoon players support most of the weight of their instrument with one finger of one hand when playing. Motorcyclists are subject to an MSD known as "tingle-finger" which is caused by vibration in the handlebars the vibration drives blood out of the fingers, resulting in nerve and tissue damage in the hands. In recent years, teenagers are being diagnosed with a malady known as "texter's thumb", caused by using one's thumbs for too much typing. Carpenters, engineers, painters, sculptors, drafters, programmers, designers, students anyone at all can be at risk for MSD/RSI.
MSD/RSI Symptoms & Warning Signs

The symptoms and warning signs of MSD/RSI usually appear in the hands, wrists, arms, shoulders, neck, or back. Symptoms include:

Pain Numbness Tingling Throbbing Weakness Swelling

Burning Soreness Aching Cramping Stiffness

Computer Ergonomics - Avoiding MSD and RSI

You may feel such symptoms when typing, using a mouse, drawing, or any number of other activities. You may also experience these symptoms when you're not engaged in the activity responsible for the injury, such as at night. If you experience any of the symptoms listed, or any other pain or discomfort you think is related to an RSI, you should promptly consult a doctor.
Additional Risk Factors For MSD/RSI

Your ability to avoid MSD/RSI while working or pursuing recreational activities can be affected by your general state of health. Some factors that have been shown to increase an individual's risk for MSD/RSI are listed below.

Inflammatory disease, such as arthritis Diabetes Excessive weight Hypertension Stress Smoking Conditions affecting hormone levels, such as pregnancy or menopause Advancing age General poor physical condition

In the preceding list, notice that most of the complicating factors are related to conditions that may impede blood circulation. Use of tobacco products, for example, puts nicotine in your system. Nicotine is a vasoconstrictor drug, and reduces blood circulation in the extremities, hence increasing the risk of RSI such as Carpal Tunnel Syndrome. The remainder of this article describes proper computer workstation setup, posture, and work habits to help you avoid MSD/RSI.

Computer Ergonomics - Avoiding MSD and RSI

Preventing MSD/RSI
he basic techniques for avoiding MSD and RSI are to use good ergonomics in your workstation, and to engage in healthful work habits and lifestyle. Ergonomics is the study of adapting work or working conditions to suit the worker. This section describes basic ergonomic posture, briefly describes correct ergonomics for working at a desk without a computer, and then describes the correct ergonomics for a computer workstation in detail.
Note The fundamental item you'll need to achieve correct ergonomics at your workstation is a heightadjustable chair. Ideally, your chair should also have a tilt-adjustable seat (the seat of an office chair is sometimes called the pan), and the ability to adjust the distance of the back from the seat. If your workstation desk does not have a height-adjustable top, you'll probably need a footrest of some kind. Basic Ergonomic Work Postures

The basic elements of good ergonomic posture involve three points:

Keep wrists and neck straight; don't bend them up, down, or to the side. Avoid pressure from edges of tables and chairs (even blunt or rounded edges) against the wrists, arms, back, or legs. Keep shoulders, arms, and hands relaxed.

Working At Your Desk

When working at your desk (using pencil and paper, as opposed to using your computer), you should sit upright, with your weight slightly forward. Keep your work close to you, and your forearms flat on the table-top. Your hips should be slightly higher than your knees, without putting pressure against the backs of your thighs from the edge of your chair's seat. If your chair has a tilt-adjustable seat, it should be tilted slightly forward.
Computer Workstations

When working at your computer, you should sit upright in a relaxed posture, with your weight slightly to the rear. Avoid either slouching forward, or leaning too far back. Your knees should be slightly higher than your hips, especially avoiding pressure on the backs of your thighs from the edge of your chair's seat. If your chair has a tilt-adjustable seat, it should be tilted slightly back.

