
How I Beat Repetitive Stress Injury - henrik_w
http://henrikwarne.com/2012/02/18/how-i-beat-rsi/
======
graeme
I had pain in my right hand, that I fixed with trigger point therapy.

Using a mouse, typing, or using an iPad all made the top of my right hand hurt
and feel very tired.

The trigger point therapist pushed on a few points in my forearm. When
pressed, I could feel tension in the usual spots on my right hand.

Having found the right spots, the therapist simply pushed on them really,
really hard, and maintained the pressure. It hurt, but immediately afterwards
my hand was useable for everything except the iPad.

I went in for another session a few months later, he found another small spot
that again referred pain to my hand, and after that session I could use my
iPad normally.

It's a year later, and I'm totally pain free. If you have an insurance plan
that covers trigger point therapy (most likely under "massage"), you should
definitely try it.

Note: It can be hard to find a good practitioner. I'm not talking about deep
tissue massage. Trigger point therapy is sustained applied pressure more than
massage. The technique should hurt if it's being done properly, but the
results are worth it.

~~~
lutorm
Trigger point therapy has made a world of difference for me, too, both for RSI
and for neck problems due to and old motorcycle accident. Check this out:

[http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-
Tr...](http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-
Treatment/dp/1572243759)

I was first introduced to it by a physiatrist (no, not psychiatrist), which is
a real MD. They had a team of essentially physical therapists that worked on
trigger points. Even if your insurance doesn't cover massage, most will cover
visits to such places, since it's under the care of a doctor.

~~~
graeme
I may get that book.

Also useful is a theracane. Lets you self-massage and apply trigger point
therapy to your back and other hard to reach areas. Not too expensive either,
only $40. It helped clear up a tight trapezius muscle which was causing a
shoulder ache.

<http://www.theracane.com/index.html>

(this was recommended by the same therapist who helped my hand)

~~~
lutorm
Yeah, the Theracane is pretty good. My favorite gadget for forearm trouble is
the ArmAid: <http://armaid.com/> It's very good for kneading your forearm
extensors and flexors. When my forearms get tight, a few sessions with this
usually fixes it.

~~~
graeme
wow, I'm glad I posted, that looks to be very useful. Do you need the leg
strap, or do you just balance it on your leg?

~~~
lutorm
I never use the leg strap, personally, though I can imagine that, if your
hands are in bad shape, it would reduce the force needed to hold it in place.

It's actually also really good for kneading your calves for people like me
that have perpetual trigger points there. It's a bit undersized, so I've been
meaning to email them and suggest they make a "LegAid" that's larger and more
robust...

------
eps
It's all in your head. This is a must read for any _stressed out_ programmer,
founder, new parent -

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

~~~
snowmaker
Please, everyone reading these comments, read the above linked article.

If you have not read about the psychosomatic theories of RSI and are affected
in any way by the disorder, you owe it to yourself to read this article before
you spend the rest of your lives blithely following unproven advice about
ergonomics.

There is very compelling scientific evidence that suggests that the accepted
medical hypothesis connecting RSI, ergonomics, and typing is flat out wrong.
Read the article and if it piques your curiosity, do what you do best as
hackers and evaluate the evidence and decide for yourself.

~~~
nessus42
_unproven advice about ergonomics_

What makes you say that such advice is unproven? I know many people, myself
included, who had serious RSI problems. _Everyone_ I know, including me, who
addressed their ergonomics, and perhaps also did some physical therapy, has
seen massive improvement.

