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December 11, 2014

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Repetitive strain injuries: It’s time to reframe the debate


A few months ago I wrote a blog for SHP online about DSE assessments and how they need to do more to prevent the proliferation of repetitive strain injuries (RSIs).

After suffering my own RSI about 10 years ago, I got a qualification in display screen equipment (DSE) risk assessment from the British Safety Council so that I could help others avoid what I’ve been through: years of pain, exorbitant costs of treatment and frustration, anxiety and hopelessness of not being able to use computers and other digital devices with the same impunity as everyone around me.

I got some great responses from people, proving that RSIs are indeed a worrying trend for many people, businesses and the H&S community.

I also received several comments questioning my use of the term ‘RSI’.

It’s true, there are many medical conditions that get lumped under the RSI umbrella and varying opinions about what defines an RSI. The NHS defines it as:

“RSI can be divided into two types. Type I is when the pain is the result of a specific medical condition, such as carpal tunnel syndrome or tennis elbow. Type II is when no specific cause can be found and is often referred to as non-specific upper limb pain.”1

For those who suffer from Type I RSI, there are some diagnoses, eg, carpal tunnel syndrome, which everyone seems to agree upon. In the case of carpal tunnel syndrome, surgery can be an option for some people. It’s important to note that this surgery has mixed results, with one NHS Trust reporting that 7% of people end up worse than before; 6% unchanged; and 10% only slightly better.2 This is usually due to the fact that after these people return to work, they return to the same behaviours that contributed to the problem in the first place.

For those who suffer from Type II RSI, the problem is considerably more difficult to pinpoint and therefore assign a diagnosis that all healthcare practitioners (and indeed H&S experts) will agree upon.

Like many people with pain associated with the use of computers and other digital devices, I’ve consulted with a long list of healthcare experts, including two back surgeons, a hand surgeon, three orthopaedic surgeons, three rheumatology specialists, a consultant in pain management, a consultant in pain medicine and more physiotherapists, osteopaths, acupuncturists and massage therapists than I can keep track of.

And like so many others, I have a bewildering collection of diagnoses; some of them indicate symptoms of Type I RSI and some of them Type II. With every diagnosis, I have undergone the recommended treatment, each time with varying and fleeting success, always depending on how much time I spend on and off digital devices.

I agree that an appropriate medical diagnosis should be the first port of call for anyone with computer pain. And I further agree that accurately classifying RSIs is a valuable and necessary discussion.

For those who receive a diagnosis and subsequent treatment that is successful, their problems are over. Though I wonder how long it will be before they are demonstrating symptoms again, as in the case of those who underwent carpal tunnel surgery only to have it or another problem arise.

For those with Type II RSI or, like me, those with a mix of Type I and Type II, I think it’s time we reframe the debate. Let’s start worrying about what we are going to do about RSIs at least as much as we worry about how to define and classify them.

Just as there isn’t a one-size-fits-all RSI, there isn’t a one-size-fits all solution. We need to start with DSE assessments that look at each individual’s specific behaviour, not simply how their equipment is set up. We also need to raise awareness, teach behavioural change and instigate workplace culture change if we are going to successfully help the increasing number of people with pain related to the use of computers and other digital devices.

Here’s some of what I’m proposing:

  • DSE assessments need to be thorough, including consideration of an individual’s digital device use from when they wake up to when they go to bed. Our devices are now so compact and therefore mobile that we never have to shut off. People need to be made aware of how their total use throughout the day contributes to their health.
  •  Once a thorough DSE assessment has been completed, it must be read by everyone involved, including employee and line managers. (So often, I follow up with someone after an assessment only to learn that they’ve never seen their own DSE assessment.)
  • In the cases where there is a severe problem, managers should sit in on the assessment so that they are aware of the steps that need to be taken to implement behaviour change and prevent further injury.
  • After the assessment, managers need to continually follow up with the employees to make sure that the necessary steps/advice are being implemented.
  • Workplace culture change needs to happen, and to achieve this, senior management must be engaged.

RSIs are a real problem and we need real solutions, real fast.



2Dr Jeremy D P Bland, MB ChB, FRCP, consultant in clinical neurophysiology at the Kent and Canterbury Hospital and also at Kings College Hospital in London,



Raquel Baetz, MA, is an independent DSE assessor who uses her personal experience with RSI to inform the advice she provides for each individual. She gives talks and does one-on-one assessments for office workers, for individuals who work outside the traditional office, and for schools. Follow Raquel @SafeHandsDSE or visit


What makes us susceptible to burnout?

In this episode  of the Safety & Health Podcast, ‘Burnout, stress and being human’, Heather Beach is joined by Stacy Thomson to discuss burnout, perfectionism and how to deal with burnout as an individual, as management and as an organisation.

We provide an insight on how to tackle burnout and why mental health is such a taboo subject, particularly in the workplace.


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Diane Smith
Diane Smith
9 years ago

I too have a combination of Type 1 and Type 2 and understand the frustration that you feel Raquel. I also trained as a health and safety professional to help others to avoid the continual discomfort/pain and not being able to do many of the hobbies I loved. My yoga teacher said only on Tuesday that there is some evidence to show that 5 years texting an average of an hour a day puts the equivalent of a 60lb loading across the shoulders! You are quite right in saying that the solutions lie not only with the individual but the… Read more »

Ash Williams
Ash Williams
9 years ago

Interesting article, but sadly I feel it could do with some balance as it is implies that everyone sat in front of a computer, using a laptop, hand held data device or the likes will develop a Work Related Upper Limb Disorder (WRULD). This is simply not true as genetic factors, actual usage levels and to some degree gender all apply otherwise potential sufferers would be in excess of the 30% estimates. Looking at the 30% estimate many of these may be discounted as WRULD or RSI issues as they are more likely to be related to Muscular Skeletal Disorders… Read more »

Nigel Dupree
Nigel Dupree
9 years ago

The problem for health and safety is that there is currently no “objective” risk assessment of the amount of stress the DSE is actually experiencing and solely relies on “subjectively” reported symptoms, often debilitating in nature, that will be related to “over-exposure” to a stressor that, over time, will be exacerbated to the point of “adaptive exhaustion” when the body / mind says enough is enough and will present or manifest in injury or illness sufficient to prevent ongoing perseverance founded in well-meaning or necessary coping and ongoing tolerance of the stressor often self-medicated. What I have found alarming is… Read more »

Georga Costi
Georga Costi
9 years ago

Great article Raquel and an ever increasing problem that is faced throughout our organisation. I’m a Safety Assistant and Raquel came in to assess an employee who was experiencing constant aching- Raquel’s extremely thorough assessment and recommendations not only made an improvement for the user but taught me so much about how to assess each individual’s behaviour and to consider every aspect of their life but most of all how to explain in a way that allows THEM to understand their own body. As Raquel mentioned, professional medical diagnosis and treatment should always be the first port of call, without… Read more »