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JWZ on Dealing with Wrist Pain 186

Posted by Hemos
from the stop-the-pain dept.
Kodi writes "Jamie Zawinski has put an interesting page on his site describing his fight with wrist pain. The most important thing is that you don't ignore it. Also check out the Typing Injury FAQ, which he links to. " Having had a scare a couple weeks ago, I can testify to the truth behind this - we've done some AskSlashdots about this before as well. Don't assume it'll fix itself.
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JWZ on Dealing with Wrist Pain

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  • I'm getting wrist pain from checking what VA Linux is trading at every 2 minutes. :)
  • by albalbo (33890)
    Wrist pain is more commonly called 'RSI' in the UK, short for 'Repetitive Strain Injury'. It's basically an injury you get from stuff other than just typing: tennis elbow is related to RSI, for instance.

    It's all down to posture at the end of the day. I keep thinking about getting one of those posture braces?! They're good for your back and all (I'm well over 6 foot!), but you don't half look a nancy wearing one.. although, health comes before looks I suppose. Anyone got any links to Alexander Technique?!!!
  • Yeah my friends don't ignore it. I did and couldn't use my mouse for three months.
    I'm now permanently affected with aches and pains most days.
    The worst thing I did (and soemtimes still do) is to rest the weight of my arm on my wrist while mousing using the ball of my wrist as a kind of pivot (obviously for hours at a time).
    Take care of yourselves now my friends. The day you start getting pins and needles in your face is the day to take a look at the way you position yourself! ('cos it's pretty scary)
  • That "FAQ" doesn't appear to have any questions, frequently asked or otherwise.
    ---
  • I may be completely wrong, but there seems to be two different types of wrist pain in my experience.

    1) Wrist pain from not having enough experience with large amount of typing, mousing, and other similar types of activity.

    2) Wrist pain from typing, etc AFTER you have built up the wrist and finger muscles over month or years.

    If you have the first problem, from starting a computer-related job after never really doing large amounts of typing before, you can normally just continue with intermittent breaks and will find the pain to diminish as your hands toughen up. Otherwise, if you type 5+ hours a day (like a secretary or heavy programmer) and start experiencing recurring pain, you probably need to see a doctor and think about ergonomic improvements.

  • ...is to get a girlfriend.

    (Will it be funny, offtopic, or flamebait? vote now! vote early!)


    Dan
  • I had a Ganglioneuroma develop last year because of typing. Probally from IRC, but work related stuff as well. It is a bunch of nerve cells that is caused by the tendons in the wrist moving too fast for too long. It felt like a gumball size lump in the base of my hand on the top of the wrist. Not very painfull, but causes my left hand to type a little slower.
  • by duder (86761)
    I had wrist pain for most of high school. It turns out that I had a whole bunch of torn cartilage in my wrist. Had a surgey and the recovery time was a bear but it is pretty good now. I have had wrist pain since then but because of my job (shoveling). I saw a thing on television about computers and posture and they suggested that the little legs on the keyboard not be used- it seems to actually help a lot!
  • Remeber, your body has a network of nerves, and your spine is the main 'backbone' (DOH!)...

    If the backbone is congested (pinched nerve), the rest of the network doesn't work quite right.

    Get your back looked at before you spend big bucks on surgery or pain killers.

  • This is a bit of a rehash but if it helps someone out - what the hell.

    I actually find that my mouse is probably more helpful than harmful. The act of moving my hand from the keyboard to the mouse provides some variety which is important.

    Consider this: the one time I really experienced wrist pain was after an all-nighter, cranking out a 30 page term paper.

    I just don't have the same problem when I'm programming though. I tend to pause and think about things, often taking my hands off the keyboard when I do. I scroll around and browse different files with the mouse. In other words, giving my wrists a break is just part of my work.

    Now, if I were to type in a large amount of source code from a book, verbatim, then I'd probably start feeling pain again.

    For what it's worth, the Microsoft Natural Keyboard really is a pretty good design (aside from the extra "Win" keys... grr). But if you place your hands on it, your fingertips down to your elbows are in a straight line. If you keep this position, and vary your actions like I said above, you'll be alot less likely to have problems.

    Best regards,

    SEAL

  • Nope, just links to FAQs on different topics... Just a bit confusing is all.

    Eric
  • by NateTG (93930) on Thursday December 09, 1999 @09:32AM (#1471349)
    Specifically that RIS I caused by people who use Keyboards and other systems with insufficient resistance. Notably RSI begins to show up at the same time journalists moved away from mechanical typwrites en masse. Something about he lack of resistance ecouraging/allowing bad hand posture?
    Any comments on this? It may also have to do with increased typing speed. However, there have been typing pools since before WWII and RSI seems to be a more modern phenomenon.
    I've had some problems with my hands while digging a long trench, but I think that was just old fashioned wear an tear, since they occured after only a few days of work digging.
  • ok so I probably over evangelise these keyboards, but I just love them :) the Kinesis Contour (kinesis-ergo.com [kinesis-ergo.com]). I've done a quick review of mine at base.yi.org [yi.org] which is maybe worth a read.

    Anyway, they're superb for people with wrist injuries. Infact most of the manual is dedicated to how to reduce wrist injuries, and even has a section at the back with an intro written by Herman Miller Inc (those really comfy chairs that Rob and co have from hmstore.com [hmstore.com]) that goes indepth into workspace ergonomics and risk reduction etc.


  • I read a good article on repetitive motion
    injury in bass player magazine a couple of
    years back (They might have it archived @ www.bassplayer.com, but don't take my word for it). It just had a few points in general.. some of the things I picked up were, I bought a pair of
    these elastic/molded gloves for $30 and I type with them when i get the pains.. i have to wear them for a while but they start to help.. apparently lower body temperature to the wrist because of bad circulation causes a lot of pains.

    I cut down on my caffeine intake about 90%, started wearing the gloves, and regularly take breaks to flex my wrists & fingers.. sometimes dupping them in warm water for a few minutes..

    it's helped a lot.. 2 years ago I got so bad that i couldn't type for more than a half hour @ a time.. now i'm great.
  • Does anyone out there have any preventative measures that don't cost a few hundred dollars? I'm a student right now and can't afford that kind of stuff.
  • by Esjion (58700)
    I am not sure if this is what you were looking for, but a quick search on "Alexander Technique" brings up this link [uiuc.edu], which appears to be a rather helpful list of links to information about the Alexander Technique.
  • Does anyone have any experience with the Kinesis keyboards? I currently use one of the old style Microsoft ergo keyboards, but the control key is killing me and the ESC key is too far away. Emacs likes the CTRL and ESC keys and I need them closer to home. I find myself constantly pivoting my left hand to do common actions like C-x C-f... that's not good.

    Anyone want to comment on the Kinesis [dmb-ergonomics.com] keyboards?
  • Actually, the "Windows" keys on the Microsoft Natural Keyboard actually do have some functions if you're running KDE or GNOME, depending on the theme you set up for these windowing environments.

    What's interesting is that while Linux users naturally hate Microsoft software, they do like the Microsoft Mouse ("Dove Bar" variant and newer) and the Microsoft Natural Keyboard. I use the Natural Keyboard myself and enjoy the fact I can type for long periods comfortably, thanks to the fact on the MS Natural Keyboard the wrists are not "bent" to accommodate home key positions like you do on a normal QWERTY keyboard.
  • apparently jwz is running his webserver off isdn or something :) but it's slashdotted - any one that can get to it willing to throw up a mirror? or post the text here? REMEMBER - include copyright info :)
  • The Computer Users's Survaival guide. Very well
    worth it.

    Be carefull with RSI. It can really make your life
    misserable. And make earning a living very hard.
  • by trance9 (10504)
    xwrits [freshmeat.net] is break software. It reminds you to get up from your computer and take a break every so often. It monitors your typing and mouse usage.

    Compared to similar programs for windows it's pretty crude. However, it's effective.

    One of the most important things you can do to avoid/prevent/cure typing injuries is to make sure you take adequate breaks. This does not mean lunchtime--this means every 10-15 minutes you get up and stretch.

    Programs like xwrits remind you it's time for a break.
  • Yes! I will second that. I've had back problems my whole life. Only recently have I started to go to a chiropracter(sp?) about it. The change is immense. Simply getting things back into order on a regular basis has imporved everything from backpain to regular sickness. (I haven't been really sick since I started going (about 4 years now) That might not say much, but if you knew me before that time I was sick ALL THE TIME (especially in winter months)). I think there's a much larger connection between your spine and overall health than most people think.

    l8r
    Sean
  • by trance9 (10504) on Thursday December 09, 1999 @09:44AM (#1471365) Homepage Journal
    Stretching is very important. Stretch your arms, your forearms, your neck, your back, etc., do it frequently. Don't be too aggressive--mild stretching is the best.

