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Repetition strain injuries

Everything about Repetitive Strain Injury (RSI) is controversial, even the name. Occupational musculoskeletal disorders, acute pain in the hands, arms, shoulders or neck arising from keyboarding, as well as many other jobs, have attracted many names from physicians, ergonomists and others trying to find a description which fits their point of view. Some examples are Work-related Upper Limb Disorders (WRULDs; currently favoured by the UK authorities), Occupational Overuse Syndrome, Cumulative Trauma Disorder (the most common term in the USA) and Refractory Cervicobrachial Pain. Many of these terms merely reflect the difficulty for the user in coming up with a satisfactory explanation for the phenomenon s/he is reporting.

The London Hazards Centre continues to use RSI as a term in popular usage for damage to muscles, nerves, tendons and other soft tissues resulting from over-use or misuse. A leading rheumatologist uses a more limiting description, defining RSI as a condition, usually occupational, characterised by pain which arises as a result of repetitive muscle activity responding at first to rest (Huskisson 1992).

Types of RSI

Within the broader definition of RSI, there are a large number of medical conditions used as diagnostic labels. Among these are:

tenosynovitis

inflammation of the synovial sheath protecting tendons; tenosynovitis is the only prescribed industrial disease of the RSI type

tendinitis

inflammation and thickening of the tendons

carpal tunnel syndrome

pressure causing pain on the median nerve passing from the arm to the hand

ganglion

a cyst-like swelling at a joint or in a tendon sheath, usually on the back of the hand or wrist.

Upwards of 30 terms are in common use to describe various forms of RSI.

The symptoms of RSI are pain, swelling, tenderness, crepitus ('crackling' feeling when tendons or swelling are pressed tightly), pins and needles, loss of sensation (numbness), ganglion, muscle weakness, muscle spasm and joint restrictions/loss of movement. These symptoms can occur at any stage in the development of the injury and not all sufferers experience them all. Often there are no visible signs at all.

RSI is a progressive, long-term condition which can be divided into three broad stages:

• stage 1 (mild), pain, aching and tiredness of the wrists, arms, shoulders or neck during work, which improves overnight
• stage 2 (intermediate) recurrent pain, aching and tiredness which occurs earlier in the working day, persists at night and may disturb sleep
• 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.

Stage 1 is virtually impossible to distinguish from aches and pains arising from fatigue and may continue for weeks or months. However, the transition to Stage 3 can take place within weeks and sufferers can be in extreme pain or incapacitated for months or years. It is therefore vital to take all symptoms seriously and to take the proper preventive action as soon as they appear (see later). Victims have written of the intensity of the pain and the difficulty of carrying on a normal life (Community Information Project 1990).

Causes of RSI

Keyboard-induced RSI is caused by a combination of rapid movements and static loads over an excessive period. Static load injuries are due to continuous muscle contraction caused by a person holding a fixed position while their limbs are unsupported. For example, when someone uses a keyboard that is too high, a static load is placed on the muscles of their back, shoulders and forearms. Poor working conditions and monotonous, stressful work can add to the likelihood of RSI occurring. The following, based on the booklet Tackling Teno (GMB 1985), is a list of factors that can lead to keyboard-related RSI:

• excessive work times
• excessive work rates
• rapid repetitive movements
• bonus and piece-rate payment systems
• poor workstation and equipment design
• awkward working positions
• excessive work load
• tight deadlines
• inadequate rest breaks
• compulsory overtime
• inadequate training
• overbearing supervision
• monitoring of work rates
• lack of control over the work process
• changes in the work process

Because physiological signs are sometimes absent in RSI cases and the medical profession is divided on the causes of the injury, other theories of the causes of RSI have concentrated on blaming the victim, that is it results from malingering or hysteria (Lucire (1986). No evidence has been put forward to support these ideas. After a widespread outbreak of RSI in Australia in the early and mid 1980s had subsided, there was a great deal of speculation on the possible causes, focusing on a variety of personal and social factors. However, it has been pointed out more recently that new cases are still appearing in numbers and that it has become more difficult for workers to claim compensation (Bammer 1990 and Meekosha and Jakubowicz 1991).

