Avoid repetitive stress injuries such as carpal tunnel syndrome and tendinitis

Disclaimer

I am not a doctor, and these are not medical cures. I have intentionally not researched this article using outside sources because it is not intended to be a reference about the conditions or current medical methods of treating them. It is one personal perspective reporting the results of my own experiences and experimentation.

Introduction

For the past 27 years I've dealt at times with symptoms of carpal tunnel syndrome and tendinitis in the hands, wrists, elbows, and shoulders, ranging from mild to moderate, not requiring drugs or surgery.

The following best practices have proven useful for keeping it under control:

1. Warm up with full-body (not hand and arm) exercise before working.
2. Reduce the total workload on your hands and arms.
3. Work smarter, not harder, for the typing you can't avoid.

Get some exercise before you start to work.

A key element to keeping your hands and arms healthy is blood flow.

If you're a very fast typist and type for several hours a day, you are a hand athlete. You are expecting from the muscles of your hands and forearms an athletic level of performance, for which those muscles need adequate blood flow.

However, those muscles, no matter how strenuously they are exercised, are not large enough to increase your heart rate or produce the dilation of your blood vessels that the exercise of your large muscles produces. In effect, you are expecting an athletic performance from your hands at a time when the rest of your body considers itself to be at rest, and it fails to provide the blood flow that your hands need.

The solution is to get, before you begin working, enough exercise to raise your heart rate, dilate your blood vessels, and warm up your hands. It doesn't have to be a huge amount of exercise.

There are stairs where I live, so I walk up and down stairs. 20 flights of stairs in 20 minutes is enough to raise my heart rate and make me sweat a little and feel like I'm getting some exercise.

I have a walking cane that belonged to a relative, and I use that, too, periodically switching it from hand to hand. The alternating grasping of the handle and the fact that I put a lot of my weight on it involves my arms in the "workout", warms them up, and has increased their strength.

Sound complicated? It's not: Before work, grab my cane and walk up and down the stairs 20 times.

This has had a very beneficial effect, the most important thing other than reducing the total workload, which isn't always practical.

Don't work when you're hungry or your hands are cold.

Have you ever had this feeling? It's lunchtime, you're in the middle of something, maybe you're on a diet, your hands are starting to get cold and clammy, but you figure you'll just keep going anyway.

Don't do it. This is even worse than working without warming up. Stop, eat, and don't start working until your hands are warmed up again.

Use speech recognition whenever you can.

Windows XP has built-in speech recognition software that works pretty well once you've trained it. It's not much good for writing program code, but use it for documents, email, forum posts, and wherever else you can.

Vary your work tasks.

1. When I was first learning programming, I had few problems with my hands and arms even during 12 or 15 hour days because every line of code required some research in a book before I wrote it. That provided needed breaks.
    
2. When you're doing a repetitive task that takes a lot of keystrokes (like a long series of search-and-replace edits) and you reach a point where you're intensely focused on the task and think, "This is great! I'm doing this practically like a machine!", that is unfortunately the point where you should stop and do something else. Prolonged periods of the exact same motions must be avoided, and the more exactly the same the motions are, the worse they are.

Change the position of your mouse, keyboard, and you.

When you start to feel discomfort from holding the mouse with one hand, move it to the other side of your keyboard and use the other hand.

Windows lets you reassign your mouse buttons so the left and right buttons are reversed, but you might find that's not even necessary. It's fairly easy to learn how to use the mouse one way with one hand and backwards with the other hand.

You can also position the mouse in front of your keyboard, or on a small separate table next to you on your left or right, or on a small shelf placed on your lap. At one point, I made a raised shelf for my keyboard so the mouse could sit directly underneath it, centered in the middle where I could operate it with either hand. That worked really, really well, but holding my hands up to the keyboard on its shelf eventually took its toll, and for a few months I ended up with "frozen shoulders"! It's always something!

The goal isn't to move things around until you find a comfortable positioning that you can stick with. It's to keep moving things around from day to day so you don't spend long periods using the same positioning.

Copy and paste code.

Never type anything fresh if you can copy and paste it from somewhere else using fewer keystrokes.

Use macros.

Wherever you can, reduce keystrokes by using macros, text and code snippets, automatic code completion, and Microsoft Word AutoText.

If you're old enough, you might remember Speedwriting advertisements that used to say, "If u cn rd ths, u 2 cn b a secty". I created a large dictionary of abbreviations like this and added them to Microsoft Word AutoCorrect. When I type the abbreviations, Word inserts the full text, sort of like shorthand for a typist. Before I had speech recognition, this was a very good way to reduce keystrokes when typing long documents.

Vary your typing speed.

If you are a fast typist, it's fun to push yourself, but it's rarely necessary.

On a standard QWERTY keyboard, some letter sequences are easy and others are awkward. Don't try for a consistent pace. Type the easy ones fast and the awkward ones slowly. If you allow yourself to find it, there's a natural rhythm for the various different key sequences.

Things that haven't helped

Take a break

Breaking up my work into short intervals as described above (read a little, type a little, read a little, type a little) was helpful, but taking a 5/10/15 minute break after every hour of work wasn't. The steady 1 hour of typing couldn't be offset by a few minutes of rest.

Stretching

Stretching before work never did much good even when I did it a lot. It only stretches the muscles. It doesn't warm them up and isn't a substitute for the exercise described above.

However, when my hands and forearms are overworked, the muscles tighten up, my fingers curl into a fist and my hands curl toward my arm, with pain in the wrists. I do stretch after work to try to prevent that. The thing that helps most, is to, for example, fall asleep on my left side with my right palm flat on the bed, to keep the fingers and wrist extended and prevent them curling up. Yes, it sounds silly, but it helps. It at least keeps them stretched until I start moving around in my sleep.

Vitamins

Many years ago, a doctor prescribed a B vitamin, probably more for the nerve involvement I was experiencing than for the muscles. I don't remember it helping at all.

Aspirin

Sure, aspirin or other painkillers or anti-inflammatory drugs can work wonders for injuries you've already done to yourself, as long as you stop doing the thing that is injuring you.

It does not seem wise to take painkillers just so you can be more comfortable while you keep on injuring yourself. That can only be asking for trouble. The exception would be if your livelihood depends on the activity, and you have absolutely no other choice. In that situation you should be talking to a doctor and not reading a blog article.

These tips can help even if you don't currently have a repetitive stress injury.

My worst experience with RSI was the first one, in 1980. Since then it has seemed as though having had it once made it more likely to recur later with less provocation.

If you spend many hours at a keyboard, you should be aware of the risk it poses and take reasonable precautions to prevent RSI. If you can prevent getting it the first time, you won't ever have to deal with it, but if you get it once, you may then have to deal with it over and over again.

Summary

1. Before starting work, get a little bit of exercise, enough to warm up your body, dilate your blood vessels, and increase the blood flow to your hands.
    
2. Don't type when your hands are cold.
    
3. Use every trick you know to reduce keystrokes.
    
4. Don't stay in the same position for long periods of time.

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