~~~
nvarsj
I think his point is that there is no scientific evidence linking ergonomics
to RSI. So it's possible that your belief that improved ergonomics improved
your RSI is the placebo effect in action (which is remarkably powerful!).

~~~
nessus42
_"The National Academy of Sciences and the Institute of Medicine recently
released their long-awaited report on Musculoskeletal Disorders and the
Workplace. The report, requested by industry groups and conservative
Republicans who opposed an OSHA ergonomics standard, finds that there is
strong scientific evidence showing that exposure to ergonomic hazards in the
workplace causes musculoskeletal disorders and that these injuries can be
prevented. Prepared by some of the world's top scientific and medical experts
in ergonomics, the report calls MSDs an important national problem and
strongly supports the approach that OSHA took in its now-defunct Ergonomics
Program Standard. This is the third comprehensive review of the scientific
literature in the past four years that has come to the same conclusions. The
National Institute for Occupational Safety and Health (NIOSH) published a
comprehensive review of the data on the relationship between MSDs and the
workplace in 1997. The NAS also came to similar conclusion in an earlier
report published in 1998. The NAS report puts to rest, once and for all, the
claims by some industry groups and conservative Republicans that there is no
scientific evidence that workplace exposures cause musculoskeletal disorders.
It shows without question that an OSHA ergonomics standard is needed and
justified."_

If you ask me, any claims stating that there is no scientific evidence that
ergonomics is linked to RSI are abuses of science of the kind put out by the
cigarette industry. It is bad science by those who want to create FUD about
the proper remedies. It is a cynical agenda by those who would rather treat
employees as disposable, rather than spending a single penny to help their
employees continue on with their means of feeding and sheltering themselves.
And then the same such cynical people, after putting employees with such
ailments out on the street want to tell them, "Just get a job!"

------
zdw
I find trackballs where the hand rests on top and the ball is manipulated only
with the thumb are much better than mice and trackpads for cursor movement.
Our fine motor skills are more refined in the thumbs, not in the fingers or
forearm, which is something video game controller vendors have known for
years...

Logitech makes these - this is the newest version:
[http://www.logitech.com/en-roeu/mice-
pointers/trackballs/dev...](http://www.logitech.com/en-roeu/mice-
pointers/trackballs/devices/7365)

They've been making variations on the same thing since the early 90's - I have
an ancient Mac ADB version in beige somewhere around here, which predated the
invention of the scroll wheel...

~~~
varelse
I humbly suggest the cheaper model: [http://www.logitech.com/en-roeu/mice-
pointers/trackballs/dev...](http://www.logitech.com/en-roeu/mice-
pointers/trackballs/devices/4786)

The high-end model just didn't work for me.

~~~
zdw
That model still uses the forefingers to move the mouse.

While I've tried those, I've never found them to be comfortable or functional.

To each his own, I guess.

------
tsuraan
I tend to get considerable pain in my forearms when I've been typing too much
for too long, and I've found the easiest thing that helps is rock climbing. As
little as an hour a week is enough to keep the pain and discomfort away, and
it only takes two or three times of doing it after a "break" before the pain
is gone.

I'm not sure why adding more muscle strain to the equation (when I'm in shape
I climb 5.10/low 5.11) helps, but I've read that it's important to balance
strength with agility, so maybe that's related somehow. Anyhow, climbing is a
ton of fun, and anybody with bad RSI who's already using a trackball and an
ergo keyboard should give it a shot.

~~~
varelse
My guess: you're stretching the muscles overall and strengthening the ones
that get neglected while you type. You're not far off from my own approach of
lifting weights and using an elliptical to shake off the pain. Finally,
there's probably some endorphins in the mix...

