
Ask HN: Does anybody else get bad carpal tunnel/RSI? Any tips? - nikcub
I have been getting very painful and numbing carpal tunnel in my right hand. Struggling to type this atm.<p>Anybody else? Any tips?
======
metageek
There's lots you can do. First: stop typing. Get voice recognition software.
It is possible to program with VR; I did it for a year or two, by using
ViaVoice's Java bindings to control emacs. (I stopped when I no longer needed
it, not because it didn't work.)

Second: get a good keyboard. The Kinesis is a good first step. You may find
that curved keyboards like the Microsoft Natural don't work for you--when I
tried one, it required me to stretch my fingers further, which hurt more.

Third: find a doctor. (Actually, call the doctor first; but you should be
helping yourself while waiting for the appointment.) If you're in the Seattle
area, I can recommend Dr. William Ericson [1]. He did my surgery (years ago,
before he moved to Seattle). Some time back, he figured out that a lot of the
patients he was seeing, who weren't responding to carpal tunnel treatment, had
something in common: extra ligaments near the elbow that pinch the nerves that
go through the carpal tunnel when you turn your hands face-down. He can cut
those ligaments--they're totally unnecessary; 75% of the population doesn't
have them--and the problem goes away. Worked for me--very minor surgery; I was
conscious for the whole thing.

[1] <http://www.wbericson.org/>

------
KirkWylie
1) Go to a doctor, and get diagnosed as to how bad things have gotten. You
catch it early, and you just change behavior. A little later? Cortisone
injections. Too late? Surgery that may cripple you. 2) Get your doctor to get
you to a physical therapist that specializes in this. When I did mine I was in
Silicon Valley and they were everywhere, but where you live YMMV. 3) Listen to
the physical therapist and do what he/she tells you. _ignore everybody else
here._

For me, my #3 was "Code only, exclusively, and forever on a Kinesis Ergo or
Maltron Keyboard, and never, ever, ever, for any reason, use a mouse; only a
Logitech Marble Mouse". That might be the right story for you. It might not.
My particular problems are with the messed up way I type on a flat (or flat-
ish) keyboard, and wrist pronation from bad mouse usage.

Here's the thing: _My Symptoms Are Useless To You_. As much as this thread
could turn into 50 people recounting their RSI stories, it's rubbish to you.
Follow my #1, #2, and #3, and you'll be fine. Ignore any of them, for any
reason, and you may cripple yourself.

