Eric Barkley, a software engineer with Computer Sciences in Los Angeles, never even has to think twice when asked to work overtime. Even in his off-hours -- whether at home or work -- the affable 40-year-old can most often be found in his favorite spot: smack in front of a glowing computer screen. But like many other programmers, Barkley has suffered the consequences of his long-standing love affair with the computer: a painful overuse injury linked in part to poor workplace design. The injury kept him away from the profession he loved for more than a month. During this time, even the simplest household tasks, such as cooking and cleaning, utterly defeated him.
In Barkley's case, performing the same physical motions thousands of times an hour while keying in data up to 16 hours a day led to an official diagnosis of two repetitive strain injuries: carpal tunnel syndrome and forearm tendinitis. If left untreated, carpal tunnel can sometimes cause permanent nerve damage, and tendinitis can harm the tendons, ligaments, and muscles that are engaged in repetitive motion.
How do such injuries develop? Standard keyboards require employees to hold their hands in a fixed and unnatural position, which can strain the forearms. If the desk is too high, some programmers may also key in data with their wrists flexed, which puts too much pressure on the median nerve. Meanwhile, the constant pounding on keys can create tiny tears to muscle and tendons. If adjustments aren't made, minor strain and discomfort can eventually develop into a disabling injury that can take months to heal. In some cases, the nerves in the wrist become hyper-sensitized so even the slightest of movements, like turning a doorknob, will cause extreme pain. To prevent RSIs, programmers need to approach everyday tasks in an entirely different way -- from the way they sit to hand and arm placement at the keyboard.
The good news is that such disorders are both preventable and treatable. Regular breaks, good posture, and workplace design, or ergonomics, go a long way toward warding them off entirely. Repetitive strain disorders are common among software engineers primarily because their wrists are either flexed or extended during keyboarding, according to Edward Bernacki, MD, director of occupational medicine at the school of occupational medicine at Johns Hopkins University. This problematic posture usually results from the chair being too high or too low in relation to the keyboard, Dr. Bernacki points out. "If an individual having symptoms of numbness in the hands due to excessive keyboarding consults a physician early enough, the condition is usually reversible," he says. "If carpal tunnel syndrome is attended to early and treated conservatively, surgery is rarely indicated."
A Programmer's Nightmare
In Barkley's case, he put off consulting with a doctor until the pain was overwhelming and his ailments had turned into a programmer's nightmare. "I got to the point where I had so much pain and weakness in my forearms that I couldn't drive a car, it was a nightmare doing my laundry, going to the grocery store was a big ordeal. To get the food into the house I would literally have to carry it in the crooks of my arms," he says matter of factly. "Then one morning, I was reading the Sunday paper and it was all I could do to turn the page. I realized something had to be done."
Despite his ailments, Barkley managed to hold down his job throughout most of this period by controlling the constant ache, burning sensations, and occasional stabbing pains by popping aspirin regularly -- a way of working through pain frowned on by doctors. He worried, as do many programmers, that if he complained he might lose his job -- and so tried to cover up the increasing effort it took to do any amount of typing. "I guess I was just in denial," says Barkley. "I was hoping it would somehow get better."
Finally, after his ordeal with the newspaper, he could no longer afford to ignore his condition. The next day Barkley got up his nerve, walked into his boss's office, described his symptoms, and told him that he urgently needed to file a workers compensation claim. Luckily, his employer understood and fully supported Barkley's right to a workers compensation claim, which allowed him to take over a month off. Still, a year later, Barkley had not fully recovered.
"There is no one, perfect fix for these conditions," says Barkley, who recommends from experience that RSI sufferers try out various approaches to realign their posture and lessen the strain on their hands and arms. For the software engineer, physical therapy helped reduce his chronic pain. In addition, his therapist videotaped his typing so the two could analyze what he was doing wrong.
"I used to really wham on the keyboard when I typed," says Barkley, "and I don't do that anymore. I'm a lot more careful with my body." He also began working fewer hours, taking more breaks, and setting up his workstation so that his wrists and arms were in a straight line. "There's a real tendency to disassociate your mind from your body when you're into programming," says Barkley. "People have to fight against that. Your body is constantly sending you subtle signals: When do I need to take a break? When do I need to relax? You have to listen to that."
