June 2007 Goal: Reduce RSI Pain
I’ve been a heavy computer user since my parents brought home an Apple ][. Immediately addicted by the glowing screen, I typed and clicked until my wrists and fingers would no longer let me. At that stage, the pain usefully reminded me to take a break from the eight-hour starcraft marathon. After a day, the ache would abate.
But last month something scary happened: the pain in my hand didn’t go away. The first and middle fingers on my right hand chronically hurt even when I wasn’t on the computer.
The pain grew and, concerned, I visited a doctor who diagnosed it as a repetitive strain injury. When I asked what could be done to fix it, his advice was essentially: “Sucks to be you. Take some ibuprofen and stay off the computer, nerd.”
While just five years ago I would have felt guilty not following advice to limit my computer use, I don’t now. Like it or not, benefit or not, the computer is a central focus of life now for the younger half of the population. I’m lucky that as a teacher, I don’t spend a full working day at a computer, but resource creation still requires screen time. All my hobbies, from photography to writing, to drawing involve the computer. Living overseas, the computer is the only practical way to keep in touch with my friends back home. Giving up my silicon symbiote, isn’t an option.
So, I face this month’s goal: to reduce my RSI as much as possible without giving up my computer. I have no idea how this will work, so I’m open to suggestions.
36 Comments:
Dvorak and an ergonomic keyboard. It takes a few months (2-3) to get back up to your old QWERTY typing speed, but from what I hear, it's substantially better on your hands. They keys are better positioned, allowing you to move your hands less. For example, to write your article in qwerty, you had to move your fingers approximately 66 meters, while in dvorak, you would have only moved 50 meters. 16 meters may not sound like much, but when you add it up over the course of a day or week, you could be saving miles.
Hope this helps!
-Jeff
I'd install Workrave if you haven't - forces you to take breaks and stretch a bit.
For me, the greatest source of trouble with the computer seems to be use of the mouse. At work I use the my mouse left handed which helps relieve some of the strain. Surprisingly switching didn't really slow me down for most tasks. For a long time this let me use the computer at work and home without much incident.
I have had occasional pain (wrist and hand) from extended computer use, like you mention. Then just taking a break or doing some hand exercises seemed to help. Two months ago, though, I had a similar experience to what you described. My pain was a soreness which became piercing pain if I tried to grip anything (including a pen).
My mom, who I knew had been having wrist problems, said the thing that really made a difference for her was to wear a wrist brace at night. She had a brace custom made, but I found one at Walgreens for $20 that fit well and kept my wrist in place during the night. For some reason the chance of sleeping with my wrist bent was adding to the strain of using the computer for much of the day. Having the brace to keep it straight has made a tremendous difference.
Hope that helps.
I've suffered from repetitive strain for a long time, though probably of a different sort (typing isn't a problem, but gripping things can be).
My recommendations:
1) ergo everything (keyboards, mice, keyboard and mouse gel-type wrist supports, joysticks)
2) seek therapy (of the occupational kind, at least). There are some good stretches you can do.
3) take frequent breaks during your work time to stretch those muscles
4) ice packs and creams can reduce inflammation.
5) alternatives for the activities. For instance, instead of typing emails, send video or audio messages (if you have the goods to do so).
6) Raid neighboring towns, collect slaves, force them to do your work for you.
Personally, #6 works best for me....
(visit my blog at: angrylabrat.blogspot.com)
NO! No ergonomical keyboard. Ergokeyboards require different movements so it might help for a time, but in the long run it doesn't work, honestly. What you need is a keyboard as flat and light to the touch as possible. If they have a Dvorak of this type, fine (if you can afford the learning curve); but do not buy a Dvorak if it is not flat and light to the touch. Saving "travelling distance" can also be done by buying a small-surface keyboard (the ergonomical keyboards are never smaller than full size). Do not buy one of them special ergonomical or qwerty/Dvorak keyboards that cost hundreds of $$, the benefit won't outweigh the cost. A simple laptop keyboard with a small surface is best (on a thin laptop, e.g. Thinkpad x60 series). Do not--ever!--use a keyboard's little feet to tilt it. This squeezes off your wrist (try making that movement on its own--sucks, doesn't it?). I wonder why everyone in the computer labs uses this option. As a teenager I guess I used to do it because it felt more Star Trek.
