TOO MUCH OF A GOOD THING: PREVENTION OF COMPUTER-RELATED REPETITIVE STRAIN INJURIES AMONG CHILDREN
Computers have revolutionized education and the workplace, and many people are doing an excellent job of teaching students to use computers. However, there has been far too little attention paid to the dangers of Repetitive Strain Injury (RSI) among children and young adults who use computers extensively. There are simple safety skills and understandings that can be easily incorporated into computer instruction, and this article will provide some suggestions about how to help students understand the dangers of computer use and prevent RSI’s.
THE IMPACT OF RSI’S
RSI’s can take many forms. Carpal tunnel syndrome is one that everybody has heard of, but there are many other specific injuries that can result from repetitive strain. For my purpose here, the details aren’t important. What does matter is that RSI’s can be extremely painful and incapacitating, and yet there are simple precautions which will reduce the risk factors for RSI’s.
RSI’s can lead to excruciating pain and the inability to work at the computer or even do many simple daily-life tasks such as turning door knobs or opening bottles of milk. Here are excerpts from two letters (from an Internet newslist) by young people who have experienced RSI’s:
As one of those kids who's always been into computers--- my first was an Apple II+ when I was 4 -- I wish someone had shown me about proper typing posture. 16 years later, it's coming back to haunt me, and I know I'm not the only one. I wonder how long it will take before people start noticing that significant numbers of people my age can no longer do the things they've been doing all their life.
Since the surgery I lost a great deal of strength and the pain just seems to travel higher and higher up my arm. Leaving it feeling constantly sore and heavy. At first my hand and fingers didn't fall asleep that often, but my thumb always had a burning sensation. As times goes by, though, the numbness is becoming more familiar. And the pain almost never goes away any more. The things that seemed so simple at one time in my life are now difficult, which leaves me frustrated and extremely depressed. I am 26 years old and RSI has now taken over my life, which is very very depressing. I cry constantly because it has robbed me of doing things with ease. My life is now centered around my injury. I am told that I must resign [from my job] or end up being permanently disabled.
A third letter goes to the heart of the suggestions that will be offered in this article.
I was watching TV last night and they had a show on ... about an after school program ... for young teenagers... where they are taught about computers.... However, I got really angry watching this. I noticed that the kids' ... postures were atrocious - and no one was teaching them otherwise! .... I just felt very upset for these children. I think it's good that they're being offered this opportunity to start a career and get exposed to necessary internet skills, but they are in my opinion, being set up for heartbreak. They are not being taught the essential, peripheral PHYSICAL skills, cautions etc. needed to preserve their bodies, and are abusing them at a very tender age through improper ergonomics.... This is what happened to me!! I used computers regularly (many hours a day) from age 10 on. I was your basic "computer nerd" - writing, drawing, gaming, programming, etc.... And now I'm paying for it!!
BODY AWARENESS TRAINING
Body awareness training is the foundation for computer safety. Body awareness training teaches people to: (1) notice and feel their bodies as they engage in various tasks; (2) experience and understand principles of relaxation, balance, and movement efficiency, and (3) discover the most economical and strain-free ways of accomplishing movement tasks and setting up workstations.
Observe children sitting at their desks and using computers. What do you see? Are the chairs and the desks the right height, or do the child have to reach too far or too high to the keyboard? Are the children resting their wrists against the sharp edge of the desk? Are the children sitting in a relaxed, balanced, comfortable manner, or are they all twisted up or hunched over? Are the children tense with excitement or relaxed? Do the children take rest and movement breaks, or are they glued to the screen for long periods of time?
Observe a computer lab. Are the students given adequate instruction in proper posture and relaxation for computer work? Are they taught about movement breaks? Are they taught how to set up a workstation to minimize physical strain? These subjects are crucial and, actually, quite simple, but they do take specific instruction.
