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Path: senator-bedfellow.mit.edu!bloom-beacon.mit.edu!spool.mu.edu!howland.reston.ans.net!newsserver.jvnc.net!newsserver2.jvnc.net!nntpserver.pppl.gov!cnn.Princeton.EDU!kastle!dwallach From: Dan Wallach <dwallach@CS.Princeton.EDU> Newsgroups: sci.med,sci.med.occupational,comp.human-factors,comp.answers,sci.answers,news.answers Subject: Typing Injury FAQ (2/6): General Info Supersedes: <typing-injury-faq/general_800694158@cs.princeton.edu> Followup-To: sci.med.occupational Date: 17 Oct 1995 07:52:18 GMT Organization: Princeton University Lines: 1229 Approved: news-answers-request@MIT.Edu Expires: 25 Nov 1995 07:52:11 GMT Message-ID: <typing-injury-faq/general_813916331@cs.princeton.edu> References: <typing-injury-faq/changes_813916331@cs.princeton.edu> Reply-To: Dan Wallach <dwallach@CS.Princeton.EDU> NNTP-Posting-Host: kastle.cs.princeton.edu Content-Type: text/plain; version=1.0; title="Typing Injury FAQ: (2/6) General info" Summary: information about where to get more information Originator: dwallach@kastle Xref: senator-bedfellow.mit.edu sci.med:148777 sci.med.occupational:4401 comp.human-factors:15143 comp.answers:14903 sci.answers:3278 news.answers:55418 Archive-name: typing-injury-faq/general Version: $Revision: 5.23 $ $Date: 1995/10/17 07:41:35 $ URL: http://www.cs.princeton.edu/~dwallach/tifaq/general.html Prologue This FAQ may be cited as: Wallach, Dan S. (1995) "Typing Injury FAQ: General Information". http://www.cs.princeton.edu/~dwallach/tifaq/general.html World-Wide-Web users will find this available as hypertext: * http://www.cs.princeton.edu/~dwallach/tifaq/general.html * (Dan Wallach's page) http://www.cs.princeton.edu/~dwallach/ Answers To Frequently Asked Questions about Typing Injuries The Typing Injury FAQ - sources of information for people with typing injuries, repetitive stress injuries, carpal tunnel syndrome, etc. Copyright ⌐ 1992-1995 Dan Wallach <dwallach@CS.Princeton.EDU> [Current distribution: sci.med.occupational, sci.med, comp.human-factors, {news,sci,comp}.answers, and e-mail to c+health@iubvm.ucs.indiana.edu, sorehand@vm.ucsf.edu, and cstg-L@vtvm1.cc.vt.edu] Table of Contents: 1. Publications, mailing lists, newsgroups, WWW pointers, etc. 2. The ftp.csua.berkeley.edu archive 3. General info on injuries 4. Typing posture, ergonomics, prevention, treatment 5. FAQ's About Computer Ergonomics and Workstation Injuries 6. Requests for more info 7. References ------------------------------------------------------------------------------- Publications, mailing lists, newsgroups, WWW pointers, etc. (thanks to Rik Ahlberg <rik@world.std.com> for parts of this info) 1. Publications CTDNews is a monthly newsletter that covers cumulative trauma disorder. It's a bit pricey ($146/year) but fairly concise. They'll send you your first issue free, so you can look it over. Address CTDNews PO Box 239 Haverford, PA 10941 Phone 215-896-4902, or 800-554-4CTD to order Fax 215-896-1488 WWW http://wanda.pond.com/mall/ctdnews/rsi 2. FTP & Gopher & WWW sites world.std.com The home of the Boston RSI Archive ftp://ftp.std.com/pub/boston-rsi gopher://gopher.std.com/11/FTP/world/pub/boston-rsi Boston RSI changed its name to RSI-East, and the new archives are at sjuvm.stjohns.edu (detailed below) The RSI Network Newsletter is a bi-monthly online newsletter produced by Caroline Rose <crose@applelink.apple.com> and distributed online by Craig O'Donnell <dadadata@world.std.com> ftp://ftp.std.com/pub/rsi gopher://gopher.std.com/11/FTP/world/pub/rsi ftp.csua.berkeley.edu Extensive anonymous ftp archive, including the typing injury FAQ (frequently asked questions), alternative input device information (descriptions, reviews, and GIF images), and some software. Maintained by Dan Wallach <dwallach@CS.Princeton.EDU>. ftp://ftp.csua.berkeley.edu/pub/typing-injury (more info below...) sjuvm.stjohns.edu A gopher site containing the Electronic Rehabilitation Resource Center. Lots of disability information, including a searchable database of national disability resources and access to other gopher sites with geographically local disability information. Also home to RSI-East, its message archive, and an archive of the RSI Network Newsletter. gopher://sjuvm.stjohns.edu/11/disabled ftp.demon.co.uk An ftp site containing the archives of RSI-UK. ftp://ftp.demon.co.uk/pub/rsi Also, Demon now mirrors the typing-injury archive: ftp://ftp.demon.co.uk/pub/mirrors/csua/typing-injury engr-www.unl.edu A World-Wide-Web page with some good pictures of how to hold your hands, MPEG videos of various exercises, and more. http://engr-www.unl.edu/ee/eeshop/rsi.html Other WWW sites: The Ergonomic Page, from Applied Software Unlimited [- NEW!] http://www.best.com:80/~ergoware/ Emacs keybindings and ergonomics [- NEW!] http://www.santafe.edu/~nelson/ergo/ Amara's RSI Page [- NEW!] http://www.amara.com/aboutme/rsi.html MouseMitt International - padded lycra wrist braces [- NEW!] http://www.mousemitt.com/ Workstation Environments - a company which designs high-end furniture [- NEW!] http://www.workenv.com/ Safety Related Internet Resources [- NEW!] http://www.sas.ab.ca/biz/christie/safelist.html Some human factors and ergonomics research by Alan Hedge http://www.tc.cornell.edu/~hedge TechTime articles on RSI Injuries http://hoohana.aloha.net/~billpeay/TECHT08.html A Patient's Guide to Carpal Tunnel Syndrome http://www.cyberport.net/mmg/cts/ctsintro.html Medical Matrix - A Guide to Internet Medical Resources http://kuhttp.cc.ukans.edu/cwis/units/medcntr/Lee/HOMEPAGE.HTML ErgoWeb - lots of information for designers of ergonomic tools http://ergoweb.mech.utah.edu/ Oversensitivity to Electricity http://www.isy.liu.se/~tegen/febost.html Disability Resources from Evan Kemp Associates http://disability.com/ Intergraph Workstation Furniture