------
omegant
Has anybody read "pain free" by Pete Egoscue? His aproach is that due to the
continuous bad position certain back and shoulder muscles become weak and the
other (not properly suited) have to make the force of the original ones. They
finally contract or create pain due to the forced possition( take this
explanation with a grain of salt as is from memory). He gives some easy
exercices to recover the possition and strengthen the muscles. It is very
straight forward. BTW he is no MD, but the system seems to work. Just as a
note my wife is reumatologist and used to be very sceptic of this kind of
"structural" theories, as there is very little of this on the medic
literature. Now acter trying some of them herself, she thinks they have their
place for some kind of pains. ( caveat this only a n=1 enviroment). I think is
worth a shot.

~~~
nessus42
I haven't read this book, but had terrible back pain due to these very issues.
Certain muscles in my back had atrophied to the point that I could not hold my
shoulders down and back without a lot of strain to do so. This resulted in a
great deal of tension in my neck and other muscles that had to take up the
slack. I went through physical therapy to strengthen the back muscles that had
atrophied. The exercises were very hard and rather painful, but after several
months, they worked like a charm.

------
white_devil
I had (1) RSI too. The solution is in ergonomics, not a new mouse or keyboard
or wrist support or whatever.

It's all about the way you sit in front of the computer.

Your wrists should be around elbow-level or a little lower when typing, your
feet should be on the floor, and the upper half of your screen should be
roughly at eye-level or a little below.

All of this is affected by the height of your desk, your chair, and of course
your monitor.

    
    
      - Are you using a laptop and looking downwards at the screen? -Expect neck pain. 
      - Are you sitting too low? -Expect pain in your forearms.
      - Are you sitting too high? -Expect wrist pain.
    
    

1) I still kind of have RSI. If I'm doing something wrong, my forearms get
irritated quite fast.

------
ChrisLTD
I posted a similar story here on Hacker News last week:
<http://news.ycombinator.com/item?id=3592000>

Long story short: Using keyboard shortcuts and taking frequent breaks helped
reduce the tension and pain I was getting from long hours at the computer.

I highly recommend AntiRSI if you're looking for a Mac OS X utility to remind
you to take breaks:
[http://itunes.apple.com/us/app/antirsi/id442007571?mt=12&...](http://itunes.apple.com/us/app/antirsi/id442007571?mt=12&partnerId=30&siteID=cxyf8xxWmGo)

------
AJ007
I've spent thousands of dollars on ergonomic keyboards and chairs. In the end
all of them were nothing more than a crutch.

Here is the comment I left on the original blog post, since I think most
readers will miss it; I've shared this before here to one degree or another:

I can one up you on this, I cured my RSI.

My story is similar to yours (short of the rolfing and acupuncture.) Around
2005 developed extremely painful RSI. Just using a non-ergonomic keyboard hurt
like hell within 10 minutes. The only thing that really helped was limiting my
work and typing.

That was, until I started doing body weight exercises back in late 2010. Back
in 2005 when it hit me hard I was lifting weights regularly. That led me to
believe that the weight lifting was at least half responsible. I backed off
all upper body strength training completely. I felt like I was physically
damaging myself when I did.

I wanted to build up some basic strength so I got this book “You Are Your Own
Gym.” I hadn’t done a pushup in years so I started out doing them against a
wall. By the end of the month I was doing normal pushups no problem. Then one
day I got really sick and sat in bed on my laptop. Hours in I realized I had
no pain whatsoever. It was mind blowing. Just months earlier things had
progressed so my hands were partially numb _all_ of the time.

Its been over a year and a half now. I had a few tiny incidents were I
developed minor pain. I can do pull ups all day long. I can do clapping
pushups. I can do handstand pushups. No wrist pain using a laptop 12 hours
straight. I was really cautious saying this at first but I’m pretty sure now
that I’m cured — assuming I get up with my workouts.

~~~
bmohlenhoff
I've had a lot of success keeping my hands and wrists in shape by doing a
couple of fingertip pushups every day. If you can't support your bodyweight on
your fingers, do them against a wall or put your weight on your knees instead
of your feet.

------
nessus42
Here's what worked for me to cure my RSI:

(1) Kinesis Contour Keyboard.

(2) BodyBilt ergonomic chair with linear tracking arms.

(3) Stretch Break, a program which stops you periodically to do some
stretches, which are illustrated by computer animated figures.

(4) Physical therapy to identify muscles that had completely atrophied in my
back and to do (hard!) exercises to build them back up.

I'm sure I would have had to go on disability without these things, but I've
been fine now for the last 18 years.

~~~
georgieporgie
I love my collection of Kinesis contoured keyboards. I have one huge grip with
them, though: the function keys are spongy and too closely spaced. I regularly
hit F1 when I meant to hit Escape. Do you (or others) find this irritating as
well? It would be a flawless programmer's keyboard if only it used regular,
evenly-spaced, mechanical function and escape keys.

~~~
nessus42
Yes, the function keys suck, but I don't use them all that much, so it's not
so bad. Also, I mapped Esc onto one of the thumb keys.

My bigger gripe is that it sometimes misses _up_ -key events, so a key will
start repeating, or the Alt or Shift key will be virtually stuck down. All it
takes to fix this is to press the key in question, but that's a pain in the
butt. I've complained to Kinesis, but they claim to have never heard of the
issue. This despite the fact that it happens on all of my Kinesis keyboards,
and all my friends with Kinesis keyboards complain about the very same issue.

On the other hand, these issues are a minuscule price to pay for how good the
Kinesis keyboard has been for my hands. More than anything, I credit this
keyboard for allowing me to continue to be gainfully employed.

I've recommended this Keyboard to a number of my friends when they've started
to have RSI problems. At first they always call me back in a couple of weeks
and tell me that they can't believe I recommended this terrible keyboard to
them. Then a year later they call me back and thank me profusely for having
saved their hands!

