
Ask HN: Wrist Pain - matt1
I've been a heavy computer user for more than a decade and I think all those hours are finally taking a toll on my wrists. About a year ago the discomfort was so intense that I switched hands so that now I use my left hand both at work and at home. The problem is that my day job has me at a computer for 35-40 hours/week and then I come home and program for another 20-25.<p>Currently there's kind of a dull, persistent numbness 24/7. Also, when I bend my wrists too far forward or backwards, I feel a sharp pain on the back of my hands. I also occasionally wake up at night and notice that they're numb, which I've read is a symptom of carpal tunnel.<p>I've tried a few ergonomic changes including a new chair, adjusting the monitor position, and a wrist pad for my keyboard and mouse, and even a wrist brace a portion of the time, but the discomfort persists. I asked my doctor about it a few months ago and he gave me a 20 page packet with the usual diagrams showing where my head should be positioned in relation to my monitor and things like that, but not much of it was practical "do this" advice.<p>I'd like to work on a startup in a few years and this is a major concern.<p>I figure a lot of you have had similar problems. What worked for you?
======
geuis
Too many of these suggestions are impelling you to try different gadgets to
fix what is a bio problem.

You need to work out.

Over a year ago, I was starting to get the beginning stages of RSI. I smoke
and was really overweight. I had never been to a gym.

The thing that fixed my wrists was pushing weights. Putting aside the other
workout stuff I do (biking, rowing, and moderate running) because they don't
pertain to this discussion, moderate weight lifting is key.

The muscles and tendons in your wrist are weak. Mine certainly were. Adding to
that the 8-10 hours a day of keyboard typing, you develop RSI.

When I started using weight machines, my wrists were numb and I had
flexibility problems. Simply using upper-body weight machines for several
months quickly helped to increase my upper body strength, but more importantly
let my wrists develop strength they didn't have before. Ever since my wrist
problems have _completely_ vanished.

So yes, ergonomic keyboards are definitely useful, even though I don't
personally use one. The text editor you're using has absolutely to fucking do
with problems with your wrists. Get an ergo keyboard if you feel like it. It
won't hurt and will probably help.

However, if you absolutely want to solve your pain you need to work out.
Pushups and upper-body workouts are what you need. No body-building crazy
shit, just moderate strength training 2-4 times a week for a half an hour at a
time.

On the broader workout subject, weight lifting is the fun part of the workout
for me. The biking/rowing bit are just tedious calorie burners. When you lift
the weights, you're immediately releasing endorphins into your system. So
after a good session, you actually feel _good_.

~~~
kbaribeau
Yes.

You could also see a physiotherapist.

A good one will give you exercises you can do to strengthen the muscles in
your wrist. Mine gave me things I can do while I'm sitting in my chair
thinking, or just on a quick break while still in the office.

Anyway, I agree with the parent: gadgets might help, but the real fix is
likely exercise.

~~~
mrtron
If you are like me and prefer the homebrew solutions:

Take a broom handle and just rotate it in your hands for a minute. Add a
string on that and a _small_ weight, and continue adding weight slowly
(rolling the weight up to the bar and then back down). (edit: slowly being
weekly)

Squeeze a stress ball for a solid 5 minute session in the morning.

Pushup type motions focusing on rotating through wrist angles once you are
able.

I would recommend these to the healthy - if you are severely injured go to a
doctor and get better first.

~~~
redcap
Do you use your whole hand/s to rotate the broom handle or just your fingers?

~~~
mrtron
Whole hand.

------
mechanical_fish
First: You need to take this very seriously. "Dull, persistent numbness 24/7"?
Get thee to a doctor who will react to this news with _action_. If nothing
else, get referred to a physical therapist.

Don't use pads or braces without medical advice. You can actually injure
yourself more by bracing your arms, wrists, or hands against things.

Don't assume your wrists are the problem. I have had occasional wrist pain or
numbness for twenty years, most of which turns out to emanate from a nerve
pinch in my _shoulders_. Doing certain shoulder exercises makes the wrists
feel great. Again: find a doctor or a PT who will give you specific advice.

Don't think that gadgets and gimmicks are the whole solution. They can be
useful -- I swear by my Kinesis Advantage keyboard, I have Ergotron monitor
arms to put monitors _precisely_ where they need to be, I have a keyboard
drawer with an adjustable arm to adjust height, tilt, and distance and with an
attached mouse support that I've tinkered with to get the height correct --
but this is secondary stuff. The real secret for me is exercise, strategically
placed pillows and cushions [1] and, of course, rest breaks. Get some software
that orders you to take breaks, like Workrave or AntiRSI for the Mac. Try not
to learn to ignore the software.

Get into shape. You would be surprised at the extent to which walking and
biking will improve the health of your wrists, not to mention the rest of your
health.

EDIT: Oh, and codedevine is right: Be _very_ careful using laptops, and don't
use one for any length of time. They force you into specific postures which
are generally terrible. I get away with using mine for one or two days at a
time, but only because I've been diligent with my health.

\---

[1] For the _back_ , not the wrists. Don't rest your wrists on things!

~~~
matt1
I recently read a post you made about two years ago where you advocate
spending $2K getting set up (<http://news.ycombinator.com/item?id=104977>). On
behalf of everyone you've helped with your responses to these threads, thanks.

Btw, I met you last week at the HN Startup Bootcamp meetup. I remember you
vividly because everyone else was like, "Hi, I'm Dan" and you came up and were
like, "Hi, I'm mechanical_fish" Ha. I was sitting across from you for a good
chunk of it :) Hope your Drupal endeavors are going well.