http://www.intergraph.com/furn.shtml Safe Computing's Internet Store - buy ergonomic products online http://www.netmedia.com/safe/ The Martial Arts FAQ http://www.cis.ohio-state.edu/hypertext/faq/usenet/martial-arts/top.html The Ergonomic Sciences Corp, Mountain View, CA. http://www.internex.net/multipresence/ergonomics.html The (USA's) Occupational Safety and Health Administration http://www.osha.gov Canadian Centre for Occupational Health and Safety http://www.ccohs.ca Repetitive Stress Injury Help Page (CMU) http://http://www.cs.cmu.edu/afs/cs.cmu.edu/help/www/06-Miscellaneous/RSI/repstrTOC.html Some other WWW indices to the typing-injury archive http://www.santafe.edu/~nelson/rsi/typing-gif.html http://alumni.caltech.edu/~dank/typing-archive.html The FAQ for a2x (a program to interface an external keyboard or speech synthesizer to an X window system) and the FAQ for DragonDictate (a speech recognition system) are both available here. http://www.cl.cam.ac.uk/a2x-voice/ (this should include information on the new a3x software which works with Windows NT instead of Unix and X) ftp://ftp.cl.cam.ac.uk/a2x-voice/ Another RSI page in the works http://dragon.acadiau.ca:1667/~rob/rsi/rsi.html Magnetic Devices from Total Health Mktg., Nikken Independent Distributors http://www.icw.com/~total/health.html 3. Listserv Mailing Lists Sorehand is a San Francisco-based listserv mailing list for people with RSIs. Subscribe by sending mail with any subject to: listserv@itssrv1.ucsf.edu with the message body reading: subscribe sorehand Your Name C+Health (Computers & Health) is a listserv mailing list which deals with the technologies causing injuries to folks who use them. Subscribe by sending mail with any subject to: listserv@iubvm.ucs.indiana.edu with the message body reading: subscribe c+health Your Name RSI-East is the east coast's answer to sorehand, where users discuss their experiences and offer support, referral, and treatment information to one another. Subscriptions are available to anyone with an interest in RSIs, but with the caveat that the list is intended as a regional resource for networking. Subscribe by sending mail with any subject to: listserv@sjuvm.stjohns.edu with the message body reading: subscribe rsi-east Your Name RSI-UK is Great Britain's RSI mailing list, open to anyone. Subscribe by sending mail with any subject to: listserv@tictac.demon.co.uk with the message body reading: subscribe rsi-uk Your Name Also, check out the RSI-UK Web page: [- NEW!] http://www.demon.co.uk/rsi/ 4. Usenet Newsgroups misc.health.therapy.occupational The successor to sci.med.occupational. sci.med.occupational A Usenet newsgroup which deals in occupational medicine. Lots of practitioners read it! comp.human-factors Mostly software design, but occasional discussion of accessibility issues for people with RSIs. alt.support.arthritis Support for those with arthritis. New as of 11/93. bit.listserv.ada-law Usenet feed of the ada-law listserv. Covers issues relating to the Americans with Disabilities Act (ADA). bit.listserv.dsshe-l Usenet feed of the disabled student services listserv. Particularly of interest to computer science students dealing with RSIs or folks pondering a return to school and/or retraining after a disabling RSI. 5. Real-time chatting If you've got an account on America On-Line, you might want to check out the RSI Support Group, which meets every Wednesday night in the Equal Access Cafe. This realtime chat starts at 9:15pm eastern time. Check the current AOL schedule for the most current information. 6. Books / Literature A large amount has been written in the popular press and the medical literature, and more comprehensive bibliographies (rsi.biblio and rsi.biblio2) are available in the typing-injury archive. Here are some books you might want to check out: o Emil Pascarelli and Deborah Quilter, Repetitive Strain Injury, a Computer User's Guide, John Wiley & Sons, ISBN 0-471-59533-0. + The Pascarelli book is often cited in various on-line conversations. If you buy only one book, this is probably the one to get. o Don Sellers, Zap! How Your Computer Can Hurt You-And What You Can Do About It, Peachpit Press, Inc., 1994. ISBN# 1-55609-021-0. Author's e-mail: dsellers@netcom.com o Stephanie Brown, Preventing Computer Injury: The Hand Book, Ergonome Press, 1993, ISBN 1-884388-01-9. o David Zemach-Bersin et al., Relaxercise, Harper Press, 1990, ISBN 0-06-250992-6 o Bonnie Prudden, Pain Erasure - The Bonnie Prudden Way. M. Evans & Co., Inc., 1980; ISBN 0-87131-328-6 (hardcover). Ballantine Books, Inc.; 1982 (softcover). o Martin Sussman et al., Total Health at the Computer. Station Hill Press, 1993. o Don Aslett, Make Your House Do The Housework, Digest Books, 1986. ISBN 0-89-879227-4. 201 pages. o Sharon Butler, Conquering Carpal Tunnel Syndrome (& other RSIs), Advanced Press (no ISBN, but phone 800-909-9795, pay $18.95 + shipping). Author's e-mail: SButler100@aol.com o A free packet of information is also available from the U.S. Government. You might want to ask for: Carpal Tunnel Syndrome Selected References (March 1989) NIOSH Publications Dissemination 4676 Columbia Parkway Cincinnati, Ohio 45226 Alternatively, you can call NIOSH's 800 number: 800-356-4674 (800-35-NIOSH) or poke around their WWW page: http://www.cdc.gov/niosh/homepage.html [- NEW!] 7. Societies / Support Groups [- NEW!] This section is new, so please forgive it's incompleteness. Please send me mail so I can register your support group. o RSI patienten vereniging Postbus 1222 NL-3800 BE Amersfoort The Netherlands phone (via FNV) (03480)87804 phone (abroad) + 31 3480 87804 ------------------------------------------------------------------------------- The ftp.csua.berkeley.edu archive Check out the ever-increasing typing injury archive! Just use anonymous ftp or WWW: * ftp://ftp.csua.berkeley.edu/pub/typing-injury * http://www.cs.princeton.edu/~dwallach/tifaq/archive.html Informative files: typing-injury-faq/ changes changes since last month's edition general information about typing injuries keyboards1 and keyboards2 products to replace your keyboard software software to watch your keyboard usage furniture details about various desks, chairs, etc. adapting-at-home some simple ways to make things like mopping and tooth brushing less painful alexander-vs-feldenkrais [- NEW!] Mike Mossey compares two healing techniques amt.advice about Adverse Mechanical Tension amt.more_info e-mail from Dr. Peter Bower about this stuff amt.references a bibliography for more AMT info ansi-standards a note about ANSI/ISO, EC, and MIL-STD "standards" armrests how to correctly use armrests arms-blurb info about the Assoc for Rep. Motion Syndromes back-exercises three simple exercises for your middle back biofeedback learning to listen to your body car-seats replace your car seat with something more comfortable caringforwrists.sit.hqx PageMaker4 document about your wrists caringforwrists.ps PostScript converted version of above... carpal.info info on Carpal Tunnel Syndrome carpal-myths a discussion of what carpal tunnel syndrome is and isn't carpal.explained very detailed information about CTS carpal-new-therapy new treatments that don't involve surgery carpal.self_care excerpt from Rosemarie Atencio's book carpal-steroid-therapy abstract of a paper discussing steroid (cortisone) treatments for CTS carpal-story one person's story of CTS diagnosis, treatment, and recovery carpal.surgery JAMA article on CTS surgery carpal-surgery-tips some general tips for recovering from the surgery carpal.tidbits TidBITS article on CTS ctdnews.info info about the CTDNews publication chord-keyboards interesting facts and references to more cumulative-disorders Cumulative Trauma Disorders: Are They Preventable? Yes, No, Maybe - a paper by Joy Linn disability.keyboards large list of keyboards, more relevant for users with motion disabilities disability-mailing-lists large list of mailing lists for a various disabilities double-crush double-crush syndrome, CTS, and more dragon-vocab-size should you buy the version with a bigger dictionary? dragon-vs-kurzweil a detailed comparison of both voice systems dragon-vs-kurzweil2 [- NEW!] an even more detailed comparison of the two systems dvorak.info lots of into about Dvorak keyboarding exercise-discussion exercise in the workplace exotic-mice info on some newer mice feldenkrais-info some background info on how the Feldenkrais method can ease stress footswitch.doc how to hack a footswitch into your computer footswitch-sources where to buy a footswitch glare-control hints about controling glare from your screen glidepoint lots of information on the GlidePoint trackpad pointing device guitar-playing RSI vs. playing guitar handeze.info info about Handeze gloves hmo-advice advice on picking a health-care provider in the USA industrial-injury one person's story of an injury injury.factors why some get injured and some don't injury.profiles statistics about what gets injured internet-safety-resources a huge list of pointers to Internet resources keyboard-commentary Dan's (increasingly ancient and outdated) opinions on the keyboard replacements keyboard-companies [- NEW!] Simpson Garfinkel's article about companies building new keyboards keyboard-trays all about picking a good tray kinesis-sun-mappings some useful xmodmap calls when using a Kinesis Sun adapter box martial-arts using martial arts to combat RSI's microsoft-vs-generic-split comparison of Microsoft Natural and Taiwanese generic split keyboards mouseless.mac keyboard shortcuts and tricks nervous-system-anatomy basic information on how the human nervous system works no-rsi-in-uk info about British judge saying RSI isn't real nonsurgical-treatment [- NEW!] Various nonsurgical treatment options for upper extremity overuse injuries office-safety Worker-oriented solutions to office safety pain-discussion All about pain piano-posture Some observations about professional pianists pointing-devices advice if pointing devices are your problem physical-therapy explanations of different types of physical therapy resellers a short list of dealers and consultants rock-climbing lots of advice about how to climb without hurting yourself rsi.article Article in The Independent (London, UK) rsi.biblio bibliography of RSI-related publications rsi.biblio2 another bibliography rsi.dentists stats on RSI happening to dentists rsi.details long detailed information about RSI rsi-fda-seminar Dr. Leo Rozmaryn of the US Food and Drug Administration's seminar on RSI's rsi.foundation an attempt to start a U.S. advocacy group rsi.intro basic article from FDA Consumer rsi-network/* archive of the RSI Network newsletter (currently, containing issues 1 through 19) rsi.physical study showing RSI isn't just psychological speed-kills it's better to type slower sword.review reviews a Mac program to reduce keystrokes tendonitis.info info on Tendonitis thoracic-info info about thoracic outlet syndrome (TOS) thoracic-info2 more info about thoracic outlet syndrome thoracic-info3 treatment info, exercises, and more (useful for many folks) uk-rsi-resources RSI resources in Great Britain vibration-gloves why anti-vibration gloves aren't necessarily helpful vitamin-b6 possible links between vitamins and RSI's voice-comparison a brief comparison of recognition systems voice-problems how to avoid hurting your voice with overuse (as you might do with a speech recognition system) voice-programming detailed information about the appropriateness of a voice dictation system to programming tasks voice-recognition-critique all about using a voice recognition system as a programmer workers-comp dealing with insurance and lawyers wrist-supports picking your supports