How I stopped the RSI pain that almost destroyed my programming career
codewithoutrules.com
codewithoutrules.com
Since 'RSI' may have many causes, it is unlikely a single treatment will help everybody. This article, in particular, looks like anecdata to me.
Having said that, the suggestions others give to sleep and exercise almost certainly can't hurt and if they may hurt you, you probably already know how fragile your body is.
Exercise breaks during work have the added benefit of introducing breaks. If I had to bet, those breaks are more important for RSI-like symptoms than the exercises themselves.
[1] A disease is a particular abnormal condition, a disorder of a structure or function, that affects part or all of an organism (https://en.wikipedia.org/wiki/Disease, via https://en.wikipedia.org/wiki/Condition#In_medicine)
For anyone reading here, if you’re regularly feeling any level of pain while typing, take an immediate break to figure out what’s wrong. If you let it persist it can do you serious damage.
There are a number of ways you can relieve your symptoms. Scale back your typing and keep trying ideas until the pain goes away. If pain persists or if it is acute/severe, go see a doctor right away. A doctor can much better diagnose you than internet commentary.
(1) Make sure your wrists are in a straight and neutral position while typing. This is in my opinion (having talked to many people with RSI and watched their typing style) the #1 contributor. Other arm/hand/finger position problems can also contribute, but keeping the wrists relatively straight and relaxed is the first most important step to take. Try to pull your keyboard in close to your body and tilt it so that its top is parallel to your forearms (the right tilt to use will depend on the height of your desk and chair and the shape of your body) and stop resting palms, wrists, or arms on a palmrest whenever actively typing (leave your hands “floating” above the keyboard, with just fingertips resting lightly on the home row). If the keyboard’s flip-out feet won’t let you get to the appropriate angle, try propping books or something under the near or far side, as needed.
(1a) More generally, pay attention to your body, and try to notice any muscles/tendons which are statically loaded while you type. Ideally you should be able to be in a position where your muscles are mostly relaxed, and only being used to actually press the keys.
(2) Try to avoid typing for too many hours a day, or for too long at a stretch. (Take a break to stand up and walk around a bit once at least every 45m or so. Go to the bathroom, make yourself a coffee, walk around the block, whatever.)
(3) Examine your seat and desk. Try to make sure your back is as straight as possible and your arms are in a relaxed position. Consider switching seat positions at least a few times throughout the day. Most office workers have their desks set too high compared to their torsos (this is because standard office furniture was designed for medium-tall European males to write with a pen on paper, not for people of arbitrary size/shape to type on a keyboard). You can either lower your desk or raise your chair to compensate. Consider alternative types of chairs (e.g. saddle seats) or an adjustable-height (e.g. sit–stand) desk.
(4) Try to eat a balanced diet, get enough sleep, exercise a few times per week, and avoid too much stress in your life. Obviously you should try to do these things anyway, but they can absolutely contribute to typing pain.
(5) If those changes don’t help, consider changing your physical keyboard/mouse hardware. A split keyboard with sufficiently “tented” sides eliminates the need to pronate your wrists, as is required for one-piece keyboards. This allows the elbows to be brought closer to the body, the shoulders to be relaxed, and generally reduces static load on several tendons/muscles. Consider an “ergonomic” mouse, a trackball, a roller mouse, or similar, or try to eliminate extraneous mousing. Consider changing the keyboard layout to avoid awkward stretched chords (“emacs pinky”), or even get a Maltron or similar row-oriented keyboard. Get a keyboard with switches that actuate halfway through the stroke (not a standard rubber dome keyboard), and try not to smash the keys hard into the bottom of the stroke while typing – aim for a light, fluid “dancing” style of typing.
The article wasn't brushing off RSI, just pointing out that none of those things worked for him, and that emotional stress and cold seemed to be the major factors.
I certainly agree that you should look into ergonomics, but additionally you should definitely consider emotional stress, as there is ample evidence that stress may be a significant factor in many types of chronic pain.
I agree with you that features discussed in the OP like being too cold or having emotional stress in your life could contribute to the problem.
Physician here, and my wife is an occupational therapist. RSI is like saying you have a cold. Yes, there is a problem, no it's not specific, but it gets us to the right chapter of the book. Some of the things you list have very specific causes and treatments that have nothing to do with RSI.
The article would be more like a case report: an interesting, uncommon source of RSI. Anecdata? Yes, but the interesting data is often the edge cases.
Even the methods that didn't work for the author might be more applicable to others, if they have different root causes. In a situation where there's typically no precise clarity as to the root cause, shotgunning solutions is reasonable self-experimentation.
In fact, that's often how doctors prescribe treatments; shotgunning starting from suspecting the most common root cause and working down, testing to see if that's the root cause by seeing if the treatment for said root cause happens to be working.
Push-ups, pull-ups, dips, and sit-ups. Every day. You'll be a coding machine. At the VERY least, push-ups. Every hour or two, take a break, knock off ten push-ups, walk around a bit, get some water, get back to work. I'll do this right at the office, often in the server room.
A good chair helps, but all of this other nonsense is unnecessary. Exercise, and nutrition is the key to basically everything in life.
As mentioned below. SLEEP.
It doesn't take much time to learn how to do it correctly, and it's a lot more fun than running. All those aches and pains have gone away. Seriously, I can't recommend enough getting into lifting.