A huge volume of research has been conducted since the early reports of keyboard-related RSI and there is a great deal of evidence that the onset of injury is related to the volume of work (English et al 1989) and the design of the workstation (Sauter et al 1991). Much recent research has focused on the influence of 'psychosocial' factors, ie. job and home conditions producing stress in the VDU operator. A very detailed study carried out at US West Communications in the USA at the request of both union and management concluded that psychosocial factors played a role in the onset of musculoskeletal disorders (NIOSH 1992). Factors cited were fear of being replaced by computers; jobs which required a variety of tasks; increasing work pressure; lack of a production standard; lack of job diversity with little decision making opportunity; high information processing demands; and surges in work load. Overall job insecurity and lack of co-worker and supervisor support were also associated with symptoms as was electronic performance monitoring.

The prevalence of RSI varies widely from workplace to workplace but there have been reports of up to 35 per cent of the workforce in a given workplace contracting the injury over a five year period (Hocking 1987). A survey in Southwark revealed that the likelihood of RSI was closely related to time spent at the keyboard (Southwark Trade Union Support Unit 1990).

Diagnosis and treatment

One of the most severe difficulties that RSI sufferers encounter is in finding doctors who will diagnose and treat them both effectively and sympathetically. There may be no objective clinical signs in the early stages and few GPs have much training in occupational medicine. Some doctors are hostile to the idea of RSI as a physical injury. There is therefore a great deal of non-diagnosis and misdiagnosis. Some doctors can confuse RSI with rheumatoid arthritis and recommend treatments which only make matters worse. A blood test can distinguish between rheumatoid arthritis and RSI and it is worth demanding that this is carried out if the doctor diagnoses rheumatoid arthritis. Other doctors prescribe painkillers and advise sufferers to return to work, running the risk of exacerbating the injury.

Sufferers should insist on being referred to a specialist as soon as possible, though even this can be problematic. The number of sympathetic specialists is still very small and they are reluctant to commit themselves on the origin of the injury. A smaller number still work within the National Health Service (NHS). People are now entitled to see their medical records and should do so in the case of occupational RSI, especially if they are under pressure from their employer to allow disclosure.

A wide range of treatments have been proposed for RSI and there is no consensus about what is most likely to be effective. This will depend on the particular type of injury which has occurred. To help reduce inflammation, hot and cold treatment may be useful. This can be done several times a day by massaging the inflamed area with oil and then wrapping in wet crepe bandages or applying a cold compress. Lightweight splints can also be used to support the painful area and should be custom made. They may give some relief from pain but will not hasten recovery. They should not be worn for more than 12 hours a day.

Some people have found alternative therapies helpful but there has been no real assessment of their benefit and they are not generally available on the NHS. Physiotherapy has strong advocates and has become more popular, some employers even recruiting physiotherapists to minister to their employees. Physiotherapy should not involve exercising the affected part of the body as this can even make the problem worse. The possibility of cure then becomes more remote, producing frustration and suspicion on the part of sufferers, doctors and employers. Ultrasound in conjunction with physiotherapy is sometimes used to assist in pain relief and the reduction of inflammation. Painkillers should not be used simply as a means of getting people back to work but can be used for relief in conjunction with other treatment.

Surgery is drastic and does not have a good record of success. The best treatment so far found for RSI is rest of the affected limb. The worker should not return to work until completely pain free. If complete rest is not possible, there is now a range of kitchen utensils and other implements designed for the RSI sufferer (see Contacts and resources). In far too many cases the opportunity for rest is not taken because the condition is misdiagnosed or the worker cannot afford to take time off or does not dare to admit to the employer that there is an injury.

Prevention of RSI

As RSI is a long-term, painful condition with damaging effects on job prospects and social life, prevention of the injury is paramount. The good news is that RSI is not at all an inevitable consequence of VDU work but can be avoided by attention to the following factors:

• posture
• workstation design
• job design
• work load including working time and work rates
• payment systems
• workplace conditions
• early reporting of symptoms
• training

Many of these factors are addressed by the DSE Regulations which are dealt with in more detail in Chapter 9. The onus is on the employer, under the DSE Regulations, the Health and Safety at Work Act and common law, to provide a safe workplace. If even a small proportion of the workforce has developed RSI, then the employer is not fulfilling that duty. If a change of work or job rotation is the only way to protect the worker, then the employer is obliged in law to transfer him/her to other tasks. This can apply particularly to an RSI victim returning to work where there is a high risk of the injury recurring.

