Preventing RSI - What Employers Must Do

Having taken a step by step approach to assessing where the potential for RSI is in their organisation and identifying who might be at risk, employers must implement the appropriate measures needed to prevent or control the risk of RSI.

The Approved Code of Practice to the Management of Health and Safety at Work Regulations sets out the principles which employers must follow when deciding the appropriate preventive measures to apply. The approach which the Code recommends is essentially an ergonomic and holistic one. The main principles include:

avoid the risk altogether eg by not using a particular tool or process
combat risks at source rather than applying palliative measures
adapt work to the individual especially as regards the design of workplaces, the choice of work equipment and the choice of working and production methods, with a view to eliminating monotonous work and work at a predetermined rate
take advantage of technological and technical progress to improve working methods and make them safer
ensure that the measures form part of a coherent policy of reducing risks, which takes account of the way work is organised, working conditions, the working environment and any relevant social factors
give priority to measures which protect the whole workforce
ensure that workers understand what they need to do by providing information and training
ensure an active health and safety culture throughout the workplace as a whole

The HSE have also published specific guidance for employers on preventing RSI, Work related upper limb disorders - a guide to prevention. This stresses the need for risk assessment and for applying ergonomic principles so that the job fits the worker rather than the other way round. The guidance makes it clear that employers should look at:

organisational factors - organisation of work, job rotation, management style, work rate, monitoring, consultation, bonus systems, stress
task and equipment factors - use of force, repetitive movements, rapid movements, twisting movements, awkward postures, overstretching, lack of rest breaks, design of tools and equipment
individual factors - training, height and build, personal protective equipment
environmental factors - stressful noise, lighting levels, flickering lights, cold temperatures, vibration

This official guidance contains checklists to help employers identify problems and examples of what can be done. A whole range of other publications is available to help employers decide what to do.

The London Hazards Centre has received many accounts of the appalling working conditions that people have endured to their cost.

The Reality of Work

In a ceramics manufacturing company, for example, workers had to paint figures on a piece rate system for 8½ hours a day with only a 30 minute break for lunch and one other 15 minute break. The job involved repetitive gripping and twisting movements. Some workers developed RSI. The company did have a written procedure for dealing with RSI but this amounted to how they would terminate the employment contract and did not mention prevention at all.

Poultry workers have suffered notoriously high-risk working conditions with many of the tasks involving repetitive or forceful movements. Eviscerating, for example, requires workers to make forceful gripping and twisting movements of the hands and wrists to remove the guts from the poultry. Trussing requires workers to make repetitive and forceful movements of the wrists and thumbs to bend the bird’s legs and wings and tuck the legs inside the body cavity. In a court case involving six poultry workers at Bernard Matthews, the court heard that one woman had been lifting the equivalent of 150 tons of turkey a day in the manufacture of turkey products. The judge found that the employer should have had an effective job rotation system and a suitable system of training. The judge also noted that the company slowed down the production line when demonstrating it to potential customers and speeded it up again afterwards to regain lost production.

At a factory servicing charter aircraft, women workers reupholstering aircraft seats were required to control the speed of the sewing machine by an elbow operated lever. Many of them developed tennis elbow as a result. The response of the employer was to move the lever so that they could operate it with their knees. The problem was not solved, merely moved to a different site of the body.

A Japanese computer manufacturing company setting up an assembly operation in Britain found that many of the assembly workers were complaining of neck pains. The conveyor had been brought in from Japan and was designed for Japanese workers who tend to be shorter than European workers and so was too low for many of the operators. In this case a new conveyor was designed. The case is interesting because in so many situations it is the reverse that happens. British workstations and tools are designed to suit European men and no account at all is taken of the fact that many of the operators are women or Asian workers who may be of much smaller stature and strength. They are just expected to adapt.

Some of the main measures that employers can take to prevent RSI are listed below under the headings identified at the beginning of this chapter. It is important that qualified ergonomists are brought in to provide expertise and advice so that RSI can be designed out of the workplace:

Improving work organisation

Work should be organised in such a way that employees health and safety is not put at risk. Work organisation can be improved in a number of ways, for example:

by improving communications between management and staff in both directions
by consulting employees and their representatives about their jobs and any changes to them
by ensuring that jobs which pose a risk and which cannot be completely eliminated are rotated so that no individual spends long on that task
by ensuring that all employees have sufficient variety of tasks to enable them to use different muscles and postures and to make their job more satisfying
by providing adequate rest breaks to prevent the build up of fatigue and by ensuring that the breaks are taken
by identifying and removing stress factors from the workplace
by giving workers control over their pace of work and how they plan their day
by removing piece rate and payment by results systems that make earnings dependent on excessive work rates
by removing bonus, performance or monitoring schemes which make workers push themselves beyond their capacities
by having proper monitoring and reporting procedures for symptoms of RSI

