The convenience of the computer - either at the office or at home - has brought with it health issues as longer time spent on the keyboard has resulted in stiff necks and shoulders as well as strain on the eyes, elbows and wrists.

At the root of the problem is improper desk and computer heights, chairs not designed to adequately support the back and keyboard positioning that puts too much strain on the elbows and wrists. The issues were tackled recently by the physiotherapy staff at the hospital who visited the various departments last week and this week as part of Physiotherapy Month to inspect work stations and give advice to staff members.

One of the things they quickly discovered was that most of the desks were not computer desks which meant that they were not of the proper height. Keyboards that slid out from under the desk are better than those that sit on the desk and are often too high, causing the wrists to be bent back, rather than flat.

"People would use the computers for seven or eight hours a day on little tiny chairs and nobody complains about it," said Physiotherapist Carol Sawyer. "A lot of the desks are more for writing, they weren't made as computer desks and along came the PCs which were just put on top of the writing desks, so a lot of people don't have the ideal setup.

"A lot of what we're recommending is just really simple stuff, like if you are working for seven hours a day, don't have your monitor off to the right hand side because you are going to get neck or shoulder strain. It should be in the middle."

The modern chairs designed for office use have levers to adjust the height and the back as well as allowing for reclining. But the proper positioning is crucial, especially for sitting for long periods.

"The chair should have extra back support," said Ms. Sawyer who is coordinator of the Physiotherapy Department.

"We've found a few people, especially the women, whom we have gone around to who are quite short, sitting in nice big chairs. If they were six-foot that chair would be fine, if they are five-foot-three then that chair is too deep.

"What we have is people perched at the edge of the seat, not able to six back and use the seat properly. With one of the nurses we gave her two rolled up blankets (to support her back) and she's like `oh, that's good, I never thought of doing that'. It was something really simple."

She added: "What people need to know about the chair is when their backside is up against the back of the chair the front of the chair should finish two or three inches before the knee.

"Otherwise it is going to press in behind the knee and cause circulatory problems, with people complaining it is uncomfortable on the back of the thighs.

"The main is made to support you, or it should be, but not every chair fits every single person. A lot of the chairs here are standard chairs, if you're average height it's probably fine, but if you're six-foot-six or five-foot-nothing those two people can't have the same kind of chair."

Prolonged sitting at a desk or computer terminal can cause muscular tension and pain, but taking a few minutes to do a series of stretches can make your whole body feel better. Those who sit for long periods should learn to stretch spontaneously throughout the day whenever they feel tense.

Another Physiotherapist who was making the rounds with Ms Sawyer, Andrew Cooper, warned that the length of the chair's seat was also very important and it had to allow the person's feet to rest flat on the floor. The same applies to desks which are not designed for computers.

"Basically the technology has just come in but the furniture hasn't kept up with it," said Mr. Cooper. "Initially maybe it was just a few people doing word processing and they might have changed over from the electric typewriter, but now with so many people using PCs and having keyboards that are being plunked on desks and countertops.

"No one really questions it because there is such a huge variance, some use it for five minutes and go off and do something else and for them it's probably not a problem. Even for people at home who are surfing the net four hours at a time, they can really cause irritation, particularly if they go to work and do similar things."

Mr. Cooper says that is where the term repetitive strain comes from.

"You don't do it in one night or one week, but it's many repeated small injuries and then suddenly it is at the point where it is the straw that broke the camel's back," he explained.

Carpal Tunnel Syndrome is caused by straining the wrists when performing such functions as typing. It happens over a long period.

"Then you've got terrible pain and you've got disability in your hands," said Mr. Cooper.

"You get inflammation and swelling and pressure in the small space (in the wrist) where the tendons, blood vessels and nerves have to pass through. You can get pain or numbness (in the hands).

"It can be treated with physiotherapy but in the more severe cases it could need surgery to relieve that pressure. It's not that difficult to treat but you don't want to get it started in the first place because it can be prevented quite easily by treating your wrists nicely."

The design of laptops also violate basic ergonomic requirement for a computer, namely that the keyboard and screen are separated. In the early days of personal computing desktop devices integrated the screen and keyboard into a single unit and it resulted in widespread complaints of musculoskeletal discomfort.

By the late 1970's a number of ergonomics design guidelines were written and all called for the separation of screen and keyboard. The reason is simple... with a fixed design, if the keyboard is in an optimal position for the user, the screen isn't and if the screen is optimal the keyboard isn't.

Using a laptop is a tradeoff between poor neck/head posture and poor hand/wrist posture. Because the neck/head position is determined by the actions of large muscles, users of laptops are better off sacrificing neck posture rather than wrist posture.

All users should pay some attention to how they use a laptop but full-time users may have more problems. For those who use their laptop at work as their main computer they should position it on their desk/work surface in front of them so that they can see the screen without bending their neck.

Ergonomics (the study of the relationship between people and their working environment) is an issue many businesses, not just the hospital, should be paying close attention to.

"As more and more businesses and Government agencies are using PCs so much, these people have to be educated to avoid injuries," said Mr. Cooper.

"We are all doing two visits to a particular area of the hospital, this week and next week, by request. We put up posters to let people know we are willing to come and assess their work situation and make recommendations."

Said Ms Sawyer: "We will have seen between 80 and 100 people by the time we've done everybody. We are doing it for the wellness of staff.

"We do get patients who are staff who are referred to us in physio, not always for computer desk problems. If they have a bad neck and their desk setup isn't right then their neck problems aren't going to get better.

"It doesn't matter how much physio you have, the problems aren't going to go away if the cause hasn't changed."