TEN COMMON SOURCES OF REPETITIVE STRAIN

Repetition is the mother of skill

- Tony Robbins

Repetitive strain injuries refer to injuries, irritations, and other discomfort that arises when a person undertakes the same movement repeatedly (Van Tulder et. al., 2007). Repetitive strain injuries are not one diagnosis, but the term is used as an umbrella for disorders that develop following things like awkward postures, sustained force, as well as repetitive movements. In life, may things are done repetitively for the sake of simplicity or because that is the only way they can be done - depressing an accelerator or brake in peak-hour Hoddle Street traffic, moving one's thumb over a phone to check the Public Transport Victoria app, cutting up the vegetables one may have bought at the Preston Market, all of these things are repetitive movements.

So many activities in regular human life have the potential to develop into sources of discomfort. The likelihood that a regular activity may cause discomfort, pain, or other limitation depends on many factors such as the person's work (Descatha et. al, 2003), age and gender (Picavet & Schouten, 2003), and a person's overall health. These are many and varied and so may be difficult to stratify, but the matter may be simplified by considering those movements which may give rise to discomfort as a root cause rather than considering the ecosystem of factors that may predispose a person to developing a repetitive strain injury. Safe Work Australia's [SWA] Model Code of Practice for the Management of Hazardous Manual Tasks (2018) recommends hazard identification and categorisation before considering individual risk, and so this will be undertaken here. Following are ten common activities which, owing to their repetitive nature, may expose a person to increased risk of developing a repetitive strain injury.

1. Typing and Keyboard Data Entry

Visual Display Terminals (VDTs) and Information and Communication Technologies (ICT) are typical features of Australian workplaces. All workplaces, from small cafes on High Street in Westgarth, to larger offices further to Preston, to factories in Fairfield and speciality retail and manufacture, use some degree of computerisation which requires data entry through keyboards. Keyboards are a computer peripheral operated with the hands through which alphanumeric information is managed in a computer system (Idowu et. al., 2005). Keyboards are typically placed in front of a screen and used by hand, or are found on the lower part of fold-out laptops and tablets, over which the hands need to be aligned (Keller et. al., 1998). The sustained turning of the hands inward over the keyboard which may be more or less dramatic depending on the typing style used exposes the wrist and hand to sustained strain to which repetitive movements are added owing to the movement of the wrists and the action of the fingers (Cheung et. al, 2008). The strain experienced through keyboard use may be increased if the hands and arms are inappropriately positioned toward the keyboard as well, such as if the keyboards are too high or too low (Gerr et. al., 2006).

2. Using Computer Mice for Long Periods of Time

Computer mice are another peripheral used when working with ICT and VDTs more specifically. Where keyboards are used to manipulate information in specific fields or in documents, mice are used to navigate the screen more generally, to make selections, to navigate windows, to coordinate tasks, and to arrange the working space of monitors. In contrast to keyboards, arm movements when using mice are more profound (Richardson & Larsen, 1997) owing to the relative reaching requirements of those tasks (Dennerlin & Johnston, 2006). The mousing hand must move in larger ranges to move the mouse pointer over more distance, and that distance may become larger with different screen sizes or in workspaces where multiple monitors are used. The movement of the computer mouse requires muscles in the forearm, upper arm, shoulder, elbow, wrist, and fine muscles of the hand (Cook & Kothiyal, 1998), which in combination and sustained exposure may give rise to irritation which may develop to injury. This may be further complicated by the positioning of the mouse within the workspace more generally, and those combinations of movements that require typing and mousing or entry and mousing at the same time, such as navigating large spreadsheets or using variable axes of viewing to look at different parts of a 3-d model.

3. Repetitive Movements of the Head and Neck in Desk Work

VDTs are part of workstations which include peripherals and parts outside of the computer terminal itself. Keyboards, mice, phones, and monitors all form part of the computerised workspace. In addition to these, other peripherals like touchscreens, printers and scanners (and fax machines!), magnifiers, and billing machines may form part of the workspace. When workers attend to different elements of their environments they typically move their heads to look at what they are doing (Korhonen et. al., 2003). Repetitive movement of the head and neck when looking between different elements of the working environment may give rise to muscular strain in the neck and shoulders (Sun et. al., 2017). The significance of these movements may increase where whole-body repositioning is needed, such as those that might be required in a dentist's clinic on High Street or otherwise, a bakery on Plenty, or at a doctor's office at Preston Market. The development of strain in these and other contexts can also be informed by the movement between static and dynamic postures of the neck, wherein the ecosystem of strain to which a person is exposed can give rise to irritation for which a person may be at greater or lesser risk of developing into injury based on individual characteristics.