~~~
mechanical_fish
I still recommend spending the $2k. If you're in this for a lifetime, $2k
every decade or so is nothing.

But my experience since that last post has suggested that a lot of ergonomics
is about _overall health_. The guy who advocates moderate weightlifting as the
solution is probably on to something. When I'm healthy and well-rested and
getting even moderate exercise, I can get away with breaking my own ergonomic
rules... by, say, using a laptop for more than fifteen seconds at a time.

You can't actually do nothing but sit and type for 14 hours per day, every
day, for the rest of your life. All the better reason to make your keyboard
hours count. ;)

------
ShabbyDoo
I've had carpal tunnel syndrome, but it was a result of excess IV fluid
infusion after an accident rather than from repetitive stress/strain. In my
case, it got better a little on its own, and a cortisone injection pretty much
fixed it.

One strange advantage of having had this injury is that I can tell the
difference between carpal tunnel-like pain and other sorts of muscle fatigue.
So, I can feel that I've been over-doing it with, say, a laptop keyboard and
take corrective action.

For me, the Microsoft "natural" series keyboards have been a huge benefit. If
I use a regular keyboard for more than a few days in a row, I start to feel
wrist pain.

Another commenter suggested seeing a physical therapist. At least in the US,
you might be better served seeing an occupational therapist who specializes in
hand/wrist injuries. My wife is a PT, and her education did not include any
special training on repetitive stress injuries.

However, as suggested by this same poster, your first stop ought to be a
physician who actually gives a damn. You might call a hand surgeon's office
and which physicians tend to send RSI referrals and then make an appointment
with one of them.

Now, I'm on to picking out a good chair...

------
stuntmouse2
Numbness, especially persistent is a strong warning sign. Don't ignore it like
I did!

First off, you should see a qualified physical therapist (someone who knows
the wrist) immediately. She will help you change your setup to be more
ergonomic and probably give you some light exercises. Another benefit is that
she can measure the problem, allowing you to track your progress and the
effectiveness of any treatment.

Next, I can recommend a few products that have really helped me out:

Number one, make sure your keyboard is big enough if you're using a laptop. I
used to use an IBM Thinkpad X31, the keyboard was way too small and that was
the beginning of my serious wrist problems.

Next, for mice, I heartily recommend the Evoluent Vertical Mouse. There is a
bit of a price premium, but these are great optical mice for those with wrist
issues. I have two, one for right and left that I switch between if I feel any
pain or tingling.

For keyboards, I've stuck with the Microsoft Natural Keyboard Pro. Once you
have it at the right height, and you're using it at the right angle, this
makes a fine keyboard.

Best of luck. I got over this completely and so can you.

------
sachinag
Don't use wrist braces - they're for immobilization, not pain mitigation. If
you need to persist in the same activities (and you really should look into
PT), the ACE bandage wraps are the best to "offload" stress:
[http://www.walgreens.com/store/catalog/Braces-and-
Supports/A...](http://www.walgreens.com/store/catalog/Braces-and-Supports/Ace-
Wrist-Brace/ID=prod3543918&navCount=1&navAction=push-
product?V=G&ec=bz_557078&srccode=cii_10043468&cpncode=24-56988976-2)