    Stretching helps promote healing, and keeps muscles from tightening up. A good massage is also a reasonable preventative measure--work on shoulders and upper back problems as problems here are often are responsible for inefficient use of your fingers, wrists, and forearms.
  • My doctor told me to start wearing a wrist splint while working. My wrist and the base of my thumb were very swollen. The splint actually made things worse. My reaction to feeling something in my palm is to grrasp it. Therefore I was constantly flexing my fingers and agitating the injury.

    I decided to try Hand-Eze gloves [handexe.com]. They are fingerless gloves -- there is a picture at the link. They work for me. I have practically no problem now, and I don't even wear the gloves anymore.

    Another thing I did was to start using my left hand for mousing. I'm right-handed so that took a bit of work. The only drawback now is that every time a new quake comes out I have to reconfigure the key bindings. :-)

  • by Anonymous Coward
    back pain. Once you get, you've got it forever. But if you take care of yourself, you may be able to control it. I've had some bad boughts with RSI. These days, I can usually manage it. As someone else said, I find that the two biggest killers are the mouse and the joystick. But it does come down ergonomics. Your fore-arms should be parallel to the floor, at right angles to your body. Your wrists should be straight. I use a mouse pad with a wrist wrest (you don't want to rest your wrist on the desktop, because then your wrist is cocked at an angle). Take frequent breaks and stretch. Definately see someone in occupational health about this. Take some Aleve. Ice up down your forearms and wrest for a while. I've hurt myself more using computers than any sport I've every played. Jared
  • ...Real Programmers (tm) use Direct Neural Interfaces!

    (Okay, moderate me down now. I deserve it.)

    Well, just to make sure that I don't get hit /too/ badly, let me share my personal experience. I use a ridiculously small iWhack keyboard mounted on top of what is basically an open drawer, with no hand-resting space or anything. I've been using this setup for more than a year now (since the iWhack arrived here in Brazil), and I've never experienced any kind of wrist or back problems. Nonetheless, I have good posture and the screen is set on a good eye level.
  • I use one... a few months ago (about 6 now) i was the lead engineer in a software development firm. We had a 6 week rush during which I worked between 70-90 hours a week of solid programming. It got to the point where I sincerely believed I was going to have to quit computer science/computer programmng... it was not a "good thing". I approached by boss and I told him about the pain, and I told him that I heard that the Kinesis [kinesis-tech.com] Ergo was a wonderful keyboard.

    Well, after pitching a slight bitch fit, I got one. I have been using it now for about 6 months, and I can say beyond a shadown of a doubt, that I am eternally endebted to Kinesis for this keyboard. Within 3 weeks ALL of my wrist pain was gone. It does take a while to learn how to type on it (and you had best be a great touch typist) but once you have it down, it is unbeatable. The programmable nature of the keyboard has alowed me to program some very helpful macros and I can say has nearly doubled productivity in some tasks.

    If you can afford the rather hefty pay check I can suncerely suggest that you get it... it might save your wrists...
  • My wrists have been popping a LOT recently. Would this be an early warning sign of RSI or something? It generally doesn't hurt but it can't be good. What are some other early warning signs?

    WEEMADARTHUR
  • However, everytime I read an article like this, my wrists start to tingle, and I feel an urgent need to stretch.

    Any other time, my wrists feel fine.

    I think my therapy solution would be to stop reading articles about repetitive stress injuries... :)
  • by Anonymous Coward
    Hrm... not so strange.

    I recall using a manual typewriter and maybe getting tired right then and needing to take a break (built in safeguard?) but that was it. No delayed problems sneaking up like with electronic keyboards.

    I wonder if the 'glass arm' telegraphers got is similar. They used 'bugs' (a sort of sideways semi-automatic key) to increase speed.. and the better telegrpahers risked 'glass arm' The rest were more likely to have more time off the keys/bugs.

  • My mother was a secratary/typist for years, and eventually (after not typing for a few years), her wrists started hurting so much that she couldn't sleep at night. Nothing seemed to help so she opted for surgury, which at the time had the risk of, if the doctor screwed up, causing a complete loss of hand motion. Not something you'd want even if you don't type.

    So do people still have surgury for CTS? And have the risks gone down?


  • Perversely, one of the only two times I have ever had significant wrist pain from computer usage was just after my company brought in an "ergonomics expert". This individual told me my keyboard was positioned too high, and adjusted it to a lower level. The pain began shortly thereafter. I put my keyboard back to where it had been before, and the pain went away. Moral: take "ergonomics experts" with a grain of salt.

    I suspect the real problem was not the keyboard, but the mouse. Since the keyboard and the mouse sit side-by-side, lowering the keyboard meant lowering the mouse also. This forced my wrist to bend at an odd angle whenever I used the mouse, and indeed, it was after using the mouse almost exclusively for an hour (in a paint program) that I first noticed the pain.

    The other wrist pain incident was just after Microsoft came out with their "middle-button wheel" mouse. I made heavy use of the wheel when I first got one of these things, and found that it led to wrist pain (perhaps because rapidly spinning the wheel with the middle finger is a rather unnatural motion). So I stopped rotating the wheel (back to scroll bars, alas!) and the pain went away.

    I strongly urge anyone experiencing wrist pain from computer use to take the problem seriously and get it taken care of early. One of my coworkers has been out on disability for nearly three years now because he ignored his wrist pain.

  • Actually this doesn't sound that strange after using this new Key Tronic Ergoforce keyboard. It seems that Ergoforce is designed to be as non-responsive as possible. After 15 minutes of work with it will cause me terrible pains. But with this good oldtimer Key Tronic keyboard with clicking keys (and without those stupid M$ keys) there isn't any problems. I think that there really is a connection between insufficient resistance and wrist pains.

  • I think the lack of resistance found on most modern keyboards is the catalyst.

    I get amazed at the number of people I see with poor typing practices, and then they go complaining about wrist pain.

    From my many years of piano playing, I got the "correct" technique for playing piano engrained into my brain. The technique seems to work well with keyboard typing too. Get your wrists UP off the table, and curl your fingers so they look like claws. Don't use armrests for your elbows. Your arms should be dangling loose, not resting on anything.

    If you need a little help getting your wrist off the ground, move your keyboard to the edge of the desk. That way, you're forced to have your wrists up. You may find that your shoulders will get tired, but as they strengthen up it'll pass.

  • by Anonymous Coward
    Is it a coincidence that Ben Wing, head of the Xemacs project right now, Jamie Z, "Mr. Lucid Emacs", and Richard Stallman, ALL have wrist pain problems, and have been potentially crippled by them? Is it possible that using EMACS with it's funky key combinations actually CAUSES this problem? Mind you, I'm an emacs user myself. I love it. And don't want to give it up! But umm, this is just too much of a coincidence to not be noticed!
  • by Quinn (4474)
    I've been typing 10+ hours a day for more than 10 years (everything from a Laser128 to various PC keyboards, but never any of that new-age "ergonomic" crap!) and I have never experienced wrist pain.

    What are you people doing?

    Half those years included a lot of masturbation. Maybe you should work that into your therapy?

    --
  • Cayenne pepper (taken internally or externally) will also help circulation to the extremities. I don't know about helping wrist pain (fortunatly, I don't have that), but it does help with back pain.

  • My freshman year of college, I began suffering from severe pain in my wrists, probably caused by a combination of bass & guitar playing, mountain biking, taking a ridiculous amount of notes, and typing for at least 3 hours a day. I was at a point where the pain was enough to keep me from typing, and I would actually ride to class with my arms resting on the handlebars so I wouldn't put pressure on my wrists.

    I tried a variety of things, from pain medication to wrapping my wrists in Ace bandages (sometimes with cold packs I kept in the freezer) to going to a sports medicine therapist and trying prescription pills. Ultimately, the single thing that made the most difference (besides cutting down on my acoustic guitar playing) was a $3 padded wrist rest that I bought at Walmart on a whim. Believe it or not, it really helps, and while my wrists are definitely weaker than they were before they started hurting, I can at least use them regularly without pain. You don't have to buy one of those $15-20 gel ones, either - mine is plain black, not terribly soft, and sits at the base of my keyboard. It annoyed the hell out of me for the first week or two, but I got used to it quickly, and really prefer it now. All geeks with wrist pain should get one.

