WORKPLACE injuries used to mean tumbles from scaffolding, collisions with trucks, accidents with machinery and the like. But these days, most injuries are sustained working on computers and talking on telephones. Repetitive stress or strain injury (RSI) is becoming more common in Hong Kong as office workers are tied to their desks in what are often cramped conditions. Hong Kong Polytechnic University's Rehabilitation Clinic has seen a sharp increase in cases since it opened. In 1997, it saw 71 patients suffering from lower back, neck and shoulder pain. In 2002, there were 402. 'Many Hong Kong offices have very limited space,' says clinic physiotherapist Grace Szeto. 'Most desks aren't large enough for a computer, monitor, keyboard and mouse, as well as a phone, documents and so on. 'People commonly use a drawer as a support for the keyboard, or have the display screen at all sorts of funny angles. They may start to feel aches and pains, but with the current economic downturn, may be reluctant to report their problems.' The city's long-hours culture may be exacerbating the problem. Health concern group Arms Care recently called for mandatory 10-minute rest breaks every two hours, after about 100 workers suffering from various forms of RSI sought its help. 'Hong Kong is a very stressful, high pressure place,' says physiotherapist Janice Morton. 'Employers expect very high productivity. If someone is piled with a huge amount of work, they haven't got time to take breaks.' RSI - or work-related musculoskeletal disorder as it's referred to by the medical profession - is caused by the repeated movement of a particular part of the body, which causes damage to tendons, nerves, muscles and other soft body tissue. Although many occupations, from meatpackers to musicians, are at risk, the increasing use of computers has resulted in an epidemic of injuries of the hands, arms and shoulders. The Occupational Safety and Health Council conducted a survey of 368 Hong Kong office workers in 2001 and found that 60 per cent had suffered back pain and 40 per cent neck pain as a direct result of operating display screen equipment. 'The intensive use of the mouse is a big problem among professions such as draftsmen, engineers and designers,' says Szeto. 'Data entry clerks have problems because they may only hit the number keys for hours, often at high speeds. People who type all day, such as secretaries, accountants and transcript typists, are also at high risk.' In medical terms, there's a range of RSI conditions. The most common hand problem is a condition known as tendonitis, when the tendons connecting the fingers to muscles in the forearms become inflamed. Another is tenosynovitis, where the fluid-filled sacks that surround and protect the tendons swell. These can lead to carpal tunnel syndrome, when the nerves passing through the wrist bones get crushed. Techniques and postures that put extra stress on tendons and nerves are often as much to blame for injuries as the repetitive motion itself. 'If someone is in an ergonomically incorrect posture, the nerves powering certain muscles become irritated, and the muscles can't switch off,' says Morton. 'When they move the opposite muscle, the two muscles are pulling against each other, which causes extra friction of the tendon.' RSI symptoms include: pain or stiffness in the hands, wrists, fingers, forearms, elbows, upper back and shoulders; pins and needles or numbness in the hands; clumsiness or loss of co-ordination; and a need to massage the hands, wrists and arms. Occasionally, the damage can't be repaired, and there are cases in which workers have been unable to return to their normal duties. RSI sufferers are often prescribed exercise and anti-inflammatory drugs, alongside physiotherapy. Attempts usually are made to correct the conditions that caused the injury in the first place. Bad posture is a common problem. 'Often people aren't aware they sit with their chin poked out or their shoulders rounded,' says Szeto. Part of the reason is that we're naturally designed to be moving around, rather than sitting for nine hours staring at a computer. In studies in which people were taught to sit up straight and then given a chair with no back support, it took an average of about 10 minutes before they slumped. 'The subconscious reassures you the chair is not going to collapse, so you conserve energy by allowing your anti-gravity muscles to relax,' says Morton. Postural errors may be exacerbated outside the workplace. 'Everything may be set up correctly at work, and then people go home and work with a laptop on their knees all evening,' says Morton. 'They may be sleeping in the wrong position, with the wrong height pillow, or be sliding down the sofa while watching television in the evening.' RSI sufferers are given the same advice as anyone wanting to prevent themselves getting it: avoid awkward angles. 'Your hips, knees, ankles and elbows should be at 90 degrees, the back straight and the shoulders back,' says Morton. 'Your legs should be right under the desk, and your forearms flat so the wrist is never pulled back when using the keyboard or the mouse. 'The screen should be at eye level. Learning to touch type is a good idea, so you don't look down all the time.' An ergonomically correct workstation maintains the right posture. 'Wrist rests are good for using the mouse,' says Morton. 'The chair arms must have height adjustment so they can be brought under the desk. You shouldn't have to stretch to move the mouse because it pulls on the shoulder and neck.' But even a perfect posture may result in problems if it's held rigidly for long periods of time. 'Get up and walk around every hour or so,' says Morton. 'To stretch the shoulders, raise the arms above the head, and put your hands behind the chair and lift them, keeping the arms straight. For the neck, drop the head forward and back, look over each shoulder, and drop each ear to each shoulder. 'A good massage of the neck and shoulders and the forearms may be helpful, but I don't advise going to a masseur who manipulates backs, because they don't have the medical knowledge to recognise contra-indications and may actually do harm.' Learning to recognise what's uncomfortable before you're in pain could also prevent injury before it happens. Many physiotherapists recommend physical re-education techniques such as Pilates, tai chi, yoga and the Alexander technique. The prognosis for RSI is good, provided patients adhere to professional advice on their workstation, posture and stretching exercises. 'Usually pain is a great motivating factor. People do start slipping back into bad habits,' says Morton. 'But when the pain returns they tend to reassess what they're doing.' Eye problems are another common affliction for computer users. Symptoms include eyestrain, headaches, blurred vision, dry and irritated eyes, slow refocusing, light sensitivity, neck and/or backache and double vision. 'Many people should have a reading prescription but don't,' says optometrist Gary Kots. He recommends measuring the distance between your eyes and screen before going for an examination, so that if you need glasses, they can be tailor-made. There are other measures you can take to prevent eye fatigue and irritation. 'The UV and vibration of artificial lighting can make the eyes feel uncomfortable, so the more natural daylight there is, the better,' says Kots. 'It's a good idea to get a screen protector with an anti-reflective coating. When we're looking at the screen, our eyes unconsciously pick up reflections, for example of people walking behind, and get fatigued. Air-conditioning dries out the eyes, and a lot of people forget to blink. If you can't correct this easily, use eyedrops.' Kots also advises taking a break from the screen for a couple of minutes every hour and focusing on something in the far distance to let the eyes relax. Useful contacts Your family doctor can refer you to a private physiotherapist. There are various clinics around the city. The Department of Health also has an occupational safety and health centre, at 2/F Kwun Tong Jockey Club Health Centre, 457 Kwun Tong Rd, Kowloon. Appointments: 2343 7133. Officers from the centre regularly organise seminars and talks on various occupational safety and health to enhance public awareness of the issues. Call for more details. For Computer Related Repetitive Strain Injury, the website http://eeshop.unl.edu/rsi.html features information about various RSI syndromes, links, exercises and book reviews. For tips on safe computing and preventative postures, go to www.healthycomputing.com and www.tifaq.com . For more information on computer-related eye problems, go to www.cvconsulting.com and www.doctorergo.com . Descriptions of body re-education techniques can be found at www.felden - krais.com, http://extensionyoga.com , http://alexandertechnique.com and http://www.trager.com . For animated yoga-based desk exercises for RSI, go to www.will-harris.com/yoga/rsi.html .