You don't want the heavy velcro braces: again, they're for immobilization, not
for pain mitigation.

~~~
akeefer
I would disagree about not using wrist braces; my doctor recommended I use one
when I was experiencing wrist pain several years ago, and it helped a lot. A
lot of RSI conditions are caused by pinched nerves, and the immobilization of
the wrist prevents the sort of bending that leads to pressure on those nerves,
allowing it to slowly be relieved over time. They don't help mitigate the
pain, they help treat the cause of the pain. It helped me to wear them while
working, but I also got a lot of benefit out of wearing them while I slept,
ensuring that my wrists were perfectly flat and healing.

------
hy3lxs
How I solved my own carpal tunnel after too much quake^H^H^H^H^Hcoding.

(1) Take some time off. If you can't do that, for your own sake take a break
at least once an hour where you yawn/stretch and drink lots of water. This
will help your body repair itself and turn your bladder into an internal timer
to take a break. Seriously, it works.

(2) Wrist position is the _key_: hands must be straight extensions of the
forearms. Angling up/down or side/side is a no-no. If one hand hurts more than
the other it could be a mouse issue.

(2a) If you don't know what the "ideal position" feels like, then wear IMAK
ergobead gloves which have this hard strip inside (like an injury brace) that
forces you into the correct position. Wear these for several weeks until the
pain recedes and you've "learned" the proper position. Think of them as
training wheels for your wrists. Try them on in a store to make sure you get
the right size (I think Fry's carries them).

(3) If you mouse a lot, consider an IMAK ergobead mouse wrist rest. All other
wrist rests I've tried are either too hard or not supportive enough. If you're
cheap, make your own bean bag (double-ziplock some small dry
beans/beads/whatever, fold it in half, and put a thin towel over it). Think
Japanese buckwheat pillow for your wrist.

(4) At minimum get an "ergo" keyboard where there is that split in the middle.
If you can afford it get one of the fancier ones that have continuous levels
of adjustment. I've tried Kinesis and Goldtouch to good effect. If you have
small hands the Microsoft ergo keyboard may be too large for you.

(5) TAKE FREQUENT BREAKS or someday you will not be able to type. See rule #1.

Oh, and use vim for home-row navigation ;-)

To the "bio" guy: it's actually a mixture of gadgetry (so that your hands are
in the right position with less effort) and having stronger arms (so that your
hands can be held in the right position without getting tired).

Undisclosure: I have nothing to do with IMAK whatsoever but after trying lots
of different product lines, their products were the only one that subtracted
from the pain instead of adding to it in the long run.

------
rit
All of the things you've tried are steps down the right path, but I hate to
say the one thing I don't see you mention is a new KEYBOARD.

The keyboard is a tool you use every day, during those 40 hours. A poor
keyboard is guaranteeing murder on your hands. I had issues for years, which
were/are exacerbated by an injury I sustained when I was younger (nerves, all
tendons and significant portion of artery destroyed in my left hand, which
required extensive surgery).

The one change I have found, repeatedly, that has made the most significant
different is a keyboard. I won't go overboard in recommending any particular
setup, as I find different people have different preferences - I find the best
relief in mechanical switch (I used das keyboard for years but have moved to
majestouch recently as DKs have wonky controllers), but a lot of people swear
by ergonomics, etc. I can't use ergonomic/split hand keyboards well because of
limits on my bad hand, but YMMV.

One of the best resources I've still found is from JWZ, who talks about all
the different steps he went through in his own wrist pain:

<http://www.jwz.org/gruntle/wrists.html>

Another set of things I recommend is to make sure you use your muscles in
different things than just typing. Get a stress ball and some light-weight
finger exercisers (You can usually get them at guitar stores, it has a spring
loaded "weight" for each finger and you can flex individually).

I am by no means a doctor, but I've dealt with a lot of re-constructive
therapy on my own hand, and my own typing issues (seriously, look into a
better keyboard. The $20 membrane switch piece of crap that came with your
computer is NOT helping things at all). On top of it my mom was an OR nurse
for ~30 years and had hand issues of her own that stemmed from the fact that
apparently holding medical instruments in one position for ~12 hours a day is
bad for your hands too.

Make sure you get good tools, not just augmentation (like padding) to the
tools you already have. And give your stressed muscles other things to do, so
you aren't just straining them in the same positions and actions day after
day.

------
htsh
I had luck with the book "Its not carpal tunnel" or something --
<http://bit.ly/Ocwy5> .. It suggested some stretches, one which worked in my
case.

My pinky and half my ring finger were going numb from the bottom of my wrist
sitting on either the desk or the laptop, and the exercise that worked for me
involved holding my arm straight out away from me and repeatedly twisting it
at my shoulder.

I found a good doctor in Chinatown, NY who recommended the book and suggested
stretching daily instead of looking to any of the various surgeries suggested
by other doctors.

------
ars
If you ignore this you will end up not being able to tie your shoes or button
your shirt.

Pretend that already happened - how would you work? Whatever method you
choose, do it now. Don't wait till you can't function.

------
cperciva
I had symptoms similar to those last year; the most specific symptom I had was
numbness and occasionally tingling/pain in the _back_ of my hand. I:

1\. Got a Microsoft Natural Ergonomic Keyboard 4000 and used that instead of
my laptop's keyboard.

2\. Got a mouse (Microsoft something, I think?) and used that left-handed
instead of my laptop's touchpad.

3\. Wore wrist splints.

4\. Refused to lift anything heavier than my (5 lbs) laptop.

After about 3 months my wrists were back to normal.

I'm not sure which of the above helped, and I don't want to re-injure myself
in order to be able to conduct properly scientific trials; but I suspect that
the largest factor was keeping my wrists straight (not bending my hand up or
down OR left-to-right) with the wrist braces mostly serving just to get in my
way and prevent me from unconsciously lifting anything heavy.

Hope this helps -- sorry I can't be more specific.

------
matthew-wegner
I've been wearing "computer gloves" for 10 years, and like them a lot. People
made fun of me when I got to college; those same people asked me where to find
them after a few semesters (cg/digital art school, so a lot of people going
from little computer use to full days).

Sounds like your hands are pretty trashed, so I doubt these will be a magic
bullet. Go see someone, start working out, take breaks, etc. But give these a
try too:

<http://www.softflex.com/>

Note that wearing any wrist support sporadically will probably be worse than
wearing none at all. You'll discover this the first time you need to type a
bunch and don't have them on you (it won't happen more than once or twice,
since it's acutely noticeable).

------
froggy
Completely agree with geuis above. You need to work out. I had the same
problem 2 years ago when I was programming long hours (dull persistent
numbness, and eventually sharp pain). I self-diagnosed it as wrist tendonitis
and wore a splint brace for a few weeks. Once the wrist felt better, I got
back to the gym and started doing light weights with a sort of stretch bandage
on my wrist. Also bought a resistance hand grip to squeeze whenever I could
and did hand/wrist stretching exercises daily for a few months.

<http://www.med.umich.edu/1libr/sma/sma_wristten_rex.htm>

This fixed it within a couple months and I haven't had a flare-up since.

------
watmough
Get a trackball. Learn to use it with either hand.

Don't work so hard.