  • My thoughts on this are a bit odd, but... DON'T TOUCH TYPE.

    I think that this standard 5-finger technique is the cause of a lot of wrist stress related injuries.

    Here's why:
    The only time I have ever experienced serious wrist pain is when playing quake for hours on end, and literally not moving my wrists to any great extent. One hand on the keyboard, one on the mouse. The slightest mouse movement spins me around (I keep my sensitivity super high), so my wrist doesn't really move a lot.

    I am not a touch typist. I learned to type through massive amounts of practice hunt-and-peck.. Just the way you would naturally learn. I also type 50-60 WPM. :-) I simply know where the keys are. It's a memory thing. I've been typing on a computer since I was 7. You learn the keyboard that way. My touch-typist friends think I'm really odd, since my hands are flying all over the place when I type.

    I never get wrist pain even after hours upon hours of typing. Why? I think it's because the wrists are never immobile. It's like a form of very light exercise for the hands.

    I see these touch typists who type for hours without lifting their hands at all. They don't even move them to think, because they're so used to the position of their wrists on the keyboard. I'm sorry, but that simply can't be healthy for your wrists. The strain you're putting on them in that position is just too severe, over a long period of time...

    Anyway, yes, I probably could type faster if I unlearned the way I type, and learned the "correct" way. But hell, I don't need to type so damn fast that I risk my health, yeh?


    ---
  • Check with your doctor, but I think the popping is a sign of arthritis...
  • by albalbo (33890)
    Yep, that's what I was on about. This link was particularly good: http://www.life.uiuc.edu/jeff/at_ description.html [uiuc.edu] - it's a short description of Alexander Technique. All about posture & stuff, basically..
  • Jamie didn't cover this enough.
    When you do your weightlifting (as you all should be doing) add in some wrist curls at the end of your exercises (do it at the beginning and you will injure yourself doing other chest or arm exercises) and you'll feel great. Always. I haven't had wrist pain since I started this ~8 months ago.
  • Speaking of direct neural interfaces, I found a link from that FAQ to a company called Brain Actuated Technologies, Inc. [brainfingers.com] Looks like they use a few forehead sensors to detect electrical and muscular impulses. Neat, but quite an expensive toy. =)

    I actually tried out something similar at Epcot Center in Orlando, FL. It was a kind of neural joystick hooked into an SGI workstation running a skiing game. You basically stuck your finger in the interface and it would pick up electrical impulses from your brain. It took a few tries to get myself going safely, but it got easier after some practice.
  • It's hardly enough of a coincidence to be noticed.

    I *never* use Emacs. I have wrist pain. What these people have in common is that they do a whole lot of typing.

    The funny thing, my wrist pain has only startd in the last two weeks since I cleaned my desk and got rid of all the piles of paper encroaching on my keyboard. Perhaps I shoild go back to the clutter.
  • A paperback book called "Repetitive Strain Injury - A Computer User's Guide" by Emil Pascarellie and Deborah Quilter. I got my copy at amazon.com [mazon.com]. I forget what I paid, but the back cover of the book says $16.95 (US).

    I too am a poor college student doing part time programming work. My wrists begain to ache badly some time ago, but two things greatly helped: I purchased an ergo-keyboard (split down the middle) and stopped resting my hands on the keyboard and mouse when using them.

    A small investment now will hopefully prevent future problems.

  • I dealt with RSI with some simple steps; I found that the worst of my RSI was caused not by computer work but by my poor driving habits. A few minor computer tools helped also.

    First, I arranged my driver's seat so that I could comfortably grip the steering wheel without bending my wrists. I keep my hands at 10 and 2, wrists strait (but not rigid) and that helped a LOT.

    Next, I added one of the afformentioned keyboard strips and had a great deal of response.

    I did the wrist splint for a while, it might have helped but I stopped after the pain went away and I was doing the above things at the same time too.

    My pain went away about seven years ago, and has not been back (I was diagnosed in 1980 or so, maybe '82 or '83...)

    On the other hand, my mom (who works as an Op) had the surgury and complained a lot about it -- out of work for many weeks, couldn't drive for months, still had pain, etc.

    We often attribute our wrist pain immediately to computers, without looking at what other wrist-related bad habits might be contributing as well. Essentially, you need to keep pressure off the wrist tunnel as much as possible; whether you're at the computer, driving, golfing, or channel-surfing!
  • Even if you're under deadline pressure or otherwise typing in a frenzy, you should always keep your shoulders, arms, and hands relaxed when typing. It doesn't take a great deal of force or movement to type quickly, so don't overexert.

    These injuries are not inevitable, even if you sit and type for long periods of time. In college, I majored in piano, and they repeatedly told us that RSI is preventable as long as you make sure you don't tense up when playing. The same applies to typing, or any fine motor activity.

  • I've had the problem myself, and yes you can work on it yourself. IANAD, and your milage may vary, but...

    Thing one. Act early. I started to get tingly feelings in my fingers, they started to twitch a bit on their own, and it was a little painful to stretch them out fully. Does that sound familiar? If so - STOP. Right now.

    Thing two. Get a wrist pad - it's the cheapest addition that might help you. DO NOT get a foam one - these are junk IMO. Get a GEL wristpad (about $15 at a computer store).

    Thing three. READ THE FAQ. Understand it. Work on ergonimics. Rearrange your work area. Use bricks and boards if you have to - it doesn't have to look pretty.

    Thing four. Take breaks. Do the stretches. Work on (gasp!) paper to figure out new things. Go for variety.

    Thing five. Baby yourself. It sounds silly, but act like a baby - if you feel anything at all, stop. Do other stuff until it feels better. Work slower. Use the mouse. Get creative with your bash history - anything to avoid more keystrokes.

    Thing six. If it doesn't get better, or already hurts a lot, go to a doctor - go to your councillors - go to your dean - go to your attached medical school. You're in school dammit - get creative! Get help!

    That's my $.02. Don't spend it all in one place.
    Good luck.
  • I have one of these on my Xmas list, and I am certain i am going to get it. Has anyone had an experiences with it? Wrist pain go up, down, left, whatever?
  • What happened to the Glorius Meept? Just Meept? Are you the real Meept?

    What have we unleashed?! Are you truly the Unspeakable One? Were you recovering from RSI? Are you better now?

    --still awaiting the return of our illustrious and glorius leader Meept!

  • If the pins and needles don't do it for ya try the the good ol' Carpal Tunnel Workshop [thecorporation.com].

    Some of you probably remember this from 'The Corporation' website.
  • by mezzo (20109)
    The little legs are actually bad for you? *confused*
    Is this true? Links to any studies?
  • by nicksand (28560) on Thursday December 09, 1999 @10:21AM (#1471406)
    I'm not sure that this is ergonomically correct, but I have never experienced any major discomfort from the method that I use, even after a multi-hour programming rampage.

    For typing, I keep about four inches or so away from the front edge of my desk. The weight of my hands rests on the bottom part of my palm, which allows me to arch my fingers (I have big hands) comfortably over the keyboard, while maintaining my usual typing pace (80wpm avg). When possible, I rest my elbows on armrests.

    As for my mouse, I keep it and its pad very far away from the front of the desk. Basically, my arm rests flat on the desk almost to the elbow. I keep my mouse sensitivity turned way up so that I can reach any side of my desktop, even at high resolutions, by only moving my hand a few inches. Since my entire arm is supported, this position is quite comfy.

    For FPS games however, I move the mouse forward a bit, so that about half of my fore-arm area is supported by the desk. This seems to be more effective for those trigger-reflex type games.

    I'm interested in hearing what positions other people use to stay comfy.

    Note: I don't use any ergo-stuff. I use the HP keyboard that came with my old 486 (still love it!), and a microsoft serial mouse (no wheel) for mousing.


  • Consider this: the one time I really experienced wrist pain was after an all-nighter, cranking out a 30 page term paper.

    I'll second that, but it seems to be more related to stress in general. There's a lot of fluctuation (new CEO, massive reorganizations, and I'm severly bored) at work right now, and my left wrist is sore. In college, writing my own 30 page term paper, my other wrist was sore.

    Excercise and stretches seem to help. Anything to stretch and to relax that spot between the shoulder blades helps.

    What really hurts is Quake -- it's the hunching forward to look at the screen and the rapid finger movements on the numberpad with my left hand and my right hand on the mouse that kills me there. Ugh.