Have your keyboard relatively close to the edge of the desk so your elbows are 90 degrees. Sit up straight; top of the screen at eye level (adjust the screen to match this criterion; if you use a laptop, consider using an external screen as your primary, very practical for working purposes, too). Knees 90 degrees.
Wrist supports shouldn't help because your wrists are not supposed to rest on anything while typing. They may feel comfortable, but they're the wrong approach.
I did use IBM ViaVoice (now discontinued) for a while and in fact wrote some short papers with it. Speech recognition is doable as long as you use relatively common words. As my coursework began to involve more and more words in Old English and Latin, this stopped making sense. Also, it feels easier and faster to just type things and get the words right at the outset.
Regular physical therapy hasn't helped me much, but it does make sense to get a kind of therapy where they teach you daily exercises. Then do them twice a day and don't give up like I did. Helps some.
Do you do sports? I asked my therapist for advice and she said that selected (!) activities at the gym are in order. I did them, and they made me feel somewhat stronger in my wrists. Placebo? I don't know.
Drink a lot of water or tea (keeps you moving back and forth between rooms), make it so that you don't have everything you need in the room where you work (likewise).
Use keyboard shortcuts rather than the mouse. Memorise all the shortkeys of your O/S and fling that mouse right out of the window. Don't hurt anyone with it though.
1. Ergo keyboard. Not only is the strain on the wrist less, your hands are in a more natural position. I find I type faster on my ergos.
2. Keyboard shortcuts.
3. Alternate hands with the mouse. Don't bother switching primary and secondary buttons, your subconscious will figure it out. This has made the most difference to me. I develop programs with the mouse on the left side, and test on other computers (those belonging to the wife and the kids) with the mouse on the right.
4. Get up and move around. Take frequent breaks. Exercise (weights and rowing have strengthened my hands, wrists, arms).
I wonder what is the difference between people who get these kinds of injuries and people who don't, assuming the same amount of activity. I think maybe reducing your overall stress level (so that your movements are more relaxed), using better equipment (ergo/light touch mouse, and a light touch keyboard), and taking breaks, stretching your arms and wrists, etc. Regarding your equipment, you shouldn't really be working at using it - it should be as easy as just wiggling your fingers (I have an old Logitech ergo mouse that is excellent). Also, I ignore the old typing rules and rest my wrists while I type and click, for minimal movement and strain - it's not proper form, but you might find that proper form is baloney. Hope this helps - I know it can be very painful.
I have had some sucess with workrave, but I tend to ignore its warnings now :-) For my clicker finger pain, the best help has been learning to mouse left handed, avoiding laptop touch pads, and getting a 3M ergonomic mouse.
It really helps!! http://solutions.3m.com/wps/portal/3M/en_US/ergonomics/home/products/ergonomicmouse/
I would recommend getting the large size, the small size seems tiny even for my normal sized hands.
As a quick addition to Dr. Paul's comments: There's no particular need to look for or purchase a "dvorak" keyboard.Any normal keyboard will do, as the switching can be done very easily at the OS level. If you /really/ want the keys you're typing on to be in the right spots, pop 'em off (Most non-laptop keyboards' keys come off quite easily) and plop 'em back down in the right places.
Still, he does make a good point about the learning curve: There are a lot of people that just can't afford the time it takes to switch.
He also makes an interesting point about keyboard feet... And prompted me to flip my down after reading his comments. My wrists /do/ seem to be at a more comfortable position now.
Cheers!