and splints Various product literature and reviews: apple-press press release on the Apple Adjustable Keyboard apple-tidbits extensive info about Apple's Adjustable Keybd bat-info MacWeek review on the Bat comfort-factors, comfort-features, comfort-letter, and comfort-survey marketing info on the Comfort Keyboard comfort-review one user's personal opinions comfort-review2 another user's opinions datahand-review detailed opinions of the DataHand datahand-review2 follow-up to above datahand-review3 another review of the DataHand datahand-desc description of the DataHand's appearance dragon2.info info about DragonDictate 2.0 in3-press details about the IN3 Voice Commander keyboard-phone-numbers [- NEW!] Tom Bell's list of keyboard vendor phone numbers kinesis-review one user's personal opinions kinesis-review2 another user's personal opinions kinesis-summary a collection of opinions on the Kinesis kinesis-vs-maltron a comparison of two similar keyboard alternatives kurzweil-review info about the Kurzweil voice recognizer maltron-flyer and maltron-letter marketing info on various Maltron products maltron-review one user's personal opinions mskeybd-review one user's personal opinions of the Microsoft Natural Keyboard ncc-digital-dictate [- NEW!] the Digital Dictate add-on for IBM VoiceType vertical-info marketing info on the Vertical voicetype2-info marketing info on IBM VoiceType worksafe-australia.info how to get more info from Australia's govt workstation-setup how to arrange your computer/chair/desk wrist-rest-phone-numbers [- NEW!] Tom Bell's list of wrist rest vendor phone numbers Programs (in the software subdirectory): UNIX/X Software: (Note: a2x.tar and rk.tar are both from ftp://ftp.x.org/contrib/ so they may have a more current version than ftp.csua.berkeley.edu.) a2x.tar a more sophisticated X keyboard/mouse spoofing program. Supports DragonDictate. a2x-RawPC-1.4.tar a hacked version of a2x that can take input directly from PC keyboards via the serial port and an adapter. dcm.shar Dragon voice macros to accompany a2x use hsh.shar a program for one-handed usage of normal keyboards kt18.tar generates fake X keyboard events from the serial port - use a PC keyboard on anything! rest-reminder.sh yet another idle watcher rk.tar the reactive keyboard - predicts what you'll type next - saves typing serkey.sh like kt, generates fake X key events, but from a raw PC keyboard via the serial port spacebar_hacks.patches patches for X11R5 to allow the spacebar to be both a spacebar and a control key timeout.zip MS Windows break-reminder program typewatch.shar tells you when to take a break xgdvorak.sh turns your QWERTY keyboard into Dvorak xidle.shar keeps track of how long you've been typing xwrits.tar X-Windows program which pops up and tells you to take a break. watch.shar OpenWindows activity monitor / rest reminder PC/DOS Software: accpak.exe a serial port keyboard spoofer for MS Windows getup.com getup.readme simple TSR program - remind you to take breaks Pictures (in the gifs subdirectory): (Note: you can see inlined images of these keyboards in the keyboards FAQ document) howtosit.gif picture of good sitting posture (the caringforwrists document is better for this) half-qwerty.gif (new name, same file as old 1handpic.gif) keymappings for the Half-QWERTY accukey1.gif beautiful grey-scale picture accukey2.gif chord-mappings for the accukey apple.gif the Apple Adjustable Keyboard bat.gif the InfoGrip Bat comfort.gif the Health Care Comfort Keyboard datahand1.gif picture of the keyboard datahand2.gif key layout schematic E2H_Grahl.gif Grahl split-back ergonomic chair E_Grahl.gif Grahl normal-back ergonomic chair ergologic.gif the ergoLogic 7.1 keyboard (same as flexpro) ergomaster1.gif and ergomaster2.gif the Genovation ErgoMaster keyboard ergomax.gif the Maxi Switch ErgoMax keyboard flexpro.gif the Key Tronic FlexPro keyboard (same as ergologic) fountain_hills.gif the Fountain Hills keyboard generic-split.gif a generic keyboard, made in Taiwan handeze.gif hand size chart for Handeze gloves handeze.ps properly scaled Postscript of handeze.gif kinesis.gif the Kinesis Ergonomic Keyboard lexmark.gif the Lexmark Select-Ease keyboard maltron1.gif, maltron2.gif, maltron3.gif, and maltron4.gif several pictures of Maltron products marquardt.gif the Marquardt MiniErgo mskeybd.gif the Microsoft Natural Keyboard mskeybd-proto.gif ... and a prototype that didn't make it mykey.gif ErgonomiXX MyKey somers1.gif Somers EK1 Ergonomic Keyboard somers2.gif schematic picture of the keyboard tony.gif The Tony! Ergonomic Keysystem twiddler1.gif Twiddler, "front" view twiddler2.gif Twiddler, "side" view vertical.gif the Vertical keyboard wave.gif the Iocomm `Wave' keyboard Many files are compressed (have a .Z ending). If you can't uncompress a file locally, ftp.csua.berkeley.edu will do it. Just ask for the file, without the .Z extension. ------------------------------------------------------------------------------- General info on injuries First, and foremost of importance: if you experience pain at all, then you absolutely need to go see a doctor. As soon as you possibly can. The difference of a day or two can mean the difference between a short recovery and a long, drawn-out ordeal. GO SEE A DOCTOR. Now, your garden-variety doctor may not necessarily be familiar with this sort of injury. Generally, any hospital with an occupational therapy clinic will offer specialists in these kinds of problems. DON'T WAIT, THOUGH. GO SEE A DOCTOR. The remainder of this information is paraphrased, without permission, from a wonderful report by New Zealand's Department of Labour (Occupational Safety and Health Service): "Occupational Overuse Syndrome. Treatment and Rehabilitation: A Practitioner's Guide". First, a glossary (or, fancy names for how you shouldn't have your hands): (note: you're likely