4. Repetitive Movements of the Head and Neck in Driving

Outside of the computer workspace, and workspaces more generally, people need to get to and from work. In 2016, 62% of Australians drove their car to work, and 1% cycled. In 2021, those numbers changed, probably to reflect changing modes of work consequent to the Coronavirus pandemic in 2020, where in 2021 only 53.1% of Australians drove to work (Australian Bureau of Statistics, 2022). Driving a car and using the roads imposes strain on the head and the neck from repeated turning to check mirrors, to look at the internal environment of the car, and to monitor other road users (Grujicic et. al., 2010). The problem may be even more profound for those workers who need to drive freight or company vehicles, such as those which may deliver fruit and vegetables to the Preston Market, or forklift drivers who need to navigate warehouses in Plenty. Repetitive head checking requires turning of the neck into extreme ranges (Fice et. al., 2018), the significance of which may be increased where the work requires repetitive or frequent reversing such as when using a forklift to manage goods on pallets or when loading or unloading a truck. Similarly, the repetitive movement of the feet and legs while driving may also predispose a person to the development of particular discomfort. Safety in driving isn't just about obeying the road rules, but of being mindful of physical and postural strain as well.

5. Cleaning, Scrubbing, Ironing, and Wiping

At home and professionally, cleaning of workspaces and home spaces is a typical cause of repetitive strain. Scrubbing, wiping, brushing, ironing, sweeping, vacuuming and picking up litter and clutter all require repetitive movement of the upper arms against more or less resistance depending on the activity that is being done (Cabeças, 2007). In civilian or nonprofessional environments, from homes throughout Melbourne to the shopfronts and kitchens of Westgarth, Clifton Hill, and Ivanhoe, it's possible to stop, take breaks, and vary the work being done to improve sustainability. In professional environments, the combination of repetitive manual tasks against resistance done over the duration of a shift without appropriate rotation of tasks, worker rest, or alteration of duties to minimise strain may be combined with stressors from time pressure, practical demands, or other sources of psychological stress which may increase the severity or appreciation of physical discomfort (Amadio et. al., 2001). Returning to the mechanical nature of those activities, cleaning activities are rarely done in standardised environments because every building is different. An Ivanhoe brownstone has different area ergonomics when compared to an Alphington worker's cottage, both of which bear little resemblance to the more contemporary buildings being drawn up in Preston, Coburg, and Heidelberg. The strain experienced is therefore a consequence of the demands of the work being done undertaken in variable physical environments in systems of work which may predispose a worker to more or less physical or psychological and occupational / operational strain depending on the design of that task and work.

6. Cooking and the Preparation of Food

Humans are animals, and animals need to eat. The preparation of food, whether that involves the cutting of vegetables and fruit purchased at the Preston Market, the slicing of bread gotten from a High Street bakery, or even the grinding of coffee from a Heidelberg or Fairfield roaster, requires manual effort from the hands and arms. The cutting of food from larger to smaller sizes exposes people to known and understood strain which may develop into discomfort (Van Tulder et. al., 2007). For workers engaged in the preparation of food in temperature-controlled environments like Fairfield meat-packers or in Preston Market kitchens, the interaction of repetitive manual tasks with cold environments can increase the risk of acquiring a repetitive strain injury (Sormunen, 2009). The problem may be further concentrated when considering those workers and tasks which require working specifically with cold food, like ice cream scooping or the shaping of cool cakes and confectioneries which are typically eaten at cold temperatures, like in Melbourne ice-creameries or in cold-food cafes.

7. Using Vibrating, Hand-Held Power Tools

Tools are mechanical devices that allow workers to direct forces in excess of those that may be produced by the human body, in a more sustainable way. Tools may be powered and unpowered - unpowered tools require the generation of force by the human body, where the tool directs the application of that force to the part or thing being worked. Hammers, saws, screwdrivers, chisels and files use simple physical and mechanical principles to optimise the delivery of force to the object being worked. Powered tools use an external power source and integrated or close drivers, motors, or compressors to provide force generated by that non-human power source, where the human then simply directs the force that the tool provides toward its target. The use of vibrating and shuddering hand tools may give rise to repetitive strain injuries (Tyrer, 1998) as a consequence of exposure of the hand and upper limb to hand-arm vibration (Muggleton et. al., 1999), which may develop into other musculoskeletal issues affecting the elbows, shoulders, or other parts of the body depending on which limbs and structures are doing the most repetitive work.