~~~
s3graham
I'm sure this worked for you, but for me a trackball made things _much_ worse.
It seemed to be more weird movements in my thumb/hand.

I do notice that if I'm not doing much work (i.e. more browsing with the
mouse) things are worse than when I'm working hard (i.e. more Vim)

~~~
chancho
Which trackball? Logitech Marble Mouse works great for me because it puts my
hand in a position that most resembles a hand-shake (relative to other mice
and trackballs.) I noticed immediate benefits and thought "Hey trackballs are
great!" but then I started using a Mac at work and the scrolling there is not
so great so I bought a Kensington Expert Mouse for the fancy scroll ring. Just
awful. Wrists flat on the desk, hands bent up toward the ceiling. Worse than a
mouse. Not all trackballs are great.

------
dstorrs
There's plenty of good suggestions in here, so I'll just add a small pointer:
SmartBoard keyboards from DataDesk Technologies. "Oh, go buy an ergonomic
keyboard!" sounds like trivial advice. A few years ago, I had wrist pain--not
as bad as yours, but plenty sufficient to scare me. I bought this keyboard,
and it vanished. They are also durable: I've had one for 5-7 years, I use it
8-10 hours a day every day and it's just starting to lose some keycaps.

The only problem is that they are almost impossible to find.

~~~
jacoblyles
I use the Microsoft Ergonomic keyboard and it made a world of difference. A
simple wrist pad like the OP has is not equivalent to a good ergonomic
keyboard.

~~~
alec
I used to use a Microsoft ergonomic keyboard, but found it was bad for me it
has a required lots of pressure to push the keys. I can"t use one of them for
more than a few minutes now; I can type on a Kinesis keyboard for an entire
day (with proper breaks, of course). While I think the Microsoft ergonomic
keyboard gets the hand spacing right, I couldn't recommended it in place of
something like the Kinesis.

------
nostrademons
#1 thing you can do to help your wrists: don't rest your them on your
keyboard/desk/wristpad. Don't rest them on anything. Your hands should float
above the keyboard, with the wrists straight.

I've found that switching to a Dvorak layout helped a lot - because I _had_ to
touch type (I didn't physically change the keys, and didn't get stickers or
anything for them), my hands naturally floated over the keyboard. Also helps
if your elbows are above the keyboard. Various ergonomic keyboards may help
too.

------
frossie
Thinks that worked for me for wrist pain:

1\. Make sure you sleep with your wrists in a neutral position (i.e. straight
- neither bent back or bent forward). Use wrist wraps if you absolutely have
to, but better if you can manage it by force of will, or changing your
sleeping position.

2\. I am not sure about the ergonomic gizmos - but I replaced my keyboard with
a MUCH smaller keyboard (
<http://en.wikipedia.org/wiki/Happy_Hacking_Keyboard> ) - there's nothing
gimmicky about the keyboard except that it is _short_ \- that means that you
have to reach a lot less for the mouse. This helped me enormously.

HOWEVER. It is possible that if you are experiencing wrist pain and numbness
that you do not have a problem with your wrists at all but with your shoulders
(pinched nerves) or other upstream body part. You really ought to ask for a
referral to a specialist. If you are in the US, look for a member of American
Association of Electrodiagnostic and Neuromuscular Medicine (AANEM).

What they can do (if they rule out carpal tunnel) is do a nerve test (caveat:
it hurts) to pinpoint what nerve or muscle is causing the issue.

It's your livelihood - take it seriously and shake the medical profession tree
until you can find someone who can help you.

------
seven
Had a wrist infection caused by intense bmx riding. Only thing that could fix
it was to force myself to let it rest. Rest all the time, no exception.

And a somewhat ugly experience. After my first big project I had a visible
'bubble' (size of a big coin) beneath my skin at my wrist. As every idiot
would do, I ignored it. It did not disappear after some weeks and I went to
see the doctor: 'We need to cut that open!' .. so.. as a good coward would do,
I assured the doc that I would come back.. and stayed home.

Now comes the ugly part: After living with my bubble for several more weeks, I
made a certain movement... and this bubble thing cracked inside my wrist and I
felt the fluid rushing into my arm. I paniced a bit.. but I am still alive and
my wrist is fine. No pain at all, btw.

I told a friend about my experience. He took me to my office, asked me to show
my 'programming position'. Then he told me the same stuff your doctor told
you. (I guess.) And he was right.

I would suggest that you pay more attention to your body. I know it from
myself, that sometimes you really want to make that last test case pass,
before paying attention to the pain in your back. This is not good.

I do most programming on a big sofa, where I can easily change position. When
forced to work in an office I never use the keyboard sitting on the desk. I
find it much more comfortable to let it rest on my lap.

General rule: If you do not feel comfortable, change it.

More advice: Never write tec on a german keyboard. :)

Take this serious and try to see another doctor.

Hope you get better soon.

------
sb
I had really strong tendonitis (endured 1 month of pain) and this is what I
did:

* Got hardware: Kinesis Freestyle (which is not the Advantage, but still highly recommended!) and the Kensington Expert Mouse (which is probably the best trackball around)

* Started using workrave on work and home computers; using intervalls of 48 work : 12 rest minutes. Workrave includes some excercises which are highly recommended. There are also a couple of excercises you can do at your workplace, I used: <http://www.ehs.utoronto.ca/services/Ergonomics/exercise.htm>

* Started to excercise: 3 x running a week (-> check runnersworld.com excercise plans, please use a hrm if you are beginning slowly); after 1 year I can run > 10 miles without any problems and it even resolved my troubled back problems. Compensate this with upper-body training, crunches, push-ups, and pull-ups. Running with small 2 pound weights is very good for strenghening wrist strains without being forced into a gym -- I clearly prefer nature, even in winters. (Seeing green trees and breathing forrest air certainly is relaxing in its own right, too.)

* Diet. When I was in college I ate pizza twice a day. While essential (nomen est omen) at that time, I put on a lot of weight and did not feel good. Now I try to eat salad at least once a day, start with a healthy breakfast and never eat after 8pm. In addition to that I eliminated any form of soda -- the carbonic acid is not good and can lead to gastritis or worse. Watered down ice-tea or apple juice alternating with mineral water or just water (if it's drinkable in your geography).

------
sever
I used to have "chronic" wrist pain for 8 years, and have now been completely
pain free for just over a year.

Saw many doctors, many bouts of physical therapy, many batteries of tests -
steroid injections, nerve conduction, MRIs, rheumatologists, chiropractors,
acupuncture, etc, none of that was helpful.

In the end exercise cured it. Now and again I had hints that exercise could
help, I'd do bicep curls, or reverse curls, and it made the pain recede, but
the relief wouldn't stick.

A year ago, I started doing wall push-ups, 1 set, daily, in the morning. In
the beginning, I couldn't do one without pain. No fixed schedule, I just kept
growing reps, still one set, having rest days when it seemed appropriate,
probably about once a week. In 3 months I could 100 wall push-ups, with no
significant discomfort. I'd also have a break of about 1-2 hours after the
exercise, before I had to start typing for work.

At some point I added "finger extensions" -- wrap rubber band around the
fingers, and straighten them, the load is the reverse of typing where you need
force to curl you fingers. It seemed like a good idea to balance the load on
the muscles. I'm don't recall when I added them in, my best guess is that they
helped, I think the wall push-ups were the main thing.

When I started, I could type about 5000 keystrokes per day (so about 300
words), with pain, on a datahand keyboard. As things progressed, I increased
keystrokes, then eventually switched to a Microsoft Natural keyboard, and
recently to a regular one, with essentially no limitations on how much I type,
and with no discomfort.

After 8 years of pain, my outcome has been nearly miraculous. Perhaps this
will be helpful, and I hope a similar experience is waiting for you. Best
wishes.

------
viraptor
You didn't say what keyboard are you using. Is it just the standard, straight
one? Try something more curvy, like ms natural keyboard.

I've never had any major problems with my wrists, just some slight discomfort
from time to time... but man, does that keyboard make a difference!

Also you could configure your desktop to be more accessible with keyboard
only. Less switching between keyboard and mouse == faster work and fewer
useless movements.

