Maybe it’s a neck that constantly feels stiff, or a wrist that’s sore; a backache that won’t go away, or shoulders that can’t relax. Editors, sound editors, mixers and basically anyone who works sitting down in front of a console or computer all day may experience Work-Related Musculoskeletal Disorders (WMSDs).

WMSDs have been recognized since the 17th century, when Bernardo Ramazzini, the father of occupational medicine, described illnesses caused by “violent and irregular motions and unnatural postures of the body,” and cited the strains on the hands and arms of scribes and notaries which led to a “failure of power to the right hand.” In the 21st century, the problems continue and afflict more people than ever before.

Work activities that are frequent and repetitive or involve awkward postures can result in pain during work or at rest. Most editing and mixing motions require the use of the arms and hands (the upper extremities), and therefore if problems occur, they are usually in the hands, wrists, elbows, shoulders, and neck. Post production today rarely requires repetitive use of the legs, which can lead to WMSDs of the feet, ankles, legs and hips, so problems of the lower extremities will not be discussed here. Certainly editors and mixers can develop low back problems, mainly from sitting and awkward postures, but this article will focus on the upper extremities.

WMSDs are a group of painful problems involving muscles, tendons and nerves. Though “skeletal” is part of the name, problems with bones are usually not included, and this points out that there’s not a perfect name for these disorders. WMSDs are also called Cumulative Trauma Disorders (CTDs), Repetitive Strain Injuries (RSIs), Repetitive Strain Disorders (RSDs), Repetitive Motion Injuries (RMIs), and Occupational Overuse Syndrome (OOS). WMSDs are not diagnoses, they are disorders with similar characteristics and causalities. Specific diagnoses that fall under the WMSD umbrella include Tendonitis, Lateral Epicondylitis (Tennis Elbow), Medial Epicondylitis (Golfer’s Elbow), Trigger Finger, Carpal Tunnel Syndrome, Thoracic Outlet Syndrome and Tension Neck Syndrome.

Confusing? You bet. Just try asking your family practice doctor, internist or surgeon about one of these problems — they’ll probably each have a different name for it. Primary care providers generally do a good job of treating acute injuries, such as cuts, strains and fractures, but they often do not have much training in treating WMSDs, which usually develop over time. WMSDs may take days, weeks or months to develop and may take even longer to heal.

Kensington’s new trackball features a soft detachable wrist rest.

Risk Factors

Ordinary arm and hand movements such as bending, turning, gripping, holding, twisting and reaching are common movements usually not harmful in daily life activities. However, they may become problematic in work situations where forceful repetition, quick movement and lack of time for recovery occur. Sometimes activities outside of work also contribute to the development of WMSDs. For example, it’s not uncommon for editors and mixers to spend hours at work, then go home and spend more hours at the computer performing similar motions. I recently had a patient who complained of pain in both wrists. Upon further investigation, I discovered that he was riding a Harley motorcycle two hours a day to and from work. Because the handlebars were above shoulder height, he was lifting up his arms and flexing and extending his wrists for an additional two hours a day. That’s what was causing his pain, not his assembly line work.

Work patterns that are associated with WMSDs include fixed or constrained body positions, continual repetition of movements, force concentrated on small body parts, such as hands or wrists, and a work pace that doesn’t include sufficient recovery time between movements.
WMSDs usually do not occur as the result of a single injury or accident. Instead, they develop gradually as a result of repeated trauma. Repeated episodes of tendon and muscle stretching (causing micro-tears) may produce tissue inflammation, swelling, pressure on nerves and long-lasting injury.

Symptoms

Pain is the most common symptom in WMSDs, but joint stiffness, muscle tightness, redness and swelling at the affected area may also occur. Numbness or a “pins and needles” sensation is also an important neurological symptom and should not be ignored.

At first, aching or tiredness of the affected limb will occur during work but disappear at night and during days off. After some time, aching or tiredness will occur earlier during the work shift and continue in the off hours. The patient will have a reduced capacity for the repetitive work causing the problem. Finally, aching, fatigue and weakness will persist all the time, and the patient will experience an inability to perform light duties and have problems sleeping.