Power cage [0]
Realistically, the most expensive part of the setup was...the weights. Shipping that shit costs a lot, and they're not cheap to begin with. I bought some bumper plates for deadlifting, and a bunch more as regular plates. Total weight is like 400 - 500 lbs, I forget exactly. All in all, it cost me like....$1400 or so. Worth it if you know you're gonna stick with it, but you should probably start in a gym and make sure it's gonna stick.
Oh, and if you want advice on getting started, let me know.
[0]: https://www.amazon.com/gp/product/B004UMM4QC/ref=oh_aui_deta...
But yes if you're using a squat rack for anything other than squatting, and the gym is busy, give others a turn. Or at least let them work in with you.
Given that I have chronically cold hands only during the winter months, I'll assume that it isn't something that warrants concern.
That said, the suggestion about fingerless gloves is spot-on. Some folks just get cold easier: For me, cold hands could just be related to hormones (female here). Chronic due to the recurring nature of it all, but seriously not a big deal.
It took me way too long to realize that coding all day and games all night is a recipe for pain. Working out is not fun, but it's absolutely necessary for serious software work.
After I had my tennis elbow due to overwork at the computer, and many months in PT, I learned my lesson: Go work out regularly.
It's worked out great. Better health metrics, stronger muscles, etc.
And then I had ergo pains again. And again.
So I unlearned my lesson.
Exercise does great things for me. Solving my ergo related pains? No.
I promise you that exercise is not much of a cure. By all means, go do it because you should anyway. But don't go to sleep thinking it is a solution.
In this guy's case, he tried exercise. Various types. He biked to work. It still didn't fix things.
His problem was cold. There's probably not much else that could fix that.
General gym workouts help, so long as I use weights and machines with care. But I have gone back biking after forgetting about the wrist pain, only for it all to come back and become chronic again.
What I've learned in the past two years of intense PT is the most important thing is to focus on fixing muscle imbalance through strengthening (specifically, avoiding upper crossed and lower crossed syndromes). These put the body in a better position and reduce the load on neck muscles, which in turn reduce referred pain and muscle tightness into the arms and wrists. Most RSI-like symptoms are actually problems starting in the neck.
Having a well-balanced body that is durable is an amazing protector against all sorts of poor physical environments. The article alludes to this by saying 'improve your posture', but that's not very specific - posture improves when you have better balance between muscle groups.
Of course, improving ergonomics, body mindfulness, getting adequate rest, temperature, etc are important as well, but those alone don't do it, nor does cardio.
https://github.com/melling/ErgonomicNotes
There's an extensive checklist of things people have tried but there doesn't seem to be one answer that works.
I have a regime of dumbbell exercises plus at least 5x25 pressups spread through the day.
In this I'm lucky to work from home - not everyone has the freedom to knock out a set in their office environment.
Maintaining condition goes far in mitigating the stress of the particular motor repetitions required by our profession, but I also find that periodically firing up the physical engine calalyses problem solving too.
I used to have a lot of wrist trouble (carpal tunnel I assume) from drumming and computing incessantly, but as long as I stick to the regime, I have no issues.
If you have the stiffness and pain in your muscles, hydrate yourself well, take the day off from these exercises and substitute light stretching to work on your flexibility, but always always drink plenty of water.
Thought I had RSI. Got x-rays etc. Started lifting heavy weights. No more RSI.
You can't do nothing but code, or your body will rot. Go swim, run, lift some heavy stuff. Body works better.
I started working out with machines. It helped.
I started working out with barbells. It helped more.
I started working out with free weights. It helped even more.
I started boxing. It fixed my RSI right up.
The pattern: the most intensive and freeest exercises have the greatest effect.
If that's not correct, I can't follow why you just discarded the entire article.
One note - you can't just do pushups and call it a day. You need to work your back muscles to keep balance between those muscle groups. Pushups alone will cause your shoulders to roll forward, exacerbate forward head posture, and lead to upper crossed syndrome, which is already a major cause of many computer related RSI issues. Personal experience speaking here.
ehhhh... years of daily pushups contributed to the slow shredding of cartilage in my wrist and two operations before i could type again.
but
> walk around a bit, get some water, [...] SLEEP.
this. can't stress enough.
Also, stretch your arms.
For me, this book was a God-send:
https://www.amazon.com/Repetitive-Strain-Injury-Computer-Use...
I had pretty serious RSI issues a few years ago. Thanks to this book (and working out), I forgot all about it - you can do it, too!
Anecdotal, but what worked for me was stopping walking around with my hands in my pockets. Seriously! Must've been something to do with body tension - once I figured out that letting my arms swing freely when I walked places, instead of keeping them rigidly in my pockets, the pain went away and hasn't come back.
Last year I broke my arm, metal plates put in, then taken out, ended up with nerve damage and no feeling in half my hand, 3rd surgery to fix the nerve.
About 3 months ago pain started to come back. Doctor gave me the all clear to go back to the gym. Started 2 weeks ago. Pain gone completely.
Gym may not work for everyone. Works for me.
For me, it was not exercising my wrists in any way. When I'd code, my wrists would be in one position which would eventually start to hurt. But then I took up rock climbing. In climbing, my wrists were forced to strengthen and be put in many other positions. And my RSI pain just went away. I wasn't coding any less than before. But in the time I wasn't coding, I was doing the exercises necessary to keep my wrists healthy.
Also, as an aside, most people's pain tolerance is also terrible. They let their mind take minimal pain signals from their bodies and magnify it tenfold until its excruciating. Some basic meditation training will teach people to minimize what little actual pain they have, which could also allow most to continue working through the pain.
My post became longer than I expected to write
TL;DR: Similar problems, fixed diet, lost a bunch of weight, started exercising daily after achieving normal weight, all problems thing of the past. True for > 5 years now.