A proportion of typists who used manual and electronic keyboards suffered from RSI but there are several features about VDUs that seem to make RSI more likely. VDUs are physically different from electronic or manual keyboards with their light touch keys, extra function keys and screens. They eliminate the need to change paper, physically correct errors and wait for or make a carriage return. These features increase two of the major factors in RSI, repetition and static loading.

Posture

The thighs should be horizontal and the lower legs and torso vertical. The upper arms should hang vertically down and the forearms should be horizontal. The wrists should be straight. It is very important to keep the elbows in at the sides of the body to minimise any bend in the wrists. Extension, flexion or deviation of the wrists should be kept to a minimum. A footrest may be of assistance in achieving such a posture and should be supplied by the employer if requested. Stretching exercises of the shoulders and arms are helpful in retaining suppleness.

Workstation design

The design of the VDU workstation (known as ergonomics) is crucial. All aspects of the workstation, the monitor, computer, keyboard, desk, chair, footrest and document holder, if available, and ancillary equipment, and their inter-relationship must be taken into account in order to provide a safe and comfortable workstation.

The chair should have a stable base and allow the worker freedom of movement. The seat should be adjustable in height and there should be a back support which is adjustable in height and tilt, with good lumbar support. The desk should also be adjustable in height and allow separate adjustment of the screen and keyboard heights. The worker should be able to sit 'square on' to the screen in a position that allows easy movement. The relative heights of the screen, keyboard and chair should enable the worker to achieve the correct posture as described above. The screen and the document holder should be at the same height.

The keyboard should be tiltable and separable from the screen so that the worker can place it in the optimum position. The keys should have springs stiff enough to resist the relaxed weight of a finger (approximately 100 grams). Keys should have a smooth rather than a jarring bottoming. Resting the keyboard on a foam rubber pad helps. While the traditional QWERTY keyboard is still very widely used, alternative keyboards, particularly the Maltron model, have their advocates. It is claimed that they can prevent or even cure RSI though such claims have not been subjected to independent corroboration. There should be sufficient space between the keyboard to provide support for the hands and wrists of the worker, though it should be said that many people find this an uncomfortable position and prefer to place the keyboard at the edge of the desk. There has been little research on the effects of hand/wrist supports in front of the keyboard and it may even be that these are harmful in impairing the blood flow in the hands.

Many people transfer from a VDU to a non-VDU workstation on a number of occasions in the course of a working day. It is important to ensure that chairs, desks, etc. are reset on each occasion to obtain an optimum position for each individual using the workstation. It is also important that any ancillary equipment does not have any adverse effect on the overall arrangements. For example, audio typists should ensure that the leads to headphones are sufficiently long and flexible so as not to affect the posture. No-one should attempt to key in while cradling a telephone on their shoulder, as a number of journalists have found to their cost. There are instances of people with 2 PCs on their desk; by definition they cannot both be in the right position!

There have been a number of reports of workers developing musculoskeletal disorders through using a mouse, trackball or similar device. There is little guidance on the ergonomics of such devices but it seems clear that they should be designed to fit comfortably in the hand and used on a surface that enables them to move freely.

Job design

Continuous VDU work throughout the working day is a surefire recipe for RSI. Jobs must be designed to ensure that there are breaks in keyboarding. It is the employer's duty to plan breaks and changes in activity. There has been much debate on the optimum conditions for breaks and the current view is that short, frequent breaks are more satisfactory than longer, occasional ones. The Health and Safety Executive commissioned a study (which it ultimately decided not to publish) of the effect of VDU working times on productivity rather than safety which concluded that a 12-15 minute break every hour led to maximum productivity (Cox, cited in NALGO Safety Representative June 1991). This coincides with the London Hazards Centre's recommendation on safety grounds. There should be an absolute maximum of two hours keyboarding without a break. Breaks should be included in working time and should not be a reason for more intense work at other times. Breaks should be taken away from the screen and the onus is on the employer to find other work to do. Taking breaks is crucial in preventing RSI though the experience has been that it is often difficult to persuade people to do so even when satisfactory conditions are in force. Modern software is available which can flash messages on the screen or make the computers go down at periodic intervals, but this can have the effect of further reducing the worker's control over their work. It is the objectives and methods of the employer and the attitudes and organisation of the workers which are critical.

The job should also be designed to allow the worker individual discretion over how to carry out tasks. There should be control over the nature and pace of work so that the worker can carry it out under the optimal arrangements. Deadlines should be reduced to an absolute minimum and planned out of the job wherever possible. The manager who rushes out with a report at the last moment that absolutely has to go in that night's post must be re-educated to organise his own time properly.