~~~
matt1
I use one of those flat white mac keyboards on one computer and a normal Dell
keyboard at home, and another normal Dell keyboard at work. I think I'll try
out one of the curvy Microsoft ones as a start. Thanks for the feedback.

------
justlearning
I do the following to prevent wrist/shoulder pain.

* keep the hand from elbow to your wrist on the same surface.(if you use a laptop on a table, your wrists are placed higher on the laptop, that's ok.) The key is make sure your elbow/shoulder doesn't move, while you type. This is guaranteed if you rest your elbow on the same surface as your wrist.

* When placed on a table, don't keep your keyboard away from your chest - keep it at an arms length(almost). Once you have found your chair's relative position to table, stretch your arms towards the monitor and place them on the table (placing the elbows first) - place your keyboard in the area where your fingers landed(wrist pad helps)

* Surely helps, if you can forego the laptop keyboard and move to a regular keyboard.

* most keyboards have a "lift" option at the backside- in my experience, I had some pain when I kept the keyboard flat. The lifted keyboard in conjunction with the wrist pad worked fine for me (took few days)

* Never, Never - use laptop (or wireless keyboards) on your lap, pillow etc or places that prompt your shoulder movement.

* Never, Never lift your wrists or elbow while typing?

* (my most effective weapon against pain) - Never, Never use the mouse keypad. Don't touch it. I have disabled mine and use the mouse all the time (again the elbow rest on the table rule applies)

* (edit) work out: swimming helped me.

PS: use the keyboard as you would use a pen.The pain/symptoms of using a pen
"abnormally" are similar to pain inflicted by a keyboard.

public places like airport and other places where you don't get a table and
cannot rest a mouse, I prefer to read a book, rather than code with
hunched,lifted shoulders. It has helped me so far.

------
holygoat
Go and read "It's Not Carpal Tunnel Syndrome". It made a lot of sense to me.

<http://cow.org/r/?603b>

(Disclosure: that's got an affiliate link in it.)

Lots of people get misdiagnosed, have surgery, and end up right back where
they started.

The authors explain that most people with persistent strain disorders are
suffering from a combination of nerve adhesions, inflammation, and microscopic
muscle spasms (tender points or knots) that cause pain, weakness, numbness,
and so on. Actual carpal tunnel syndrome is much rarer than commonly thought.

Their primary thesis is that treating a symptom does not help. Cutting your
carpal tunnel will only shift the problem elsewhere. Adjusting your position
will, at best, move the problem elsewhere. You need to treat the (several)
root causes, working your way along the chain until you're nearly pain free.