Improving task and equipment design

This can be done by applying good ergonomic principles to the design of tools, equipment, workstations, tasks and work methods. Improvements can be achieved:

by selecting tools and equipment appropriate for the job and suitable for the individual who has to use them
by maintaining tools in a condition which makes them easy to use, eg by keeping them sharpened or lubricated
by providing powered versions of tools
by selecting tools with handles which allow the worker to keep their wrists straight
by redesigning workstation so that everything is within reach, or so that controls are easier to use
by providing seat, equipment etc that can be adjusted to meet individual needs and by providing training in how to adjust it
by giving the worker more space in which to work
by redesigning the task to minimise repetitive movements
by automating the task
by redesigning the work method to avoid overreaching and other awkward postures

Taking account of the individual

Employers need to ensure that workers are not at risk through lack of training or because of individual factors. They can help protect their employees from developing RSI:

by providing information and training about RSI and how to recognise the symptoms
by providing information and training about how to avoid RSI through safe working techniques and safe working postures
by advising employees of the importance of taking breaks before the onset of fatigue and of varying their work routines
by informing employees of the importance of reporting symptoms of RSI straightaway
by providing information on how to report symptoms of RSI
by ensuring that workstations and equipment can be fully adjusted to accommodate people of very different sizes, heights or with particular needs
by ensuring that workstations and equipment can be adjusted to the needs of people with disabilities
by ensuring that women do not have to use equipment and tools designed for men
by ensuring that new employees or those returning from a long break are allowed to build up their work rate gradually
by ensuring that the wearing of personal protective equipment or clothing eg gloves does not increase the risk of RSI

Improving the work environment

The physical work environment can be a source of stress and strain to workers. Employers can help to reduce these stresses:

by ensuring noise levels are kept as low as possible
by improving lighting levels and removing irritating flicker or glare
by improving temperature and ventilation
by providing well designed protective clothing and regular breaks in a warmer environment for workers who have to work in cold conditions or with frozen foods
by providing suitable rest areas away from the workstation for workers to have recuperative breaks
by reducing the need to use vibrating tools
by providing vibration absorbing grips on tools and by maintaining them in a good state of repair

Monitoring health

Health surveillance can play an important role in the prevention of RSI by detecting symptoms early so that remedial action can be taken. It should be seen as an essential backup to the preventive measures taken to design RSI out of the workplace. The Management of Health and Safety at Work Regulations require employers to provide health surveillance where:

there is an identifiable disease or adverse health condition related to the work
valid techniques are available to detect indications of the disease or condition
there is a reasonable likelihood that the disease or condition may occur under the particular work conditions
surveillance is likely to further the protection of the employees’ health

Employers should at the very least set up an internal reporting system so that symptoms of RSI can be monitored and recognised early on before the condition progresses to a more serious state. In order for such a system to be effective, it must be explained properly to employees so that they understand the purpose of the system, how to recognise symptoms of RSI, how to report them and what will happen when they do report them. Employees are unlikely to report symptoms if they think their future employment will be put at risk so the system must be seen as a positive element of the employers' approach to RSI prevention. It should be linked to a policy on job protection.

Some employers have tried to introduce pre-employment screening in an attempt to weed out people who may be susceptible to RSI and so reduce the chances of future litigation against them. Not only could this amount to discrimination under the law, but the evidence shows that there is no reliable test available. Health surveillance systems have been reviewed in Work related musculoskeletal disorders (WMSDs): A reference book for prevention, which concluded, "There is no scientific evidence to show that pre-employment and preplacement screening can predict the risk of developing a WMSD." Even the HSE, in their guidance to employers, advise, "Attempts have been made to devise screening tests to predict susceptibility to ULDs on a basis of skin temperature tests, wrist X-rays, muscle strength tests etc. These tests have not been shown to be effective and are not recommended." The London Hazards Centre has always believed that the principle must be to make the workplace safe for everyone and not to try and select out all but a workforce of super-resilient men and women.

