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UNISON DOCUMENT

Information Sheet on Repetitive Strain Injury

RSI covers a wide range of injuries to muscles, tendons and nerves.

Last updated August 2000.

WHAT IS REPETITIVE STRAIN INJURY?

RSI covers a wide range of injuries to muscles, tendons and nerves. Usually hands, wrists, elbows or shoulders are affected. Knees and feet can also suffer, especially if a job involves a lot of kneeling or operating foot pedals on equipment.

RSI is the more commonly known term for a set of disorders called Work Related Upper Limb Disorders or WRULDS. It is a serious disease that must be stopped at an early stage or permanent disability could be caused.

There are many different names for these injuries, including:

Tenosynovitis
Carpel tunnel syndrome
Tendinitis
Dupuytren’s contracture
Epicondylitis or ‘tennis elbow’
Bursitis
‘Housemaid’s knee’ or ‘beat conditions’
Overuse injury

WHAT CAUSES RSI?

RSI is caused, or made worse, by work demanding awkward or repeated movements, especially if you need to apply pressure as well. For example, wringing out clothes means twisting your wrists and arms while gripping the cloth tightly. If these movements are repeated frequently, your hands and wrists will be strained and start to feel painful or numb.

WHO IS AT RISK?

Anyone whose work involves some of the following risk factors:

awkward posture,
awkward grip,
badly designed equipment, tools or workstations,
repeated movements,
overwork,
applying physical force,
fast-pace work,
vibration,
inadequate rest breaks,
lack of training, and/or
no variety of tasks.

All these factors are worse in the cold or in stressful working conditions.

Although most cases UNISON deals with involve keyboard workers like typists and computer operators, nearly all work carries some risk. It has been linked to manual work, including the use of vibrating equipment.

GROUPS AT RISK

UNISON members at risk include:

cooks,
cleaners,
typists, clerical, and data processing workers,
drivers,
carpenters, and
machine operators.

But many other jobs can cause RSI unless measures are taken to avoid it.

HOW CAN RSI BE PREVENTED?

The job should fit the worker, not the other way round. he first step is to look at the way jobs are carried out. Does the work include any of the risk factors listed? Use the checklist to find out what improvements are needed. If the answer to any of these questions is ‘yes’, there is a risk of repetitive strain injury.

RSI checklist

1. Does the work involve:

awkward movements of hand, wrist, arm or shoulders?
rapidly repeated movements?
prolonged physical pressure, such as gripping or squeezing?
holding an uncomfortable position for a long time?
too few breaks to allow muscles to recover?
lack of variety of physical tasks?
long hours or fast-paced work?

2. Are tools and equipment:

too heavy?
the wrong shape to be used comfortably?
causing problems of vibration or noise?
designed for men but used by women?

3. Are workstations and work areas:

too high or too low?
not adjustable for individual users?
noisy or poorly lit?

4. Is training:

adequate?
not provided for all employees, especially those who are new to the work?
not provided when there is a change in equipment or methods of working?
provided but not include risks and ways of avoiding RSI?

5. Are problems:

ignored?
not reported to management?
not reported in writing (preferably in the accident book)?

Depending on the problem areas you have identified, the following measures will help to prevent RSI:

redesign equipment and/or tools,
change the way the work is done,
redesign work area or work station,
reduce the pace of work,
introduce rest breaks and more variety of tasks, and/or
training to include risks and safer methods of work.

EMPLOYERS DUTIES

All employers have legal duties to ensure their employees’ health and safety at work, provide safe work methods, workplaces and equipment, and give employees health and safety information and training.

ASSESSING THE RISKS

Health and safety laws mean that management have a duty to conduct ‘risk assessments’. This means that your employer has to work out the risk factors associated with each job and then minimise those risks. It is vital that union safety reps are involved, to make sure:

that risk assessments have been done for all jobs (especially where workers are complaining of RSI symptoms),
that all the RSI risk factors have been examined,
that management have consulted the workers concerned,
that experienced people have carried out the assessments (they don’t need to be experts, but they do need experience and knowledge), and
that an action plan has been developed to make sure that risks are reduced and monitored (they should be reassessed if the job or work changes ).

The legal basis for all this is in the Management of Health and Safety at Work Regulations 1999. More information is given in UNISON’s guide to these regulations. In the case of keyboard work the Display Screen Equipment Regulations are particularly relevant.

WHAT ARE THE SYMPTOMS?

People are different and different people will develop WRULDS for different reasons at different times. Symptoms of RSI vary from sufferer to sufferer. Symptoms include:

numbness or tingling in the arm or hand,
aches and pains in the muscles or joints,
loss of strength and grip in the hand,
loss of sensation and even whiteness in the fingers, and
cracking in the joints or muscles.