For example: pregnant women often get the symptoms of carpal tunnel syndrome.
Advocating surgery for pregnant women is obviously insane, but it's commonly
suggested for us programmers when the ol' "try wearing a wrist brace at night"
trick doesn't work. Perhaps hammering away at a keyboard for thousands of
hours might have something to do with it, rather than an actual problem with
the carpal tunnel?

The authors have a ton of material on the web, so you can read before buying
the book:

<http://www.rsirescue.com/>

My personal approach: I use an ergonomic keyboard, of course. I eat better
than I used to. I take breaks. I massage my forearms. I lift weights and
exercise. I don't take ibuprofen. I don't stretch too much (my arm joints are
hypermobile).

Seriously, go read the book.

------
qeorge
I've found the exercises in this video help me a lot:

<http://www.youtube.com/watch?v=hUyMNyrOHJQ>

Also, when I was having problems a few years back, I narrowed it down to my
laptop. The touchpad style mouse was killing my hands and wrists. It sounds
like you're on a desktop, but I thought I'd mention it just in case.

------
ChiroFITCMT
I'm a massage therapist. I have worked with professional athletes, college
swimmers, and desk jockeys alike.

Get yourself a good massage therapist, I don't know where you are, but find a
qualified professional on www.AMTA.org. be sure to ask them questions about
whether they have dealt with chronic wrist pain in the past, and they can show
you a series of stretches and/or exercises to help you be more pain free. Now,
I truly hope massage can help your situation, letting symptoms go unattended
to is definitely a BAD idea, as prolonged compression of a nerve can lead to
permanent nerve damage. You should feel some relief after your first session,
but I would highly recommend going once a week for 30 minutes to an hour for
at least the first 3 weeks of treatment. Your therapist should work on the
small passageway of your ulnar nerve right at the base of your wrist below
your little finger as this area often gets compressed from keeping your wrists
pointed IN and your hands turned out to stay aligned with the keys. The wrist
flexor and extensor muscle attachments should also be attended to at the top
of the forearm near the elbow and on the underside of your forearm as well.

Another very immediate thing you can do is to purchase an ergonomic keyboard
with the split down the center, this allows the wrists to be at a much more
normalized angle than traditional keyboards. Also look at how your mouse
is...if it's straight up and down, with the two click buttons evenly placed at
the top, this is not the mouse for you. Ideally, a mouse at an angle to fit
your hand with a trackball on the thumb side is what you're looking for. Try
and find a mouse with an offset right and left click button to follow the
natural difference in first and second digit finger length.

If you have any questions, please feel free to contact me at my office,

Andrea J. Munsell, Certified Massage Therapist The ChiroFIT Wellness Center
2249 Wealthy St. SE, suite #240 East Grand Rapids, MI 49506 (616)458-CFIT
(2348)

------
jacquesm
Have a real good look at the total picture, not just your wrists.

Getting a new chair is one thing, but that doesn't mean that it is the right
chair for you.

There are people that specialize in this sort of thing, maybe you can find one
in your environment ? There are so many factors to consider that you'd be
studying for weeks if not months to figure out exactly what is going on here.

Hardly any of these symptoms is 'single cause', and like debugging any problem
that has multiple interrelated parts it's going to be hard to break it down
into items that can be fixed individually.

It's really good to see you take this serious, don't ever ignore those warning
signs. And that dull, persistent numbness is a good indicator that you have a
very serious problem, as long as that persists I'd avoid that
keyboard/screen/desk/chair setup like the plague unless you absolutely have
to.

And find a doctor that will get you referred to someone that can have a good
look at your wrists.

------
apinstein
I went through this a few years back -- had headaches, shoulder pain, wrist
pain, back pain, neck pain. And I work out, am in good health, and play a lot
of tennis.

This article pretty much sums up what you need to do positionally:
<http://www.codinghorror.com/blog/archives/000938.html>

The chair is important, but I already had a nice one and couldn't get the rest
of the geometry right with my existing desk & monitor.

So I got myself a fully-articulating monitor stand, a split keyboard, a pull-
out keyboard tray with negative tilt and a mousepad extension.

The new setup eliminated all of the problems in a matter of a week or two. The
monitor and keyboard stands came from Humanscale, and the keyboard itself is
just a cheap MS Natural Keyboard. It isn't an ideal keyboard, (the mouse is
still way over to the right which hurts a little).

Hope that helps. Good luck!

~~~
apinstein
Reading other comments I see a lot of people recommending the short keyboards
to avoid reaching so far for the mouse. That is good advice -- I just have yet
to find a split-key that is short. But the one failing of my ergo setup is
where to put the mouse.

~~~
joe_the_user
I would recommend _never_ using a mouse in your daily computer use. I use a
laptop with trackpad. You might be able to find a keyboard with a built-in
trackpad but make sure it's centered the way a laptop's trackpad is center.
This is also why I think keyboard shortcuts are very important...

------
nradov
I had a similar problem many years ago. Switched to a Microsoft Natural
keyboard on all computers I use heavily and haven't had a twinge since.
[http://www.microsoft.com/hardware/mouseandkeyboard/ProductDe...](http://www.microsoft.com/hardware/mouseandkeyboard/ProductDetails.aspx?pid=022)

------
gtani
I've been fighting wrist pain for a while, mostly when i'm having to drive
more than an hour and a half a day; I recommend 3 exercises from here,
DynaFlex spining ball , power Web rubber net and wrist curl bar, AKA wrist
roller. Gave substantial relief after using 3-4x/week for 3 weeks.