-Jeff
I have several software engineering friends who also suffer from wrist pains, and one who is preemptively taking steps against RSI because he is a fervent piano player. In their opinion (this is not a plug, and I haven't yet applied this to myself), getting a real ergonomic keyboard is a lifesaver. While that alone with no other treatment (such as Workrave) won't take the pain away, it goes a long way to avoid unnatural finger movement.
By real ergonomic keyboard, I mean nothing with "ergonomic" in the keyboard name, or any of the "split" keyboards. A real ergonomic keyboard is a Maltron or a Kinesis Contoured (important, Contoured only, the others don't help). These are three-dimensional keyboards, with each key at the right distance from the finger that should be used to strike it.
Like I said, I haven't tried these personally for any length of time, but I have several strong recommendations from people I trust. They say it takes about a month to get used to the weird 3D feel of the keyboard, but after that you get back up to (and even beyond, if you have RSI and the keyboard helps) your regular speed. Unfortunately, they are expensive, but I believe they are worth it.
(sorry if this sounds like a plug, I have no vested interests in selling Maltron or Kinesis, other than hearing nothing but good of their products and wanting one myself)
okay, really long post.
You have my sympathies. I have also had that unsettling 'oh-crap' moment, realizing that I may have done some serious and permanent damage.
On reflection, between work, my home computer business, and gaming, I realized that I was clicking and typing on the pc for almost 12-16 hours a day, 6 days a week.
I read up on RSI afflictions, and it seems that they are almost always expressed as one of two types in the hands and wrists; tendon/ligament(& sheathing) damage, or joint/ cartilage damage. Both can usually heal on their own, but both injuries also usually lead to some type of permanent arthritic inflammation. Where is where the ibuprofen comes into play. :(
In my case, the joint damage in my index knuckles was from too many damn clicks and using the keypad for $data entry for orders. I had tendon strains in my wrist from improper ergonomics.
Here are some tips;
1. Get the right chair. You need a comfortable and supportive chair that can be raised or lowered(depending upon your height/body type) You need to raise your chair so that your feet are comfortably flat on the ground, but your mouse/table top is BELOW the level of your elbow at rest. Put your hand on your mouse, then put your hand on your knee. Your knee is always going to be more comfortable for your arm and wrist, and angling your arm down to your mouse is a far more natural and position and produces less strain to your wrist and arm than any other position.
.
*NEVER have your keyboard/mouse above the level of your elbow at rest,
this forces you to put strain on your elbow, ligaments in your forearm, and severe strain on the tendons/tsheaths in your wrists that power your fingers.(there are no 'finger muscles' in your hand. Your fingers are moved via sheathed tendons connected to muscles in the forearm. These tendons & tendon sheaths are very similar to bicycle break lines. When you bend your wrist, it is the equivalent to taking a pair of pliers and bending the break line to a 90' angle. The line moves back and fourth, and the friction eventually saws through the sheath. Same thing happens to the tendons in your wrists while you have them bent. its a perfect recipe for carpal tunnel.) Some of the fancy office desks you can buy now are adjustable and will actually tilt down to the back of the desk and can be raised or lowered to help accommodate individuals.
.
Putting something under the two closest legs of your desk can also give the desired position. two small pieces of a 2x4 perhaps. You can also buy kits at office supply stores for insanely high prices.
.
2. Technological advances
Ditch the mouse,
.
Trackballs, some integrated cleverly into keyboards. you only have to move one finger/thumb.
http://www.newegg.com/Product/ProductList.aspx?Submit=ENE&DEPA=0&Description=trackball&x=0&y=0
.
Wireless mouse w/trackball
http://www.newegg.com/Product/Product.aspx?Item=N82E16826116103
.
Wireless Gyroscopic mouse
http://www.newegg.com/Product/Product.aspx?Item=N82E16826139004
.
There are also some free eye tracking software projects in development by the open source community that can work with retail high res. web cams..But those are a ways away.
Hope this helps.