These Symptoms are very similar to aches and pains of everday life – especially after physical effort. But those aches and pains die away after a day or so. The signs to watch for are the pains that come even when you have not exercised.

There are commonly three stages of injury:

Stage 1: Mild

Pain, aching and tiredness of the wrists, arms, shoulders or neck during work, which improves overnight. This stage may last weeks or months, but is reversible (threatened over-use injury).

Stage 2: Moderate

Recurrent pain, aching and tiredness occur earlier in the working day, persist at night and may disturb sleep. Physical signs may be visible such as a cyst-like swelling near a joint or a tender swelling in the affected area. This stage may last several months.

Stage 3: Severe

Pain, aching, weakness, and fatigue are experienced even when the person is resting completely. Sleep is often disturbed, and the sufferer may be unable to carry out even light tasks at home or work. This stage may last for months or years. Sometimes it is irreversible and the person never gets back use of the affected part of their body (established over-use injury).

REPORTING SYMPTOMS

The first thing a member should do is let their employer know about the symptoms, especially if they think they have been caused or made worse by work. If RSI is recognised in the early stages, it can be treated by resting the painful arm or hand, etc.

Other measures, such as painkillers, arm-splints, physiotherapy, ultrasound or surgery will not cure the condition if the sufferer is forced to continue the work that caused the problem in the first place. If you have a member you think may be suffering from RSI due to work:

Get them to tell their GP about the work they do, their symptoms and why they think they could have RSI. They should not delay in getting treatment, including sick leave. They should follow their doctor’s advice and try to stop doing anything they think may be causing their symptoms.
Make sure the member reports it to their manager and to the occupational doctor or nurse, if there is one. They should make it clear that they believe it is work related RSI and keep a copy. Make sure the symptoms are written in the accident book.
Get advice from the Employment Medical Advisory Service if necessary.
Ensure that management do a full assessment of the member’s workplace and take any necessary action to remove any possible causes of RSI.
Prevention is obviously best, but if RSI is confirmed, you may want to see if the member can claim benefits and compensation for injury (see below). Do this as soon as possible.
You may want to suggest the member contact the RSI Association for details of their nearest self-help group (see last page).

CLAIMING COMPENSATION

Some types of RSI are prescribed industrial diseases. This means that sufferers may be entitled to injury and disability benefit from the DSS. To claim this benefit, the member must ask for form B1 100B at their nearest social security office.

The types of RSI that are prescribed industrial diseases are:

tenosynovitis,
writer’s cramp, and
beat hand, elbow or knee.

Carpel tunnel syndrome - a common type of RSI – is only prescribed if the member got it from using vibrating equipment. They may also be entitled to claim benefit for it if they suffer from tenosynovitis as well. At present, only sufferers assessed as at least 14% disabled will be paid DSS disability benefit.

The member may also be able to claim compensation for their injuries from the employer. They will need to prove that RSI was caused by work and that their employer should have prevented it

UNISON can help members if they want to claim compensation. Ask your branch secretary for a UNISON Legal Services Form P1 to apply for legal assistance for work-related cases of injury, illness, or disease. It is not always easy to take compensation cases but, once the member has completed the form, UNISON’s Legal Services will be able to advise them about whether to go ahead.

YOUR ROLE AS A UNISON SAFETY REPRESENTATIVE

UNISON has at least two tasks to do:

get employers to prevent risks, and
support members with WRULDS/RSI.

Workers should be encouraged to report their symptoms – and management must be made to deal with the cause of the problem, and not take it out on sufferers.

The law requires employers to investigate reported health and safety problems and take steps to prevent them. If they just sack employees without any attempt to rectify the problem or rehabilitate the employee, this is grounds for unfair dismissal. As a workplace safety rep, you have legal rights to:

be consulted in good time over any change to working practices or equipment that might affect safety,
be consulted about risk assessments,
be consulted about health and safety information and training for employees,
be consulted about any experts or competent persons appointed to assess WRULDS/RSI problems,
set up a safety committee (make sure any WRULDS/RSI problems are discussed at it),
time off to represent your work colleagues’ safety interests and carry out workplace inspections for WRULDS/RSI, and
time off to attend TUC and UNISON health and safety courses.

HELP FOR PEOPLE WITH RSI

The RSI Association provides help and advice for sufferers. Contact them for details of the nearest self-help group.

They publish an information pack available from:

The RSI Association 380 – 384 Harrow Road LONDON W9 2HU

Telephone: 020 7266 2000 (10am – 5pm, Monday-Fridays (except Thursdays)).

They also run a helpline on Mondays, Wednesdays, and Fridays. Telephone 0800 018 5012.

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