Both of my wrists were broken in my youth, in separate incidents. To make matters worse, one didn't heal correctly and needed to be re-broken.
Until my late 20s I obsessively spent long sleepless days at the computer, all classic qwerty keyboards, either model M or classic thinkpads later. My wrists would bother me at the computer, but they also would hurt when it rained, or other random moments. When I would try do some push-ups, my wrists would hurt like hell before I got anywhere near the expected muscle fatigue. This was generally accepted as expected and how things would be forever (or worse) thanks to the broken bones, according to those I consulted (doctors and family).
Except I wasn't minding nutrition, physical activity, or sleep at all, and lived in an environment (fly-over state) with an unhealthy food culture and awful climate. Without making a conscious deliberate effort, the default outcome was to slowly become fat and sick.
Fortunately a startup relocated me to the bay area, where I discovered even walking up a mild hill had become a strenuous, exhausting activity. Having a great climate, accessible local produce that actually tasted good, and a newfound interest in enjoying a life beyond the keyboard with the abundant outdoor beauty and activities, improving these facets of life came easily and I dare say I played little role beyond cooperating.
For ~5 years now I've been doing 300-600 push-ups daily, two sets in the morning and two in the evening. My wrists never bother me, not during push-ups, not at the computer, my injuries are a forgotten memory that I'm only reminded of in threads like these. There's usually also some sets of ~12 hand-stand push-ups, and holding a hand-stand for a minute while doing leg-spreads against a wall.
The only reason I'm able to sustain this daily routine is my weight got down to ~165 (5'8") from ~225. This didn't result from exercise, just vastly improved nutrition fixed my weight. After my weight was normal, the activity started because it was easy, fun, and painless. Words can't describe the pleasure of doing calisthenics with a body 25% lighter than it used to be. My experience exercising now is a daily celebration of being alive and well, and the feedback these activities provide keep my life in check.
I've also noticed that as I became stronger and more adept at push-ups, I was less abusive to my wrist joints and instead distributed the weight across my fingers and even slightly elevated the heel of my palm rather than leaving the area inactive (letting the wrist joint just take up all the abuse as I repeatedly drove my weight into the floor through it.) This wasn't possible for a long time because all the other muscles had to develop and catch up to the chest which was always capable of doing 20-30.
For those of you saying your wrists are ruined from daily push-ups, I'm dubious of your claims. My wrists seem to only become more resilient as I do more push-ups. If you're overweight, have gout, or something else caused by poor nutrition then you should probably address that instead of ceasing the activities altogether. There are more or less abusive techniques to push-ups, and if you're doing them daily in large quantities, you should be able to develop a painless technique, be nicer to your joints by activating the muscles in the area.
My $.02.
Exercise does work wonders. And will solve SOME problems. But some problems really do need their own solutions. And sometimes it does take time and effort to figure out exactly what that solution is.
Any pain I have in it is halved, and it feels much looser and stretched out. And as a bonus my medium distance vision also gets a workout.
I bought a power tower for chinups and pullups earlier this year but unfortunately it contributed to aggravating both my elbows and forearm.
* Two keyboards and two mice. One set on my desk. The other keyboard on my lap and the other mouse on a pedestal at my side. I would switch up which keyboard/mouse I was using every 10 minutes or so.
* Typing like I couldn't move my hands. Literally letting them hang limp and moving my arms a lot.
* Stretches and massage before, during, after typing. This "Essential Hand Stretches for Guitarists" video helped me a lot https://www.youtube.com/watch?v=TSrfB7JIzxY
* Pay attention. Take breaks. Notice what feels bad. Notice when you need to change up what you are doing --probably many times an hour. Take off your watch/rings. Watch out for resting your forearm/wrist on anything.
Turned out, I managed to eliminate it by completely changing my keyboard technique to tuck my thumbs underneath my fingers when typing. I'm surprised no-one ever told me about this before.
The action of tapping the space bar with the corner of your thumbnail instead of smacking it with a big lateral thumb tap makes all the difference in reducing strain on your carpal tunnel.
If your arms are at rest beside your body while standing, the 'natural state' of your fingers and thumbs in this position is the exact same hand posture you should maintain when typing. If you are instead performing an up-down movement with an unbent thumb, that can lead to RSI problems.
Learnt about this from: http://www.kogosowski.com/product/prevent-rsi-ebook/ * This e-book was written by a really smart concert pianist and the thumb positioning was the main take-away for me
Thousands of dollars of ergonomic chairs, keyboards, and so on made it so I could work but still had constant pain.
Started doing pushups (which I had avoided because I thought they made it worse.) Four weeks later I was using a laptop and suddenly it hit me I had been typing for 30 minutes with no pain. Life changing. Zero pain now and I can work 12 hours straight.
Definitely is some combination of the muscles and tendons tightening up in the arms and shoulders. The pain being in a different spot makes in misleading.
My first real recovery came when I got an Aeron and lowered the arms enough to where I couldn't lean on them, switched to a tiling window manager and stopped using the mouse (I am back to normal mouse and window manager these days, but when I feel the twinges of pain, I will sometimes switch back), and fixing the source of some of my stress (money was a stresser back then, and I took a contract job that paid well and got my debts paid off and some savings in the bank, so I could get back to working on the stuff I wanted to work on).
I don't know which of these things was the real cure, though I do know that using a chair with arms I can lean on is the fastest way to bring the pain back.
