Matthew S. Caywood '99, a computer science major, says that last year, he was able to work 10 hours straight typing away at the computer the night before his assignments were due.

Then he developed RSI.

Now Caywood, who has tendonitis in his wrists, has joined the company of many other students who must deal with computer-related hand and arm injuries. These injuries are collectively known as RSI, or repetitive strain injury.

RSI is caused by small, rapid, repetitive movements while the body is in an awkward or fixed position for a long time. Gradually, these movements damage muscles, nerves and tendons of the forearms, wrists and fingers.

RSI is a broad category of disease that includes such injuries as carpal tunnel syndrome, tendonitis, tenosynovitis and tennis elbow.

Experts say that computer users should take periodic stretch breaks as an important preventive measure.

But Caywood says that during crunch periods, when work must be produced quickly, occasional breaks are a luxury most Harvard students cannot afford.

"You feel bad about taking breaks," he says. "They tell you to take five-minute stretch breaks, but you feel like you don't even have time to do that."

With proper treatment and therapy, RSI can get better. It is still unclear if the condition can ever go away.

Health providers at University Health Services (UHS) are currently working on estimating how many students have RSI, according to Christine Hollis, manager of UHS's Center for Wellness and Health Communication (CWHC).

Caywood estimates that between 20 to 30 percent of computer science majors have or have had RSI. Because of its prevalence, he says there is an "informal support network" within the department.

James T. Grimmelmann '98-'99, a computer science major with RSI, says that many students within the department know about each other's problems and can relate to each other because they have shared similar experiences.

"You have to have gone through it to understand it," Grimmelmann says.

Hiding RSI

For some students, however, RSI carries a powerful stigma. A graduate student in the humanities, who asked to remain anonymous, says she feels that there is a lack of openness among some students with RSI.

"I know people who have RSI and don't want to let on that they have it to the people in their department," she says.

In her own experience with RSI, she says it took her a while to tell people about it.

"I even hid it from my advisor," she says. "I felt like I was weird for getting it."

Joshua T. Goodman '92, a graduate student in computer science and co-director of RSI Action Group at Harvard, says he had RSI for almost three years.

He says that having RSI "is just very embarrassing."

Goodman says he was embarrassed to the point that he hid his injury and suffered pain rather than revealed it to others.

He says that when he rode a crowded bus and there were no seats left, he would hold on to handstraps--a very painful task. Goodman was too embarrassed to ask anyone to give up a seat.

"I chose to hold on and hurt myself," he says.

Goodman says he has since overcome his embarrassment and will ask for help when he needs it.

Crying Wolf?

But asking for help is a troubling task for people with RSI, he says. Goodman says that, for the most part, he can do anything he wants to do. But doing those things can cause pain that will eventually make his recovery time longer.

Goodman says that he chooses to ask for help in a selective manner. To an observer, then, RSI may appear to be a selective problem, he says. They may think injured people decide when they are hurt and when they need help. This situation, Goodman says, unfortunately breeds a distrust for people with RSI.

Even some doctors, according to Goodman, distrust people who claim to have RSI. This makes the experience of having the injury even more grueling.

"It is difficult to confront the medical community that doesn't trust us," he says.

A Long History

RSI is not a recent problem emerging from the computer revolution. Work-related hand and arm injuries have actually been recognized for more than 250 years.

According to an article in The New York Times, in the early 1700s, an Italian doctor named Bernadino Ramazinni described cumulative microtrauma as a main cause of occupational disease.

One of the diseases Ramazinni recognized was writer's cramp--"disease of the scribes." He says it was an injury people got from "an incessant driving of pen over paper," according to Repetitive Strain Injury, a book by Emil Pascarelli that is recommended by RSI Action members as a foremost authority on the injury.

Historically, RSI had plagued meat-packers, sewers, musicians, telegraphers and cashiers. But RSI was given little attention before it struck the white-collar workers in the corporate and academic world.

Interfering With Daily Life

Students who have RSI say that the injury has interfered with their academic activities and daily life.

Carmen C. Green '99, a biology concentrator, was diagnosed with carpal tunnel syndrome last summer after working nine-hour days at the computer for her job at a hospital in her hometown of Memphis, Tenn.

She says that before she went to the doctor, her injury was very debilitating.

"I had excruciating pain in my hand," she says. "I couldn't drive...I couldn't do anything."

Since August, Green has worn arm braces every day. These have helped her to use a computer again.

"Even if I am checking e-mail, by just typing my login name, I start to have pain and have to put on my braces," she says.

But Green says the braces do not enable her to do everything as well as she used to. She particularly notices that her ability to take notes in class has deteriorated. With RSI, she says she must take notes more slowly because it is painful to write too fast.