Where I work, half the people in my group use them, and they all came to the
Kinesis keyboard independently. Everyone who uses one loves them.

~~~
georgieporgie
_I mapped Esc onto one of the thumb keys._

That's a good idea, and one I hadn't thought of. Which one did you give up?

 _My bigger gripe is that it sometimes misses up-key events_

I experience that fairly often with this particular keyboard, with the shift
key. They have a note on their website about it[1]. Another not-uncommon
problem is for a vertical row of keys to go out. I think that's due to a
failing PCB trace. I've had keys get flaky on one side or the other, and it
turned out that the ribbon cable connecting the hand pocket had wiggled a bit
loose, so it was an easy fix. The worst problem I've had is when one of my
keys just stopped working altogether. I emailed Kinesis and they sent me four
or five Cherry MX switches, no charge. Ten minutes with a screwdriver and a
soldering iron, and it was fixed.

 _recommended this Keyboard ... they always call me back in a couple of weeks
and tell me that they can't believe I recommended this terrible keyboard_

I should probably mention my own experience, for the benefit of HNers. When I
first bought the keyboard, it seemed awful and I regretted wasting so much
money. I went from being an 80-100 wpm typist to a snail's pace. I had to
interrupt my muscle memory and force my fingers to their new positions. It
wasn't as bad as learning to type the first time, but it was tough. Learning
to use the new arrow keys (two rows under home row, no hand movement
necessary) was mind-bending. My wrist pain actually _increased_ for about two
weeks.

After that, it became more natural, and I started to appreciate how smooth and
consistent every key was. Spreading more responsibility to my thumbs, and
changing the vector of thumb pressure began to feel much better.

I always warn people that the first couple of weeks will be difficult, and not
to switch in the middle of a work crunch. :-)

[1] <http://www.kinesis-ergo.com/tech_support/trouble.htm#q5>

~~~
nessus42
>> I mapped Esc onto one of the thumb keys.

>> That's a good idea, and one I hadn't thought of. Which one did you give up?

I have done a bunch of remapping. I

(1) mapped Esc onto End so that Esc is on my thumb.

I can still do Home and End by going into Keypad mode, but I don't use these
keys too much.

These are other remappings I did:

(2) Reversed up and down arrow so they match vi cursor movement. (I don't use
vi, but gmail uses the vi mappings for up and down.)

(3) Put Meta (aka Mac's Option) (for Emacs) on Home and Page Up so that I have
a meta key on both thumbs. Put Page Up on Right-Alt so that I still have a
Page Up key.

(4) Swapped Delete and Tab so that Tab is on my thumb.

I think that's about it.

------
TheFuture
I started wearing one of these while I'm working

[http://www.amazon.com/Mueller-Reversible-Splint-Wrist-
Brace/...](http://www.amazon.com/Mueller-Reversible-Splint-Wrist-
Brace/dp/B001ICYL1S)

Mueller wrist brace with splint

It only worked with a full-size keyboard and mouse. I can't wear it while
typing on my laptop. I'll occasionally pop an Aleve in the morning if my
forearm is bothering me.

Previously I was having occasional numbness and tingling in my right wrist.
That has gone away.

Doc also suggested wearing a soft wrap on my wrist at night. Keep the area
warm to promote healing, and keeps it in a relatively neutral position to
prevent further inflammation.

[http://www.amazon.com/Mueller-Wrist-Support-Wrap-
Black/dp/B0...](http://www.amazon.com/Mueller-Wrist-Support-Wrap-
Black/dp/B000UTI6KW)

I also have started lifting weights, though my doc said that could actually be
putting further strain on the area. I think that was the case at first, but
now I feel like my arms are strong, but more importantly my core and upper
body and back are stronger. Helps with posture, and a lot of times the root of
the wrist pain originates with other parts of you body being in a poor
position all day. (skip the isolation exercises and just do compound
exercises, especially deadlifts, probably the most underrated and unsexy, but
its one of the best exercises)

Make sure your desk is low enough. It was subtle, but lowering it an inch put
a lot less pressure on my forearms and less reaching.

And I drink a ton of water all day, which ensures I get up at least once an
hour to pee or fill my water bottle. As others have said, taking breaks could
be the most important.

------
steve8918
Near the beginning of my career, I started getting really bad pain in my
wrist, arms and back, and numbness down my right arm. I went through all the
requisite things like the OP, even going to a rheumatologist, and nothing
worked, and I was worried that my career was going to be cut short from this
problem.