I suspect it is never "cured", it's just managed. Since figuring out my triggers it's been rare that I've experienced the pain for more than a few hours or days, and taking a walk, massaging my hands and wrists, etc. can usually get me back to work.
Now in my mid-30's I have no problem and enjoy typing very much, so I guess the best thing to do is start with the precautions before the damage is done. Of course my conclusion might be very much premature, but I'm carefully optimistic.
While I feel no pain at all I'm pretty paranoid about getting any pain/RSI in the coming years (recent graduate now working full time)
Just using Qwerty for a few sentences feels awful. It doesn't hurt, of course, it's just a few sentences, usually on someone else's computer. But it's like using chopsticks to eat oily rice, when you're used to eating potatoes with a fork.
To everyone:
- Print this PDF: http://www.dvzine.org/type/OneSheetDVmap.pdf
- Change your keyboard layout to Dvorak
- Don't look at the keyboard, look at the printout to see where the keys are.
- Relax :)
(Qwerty: so much is one one hand. "st a few se", "lly on", "oily". Common things like "ter" and "sed" and "ard". This is the uncomfortable typing.
In Dvorak, the longest sequences on one hand in the above are "12 yea" and the "ng ch" in "using chopsticks".)
But anyway, as a programmer, you spend more time hitting key chords and special characters, which aren't much better in Dvorak and are probably part of why programmers are so prone to RSI despite in absolute terms not typing that much compared to, say, a secretary.
Even when I'm writing code, alphabetic characters and normal punctuation are still by far the most commonly used. It's only the rare punctuation []{};: that's worse off, and even within code I still type for more S characters than semicolons.
If this concerns you, there's Programmer Dvorak layout, but I prefer to keep compatibility with a wider range of computers and use standard Dvorak.
I've been a Dvorak user for ~20 years. I only use a laptop, am working on it basically all day every day, and have terrible posture. And I've never had any RSI issues.
IIRC with Dvorak your fingers only travel about a third as much as when typing on a regular keyboard. Even if it hasn't been scientifically proven or whatever, imho anyone in the tech industry who isn't using Dvorak is crazy.
If you worked as an orchestra conductor, would you spend your weekends going to EDM shows without hearing protection? Of course not, because you make your living using your ears. Same idea.
I still had issues with my left hand, and for me what has helped this time around is a ComfortBead Wrist Rest along the bottom of the keyboard. I'd used it years ago and wasn't convinced, but this time it's clearly and definitely helped a lot.
In the past, I've sometimes gotten some relief by switching which hand is the mouse hand. Every once in awhile I'll let my left hand control the mouse for a bit.
I'm not a doctor, etc.
I set my mouse acceleration pretty high. I have a relatively small mouse, Logitech M325. My forearm, elbow and shoulder don't move at all when I move my mouse.
To move the mouse from one corner to the opposite diagonal, the mouse just moves under my fingers. Most of the time my wrist doesn't move at all.
I've been a programmer, and later jobs that type just as much, since the eighties, and I've never had any kind of RSI. Of course that's me, my body and activity, YMMV etc. But this is worth a shot.
It's also extremely fun to watch a colleague try to drive my mouse and drive off the cliff.
EDIT: Thinking about this a little more. First of all "I've never had any kind of RSI" could just mean that I'm not susceptible to that type of injury.
How I hold my mouse: (works for me)
If I hold my arm up a bit, so that my upper and forearm are something like a V, hand held loosely out and relaxed, then the thumb and index form something like a V, and the fingers are loosely spread out. This puts my thumb about an inch, inch and half below my index.
Now I drop my hand down over my mouse (I don't actually go through this procedure, this just gets you to my position), maintaining that hand configuration roughly. This puts my thumb and pinky just below the bottom edge of the mouse, index on the left button and middle resting lightly on the weel, and ring finger just under the top edge of the mouse on that side. If I pick up the mouse it's held by the thumb and pinky, with a little extra support from the ring finger. To use the right button I move my middle finger over as necessary.
Note that I don't have to move my middle finger forward or back to use the wheel, it's already there. If things get wheely I can lift the middle up a bit. For my hand, this puts the back of the mouse below my highest knuckles.
There are depressions on both sides of the mouse, which look like the natural place to hold it. But if I move my thumb and pinky up into the depression, that pressures my index and middle up. To depress either button or mousewheel it feels like I'm slightly overextending my fingers, and I can feel more effort in my forearm muscles. I also feel effort in my wrist to hold my hand up like that.
When I move the mouse, the outside edge of my pinky and side of my thumb drag on the desk (or couch, at the moment).
If I do lift the mouse up, I just hinge my wrist up a bit, I don't lift my forearm. And my hand hardly moves out of its place, to the point that I sometimes have to clean gummy gunk off my desk, within about the area of a single hand, in one specific place.
So this works for me, I think, because I let all my hand/finger positions and muscles be as natural and lazy as possible. Plus, the mouse fits my hand well, and I've been doing it like this for a long time.
Side note: I hate track pads, and always disable mine, for whatever that's worth.
The two biggest wins for me have been a standing desk for posture improvement, and wearing wrist braces at night.
After a very dark period of taking jobs that required less typing (Kafkaesque jobs at mega-corps involving mostly fixing other people's bugs), I'm better now because of:
1) Using an Apple keyboard, which even though it doesn't look ergonomic, the reduced key travel has helped immensely. 2) Using JetBrains' IDEs instead of vim. If you are a bash/vim/tmux (or equivalent) user like I was, try coding in your favorite language in a JetBrains IDE. Automated refactoring and code completion are your friends. 3) Try drinking red wine. The resveratrol in red wine is a natural anti-inflammatory.