Computer Ergonomics - Avoiding MSD and RSI

Ergonomics At Your Computer

Figure 1 Correct Posture for Computer Work This section explains correct posture while working at your computer, and describes how to correctly determine the height for your chair, desk or table top, and monitor display. This section also describes how to correctly position your mouse and keyboard.
Computer Work Posture

Keep your shoulders relaxed, with your forearms and wrists parallel to the floor. Adjust your table and chair heights so that your forearms are parallel to the floor, with your wrists straight (refer to Figure 1). You should be able to maintain the correct arm position and place both feet flat on the floor. If you cannot place both feet flat on the floor without pressure on the backs of your thighs, use a footrest to raise your knees. Sit against the back of your chair, and position your chair's backrest so that your lower back is firmly supported. Most computer workstation furniture has height-adjustable table tops and monitor shelves. Preferably, you should adjust your chair for correct leg height, then adjust the height of your table top for the correct arm position. If your table is not height-adjustable, adjust your chair height to obtain the correct arm position, and then use a footrest to obtain the correct leg position.

Computer Ergonomics - Avoiding MSD and RSI

Monitor Height & Position

Position your display monitor directly in front of you at a comfortable viewing distance; typically about 18 to 24 inches. If you use a document holder, position it at the same level and near the display monitor. Keeping your neck straight is an important part of computer ergonomics. The height of your monitor tends to control your neck position. If your monitor is too high, you'll end up tilting your head backwards, resulting in neck strain. There are two basic rules you can apply to determine the correct monitor height for you:

The top of the monitor's display should be at eye-level when your neck is held in an upright position. If you can't use the rule above (as happens with very large monitors), a secondary rule is that the center of the monitor's display area should be at shoulder height, enabling you to see the entire display area without tilting your head backwards.

Note If you wear multi-focal corrective lenses (bi-focal, tri-focal) you may find yourself tilting your head back to bring the monitor into the appropriate focal range. If this is the case for you, lower your monitor so that you don't need to tip your head back. Tip If you wear multi-focal glasses, consider getting a pair of "task glasses" to wear when using your computer task glasses are made for your near-vision correction, eliminating any need to tilt or turn your head to focus on different areas of your monitor. Task glasses can save you a lot of neck and eyestrain. Positioning & Using The Keyboard

Figure 2 Proper Keyboard Wrist Position Your keyboard should be directly in front of you so that you can reach it easily with your elbows remaining in a relaxed position at your side. Remember to keep your shoulders, arms, wrists, and hands relaxed as you type, with your upper arms hanging freely at your sides. When typing, keep

Computer Ergonomics - Avoiding MSD and RSI

your wrists straight (refer to Figure 2). Do not splay or arch your wrists up or down (Figure 3), or to the sides (Figure 4). Avoid resting your arms or elbows on the edge of the table. Use a wrist pad to support your wrists and/or cushion the edge of a table, but don't let the weight of your arms rest on the pad. If you have a chair with arms, don't rest your elbows or forearms on the arms of the chair while working. Doing so has two negative effects: first, resting your elbows or forearms on the arms of the chair tends to lock your arms in place. With your arms immobilized, you are more likely to splay or arch your wrists and/or experience shoulder pain. Secondly, resting your elbows or forearms on the arms of the chair is another source of point-pressure which may affect circulation and/or put direct pressure on nerve bundles. It is best to use a chair without arms for computer typing and mouse work.

Figure 3 Don't Do This: Wrists Flexed Up Or Down

Figure 4 Don't Do This: Wrists Flexed In Or Out

Computer Ergonomics - Avoiding MSD and RSI

Positioning & Using The Mouse

Position the mouse at the same level as the keyboard, and within easy reach. Like the keyboard, you should use the mouse with your forearm parallel to the floor, and your wrist straight (refer to Figure 5). Make sure that the thickness of the mouse pad does not raise the mouse higher than your elbow, forcing you to bend your wrist.