Work load

As repetition of keystrokes is a critical factor in causing RSI, the speed of work and the total period for which it is carried on are of major importance. Much experience has shown that for RSI, as for other VDU-related hazards, four hours per day is the maximum safe level. Above that the incidence of injury begins to increase (NIOSH 1990 and Rossignol 1987). Keystroke rates, particularly those exceeding 10,000 per hour, can lead to the onset of RSI symptoms. This is about 30 words per minute which might not seem like a lot, but an average sustained over a period of hours is a different matter.

Payment systems

Productivity schemes, performance related pay, bonus systems and overtime incentives, all payment systems which are based on piece rates tend to increase the risk of RSI by encouraging the worker to work as long as possible as fast as possible. The objective should always to be on time rates or, preferably, salaried status. Piece rate systems are used in conjunction with electronic performance monitoring which should only be used with the worker's consent. Systems which impose penalties for errors put further pressure on workers to go too fast and should be resisted. Where work rates do exist, these should be negotiated between the union and the management.

Workplace conditions

Other conditions in the workplace, called 'psychosocial' factors in the currently fashionable jargon, can exacerbate the risk of RSI. Among such factors are threat of redundancy or discipline, attitude of supervisors and managers, monotonous work, deskilling, lack of control over the job, and so on. These kinds of factors, adding up to stress, can compound poor workstation and job design and excessive workload. They need to be identified and reduced if not eliminated, again fundamentally a subject for negotiation between union and management.

Early reporting of symptoms

Many people work through symptoms of RSI or use painkillers in the belief that there is nothing much wrong or that they will receive a hostile response from their employer. Regrettably, the latter is all too often the case and disclosure of symptoms to the employer is something that always has to be thought about carefully. Advice should also be sought from the union representative who is probably best placed to gauge the management reaction. But basically if it is a question of arranging for time off work or trying to get some aspect of the job changed, an explanation has to be given to the employer and it is better that this is accurate and done sooner rather than later. It is also extremely important in establishing a case for compensation if that should prove necessary. Symptoms should be entered into the workplace accident book, even if the condition does not seem serious at the time. You should also record the injury with the DSS and apply for a decision about whether your work caused the injury by completing DSS form BI95.

The employer may want access to the worker's medical records and this should only be agreed when the worker has checked that nothing untoward is contained in the record. Even then, only that portion of the record that is relevant to the inquiry should be disclosed. Examination by a company doctor or participation in a company rehabilitation scheme may be obligatory but in all cases independent medical advice should be sought before agreeing to this.

Training

Employers are now obliged to provide training and information on the health and safety aspects of VDU work. This should encompass hazards of VDU work, best practice in their avoidance, work rules, union/management agreements and legal aspects. The training and information should be available both to new employees and to already established ones. It should not be sufficient just to show a video in the lunch hour, as some companies have done. There should be an opportunity to go on courses or at any rate ask questions of someone qualified to answer them on aspects of VDU safety.

Compensation

While claiming compensation from an employer for RSI is a difficult and lengthy process, the situation has improved slightly in the last few years. However the onus is still on the employee to show that the employer was at fault. To obtain damages you have to sue your employer, provide evidence that you have RSI, that it was your job which caused RSI and that a reasonable employer would have prevented it. You need evidence such as:-

• the employer knew there was a risk and ignored it
• the employer did not know there was a risk, despite information being available
• there were complaints made to the employer about symptoms of RSI, or about problems with the equipment, which were not dealt with
• the speed of the work was excessive
• no information or training about the risks was given
• previous cases of RSI were not acted upon by the employer
• reports of RSI were recorded in the accident book and sickness records
• trade union proposals on the issue which were not taken up by the employer
• there was a failure to provide suitable breaks

An action for damages must be initiated within three years of an accident or injury taking place and to have any chance of success needs to have an authoritative medical opinion that the injury was work related. It needs to be handled by a lawyer with experience of personal injury claims. There are many unfortunate cases on the London Hazards Centre books of individuals consulting neighbourhood solicitors and spending a large part of their savings, only to find out that they did not have a strong enough case to proceed. Legal aid may be a possibility but for a variety of reasons this is becoming increasingly less of an option.

