Text Milou van der Horst illustration Eva van Schijndel
Master’s student Nynke – she’d rather not have her surname in Resource – had to stop everything earlier this year, from her studies to her competitive rowing. Even WhatsApping and the washing up were off-limits. ‘Before that I thought: I must just grin and bear that pain. But in the end I only made things worse that way.’
When she was writing her final thesis for Health and Society, the pain in Nynke’s forearms – CANS to the professionals (see text box) – got worse and worse. Physiotherapist Karin Vaessen gave her relaxation exercises and helped her improve her posture. She had her desk and chair adjusted and was able to borrow an ergonomic keyboard and mouse, and speech recognition software through the dean of Wageningen University & Research. ‘But it was already so bad then that I even had pain when at rest. I couldn’t sleep.’
Perseverance
Eventually the dean sent Nynke to the then student doctor André Godkewitsch, who advised her to stop all her activities. ‘That was really terrible because I was just working towards my last competitions of the rowing season. I was desperate to win one.’ And she did take part in the last race but her team did not win – partly because of her, thinks Nynke. ‘My arms were so painful.’
Student doctor Godkewitsch quite often sees this kind of perseverance in students affected by CANS. ‘Most of them are people who want to do everything they do well, want to keep going, are ambitious and can’t feel or set limits.’ He usually advises them to stop the activities that cause them pain in good time. ‘First you need to reduce the symptoms considerably, so that you are out of danger of it becoming chronic. After that you build up again step by step.’
Meanwhile, physiotherapist Vaessen works with the students on the five Ws: work approach, workplace, work attitude, dealing with work pressure. The latter is important, says dean Ruur Boersma: ‘Students with CANS have to learn to feel their stress levels and their bodies, so they are not just busy thinking all the time. They also need to start setting limits. Their whole attitude to life has to change.’
RSI is now called CANS
CANS – complaints of arms, neck and shoulders – is the new name for what used to be called RSI. These complaints are caused by prolonged overuse of muscles, ligaments and connective tissue for small, static arm movements in combination with poor posture and/or stress. This leads to compressed blood vessels in the neck and shoulders, restricting circulation. Personality traits such as perfectionism play a role too, as does a person’s capacity to feel where the limits lie. The complaints can range from tingling and soreness to a loss of functions.
Hours of typing
In retrospect it was typing out interviews for hours on end that did for Nynke. ‘From May onwards I was working for eight hours a day, with just one break.’ That is not unusual among Leeuwenborch students, says physiotherapist Karin Vaessen. ‘Social science students have to write very long papers and type out interviews word for word. That is a stumbling block.’ Vaessen sees a lot of students of Forest and nature management and of Landscape architecture too. ‘There are always a couple of students who get stuck, especially during the big studio assignments for Landscape architecture.’ But lots of bending over and repetitive movements in the lab can cause CANS as well, says Vaessen.
Nynke eventually had to minimize all activities for which she used her hands. ‘That really was very difficult, because you need your hands all the time. I took WhatsApp off my phone, installed an automatic email reply, and left the washing up to my housemates.’ But she didn’t just sit around and wait; she used the summer to look up old friends and now she teaches refugees a couple of days a week.
Nynke tries to improve her circulation by swimming and walking. That is important, says Vaessen. ‘The fiddly little movements you make when you’re at the computer generate waste products but little circulation. So you are producing a gigantic rubbish heap that doesn’t get carted away.’ After even just a quarter of an hour of real exercise your body cleans up the mess, says Vaessen. ‘Simply getting enjoyable exercise, that is the main trick.’
Uncertainty
Nynke can start her internship in February if her symptoms diminish, which they have not done yet. ‘I find it very hard to live with that uncertainty. I am really scared of the pain becoming chronic.’ There is a risk of that, admits Godkewitsch. He reckons about five percent of the people laid off work for health reasons suffer from a form of CANS. ‘It is a very cruel and extremely stubborn complaint.’ Although Nynke is very pleased with the way WUR handles CANS cases, she feels the university could do even more to inform students about the importance of good posture, enough rest, and the effects of CANS. Vaessen agrees. The university currently spreads information through the introductory courses for first-years. But at that stage the information doesn’t stick in their minds, says Vaessen. ‘Information campaigns would work better later in the year, once they realize how many papers they have to write and start to get themselves organized.’ Vaessen also thinks information campaigns would be useful at the point when students embark on their Bachelor’s or Master’s theses.
Prevention works
Fifty students with CANS consulted the deans at WUR in 2015. That was a big drop: in 2012 there were 122 students reporting these problems. Prevention of CANS has been a priority for the university since the 1990s. At that time pain related to computer use was such a widespread problem that student doctor André Godkewitsch sounded the alarm and set up a working group. WUR then bought a lot of adjustable furniture and tried to reduce the problems with information campaigns, subsidizing ergonomic aids, lowering work pressure and installing workbreak software. This worked. Physiotherapist Karin Vaessen: ‘At the end of the nineteen nineties we honestly saw people who couldn’t lift a cup to their lips. I rarely see that now, luckily.’