Figure 5 Proper Mouse Wrist Position Use your whole arm to move the mouse. Hold the mouse with a relaxed hand; avoid gripping the mouse tightly. Many people experience strain when using a mouse in activities that involve a lot of dragging or double-clicks. Keep in mind that MS Windows can be configured so that items usually selected with a mouse click are selected when the mouse pointer is moved over the item, and that items activated with a double-click can then be activated with a single click. Also, a multi-button programmable mouse can help eliminate strain in the hands. Typically, you configure one or more of the mouse buttons to provide a double-click, without the user actually having to doubleclick. If you perform many mouse-drag operations, you may find it easier and more comfortable to use an alternate pointing device, such as a trackball. A trackball avoids stress on the finger tendons by using the fingers to perform delicate maneuvers and the thumb for clicks. Because the thumb tends to be much stronger than the fingers, a trackball may alleviate fatigue associated with using a mouse. The same basic recommendations for using a mouse apply when using trackball or touchpad pointing devices keep your wrists straight and relaxed, parallel to the floor.

Computer Ergonomics - Avoiding MSD and RSI

Notes For Laptop Users

All of the guidelines here apply to laptop users. Laptop users need to be especially careful of wrist position. Using the laptop in your lap often results in wrists arched back (not a good thing, ergonomically). Many on-the-go locations, such as a cafe table, will be too high, resulting in wrists arched down. In 2010, many news sources began reporting on a condition known as "laptop thigh" or "toasted skin syndrome", a rash and discoloration of the skin caused by holding a hot laptop on one's thighs.
Arm & Hand Motion

Use natural, comfortable motions to avoid strain. Keep your mouse and keyboard within easy reach. Also keep frequently used work materials within easy reach; frequent over-extension to reach reference books or other work materials may result in injury. Use these motion guidelines when working at the computer:

When typing, keep forearms and wrists level and parallel to the floor. Keep your elbows in a relaxed position near your body, but don't press them tightly against your body. When using the keyboard, mouse, or other input device, keep your wrists in a natural, straight position. Avoid bending, arching, or angling your wrists. If you use a palm rest, use it only briefly for resting. Do not use a palm rest, or rest your hands on the table, while you are typing. Keep your thumbs and fingers in a relaxed, natural position. Use the minimum amount of force needed to push down keys or mouse buttons. Avoid banging on the keys or pressing mouse buttons with more than the minimum force required.

Preventing Eye Strain

Eye strain is not an MSD or RSI. Eye strain and fatigue are, however, a common experience for people who spend long periods looking at a monitor display preventing eye strain is an important topic when discussing how to improve your well-being while working or playing at your computer. Follow these general guidelines to help reduce eye strain and fatigue:

Eliminate (or reduce) reflections and glare from the monitor screen (see Reducing Reflections & Glare). Use the brightness and contrast controls on the display to improve character and image quality. A too-bright display can be a source of eye strain. Use the customizing features of your operating system and video drivers to increase the size at which text and symbols are drawn on your screen. Take frequent breaks and rest your eyes, be sure to focus on objects at varying distances. Keep your glasses, contact lenses, and the display clean.

Computer Ergonomics - Avoiding MSD and RSI

If you use a glare filter, clean it according to the instructions. Have your eyes examined regularly by a vision care specialist; out-of-date corrective lenses can cause a lot of discomfort. Consider having glasses made that are specifically suited for working with the computer display.

The remainder of this section discusses two common eye strain problems: dry eyes, and reflections/glare from the monitor screen.
Dry Eyes

When you look at a computer monitor screen, the rate at which you blink your eyes (blink-rate) goes down. This can cause a great deal of discomfort during long periods of computer use. With a lowered blink-rate, your eyeballs are moistened less frequently, and are likely to begin feeling irritated. This drying effect may be especially noticeable to persons wearing contact lenses. To alleviate this extra drying, try massaging the outer corners of your eyes to help lubricate them, and take frequent breaks from looking at your monitor. If you wear contact lenses, you can use an eye lubricant approved by your vision-care specialist.
Reducing Reflections & Glare

To reduce or eliminate the most common causes of eye strain - reflection and glare - you need to pay attention to both how you place your equipment and how you light your work area. Basically, any strong light source behind you will cause reflections and reflected glare on your monitor screen. A strong light source in front of you will cause glare, and make it difficult to see the image on your monitor. You need to position your monitor and/or alter the room lighting to avoid glare or bright reflections on the monitor screen. In general, placing your screen at right angles to strong light sources (such as a window) will eliminate or reduce reflections from that light source. (This means the side of the monitor enclosure is facing the bright light source.) If an overhead light source is causing reflection/glare, you can often use the monitor's tilting feature to eliminate the problem - tilt the monitor forward or back to change its angle in relation to the offending light source and eliminate the glare. Other tips to help arrange the lighting, or arrange the monitor in relation to lighting:

Position the display between the rows of overhead lights to avoid glare. Combine general and task lighting, but avoid bright light sources in your field of vision.

