Typing, Writing, and Repetitive Strain Injury

Somewhere around 1993 I started having pain in my right hand. It came on fairly quickly, and within a week I pretty much couldn’t use that hand. Within the next week, my left hand went too. At the time I was working typesetting physics papers in LaTeX. Anyone familiar with LaTeX and equations will know that in order to typeset equations, you have to use all of the little keys around the edges of the keyboard, and the shift key. This means that you have to extend your wrists and fingers a lot – just about the worst thing you can do for your hands.

My employer was required by their own rules to supply me with whatever I needed in order to deal with the tendonitis. The college I worked for had this neat thing called an ATIC lab (Access Technologies In Computing, I think it was). You could go there if you were handicapped in any way to test out various types of equipment. I played around for a bit, and discovered that only one keyboard helped me: the Datahand. I could actually type an entire paragraph without hurting, which at the time was a major achievement! It was expensive, however – more so then than now. (Last I checked about two years ago, it was $1,000; back then it was $2,000). So, my supervisor dawdled and took several months to get it.

I didn’t want to argue – back then I had even more trouble than I do now speaking up for myself, and I felt that I was asking for a lot, and thus that I had no right to be pushy about it.

Standard disclaimer: I am not a medical professional, nor have I ever been one or even played one on TV. This information is based on my own experiences and is not a substitute for the help of your doctor.

The Damage Can Become Irreversible

I should have been pushy about it.

If you catch RSI fast enough, depending on the type it is possible that if you take care of yourself, the damage may heal. If you don’t catch it fast enough, it won’t. No matter how much better it gets, it will never go away. I meet so many people who don’t understand this. So they feel the first few pains, and they decide to wait to do something about it, because it isn’t that bad yet. Know now that if you decide to wait, you could permanently handicap yourself.

Prevention

Make sure you have a good computer set-up. You should be able to look at your monitor without looking either up or down, or tilting your head, or turning to your side. Your keyboard should be placed such that your elbows are at a 90-degree angle at your side, if possible. Most importantly, you don’t want your arms at an angle that puts stress on them, or that puts your fingers at an unnatural angle. If your feet don’t rest on the floor, then get a foot-rest – you want your knees also at a 90-degree angle. Make sure your mouse is somewhere such that you don’t have your arm at a bad angle.

Take rest breaks. Preferably break for a moment or two every five minutes of typing. Stretch out your hands. Every half-hour, get up out of your chair and stretch out a bit. Run your hands under cold water once every half hour if you have any tendency toward tendonitis. (Icing instructions may not apply to carpal tunnel, which I am less familiar with than tendonitis; talk to your doctor!)

Most large employers (and many community centers) have one-session programs you can go to that will give you some idea of how to take care of your hands. Go to one of these. Get regular exercise and try to relax. Tension is bad for your hands and arms.

What To Do Once You’ve Got It?

Exercise: See a physical therapist (and of course your regular doctor). A therapist can teach you exercises that will help to strengthen the muscles in your hands. Your doctor can tell you whether you have tendonitis or carpal tunnel – the treatments can be different for each. Keep in mind that I have tendonitis, and that my suggestions are geared toward that. Also, since tension tends to make RSI worse, you may find that regular massage can help.

Ergonomics: If you didn’t preventatively fix the ergonomics of your environment, then do it now!

Rest & Ice: Take those rest breaks! Ice your hands every half-hour (my doctor told me that a bag of frozen peas works best, oddly enough, because it can conform to the shape of your hands). If you don’t have a place where you work to keep something frozen, then run your hands under cold water.

Keyboards: Find a keyboard and mouse that work for you. There are lots of spiffy keyboards out there. There are split keyboards, split angled keyboards, and on and on. Be sure to try it before you buy it – the keyboard that works for one person sucks for another. Same with mousing options – some people find trackballs make them worse; others prefer them to a mouse. There’s voice recognition software out there; it works for some, but others find it too cumbersome. There are also mice that you operate with your feet. Some people find the smaller keyboard of a laptop either easier or harder on their hands. (I find it a lot easier.)