-Mike
Hmm... I credit me not having RSI or Carpal Tunnel on my years of Ergo Keyboard use. I initially bought one because I thought it "looked cool". I got my typing speed back to regular within a couple days of use, and you don't lose speed on regular keyboards either whenever you're using a non-ergo keyboard...
I've also heard good things about trackballs. They take a whole load of getting used to, but I've known people who play First Person shooters with them, just aswell as a mouse user!
Now, my wrists are shot from my martial arts and typing all day doesn't help, but I have found a good wrist guard that helps whenever I may have hyper extended the day before in training. It's made by Müeller.
http://www.muellersportsmed.com/wristbracewithsplint.htm
They have a whole range of different wrist braces for RSI or sports injuries, but the one above is the one I use, the splint may get in the way if it's on your mouse hand but it is removable...
You may wanna look at some wrists stretches also ;)
http://www.will-harris.com/yoga/rsi10.html
Speak to boxers/martial artists about wrist injuries, they usually have good advise :P
I'm a programmer so I have the same problem about not being able to "give up" working for 8 hours a day on the pc.
I found the most drastic difference was getting a mouse that was a bit larger at the back so that there is more support in the center of my hand. I dont know why it worked, but the pain went away fast!
I used to get terrible RSI problems in my left hand/forearm from playing online games too much. It would often take 2-3 weeks of rest to recover. Then in 2005 I had to go to Japan to work for a week. In my hotel they had a massage service that I tried, I was expecting a petite young lady, but got a great strapping big bloke, who together with his wooden tools proceeded to massage my upper torso, no dainty touch here, he found knots in muscles round my ribs, shoulders upper arms that I did not even know where there. Well in the morning, I then noticed that my RSI injury seemed to have vanished completely. In the rare cases that I get injuries now, I'm still stuck with weeks of reduced activity till it heals, I've tried swedish massage and a few others, but they just can't do it. Its more of a 30 minute tickle than a massage. So if you have a Japanese massage service in your area, and get RSI, try it, you might be surprised!
1.WorkRave
2.Right Chair
3.Depending on how you move the mouse, you might benefit from switching from mouse to trackball to touchpad (work on a laptop) every week or two.
The last one really helped me, since you essentially alternate your movement patterns, sto the "R" in RSI goes away.
I'm a freelance programmer and can spend up to 16 hours a day working when I'm busy. I find making sure you have both elbows on the desk whilst working reduces strain in all areas, as does a good work area and equipment.
Why don't you draw and write with a pen and paper for a few weeks? It's normally good for creativity to get off the computer if nothing else. I suspect you'd be disgusted if someone spent the amount of time we spend on computers watching TV or doing virtually any other stationary activity.
I've heard good (paid for) speech recognition has been known to help in situations where the computer can't be avoided.
I feel for you, I'm dreading that this may happen to me, but in 7 years of full-time coding it hasn't happened yet so here's hoping.
I'm not sure that all this light touch stuff is of any use unless you've already got RSI and are working thru it. Think of the old typewriters, light action, no not really, lots of reports of RSI in the typing pool? My grandfather was in signals and used an old teletype for a least eight (sometimes up to sixteen) hours a day six days a week, for over three years during WW2. All random gibberish five letter combos at 120wps, thats a feck load of typing and he can't remember anyone with RSI in the squad, I'm not sure keyboards are to blame for the modern prevalence, mice on the other hand are tools of the devil.
I've been using keyboards (and mice) for about 18 years now, and despite having a recurring wrist injuy on my right side its the left one that I use for mousing that I'm more aware of.
Mousing with the left hand is better for most people than the right as most keyboards have the numeric keypad on the right and so you have to reach further.
Its very difficult to live without some kind of pointer input device, a stylus/digitiser pad combination often helps instead of a mouse; especially if you do a lot of drawing. At the cost of slower input you could try using handwriting recognition software for data entry. The only problem is the competition for desk space, you should only really use one at a time.