Computer Ergonomics - Avoiding MSD and RSI

Use indirect lighting to avoid bright spots on the display.

Tip Focusing on objects at varying distances can help reduce eye fatigue. Periodically look up from your monitor and focus on something 20 or more feet away from you. If you don't have a line of sight to something 20 feet away, use a mirror to increase the focal length - for example, if you look at something 15 feet behind you reflected in a mirror 5 feet in front of you, your eye has to focus as if the viewed object is 20 feet (15 + 5) away.

Healthful Work Habits

The arrangement of furniture, equipment, and lighting are not the only factors that determine your risk for MSD/RSI. Your work habits are also very important. This section recommends good work habits to help reduce your risk of MSD/RSI. First and foremost, vary your activities. Take some time to analyze the types of tasks you perform. Break up your routine and try to vary your tasks so that you do not end up sitting in one position or performing the same activities with your hands for several hours at a time. Staying too long in one position, or repeating the same motion many times, causes discomfort and injury. Do something different with your hands and arms for a while. For example, if you typically do several hours of data-entry each day, see if you can intersperse other tasks with your data-entry so that you do not end up typing non-stop for several hours at a time. Note People have different levels of physical tolerance for working intensively over long periods. Monitor your personal tolerance levels, and avoid regularly exceeding them. If any of the additional risk factors for MSD/RSI apply to you, it is especially important for you to know your personal limits. Note If it hurts, stop! MSD/RSI can be a lifetime crippling disorder. Absolutely the worst thing you can do is "work through the pain." If you have any of the symptoms of MSD/RSI, and altering your workstation/work-habits doesn't help, see a doctor.

If you must work at your computer for prolonged periods, make sure you take periodic breaks. Get up, stretch, and walk around at least twice every hour, if only for a minute or two. Frequent, short breaks are probably of greater benefit than fewer, longer breaks - especially in light of recent research regarding the detrimental effects of sitting still for as little as one hour. Other suggestions for work habits that can reduce your risk of MSD/RSI:

Work in a relaxed, natural position. Avoid awkward or strained postures.

Computer Ergonomics - Avoiding MSD and RSI

Alter your sitting posture frequently to reduce muscle fatigue; stand up and stretch frequently. Avoid long periods of repetitive motions (such as typing). Improve circulation in your extremities through exercise, massage, warmth (such as warming your hands by washing them). Remember to use the customizable features of MS Windows and/or your mouse to help you work with less strain.

Safety & Comfort Checklist (Summary)

Use this checklist as a reminder when adjusting your workstation ergonomics to increase your comfort at work or play, and to reduce your risk for MSD/RSI.

Keep your forearms and wrists parallel with the floor when you type or use the mouse. Do not angle your forearms up or down. Type with your wrists in a natural, straight position. Avoid bending, arching, or angling your wrists. Ensure your chair height allows you to maintain the proper arm and hand position. Be sure your chair supports your lower back. Rest your feet flat on the floor or on a foot rest. Use the minimum amount of force needed to push down keys and mouse buttons. Take periodic breaks when working at your computer for prolonged periods. Arrange your monitor for comfortable viewing you should be able to see the entire display without tilting your head back. Vary your tasks during the day to avoid sitting in one position or performing repetitive motions for several hours without interruption. Avoid reflections and glare on the monitor display by careful placement of the monitor, and by controlling room lighting. Have your eyes examined regularly by a vision care specialist. Stretch and exercise several times a day.

Wishing you happy and healthful computing!

Note Only you can determine the best workstation arrangement for the way you work. Your

choices, however, should be based on an understanding that working intensely, or for a long time in uncomfortable or unnatural positions, can pose risks.