The Merriam-Webster Collegiate Dictionary defines “disabled” as “incapacitated by illness, injury or wounds.” Many of us, when we think of someone who has a disability, think of people who are incapacitated in some way that is visually obvious. But for people with repetitive motion disorders, their disability is not always so readily apparent. This simple fact alone has led to widespread misunderstanding of the origins, symptoms, and clinical background of repetitive motion disorders, and no doubt has contributed to the recent repeal by the Bush administration of ergonomics legislation that would have required employers to take measures to protect workers from these injuries by providing ergonomic workspaces and equipment.
The whole issue of repetitive motion disorders (RMDs) is mired in a firestorm of controversy. RMDs also called cumulative trauma disorders, musculoskeletal disorders (a wider classification of injuries including those that result from repetition), repetitive stress disorders, and repetitive strain affect people differently and present with a wide variety of symptoms, all dependent on a multitude of factors. These factors make it extremely difficult to assign one “cure” for RMDs. Furthermore, since RMDs affect people differently, it can often be difficult to determine their origins, although the numbers are weighted heavily toward the workplace. This is just the tip of the iceberg.
A Widespread Problem
According to the U.S. Bureau of Labor Statistics (BLS), 246,700 people in the United States had disorders associated with repeated traumas, a number representing 66 percent of the total number of injuries recorded in 1999 (the most recent year for which statistics are available.) Not all RMDs result in temporary damage that heals with time. In fact, according to the National Institute of Neurological Disorders and Stroke, many RMDs can cause permanent damage to soft tissues in the body such as muscles, nerves, tendons, and ligaments. RMDs can occur in the hands and arms (where they most often present), but also occur in the wrists, elbows, shoulders, neck, back, hips, knees, feet, legs and ankles.
BLS statistics show that workers in almost every industry are exposed to the risk of acquiring RMDs. However, a large proportion of RMD victims are women. BLS statistics state that 18,651, or 67 percent, of all cases of carpal tunnel syndrome, and 10,127, or 61 percent, of tendinitis cases were reported by women in 1999. These statistics, says the BLS, do not account for unreported cases of RMDs. While the BLS says they cannot estimate the number of unreported cases, according to Stephanie Barnes, the founder of ARMS, the Association for Repetitive Motion Syndromes, it is becoming extremely commonplace for employers to know that they have employees who have these problems, but do nothing about it. In addition, an unknown number of workers go to the doctor for an RMD, but never file a workers’ compensation claim for fear they will lose their jobs, says Barnes.
The direct and indirect costs of RMDs in the workforce is staggering. According to a report by the National Academy of Sciences, the estimated workers’ compensation costs in the United States associated with lost workdays range between $13 and $20 billion annually. When the indirect costs of lost wages, productivity, and tax revenues are factored in, it’s estimated that an additional $45 to $54 billion are drawn out of the economy annually for disorders reported as work-related.
Barnes has a thorough understanding of RMDs and all the legal, social, and political situations surrounding them. Barnes, who has carpal tunnel syndrome, tendinitis, and fibromyalgia, discovered she was injured in 1991, when she was working for a large publishing company. Like many workers, Barnes had been wearing one too many hats at the company and was either on the phone or using a computer for long hours every day. After she began having pain in her wrists, Barnes took out a workers’ compensation claim, but didn’t reach a court settlement until late in 1996.
Barnes started ARMS in 1992, to offer educational and emotional support to others with RMDs. When she started the organization, she said, “I met with some resistance. A local journalist told me there weren’t enough people [with RMDs] to get it off the ground.” Barnes later found out the journalist’s own son had Nintendo thumb, an RMD caused by the repetitive hand motions involved in playing video games. Within weeks of the appearance of an article in a local paper covering Barnes’ organization, Barnes said she began getting swamped with telephone calls to her Santa Rosa, California home from people looking for information and support.
Crippling and Debilitating
Although most RMDs develop over long periods of time, according to Barnes, one of the most shocking things about these disorders is how quickly the symptoms can develop, and how crippling and debilitating they can be. One physical therapist told Barnes that pain is the last symptom of a developing RMD, the last sign before more permanent damage sets in.
According to a 1999 article in the Journal of the American Medical Association, more than 200,000 surgeries for carpal tunnel syndrome are performed each year in the United States, “which makes it the most common surgical procedure performed on the hand.” JAMA also said direct medical costs for these surgeries are estimated to be more than $1 billion per year.
In Barnes’ case, she had been working on computers since the early 1970s, as a writer, teacher, and bookkeeper. It wasn’t until she began to feel the pain of her injuries that she realized how important is was for her to have an ergonomically-designed workstation and a hands-free telephone. Like many companies, especially in the early 1990s, Barnes’ employer took a passive stance in regard to her situation. “It’s really common for employers to act like it isn’t happening,” said Barnes.
“A lot of people [with RMDs] wind up quitting their jobs, or employers find a way to ease them out through lay-offs,” said Barnes, marking the start of an often uphill battle for sufferers of RMDs.
The process of finding appropriate medical care can be confusing, and often extends beyond the period of time allocated by workers’ compensation. “Many specialists think their niche is the answer, but it’s a very complex situation,” said Barnes, who has spoken with ergonomics specialists, chiropractors, alternative health care professionals, medical doctors, physical therapists, and other practitioners. She said it’s important for anyone suffering from an RMD to get an exam that can be called either a “physical capacities” or “assessment exam” so they can prove they are capable of navigating the vocational rehabilitation system.
There are a variety of measures that can be taken, both on the part of the individual and on the part of the employer, to prevent RMDs from occurring in the first place. For example, work tables and monitors can be set at the correct height for factory workers. The problem, however, is that many victims of RMDs have no idea that their pain has anything to do with the work they perform for an employer, said Debora Weinstock of the AFL-CIO. “People are intimidated against reporting. Some employers encourage people not to report so their workers’ compensation costs don’t go up. Some employers even provide incentives to encourage employees not to report their injuries,” she said.
Peter Rachleff, a professor in the History Department at Macalester College who has worked as a union consultant for the past 25 years, agrees with Weinstock. “The political structure in this country is not prepared to recognize what a difficult place the workplace is,” he said. “Problems such as carpal tunnel, backaches, insomnia, and stress-related problems are not taken seriously or investigated.”
Barnes said the recognition of RMDs as a disability by official state or federal agencies is erratic, depending on the agency and the people working in it. She also said that how workers’ compensation cases are handled and how they are resolved vary tremendously. She said in some states, “Even if a workers’ compensation claim is accepted, insurance companies will find ways to get people out of the system so they aren’t covered.” In her case, Barnes’ doctor had to submit a report every 30 days, and if it was late, her benefits were abruptly cut off. She urges people with RMDs to have a reliable attorney and a physician who can document their case and provide copies of the reports if needed for legal reasons.
“What’s happening with the ergonomics legislation is the most telling indication of what’s happening in this country [with RMDs],” said Barnes. Read about recent legislative developments regarding RMDs and ergonomics in Minnesota and the nation in the next issue of Access Press.
For additional information on RMDs, the following Web sites may be of use: the Occupational Safety and Health Administration, at www.osha.gov; the American Federation of Labor and Congress of Industrial Organizations, at www.aflcio.org; the U.S. Bureau of Labor Statistics, at www.bls.gov; and the National Academy of Sciences, at www.nas.edu.