The Hindu Business Line : A pain in the neck?

Computer-related jobs come with their own dangers, and the malady called CRI (computer-related injury) is on the rise. Timely medical intervention helps.

Dr Deepak Sharan

A software engineer in Hewlett Packard, Bangalore, J. Suryakumari, who has been in the IT industry for six years, started developing sudden pain in her neck, back and shoulders last year. After several visits to various doctors, her problem was diagnosed as Grade II Computer Related Injury (CRI). She has been undergoing trigger point therapy for about eight months now and is already feeling better.

A similar but a much worse case is that of Aparna (name changed) working for a software major in Bangalore. In 1999, her problem started with neck pain that persisted even after undergoing different kinds of treatments at various orthopaedic centres in the city. The final blow came when she was at work at a customer's site. "I was pounding on the key board when the back of my hands went numb. I was shaking and felt as if I had an old woman's hands," she recalls. Aparna's case was diagnosed as Grade III CRI. Subsequently, she gave up her job and is now undergoing treatment for the malady.

Dr Deepak Sharan, a Bangalore-based Consultant Orthopaedic Surgeon and Rehabilitation Specialist, says that these are not rare cases and that CRI is not such an uncommon affliction. In his study of 700 people in computer-dependent jobs in Bangalore, he found that at least 70 per cent of them suffered from early symptoms of CRI. What are these symptoms?

Stage I symptoms are pain and stiffness of the neck, shoulders and upper back only while the person is at work. Dr Sharan says this can be corrected with proper medical and ergonomic intervention. On the other hand, if ignored, it leads to shooting pain, burning, numbness or weakness in the arm, forearm, wrist or hand, which will take several weeks or months to be treated. The third stage is when the pain is constant and even after proper treatment, recovery may not be total.

The orthopaedic says he has come across six software engineers in the age group 25-35 who had to give up computer related jobs due to CRI symptoms. Similarly affected are also call centre executives who have to be at the PC and the telephone constantly.

Workplace health hazards have posed a problem to companies and individuals from as early as the 18th century when musicians, novelists, typists and butchers suffered from what is now known as Repetitive Strain Injuries (RSI). Even writers were known to be afflicted with writers' cramps. CRI is a type of RSI that was first detected 15 years ago in New South Wales, Australia.

At that time, medical opinion was divided about the cause of the disease. While some insisted it was a purely physical condition, others swore it was a psychosomatic disorder. Dr Sharan, who has already treated 300 patients for CRI, says it's definitely a physiological malady that, of course, is enhanced by stress. And stress is not so uncommon in software jobs.

But what makes CRI worse than what it already is, is the fact that most doctors are unaware of the cause and recommend inappropriate medication such as intake of cortico steroids, antidepressants, Botox injections, multivitamin injections, unspecified `health pills' and the like.

Take the case of a 32-year-old patient from one of the top IT companies, who developed numb and painful fingers due to improper and excessive laptop usage. This patient had endured the entire spectrum of inappropriate treatment modalities. "One centre even advised him to get admitted for emergency nerve decompression surgery," says the doctor.

In his on-going study, Dr Sharan found that 65 per cent of those suffering from CRI were misdiagnosed as spondylitis, slipped disc or tennis elbow.

Only about 20 per cent were told that they were suffering from RSI. "And what is worse is that about 15 per cent of them had undergone various blood tests, 10 per cent had nerve conduction studies, and 15 per cent had MRIs and not even one person's workstation had been evaluated."

He blames the Indian office tables where the heights are fixed at 2.5 ft irrespective of the body dimensions of the user. "The only adjustment you can make is with the chair which does not work most of the times," he rues.

The other culprit is the way the keyboard and the mouse are positioned, which is way too high. This leads to an uncomfortable posture and the user is forced to type by hunching the shoulders, propping the arms on the armrests and the wrists on the edge of the table. "The result is myofacial injuries in the neck and shoulder region leading to compression of nerves and blood vessels in the neck, which manifests itself as referred pain or numbness," explains Dr Sharan.

Today, when even an internal memo has to be electronically sent, how does one prevent this scourge? The first step in the correction process is to perform a workstation assessment, says Dr Sharan, who has been conducting weekly CRI clinics at Hewlett Packard for the last three months.

"It is necessary to teach employees and the HR department the elements about healthy computing. The latter, particularly, should realise that there is no correlation between the price of the chair and its quality," he states.

He says many IT companies think twice about having ergonomic programmes because they fear escalation in costs due to purchase of new furniture or equipment. But research in the US has shown that for every one dollar spent on ergonomic programmes, the company realises a return of $17.8. "What they don't realise is that it is possible to achieve corrections within the existing facilities," he adds.

Dr Sharan has conducted awareness and prevention programmes in leading IT companies such as IBM, Compaq, Analog Devices, Ace Designers, and others. "We have even conducted workshops on how to hold the mouse," he says.

Most of the times, an ergonomic correction solves the problem, while in cases like that of Suryakumari's, the trigger point therapy is administered.

The other problem with CRI is the fact that because the disease is not recognised it is not taught in medical schools. "Some doctors make their patients take strong pain killers and wear splints while typing which is pathetic," he says.

He is also working on another pet subject: backpack injuries of children. "Imagine a generation of people who are injured when they enter the workforce community. We intend to educate the kids about this problem and how to handle it."

Warning that those working in call centres are particularly at risks, he advises people to stay away from misconceptions associated with CRI that that aches and pains are common for a working person. "My belief is that work should not hurt and it's absolutely necessary to see a doctor before it's too late," says Dr Sharan.

Not just the IT guys...

When it comes to workplace health hazards, it's not just computer professionals who are affected. Realising the strain that its counter sales executives are going through, Titan Industries Ltd has put together an awareness programme for them.

According to M. Kumaran, Human Resources, Titan Industries Ltd., "We started receiving complaints of back pain by these sales executives. Then we realised that most of them stand the whole day without even a decent lunch break. This leads to tremendous physical stress which starts affecting their back very early in life."

Last December, Titan, along with HOSMAT (Hospital for Orthopaedics, Sports, Medicine, Arthritis, Neuro and Accident Trauma), Bangalore, initiated a series of workshops where these executives were taught how to stand, what kind of posture to maintain to get some physical relief and, most important, they were taught a few exercises which, if practised regularly, would reduce the strain on their backs.

So far, Titan has covered about 25 of its employees under this programme and plans to extend it to another 75 during the year. Kumaran, whose idea it was to make the sales executives aware of the underlying risks in their jobs, hopes to include employees of Titan franchisees too under the programme.

Picture by G.R.N. Somashekar

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