[http://www.amazon.com/s/ref=nb_ss_0_12?url=search-
alias%3Dap...](http://www.amazon.com/s/ref=nb_ss_0_12?url=search-
alias%3Daps&field-keywords=wrist+strengthener)

Also, in your other daily activities, make sure you keep your hand in line
with wrist, i.e. top of hand in line with top of forearm, center of forearm in
line with middle finger. It's easy to cock your wrist at acute angles when
you're driving, riding a bike, using power tools etc, without noticing.

------
elimisteve
I had similar issues three years ago. I immediately switched from the QWERTY
key mapping to Dvorak and swapped Left-Control with Caps Lock. (For fellow
Linux users, that means running "setxkbmap dvorak option ctrl:swapcaps" every
time your system boots up.)

I also went back to using my (dominant) right hand instead of my left to move
the mouse. (I thought being able to do things with both hands was cool but my
left hand was so relatively weak compared to my right that I was holding the
mouse incorrectly, resulting in severe wrist pain).

The third thing I did was take vitamin B-12 supplements based upon something I
read online, but I'm not sure this had much to do with it.

As a result, the pain was gone in no time and I am still pain-free to this
day.

------
s3graham
Stop programming at home for now. I know, it sucks. TS.

For me, it seems to be tightness through my inner shoulder down to my elbow
and inside forearm that causes the problem. But, yours will surely be
different.

I really really really recommend going to see a physiotherapist. I was seeing
one due to having had knee surgery, and when I asked about arms/hands/wrists
he poked at me for about 3 minutes and was able to give me stretches that
solved the problem. I'd been numb/sore for 6+ months before that! Totally
ridiculous in retrospect.

I personally believe notebooks == bad too: smaller keyboard, trackpad,
hunching towards screen on your lap, etc. Too easy to do something that's
hurting you.

~~~
s3graham
Oh, and System->Preferences->Keyboard->Typing Break under Gnome, or workrave
for Windows.

Being interrupted every 30-40 minutes is irritating as shit, but if you
practice you can keep your flow alive by staring at the screen, keeping
headphones on, etc. while doing stretches for a few (5 or so) minutes.

------
paulbaumgart
I had severe wrist pain for about 5 months earlier this year, to the point
that I was seriously considering whether I had chosen the wrong career path
(I'm in the last year of my Computer Engineering B.S.).

So, I spent some time searching the web, and came across this link:
<http://podolsky.everybody.org/rsi/> which outlines some of Dr. John Sarno's
ideas on RSI, its psychosomatic origins, and how to treat it.

I doubt it's the right diagnosis for everyone, but I have to say, it worked
incredibly well for me- I've been pain-free for two months now, with plenty of
hardcore typing sessions in the meantime.

------
govandia
I had extremely bad arm and wrist pain back in the late 1990s. I started using
a touchpad with my toe because a mouse was too painful. I even dabbled with
voice recognition software for programming (pretty inefficient, as you might
imagine).

What finally cured me was a physical therapy book called "Pain Free: A
Revolutionary Method for Stopping Chronic Pain by Pete Egoscue"
(<http://amzn.com/0553379887>).

This book completely changed my life. The exercise can seem a bit odd, but
they worked amazingly well for me. I was almost completely back to normal
within a month.

------
setori88
* Start from your diet: <http://www.thechinastudy.com> * use dvorak keyboard layout * regular non-strenuous exercise every day for 15 mins

------
smakz
I had this problem too a few years ago. The main thing that happened to me was
that I used to wake up with numbness in my wrists. The steps I took which
helped were to get a vertically oriented keyboard and mouse. I currently use
these and the problem has not recurred in over two years:

<http://safetype.com/>

<http://www.evoluent.com/>

Although I do recommend you exercise more and have a more thorough evaluation
by a doctor, as others are recommending.

------
allenbrunson
advice in this thread is all over the place. that makes sense i guess, because
a lot of different things might work, depending on where the problem
originates. so i feel as qualified as anybody to throw my two cents in.

when i was younger, say up to my mid-twenties or so, my wrists were
indestructible. i routinely played games of asteroids that would last for
eight or nine hours, on one of the original atari stand-up game cabinets circa
1980, that applies just _slightly_ less force than necessary to actually snap
your wrists in half. at the time i wasn't even aware that the game was an
ergonomic disaster, such was the power of my wrists.

fast-forward to the year 2000. i am now almost 40. i went to california
extreme (www.caextreme.org -- great fun if you're into that sort of thing),
and they of course had several asteroids machines. i was able to play about
five minutes before my wrists were absolutely on fire.

same thing started happening to my mouse wrist, at about the same time. i was
all of a sudden acutely aware of all the cables and tendons in there, groaning
under the pressure. my wrists would sometimes go numb.

now that my wrists were forcing me to concentrate on them, i noticed that i
almost always had my entire forearm really tensed up and cramped while typing
and mousing. it had never been a problem before, due to my younger super-
wrists, but now it was.

so all i had to do was take it easier on myself. notice when i'm tensing up,
and stop it. along with the usual stuff: take a break every few hours. get up
and think about something else.

------
codedivine
1\. Get a good keyboard. Microsoft Ergonomic Keyboard 4000 is what I use.

2\. Use Vim as text editor.

3\. Use left handed mouse at least occasionally. Keyboards are typically
longer on the right hand side due to number pads so that places mice at a odd
angle at times.

4\. Though you have already adjusted your position, just ensure that your
hands are not at extreme angles.

edit: I too had wrist pain and after doing the above changes, I dont have
wrist pain anymore. YMMV obviously depending on what is causing your pain.

