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Answers To Frequently Asked Questions about Typing Injuries
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The Typing Injury FAQ -- sources of information for people with typing
injuries, repetitive stress injuries, carpal tunnel syndrome, etc.
Copyright 1992,1993 by Dan Wallach <dwallach@cs.berkeley.edu>;
Many FAQs, including this one, are available on the archive site
rtfm.mit.edu [18.70.0.224] 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@rtfm.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@vtvm1.cc.vt.edu]
Changes since previously distributed versions are marked with change
||
bars to the right of the text, as is this paragraph.
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Table of Contents:
==1== Mailing lists, newsgroups, etc.
==2== The soda.berkeley.edu archive
==3== General info on injuries
==4== Typing posture, ergonomics, prevention, treatment
==5== Requests for more info
==6== References
==1== Mailing lists, newsgroups, etc.
USENET News:
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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:
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The RSI Network: Available both on paper and via e-mail, this publication
covers issues relevant to those with repetitive stress injuries.
Setext formatting and electronic version editing by:
Craig O'Donnell, Assistant Sysop, MacWEEK Forum on ZiffNet
<dadadata@world.std.com>; or <72511,240> on CIS
Currently, there are no paper subscriptions available, although
this may change in the future. If you want to help out, you
should send e-mail to Ric Ford <ricford@world.std.com>;
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?
==2== 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. (128.32.149.19)
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
furniture -- details about various desks, chairs, etc.
changes -- changes since last month's edition
amt.advice -- about Adverse Mechanical Tension
caringforwrists.sit.hqx -- PageMaker4 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
keyboard-commentary -- Dan's opinions on the keyboard replacements
pointing-devices -- advice if pointing devices are your problem
rsi.biblio -- bibliography of RSI-related publications
rsi-network/* -- archive of the RSI Network newsletter
(currently, containing issues 1 through 12)
rsi.details -- long detailed information about RSI
rsi.physical -- study showing RSI isn't just psychological
tendonitis.info -- info on Tendonitis
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-* -- marketing info on the Comfort Keyboard
datahand-review -- detailed opinions of the DataHand
datahand-review2 -- follow-up to above
datahand-desc -- description of the DataHand's appearance
in3-press -- details about the IN3 Voice Command
||
kinesis-review -- one user's personal opinions
kurzweil-review -- info about the Kurzweil voice recognizer
maltron-* -- marketing info on various Maltron products
maltron-review -- one user's personal opinions
vertical-info -- marketing info on the Vertical
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
kt15.tar -- generates fake X keyboard events from the
serial port -- use a PC keyboard on anything!
serkey.sh -- like kt, generates fake X key events, but from
a raw PC keyboard via the serial port
accpak.exe -- a serial port keyboard spoofer for MS Windows
spacebar_hacks.patches -- patches for X11R5 to allow the spacebar to
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be both a spacebar and a control key
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(Note: a2x.tar and rk.tar are both from export.lcs.mit.edu:contrib/
so they may have a more current version than soda.)
a2x.tar -- a more sophisticated X keyboard/mouse spoofing
program. Supports DragonDictate.
a2x-RawPC-1.1.tar -- a hacked version of a2x that can take input
directly from PC keyboards via the serial port
and an adaptor.
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)
(NOTE: I threw out the old accukey pictures -- these are much better)
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 -- fuzzy picture
datahand2.gif -- key layout schematic
datahand3.gif -- a much better picture of the datahand
flexpro.gif -- the Key Tronic FlexPro keyboard
kinesis1.gif -- the Kinesis Ergonomic Keyboard
kinesis2.gif -- multiple views of the Kinesis
maltron[1-4].gif -- several pictures of Maltron products
marquardt.gif -- the Marquardt MiniErgo
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mikey1.gif -- the MIKey
mikey2.gif -- Schematic Picture of the MIKey
tony.gif -- The Tony! Ergonomic Keysystem
twiddler1.gif -- "front" view
twiddler2.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.
==3== 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).
==4== 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 10. -- 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 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.
==5== 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 obvy goofed.
==6== 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 1992
ISBN 0-477-3499-3
Price: $9.95 (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#: 510-540-5535 of its cabinet." -- CM Paris Ref. Manual, v6.0,
p48.