Good practice - what employers have done

It would be pleasing to provide extensive examples of employers’ policies on RSI prevention. However, very few appear to have such policies, despite surveys which suggest that many employers perceive RSI to be a major problem. A study carried out by the Labour Research Department in 1996 found only 8 per cent of employers surveyed had introduced an RSI prevention policy. What action had been taken appeared to be on an ad hoc basis in response to problems that had already occurred. Successful compensation claims by employees have been a notable factor in getting employers to act. For example, Bernard Matthews and the Inland Revenue have both implemented preventive measures, including job rotation, breaks, better training and reporting procedures, in the light of well publicised awards to their staff, although the unions involved, the TGWU and the PTC, believe that the measures do not go far enough and that job insecurity means that many employees are still too afraid to report their symptoms for fear of losing their jobs. One of the measures introduced at the Inland Revenue in negotiation with the union is a no fault compensation scheme for RSI sufferers, which is described in detail in Chapter 9.

The HSE has drawn together a number of examples of what employers have done to solve ergonomic problems in their workplace and reduce the incidence of musculoskeletal disorders, such as RSI, and have published these in their guidance document, A Pain in Your Workplace. Many of the problems described should have been foreseen in the employers’ risk assessments if these had been done properly. Nevertheless, the guidance provides many useful, practical case studies of measures, ranging from the very simple and inexpensive to the more complex and costly, which employers have implemented to overcome work related musculoskeletal disorders. And the knee-jerk reaction, "we can’t afford it," of so many employers to any proposal for safer working conditions is shown once again to be completely groundless, since the measures proved extremely cost effective, not only in terms of improved employee health and quality of life but also in improved productivity and customer satisfaction. Employers should be asking not "can we afford to do it?" but "can we afford not to do it?"

A case in point is the description of a boxed games packaging operation where workers were suffering RSI in their arms and hands. The job was very repetitive and a number of risk factors were identified including awkward wrist movements when picking up the boxes from the conveyor, forceful pinching and gripping to lift the boxes and to force the last two boxes into the master carton, stooping and stretching to reach the boxes on the conveyor and twisting from one conveyor to the other. The boxes were shrink wrapped and forcing them into the cartons often damaged both the wrap and the product. Various modifications were introduced to both the workstation and the work method, including reducing the conveyor speed, raising the height of the conveyor, repositioning the conveyor to reduce the reaching distance, enabling the games to be picked up in twos, and increasing the size of the master carton to make it easier to pack. The modifications cost only £1500, the RSI problems were significantly reduced and there was a 90 per cent reduction in damage to the packaging and customer returns.

At an RSI conference in Edinburgh, GMB representatives from Levi Strauss reported on the measures taken by their employer to reduce the incidence of RSI, which is a well known risk in the clothing industry. Following a number of compensation claims, the company carried out an investigation and found that in each case the RSI had occurred after the employee had returned to work after an absence. There was a performance related pay system in operation and people were trying to achieve their pre-absence performance levels straightaway. The company did not withdraw the pay system but it did introduce a Graduated Return to Work scheme whereby staff who have been absent for 5 days or more are able to return to work at a reduced productivity rate but at the average earnings rate. Over a period which can last up to 15 working days, depending on the length of the absence, the employee gradually builds up to the required productivity rate while maintaining their earnings level. The employee is not allowed to work any overtime during this period and is also allowed breaks to perform special exercises designed to help condition the muscles. A programme of stretching exercises that all employees are encouraged to carry out was also developed. In addition, the RSI reporting procedure was improved.

Display screen equipment - preventive measures

As already indicated, RSI is a risk for many different workers and is not confined to computer users, although most of the publicity about RSI has concerned keyboard users. Nevertheless, the application of computer technology is becoming more and more widespread and increasing numbers of workers are finding that they have to use computers in their work. Also, computer work appears to be particularly associated with the diffuse type of RSI. The London Hazards Centre book, VDU Work and the Hazards to Health, published in 1993, describes the hazards of VDU work in detail and includes a chapter on the risk of RSI from this type of work which contains useful advice on how to avoid it. The HSE has also published guidance to employers on how to comply with the display screen equipment legislation. Some of the measures that employers can take to prevent RSI from work with display screen equipment are set out below. It is important when carrying out risk assessments to take account of the difference in use between workers who have been trained to touch type and those non-typists who have been given keyboard equipment to use in their job and who may use only two digits. The latter may be at more risk of strain injuries in the neck area because they tend to spend more time looking down at the keyboard rather than the screen. And although their hands may be less static than those of a trained typist as they search around the keyboard for the correct key, they may be put under excessive strain if they spend prolonged periods of intensive keying in with only two fingers. The same will apply, of course, to workers who have to spend long periods doing repetitive number pad entering with the same fingers.

