KEYBOARDS DO NOT CAUSE CARPAL TUNNEL SYNDROME by Julia S. Lacey with Tom Dickson, DC,CN and Howard Levenson,OD Excerpted from HOW TO SURVIVE YOUR COMPUTER WORKSTATION: 15 EASY STEPS TO WORKSTATION COMFORT published by CRT Services, Inc. Box 1525, Kerrville,TX 78029 Five short years ago, Carpal Tunnel Syndrome (CTS), a major type of Repetitive Strain Injury (RSI), accounted for a modest 2 percent of all workplace illness, according to the Occupational Safety and Health Administration (OSHA). Today, it accounts for over 50% of all workplace illness. More than five million people now suffer from RSI, most of which involves CTS, according to the National Institute for Occupational Safety and Health (NIOSH). Nationally, CTS annually affects some 230,000 workers, costing each victim about $3,500 in benefits and and rehabilitation, for a total cost of about $800 million. NIOSH estimates that more than half of all U.S. workers in jobs with the potential of repetitive strain disorder, including nearly half the work force, or some 60 million workers, who use computers. Some 100,000 cases were due to go to surgery in 1992 at a cost of about $20,000 per worker. Staggering Rise In Incidence A 25-fold increase in five years is alone grim news. Consider, then, that the number of VDTs in the workplace has increased by only three-fold. Further, CTS is a cumulative condition which often takes years to develop. . CTS is generally excrutiatingly painful; . it can be debiltating; . surgery is the conventional treatment; . surgery-plus-recovery generally runs about $20,000; . surgery is not only painful, but often not successful. What Is CTS? CTS is a wrist and hand disorder caused by a pinching of the median nerve which runs the length of the arm and wrist, then up into the hand. This nerve has its "home" in the cervical part of the spine, in what is called the C-7, C-8, nerve root area. The seventh cervical, just to locate it for you, is the very prominent vertebra protruding about three inches below the base of the skull. Among those reporting discomfort or pain, I find most, when asked, report that in fact they have terrible neckache, and discomfort at this part of the spine. What Causes CTS? Improper use of neck muscles can cause pressure to be applied at the originating point of this nerve. Neck muscles, exhausted by holding up a surprisingly heavy head, finally spasm, gripping this C-7 area like a vise, and resulting in severe pain shooting down the arm, up through the hand where median nerve branches terminate. Other signs of RSI include numbness of the hand, inability to maintain a hand grip, tingling (especially at night), some degree of swelling on the palm side of the wrist, and a "pins and needles" sensation in the arms and hands; and finally, excrutiating pain. While all keyboards are not "created equal," their role in CTS is mostly one of exacerbating as opposed to causing, the condition. Also exacerbating the condition is lack of frequent work breaks, work breaks that are so useful for increasing productivity that I have finally come to call them "productivity breaks." Is CTS Avoidable? CTS is indeed avoidable. Avoidance calls for proper work station set-up. Micro-breaks of two to three minutes on the half hour, coupled with in-place exercise, also prevent stress from ever setting in in the first place. However, once contracted, several other ingredients are typically in successful treatment of the condition, most of which will be covered here. Proper Workstation Set-Up Avoiding CTS entails a four-part formula to proper work station set-up. First is optimal placement of your monitor. In order to minimize use of neck muscles, your monitor must be placed about eye level. Eye level placement of your monitor allows your head to balance atop the natural pivot provided by the neck. A monitor placed too far below eye level causes neck muscles to overwork in their effort to hold up a head that weighs about as much as a bowling ball. Equally critical to preventing RSI/CTS is optimal placement of your reference material stand. It should also be set about eye level. And it should be placed closed to your monitor. This gives rise to the "let-your-eyes-do-the-walking" concept, keeping your neck upright. Next is keyboard placement. Your keyboard should allow for your upper arm to be naturally at your side, with forearm (elbow to hand) to run parallel to the floor. Arms seem most comfortable in this position. Wrist rests, when used, should effect the same 90 degree angle at the elbow. What Role Do "Productivity Breaks" Play? For those spending long hours and days at the monitor, brief but frequent work breaks