Kevin Weaver is an clinical assistant professor in the Department of Physical Therapy at New York University. He is a certified Orthopedic Clinical Specialist (OCS) by the American Board of Physical Therapy, and is certified in ergonomics by the Board of Certified Professional Ergonomists (CEA) and the Oxford Institute (CIE). Weaver owns and practices at Academy Physical Therapy and Employee Wellness Solutions.
In you practice as a physical therapist what kind of computer related injuries have you seen recently?
Kevin Weaver: The increased use of the computer in the workplace has lead to a number of musculoskeletal repetitive strain issues (RSI). The most common being neck and back pain which can be attributed to prolonged sitting, poor posture, an employees not adjusting an ergonomic chair correctly, and/or awkward keyboard, mouse, and monitor placement.
Carpal tunnel syndrome is commonly cited as a problem for computer users, but the incidence is a just fraction of neck and back pain incidence. Other arm and hand RSI’s include tunnel compression at the forearm and elbow. Epicondylitis on the inside (aka Golfer’s elbow) and outside (aka Tennis elbow) can also be the cause of symptoms at the elbow. The arm RSI’s can often be attributed to repetitive action of the forearm and wrist in an awkward wrist or elbow posture while using keyboards or mice. De’Quervain’s syndrome is a tendonitis at the base of the thumb into the forearm and is o ften the cause of mouse use that combines awkward wrist postures with repetition.
What wrecks more havoc on the hand — computer keyboards, track pads, mice, or text messaging?
Text messaging is presently poses the most risk to the hand because the size of the keypads on the various smart phones requires increased precision for typing. And typing on a smaller keypad requires people to use more muscle contraction and increased flexed postures in the fingers – especially the thumb.
Keyboards were given a lot of negative press in the 90’s but the newer ergonomic designs and the increase in mouse use for software input and web surfing have lead – in my opinion – the keyboard to be the less likely culprit vs. the mouse.
I perceive the trackpad to be the least likely culprit of hand pain. I often recommend a movable trackpad in lieu of a mouse for people with RSI because you can use it on either arm with a little practice, which will help decrease ergonomic risk factors.
How does a physical therapist help cure these injuries — by brace, by exercise, by recommending getting off the computer?
Kevin Weaver: The main focus of physical therapy with any of the discussed RSI’s, neck and back pain is patient education. The patient/client must understand the ergonomic risk factors that have contributed to their symptomatology. These can include repetition, awkward postures, and force of muscle contraction in the forearm and hand. The literature cites the combination of two of these factors is often what causes people to be symptomatic. When clients are educated they are often able to make most of the changes to their existing workstation with the equipment that they already have. The physical therapist may then recommend additional equiptment, breaks and/or stretching exercises to further reduce the effects of the risk factors.
Bracing during sleep is an excellent way to reduce awkward postures at the thumb, wrist, and elbow that can often contribute to symptoms. Patients need to know what they do in their leisure activities, hobbies, and during the rest of their day outside work activities can contribute to their problems. Bracing during work activities is controversial. Some people can often increase force on symptomatic tendons and muscles by “fighting” the brace so they must brace at work with caution and be aware of any problems that may arise with the introduction of the brace.
Exercises are necessary and stretching at work may reduce the effects of repetition that may otherwise be unavoidable. Ultimately people need to strengthen the muscles around the involved structure but this may stress the injury further in the beginning of intervention. Rest from any symptomatic activity is an important step. Inflammation reduction with ice is a simple and important step in the beginning of symptoms. When people begin to reduce their symptoms they need to begin strengthening the muscles directly related to the involved area. But you can often begin strengthening weakened postural muscles in the shoulder and neck without stressing any symptomatic structure. Most people with upper extremity RSI do not realize that these areas of their body are weak and contributing to their ergonomic risk factors of poor postural habits.
What can a physical therapist offer someone who has chronic computer-related pain?
Kevin Weaver: Chronic symptoms are usually more difficult to deal with regardless of the source of symptoms. If someone is dealing with an upper extremity RSI lasting longer than several months the inflamed tendon (tendonitis) usually begins to turn to a degenerated and scarred state of tendonosis. In most cases of arm RSI the focus should be strengthening the muscle group that attaches to the tendon. This will promote proper healing and reduce the degenerative effects.
Tell me one thing I don’t know about computer-related pain.
Kevin Weaver: Many people with RSI, neck and back pain present with trigger points in the involved muscles. Trigger points are what many people describe as a “knot” in the muscle and can often be a secondary or primary cause of symptoms.
Many of the same ergonomic risk factors that may cause an upper extremity RSI can cause a trigger point in the surrounding muscles. These trigger points can be successfully addressed with ergonomic risk factor reduction, stretching and deep tissue massage as well as patient instruction in self-stretching and massage at home.