    --

  • The only wrist problems I have ever had I think I have to attribute to using the mouse. I tended to rest my hand on it and weight of my arm then went on my wrist, and so sometimes got pain in my right wrist (my left, non-mousing wrist was fine) which went away in a few days. In my opinion the mouse is a very bad device from an ergonomics standpoint, especially the act of clicking places a lot of stress on the tendons.

    These days I have a laptop with a touchpad and haven't had any problems, the amount of force required to move the pointer around on a touchpad is much less than than to move a mouse around.

    I also use a dvorak [umass.edu] keyboard layout, which places far less stress on my wrists for typing - the debate on whether it really is faster aside, dvorak is subjectivly a much more comfortable way to type.

    One seemingly minor change that I have found very nice is moving the backspace key from its far-flung position in the right corner - which forces you to either contort you wrist or move your whole arm to reach it - to the alt key to the left of the spacebar. Now deleting text is just a matter of holding down the left alt key with my left thumb, and I never have to leave the home row - faster and more comfortable. I haven't seen too many people who do this but even with a QWERTY keyboard it is a really good idea, I think.

  • We're suprised you haven't gone blind yet from all your naughty ways.

    And hey. Stop trying to make us go blind with the all caps. Just because using the CAPS LOCK key makes it less strainful, avoiding the shift key, doesn't make it ok.

    Oh and by the way, ick.

    Here's some RSI info [amara.com] to help you out.

  • Well, emacs users aren't the only people who have such problems, but what I'd say is that it's a combination of emacs and awful keyboards that do you in. Needing to lean on the control key all the time when some bozo decided to move it down under the shift key isn't going to do you any good.

    The solution I recommend to my fellow emacs abusers is the Kinesis contoured keyboard: Kinesis Keyboards [kinesis-ergo.com]. If you look at that URL, the contoured keyboard is the model on the left. It has the control and alt keys moved into the center, under your thumbs, which is particularly good for using emacs.

    What isn't so good is the teeny ESC key, and the CAPS LOC next to the A, but all of the keys are easily reprogrammable. I use the CAPS LOC as a second ESC.

    And if you're really nervous about Emacs "chording" combinations, you can always try M-x viper. You can switch to a vi-like keystroke layout without abandoning emacs's power and flexibility.

  • Me too, but I found it behind the couch.
  • duh, I get it.

    You only really need this however, if your hands are totally destroyed or crippled.
  • When I learned typing years ago on one of the old DOS programs (Typing Tutor, I think), I was always taught to use the left hand for the 5 and the right hand for the 6, but the split keyboards have both the 5 and 6 on the left hand. I love the Microsoft keyboards and have been using them for years now, but this is still always guaranteed to trip me up now and then. Anybody know if typing is taught these days to use the left hand for both the 5 and the 6, or is this a Microsoft innovation?

    Caveat emptor: There is one version of the MS split keyboard that has smaller arrow keys and the Ins/Del/Home/End/PgUp/PgDn keys are rearranged. Do not get this keyboard, because you'll never get used to the rearrangement.

    Cheers,
    ZicoKnows@hotmail.com

  • Strangely, I would suggest just the opposite. I get the most pain when using keyboards which are too close to me. I prefer to have from my elbow to my wrist supported by the desk and wrist pad.

    I think that it is more important to just pay attention to yourself. I started getting severe pains in both arms near the wrists (using the above position!). Consiously and slightly altering my exact possition eventually brough relief.

    One thing for sure, however, is it is SCARY when you start getting these pains!

  • my hands were practically useless for weeks at a time until I bought my first M$ Natural Keyboard. It was almost like magic after the old xt-style kb's (and sharp-edged desks) that I'd been working on.
  • by Reid (629)
    I noticed that new ones have moved the legs to the back, too. Fortunately, I found a cheapo ergo keyboard with three legs in the front. Feels good, and I managed to save a bundle. I don't remember the maker, but I think I picked it up in Office Max....
  • ...is buy a wrist pad for your keyboard AND mouse. A lot of people only buy a keyboard pad and don't realize their mouse hand is doing the exact same thing. I used to get pains after playing too much quake, but as soon as I got a pad the pain went away. It's cheap and effective.

    If you have a 3M mousepad that won't work with a wrist-rest, do what I do: clip it [dhs.org] on top of a pad that _does_ have a rest :P
  • I would disagree. Those old typewriters were hell in a black case. :) I've tried one, nasty! They put huge amounts of pressure on your left pinkie finger. Horrible.

    My grandma was once a typist in the days of manual typewriters. She now has arthritis. It's worst on her left pinkie finger. And she was just diagnosed with Carpal Tunnel Syndrome in addition to her arthritis.

  • by Anonymous Coward
    I've been affected by RSI for around 3 years now. Initially, it got to the point where I could not type, mouse, drive, or even rest properly.

    The thing to keep in mind is that once you notice the symptoms, your only recourse is to rest. Problem with RSI is your muscles and tendons will hurt more when they're resting if you have RSI. Bizarre and scary, but true.

    My situation was helped by a sympathetic manager and doctor. Without either one, I probably would have lost my job. People at worker's compensation will do almost anything to either get you back to work or pay you off so you're no longer a liability.

    Do not make a self diagnosis. Go to a doctor. But it is good to be knowledgable about RSI in general. A good book I can recommend is "Repetitive Strain Injury" by Pascarelli. I must apologize to its co-author because only the main author's name stick in my mind. This book was written by a doctor and a patient of his. A very excellent book, it covers stretching exercises you should do while you're resting, as well as descriptions of the various forms of RSI. I am not affiliated in any way to this book.

    My keyboard of choice is the IBM options split keyboard. It is physically split and allows "tenting." Tenting just means you can tilt the various sides so that the keyboard's surface may conform more to your hand's neutral position. I cannot use a mouse anymore and prefer a trackball. With the IBM keyboard, the trackball sits between the two pieces of keyboard so I can use either hand when mousing. Getting a trackball with large buttons is important so you don't have to stress one finger to repeatedly press a button--rather you can use several and reduce the strain required. Sadly, IBM stopped making the options keyboard (also marketed by Lexmark) due to insufficient demand. All these things may sound like I'm over-reacting but RSI develops from accumulated strain over the years and won't go away overnight.

    One thing I also want to stress is once you have RSI you shouldn't exercies the affected parts of your body until your body has adequately healed itself otherwise you'll be in worse shape than before.

    Once you have RSI, you should try anything that you think will help. Everyone's body is different in how it reacts to various stimuli. What works for others may not work for you; what doesn't work for others may work for you.
  • by doom (14564) <doom@kzsu.stanford.edu> on Thursday December 09, 1999 @10:42AM (#1471425) Homepage Journal
    Bill Joy uses emacs now.
  • Have a look at these - I'm using one and they really help out. Much better than the M$ ones.
  • Actually, it's interesting that you mention that. All of the people I know personally who have wrist trouble are emacs users. I'm a VIM [vim.org] user myself, and I've never had wrist problems.

    Chording is supposed to be pretty hard on the wrists. VI and its derivatives don't use chords for very many things, except for a few shifts, and a very small number of rarely used control keys.

    A possible alternative to a vi-like editor would be to use emacs with "sticky keys". Knowing emacs, there's probably an elisp script that can turn that on for you. Then you's press (and release) each meta key before the key it modifies. So "C-x" would be 'control' followed by 'x'.

    Or you could use one of the vi-modes for emacs... :-)
  • I did an interview with Scott Wright, Webmaster and Primary Caretaker of the Typing Injury FAQ.

    He answered these questions:
    * What is the Typing Injury FAQ? What is your role?
    * What are Repetitive Strain Injuries (RSIs)?
    * What are the symptoms or signs of injury?
    * What are the common causes or injury risks of RSIs?
    * How can injuries be avoided? What are the best preventative measures?
    * Are there special RSI considerations for Web users?
    * How is Web design related to RSIs? For example, can Web sites be better designed to prevent RSIs?

    You can find it on my site:
    The Facts About Repetitive Strain Injuries [webword.com]

    John S. Rhodes
    New e-book --- http://webword.com/ebook.html

    --


  • why is emacs as bloated as MS Office?
  • I can pop ~40-50 joints in my body, everyone says that I am going to get authritis, but it doesn't hurt so oh well. (it's good for scaring the girls in class ;-))
  • Something /.ers (and JWZ) might want to try is a DynaBee [dynabee.com]. I've never had any major wrist pains, but my girlfriend has one of these , so I tried it one day

    It's a funky little gyroscope thingy that you get going and then use the gyroscopic force as resistance for wrist excercises. It's fun, geeky and good for you!