have such a positive effect on the worker and on output that I have come to call them productivity breaks. Investment in computers and workstations is so high that employees are kept at their stations, without respite, in an effort to maximize output and, therefore, overall return. Alas, stress and other health problems clearly identified with this workpattern have the opposite effect on "the bottom line." Once stress has locked into the neck and shoulder area, it is very difficult to eliminate. Micro-breaks of two to three minutes on the half hour, during which time the VDT user can do head, neck and shoulder rolls, coupled with deep breathing, prevents stress from ever setting in. (One should note that allocating time for productivity breaks-two to three minutes per half hour, or five to seven minutes per hour-amounts to allocating less time than the 15 minutes per two hours recommended by others) Can Exercise Help? Exercise is useful. It strengthens muscles. Your physical therapist and your chiropractor are generally at the ready with specific exercises for specific parts of the body. In this case, ask for upper body exercises. Also take time to do simple arm and wrist exercises, being careful not to strain the delicate wrist area. Whatever exercise you do, remember that exercise should never cause pain or discomfort. Can Vitamins Play a Role? The most intriguing information I've encountered comes from Marion Ellis, MD, in Mt. Pleasant, Texas, who has conducted considerable research into vitamin B-6. Having lived his life in the cotton-growing area of East Texas, Dr. Ellis points out that, prior to the bleaching of wheat, cotton-pickers managed to pick 300-400 pounds of cotton daily without complaining of wrist problems. In the bleaching of wheat, all nutrients are removed from the wheat. Only a few of the 20-odd nutrients removed are returned to the wheat. Dr. Ellis' research indicates that B-6, which protects the median nerve, is among the nutrients removed and not replaced. While he suggests taking 100mg of B-6 daily, he recommends taking 50mg in the morning and another 50mg at bedtime because the B vitamins are water-soluble, meaning they are thrown off in all the ways water leaves the body. Morning and evening doses keep the B-6 dispersed. Dr. Ellis finds that 90% of his patients respond to B-6 treatment within a period of 12 weeks. Patients who exhibit patience, endurance and consistency in taking B-6 will be rewarded by healing, he promises. If symptons remain after 12 weeks, Dr. Ellis recommends further diagnosis to determine several matters, among them, whether or not an anatomical aberration is present. Dr. Tom Dickson, chiropractor and nutritionist practicing in Winston-Salem, NC, explains that the B vitamins are never found isolated in nature, provoking nutritionists to feel that the Bs work best when taken in a complete B-complex tablet such as a "B-50" (so called because it contains 50mg of each of the available B vitamins). Dr. Dickson points out that B-6, used in conjunction with a B-50, can produce best results in the control of edematous buildup (i.e. fluid retention) that can congest the carpal tunnel and subsequently reduce nerve axial flow. While finding the B vitamins helpful in reducing edema surrounding the various tunnels of the body, it has been shown that by reducing the localized fluid buildup, the carpal tunnel is decongested. Can Wristwraps Help? Some authorities feel wristwraps should not be used during work itself, but only before and after work. It is felt that one may be working against the restriction, however slightly, applying further pressure against the injured area. Some workers, on the other hand, find it comfortable to wear them while working. Judge for yourself. Wristwraps can be made from handkerchiefs, or of Ace bandages. Wrap lightly in order to only slightly restrict movement while not constricting blood flow itself. Can Surgery Be Avoided? Considering or scheduled for surgery? Chiropractors are experts in reducing nerve pressure in the cervical spine. Ask your chiropractor to check the C-5, C-6, C-7 and T-1 vertebrae of your upper spine. Numerous alternative therapies exist and should be explored: massage therapy, physical therapy, and acupuncture are but a few. Different bodies will respond differently to various treatments. On reflection, however, it seems the most successful outcome is reached by following the three-pronged approach which includes chiropractic adjustment of the cervical spine, setting one's monitor and reference material stand at eye level, and use of vitamin B-6 coupled with a B complex such as the B-50. ..... End