faq typing injuries general info monthly posting archive name typing injury faq general version revision date 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 by dan wallach dwallach cs berkeley edu many faqs including this one are available on the archive site pit manager mit edu alias rtfm mit edu in the directory pub usenet news answers the name under which a faq is archived appears in the archive name line at the top of the article this faq is archived as typing injury faq general z there s a mail server also just e mail mail server pit manager mit edu with the word help on a line by itself in the body the opinions in here are my own unless otherwise mentioned and do not represent the opinions of any organization or vendor i m not a medical doctor so my advice should be taken with many grains of salt 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 vtvm cc vt edu changes since previously distributed versions are marked with change bars to the right of the text as is this paragraph table of contents mailing lists newsgroups etc the soda berkeley edu archive general info on injuries typing posture ergonomics prevention treatment requests for more info references mailing lists newsgroups etc usenet news comp human factors occasionally has discussion about alternative input devices comp risks has an occasional posting relevant to injuries via computers sci med and misc handicap also tend to have relevant traffic there s a brand new newsgroup sci med occupational chartered specifically to discuss these things this would be the recommended place to post mailing lists the rsi network available both on paper and via e mail this publication covers issues relevant to those with repetitive stress injuries for a sample issue and subscription information send a stamped self addressed business envelope to caroline rose paradise way palo alto ca e mail to crose applelink apple com donation requested all rsi network newsletters are available via anonymous ftp from soda berkeley edu see below for details c health and sorehand are both ibm listserv things for those familiar with listserv here s the quick info c health subscribe to listserv iubvm ucs indiana edu post to c health iubvm ucs indiana edu sorehand subscribe to listserv vm ucsf edu post to sorehand vm ucsf edu quick tutorial on subscribing to a listserv mail listserv vm ucsf edu subject total listserv mania subscribe sorehand j random hacker info that s all there is to it you ll get bunches of mail back from the listserv including a list of other possible commands you can mail cool huh what ll those bitnet people think of next the soda berkeley edu archive i ve started an archive site for info related to typing injuries just anonymous ftp to soda berkeley edu pub typing injury currently you ll find informative files typing injury faq general information about typing injuries keyboards products to replace your keyboard software software to watch your keyboard usage changes changes since last month s edition new keyboard commentary dan s opinions on the keyboard replacements amt advice about adverse mechanical tension caringforwrists sit hqx pagemaker document about your wrists caringforwrists ps postscript converted version of above carpal info info on carpal tunnel syndrome carpal explained very detailed information about cts carpal surgery jama article on cts surgery carpal tidbits tidbits article on cts tendonitis info info on tendonitis rsi biblio bibliography of rsi related publications rsi network archive of the rsi network newsletter currently containing issues through rsi details long detailed information about rsi rsi physical study showing rsi isn t just psychological various product literature 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 marketing info on the comfort keyboard datahand review detailed opinions of the datahand datahand review follow up to above datahand desc description of the datahand s appearance kinesis review one user s personal opinions maltron marketing info on various maltron products maltron review one user s personal opinions vertical info marketing info on the vertical new programs with the exception of accpak exe everything here is distributed as source to be compiled with a unix system some programs take advantage of the x window system also hsh shar a program for one handed usage of normal keyboards typewatch shar tells you when to take a break xdvorak c turns your qwerty keyboard into dvorak xidle shar keeps track of how long you ve been typing rest reminder sh yet another idle watcher kt tar generates fake x keyboard events from the serial port use a pc keyboard on anything new improved version accpak exe a serial port keyboard spoofer for ms windows note a x tar and rk tar are both from export lcs mit edu contrib so they may have a more current version than soda a x tar a more sophisticated x keyboard mouse spoofing program supports dragondictate note a new version is now available rk tar the reactive keyboard predicts what you ll type next saves typing pictures in the gifs subdirectory howtosit gif picture of good sitting posture the caringforwrists document is better for this accukey gif fuzzy picture accukey gif fuzzy picture with somebody using it apple gif the apple adjustable keyboard bat gif the infogrip bat comfort gif the health care comfort keyboard datahand gif fuzzy picture datahand gif key layout schematic datahand gif a much better picture of the datahand flexpro gif the key tronic flexpro keyboard kinesis gif the kinesis ergonomic keyboard kinesis gif multiple views of the kinesis maltron gif several pictures of maltron products mikey gif the mikey mikey gif schematic picture of the mikey tony gif the tony ergonomic keysystem twiddler gif front view twiddler gif 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 soda will do it just ask for the file without the z extension if you re unable to ftp to soda send me e mail and we ll see what we can arrange 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 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 here are 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 dwallach 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 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 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 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 list of chair desk vendors 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 i completely rewrote the information section here using 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 isbn price new zealand s of course thanks to richard donkin richardd hoskyns co uk for reviewing this posting dan wallach one of the most attractive features of a connection dwallach cs berkeley edu machine is the array of blinking lights on the faces office of its cabinet cm paris ref manual v p