    They claim it "is particularity effective in the rehabilitation and prevention of repetitive stress injuries such as carpal tunnel syndrome, tendonitis or 'tennis elbow'." Like I said, I can't speak from experience, but it is fun.

    Greg

  • There is definitely something to the lower body temperature thing. I didn't start having wrist problems until a few years ago, during the summer. I sat directly under an air vent, and my hands were always cold. A friend of mine pointed me to the MouseMitt [mousemitt.com] website, I purchased some of their Keyboarders [mousemitt.com], and the pain/ numbness decreased significantly.

    I don't sit under the AC any more, but I do still use the Keyboarders when my wrists are being particulary bothersome. I find they also come in handy when using a laptop because they are much more portable than a standard wrist rest.
  • How severe should pain be before you see a doctor? I occassionally feel sore in the wrists after heavy bouts of typing (usually from typing up something due the next day). I get some sleep and rest, and the pain goes away. With my new keyboard this happens maybe once a month. Is this enough pain to warrant a trip to the doctor? Should you really have a "zero tolerance" for pain?

    -Nathan Whitehead

  • I had one of these and it actually caused me a sore wrist. Was
    a bit of a shame as otherwise I really liked the keyboard. Now
    I'm back on a generic keyboard (G83 from Cherry) and the
    pain is gone.

    I think the culprit was the function key that you have to press for the
    arrows etc. They stange thing though is that I mapped this function
    key to the left and that I got pain in my right wrist.
  • I have found that I got the worst wrist pain using a mouse... At one point I had pain in not only my right wrist, but the elbow and shoulder as well. I checked my mouse, and bought a trackball... Problem solved.
  • I know this is repetative (I posted this info in another place already, but it seems to apply here as well), but if you are looking for a cheap/ portable solution, try MouseMitt Keyboarders [mousemitt.com]. They are $19.95 for a pair, or $10.95 for one (if only your mouse hand bothers you). They are well worth the price, IMHO.
  • I agree. I have used dozens of keyboards, from the curved, smooth MS one, to innumerable cheap plastic gimcracks. The best keyboard I have ever had is the one I bought second hand from a college. One of those old, heavy-duty IBM ps/2 keyboards that they made to go with the spanking new 286 PS/2 machines.. they were designed by engineers to withstand the apocalypse. Metal and insane mil-spec plastics... big, thick springs under each key... a loud, satisfying CLICK when you type down on it.

    I ended up getting five of the things, two to use, three for parts... although I really don't think that I will need em for parts, even though these things are over 8 years old and have been pounded on by legions of students over that time, they are all as responsive as they were the day they were uncrated. This was a keyboard designed by people who made typewriters, and they wanted them to last. Unlike todays keyboard makers, who are just churning out cheap plastic crap.

    I actually felt my hands getting better after I got these things, mainly because they force you to use the correct typing procedures, or your entire hand goes numb with the effort of pressing the key down. heh heh... you won't have a chance to get RSI with these babies, as you will run out of juice long before the damage sets in.

  • Specifically that RSI is caused by people who use Keyboards and other systems with insufficient resistance. Notably RSI begins to show up at the same time journalists moved away from mechanical typwrites en masse. Something about he lack of resistance ecouraging/allowing bad hand posture?

    First of all, it's pretty unlikely that there is just one cause of typing-related injuries, any more than there is just one way to hyperextend/twist/maim any of your tendons.

    But I do honestly think that a lot of RSI-type problems are caused by crappy hand posture while typing, and those are most certainly somewhat with bad keyboard designs. I learned to type back in the day on a manual (I always used to say "acoustic" :-)) typewriter, and had practice on several electric typewriters as well. Typing on those suckers was a whole different ballgame. You had to hold your wrists a certain way, and you couldn't do some of the stupid keyboard tricks (like pound on the backspace key). And there ain't no such thing as CTRL, ALT, or ESC on a selectric. :-) Heck, even CAPS LOCK had a function back then, since, unless you were a whiz at changing typing balls or daisy wheels, CAPS was the only way to get a distinctive look, and you wouldn't want to do the "shift key bounce" for very many strokes, since it would ruin your speed.

    And let's talk about speed for a moment. I was an okay manual typist, but I couldn't type anything near the speed I can these days on a decent keyboard, which is upwards of 70 words per minute (usually around 75, but often in the vicinity of 100). This just wasn't possible for most people. And if it was possible, it was also the case that you had to take a break, no doutb about it. My guess is that these days that most people are:

    • Typing more
    • Typing faster
    • Typing with worse posture
    • Typing after fatigue has set in
    • Typing on poorly designed keyboards

    It would be miraculous if typing injuries didn't occur. Typing used to be a profession, and one that was best left to the pros. Not anymore! And just as amateur athletes appear to injure themselves more often than you would expect, the same goes with amateur typists.

    And how are my wrists doing? Pretty damned well, thank you, and I'm an EMACS user to boot. :-)

  • I've been typing 10+ hours a day for more than 10 years (everything from a Laser128 to various PC keyboards, but never any of that new-age "ergonomic" crap!) and I have never experienced wrist pain.

    Weird. Me neither: I've been typing since age 6, so I wonder if my wrist and finger muscles (and even bones) grew up to support typing motions.. Still wanna get that Aeron chair though, as my back is not too great...

    Your Working Boy,
  • My method of avoiding RSI is simplicity itself. When my mom said `get your elbows off the dinner table', I ignored her. So now, I both eat and type with my elbows up on the table. The wrists are relaxed and in a natural-feeling position, and I have no pressure being applied to their insides like those who use wristpads. Of course, you have to push your monitor and keyboard back a foot or two, which no one around here except me seems to want to do ..
  • I have a couple of 'em too. I think the URL for my comments is still http://www.plethora.net/~seebs/kinesis.html but I'm not sure. :)

    FWIW, NetBSD makes these awesomely useful - you can get a USBPS/2 adapter, and you have a *hot pluggable* Kinesis.
  • Go to any ol' pharmacy and look for something called HANDEZE. It's an eight-dollar "golf glove"-looking thing with no fingers, made out of medical-grade lycra.

    It traps heat and causes friction, both of which increase circulation in the hand and to the fingers. It's no substitute for stretching and resting, but if you work in a room that can get cold sometimes, it can help reduce minor soreness.

    (Why do I have one? Well, I'm a diabetic, and we usually have poor circulation. And any doctor will tell you that poor circulation increases the damage done by RSI -- for that matter, the Typing Injury FAQ will tell you that, too.)

  • I have a shoulder related RSI and bought a laptop with a touchpad and Dragon Naturally Speaking Professional. The keyboard has a very light action which helps and the touchpad is way better than using a mouse. The reason why I got a laptop is that speech recognition works best in a quiet environment[1] and I like to be able to move around, and also, sometimes my talking gets distracting for people around me; and there is also the privacy issue to consider. Moreover, once you trained your Dragon its quite an investment, so your play machine == work machine.

    I use the continuous speech program to write essays and letters etc., and for coding I use the discrete speech program together with XEmacs and lots of macros. I keep diffrent vocabularies for Perl, Java, LaTeX etc. Especially Lisp is great fun to code in with speech recognition!

    This also works nicely with VNC[2], so, having to use Windows is bearable, esp since it can crash and my Linux desktops stays as it is. However, since I don't have MS Office installed, my laptop rarely if ever crashes.

    I also mud with it (a great way of training your Dragon ;) and all in all, I think I'm faster now than I was before I got ill, especially now that my hand has nearly healed up[3] and I can interleave a little typing with speaking where its handy.

    Shariz

    [1] Once your Dragon is trained, it works very well even if you have music on.

    [2] VNC [att.com] is great!

    [3] I'm painfree, i.e its not keeping me awake at night anymore, _but_ if I overdo it I definitly feel it immediatly. I don't expect it to ever go away totally, but then I also think that typing a lot is unhealthy by definition -- a lot of people I know have problems, and I think that we need to get round to thinking that typing 8 hours+ a day is simply not on!
  • My girlfriend suffers from back and shoulder pain which is amplified significantly if she can't sit in a sensible position when typing. After complaining to her HR department for ages, they eventually got a government inspector to come and assess her (they get a grant for providing her with a suitable chair if she's found to need it). Her conditions were considered unacceptable, and she was recommended to get a Herman Miller chair. The company forked out the money, she got the chair, and hasn't had a single problem since. The company has easily got their money back in the extra productivity it's gained them.

    We're trying to save up to get one for her at home, too...