8. Digging, Shovelling, and Repetitive Gardening Tasks

Digging, shovelling, and gardening more generally use unpowered tools like shovels, picks, and trowels as well as powered tools like whipper-snippers, hedge-trimmers, lawnmowers, and mechanical drills to keep gardens and lawns neat and tidy. No two gardens are the same, and the diversity and breadth of gardeners' tasks and duties, whether they are civilians or professionals, exposes them to risk of irritation from repetitive movements (Knibbs, 2014). The simplest example of a repetitive garden movement is the removal of weeds which, regardless of whether this is done by hand or with a tool, requires repetitive pinching, driving, rotation of the wrist and pulling to get the offending shrub out of the ground. Trowelling, digging, and mulching may also expose a person to irritation from repetitive strain, where instead of just using the hands and arms, the whole body is being used in the case of digging and carrying (Kirkhorn & Earle-Richardson, 2006). In this case, it is important to remember that repetitive movements may be small in the case of single or double joint movements, or large in the case of those movements that allow the whole body to accomplish more varied physical tasks.

9. Assembly-Line, Production, or Piece-Work

There's a great cartoon made by the Walt Disney Animation Company called Der Fuehrer's Face, wherein Donald Duck dreams he is an unfortunate resident of the Reich in Germany. It's a hoot, go check it out. In one segment of Donald Duck's nightmare, he is trapped next to a conveyor belt, screwing detonators onto the heads of artillery shells while snapping off salutes and screeching in his nosey warble. No such industry is undertaken in Melbourne (though there may be one or two NS-sympathetic shaved-heads running around) but repetitive assembly-line and piece-work tasks such as screwing individual parts together, pick-packing, closing boxes, and applying labels are all examples of activities which in isolation are innocuous, but owing to their repetition over the length of a shift and the concentration of their strain may give rise to the development of repetitive strain discomfort (Wild et. al., 1987; Simcox et. al., 2001). Typical examples of this sort of work in a more contemporary setting include such tasks as hand assembly of a product from components like packing freight or containers, stacking shelves in particular orders, and of shelving books.

10. Musical Instrument Practice

It might seem strange but yes, playing musical instruments can give rise to repetitive strain injuries (Schafer-Crane, 2006). From piano to piccolo, from bassoon to basset horn, musical instruments are devices used to direct wind, force, and mechanical effort to produce sounds which, if in tune and if in time, are pleasant to the ear. Musicians interact with musical instruments in the same way that tradespeople interact with their tools, and the use of physical force in each of these circumstances, over periods of time, in specific or other intensity, over the duration of days, weeks, and months, can give rise to repetitive strain in the wrist (Slade et. al., 1999), the neck (Mizrahi, 2021), the shoulders (Brown, 1992) and in other areas of concentrated load.

These activities run the gamut of conventional to curious. The point of this consideration is not to inculcate fear of doing anything, but to encourage mindfulness about the ways in which things are done and the ways in which that may predispose people to injury or irritation. Sometimes, things may not be made more simple than they otherwise are, and if that is the case then that is the point from which things should be improved. The risk of injuries arising from repetitive movements may be mitigated by rotating the tasks a worker does to decrease the concentration of their exposure to a particular task (Kirkhorn & Earle-Richardson, 2006), by using breaks in shifts whose activities are made up of repetitive movements to allow a worker's body some time to recover (Muggleton et. al., 1999), by automating or mechanising the task (McDermott, 1986), or by instituting more occupational or organisational risk management measures in a systemic fashion (SWA, 2018).

The human body is the machine that we use to interact with the world around us. Our bodies accept and appreciate the strain of that interaction, which may be intense, subtle, sustained, momentary, and fluctuate over time periods long and short. The management of repetitive strain and its likelihood to develop injury depends on our ability to appreciate the nature of those activities we undertake and their nature in terms of the load they impose on us, and to acknowledge the necessity of acknowledging our own limitations so that we can live our lives in health, wellbeing, and fullness over the course of our lives.

Alex Phillipos

B-Sci, B-HSci, GD-OHS, M-PHTY, M-ESH, M-OHT

Atlas Physio

2 Bruce Street, Preston

Melbourne, VIC, 3072

None of this information constitutes medical, legal, occupational health and safety, best guidance, standard, or other guidance, instruction, or prescription.

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