"I can't take all the notes I want to because it hurts," she says. "My notes just aren't as detailed."

Grimmelmann, who got RSI while working for Microsoft Corp. two summers ago, says that he had to take his finals under special conditions the fall semester he returned because his wrist hurt so much when he tried to write. The special conditions allowed him extra time so that he could massage his wrists in between writing paragraphs.

Caywood says that his RSI has limited the types of courses he can take as a computer science concentrator.

"I'm a little afraid to take a class that has a lot of programming," he says.

At the height of Goodman's RSI, he says that he could not even hold a can of soda. Even brushing his teeth was a painful task, he says.

Goodman says his RSI was so severe that he had to make many changes in his everyday living. He switched from cereal to bagels for breakfast, used plastic cups instead of glass cups and opened doors with his elbows to avoid pain.

Goodman also had a friend take notes for him in class since writing a couple of sentences made his hand hurt for at least an hour.

According to Goodman, he began using DragonDictate, a speech-recognition software program that enabled him to work on his dissertation and use e-mail without using his hands. He spent a year without picking up a pen or typing on a keyboard and says he has since greatly improved.

"I can drive, I can cook," he said. "I can type for a limited time."

But Goodman, who has had RSI for almost three years, says that he does not know if he will ever completely recover.

"I am continuing to recover and am optimistic," he says. "But I doubt I'll ever be able to do what I use to do completely."

Grimmelmann also says his condition has improved. He says that he got RSI at Microsoft and got rid of it at Microsoft the next summer. During his second summer there, he says he paid more attention to his working conditions.

"I took the arms off my chair, watched my typing habits and wound up improving," he says.

Grimmelmann also says that going to physical therapy at UHS helped him get better. Therapists massaged his arms and lead him through strengthening exercises. They also gave him new stretches to do.

Learning About RSI

The RSI Action Group at Harvard--spearheaded by a group of graduate students--aims to educate students and Faculty about RSI and advocate on their behalf.

Goodman says that the group, which meets once a month at Dudley House, has about 100 students on the mailing list, 50 of whom are from Faculty of Arts and Sciences (FAS) and about 25 of which are undergraduates.

RSI Action has focused its efforts on education to let students know how to prevent RSI.

The group has collaborated with UHS and other organizations to make mousepads that explain "the prayer stretch"--which stretches the wrist to prevent strain--and other tips for RSI prevention.

The group has also worked with UHS to make an information brochure titled: "Preventing Problems at the Keyboard." This was given out at the first-year orientation and to all incoming graduate students, according to Hollis.

Hollis says that there has been a gradual awareness of RSI on the campus as a whole within the past two years.

From July through October, she says the demand for RSI information from the resource center was second on their list, surpassing HIV testing/counseling and stress management.

Timely Treatment Is Crucial

As advocates, RSI Action seeks to improve diagnosis and treatment at UHS for people with RSI. Goodman says the group is working to make UHS aware of a potentially dangerous delay for patients between seeing a physician and getting physical therapy.

After seeing his primary-care physician at UHS, Goodman says he has to wait almost four weeks to get an appointment for an evaluation by a physical therapist. He then had to wait another four weeks to schedule a therapy session.

This eight-week wait is typical, he says. But the scariest part of the wait, according to Goodman, is that many patients can injure themselves even more during that time.

Goodman says that because some of the doctors at UHS are not adequately trained to recognize RSI and educate patients about it, people with RSI may continue to type during the wait, thus worsening their injury.

The advice the RSI Action group wants to pass on to computer users is best put by the saying on their posters, says Goodman.

"If your hands hurt, go numb or tingle, or you drop things, stop typing, see a doctor, take rest breaks, and see our Website [http://www.eecs.harvard.edu/rsi/]," he says.

Tips for Preventing RSI

* Take frequent rest breaks and stretch hands, wrists, and arms.

* Maintain good posture without sitting too rigidly. Your body should be relaxed and your weight evenly distributed.

* When typing, keep hands relaxed and fingers gently curved. Your hands should float easily above the keyboard.

* Keep heels of hands lifted off the keyboard, using a soft padded wrist rest if needed.

* Keep hands warm to promote circulation.

* Exercise to improve circulation and overall conditioning.

The advice provided in this graphic comes from the October 24, 1994 issue of Time and from the pamphlet "Preventing Problems at the Keyboard" distributed by Harvard University Health Services.

For more information on RSI, see:

Repetitive Strain Injury by Dr. Emil Pascarelli, published by John Wiley & Sons, Inc., New York and RSI Action Group's website, http://www.eecs.harvard.edu/rsi/