These stages are arbitrary, and not everyone may go through the stages in the same way. The first aching and pain is a signal that the muscles and tendons should rest and recover, otherwise an injury can become longstanding, and sometimes irreversible. Early response to pain is critical. Change your work habits, change your work environment, see a specialist. Do not let persistent pain go undiagnosed or untreated.

Microsoft makes the most common wave-shaped keyboards.

Prevention

The best prevention is to stop activities that cause the problem, and that means in most cases, repetitiveness of work. Changing the force required, body position or pace may also prevent or alleviate problems. Unfortunately, most editing and mixing procedures require repetitive actions as a process is performed over and over again. When elimination of repetitive motions is not practical, changes in the workplace should be considered, including workplace layout, equipment design and work practices.

Ergonomics is the planning and adapting of equipment and tasks to promote the comfort and safety of workers. Simply put, it’s about fitting the work to the worker, not fitting the worker to the work. As it relates to editing and mixing, ergonomics includes such factors as body posture, seat design and workplace design (including keyboard and monitor position). Lighting, room temperature and air quality should also be considered when evaluating comfort and productivity in editing rooms or on mixing stages.

Work Practices

A well-designed workplace should allow an editor or mixer to avoid unnecessary motion of the neck, shoulders, arms, wrists and hands. However, even with a well-designed, ergonomically “correct” workplace, WMSDs may develop, and work practices should be evaluated. Rest periods and time to heal are extremely important in prevention. In the good old days, editors sat, stood, walked around grabbing pieces of film from bins or shelves, and did all sorts of physical movements. Now they usually sit in a chair doing certain movements over and over for hours on end, with infrequent breaks. Problems can be compounded by working overtime or on weekends, because that’s the time when the body should be resting or healing.
What to do? First, make sure your set-up is ergonomically correct. Choice of equipment is key, such as whether to use a keyboard, a trackball, or a stylus. Often, simply switching from one kind of mouse to another, or from a mouse to a trackball can alleviate wrist problems. Most office supply stores have a wide variety of devices at low prices, and you can special order ergonomic mice, sized to fit your hand, if necessary. If you use a keyboard a lot, try a curved one or a foam wrist rest.

Choose a chair that will firmly support your lower back. Pictured: the Aeron Chair from Herman Miller.

For neck, back or hip problems, changing chairs can produce relief. Your chair should be at a height that allows your forearms to be roughly parallel to the floor when you are working. It should firmly support your lower back so that you can sit up without strain. If you can’t find a good chair, you can get a lower back pillow that will attach to your chair with Velcro or straps.
Lighting is also a factor, particularly for eyestrain. The best lighting is a mixture of daylight and artificial. Flat, bright light, like that cast by overhead fluorescents, will create reflections and be hard on your eyes. Instead, try halogen ceiling bounce lights with dimmers, so you can adjust them to a comfortable level. Place lights behind or to the side of monitors in order to reduce reflections. Never work with windows directly behind you. This produces bright reflections and forces your eyes to constantly refocus between the reflections and the screen itself.

Whenever possible, work in rooms with some natural daylight. It’s now well known that your biological clock is set by daily exposure to 30 to 60 minutes of bright sunlight. Without it you may have trouble sleeping.

Monitor height can affect your neck; looking up or down at too great an angle can be painful. Adjustable monitor stands should help. Take the time to try different positions until you find one that’s right for you.

Then ensure that you include time for rest and healing, which may be as simple as taking a five-minute break from the repetitive action every hour. This doesn’t mean stopping work, just not doing the repetitive or harmful activity continuously. Avoid working excessive overtime, especially when the overtime is an extension of the normal workday, because it may overstress muscles and tissues by reducing rest and recuperation time. Identify symptoms early and take preventive action before they become serious and costly. Consult with a medical provider who has experience working with WMSDs. Some-times it can be more beneficial to see a nurse or physical therapist who has occupational health training than an internist who may rarely see or treat these problems.

A bad choice of chair, poor posture, and no ability to keep the arms elevated can lead to wrist, neck and back problems.		Keeping the lower back supported, the arms at a ninety-degree angle and feet flat on the floor will help alleviate muscle fatigue.