Perhaps it seems that the right ways to sit and work should be obvious to anyone and that instruction in something as basic and common as sitting is unnecessary. Perhaps it seems that good equipment would be enough to get people to sit and work properly and that providing good equipment would make body awareness training unnecessary. However, instruction in how to use the body really is necessary. Most of us have inefficient and awkward patterns of posture and movement which pose a risk when an intense task like computer use is engaged in for long periods of time. And good equipment supports the body in moving well but will not compel people to move well if they don’t already do so.
BODY AWARENESS EXPERIMENT
What is body awareness training? Let’s try a simple movement experiment to see how body awareness training functions and what kinds of information about the body need to be taught.
Sit on a flat bottomed chair, far enough forward that your back isn’t against the back rest. Slump down. Let your back get round and your chest cave in. How comfortable is that? Notice how the compression of your rib cage constricts your breathing. If you sit this way on a wonderful chair, you will still be uncomfortable.
Staying slumped, raise your arms in front of you and move them around. Perhaps you can pretend to conduct an orchestra. Notice how the constriction of the chest and shoulders interferes with free movement of the arms. If you sit this way on an excellent chair and type with this strain in your arms, you will be uncomfortable, and eventually you may incur some physical damage.
What is comfort? Comfort is the balanced, relaxed, energized anatomically natural use of the human body. The body is designed to be a self-supporting unit, and sitting at a computer does not have to be as hard as most people make it. Through an understanding of the way the legs and pelvis provide a foundation for the spinal column, head and arms, we can arrive at a good sitting posture.1
Sit up straight from the slump. How did you do that? Most people believe that straightening up from a slump is accomplished by throwing the shoulders back, straightening the back and elevating the chest. Try that deliberately, and notice that that creates tension in the muscles of the back. In reality, sitting up is done by rolling the pelvis into position below the spinal column, thereby bringing the spinal column to a position of easy balance on the pelvis. You can feel this for yourself.
Slump again, and notice that when you slump, your pelvis rolls backward, the stack of vertebrae has no foundation on which to rest, and it curves and falls down. (The pelvis can be thought of as a bowl which contains the guts, and "backward" is the direction in which the bowl would rotate to spill out the guts behind the body.) Notice also that when you slump, your pubic symphysis (the bone in the front of your pelvis just above your genitals) points upward.
Now, simply roll your pubic symphysis forward so that it points down toward the floor. Notice that when you roll your pelvis forward, you bring the spinal column into an upright position and move up to an erect sitting position. Rather than using (and straining) the muscles along the back to sit up, this pelvic movement calls into play deep core muscles (the iliacus and the psoas muscles), which are much stronger and more efficient for maintaining erect sitting. (Some people initially find this rolling movement unfamiliar or difficult to achieve. For much greater detail on how to do this movement, you could look at my book, Comfort at Your Computer: Body Awareness Training for Pain-Free Computer Use.)
Once the spinal column is balanced on top of the pelvis this way, it takes very little muscular effort to hold it there, and the posture is stable and strong. In this well supported position, you can let go of unneeded tension and effort. You can relax your muscles and sit and work comfortably. By contrast, sitting up “straight” by tensing the back will create discomfort and strain.
Sit up in the new way and move your arms around. Most people experience that then the pelvis and spinal column are balanced, the shoulder girdle and arms move with more efficiency and ease. In practical terms, this means that arm and neck strain in keyboarding will be reduced considerably.
Here is a simple hint for significantly improving comfort at the computer. Once you have learned how to balance the torso atop the pelvis, you can reduce the muscular effort that even that takes. Sitting on a chair with a flat seat pan, roll up a bath towel, and wedge it in under your tail bone. Let your two sitbones (ischial tuberosities) still rest on the chair, but put the towel roll under your tail bone. The towel will act as a wedge to keep your pelvis rolled forward into the proper position, and you will feel support all the way up your back. Pelvic support rather than lumbar support is the real key to comfortable sitting.
PRACTICAL KNOWLEDGE
I once conducted a demonstration of body awareness training for my computer users group, and the person who volunteered for the demonstration of proper sitting posture happened to be wearing a TENS unit (an electrical gadget for interfering with nerve transmission of extreme chronic pain). Once I helped her into the position of comfortable balance, she exclaimed with great surprise that the simple cafeteria chair she was sitting on felt better than the $600 ergonomic chair she had tried out just the day before. The chair didn't feel better. She felt better on the chair. That was the secret.