But the question that really bothered me was why I could spend most of my life
writing for hours at a time with a pen, and not have similar problems.

I figured out, at least for me, was that the problem was my mouse. The way the
current mouse is designed is to have your hand flat with the tabletop. When
you use a regular pen, your hands are almost perpendicular to the tabletop .
Your hands normal position relative to your body is essentially at a 90 degree
angle to your body.

When you use your mouse with your hands flat to the table, it cause you to
twist your hand out in a completely unnatural way and your elbows tend to
flare out from your body, for hours at a time, and it pinches and eventually
hurts some of the nerves in your arm and write.

My solution was to hold my mouse in different manner, with my thumb almost
near the top of the mouse, and about half of my hand on the right side of the
mouse, so that my hands were at an angle to the table. It also allows me to
keep my elbows flush against my body instead of flared out. It's a similar
hand position to how the trackball mice are, but I get away with using my $10
wired mouse.

I also switched to the original Microsoft Natural Keyboard (and I still use
the same one today despite several drink spills).

This was roughly 15 years ago, and I haven't had any problems since. I work at
my desk for hours at a time, without any breaks, and I'm generally okay,
except for the weight gain from my sedentary lifestyle.

~~~
joemoon
I use the evoluent vertical mouse for this reason:
[http://www.amazon.com/Evoluent-Vertical-Mouse-Right-
Handed/d...](http://www.amazon.com/Evoluent-Vertical-Mouse-Right-
Handed/dp/B00427TAIK/).

It has been fantastic (though I have the 3rd gen model).

------
pasbesoin
I've switched to using a laptop style, short-travel keyboard. As a matter of
fact, I just stocked up on some spares, anticipating the product's inevitable
demise.

I also have a comfortable but firm 3M gel palm rest (I don't actually rest my
wrists on it). No longer sold -- of course.

I was finding the normal keyboard stroke length -- combined with the
increasing binding during travel that inevitably occurs with today's budget
keyboards -- to be increasingly tiring. To the point where I think I was
subconsciously adjusting my workflow to avoid typing.

I'd just use the laptop keyboard, but they insist these days on manufacturing
laptops with a "ginormous" shelf in front of the keyboard. As a result, the
edge of that shelf ends up pressing into my wrists.

(On older models, years back, the shelf would end somewhere under my palms and
so was not a problem. I may try a small form factor laptop (e.g. Lenovo X220)
the next time I change machines, if I have a choice.)

------
Drbble
Over the past 15 years, my RSI symptoms have been extremely well correlated to
how much I read and hear about RSI.

Now my wrist hurts.

------
dkarl
I'm surprised that none of the doctors suggested taking a break. That's the
first thing the doctor I saw recommended: get up and walk around for a minute
or two every hour. That was in my first year of professional programming, over
ten years ago, and the problems never came back.

I think there are some doctors who make a blanket assumption that patients
never successfully maintain lifestyle changes, so you might as well jump
straight to drugs or surgery. That is probably 95% accurate, but I believe the
5% who are able to improve their lifestyles deserve consideration even if that
means treatment is delayed for the 95% who won't, and there are plenty of
doctors who agree. It was just the author's bad luck that all the doctors he
saw ruled out lifestyle changes because of ignorance or cynicism.

On another note, an important thing for people working at computers to know is
that typing may not be the culprit. Simply sitting at your computer can damage
your body if you're tense, have bad posture, or maintain the same posture for
long periods of time. The problems I had originated in my neck, not my hands
or arms.

Also, for years I only had good posture when I was paying consistent
attention. When my attention to my posture lapsed for too long (at the
keyboard or anywhere else) I would sag back into my bad posture. I made a
breakthrough when I discovered that a session lifting weights or kettlebells
makes it easy for me to maintain good posture for the next couple of days. My
"good" posture now is better than my old "good" posture, and if I've been in
the gym recently, it comes naturally instead of requiring constant effort. I
invested a significant amount of thought and effort into developing decent
weightlifting form, but the effect on my posture is a physical aftereffect of
the lifting itself -- knowing isn't enough, and apparently simply being in
shape isn't enough, either, because my posture starts to slip after just a few
days. My slack posture now is a little better than the sagging posture that
used to come naturally, but it's still pretty bad.

------
ypcx
I'd say I'm pretty heavy keyboard user - a touch-typing programmer, about 15