Treatment

The first thing to do when treating WMSDs is to avoid the activities that cause the pain. This often requires work restrictions or modifications. Body movements that cause the problem should be restricted. Splints (available at drug or office supply stores) may be used to restrict movements and immobilize a joint, and they often provide pain relief. But they should be used carefully. People will sometimes wear splints and continue performing the same activities by overcompensating with another movement, resulting in pain or problems in another area.
Applying heat or cold may also relieve some of the pain. Classically, cold is applied to decrease swelling and inflammation, and heat is applied to increase blood flow and loosen tight muscles. Either heat or cold may be used, as long as neither is extreme or prolonged and results in pain relief.

Exercise and stretching are beneficial because they increase blood flow and decrease muscle tension. However, a physician or physical therapist should be consulted before WMSD exercise or stretching programs are started, since these programs can aggravate the problem if not properly designed.

Medicine can help reduce pain and inflammation. Aspirin may help with pain, but drugs called non-steroidal anti-inflammatory drugs (NSAID), such as Advil (ibuprofen) or Vioxx (rofecoxib), tend to work better at decreasing inflammation and swelling. A health care provider or pharmacist should be consulted before starting any of these medicines. Sometimes steroids are injected into the problem area to reduce pain and inflammation. However, I rarely recommend steroid injections, especially for people who will return to the same harmful activities once the pain is “masked” by the steroid injection.

If all the above fail, surgery may be considered, especially in cases with nerve entrapment or possible damage. However — and this is controversial — surgeons tend to think, “Let’s operate, fix it, and you’re back to normal.” I believe differently. If an activity actually caused enough damage to require surgical repair, then that activity should be avoided or restricted after surgery. You should carefully consider the possible complications of surgery, including pain, infection, scarring and restricted movement. Unfortunately, some disability rating systems are set up to award higher disability to someone who’s had a surgery, and thus there is sometimes a fiscal incentive to have certain surgeries. Ultimately, it’s best to prevent a WMSD rather than to develop one, have surgery, and return to the same activity that caused it.

Above all, listen to your body. Your pain is there for a reason, and it’s telling you something. You must change your work practices, and often your priorities, in order to stay healthy. Work-related musculoskeletal disorders are usually much easier to treat in their early stages. So don’t wait for pain to increase. Make changes in your work habits. Try a new chair, a new mouse, a new schedule, and see a doctor trained in WMSDs as soon as problems occur.

J.T. O’Neal is residency-trained and board certified in occupational and environmental medicine. He received his masters in public health at Harvard University and has lectured on Movie Medicine: Illnesses and Injuries in Movie and TV Production at UCLA medical school. An award-winning short filmmaker, he is currently a graduate student in the MFA screenwriting program at UCLA. He can be reached at flydocfly@aol.com.

photo by Stephanie Argy
Bill Elias now uses his left hand and a track ball, and keeps his wrists elevated, to avoid further problems with carpal tunnel syndrome.

Three years ago, veteran film editor and Editors Guild board member Bill Elias was in pain. Over the course of two months, he had developed carpal tunnel syndrome in his right wrist as a result of using the mouse on his Avid. The pain radiated all the way up to his neck, making it almost impossible to work.

Bill went to the Motion Picture & Television Fund’s Toluca Lake Health Center where his primary care physician prescribed physical therapy. Entertainment industry workers who qualify are eligible for 16 physical therapy treatments in a calendar year. Bill went to a physical therapist eight times, learning active range-of-motion exercises (stretching and strengthening) for his arm, followed by soft tissue mobilization (massage therapy). He also switched from a mouse to a track ball, and started to use his left hand. Within six weeks, his right wrist was fully healed.

“ For me, using my left hand and a track ball was the answer,” said Bill. “I’m as fast with that as I was with my right hand. I also use the keyboard more, and I make sure that my hands are elevated.” Bill couldn’t find a wrist rest he liked, so he uses 3/4-inch tapes or his dictionary to get the proper height for his arms. He now uses a mouse sparingly, to check e-mail or surf the Net, but he doesn’t use it anymore on his Avid. “I can’t do a mouse for eight hours a day,” he said.

“ Also, when you’re viewing footage, stand up and stretch,” suggested Bill. “Surgery should be your last option — try everything else first.”

