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Cause and Effect

How can a workplace injury become an epidemic? By Richard Sine IN THE EARLY 1960s, an epidemic of a "repetitive strain injury" called occupational cervicobrachial disorder broke out among telephonists at Nippon Telephone and Telegraph. Within three years, the number of cases reported shot up from about 100 to more than 3,000. Then, almost as quickly, the epidemic tapered off; by 1973, only 1,000 cases were reported. The telephone company credited the decline to new, lightweight headsets. But if heavy headsets were to blame, then why did Australia's state telephone company, which already used the light headsets, suffer its own epidemic starting in late 1983? And if keyboards were to blame, why was RSI an epidemic among telephonists--who hit a few hundred keys an hour--but rare among telegraphists--who hit 12,000 keystrokes an hour? Even the most fervent believers that RSI is mostly caused by work admit that the problem seems to have a "contagious" quality. Reported symptoms may start with one worker at a workplace and then quickly spread. But if RSI is the physical result of workplace equipment or work habits, shouldn't it result in a steady stream of complaints rather than a jump and then a decline? Those who believe that RSI is usually work-related have an explanation for the contagion effect. They say workers learn through injured colleagues that the aches and pains they had long felt could have dire effects. Once they learn that their pain can escalate into a disabling injury, they are more likely to seek relief earlier. Eventually there is a decline in problems as companies adjust workplace ergonomics or workers learn new habits. Professor Lou Freund, director of the Silicon Valley Ergonomics Institute at San Jose State University, acknowledges that in the first two or three years of an ergonomics program companies will see more RSI-related workers' compensation cases, though those cases will be relatively mild and inexpensive. In companies that have stuck with ergonomic programs over the longer term, however, Freund has seen savings as employees learn safer work habits and use more ergonomic equipment. But physicians who are skeptical that physical work activity is the primary cause of RSI interpret contagion in a different way. "One view of the epidemic is that of a group hysterical reaction to widespread discomfort and a boring unsatisfying job, which was prompted by pressure from the media, managements, unions and the opportunity for compensation," wrote David Ferguson in the Medical Journal of Australia. Australia reacted to its RSI epidemic through a crackdown. The courts decided that workman's compensation won't be granted unless RSI sufferers can document physical injury, not just symptoms and a probable cause. The American Society for Surgery of the Hand applauded the decision. In Ferguson's view, the best solution to most symptoms under the RSI umbrella was not "rest and compensation" but treating fatigue, discomfort and anxiety within the workplace. Doctors should limit their diagnoses to physical findings and avoid diagnosing a syndrome--a sometimes diffuse collection of symptoms which may imply physical injury when none can be observed. And as Dr. Graham Wright wrote in an article accompanying Ferguson's, patients with all forms of chronic pain are typically treated not through a command to stop activity entirely, but through a "graded return to activity under professional supervision." The engineer Freund and physician Ferguson do appear to agree on one important issue: Ferguson, a consultant to Australia's government work safety program, promotes "attention to ergonomics" as an important treatment for RSI symptoms. [ Metro | Metroactive Central | Archives ]