The spread of windows software has also led to more widespread use of a mouse in addition to the keyboard and this is being implicated increasingly in the development of RSI. Problems identified include the design of the mouse itself, the position of the mouse at the workstation, and the nature of mouse usage. Excessive double clicking and click and drag operations appear to be particularly associated with RSI problems. Some users have found that a trackball is easier to manipulate and causes less strain but there are many different types available and no systematic tests have been carried out. A number of people have reverted to a mouse because they found it more difficult to position the cursor accurately with a trackball and this was causing them stress.

The importance of ensuring that VDU users are given their legal entitlement to an eye test and any corrective glasses that they may need for VDU work should not be forgotten when assessing the risks of RSI. If users have not had any vision defects corrected and sit hunched over the screen to read it properly or straining with their necks bent to read through the appropriate half of their bifocals, then the risk of musculoskeletal problems is increased.

It is also important to be aware of the wide variety of computer aids and accessories currently on the market, some of which may be of extremely dubious benefit or which could be positively harmful. While it may be sensible to provide a choice of keyboard or mouse styles so that workers can select the one that is most comfortable for them, indiscriminate use of, say, wrist rests, without proper advice on how to use them, could lead to an increase in RSI cases because workers are resting their arms in a static position while typing instead of resting their wrists on them between periods of typing. However, it should be noted that many of these accessories have not been fully validated and what may work for one person could be damaging to another Many unscrupulous manufacturers are making completely unsubstantiated claims about their products and putting workers health at risk..

Preventing RSI in VDU work

Work organisation

ensure keyboard work is alternated with other tasks requiring the use of different muscles
ensure that regular breaks and microbreaks are taken
ensure that intensive keyboard work is restricted to a maximum of 4 hours a day
avoid intensive keying in with two fingers
ensure that workloads and deadlines are reasonable
ensure that the principles of software ergonomics are applied
ensure that software is suitable to the task
ensure that software is easy to use and adaptable to the knowledge and experience of the worker
ensure that software displays information in a format and at a pace adapted to the worker
avoid performance monitoring
avoid payment systems linked to the number of keystrokes
provide training and refresher training
provide training in touch typing to employees who have to spend a substantial part of their work at the keyboard

Workstation

ensure workstation is large enough and deep enough to accommodate all the equipment and to allow user to adjust the position of the equipment to suit them
ensure chair is fully adjustable for seat and back height and angle
ensure chair and its mechanisms are maintained in working order
ensure worker can work upright , face forward and squarely on
ensure workstation height is adjustable
ensure worker has adequate leg room eg by providing pedestal rather than fixed drawers
provide footrest if user cannot rest feet flat on floor when seat height is correctly adjusted for typing position of arms
provide document holder so that copy can be positioned at same eye level as screen

Work equipment - screen, keyboard, mouse

ensure the screen’s tilt and swivel mechanisms are in working order
ensure screen is kept clean and free of dust
ensure the appropriate polarity is used for the conditions (dark background to reduce flicker, light background to reduce reflections)
ensure that user has had eye test and any corrective glasses to avoid hunching/peering at screen
provide adjustable screen holder if screen is too low or too high for the user to read comfortably
rearrange layout so that screen can be positioned at 90° to window to reduce glare
provide screen filter if glare cannot be reduced by repositioning
provide a choice of keyboards to suit users eg left-handed keyboards, split keyboards, curved, ergonomic keyboards, keyboards with more cushioning of keys, keyboards with integral mouse function etc
provide voice recognition systems to minimise keyboard action
ensure keyboard height can be adjusted
ensure that keyboard can be used in a flat position
ensure keyboard can be positioned squarely in front of user and at a distance that allows elbows to be kept close to the body
ensure keys are kept clean and legible
provide a choice of mouse or trackballs to suit users
provide a 3 button mouse to avoid double clicking
ensure mouse can be placed within easy reach so user does not have to stretch out arm to use
provide a mouse mat
ensure mouse is kept clean

The individual

provide training in the risks of RSI and how they can be minimised
provide training in the importance of taking breaks
provide training in correct posture to be adopted at keyboard
ensure that correct posture can be adopted in each individual case
ensure that individual needs are taken into account and that people at the extremes of height and size ranges are catered for.

RSI Hazards Handbook Chapter 5
© London Hazards Centre, Interchange Studios, Hampstead Town Hall Centre, 213 Haverstock Hill, London NW3 4QP, UK

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