  • by CrayDrygu (56003) on Thursday December 09, 1999 @11:51AM (#1471463)
    The other wrist pain incident was just after Microsoft came out with their "middle-button wheel" mouse. I made heavy use of the wheel when I first got one of these things, and found that it led to wrist pain (perhaps because rapidly spinning the wheel with the middle finger is a rather unnatural motion).

    I got one of the wheelmice, and now I don't know what I'd do without the wheel. You're right, though -- using your middle finger to scroll the wheel is rather uncomfortable.

    I found a position (without even trying, it just kinda happened) to hold the mouse that makes it a lot more comfortable. You need to hold it at an angle, like shown here:

    http://silverlight.org/cray/wheelmouse.g if [silverlight.org]
    I drew this in MS Paint, gimme a break =P

    It may seem a little awkward to get used to at first -- and it probably is -- but once you get used to it, it's realy easy. Up and down motion can be achieved just by pushing and pulling with your fingertips, side-to-side with your thumb and ring finger, and scrolling can be done comfortably with your index finger.

    If anybody else tries this and likes it (or already does this) I'd be interested in hearing about it. My email's cray@[domainGivenInURLAbove].org

  • I guess the moral of the story is: Whatever works for you. :)

    I suppose when your body starts talking, you better listen before it starts shouting. :)

  • Ever had your palms, fingers, and wrists massaged? It actually feels quite good. Perhaps there's a FAQ out there on how to properly massage the hands and wrists.
  • Yup, the spine can cause similar symptoms. A herniated disc can pinch a nerve as it exits the spine. Also, the muscles of your neck and the first rib can pinch nerves as they traverse the neck on the way to the arm. This is called "Thoracic Outlet Syndrome", and it is actually pretty uncommon. It used to be "common" because doctors did not yet realize that the symptoms were related to a problem in the wrist, so they frequently misdiagnosed (and operated upon) the problem as thoracic outlet syndrome. Needless to say, the results were less than good. Carpal Tunnel Syndrome was not yet on the map at the time. With a modern understanding of these entities, and with tools such as EMG/NCV, these etiologies should rarely be confused.

    If you have Carpal Tunnel Syndrome, Chiropractic (spine popping) is very unlikely to help at all, since the problem lies in the wrist. If you have certain types of neck pain, then it can sometimes help, but you must also consider that, like any other medical procedure, it is not without risk. I have personally treated people who have suffered paralysis (fracture) and stroke (vertebral and carotid artery dissection) after chiropractic manipulation of the neck. Just make sure that you are formally diagnosed (including EMG/NCV) with a specific problem before you undergo any medical procedure that carries risk. Chiropractic has a place where appropriate, but I do not recommend using it for carpal tunnel syndrome since it will be all risk and no benefit.

    The stuff below is one of my posts from a previous slashdot thread:

    Is there a doctor out there (or anyone, for that matter) who can describe the symptoms of CTS?

    Yes, as a neurosurgeon, I see a fair number of patients who suffer from carpal tunnel syndrome, some of which eventually have surgery.

    The simplest way to conceptualize carpal tunnel syndrome is to think about it as a problem of proportions: The median nerve must pass through the carpal tunnel in order to reach the hand. If the carpal tunnel is too small (for any number of reasons) or the median nerve is swollen or enlarged (again, many possible causes), then you may develop the symptoms of carpal tunnel syndrome, since the median nerve is essentially being "pinched" as it passes through the carpal tunnel. Nerves really do not like to be pinched!

    There are many possible contributing factors which can lead to such a situation, some of which can be improved with medications of behavior modification, and other which cannot.

    Some Contributing Factors

    • You were born with a small carpal tunnel (congenital) and are predisposed to the syndrome. Sorry!
    • Pregnancy - hormonal changes in the mother lead to widespread changes in the tissues of the bodies, many of which are quite noticeable. CTS often results, but usually improves or resolves after delivery. Some women on oral contraceptives will develop CTS for similar reasons.
    • Hypothyroidism
    • Major Wrist Trauma - i.e. wrist fracture. The geometry of the carpal tunnel can be unfavorably altered by the fracture.
    • Repeated Minor Trauma - also known increasingly as Repetitive Strain Injury (RSI) for those of you who are buzz-word compliant. Repetitive minor trauma to the median nerve/carpal tunnel complex may lead to a swollen nerve and secondary inflammation that causes thickening of tissues. This is a fairly straightforward concept that is really just common sense. Joggers with bad technique will wear out their knees, pitchers with bad techniqe will wear out their shoulders or elbows, etc. Why does hacker X get CTS when he types just like hacker Y, who doesn't get it. Answer: Hacker X may have other factors at play (smaller carpal tunnel, more active inflammatory response to minor injury, etc.) other than the repetitive strain that predispose him to CTS. Hacker Y may type with bad techniqe all his like and never get CTS because he does not have enough other contributing factors to develop a pinched median nerve. Then again, some people smoke like a chimney and never get lung cancer.
    • Rhematoid (and other types of) Arthritis - excessive inflammation leads to thickened tissues and a tight carpal tunnel.
    • Acromegaly (Giantism)- excessive growth hormone leads to thicked tissues.
    • Certain types of tendonitis - inflammation
    • Sarcoidosis - another inflammatory condition
    • Diabetes - nerves are more sensitive than in non-diabetics
    • Renal Failure
    • Others..

    Symptoms

    • Pain
    • Numbness
    • Weakness
    • Clumsy HandSince it is the median nerve that is affected, the pain and numbness will follow the course of the median nerve. Although there is variability, this usually means the "thumb side" of the hand - the thumb, index, and middle finger - and to a variable degree the ring finger. The pain and numbness are usually exacerbated (made worse) by certain activities. Sometimes the pain and numbness are constant. Often, patients will wake up in the middle of the night with pain when their unsupervised wrist gets into a bad position. Weakness in the grip or thumb may occur, especially the abductor pollicus brevis (a thumb muscle). When weakness and numbness are combined, your hand's feedback and execution are off, and you may experience clumsiness. You might find yourself dropping things that you thought you had a good grip on. In advanced cases, the muscles of the hand become atrophied, which can be disabling. Atrophy of the thenar eminence (the "mound" of muscle between the base of your thumb and your wrist) is characteristic of advanced disease. You do not want to let it get to that point, since a full recorvery is unlikely despite any treatment when atrophy exists.

      Diagnosis

      • Examine for weakness, numbness, atrophy
      • Tinel's sign - tap the middle of your wrist a few times. Did you reproduce your pain or get a painful shock in your fingers?
      • Phalen's sign - push the back of your hands together so that your wrists are forcibly flexed. Hold that position for a minute or two. If your pain is reproduced, the sign is positive.
      • EMG/NCV - electrical tests of nerve and muslce. Prolonged motor or sensory latencies are suggestive (delayed transmission due to abnormally slow conduction though the pinched portion of the nerve). In advanced cases, you may see "dennervation potentials".

      Treatments

      • Behavior modification - this is where the RSI stuff fits in. Sometimes this is sufficient to turn the tide, other times not.
      • Anti-inflammatory medications - most causes of CTS lead to at least some degree of inflammation, which can lead to thickened tissues when it goes on in a chronic fashion.
      • Wrist Splints - helps prevent motion of the wrist. Especially helpful for keeping wrists straight at night when you are not awake to supervise them.
      • Surgery

      What does surgery do?

      Surgery entails an incision over your wrist and a portion of the palm of your hand. The transverse ligament, which is the "roof" of the carpal tunnel, is then cut so that the median nerve is no longer trapped inside a tunnel. The tunnel becomes a ditch. The nerve breathes a sigh of relief. The degree of tightness is often quite impressive, and often the nerve is visibly swollen or even discolored. In those unfortunate enough to have waited too long, the nerve is visibly atrophied.

      If pain and intermittant numbness were the only symptoms, then there is a very good chance for an excellent recovery after surgery. If, on the other hand, there is 'round-the-clock numbness or weakness prior to treatment, then this suggests that the nerve may be permanantly damaged, and a complete recover is less likely. In these cases, the pain will usually resolve fairly quickly postoperatively, but the numbness and weakness may take months to recover, and may not recover completely. Recovery in these cases is slow because the median nerve has actually lost some of its fibers (axons), and they must regrow. The axons begin in the spinal cord or a ganglion in the neck and extend all the way down the arm into your fingers. When there has been prolonged CTS and associated inflammation of the median nerve where it was pinched, there may exist scar tissue within the nerve which prevents the axons from crossing that segment as they try to regrow though the wrist to the hand. So the moral of the story is: try conservative measures if you are having pain or intermittant numbness. If the conservative measures do not work, and the CTS is interfering with your life, or if you develop 'round-the-clock numbess or signs of weakness then you should consider surgery. Most cases will not require surgery, but it is a sad thing to see when CTS is allowed to progress to the point at which damage to the nerve is permanant.