The Datahand really did work out perfectly for me and for a number of people I know. I had tendonitis so badly that I had trouble turning a key in a lock. Within the first week that I used the keyboard, my hand-strength had gone back up four pounds. I am now to the point where I can type normally. The keyboard looks imposing, but you may be surprised to find that the keys are in very natural places. The keyboard was originally designed for speed – not for RSI – so although it takes a few weeks, you can easily get up to your previous typing speed on it. Note: yes, $1,000 for a keyboard is a lot of money. It’s cheaper, however, than simply not working any more, which was my other option.

Carrying things: Try to find someone to help you out whenever you need to lift anything heavy. You will find (I guarantee you this) that it is almost impossible to remember at first not to pick up heavy things. This is bad – this continually damages your tendons. Do anything you have to in order to remind yourself not to lift things (wrist braces can be a good reminder).

Keep in mind that not everyone can find a “miracle cure” like the Datahand. I’ve known a couple of people who’ve never been able to find anything to make their tendonitis livable, who can’t really type – a serious handicap in this day and age.

“If It Hurts, Then Don’t Do It!”

There are many doctors who will tell you, “stop typing before you ruin your hands!” If you can afford to do this, then great! Go for it! It’s the best thing you can do for yourself!

For those of us who are not independently wealthy, however, this is usually not an option. For us writers who find voice recognition software ultimately somewhat cumbersome, this is also not an option. (And once I developed tendonitis I found handwriting to be even harder on my hands than typing.) I don’t know about you, but I get pretty frustrated with doctors who rattle this advice off. “Well, that’s nice, but my lease says I have to pay rent in two weeks. Wanna pay my rent check if I can’t work?” Yes, look into other options. See if there’s work you can do that doesn’t involve whatever it is that’s hurting your hands, and try out some voice recognition software to see if you can use it for your writing.

If your hands are getting so bad that you can’t work, look into workman’s compensation. If it’s your job that’s doing this to you, you may be entitled to workman’s comp. It isn’t your full salary, but it’s a hell of a lot better than nothing.

If, like me, you just can’t afford to stop working, then get started taking care of your hands now. Spend the money for the keyboard or the voice recognition software. Take the frequent breaks. Get the exercise. I was barely past 20 years old and facing the prospect of not being able to work – that’s pretty terrifying. Try not to let yourself get into that situation.

Learn to Control Your Guilt

It’s natural to feel guilty when the people around you are lifting heavy things and you can’t help. It’s natural to feel a certain amount of shame when you have to call on your friends to help you do things as simple as making dinner. Don’t let your guilt or shame push you into abusing your hands. If your hands get worse, after all, you’ll need your friends’ help even more. Learn to swallow your guilt, thank your friends profusely, and find ways to make it up to them that don’t involve hurting your hands.

In the Long Run

My tendonitis hit the irreversible point. I still hurt when it rains, or when I get very, very tense, or when I pick up something heavy. I have to be pretty careful. But as long as I stay relatively relaxed, keep my work-space in a good shape, remember not to lift heavy things, and use my Datahand, I can live almost normally.

So whatever you do, don’t delay. If you’re having any pain at all in your hands and/or arms, go see your doctor, and stop telling yourself that the pain isn’t really so bad.

Postscript on Wrist Braces

Most people find that, as a “treatment,” wrist braces do nothing. Even my doctor agreed with this. However, they have one minor, but helpful purpose, and one surprisingly important purpose.

  1. You can use them to more easily carry things, push on things, and so on; a light grocery bag can rest on the brace without a problem, generally. Also, wrist braces can function as a very important reminder not to pick up heavy objects.
  2. Wearing braces makes it clear to people that you are hurt. There is no outside indicator for tendonitis or carpal tunnel. There is no way for people to see that you are hurt. When simply pushing a door open can cause you a world of pain, this can be a real problem. Wearing wrist-braces is a way to let people know that you need a little extra help, and that they shouldn’t ask you to do things like carrying heavy objects.
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