This is an area in which trade union membership is an advantage; unions will pursue personal injury claims on behalf of their members and employ specialist lawyers for that purpose. There is a better chance of winning your claim or at least obtaining an informed assessment of your chances.

There have been a number of substantial out of court settlements of keyboard-related RSI cases but to date there has only been one case where a court found that keyboard work was responsible for the workers' RSI. This was a case brought by 11 data processors formerly employed by British Telecom and referred to injuries sustained in the early 1980s; the judgement was given late in 1991. The case was backed by their union, the National Communications Union. The women were expected to work at an average of 13,000 keystrokes per hour over a seven hour day with electronic monitoring in force. The design of the workstations was deficient and no training was given. Judgement was given in favour of the women on grounds of the poor design of the workstation and the lack of training. The judgement did not refer to the working time or work rate issues. Two of the women were awarded compensation of £6,600 for the pain and discomfort caused but awards of further sums for loss of earnings was delayed by both sides' appeals against the ruling. A few days before the case was to have been heard in the Appeal Court an out-of-court settlement was agreed involving payments to the 11 data processing operators.

Another significant case is due to be heard in mid-1993 involving a former employee of the press agency Reuters who is being backed by his union, the National Union of Journalists. A number of other unions have a number of cases pending but the first few judgements are going to be crucial in establishing the basis of liability and the size of settlement.

There are instances of employers who have accepted their responsibility for outbreaks of RSI and who have been prepared to negotiate (or more usually impose) compensation terms for their employees. One such was the Financial Times (FT) where a huge number of journalists suffered injury in 1987-1990, generally agreed to be caused by the installation of a badly designed direct input system. After long negotiations and the threat of strike action by the National Union of Journalists, the management finally imposed the following terms early in 1992:

• final decision on who should leave to be made by the company in the light of medical reports, including consultation with physiotherapists and other treating professionals
• ill-health pension, which is based on the actual service to date and potential service to normal retirement age, and on present salary, for those in the pension scheme
• a cash payment by the FT of at least 12 months salary
• additional payments of £15,000-27,000 in several cases, depending on individual circumstances
• insurance benefit of 75 per cent of salary, less equivalent of state invalidity benefit, for the one person not in the pension scheme, plus payment of 24 months salary
• an option to stay on staff an additional six months, with a corresponding reduction in payment on departure
• a commitment to re-employment at the FT, subject to reasonable conditions, on full recovery
• membership of the private medical scheme till the end of February 1993
• if in alternative employment, pension reduction which avoids a pound for pound cut and with no cut in first year of re-employment
• no pension reduction if retraining
• no pension reduction for the one person near normal retirement
• assurances of the company's intentions on final pension when normal retirement age is reached, subject to Inland Revenue rules at the time
• professional career counselling and financial advice
• possible job interviews at other FT-related companies

The FT is obviously a special case and very few companies would contemplate offering terms like these. Nonetheless, negotiators can use these terms as a bargaining lever if they have to deal with an employer who is seeking to medically retire (sack) RSI victims.

The other source of compensation is the state benefits system which is also fraught with difficulty and delay. There are indeed epic stories of RSI sufferers taking on the Department of Social Security for years with countless meetings, tribunals and reports before establishing their right to benefit. Tenosynovitis is the only form of keyboard related RSI that qualifies as a Prescribed Industrial Disease; if you suffer from it you can claim disablement benefit using claim form BI 100B. In March 1992 the Industrial Injuries Advisory Council proposed a slight extension of the Schedule of Prescribed Industrial Diseases which has still to be implemented but which is not likely to affect keyboard users. Even if you are diagnosed in the right category, you still have to be assessed as being 14 per cent disabled to qualify for disablement benefit. Even sufferers of RSI so severe that they cannot brush their teeth are generally assessed at between 8 and 12 percent disabled. Thus only about 500 cases of RSI qualify from disablement benefit each year when the 1990 Labour Force Survey reckoned that over 75,000 people had a musculoskeletal disorder caused by work in the previous 12 months.

There are two other kinds of state benefit that people can apply for: disability living allowance and reduced earnings allowance. Disability living allowance has been available since April 1992. If you are unable to work and need help with domestic and personal care (even if you don't actually get any help), you should get a claim pack from the Department of Social Security (DSS). The claim form is very long indeed, and you will need a statement from your doctor and from a friend or family member that your self-assessment of your disability is accurate. You will not normally have to undergo a DSS medical assessment, but a percentage of claimants are called in.