There's a time and a place for "Ask HN". This isn't. This is a time a place
for "Ask a bloody Doctor".

~~~
iuguy
This is precisely what I came to post. I average 60 WPM for 4 hours a day
straight on some days, so I inevitably get it but not as bad as most.

I'd go as far as to say stop what you're doing and move away from the
keyboard, make an appointment to see the doc. Every second the poster is here
they're just exacerbating the problem.

------
nikcub
Update: thanks for all the comments, absorbed a lot of info.

This post was v interesting:

[http://aaroniba.net/articles/tmp/how-i-cured-my-rsi-
pain.htm...](http://aaroniba.net/articles/tmp/how-i-cured-my-rsi-pain.html)

check if out if you haven't read it. I am ordering the book today.

The author of that post talks about a pain that is difficult to distinguish
from a sprained wrist or ligament damage. Mine is very different - it is a
numb sensation that has a tendency to move around from the wrist, elbow and up
into the shoulder.

I ended up going to emergency and getting a cortisone shot, which helped a
lot. What I found out that RSI is a cause, pain or numbness are the symptoms,
but the root problem can be any number of things. It is best to get it
properly diagnosed by a doctor and there is a bit of trial and error involved.
At the moment the cortisone is simply treating the symptoms.

I also found that rest doesn't help. I had the flu for 3 days earlier this
week and I worked very little during that time - but the pain persisted. The
first signs were a week ago but it really flare up last night and today. It
was the worst only a few hours after getting back into work after being ill.

I adjusted my ergonomics a while ago - I went from constantly being in a
leaning back and feet up position with keyboard on my lap to having my feet
planted, arms straight etc. Changing this still didn't prevent the most recent
flare-up.

Thanks again for all the info, comforting to know that there are a lot of
other ppl who experience similar problems and a lot of people have experiences
that they shared.

------
pivo
I did have this problem in the past. I fixed it by switching to a Microsoft
Natural keyboard (the $40 one). That got rid of the problem for me after about
three days.

At first I thought the improvement was due to the ergonomic form of the
keyboard, but after using my MacBook Pro's built-in keyboard for months with
no pain, I now think that my problem was just that my original cheap, foam-
sprung keyboard was just awful for typing. So maybe the answer is to just get
a better keyboard.

Additionally, posture and angle of forearms to the keyboard surface is also a
factor with any keyboard. Your forearms should be parallel to the ground and
your keyboard flat, at least that's what works for me. If your chair is too
low this might be forcing you to contort your hands in order to type.

For example, my MacBook Pro's keyboard works fine for me, but the external
Apple wireless keyboard (with the same type of keys) causes RSI very quickly.
Since the keys are essentially the same on both, I'm sure that this is because
the external keyboard is angled (higher in back where the batteries go) while
the laptop's keyboard is flat.

------
shrughes
I got a piano and started playing difficult pieces on it. The pain and
inability to squeeze things went away utterly completely.

------
wglb
I have had two runs of hand/finger pain. The most recent bout was the result
of using a mouse and a not-very-good keyboard. I threw out all the mice and
got a trackball and use it with my left hand, even though I am right-handed. I
acquired a Kenisis keyboard and use that. I also paid attention to my wrist
positions, and the height of the chair. Over the period of many months, the
pain slowly went away and now there is none. I still use the left-handed
trackball and at home I use an Avant Prime (remember the omnikey/Northgate
keyboards?) and so long as I keep the wrist position good it works. At work, I
have the kenisis.

(I used to have a kinesis at home, but an errant cup of tea (with honey) kinda
put an end to that one. Now I do more typing at work.)

Dvorak would have not helped in this case. It was all about gripping the mouse
and bad wrist juju while typing.

------
arn
I had some issues that I localized to my right index finger. I apparently
click a lot. So my mouse was the main issue.

I did end up buying a MS ergonomic keyboard which I liked, but ultimately, a
new mouse is what was the best solution for me.

[http://www.amazon.com/3M-Ergonomic-Mouse-SMALL-
MEDIUM/dp/B00...](http://www.amazon.com/3M-Ergonomic-Mouse-SMALL-
MEDIUM/dp/B00008KWWG)

(note it comes in large also). I tried a couple of other designs, but I liked
the 3M one the best. It's weird at first, but works well. Thumb for left/right
click. I also use the button that's on the stick for scrolling. It's sort of a
grab and scroll motion, that works really well. I had to use a utility to
implement it: <http://www.marcmoini.com/sx_en.html>

------
laika4000
I'm a technical writer and always treated rsi as an unavoidable occupational
hazard. Then I read this: [http://aaroniba.net/articles/tmp/how-i-cured-my-
rsi-pain.htm...](http://aaroniba.net/articles/tmp/how-i-cured-my-rsi-
pain.html)

What worked for him also worked for me.

------
justrudd
There is no one magic bullet for RSI. Mine got so bad that I've had the
surgery for it. And that hurts. Or maybe I just have a low pain threshold. But
after the surgery, it was fantastic. If you can afford it (i.e. insurance or
have the money), I'd highly recommend you go to a doctor. It might not require
surgery and only physical therapy. After my surgery, my physical therapist and
I came up with the following list for me. YMMV.

Use a keyboard without the number pad. With no number pad, your hand doesn't
have to move far from the keyboard to get to the mouse (trackball in my case).

I've got foot pedals programmed to be the control and alt keys so I don't have
to move my fingers off the main keys at all (except for shift. I never could
get used to using a footpad for shift). I've been experimenting with a foot
pad for backspace as that is the longest throw I have right now.

Exercise your fingers. Get one of those stress balls and squeeze it. For a
long time, I used electronic todo lists or wrote pseudo-code in VIM when
thinking about an idea. Now I use notebooks, and I've taught myself to write
with both hands (left hand is weak hand. I can read it, but no one else can
:). So when I'm stuck or need to make a list, I'll write out what I need to
accomplish. I'll squeeze the ball with whatever hand I'm not writing with.

Stretch your fingers and wrists. Before I start work in the morning, I'll
stretch my fingers and wrists for 10 to 15 minutes.

I've got a stopwatch to time myself. I'll only code for 1 hour and 50 minutes.
Then I'll stop, do nothing for 10 minutes (absolutely nothing. I'll just sit
with my eyes closed. If I'm pairing, I'll turn over the keyboard), and then do
my stretching exercises for 10 minutes.

One of my biggest contributors was posture. I'd sit slumped so my arms were
way higher than they should have been. I've now taught myself to sit upright.
I still slip at this sometimes, but I can generally catch it before I've done
it too long.

Like I said before, those items helped me. I came up with that list with the
help of a physical therapist that watched me work and made suggestions. Some
of them may or may not work for you.

------
sainttex
Yes, it's the worst. My sister and another friend have it pretty bad from
working in a coffee shops. Mine hasn't been bad, just a little uncomfortable
at times.

It can help when it's really bothering you to wear wrist braces at night to
make sure there is no movement and give the inflammation some time to go down.
The only other fixes I've been told are regular wrist exercises and obviously
making sure your work area is ergonomic. Have a look at some example exercises
online, building up certain muscles can drastically help you out.

Good luck with it, hopefully you find something that helps.

------
curt
Used to have it really bad then started doing more pull-ups and push-ups to
strengthen the forearm muscles. While I still have occasional discomfort, the
pain has disappeared.

