It starts out as a minor twinge in the wrist that barely cramps the style of the countless workers who spend hours at the keyboard every day. But then, for many, it escalates until workdays are cut short with acute pain radiating from the hand to the elbow, shoulder and back.

Carpal tunnel syndrome and other forms of repetitive strain injuries (RSI) are a major issue for millions of employees. Now, RSI is fodder for President Bush's rollback of Clinton-era policies viewed as anti-business. In March, Bush signed a repeal of ergonomics regulations designed to protect Americans against workplace injuries, calling the rules overly burdensome.

A poll on the Society of Human Resource Management's Web site found that 70 percent of respondents' companies had no ergonomics plan in place. Furthermore, many RSI-prone independent workers aren't subject to Occupational Safety & Health Administration (OSHA) regulations. But if you put a premium on your health, it might behoove you to examine the ergonomics of your work environment. Cornell University's Ergonomics Web puts it this way: "Good ergonomics programs are always cost-effective; they save more than they cost." With that in mind, consider these options for prevention and treatment.

Prevention

Although the treatment of RSI is mired in contradictory viewpoints, many prevention techniques are widely accepted. Experts agree that workers should take frequent breaks from their computer workstations, shift sitting positions and stretch regularly.

"The golden rule of ergonomics is to work in neutral positions," says Jack Bellis, coauthor of It's Not Carpal Tunnel Syndrome: RSI Theory & Therapy for Computer Professionals. This means positioning yourself, your chair, your keyboard and your computer monitor correctly (see Resources below).

Ergonomic hardware and furniture may offer substantial relief from hand, arm and back pain if properly chosen and installed. But beware: Some devices and furnishings may cause further injury. Check with a certified health practitioner before changing your behavior or workstation setup.

Hardware and Software

On the hardware side, ergonomic keyboards ($35 and up), and adjustable keyboards and mouse trays (be wary of any priced under $200) can help you maintain proper posture and neutral wrist position. If you ever type while talking on the phone, a telephone headset (at least $75) will help ward off a serious neck pain. Do you spend many hours a day working on your notebook PC? "Laptop computers on a desk may be one of the worst situations," warns Bellis.

Some writers, programmers, designers and consultants have turned to speech-recognition software to reduce stress on their hands. These software programs, which in recent years have improved somewhat in accuracy and usability, let you dictate text and even enter commands with your voice. The financial investment is moderate (around $200 for a capable product), but most users spend lots of time correcting dictation errors and training the software to understand their words.

Treatment

When should you seek therapeutic treatment of RSI? As soon as you suspect you may have a problem. The longer you wait, the more costly the course of treatment -- in terms of money, time and pain. What kind of treatment should you get? There are many options.

Some orthopedic surgeons insist that surgery is the only effective treatment for advanced carpal tunnel syndrome. "A lot of people get surgery and it helps them immensely," says Bellis. "But there's a good chance that surgery will just address your latest point of failure." For example, surgery may decrease wrist pain but not prevent the emergence of related RSI problems in the elbow and shoulder.

Physical therapy may be a better form of initial treatment for RSI patients, according to Bellis and his coauthor, Suparna Damany, a certified hand therapist and ergonomic assessment specialist. Massage is one therapy that can give lasting relief to some RSI sufferers.

If a physician suggests surgery, take a deep breath and consider therapeutic alternatives offered by licensed specialists. If you're hyperventilating at the notion of spending several hundred dollars to improve your workstation's ergonomics, compare that to the prospect of an RSI disability that could cost you thousands of dollars in billings.

RESOURCES

Quiz Yourself
What do you know about workstation ergonomics?

Web Guides to Ergonomics and RSI
Primer on Repetitive Strain Injuries
RSI Program
Cornell University Ergonomics Web
ZDNet guide

Government Information
OSHA primer
OSHA publications
NIOSH Report on Alternative Keyboards

Books
Conquering Carpal Tunnel Syndrome And Other Repetitive Strain Injuries by Sharon Butler

It's Not Carpal Tunnel Syndrome: RSI Theory & Therapy for Computer Professionals by Suparna Damany, Jack Bellis and Martin Cherniack

The Repetitive Strain Injury Handbook: An 8-Step Recovery and Prevention Planby Robert Simon and Ruth Aleskovsky

Community
Human Factors and Ergonomics Society
Sorehand mailing list

Shopping
Ergonomic Resources
Safety Online

Speech Recognition
IBM ViaVoice
Dragon NaturallySpeaking