to hear these terms from doctors and keyboard vendors :) RSI Repetitive Strain Injury - a general term for many kinds of injuries OOS Occupational Overuse Syndrome - synonym for RSI CTD Cumulative Trauma Disorder - another synonym for RSI WRULD Work-Related Upper Limb Disorders - yet another synonym for RSI CTS Carpal Tunnel Syndrome (see below) Hyperextension Marked bending at a joint. Pronation Turning the palm down. Wrist extension Bending the wrist up. Supination Turning the palm up. Wrist flexion Bending the wrist down. Pinch grip The grip used for a pencil. Ulnar deviation Bending the wrist towards the little finger. Power grip The grip used for a hammer. Radial Deviation Bending the wrist toward the thumb. Abduction Moving away from the body. Overspanning Opening the fingers out wide. Now then, problems come in two main types: Local conditions and diffuse conditions. Local problems are what you'd expect: specific muscles, tendons, tendon sheaths, nerves, etc. being inflamed or otherwise hurt. Diffuse conditions, often mistaken for local problems, can involve muscle discomfort, pain, burning and/or tingling; with identifiable areas of tenderness in muscles, although they're not necessarily "the problem." Why does Occupational Overuse Syndrome occur? Here's the theory. Normally, your muscles and tendons get blood through capillaries which pass among the muscle fibers. When you tense a muscle, you restrict the blood flow. By the time you're exerting 50% of your full power, you're completely restricting your blood flow. Without fresh blood, your muscles use stored energy until they run out, then they switch to anaerobic (without oxygen) metabolism, which generates nasty by-products like lactic acid, which cause pain. Once one muscle hurts, all its neighbors tense up, perhaps to relieve the load. This makes sense for your normal sort of injury, but it only makes things worse with repetitive motion. More tension means less blood flow, and the cycle continues. Another by-product of the lack of blood flow is tingling and numbness from your nerves. They need blood too. Anyway, when you're typing too much, you're never really giving a change for the blood to get back where it belongs, because your muscles never relax enough to let the blood through. Stress, poor posture, and poor ergonomics, only make things worse. Specific injuries you may have heard of (note: most injuries come in two flavors: acute and chronic. Acute injuries are severely painful and noticable. Chronic conditions have less pronounced symptoms but are every bit as real.) Tenosynovitis an inflamation of the tendon sheath. Chronic tenosynovitis occurs when the repetitive activity is mild or intermittent: not enough to cause acute inflamation, but enough to exceed the tendon sheath's ability to lubricate the tendon. As a result, the tendon sheath thickens, gets inflamed, and you've got your problem. Tendonitis an inflammation of a tendon. Repeated tensing of a tendon can cause inflamation. Eventually, the fibers of the tendon start separating, and can even break, leaving behind debris which induces more friction, more swelling, and more pain. "Sub-acute" tendonitis is more common, which entails a dull ache over the wrist and forearm, some tenderness, and it gets worse with repetitive activity. Carpal Tunnel Syndrome the nerves that run through your wrist into your fingers get trapped by the inflamed muscles around them. Symptoms include feeling "pins and needles", tingling, numbness, and even loss of sensation. CTS is often confused for a diffuse condition. Adverse Mechanical Tension also known as 'neural tension', this is where the nerves running down to your arm have become contracted and possibly compressed as a result of muscle spasms in the shoulders and elsewhere. AMT can often misdiagnosed as or associated with one of the other OOS disorders. It is largely reversible and can be treated with physiotherapy (brachial plexus stretches and trigger point therapy). Others for just about every part of your body, there's a fancy name for a way to injure it. By now, you should be getting an idea of how OOS conditions occur and why. Just be careful: many inexperienced doctors misdiagnose problems as Carpal Tunnel Syndrome, when in reality, you may have a completely different problem. Always get a second opinion before somebody does something drastic to you (like surgery). ------------------------------------------------------------------------------- Typing posture, ergonomics, prevention, treatment The most important element of both prevention and recovery is to reduce tension in the muscles and tendons. This requires learning how to relax. If you're under a load of stress, this is doubly important. Tune out the world and breath deep and regular. Relaxing should become a guiding principle in your work: every three minutes take a three second break. EVERY THREE MINUTES, TAKE A THREE SECOND BREAK. Really, do it every three minutes. It's also helpful to work in comfortable surroundings, calm down, and relax. If you can't sleep, you really need to focus on this. Rest, sleep, and relaxation are really a big deal. There are all kinds of other treatments, of course. Drugs can reduce inflamation and pain. Custom-molded splints can forcefully prevent bad posture. Surgery can fix some problems. Exercise can help strengthen your muscles. Regular stretching can help prevent injury. Good posture and a good ergonomic workspace promote reduced tension. Ice or hot-cold contrast baths also reduce swelling. Only your doctor can say what's best for you. Posture - some basic guidelines [I so liked the way this was written in the New Zealand book that I'm lifting it almost verbatim from Appendix 10.] * Let your shoulders relax. * Let your elbows swing free. * Keep your wrists straight. * Pull your chin in to look down - don't flop your head forward. * Keep the hollow in the base of your spine. * Try leaning back in the chair. * Don't slouch or slump forward. * Alter your posture from time to time. * Every 20 minutes, get up and bend your spine backward. Set the seat height, first. Your feet should be flat on the floor. There should be no undue pressure on the underside of your thighs near the knees, and your thighs should not slope too much. Now, draw yourself up to your desk and see that its height is comfortable to work at. If you are short, this may be impossible. The beest remedy is to raise the seat height and prevent your legs from dangling by using a footrest. Now, adjust the backrest height so that your buttocks fit into the space between the backrest and the seat pan. The backrest should support you in the hollow of your back, so adjust its tilt to give firm support in this area. If you operate a keyboard, you will be able to spend more time leaning back, so experiment with a chair with a taller backrest, if available. [Now, I diverge a little from the text] A good chair makes a big difference. If you don't like your chair, go find a better one. You really want adjustments for height, back angle, back height, and maybe even seat tilt. Most arm rests seem to get in the way, although some more expensive chairs have height adjustable arm rests which you can also rotate out of the way. You should find a good store and play with all these chairs - pick one that's right for you. In the San Francisco Bay Area, I highly recommend "Just Chairs." The name says it all. Keyboard drawers, wrist pads, and keyboard replacements: There is a fair amount of controvery on how to get this right. For some people, wrist pads seem to work wonders. However, with good posture, you shouldn't be resting your wrists on anything - you would prefer your keyboard to be "right there". If you drop your arms at your side and then lift your hands up at the elbow, you want your keyboard under your hands when your elbows are at about 90 degrees. Of course, you want to avoid pronation, wrist extension, and ulnar deviation at all costs. Wrist pads may or may not help at this. You should get somebody else to come and look at how you work: how you sit, how you type, and how you relax. It's often easier for somebody else to notice your hunched shoulders or deviated hands. Some argue that the normal, flat keyboard is antiquated and poorly designed. A number of replacements are available, on the market, today. Check out the accompanying typing-injury-faq/keyboards for much detail. Lately, a number of people have been having luck with gloves. You may want to try some light gloves, possibly with the fingers removed if they're too warm. Many seem to like the Handeze Gloves, available for around $20 from Patternworks, P.O. Box 1690, Poughkeepsie, NY 12601 (800/438-5464). See the typing-injury archive "handeze.info" for details. Another place you may be able to get stuff: a company called Enrichments has a catalog of ergonomic products you may find interesting. Their phone number is 800/323-5547. Or, you might want to contact AliMed at 800/225-2610 and ask for their Ergonomics catalog. Here are some sources for fancy keyboard drawers: Ergotron, Eagan, MN, 800/888-8458. A wide tray that mounts under a desk and is adjustable, has a wrist rest, and is wide enough to accomodate a mouse pad. Ergo Systems, East Hartford, CT, 203/282-9767. They make keyboard trays and a retractrable mouse pad, too. Rubbermaid makes a simple $20 plastic keyboard tray that works well. I found mine at CompUSA, so check your local computer store. ------------------------------------------------------------------------------- FAQ's About Computer Ergonomics and Workstation Injuries Copyright ⌐ 1992-1995 Jonathan Bailin, Ph.D. <bailin@mizar.usc.edu> Question Categories General Info, Monitor, & Desktop Accessories......................1-6 Wrists, Body Posture, & Chair Features............................7-13 Active Breaks, Microbreaks, & Excercises.........................14-15 Varieties of Computer Injuries.....................................16 Kinesiology for RSI................................................17 Emergence of RSI...................................................18 Lifestyle Changes and Reducing RSI Risk............................19 1. Q. What is "ergonomics"? A. Ergonomics is the science of adjusting your work environment to fit your body and make it most comfortable. 2. Q. What is the best room lighting to help reduce eye strain? A. A mixture of fluorescent and incandescent light is usually most pleasing. The most important aspect of lighting is to reduce glare and bright reflections from your screen, nearby glass, or shiny surfaces. Since light conditions change during the day this may require several adjustments while working. If you smoke while keyboarding, be sure to clean your screen frequently as water vapor and smoke make a potent film forming process. 3. Q. What is the best position for the monitor at my workstation? A. Many make the common mistake of putting the monitor, the keyboard, or both off to one side on a desk. If you perform more than a few minutes of keyboarding a day, the keyboard and monitor should be placed directly in front of your normal sitting position. The screen should be 18-30 inches from your eyes or about an arm's length. 4. Q. Is there an optimum height for my monitor? A. Yes. The top of the monitor should be at eye level because the eyes are at their most comfortable position straight ahead but slightly downward. This is why reading lenses in bifocal glasses are placed just below the horizontal plane. On the topic of eye correction, make sure your eyes are 20/20 and hat if you do need correction your optometrist should know about the amount of your monitor use and its distance from your eyes. A correction just for monitor use may be necessary. Be sure to look away from your screen at least every 30 minutes and focus on something over 20 feet away. 5. Q. Is there an optimum screen brightness and color scheme to help prevent eye strain? A. Black characters against a light gray background are often easiest on he eyes for long periods. Contrast and brightness should be adjusted to create the brightest screen without blurring. 