Reduced earnings allowance has a 1 percent disability qualification, but was abolished in October 1990. If your condition dates from before this time, you can still apply, but you must have had continuous loss of earnings since before that date to the present time.

Obtaining compensation by any route is long, complex and likely to yield inadequate results at the end. Money in any case is no real compensation for the pain and damage to career prospects, home and social life. While the struggle to improved compensation for victims must continue, this should never become a substitute for the prevention of RSI.

Organising for safety

Individual approaches to the management about RSI, as with most other issues in the workplace, are unlikely to yield many results. Raising the issue of RSI needs to be carefully thought out and tactics planned. What you can do in your workplace will depend on whether a union is recognised by your employer. But in any case, if you are not in a union, you should join one. If you are unsure about which one to join, contact the Trades Union Congress (TUC) (see Contacts and resources).

A useful method of making people aware of RSI and uncovering the extent of the problem is to do a survey. Details of how to do an assessment of the ergonomics factors that might be causing RSI are given in Chapter 9. There are some points that need to be followed if a questionnaire is going to be successful:

• keep it as short as possible
• keep it confidential - people have the right not to be identified if they provide this kind of information and are more likely to respond if they are confident that the results will be kept confidential. Make it clear that the results are for the workers' or union's eyes only and information won't be given to the management except at the request or agreement of the person concerned
• make sure that the questions are asked in straightforward language

Questions can be asked either verbally or by getting respondents to fill in a form (or a mixture). The method will depend on the particular circumstances. Here are some possible questions that should help you get to the heart of the matter:

Analysis of survey results can be tricky but you should see trends developing. You may need advice from your union or from a Hazards Centre on how serious a problem you have got. But basically, if anyone is in pain, then changes are needed. The next step is to decide how to present the results to the management. If you are not in a union, this is especially sensitive. Make clear that you are representing a body of workers and never go alone to a meeting with management.

Many unions have by now provided information and advice on RSI. You should contact your branch or your fulltime official to obtain this. Most union branches have funds which can be used to buy leaflets, posters and booklets which can help raise the issue. Most unions will also provide information and training on the rights of safety representatives and safety committees. Safety representatives of recognised trade unions are entitled to paid time off to receive training. They can inspect workplaces, investigate accidents, receive information from employers and be provided with facilities for carrying out their function. Joint union/management safety committees, which must be set up at the request of two safety representatives, should oversee the operation of health and safety policy in the workplace. More details of the new rights for safety representatives in the Management of Health and Safety at Work Regulations 1992 are given in Chapter 8.

If RSI is a problem in your workplace and you consider it is impossible to approach your management about it, then you can contact the authorities responsible for enforcing the law. This can be done anonymously and the authorities are bound to follow up the complaint. The law is enforced in offices, shops and similar places by the local authority Environmental Health Department and in factories, warehouses, etc. by the Health and Safety Executive. But these organisations are poorly resourced and do not have VDU work at the top of their list of priorities. They are not a substitute for organising into a strong trade union. It is important to have a clear set of demands to make of management which can be used as the basis for seeking improvements in working conditions wherever these are required. Some of the basic demands are as follows:

1. Risk assessments under the Display Screen Equipment Regulations to be carried out in conjunction with union representatives and with the results reported to the workers
2. Rapid timetable to be agreed for bringing all workstations up to the minimum requirements of the Regulations
3. Training and information in health and safety to be provided for workers, supervisors and managers to enable RSI to be prevented
4. Arrangements for consultation over proposed work changes
5. Arrangements for taking breaks, say a minimum 15 minute rest break during every hour of continuous keyboarding in addition to tea and meal breaks
6. Maximum working time, say four hours per day
7. Wages to be paid on time rates not piece rates
8. No keystroke monitoring
9. Arrangements for a system of reporting RSI symptoms with a guarantee that victims will not be penalised
10. Agreement that all people with symptoms of RSI are moved to other work or given time off without loss of pay, conditions, status or other benefits
11. Assistance with treatment, rehabilitation and claiming benefits

The European Commission is considering a proposal to draft a directive on RSI. Assuming that this is ever processed through the maze of EC bureaucracy, and that the UK authorities are prevented from watering down any provisions which would impose new safety requirements on employers, this might offer enhanced protection for workers at risk from RSI. In the meantime, a package of conditions like those listed above will go a long way towards dealing with the issue of RSI in your workplace.