~~~
imp
Same here. As soon as I started a basic weightlifting program, my mild pain
disappeared.

------
bdarnell
Right-hand-only pain is likely to be mouse-related rather than keyboard-
related (assuming you mouse right-handed). Try different pointing devices and
see what feels best for you. I switched to a trackball (currently a Kensington
"Expert Mouse") years ago at the first sign of pain, and haven't had any
trouble with my mousing hand since. (I also use a Kinesis keyboard, and highly
recommend it especially for emacs users to move the modifier keys to your
thumbs)

------
Travis
I notice it starts to come on from time to time. Starts with dull pain in the
outside area of my wrists (wrist/arm juncture on the pinky side of the hand).

Icing at night works wonders for me. RSI can be due to inflammation in the
tendon sheaths. Put an incepack (I wrap my in ace bandages to keep them on)
for 15 minutes every couple of nights. Don't ice too long, don't let the ice
touch your skin, or you'll risk some cold burns.

------
deathflute
I was having severe pain with this last month. Some steps that I took that
have helped -

1\. Minimize computer usage - the best way to deal with RSI is to rest your
hands. So if you are doing something at the computer that you can avoid, stop
doing it.

2\. Avoid using a laptop keyboard/trackboard. Most of them are ergonomic
disasters. I use a kinesis advantage pro now.

3\. Mild exercise like yoga or cycling.

4\. xwrits to take frequent typing breaks.

------
koichi
You could try a different keyboard layout. Dvorak is pretty good, and there
are a couple others as well:

<http://en.wikipedia.org/wiki/Dvorak_Simplified_Keyboard>

Won't help your current symptoms get better, but could help in the future.

------
shard
Here's a list of things you can try: [http://blog.chromarati.com/2010/04/rsi-
my-problem-child-10-t...](http://blog.chromarati.com/2010/04/rsi-my-problem-
child-10-tips-for.html)

------
steve19
About once a year I get it badly in the wrist I use with my mouse.

Switching the mouse to the other side really helps. Slowly it goes away.

------
cjtenny
I started getting it in the 8th grade, and this is what I've done to this
point (sophomore year of college):

-In 10th grade, I switched to Dvorak, more-or-less on a whim. After two painful weeks of hating using a computer, I was semi-fluent in typing and could resume normal use. The key was forcing myself to use it for everything. Although this may be wishful thinking, I feel I have become able to type much more comfortably while using Dvorak, and my wrist pains lessened for a few years.

-I have tried to remove the mouse from most of my workflow; I do this primarily by using keyboard shortcuts and Emacs, although last week I started learning how to use vim because A) (proficiency with) two editors are (is) better than (proficiency with) one, and B) its commands seem shorter, which I think might help.

-When I do use a mouse, I now use an Evoluent vertical mouse; this has been one of the most important changes, and relieves much of my wrist pain. I've realized now how unnatural it is to have your hand flat while mousing.

-This summer, I used a Kinesis Advantage Pro contoured keyboard, and pending financial feasibility (e.g. I'm a college student and I owe $23,000 next month) I'll be buying one for my desk; that thing worked wonders.

-In the meantime, I use a Microsoft Natural 4000 ergonomic keyboard, which helps; I'm looking into cutting off the numpad so that the mouse isn't so far off to the right. It's been done before, there are resources online; it's not that hard.

-I've migrated much of my work to a standing desk; this makes it much easier to get proper posture (IKEA Fredrik desk). I have several barstools I can lean on or sit on at the proper height, if I need to rest, although I find I'm more productive standing.

-I stopped playing video games. (The pain persisted, but video games were the worst transgressor) (I didn't play much, but tetrinet / puyo puyo / etc can be pretty nasty to your hands and wrists)

Of course, all of these things probably have the sum usefulness of taking
regular typing breaks and doing the proper stretches, which a doctor I met
with years ago told me I should do; however, I've found myself to be quite bad
at keeping up with that, both enforcing breaks and doing stretches for the
duration. I like all of these options because once I set them up, I don't have
to do anything (or at least, very little) to maintain (in my opinion) healthy
habits for my wrists.

Maybe someday, though, typing breaks and stretching. Never push through the
pain; it'll only make it worse next time. When it gets really bad, step back
and stop. I never take Advil or any anti-inflammatory for the pain because I
don't want to power through it and do damage when I should've listened to my
body.