6. Q. What other accessories and placement are important? A. Frequently used items should be within arms reach from your keyboarding position. A document holder should be at the same height and distance as he screen so that your eyes don't need to change focus frequently. Frequent telephone use should utilize a headset to avoid bending the neck while keyboarding. Remember that many RSI's begin with nerve insult in the neck and shoulders. 7. Q. What is the most healthy posture for my wrists while typing? A. The best position is neutral. In other words, the knuckles, wrist, and op of the forearm should form a straight line. 8. Q. Can a wrist pad sitting in front of the keyboard be used during keyboarding? A. The neutral position described in #7 can not be achieved while in contact with most commercial wrist pads. For this reason keyboarding is best performed from a "floating" wrist position. Contact wristpads for rest periods only. Frequent rest becomes necessary with floating wrists because it tends to emphasize shoulder muscle contraction. Don't forget to use the lightest possible finger pressure during keying. 9. Q. What is the best elbow and shoulder position while keyboarding? A. The elbows should form a 90 degree angle while *hanging* at your sides from the shoulders. Rarely do chairs with armrests allow this position. It is *very* important that the shoulders remain relaxed in a lowered position during keyboarding (see #6). 10. Q. What is the best seat height for keyboarding? A. It is most important that seat height should allow the upper body postures described in #7, #8, and #9. This upper body posture is most responsible for reducing risk of injury. Once this is accomplished, the feet should be flat on the floor. If the resulting seat height prevents the feet from resting flat on he floor, a foot rest is necessary. This should allow the lower legs to be vertical and thighs horizontal. 11. Q. What should I look for in the backrest of a chair? A. Expensive motors and adjustable sections are not necessary if the backrest has firm support for the inward curve of the lower spine (lumbar) and outward curve of the upper spine (thoracic). Wether you need upper body support to help keep your torso and head vertical is a matter of preference. 12. Q. What other characteristics of a chair are important? A. The seat of the chair should be large enough to accommodate frequent changes in position and firm enough to allow your weight to be supported hrough the buttocks not the thighs. If others will use your chair, easy height adjustment is a must. 13. Q. How often should I change positions and take breaks during keyboarding? A. You should change your sitting position at least every 15 minutes. Active breaks should be taken at least every 30 minutes especially for those who perform more than 2 or 3 hours of keyboarding a day. Microbreaks should occur more often. 14. Q. What is an "active break" and a "microbreak"? A. An active break occurs when you stop keyboarding to do other things like ake phone calls, file papers, or get up to get a drink of water. An active break should also include specific exercises. These exercises should also be done during keyboarding microbreaks which occur while seated at your workstation. 15. Q. What are some of the best exercises for keyboarding microbreaks while seated? A. The "Shoulder Blade Squeeze" is performed by raising your forearms and pointing your hands to the ceiling. Push your arms back, squeezing you shoulder blades together. Hold for at least 5 seconds and repeat 3 times. "Eye Palming" is performed by placing your elbows on your desk, cup your hands, close your eyes, and place your eyelids gently down onto your palms. Hold this position for 1 minute while breathing deeply and slowly. Then uncover your eyes slowly. The "Arm & Shoulder Shake" is performed by dropping your hands to your sides then shake your relaxed hands, arms, and shoulders gently for at least 5 seconds and repeat 3 times. "Spanning" is performed by placing you arms straight in front of you and spreading your fingers as far as possible for at least 5 seconds and repeat 5 times. This exercise was made famous by pianists. With the arms extended in front of you spanning can be combined with a "Forearm Stretch" by turning the hands so that their backs touch then turning them so that the palms face the ceiling. These are only a few key exercises. Many more are useful for preventing repetitive strain. Try to find the best series for your areas of ension and particular relaxation needs. Frequent breaks yield better long erm productivity! 16. Q. I've heard many names for keyboard injuries. What do they all mean? A. Repetitive Strain Injury (RSI) is a description of an injury associated any repetitive activity such as hammering, piano playing, truck driving, computer use, or even shaking hands. Occupational Overuse Syndrome (OOS), Cumulative Trauma Disorder (CTD), and Work Related Upper Limb Disorders (WRULD), are all equivalent expressions to RSI. Tendonitis and tenosynovitis are characterized by inflammation of tendo ns or their surrounding sheaths, respectively. Both of these RSI disorders usually begin as mildly aggravating and, given bad habits, may quickly progress to be severely debilitating. These common RSI injuries also add to he difficulty of proper diagnosis and deserve greater recognition. These endon inflammations usually occur before full blown Carpal Tunnel Syndrome. Carpal Tunnel Syndrome (CTS) is a specific, severe, and debilitating form of RSI which describes a squeezing of the median nerve as it runs to hand. The nerve is squeezed by swollen tendons surrounding it as they cross hrough a tunnel made by ligaments at the inside of the wrist. The National Center for Health Statistics estimates at least 1.89 milli on people have Carpal Tunnel Syndrome. Many experts feel that CTS is also associated with nerve compression symptoms in the chest or shoulders. **All RSI symptoms should receive immediate medical attention from physicians experienced in RSI.