Dr. Bernaki adds that treatment for carpal tunnel often involves splinting the wrists so they're in alignment. In addition, he says, the chair height should always be adjusted so that the wrist is neither extended nor flexed during keyboarding.
Addicted to the computer?
Repetitive strain injury is not the only job hazard that software engineers face. But it's probably the most common, as well as the most expensive for employees and employers alike. After all, this is a profession that fosters an involvement with computers that many programmers themselves often describe as obsessive.
"I've been in offices where people are really driven," says Barkley. "They're working on a program and someone says, 'Oh God, I've really got to use the bathroom.' So? Use the bathroom. But the thing is, they don't. They stay at the computer. It's definitely an addiction."
John Blyth, an Internet Web programmer in Rohnert Park, California, agrees. "It's thrilling," says Blyth, "when you can make changes in the program, and a moment later see it work before your eyes." Blyth has not upgraded his computer equipment at home, however, because as a victim of RSI he fears the temptation. "There's more to life than a computer," he says, "but the problem is it's too addictive. I love programming and I wish my body could do it all the time, but my hands just aren't up to it."
According to OSHA, work-related musculoskeletal disorders, which include RSI injuries, cost employers well over 600,000 lost workdays a year, and account for $1 of every $3 spent for workers' compensation. Employers pay up to $20 billion in workers compensation costs for these injuries, and associated disorders run as high as $50 billion per year.
Other job hazards
Along with repetitive strain injuries, intense sessions at a computer can also put programmers at risk for eye strain from staring for too long at a computer screen. The American Academy of Ophthalmology warns that computer-caused eye problems -- usually eye strain -- are widespread. In fact, statistics from the National Institute of Occupational Safety and Health show that 91 percent of the 75 million people who use computers for more than 2 hours a day suffer some kind of vision problem, usually resulting in eye strain or headaches.
To combat this problem, programmers should use an anti-glare filter on their screens, readjust their office lighting to lessen glare, and set their monitor-refresh rate -- the rate at which the monitor screen fluctuates -- to at least 60 cycles per second, or higher. The American Academy of Ophthalmology also recommends that users should look up or away from their screens several times an hour. In addition, frequent blinking tends to lubricate the eyes and prevent them from drying out.
Like many other dot-com employees, software engineers are prone to diet and nutrition problems, says Keith Klein, CN, a clinical nutritionist at the Institute of Eating Management in Houston, Texas, who works with athletes from the Houston Arrows and Comets, as well as programmers at Compaq Computers in Houston. "When these people first got into computer programming they were the 'geeks,'" says Klein. "They weren't on the football team, they weren't that social, which is a gross generalization, but it's true. When I go into computer programming offices, I definitely see people who are out of shape. They are overweight, they don't exercise, it's obvious."
The four top killers in the United States are cancer, heart disease, stroke, and lower respiratory diseases, and these diseases are greatly influenced by lifestyle. Unfortunately, sitting front of computer screens all day with ever tighter deadlines to meet, many programmers fill up on what the vending machines are serving, usually sugar and caffeine, or what their company orders in -- pizza one day, meatball subs the next. After 15 to 20 years of bad habits, says Klein, the negative results of this lifestyle start to show up in high cholesterol levels and worse. To work their way into a sound nutritional program, software engineers need to eat a good breakfast and bring their own food to work -- something nutritious and low in calories if they're trying to lose weight. Also, they should spare some time each day for exercise -- even a short walk at lunch helps. Joining a gym and exercising for at least 30 minutes five times a week is ideal.
One software engineer at a dot-com in the section of San Francisco known as Silicon Gulch remains trim and fit despite months of 70- to 80-hour work weeks. He attributes this partly to avoiding junk food and to walking home every night -- a 30-minute walk up steep hills. Lately he has also cut back to working a 50-hour week and taking weekends off entirely. "It's important not to get too exhausted and worn-out," he says, "because you can become hyper-sensitive and react badly to perceived slights and conflict. Everyone needs time to relax -- even engineers."
The point, says Klein, is to achieve a life balanced among work, family and lifestyle."Programmers need to take time away from the computer to discover other things," says Klein. "I always tell them that often the most famous scientists get their best ideas doing something totally unrelated -- like Thomas Edison, who loved working in his garden. Computers are great, but you need to have a complete life."
On computers and eye problems: The American Academy of Ophthalmology at: http://www.aao.org
On nutrition in the workplace: The American Dietetic Association at: http://www.eatright.org
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