~~~
apalmblad
As far a number 1 goes, I experienced wrist pain the most consistently when I
was using a curved ergonomic keyboard. Based on my personal experience, curved
keyboards aren't the best route for everyone.

However, good point about Vim - cutting down on the need to switch from
keyboard to mouse and back also seems to help with my wrists.

~~~
ash
Another advantage of Vim is that it lightens the load on little fingers. You
don't need to press Ctrl or Alt very often. Compare with Ctrl-N, Ctrl-P,
Ctrl-F, Ctrl-B on Emacs...

------
simonw
Go to a physio. My girlfriend had exactly the kind of problems you describe -
it got to the point where she couldn't physically type (or do anything with
her hands) and she had to take six weeks off work. We tried a few and
eventually found a fantastic physiotherapist who fixed her over the course of
about six months - she can type for 7 hours a day now. This kind of thing CAN
be addressed, but you need professional help.

------
pxlpshr
I've had pretty good success with the Power Ball.

<http://www.powerballs.com/rehab.php?m=Benefits>

------
palish
I got a pair of "computer gloves" -- basically gloves with a beanbag under
each wrist. They're very comfortable and almost entirely cured my persistent
wrist pain.

You have to give the gloves a chance to work though. For me, the pain went
away after a week or two of constantly wearing the gloves each time I used the
computer.

~~~
holygoat
An alternative is _don't rest on your wrists_. :)

It's hard to do, though!

~~~
palish
I'm sure that's why my wrists hurt. It's such a habit though that I doubt I
could retrain myself after years and years of typing and mousing this way.

------
thangalin
Neck pain might be exacerbated by micro-movements required to maneuver a
mouse. Get a trackball, like Logitech's Marble Mouse. X configuration is at:
<https://help.ubuntu.com/community/Logitech_Marblemouse_USB>

------
hellotoby
I have moderate arthritis/rsi in my wrist from a bone graft when I was
younger. I've found the best way to minimise soreness is to use a Wacom tablet
in replacement for a mouse. Using a pen-like implement, whilst taking a while
to get used to, is much better for your wrists than using a mouse.

------
stse
You need to switch doctors to someone who takes your problem seriously. And
you need to start to take it seriously yourself. Don't do anything until you
have a proper diagnosis, chances are you'll just make it worse.

------
csomar
I had a similar problem few years ago, my resolution was to take a rest every
50 or 40 minutes. This mean, don't stay in front of the computer more than 2
hours without moving that's too bad.

------
wehriam
I moved from a normal sized mouse to a "portable" mouse and relieved a number
of similar problems. Since a move to a Macbook Pro trackpad it hasn't been an
issue.

------
grandalf
I've noticed that using the trackpad or mouse is far worse on my hands than
typing... Switching to emacs and mostly using the keyboard has helped
tremendously...

------
carbocation
Can you be very specific about the location of the numbness? In particular,
does it appear to affect certain fingers more than others?

------
jballanc
Dvorak

~~~
matt1
I've read mixed reviews of the Devorak keyboard, though I suppose its worth a
shot. Has anyone else had success with it?

~~~
adg
Some people claim learning Dvorak will actually slow down your typing speed on
a QWERTY keyboard. Since typing is mostly done with muscle memory, knowing two
layouts creates a bit of conflict when your brain tries to decide which finger
to use to type a letter.

That said, you only run into that problem if you're forced to switch between a
QWERTY and Dvorak layout often.

~~~
eru
> That said, you only run into that problem if you're forced to switch between
> a QWERTY and Dvorak layout often.

I do switch often - mainly because other people's computer do not tend to have
Dvorak activated on them. It's not much of a problem. Though I do get slower
when I haven't used a layout for some time and have to get used to it again.

------
mark_l_watson
Use ice and ibuprofen to reduce swelling - once swelling is reduced, things
get better. (At least this was my experience.)

------
mathgenius
"the discomfort was so intense that I switched hands"... Is this a mouse
problem ? 3M ergonomic mouse is fantastic.

------
quellhorst
Wrist pain is what caused me to switch to dvorak 5 years ago. It has been
worth it.

------
onk
<http://www.workrave.org/>

------
timcederman
3M ergonomic mouse.

------
steve19
switch your mouse to your other hand. Worked for me.

~~~
holygoat
It will allow your body to mask the problem for another few years, yes.

It would be foolish to treat it as the only solution.

(I did much the same thing, but that's because I totally ruined my right wrist
by working through searing pain. I needed at least three years for my right
wrist to recover to the point that I could use it to mouse at all.)

------
moron4hire
I would say you have spun AIDS

~~~
tomjen2
Don't down mod the parent - he is only referring to the old comic about what
happens when you ask medical advice on a forum.

In this case, I think he is wrong though - the people on this board knows more
about this particular aliment than do most doctors.

------
reg4c
Surgery.