      There seems to be a lot of talk on the internet lately about carpal tunnel syndrome as a mysterious entity that only a select group of doctors that treat famous musicians understand. Simply untrue. Family physicians see CTS all the time. Any neurosurgeon and most orthopedic surgeons (and some plastic surgeons) will be intimately familiar with CTS, as it is really quite common and is treated by a relatively minor procedure when conservative measures fail. The risks of surgery are small, but they include

      • damage to the median nerve leading to further numbness or weakness
      • infection
      • failure to completely free the nerve from compression (i.e. compression of the nerve beyond the extent of the incision).
      In my own personal biased opinion, I favor the "open" approach with an incision over part of the palm of the hand and wrist over the "endoscopic" approach which allows a smaller incision. I believe that the traditional larger incision provides superior visualization of the nerve, and thus more control over what is and isn't being cut.

      The other popular take on CTS these days on the net is that RSI is somehow being misdiagnosed as CTS. This is actually becoming a very popular misconception. The critical thing to keep in mind is that RSI (repetitive strain injury) is one of many mechanisms that can contribute to carpal tunnel syndrome. We don't tell patients that they have Repetitive Smoking Injury (another RSI!) when they have a stroke, heart attack, or lung cancer, even though smoking can certainly be a cause of those problems. It would be silly to say "You don't have lung cancer, you've got repetitive smoking injury". Similarly for RSI and CTS. If you have the signs and symptoms of carpal tunnel syndrome, then you have carpal tunnel syndrome. Repetitive strain injury may have been an important contributing factor and you may be able to help your symptoms by taking altering your behavior. The increased public awareness of repetitive strain injury (RSI) is, IMHO, a good thing because it can lead to changes in behavior that help to avoid CTS and other problems - just like increased public awareness of the dangers of smoking can lead some people to quit. But let's try not to confuse our terms! RSI is a general mechanism of injury to tissues that contributes to problems thoughout the body. CTS is a specific problem with your wrist in which RSI may or may not be a contributing factor. I hope this has helped to explain RSI and CTS!

  • IMHO, the best way to avoid RSI injuries is to build up strong fingers and wrists.

    I wrote an article on how to accomplish this for another story here [slashdot.org].

    BTW, for spine health I recommend bridging and proper posture (shoulders back, head back, chin tucked, back straight; many bad slouch-encouraging chairs become excellent chairs with the addition of a small cushion behind your hips and lower back, and of course your monitor should be at eye level). Also, deadlifts rule as a whole-body exercise for rapid and dramatic results.

    The easiest beginners bridge is to lie on your back with your feet flat on the floor (obviously you have to bend your knees for that), and just raise your butt up off the floor. This works the buttocks, thighs, and lower back, but not very much. A more advanced and productive bridge is to start in the same position, and bridge up on alternate shoulders, striving to roll yourself over that shoulder (if you actually do roll yourself right over, stop that! ^_^' I mean hug something heavy across your abdomen, like a big sack of potatos or a duffle bag full of books).

    Another extremely useful "bridge" is the dand, a staple exercise of Indian wrestlers. I recommend that it be done rather than any sit-up or crunch. You get down on all fours with legs and arms straight and your butt up in the air, then alternately push forward, arching your back and neck while lowering your butt, and pull backward, curling your abs and chin in while raising your butt. A useful advanced variant is the judo pushup (mostly for more emphasis on the shoulders and arms) which resembles a dand except that in the "arching" phase you bend your arms and knees to put your nose to the ground, rub it along the floor (well, actually you'd be 1/2 inch above it or so) for as far as you can reach, then straightening your arms and arching your spine before doing the normal dand curling-up phase. Just do as many dands as you can every second day and you'll have a spine like a teenage gymnast when you're in your eighties.

    Neck bridges are incredibly useful, not just for your neck but for the length of your spine, but you must be very careful, especially when you are starting out. Remember to warm up carefully: bridge to the front first, putting your forehead on the mat and supporting most of your weight on your hands (and keep your knees off the floor). Gently and slowly rock back and forth, going a little further each time until you finish by stretching your neck with your nose to the mat, then your chin to your chest. Very gently stretch to the sides, too; this is the most dangerous part, take extra care to control the weight with your arms. Now get up and bridge to your back; use your arms to lift yourself into and out of position and also to control the weight on your neck (after a few weeks or months you may become strong enough not to use your arms at all, like a wrestler, but be very cautious at all times). Arch straight back as hard as you can (but with careful control), straightening your legs and turning your body into a wheel that can't quite roll over, then relax and bend your knees to return to the starting position. Once you are strong in this movement you will go so far that your nose touches the mat. Repeat this arch ten or twenty times, then arch once more and see how long you can hold it. After than, do another front bridge and rock back and forth again to finish off your neck, gradually using your arms for support more and more as your neck tires, finally finishing with one last four-way stretch like you started with.

    Finish the exercise for your neck with some standing exercise: apply manual resistance as you tilt your head towards the shoulder, first one side then the other, then with no resistance turn your head alternately to the right and left as far as it will go. Having pre-exhausted the major muscles of the neck in its strongest movement, these exercises strengthen the neck in its other movements.

    You can also do gymnastic bridges (back bridge on hands and feet with legs straight as possible), but these are more of an extreme stretch than anything, and I don't recommend them.

    BTW, if you do many exercises for the front of your shoulders and chest, your shoulders will start to pull forward and ruin your posture because of muscle imbalances. Remember to stretch your shoulders and chest. You must also balance the muscle development out with upper back strength: lying on your back, grab hold of something above you (some chairs work, or a rope around a table, or a friend can stand over you and you can hold his arms) and pull yourself up, with your grip at shoulder width and your palms facing up.

    ABTW, use a nice soft surface for head bridging (duh).

    One more thing, make sure your spine is straight when you sleep. IMHO the best sleeping posture is flat on your back on a firm bed with your feet raised (supported behind the calves) and a very small pillow moulded around your neck (and, for some people, a very small thin cushion, such as a folded towel, under your lower back). Sleeping on your side is good in a fairly soft bed with two pillows and a third pillow between your knees (especially for women, the wider your hips, the more important that pillow is), but this can easily lead to shoulder problems, especially for men with broad shoulders.
  • I feel like a total tool for the man now that I look back at how often I've pimped this keyboard on all the keyboard related articles... but I love the thing. It's one of the few computer hardware products that I truly love and endorse.

    I've never had RSI, never had much more than stiff hands and wrists, usually after doing something stupid like waterskiing all day or landing on my wrists during a bike wreck or something. When it get's cold my wrists fatigue and get a bit stiffer, nothing much though and it goes away with warmth. (for some reason it's like 58 degrees in my office somedays) Never had pain. I'm a touch typist. Raised with a chiropractor and I pay close attention to my body and how I feel; my doc is amazing too, she notices all sorts of little things. I have had parents that have preached the virtues of good ergonomics, I've used wrist rests and generally had decent work areas for my computers. That's my history.

    When I got our of college and got my first good salery job I decided it was time to invest in my health a little since this is my business. I wanted to go top-of-the-line for ergonomics, no reason to screw around anymore and no excuses. I could afford it and the stuff was either good for you or I was going to end up with some nice stuff that wasn't bad for me. I bought a desk, a chair and while I was at the place (KARE products [kareproducts.com] in Boulder Colorado) I noticed the keyboard and became slightly captivated. I thought about it, it's a pretty pricey keyboard and I finally decided I'd give it a whirl, I was still high on the getting-paid-well-for-the-first-time euphoria.

    I believe the model I purchased, the Contour Classic with dual legends and the foot peddle (essentially it's the second best model, they have a better model with more memory for programming it) cost about $600 retail. I got it quite a bit cheaper since I was blowing a good chunk of money with those guys already. It was still more money than I had ever spent on an input device before. I know you can order them for as cheaply as $200-$220 for the basic non-programmable qwerty model. Still a bit pricey for you average geek, but completely reasonable for such a high quality keyboard.