If mousing is the problem, then using vim will help IMO
I thought the conventional wisdom was that Apple keyboards caused RSI?
However, one fairly significant issue is that the top row uses buttons instead of keys. It doesn't bother me too much, but I can imagine that would mess with some people's workflows. Also the corresponding "ergonomic" mouse was the worst I've ever used. It's like a large ball that forces me to stretch and grip constantly to keep my fingers on the buttons. I replaced it almost immediately.
I highly recommend reading his book "The Mindbody Prescription"
And here, related to back pain but same root cause as RSI https://m.youtube.com/watch?v=vsR4wydiIBI
I think the most confusing factor here is the (potential) mental component to these injuries. I personally ruled that out as a possibility for the first five years or so just because it didn't really fit into my understanding of things that I could experience physical pain via something mental. The idea was tantamount to calling the pain artificial, which I knew was very much not the case.
The article (and others here) mention Dr. Sarno. I also read a couple of his books, and a couple more from others who think in the same basic framework. It helped. I'm certain there is/was a mental component—but I don't think Sarno et al's framework is good enough yet (don't get me wrong though—it does work for some people). Aside from results being imperfect, the fact that much of it is grounded in Freudian psychology is an obvious defect. I think they've hit on some techniques that can help, but the theory is bad (which prevents them from effectively refining the techniques).
My latest idea on what has caused all of this: I had some kind of physical injury early on (maybe tendonitis), and it eventually resolved itself. However, I developed this habit of very anxiously monitoring/testing the wrist/hand pain whenever using mouse and keyboard, which would cause the muscles to tense to the point of being painful. Unfortunately, my mind failed to distinguish between the original pain and that caused by tensing, so I continued operating under the assumption that I had some RSI, and continued vigorously worrying about it and attempting to solve it.
The only thing I can think of doing now (and which I am actively doing), is getting better at meditation so I can hopefully one day let go and not worry and tense up while using mouse/keyboard :/
It's been 10 years since then. I now have zero problems, no special exercises, no ergonomic keyboards, chairs, desks, etc. I also regularly play ARPGs like Diablo 3 and Path of Exile, which make most people with RSI cringe.
I agree that Sarno's framework is not perfect. I'm not sure I buy his explanations as to why it works, but it does work. The key is that there is a huge mental component to RSI (or, at least, to some cases of RSI) that most people don't acknowledge. The monitoring/worrying about damaging yourself does something to those muscles/tendons that builds up over time.
However, I don't agree with Sarno's view that the mind uses pain as a diversion from psychological or emotional issues. I think it uses to pain as a way to get our attention, to let us know that we need to deal with those underlying issues.
As I was young then and did not want to waste time not being able to lift my arms or move my wrists, I experimented and found that, again for me, it's just 100% stress. Any exercise (none, too little or too much), working 20 hours or 2 hours are completely unrelated for the onset; if there is a stress factor (like; our new product is not selling!! back then) I would get symptoms immediately and they would get worse once started when typing/mousing more if the stress factor stayed constant.
After that and other health events triggered by (much heavier) stresses, I got my brain to not stress (took me a lot of years) and that worked. I can just work forever behind a computer (which I usually don't need anymore, as I found also that it's completely useless to work many hours / day) without any effects for the past 13-something years.
The fact that I was doing curls with 45 lb dumbbells in the gym didn't help the wrists, either, not to mention playing guitar.
I ended up with pain, tingling and numbness. The university sports med clinic prescribed a NSAID (naproxen). That did provide some relief.
I overcame the RSI by working exclusively through a DEC VT100 terminal (the actual DEC VT100). Its heavy-duty keyboard with stiff action and long key travel didn't irritate my wrists. Eventually I went over to the light-action/short-travel keyboards that are now ubiquitous.
Haven't had a problem since.
Turns out it was a micro-injury thing...
Not a vertical mouse, but surprisingly good. Only miss mice when playing around with graphics software. I have it in PS/2 and USB, and they did a hack job with the USB hardware, it's very low resolution. PS/2 connector gives a very smooth and nice trackball experience if anyone is tempted.
Ended up forgoing the vert. mouse altogether and buying a Logitech MX Master to replace my Logitech G500 (which I've used for many years and is now discontinued) and I'm pretty happy with it so far. I'm even pleased with its gaming performance (probably not OK for highly competitive or pro gamers, but np for me). Mouse was visibly sluggish over Bluetooth but works great over Logitech RF.
Although the MX Master is not billed as an ergonomic device, it fits my hand better than the G500 and I already feel some relief of the slight pain in my right wrist.
I've used a Kinesis Advantage keyboard for about 3 years (and the MS Ergo 4000 for several years before that, in response to pain that developed before I even turned 20) and it's been a godsend. Would like to find a good ergo mouse before I'm forced to.
I switch back and forth between a DXT mouse and a trackball every couple days so that I'm not always doing the same motions.
I also use auto-click software so that I don't have to click the mouse. I use RSI Guard which has this feature.
https://www.amazon.com/Kinesis-Corporation-Wireless-Promotes...
Haven't tried the DXT mouse mentioned in the other comment.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971639/
I do it once a week after I lift weights and it has cleared up my tennis elbow nicely (and helped programmer RSI, I think too!).
Of course if you're typing a lot and you have problem with both hands due to keyboard usage my solution will not work for you.
I also recommend using auto-click software so that you don't have to click the mouse as often. I only click to click-drag, double click, and right click.
