Handling repetitive strain injury

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By the end of my time in grad school, my wrists were in agony, and my left pinky finger was simultaneously strained, pained and numb.

Even an hour of typing per day would lead to aches and pains (up through my forearm) that lasted through the night.

So, I finally did the research on repetitive strain injury and carpal tunnel syndrome. I no longer experience any kind of RSI pain, and I can type for hours each day. I've compiled what worked for me (mostly a change in keyboarding and posture) in the hopes that it might work for others.

Fortunately, there's a lot you can do to prevent, manage and heal RSI-related pain without surgery or drugs.

Read on for my tips.

Contents

Reading

The standard medical reference for this area is Dr. Pascarelli's Complete Guide to Repetitive Strain Injury. This book is considered the book on RSI, and there's a good chance that if your company/school has an RSI lending library, they also have this book.

If you're going to try self-treating your RSI first, this book is an excellent guide. Of course, if your problems don't go away entirely after self-treatment, then you should see a medical professional.

Keyboarding solutions

  • If you're suffering from pain, numbness or tingling in your left pinky finger, then have CAPS LOCK act as CTRL. (To do this on a Mac, go to System Preferences > Keyboard > Modifier Keys.) This is particularly useful if you're an emacs user or an avid gamer. My left pinky finger used to go numb after a few hours of typing, but this remapping solved that problem, and it took only a day to get used to it. (If you have numbness in your pinky, I'd also recommend the Kinesis keyboard, since it eliminates awkward pinky positions that diminish circulation.)
  • A lot of people don't realize that the standard QWERTY keyboard layout is worse than a random layout: it's intentionally anti-ergonomic. Old typewriters used to break when heads clung together after two keys were hit too rapidly in succession. So, typewriter vendors created a layout which made common two-letter combinations difficult to type quickly: QWERTY. There are a few things you can do about this.

    Switching to the Dvorak keyboard layout improved my pain and numbness more than anything except switching to a high-end ergonomic keyboard. I think that if I had switched years ago, I may never have had a problem. The Dvorak keyboard layout is the polar opposite of QWERTY: it is designed to facilitate common typing patterns with natural hand motions. When typing in Dvorak, my hands feel like they're in a natural rhythm: words tend to begin toward the outside of the keyboard and roll inward, alternating evenly on both hands, much like the way one would rap their fingers on a desk. Dvorak feels more natural than QWERTY, and physiometric motion studies have proven that it cuts down on the total distance covered by fingers considerably.

    The down side to switching to Dvorak is that you'll have to relearn to type. In my experience, this took less time than the first time I learned to type: about two weeks to reach 60 wpm, and about two months to reach 80wpm. I don't know if I'll ever get back to 100wpm+ like I did on QWERTY, but truthfully, even 60 wpm is fast enough for my purposes. At 20wpm, which I reached after four days, I could code well enough to program at a comfortable pace. Within a week, instant messaging became possible again. I'd strongly recommend making the switch before a holiday weekend when you don't have any major work to do, since you will feel like a stroke patient for about four days. It is extremely frustrating. I almost gave up twice.

    When learning to type on Dvorak, I hit diminishing returns after an hour of practice each day. If you're trying to ramp up how fast you can learn, I found that napping after I'd hit diminishing returns allowed me to go for another hour before hitting diminishing returns again. Sleep seems to be important when learning a new skill like this.

    The best typing tutor I found was also simple, online and free. Each morning, I did three or four lessons.

    For programmers, there is also the Programmer Dvorak Layout, but I haven't tried it yet.

  • After switching to Dvorak, my wrist pain began to recede, but I wanted to knock it out once and for all, so I bought the Kinesis Advantage:

    The second you place your hands inside the buckets, you can tell it's a well-designed keyboard. It's built so that your fingers curl along their natural arc to hit keys; there is no twisting or stretching involved, and your fingers barely move. I'd used Microsoft Natural keyboards previously, and they're amateurish in comparison. They certainly didn't prevent RSI.

    I spent a lot of time researching every "ergonomic" keyboard available. The Kinesis Advantage has legions of devoted users, and I'm now one of them. The re-learning curve is about two days, and after that, wrist and finger pain are gone.

    As a warning, this keyboard is expensive. Even so, it's probably the best investment I've ever made. I doubt I'll ever need (far more expensive) drugs or surgery now. If the opportunity cost of learning Dvorak is too high for you, the Kinesis Advantage is a way to solve the problem quickly by throwing money at it.

    The Kinesis web site contains more info, but for some reason, the keyboards are often cheaper on amazon.com.

    I wouldn't bother getting the Advantage Pro (which merely has a higher memory capacity for macros) or the foot switch. I got the foot switch, but I haven't been able to take advantage of it. And, I'm not even remotely close to maxing out my macro capacity.

Posture

Fixing my body's posture helped aches and pains that I didn't even know I had, and it was the most effective way of dealing with aches in my forearm.
  • Adjust your seat height so that your feet touch the ground with your knees at a right angle.
  • Put your keyboard on your lap so that elbows rest naturally at right angles.
  • Make sure your back rest is adjusted so that your legs are at a right angle to your body.
  • Don't let your shoulders hunch; relax them.
  • At first, it's easier to use a posture corrective brace to remind yourself:


    (Yes, it works for men too.)
  • Keep your wrists straight during typing.
  • Wrist braces serve two purposes: to keep your wrists positioned properly while typing, and to hold them in the optimal healing posture (with respect to circulation) while sleeping or resting. Wrist braces are critical for healing the damage already done. When I wore wrist braces at night, I'd wake up without the ache in my wrists and forearms.
    The Thermoskin braces worked well for me.
  • A good lap desk helps to keep your keyboard and mouse at lap height. Any office supply store should carry these.
  • If you have back pains or butt aches even with good posture, it's probably your chair. When Herman Miller designed the Aeron chair, it went through the most exhaustive battery of ergonomic field tests and redesigns of any chair in history.

    The end result is nothing short of perfection. I can sit in an Aeron chair for hours on end with no discomfort of any kind, and this is after seven years of continuous use.

Exercise

Set a timer, and get up to stretch and walk around for a couple minutes every half hour to hour.

External resources


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