** 17. Q. Advice by Health Care Practitioners often includes a collection of erms from a kinesiology course. Which ones do I need to know to help identify my own workstation ergonomic problems? A. Standing with the arms at your sides, palms facing forward, "flexion" is folding of any joint of the body so that the angle between the parts decreases in the forward direction, except at the knee and toes. Returning he joint to its straight position requires "extension". A joint which continues its extension past its straight posture is in "hyperextension". This occurs in the hand and wrist when you pull the fingers back. Standing with your arms at your sides, palms facing forward, "pronation" is the turning of your hand so that you thumb points toward your leg. "Suppination" is the opposite movement. 18. Q. Why does it seem like RSI from keyboarding has become such a big problem recently? A. One reason why RSI is becoming more prevalent is because computers are now allowing us to do more office tasks which formerly allowed us to change activity. For example, a typewriter at one time required using a return carriage, "white out" for mistakes, breaks for paper installation, and getting up to file papers in a cabinet. Computer word-processing now eliminates these "microbreaks". In short, computers have greatly simplified office activity, an advance that has at least one important disadvantage. The danger is found in the possibility for long duration, continuous, and relatively motion free, precise, muscular activity called "static exertion". Humans were not well "designed" for this. 19. Q. What lifestyle changes can I make to reduce the chances of RSI? A. Two main themes permeate ergonomic study of RSI prevention; posture and relaxation. Appropriate postures are necessary to keep the strain of performing work in a near stationary position (static exertion) to a minimum. But even the best postures can fall prey to overload when with bad habits. Relaxation is critical to the body's resilience, its ability to recover from keyboarding. Office workload dynamics can have a great influence on the risk of RSI. Try to promote office policies which emphasize steady work load schedules and avoid, or at least distribute, crises deadlines. Stretching and strengthening active muscles promotes relaxation. Relaxation is as important for prevention of RSI symptoms as it is for general well-being. Take a new, more active role in promoting your general fitness both at and away from work. If you don't exercise regularly and your over 40, get clearance from a physician to add walking, bicycling, or swimming to your weekly schedule on three separate days. Cut down on stimulants like coffee, sweets, or nicotine and spread healthy snacks and water intake throughout the day. Keep water at your desk as it makes for a smart microbreak. The first symptom of dehydration is fatigue, not thirst! Fruit and vegatable snacks prevent mid-morning and mid-afternoon blood sugar drops. These dips can effect alertness, mood, productivity, and decision making. A diet emphasizing complex carbohydrates, reliable sleeping patterns, and time for yourself can do wonders for 9 to 5 productivity, not to mention your own well-being. All habits and practices hat promote relaxation are necessary to stop the threat of RSI. Good Luck. During doctoral research in Exercise Physiology/Biomechanics at the University of Southern California, Jonathan completed groundbreaking electromyographic (EMG) research on repetitive strain injuries to the forearm. He currently moderates seminars, writes and speaks on ergonomic topics, consults for Los Angeles firms, and continues further research at USC. Dr. Bailin can be reached at 310/390-8309 or bailin@mizar.usc.edu. ------------------------------------------------------------------------------- Requests for more info Clearly, the above information is incomplete. The typing-injury archive is incomplete. There's always more information out there. If you'd like to submit something, please send me mail, and I'll gladly throw it in. If you'd like to maintain a list of products or vendors, that would be wonderful! I'd love somebody to make a comprehensive list of mice. I'd love somebody to make a list of doctors. I'd love somebody to edit the above sections, looking for places where I've obviously goofed. ------------------------------------------------------------------------------- References Much of the information here is derived from a wonderful guide produced in New Zealand by their Occupational Safety & Health Service, a service of their Department of Labour. Special thanks to the authors: Wigley, Turner, Blake, Darby, McInnes, and Harding. Semi-bibliographic reference: * Occupational Overuse Syndrome Treatment and Rehabilitation: A Practitioner's Guide Published by the Occupational Safety and Health Service Department of Labour Wellington, New Zealand. First Edition: June 1992 ISBN 0-477-3499-3 Price: $9.95 (New Zealand $'s, of course) Thanks to Richard Donkin <richardd@cix.compulink.co.uk> for reviewing this posting. -- Dan Wallach Princeton University, Computer Science Department dwallach@cs.princeton.edu http://www.cs.princeton.edu/~dwallach/ PGP Ready