The point of describing this movement experiment is to indicate the content and the process of body awareness training and its necessity. It is important to realize that effective body use is not something we can take for granted or assume people have. Through miseducation and misuse, people have learned to move in ways that are awkward, strain-filled and damaging yet seem normal and right. Students need to be taught how to use their bodies well. Otherwise, they will hurt themselves.
It is also not enough to simply have good equipment. Without understanding and being able to achieve proper pelvis/spinal column balance, students will still slump or sit too tense on whatever chair they may use, however good the chair may be. Students have to learn to use their bodies appropriately to make best use of their workstation equipment.
Moreover, if students do understand principles of proper body use, then most equipment will be adequate or can easily be arranged to be adequate. For example, inexpensive chairs and tables will work well if pillows and footrests are used to help the students fit the equipment to their bodies. But they must be able to feel what their bodies need in order to determine what adjustments to make to their equipment.
Body awareness training is cost effective. Rather than needing new and expensive equipment, people who truly know their own bodies can use inexpensive aids to help customize workstations. The issue of cost always important, for both schools and parents, and body awareness training can solve safety problems with a minimal outlay.
COMPUTER SAFETY
There are three primary elements to be examined in safety training for computer users: body awareness, movement breaks, and workstation setup and use. For reasons of space, I have confined myself in this article to one brief example of the process of body awareness training, but more information is available in my book.
The first and most basic element of computer safety is body awareness. Students must be able to feel and understand the functioning of each body component, from the legs to the eyes so that they can detect strain and nip it in the bud. The alternative to early awareness is to wait until physical injuries occur to realize that strain must have been present for quite a while.
The second element is proper movement breaks. Even the best work position on the best equipment should not be maintained for too long. The body is designed for movement not for static work. Students need to learn to take rest and movement breaks in order to prevent fatigue and strain, and there are three kinds of movement breaks to consider. The first and most important is a brief, five-second movement break at the keyboard every ten minutes. That will be enough to maintain relaxation and prevent stiffness. In addition, a five to ten minute movement break away from the computer each hour will be very important. And helpful but not necessary would be a twenty-minute stretching session at home once a day to prepare the body for computer work.
The third element is equipment choice, workstation setup and task analysis. Students need to be able to feel what equipment will be comfortable and effective during long hours at the computer. They need to be able to feel how different ways of positioning the equipment affect the body. They have to understand how to position the keyboard, mouse, monitor, graphics pad, external drives, books, and so on. Students also have to understand the physical differences between the various kinds of tasks involved in computer use -- from graphic design or text entry to programming or computer games --and be able to set up and use their workstations accordingly.
As one example of an equipment hint, for simple text work it is most efficient to place the mouse to the left of the keyboard. The cursor control keys and the number pad are on the right end of the keyboard, and putting the mouse on the right means holding the right arm out far enough to significantly increase the muscular effort needed to use the mouse. But putting the mouse on the right won’t work for a right-handed person doing drawing tasks since they need to use the mouse with their right hand.
All of this is really a lot simpler than it sounds at first, and it is not hard to teach. I designed Comfort at Your Computer as a workbook which takes people on a guided tour of each element of the body and the computer workstation. It would be easy to slip the various aspects of body awareness training into computer instruction in a way that would take minimal time and yet provide students with the basics of work safety education. There are so many positive uses of computers in education, but we owe it to our children to teach them how to keep themselves safe as they use and enjoy computers.
If readers have questions about how to implement computer safety training for children, I’d be pleased to be a resource. Safety is important, and we all have to work together to protect children as they begin learning how to use computers.
FOOTNOTES
- For detailed instructions on how to do the basic breathing, body awareness, and centering exercises I teach, see the file A Downloadable Script for the Eight Core BIM Exercises on my website, www.being-in-movement.com.