I also use the CVim chrome extension to browse with a keyboard.
I think that the combination of a keyboard with a numeric keypad (wiiiide) and a right hand mouse is the main trigger, not the concentrated mouse usage with one hand. If I could find one of the narrow model M keyboards, I'd consider moving back to the other side.
The other things I've done have all centered on being aware of where nerves are near the surface, and never putting pressure there. If you're getting numbness in the thumb and first finger, it's likely carpal tunnel. If it's all over, it's more likely at the elbow.
For mouse, Evoulent is good and I have used many generations of it and I can tell you the difference is negligible so you can just go on eBay and buy an older generation for cheap. It is a b!tch to travel with as it is really oddly shaped. Oh well, nothing is perfect.
In the meantime, I have a MS "natural" keyboard, and a vertical mouse as well. Those have solved all my RSI/wrist pains.
Going back to flat or compact keyboards and horizontal mice is extremely annoying. Not just the muscle memory gap, but the positioning just feels wrong.
I once got a terrible pain in my right arm, couldn't click with my fingers, couldn't move my mouse. After a week I saw a doctor and he said I was tense in my shoulder, which wasn't causing any pain, and showed me a stretch.
Stretching for 2 days cured me, and I've never had the problem again.
The take-home message isn't that you should stretch, but that the cure for these things can be almost anything.
I know that the fact that I constantly pick at my nails (which I count as a psychological issue) is aggravating the stress on my hands.
In any event, to add to the anecdata, someone below recommends not resting your arms/wrists on anything and letting your hands float above the keyboard. I've tried this, and the small muscles in my back that keep the arms lifted would become sore bundles of fire that eventually would spread pain throughout my back/neck/arms/wrists.
I found, paradoxically, that totally resting my arms splayed wide on my desk combined with a Kinesis Freestyle so I can keep my wrists straight (this wouldn't work with a regular keyboard) is the ideal setup for me.[1]
Not saying this would work for everyone.
[1] I have a standing desk combined with a high chair oriented such that the desk comes a bit higher on my chest than a sitting desk would, such that I can just rest my arms on the desk. The keyboard is not elevated and is basically flat to the desk surface, and is separated and angled such that my wrists are not bent.
All of that said, knock on wood I guess, as I haven't had a serious flareup of wrist pain in quite some time now. Not sure why, but I'll take it.
This resolved it for him, my wife and me as well. I hope it helps someone else.
I'm certain that inadequate blood flow is a major contributor to RSI, and that's probably one reason that exercise seems to help so much. Unfortunately, I think, environmental temperature is often overlooked as a source, maybe because it can affect individuals in so many different ways (e.g. https://en.wikipedia.org/wiki/Hunting_reaction).
The Trigger Point Therapy Workbook: https://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-T...
I believe that the primary cause of my hand pain is my forward head posture. This can create trigger points in the scalene muscles of the neck which cause sattelite trigger points in my forearms (especially the extensor muscles) and in my upper arms as well. These trigger points then refer pain to the hands. Self-massage using a lacrosse ball has pretty much eliminated my pain and seems to significantly increase bloodflow to my hands.
NOTE: be very gentle the first time you do self massage of the scalenes with your fingers. I went too hard and my scalenes swelled up for 3 days and I experienced the symptoms of thoracic outlet syndrome, ie. I had numbness from my collarbone to my middle and ring finger on my left side. It went away once my neck healed.
It definitely seems circulation related: whenever I use a computer with cold hands, it causes tension and then pain. I make sure to never use a computer with cold hands. I recently purchased this Far Infrared heating pad to heat my hands. It really does work a ton better than traditional heating pads with resistive coils. https://www.amazon.com/UTK-Infrared-Electric-Therapy-19-Inch...
Also, it is critical to correct the weakness and structural problems in the body. I do yoga, strength training, and swimming and these seem to be helping keep the trigger points from coming back. I am also doing shoulder mobility exercises with a stick and following this guide to correct my forward head posture: http://posturedirect.com/forward-head-posture-correction/
Before this I was at 20% use for 3 years, tried multiple things, went to multiple doctors, etc.
I also: wear a pil-o-splint while sleeping so that area of my wrist can relax at night, make sure my hands are warm and that I've stretched before starting for the day, and changed my typing posture so that my hands are mostly flat and wrists don't touch the desk/keyboard while typing.
Finally, I stopped using emacs and the like because of the control key induced hand/finger stretching. Vim is more RSI friendly in my experience because there is less stretching required to use it.
I use an IBM Model keyboard. It is a larger keyboard so there is less sideways bending at the wrist, but Kinesis keyboard might be better there.
An adjustable standing desk. I try to stand as much as possible, and then adjust the height to keep arms relaxed.
So far feels much better, sometime pain goes away completely, but still not 100%.
All it took to switch was: 1. Practice in KP Typing Tutor 1 hour a day for 3 weeks. 2. Change my computer configuration. (The first week of change was the hardest, I was at 50% my normal speed). 3. Done.
Changing to another keyboard has a price you won't comfortably use other people's computers. And they won't be able to use yours.
But the benefit of being without pain is so worth it.
If you suffer in your hands... make the change.
I use a split keyboard with a graphics tablet in the middle and a mouse either side of the keyboard - this gives me a good variation of hand position. Right hand mouse is vertical.
I find stretching, weights and cardio to be beneficial. The stretching helps to keep the nerves free from impingement, the cardio keeps a good blood flow, and the weights are rebuilding strength and muscle that atrophied during the year where it was too painful to use my hands & arms.
