Ms S was 42 and worked in a call centre. Her problem was pain in the right upper back and right arm. A simple but common case, likely to rehabilitate well with effective management. Poorly managed, however, both are likely to cause ongoing problems with work productivity and pain.

After most of her working life as a primary school teacher in Thailand, Ms S and her family moved to Australia. She decided on a different line of work and commenced a job in a call centre for a major Australian corporation. The job involved taking inbound calls dealing with customer problems. Her call centre dealt with the more complex problems. There was a general sense in the call centre they should try to help customers and sort out the issues, although the centre's performance indicators were on the speed of the call and the time taken to answer the call. Dealing with the complex problems took time, so there was a constant tension between sorting the issue and finishing the call, and meeting the performance targets.

Ms S developed soreness in the right upper back, and a heavy feeling her wrist and forearm. Like many people with non-specific musculoskeletal problems, her initial approach was to ignore the problem. As it became more troublesome she took herself off for treatment and had four sessions of massage. She had some hesitation about reporting the problem, mindful of some offhand comments made about another staff person with a similar problem.

However, when the condition didn't improve, she reported it at work.

The workplace response was to advise her to go to a doctor. Ms S was also advised that the company didn't know she had injured herself at work, and that her bills for attending the doctor would not be covered until her claim had been assessed. She attended the doctor, who recommended an ultrasound and a month off work. There was no call or communication from work about modified duties.

Her claim was then assessed, which took approximately five weeks. A rehabilitation provider was appointed, and a return to work plan developed. Ms S returned to work two hours a day for two days a week in the call centre, doing her usual job. Her arm pain had improved over the six-week period, about 50%. On return to work her symptoms increased, but were manageable.

By the time of her return to work she was worried. She was concerned about her ability to get back to her normal job and her employer’s seeming disbelief about the situation, and had a sense of guilt about her lack of productivity as well as the burden she was placing on her husband and other family members.

Effective management

Non-specific arm pain, particularly when connected with soreness in the upper back on the side of the affected limb, is a common problem. It typically represents long-term mouse use, often where there is a degree of tension in the muscles. It's commonly seen when people do a lot of mouse work to deadlines, or do it continuously for days on end.

Important components of case management include:

Minimising mouse use.

If possible it is better to avoid use of the mouse, rather than transferring responsibility to the non-affected limb. Use of the other limb often results in similar symptoms in the other arm.

Many computer programs can be used without use of the mouse. Some specially designed software packages do not have shortcut keys, but most programs, such as Windows-based programs like Word and Excel can be navigated and used without using a mouse at all. There are hundreds of shortcut key combinations, such as ‘control (plus) C’ to copy text (on a PC), that can be used. It takes people some time to learn all of the shortcut keys, but a significant number can be learned over just a few months.

Reducing tension.

This is easier said than done. In Ms S’s case, two to four sessions with an effective HR manager or a counsellor may have helped her identify what she can and cannot do to reduce tension. This may be getting clear about her role, providing her with training in dealing with angry customers, ensuring that she understands the limits of performance targets, or providing extra training about customer problems she is dealing with.

Identifying productive duties that will allow her to remain at work.

Bringing people back to work on duties that require five- or ten-minute rest breaks every hour will not work in the everyday workplace. A reasonable worker will feel very uncomfortable or won't take their breaks. Co-workers see it as odd, and the person’s supervisor can become resentful of the breaks and the fact that the person cannot be found or is not available

Understanding the natural history, and setting up duties that will cover that period of time.

This type of condition typically takes months to settle. There is little point in setting up duties that are workable for a few weeks, but which serve as a greater cause problems if continued for some months. Co-workers can become resentful if duties are not productive and they must take over the person's load, and supervisors will get frustrated if they have to provide abnormally restrictive duties. The employee themself will become demoralised and less likely to be at work if the duties are not meaningful and realistic.

In Ms S's case, teaching her to avoid use of the mouse may well solve the problem. It may take some time for the problem to settle, but if she avoids use of the mouse it is likely to do so.

If the call centre program requires use of the mouse, then moving her into a different call centre may work. Alternatively, she may need to be placed into a different position, such as a general administration position, for some months until her condition settles.

Understanding her common problem and working with her to keep her in the workplace is effective management for her health and for workplace productivity.

Important components of the workplace systems management include:

• Aligning performance targets with the overall objectives of the call centre and company, and communicating this to staff.  
• Ensuring software does not oblige the individual to use a mouse repeatedly.  
• Training staff in dealing with difficult customers, and creating a workplace culture that supports early reporting of problems and staff well-being.