Use dictation software, Dragon Naturally Speaking is the best (or so I've heard).
A space saving keyboard with built in track pad/ball/nipple can reduce the need to reach for the mouse - unfortunately laptops are not ideal as the screen will be too low and can cause neck ache, and are more likely to be used ad-hoc in non-ergonomically sound settings.
Most desk/chair combos don't work too well. Common faults
1. they are too high, if you raise the chair to compensate for a high desk you need a foot rest/support.
2. you have to reach too far, a keyboard 'draw' hung under the desk-top often results in a better keyboard height.
3. Arm rests, often prevent sitting in a natural position, as they are too high and invasive, and force the arms and hence wrists into unnatural positions.
4. Chairs don't need back supports, you should be able to sit up all day without one. Bad backs are more common complaints than RSI, you need to pay attention to all your body.
A good friend suffered very severe RSI and his treatment was pretty much six months of dialy 'Japanese' i.e. deep tissue massage. He also did Alexander Technique to make him more aware of his posture and body mechanics.
Weights might be good exercise, but swimming probably isn't - you're effectively holding your hands in one shape and dragging yourself thru the water; my friend thinks this is what may have tipped him over the edge with his RSI.
My brother found that a tablet (pen-mouse which uses a special mousepad) was very effective.
I had severe RSI symptoms for approximately 18 months. I slept every night with wrist-braces and generally tried to stop being on the computer so much. I'm a computer programmer so that wasn't the easiest thing in the world to do. I also type 130+ WPM, to give you an idea of how long and frequently I have typed in my life.
The whole thing didn't make sense. I was 32 (I'm 35 now) and I had been typing since I was 10. As a kid, I would sometimes work on programming projects for 16+ hours per day. Never had a problem before.
I then read the book "Healing Back Pain" by Dr. Sarno. As a young, intelligent, financially successful, technology-focused atheist... I'm about as skeptical as they come. But, I don't have RSI anymore and I'm on the computer for 10+ hours per day.
I urge you to research TMS on the web (http://www.tmshelp.com/ is a good start) or to get one of his books from the library.
The short of it is that RSI and many (not all) other things are caused by repressed anger and other negative emotions. Realizing this is the cure.
Swap mouse hands (reverse the buttons if you like). It worked for me.
Nick
I've found that a trackball has been a lifesaver. I use a Microsoft Trackball Explorer, and the advantage is that your hand gets a lot of support and never has to move. All cursor movement is done with fingers, with your thumb used to click. It'll take a couple of weeks to get really used to, but I've never had the slightest pain from using it even for extended periods, while normal mice frequently cause me discomfort.
I also use a Dvorak keyboard exclusively (made by popping off the keys of a normal keyboard and moving them), and although I find it very comfortable now, the amount of time it took to learn means I probably wouldn't recommend it unless you like the idea of confusing other people who try to use your PC.
Hi, I had the same problem and tried every gizmo and medical assistance I could find. Nothing worked.
Finally I "sorted" it (3 years ago) by sleeping with my arms straight down by my side (instead of over/under my head as I had been doing).
I had details on another site, but just remembered to post it on my 'non-blog' after reading this...
http://www.ooyay.com/theoriesandthings/?p=46
Hope it helps. So far, I've convinced nobody (that I know of) to even try it, but all's I can say is it works for me!
Have you looked for a software that will put the word on the screen for you. I know a lot of people who are using this and it helps them to do a lot of writing in a short period of time. Good luck and hope it gets better.
20+ comments and only your second post. Are you, like, *paying* people to comment!? :-)
I'm as confused as you are. There aren't any links to the site other than from my homepage. Confused but pleased, more posts on the way :)
Short travel keyboards are the worst, IMO. Mice are no problem if you hold them with a light touch between the ball of your little finger and your thumb, and use your finger tips for the buttons. Never rest the palm of your hand on the top with your fingers along the buttons, even if they do have snug enticing grooves.