Thanks everyone in this thread for sharing your techniques - it's always good to hear what other people find effective.
The real solution is we should only work 30 hour weeks. Try telling that to your boss though, it's often hard enough to get an ergonomic pencil.
I don't typically recommend Microsoft products, but their sculpt keyboard is a product which is cheap[0], stylish and most importantly ergonomic.
https://www.amazon.com/dp/B00CYX26BC
[0] Cheap relative to other ergonomic keyboards.
Two weeks out of school, I had unendurable pain in both hands. I bought a Natural keyboard, the pain went away immediately, and only comes back when I use a laptop keyboard for coding for more than an hour or two.
I regularly use laptops, standard keyboards, and have no problems. When I had RSI, it was bad enough that I couldn't hold a fork for almost three months, and typing was an exercise in agony.
Seek help from a good physiotherapist, but you'll need to do some research to find a good one.
Also, see if you can find the bad habits you have that promote your injuries. I have upper body muscle tension and poor posture, and when I first recovered from my RSI I was having problems all the time with writing, typing, absolutely everything. It turned out that those problems weren't bad feelings, my hands and forearms had lost a significant portion of their strength, yet I was working just the same as I had been beforehand.
The sculpt has empty space in the middle (above the space bars), I always liked the thinkpad clit mouse - so I hacked a small trackball in the middle of the keyboard.
(This one: https://www.amazon.com/dp/B00810ROQ4)
The trackball buttons are not really accessible, but the keyboard has two space bars, so I rewired the left one to be left mouse click.
The warranty is definitely void, but it was worth it.
I tried a vertical mouse and it helped for a bit then I felt the pain got worse.
It's the only trackball of its kind I've ever seen, every other model is either a tiny thumb-ball, or an enormous whole-hand deal.
They stopped making them years ago, and now you can only find them from scalpers on Amazon for upwards of $4-500.
It's frustrating, because I'd love to get back to using a trackball, but every other model seems less comfortable to me than a normal mouse.
Edit: It's this one: https://www.amazon.com/Logitech-Cordless-Optical-Trackman-US...
So, I started wearing one at night while I slept. It took a couple of months, but I've never had problems since.
I finally got RSI. I knew it would happen eventually since I'm on my computer all the time, so I just accepted it. When the pain in my wrist became too much, I'd shift positions or take a rest.
Then one day it occurred to me that I had gotten RSI right after getting a new watch. I loosened the watch by one notch and all symptoms disappeared.
Not everyone is affected this way and I believe the root cause that caffeine exacerbates is the particular kind of stress you feel when you want to get something done already, a typical state of mind to be in running a startup. Stress and psychological factors feed directly into bad posture and this is why taking regular breaks only upped my stress levels as now I needed to work even faster.
Lastly on the level of equipment fixes, ensure your elbows are supported by arm rests.
Please don't take your ability to "pound" away at the keyboard for granted. And please don't make jokes about RSI ever. It is not a joke, unless you think a "punch line" of seriously thinking about having to type a lot as a liability for your career.
Swimming is quite possibly the best exercise. See http://totalimmersion.net for an alternative to the Red Cross endorsed and rather inefficient "pretend you are a human paddleboat" method.
Good luck! Ignoring the problem will not make it go away.
The article does suggest psychosomatic causes more than anything, imho. Especially people with neither medical training (me included) or prior contact with that phenomenon (me excluded) often seem to think about this as a question of willpower, a conscious decision or a few sessions with a therapist. I beg to differ. If your hands pain you to the point of forcing you to change careers and there's no physiologically pinpointable reason, I don't see how the most complex parts of our bodies could not play a leading role.
What helps me. 1. Heavy deadlifts. This helps grip strength a lot and strengthens my wrists. 2. Posture. I removed the arms from my chair, like SwellJoe mentioned. 3. Posture. Keeping my hand positioned on the keyboard properly. Don't rest the wrists on my laptop. 4. Stretch.
I had an RSI "scare" about ten years ago while I was a student and similar things worked for me. I started to wear fingerless gloves or other things to keep my joints warm while typing and I took steps to reduce non-physical stress. I also took more breaks and made an effort to keep my hands aligned better. I did the latter two first and by themselves didn't notice any change but all together, my pain went away.
Now I try to not type with cold hands when possible, try to keep my joints neutrally positioned and not type for too long at a time. I also used a mechanical keyboard for a long time (which requires very little pressure to activate the keys) and learned the Colemak keyboard layout. I haven't had any relapses although on busy days I can sometimes feel pressure building in my hands (I then take a break and do some stretches).
The problem turned out to be in the seams between products, not the individual pieces.
The mobo mount solves this by throwing away the table component from the keyboard/mouse equation - solving most posture problems. Try it out.
https://www.amazon.com/Mobo-Chair-Mount-Keyboard-System/dp/B...
A few years ago, I started feeling frequent hand and wrist pain. At the time I was writing a lot of code and also a lot of text. To attempt to fix it:
1) I learned more keyboard shortcuts and refactoring tools, so that I could write more code with less finger use.
2) I picked up a voice dictation system, went through the tedious process of getting comfortable with it, and switched to it for nearly all of my non-programming work.
Between these two things, I estimate my keyboard use declined by perhaps 75%. My productivity increased. Pain completely disappeared. Total cost, a few hundred dollars, including a decent wireless headset.
- If you are in pain, stop what you are doing. Be it working, stretching or exercising.