    After having it for about a year, I can say with all honesty that I'd pay $600 for the keyboard again in a second. I never had wrist problems and my hands feel noticably better after long typing sessions. They just feel more relaxed and comfortable. You can notice the difference, it feels better. I was amazed because I always type with my wrists straight and have pretty good form. I can only imagine what it must feel like if you type in pain. This is a very good keyboard, it's a bit pricey but I recommend it if you can afford it. Even if you can't afford it, it's worth thinking about, maybe buy a cheaper video card and a smaller drive this time around so you can get the keyboard, it will last you through multiple computers.

    It was a little odd for about a week but I type faster now than I did before, my hands feel better, you can program it if you want (I've done a few emacs helpers.) It's a high quality keyboard, it's very configurable (you can make it click or not, it beeps when you press capslock or you can turn it off, you can program any key to do whatever you want), it has columnar keys instead of offset ones so it's easy to learn to type on them, the keys are shaped nicely and the action is good. Initially I thought the action was a little weak compared to the IBM keyboards I used to use but I like the action a lot now, it's a touch slower and softer than IBM action. With the IBM action (not the chicklet keyboards, the ka-chunk keyboards) you kind of push on a key and after a thrushhold it sort of drops on you, I find myself hammering a lot on IBM keyboards, for the longest time this was the desired feel for keyboards because it is like using a typewriter and I grew up with it. The contour action is steady through out the full keystroke, it initially feels slower since there is resistence the full stroke but I have noticed that I hammer less and type softer now, with the softer typing I find that my hands are more nimble and I can type quicker and go for much longer periods and it is just more comfortable.

    I got the Dvorak supporting model and run it in QWERTY still. I was going to switch but haven't since they haven't upgraded me at work yet and I didn't want to do one at home and one at work. With the columnar keys and thumb keys I think my typing distribution is pretty good, I don't focus on a few fingers for most of my typing. The tilde, bracket and brace positioning are partially responsible for that too, I think my coding speed suffered for a while while I got used to that but not much. Each finger seems to carry a pretty good amount of the load and I never have to reach too far with any finger. I don't know what I'd get out of Dvorak, I still may switch but I'm not as compelled.

    The function keys would be my least favorite part of the keyboard. They are a row of smaller keys across the top. They have a different feel than all the other keys, that spongy kind of calculator key feel. It bothered me a lot at first but not so much now, mostly because I don't use them for much. They are a little offset from the numeric keys and I thought it made more sense to have them lined up. Not that big of a deal though, if you're a Linux user then you probably don't rely on the function keys that much and you program them for macros when you do use them. The palm pads are also not as easy to come buy as I would like, but they aren't hard to get. I don't play many games, the cursor keys are split with up and down being on the right hand and left and right being on the left hand. They aren't in the "T" formation. I used to use an old apple with that kind of layout and so it doesn't bother me but it might take some getting used to if your a cursor key freak or if you paly a lot of games. I kind of like the emacs control-P, control-n, control-f, control-b for a lot of my cursor navigation but I use the cursor keys for about 40% of it too and I don't miss the "T"

    It's all white with a blue home row, it looks pretty sharp, it doesn't contrast too much with anything. It's a nice conversation piece at times. The typing is amazing though. It's a really comfortable keyboard. It works with PS/2, AT, and Mac connections, you can get a USB adaptor. Foot peddle is optional and YMMV, I wouldn't get it if I could do it all again but I know a few people who love it.

    I'm not sure what else I can think of to say about a keyboard. I really like it a lot. I really think it is worth trying out if you do a lot of coding or typing. It is your health that you're dealing with. It costs more but maybe you're boss will pick it up. There aren't too many hardware products that I will really stand behind but this is one of them, it's wonderful.

  • > Perhaps there's a FAQ out there on how to
    > properly massage the hands and wrists.

    I haven't found one, perhaps because it's very tough to write about this rather than demonstrate it, but here's what I've learned from watching and talking with my massage therapist. =)

    First, a lot of hand/wrist pain can be, and often is, caused by tension in the upper and arms. I begin with the biceps and work my way all the way down to the fingertips, and that seems to work well.

    The best to use is a light touch, just enough to work the muscles, without causing undue pain; the most common technique is a small circular motion, which should be (if you're doing it on yourself) clockwise on the right arm, and counterclockwise on the left arm, so that the force of the pressure is directed towards one's heart.

    With the lower arm, one should go along the muscles on both the top and the underside of the arm, beginning at the wrist and working one's way down to the elbow, with the fingers that are doing the massaging creating a sort of spiral motion. You should be able to feel the tendons and the muscles, and feel where the worst tension is -- avoid the temptation to just stay there massaging the part that feels most tense! It might make it feel better in the short term, but it will hurt the next day. Besides, if one place is tense, that's usually a result of tension elsewhere.

    The hands are probably where it's going to feel the best, and the best thing to do there is to start at the base of the fingers and (again using that tiny circular motion) work down to the base of the thumb/edge of the palm. For hand pain caused by typing, the places that will feel best are along the edge of the palm, from the webbing where the thumb meets the hand all the way around to the opposite edge of the wrist.

    I'd suggest teaming up with another geek in the office who has hand pain; that's what I did for a while, and man, did it feel good. ^_^
  • My cousin had severe wrist/hand pain and was diagnosed & treated for RSI. This did not work and eventually she was referred to a consultant who told her that it was her back/neck that was causing the pain in her wrists. Since being treated for this, her pain has got better. So not all wrist pain is RSI.

    Someone mentioned stretching exercises. I would also highly recommend these as they do seem to help enormously with this kind of pain. Stress also seems to increase pain, so do some stress-reducing activities too.

    HH
  • I had arm problems four years ago. I got them about once a year and they lasted for a month. I never knew what caused them and what helped. I just knew that I'll heal. Until the last time of course when I got it twice a year and it lasted 3-4 months. Even when I rested, it just didn't heal and I grew desperate after doctors couldn't do anything.

    In the end a doctor told me: "What I find in you is not really anything. But if resting doesn't help, then how about using your arms?" He told me to start working again, do some heavy with my arms and exercise. Needless to say that I was shocked.

    But I tried it. I started throwing the shot put and my arms did heal in a few days. Since then I've been doing weight training regularly and haven't had any problems whatsoever.

    Here's what's bad to your arms. If you have a wrist support in front of your keyboard, don't rest your hands on it when you type. That way your arms are not moving enough. I nowadays put the rest under the fron of the keyboard so that it's impossible for me to rest my arms on anything while typing. Also don't be too careful to type. Our arms are made for heavy work, so they don't take small repetitive movement as well.

    But I can't stress enough how important it is to exercise. If you just sit by the keyboard all day and don't do any sports, your muscles are going to get smaller until you get problems. If you exercise and have stronger muscles, your arms are going to take anything. You can see it in the construction workers. Their work contains a lot of repetitive movements but they don't have arm problems like we do.

    Now, if you do have bad pain already, don't run to abuse your arms by typing along. If you can take heavy housework, do it. But talk to your doctor about this first as your case may be worse than mine was. And all you healthy ones, go lift some heavy weights to keep yourself healthy.

  • Well resting your palms when you type is a definite no-no. Your arms are not getting enough movement and the blood circulation is bad. Also you risk getting CTS because of all the static movement that your finger movement causes on the carpal tunnel.

    Resting your elbows is ok, though. But don't restrict the natural movement of your hands.

  • My wrists have been popping a LOT recently. Would this be an early warning sign of RSI or something? It generally doesn't hurt but it can't be good. What are some other early warning signs?



    Hmmm, if that's bad I may be in serious trouble. My fingers, wrists, elbows, shoulders, knees, back, neck,hips, and even my breastbone pop frequently. Oh, and I have chronic back pain, and my wrists are significantly weaker than they were 1 year ago... And it SUCKS because I'm only 19, I love martial arts and rock climbing, and weak wrists make both of those activities harder. Also, a 2 minute stream of constant typing will tire out my wrists. Anyone know if I need to see a doctor?

    Kintanon
  • It may seem a little awkward to get used to at first -- and it probably is -- but once you get used to it, it's realy easy. Up and down motion can be achieved just by pushing and pulling with your fingertips, side-to-side with your thumb an ring finger, and scrolling can be done comfortably with your index finger.

    As a lefty, this is exactly how I hold my mouse, since the buttons are on the wrong side. I've found that reversing the buttons and holding the mouse as a right-handed person would causes fatigue much faster.

    Now if only I could find a keyboard with the numeric pad on the left side...

    -ai
    "..and the stains on my boots show my life is going well."

  • Which means giving your wrists a rest. That depends on, ummm, what you're doing and how you're doing it. I tend to support my weight on my wrists a lot, which leads to even worse problems. Not that I'm complaining...

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