I have been typing for 30 years on all sorts of keyboards and I only had the start of symptoms in my left wrist since I got the hang of barre chords on my guitar.
P.S. In case you are wondering, it's your cartoons that are winning you admirers. Someone posted a link to This Modern Life on an IRC channel I frequent.
And we care about your RSI because keen physics teachers are alarmingly scarce these days.
There is a link to the Teaching Physics article on http://www.boingboing.net and another link to tgis site in February about the flow charts. I expect that boingboing.net gets heaps of hits, s not to be surprised when his vistors look here.
> The short of it is that RSI and
> many (not all) other things are
> caused by repressed anger and
> other negative emotions.
> Realizing this is the cure.
Whilst there certainly are problems caused by mental processes rather than anything physiological (see http://en.wikipedia.org/wiki/Psychosomatic_illness), RSI is not one of them: by definition, RSI is an umbrella term for problems caused by Repetitive Strain (clue's in the name). If you're problem was psychosomotic, fine, but then it wasn't RSI, by definition -- and it's certainly a fallacy to conclude that *all* people with such symptoms are suffering from something psychosomatic.
I totaly agree with swapping mouse hands.
I use my left hand at work and right hand at home (!). Strangely, I use the normal right-handed mouse setup in each situation and it doesn't give me any problems, although when I use my left hand I have the mouse facing 1 O'clock so that I can use my 2nd finger on the LH button. It sounds odd but it feels quite natural. OK, I'm wierd.
I'd like to agree with a previous poster and suggest reading "Healing Back Pain" by John Sarno. I had had terrible RSI, where I essentially couldn't type or write, for 12 months. A friend who had also had RSI suggested that book, and miraculously, within two weeks, I was able to type an 8-page paper and take a 3-hour essay exam with almost no pain during or after. My RSI hasn't recurred since despite typing more than ever.
A quick Google search will verify that loads of people have had similar success. Even if you're skeptical (I certainly was at first), you have little to lose and much to gain by buying or borrowing the book, and trying the treatment therein.
-A US physics grad student
The BBC website has a couple of pages you might find useful, workstation ergonomics, and repetitive strain injury.
All good: not resting your hands/arms on the desk while typing, switching your mouse to the left but not using a left-hand mouse (that way you click with a 'paw' rather than with one finger, similar to using a Mac mouse), using keybord short cuts. take piano lessons! great stuff for posture, and a good piano teacher will show you how to use the muscles in your whole arm to press a key.
I'm surprised more people haven't suggested voice recognition software. I second the recommendation of Dragon Naturally Speaking: it works quite well. I find the program irritating if I have to do a lot of mousing, and you need a powerful computer to use it, but it's fabulous for straight writing. Most people can speak much faster than they can type.
Mouse use is bad. Try to do the reverse movements a few times a day. This site has great finger/hand stretches: http://fingeryoga.com/
Take breaks from typing.
Do sleep on your back with arms by your sides. NEVER sleep on an arm, it cuts off circulation.
Maintain good circulation with massage and exercise of the hand muscles you DONT use in mouse/keyboard work.
DON'T rest your elbows on the desk while typing. Reduces circulation and simply forces you to use the wrong muscles when you type. Also ruins your posture.
It can help to use a gel-filled sausage wrist-rest thingy (goes along the front of the keyboard)
Hi, I had some pain myself, but in the hips and legs. I have recently been using the Julstro method with the first real success I've experienced. They also talk about carpal tunnel pain. The sites are julstro.com and aboutcts.com I think, but if you do a search for Julstro, you'll find it.
The main cause of these types of pain seems to be trigger points (muscle spasms), often located far from where you're feeling the pain. For wrist and hand pain, some of these spasms can be located in the forearms and even farther, but I don't know all the details, as I've been focusing on hips and legs for myself. Best of luck!
Brian, Keepsake Cakes, Petit Fours, Upside Down Cakes, and More
Post a Comment
Links to this post:
Create a Link
<< Home