- Keep your wrists straight using a wrist brace, at day and night, until the pain goes away. There are soft braces specific for night use. One for day use that is not invasive is: https://www.amazon.com/BRACE-RCA-Treatment-Support-Regular/d...
- You can test your wrist posture by putting a pencil on your wrist. Your wrist should be straight. I emphasize this because it's one of the most contributing factors to RSI.
- Therapy alternatives include: physical therapy, medication, acupuncture. I did not try the acupuncture personally. Physical therapy was greatly useful, especially the stretches: https://www.youtube.com/watch?v=xAKOpnqvttI
- Use the right keyboard. A short keyboard helps your elbows, a mechanical keyboard helps your fingers. Ergonomic keyboards as well as vertical keyboards did not yield results for me. Even when used under the supervision of an ergonomist.
- Exercise does help. Muscles comes in pairs. Typing makes you contract your muscles more than you extend them, creating a muscle imbalance that contributes to carpal tunnel syndrome. These products help: https://www.amazon.com/PROCIRCLE-Finger-Stretcher-Resistance... , and when you need more: https://www.amazon.com/Strengtheners-rehabilitation-Equipmen...
Finally, see this as an investment. To be injured for life will put your career in jeopardy. Invest in your health.
e: Also the Sarno book this guy recommends has always struck me as pseudo-scientific nonsense. I like Pascarelli and Quilter's Repetitive Strain Injury and Damany's It's Not Carpal Tunnel Syndrome!
e2: Also if your first impulse is to go buy a wrist brace that is completely wrong.
If you have chronic pain check out Ca and Mg - they are essential for muscles. My discovery was by chance, I have been going to doctors, gym, yoga and massage for years with no results. Even run blood tests and they still didn't catch it. Now, I can tell by the feeling in my body when I need a Calcium.
TL;DR - Calcium is for muscle pain. Magnesium is for better sleep, chronic tiredness and anxiety.
(I have had mouse-related grip stress, which I solved by switching to a trackball.)
A great keyboard is important too. I only use IBM model M's made around 1984.
And as is discussed at length in this thread - exercise! I hit the gym for 2 hours between 5 and 7pm and let almost nothing interfere with that.
I have RSI pain yes - it comes with the job - but it's reached a steady-state that I can deal with.
I had crippling pain along my left side. I saw several doctors about it; they prescribed drugs that helped the immediate pain but didn't solve the underlying problem.
Then I read on https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072780/ that wearing a wrist brace AT NIGHT helps overcome carpal-tunnel. A good wrist brace cost me about $20; I've worn it every night since, and the carpal tunnel has gone away for me.
It was recommended to me by my PT when I had hand pain, and it's helped me not only with that but back pain, headaches, and plantar fasciitis. Probably a few more, too. If you ask me, it's the best $16 investment you can imagine.
Once you address the trigger points, tools such as the Powerball, captains of crush grippers, and thick rubber bands can be used to strengthen the flexors and extensor muscles of the forearms.
I was able to solve the problem completely by starting to use a trackball with my left arm. I still use a mouse with the right when precision is necessary but 90% of the time I use the left and trackball.
A chiropractor helped me recover. It took three months, a bit more attention to how I sat and leaned and used my computer equipment. But the pain in my neck and upper back went away, the pain in my arms and shoulders went away, and the sensation and strength came back in my hands.
I didn't rush out to get a special keyboard, though my 1984 Model M keyboard is already special, just not in an ergonomic way.
The other thing that makes a huge difference to me is sleep. Days I don't sleep long /well my wrist and fingers hurt more. I don't know if this is due to giving the body more time to repair or feeling more relaxed (less tense) throughout the day.
A year later I happened to be using a mouse with my right hand and I discovered there was no pain. So I actually fixed my problem.
But suddenly the curling "clicking" movement of my index finger stared causing extreme pain. Still does, to this day, even making that movement in the air. Typing is fine for some reason.
Transitioned to full-time TrackPoint use (USB ThinkPad keyboard), or TrackPad on my Macbook when I'm not at my desk.
Foods and supplements like omega 3, coconut oil, ghee, turmeric, lots of greens, bone broth and more have helped to keep the inflammation down.
Exercise is also super helpful but may not addressing the root cause of the problem.
1. http://www.staples.com/Staples-Gel-Wrist-Rests/product_SS103...
Also, years ago I started using a trackball mouse instead of a normal mouse (or the laptop trackpad which is the worst for my wrist). It has helped a ton.
The latter was the best thing I think. I tried a trackball for a while. Switching hands entirely and getting used to a tablet where you only move your arm coupled w/ the kinesis advantage cured my rsi symptoms.
It changed my life after a year of RSI - validated on multiple people.
Mine was from my mouse. Two year into my career, my RSI was so debilitating that I was worried I had to stop programming.
I changed mice, changed how I held my mouse, and 20+ year later have never had a flare up. I now use a regular mouse, and just pivot my wrist when I use it, and haven't had a problem since then.
Start daily regular stretching fix your finger, wrist, arm, shoulder, back pain.
The worst thing are stupid standard desks. 75cm height with keyboard on top. At home I build my own desk with 80cm height and keyboard+mouse shelf.
Balt split level desk + Kinesis Advantage + Kensington Slim Blade.
1M potency in context: > 30C (diluted 30 times), 200C (diluted 200 times), 1M (1000 dilutions), and 10M (10,000 dilutions).
> A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name Oscillococcinum. As there are only about 1080 atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum would thus require 10320 more atoms to simply have one molecule in the final substance.
In the spirit of objectivity, that should be disclosed.