— Andrea Van Hook

Health Insurance

Motion Picture Industry Pension and Health Plans (www.mpiphp.org) — These trust funds were established by collective bargaining agreements between the unions and employers in the motion picture industry. Plan members have several choices of health plan coverages, including PPO and HMO plans. If you have a potentially work-related injury or illness, it is to your benefit to contact the Plan’s workers’ compensation desk at (818) 769-0007 ext. 249 to avoid any possible delay in the processing of claims. The rules for coverage of treatment under workers’ compensation are specific, so make sure you understand and ask questions.

Those Guild members not covered by the Motion Picture Plans should contact their own particular plan to find out what it covers.

Motion Picture & Television Fund (www.mptvfund.org) — MPTF has five health centers in the Los Angeles area, many with extended hours. Physician visits are under contractual arrangements with industry health plans, and health center visits are offered at no or very low cost to eligible industry members. Doctors are available at the health centers, while specialists are available through a network of over 500 providers. Through MPTF, Guild members have access to physical therapists, neurologists, physical medicine specialists (doctors who provide non-surgical treatments of neck and back injuries), orthopedic surgeons, network sub-specialist spine and hand surgeons, and acupuncturists.

Ergonomic Products

There are plenty of choices in chairs, keyboards, mice and track balls. The following is provided as a reference only. The Editors Guild does not endorse specific products.

Computer Accessories

Microsoft makes the most common wave-shaped keyboards, available at many office supply stores, with models for both Mac and PC systems.

Contour makes multi-button mice in a wide range of sizes. Programming the buttons to do repetitive tasks can reduce muscle strain.

There are also split keyboards and several other manufacturers of wave-shaped keyboards. Kinesis makes several ergonomic keyboards, available from authorized dealers or on the website at www.kinesis-ergo.com. Keyalt.com is a good resource for a variety of keyboards from different manufacturers, and you can order straight from them. Adesso, another keyboard manufacturer, has a very informative website at www.adessoinc.com. Modern Macs will work with most USB keyboards, but some keys may be missing or in unfamiliar positions.

Contour design (www.contourdesign.com) makes ergonomic mice that come in many sizes for different hands. The award-winning Perfit Mouse includes a scroll wheel positioned horizontally over the thumb, and has additional buttons to allow repetitive tasks to be reduced to a single mouse click.

Microsoft also makes a variety of multi-button mice, many of which work well with USB Macs (look for Mac compatibility information on the box). 3M makes a joystick mouse, called the Renaissance Mouse, which keeps the wrist perfectly immobile. Airtech sells Contour and 3M mice, along with other manufacturers, at www.airtech.net; items usually ship same day or next day.

Regardless of the manufacturer, a two-button mouse can work wonders on an Avid. If you double click to load a shot into a monitor, you’re probably double clicking thousands of times a day. Assigning one button to double click means that you can load a shot into a monitor with a single click instead, thereby reducing the most common mouse clicks by half.

Sometimes the simplest fix can also be the best, such as making sure your mouse ball is clean and that it is sitting on an appropriate mouse pad. Mouse movements should be smooth and fluid and require a very light touch. If you use an optical mouse without a ball, make sure you’re using a mousepad that makes movement as smooth as possible.

Kensington makes several excellent track balls, and you can purchase their products directly from their website at www.kensington.com, or from an area store such as Fry’s Electronics or MacMall (www.macmall.com). The Expert Mouse works on PCs and Macs and comes with a soft wrist rest.

Pressure-sensitive tablets can alleviate the repetitive motions of typing and some people rave about them for use with Avids. Wacom (www.wacom.com) makes the most commonly used tablets.

Chairs

The right chair can make all the difference for your neck, back and shoulders. Airtech (www.airtech.net) has a selection of Ergo Comfort and Neutral Posture chairs that can be ordered directly from their website. The Herman Miller Aeron Chair is widely regarded as the ultimate in chair design. It costs roughly $800 and comes in several sizes. The company has also just introduced the lower-priced Mirra, which starts at $640. In Los Angeles, Jules Seltzer (www.julesseltzer.com) sells the Aeron, or in New York try Sit4Less (www.sit4less.com — they will ship anywhere). Relax the Back also has a good selection of chairs. There are stores in several states including New York and California, or you can order from the website at www.relaxtheback.com.

— Andrea Van Hook