years in the profession. So what do I have to say about this? When your RSI
begins, ergonomic keyboard may help you, may not help you, and often can make
the problem even worse.

The way I see it, there are 2 main causes of RSI:

1) you work under stress, and you are hitting the keys much stronger and you
are flexing your muscles much more than when you are more relaxed - this is a
tremendous strain on your hands,

2) you are using a certain keyboard shortcut or successive combination
thereof, or you are repeating certain specific movement which is causing you
the RSI, while the RSI feels as if it's coming from the general usage of the
keyboard, from generally using it too much.

3) (bonus point) It's something unrelated, like a missing vitamin or mineral
in your body, or a heightened presence of a free radical or some other
negative element. (I'm not a doctor so I won't elaborate here.)

I don't know how many ergonomic keyboards from Microsoft I destroyed while I
was still on PC, but now I'm on a MBP 17" and at one point I had to work with
a bandage on my left hand, in pain. Turned out the cause were the shortcuts
for application and window switching on OS X. This was CMD+Tab and CMD+` (on
an US keyboard layout, so the both Tab and ` are kind of higher). So what I
did, I searched for an app[1] to remap the keys to a much more sane[2]
combinations, and that fixed my hand.

[1] KeyRemap4Macbook, my config here:
[https://github.com/ypocat/misc/blob/master/keyremap4macbook/...](https://github.com/ypocat/misc/blob/master/keyremap4macbook/private.xml)

[2] this just made me realize the default shortcut combinations for app and
window switch are in fact insane. And I don't think Lion solves this with the
2 finger swipe, which is one hell of a long movement, if you have to do it
hundreds(?) times a day. At least the swipe gives you a switching direction,
as otherwise, generally, app and window switching is one of the weakest design
points of OS X, IMHO.

------
Eliezer
RSI began. I switched to Dvorak. It never came back.

(Yes, I've read the critiques of Dvorak's research on alleged _speed_ and
_accuracy_. But your fingers definitely don't travel as far - it could hardly
be otherwise - and my fingers were a lot less sweaty afterward.)

------
thibaut_barrere
What worked for me:

\- 1.5 hour of weekly yoga (or more)

\- changing hand for mouse at the end of each pomodoro

\- learning more keyboard shortcuts instead of using mouse when possible

I applied this after nerves pinched me in the back, which stopped me from
working during almost two weeks and was really, really painful.

------
varelse
This guy's experiences are very similar to my own except that mine started in
2004 when I moved my own stuff from location A to location B, injuring my
wrist in the process.

And that started a two-year saga during which several doctors told me to quit
my job. Obviously, I beat RSI (mostly), and still code to this day.
Observations:

1) Avoid long-term use of NSAIDs: initially they work but ultimately they make
you feel crappy, possibly because they do something to your liver causing your
liver enzymes to rise.

2) Ice, ice, baby: A key aspect of the cure for me was submerging my forearms
in icewater for 10 minutes daily until they became mostly numb. They were
inflamed, and cold (though above freezing) is about the only anti-inflammatory
with no really negative side-effects

3) Lose the mouse, lose the laptop: I use a logitech trac-ball now (though
that penclic pen looks tempting) and a really big screen. If I want to revisit
my pain, all I need to do is use a mouse for a couple days or try to use a
laptop to be productive. Strangely, touchscreen tablets are fine. This tends
to run head-on into the insane focus on laptops at tech companies these days.

4) Yes, it does seem like part of the problem is in your head: I hate hate
hated my job in 2004 but I needed the money. I changed that in 2006 and
started knocking everything out of the park. That's right about the time the
symptoms gradually went away. Also, I started hitting the gym again and
lifting weights despite the pain (losing the 15 lbs I had gained during the
experience). It seems like once there's been a long-term physical trauma,
one's awareness gets rewired to focus on it despite it being mostly healed and
then the only way out is to deny its existence to the best of one's abilities.

5) I've become acutely aware of how many extraneous mouse motions and button
presses exist right now and that's a real sore point with me.

Stuff that didn't work: yoga, rolfing (felt nice though), acupuncture (except
for one time I needed to get something out by a deadline and one needle
blocked the pain long enough to get there), various alternative mice and
keyboards (Dvorak touchstreams and Kinesis were awful for me), and supplements
(though I suspect more Omega-3s might have helped had I known about them)

~~~
thenomad
Yeah, acupuncture seems to be short-term effective for many people but long-
term not so much.

Better for you than NSAIDs, though :)

------
brendoncrawford
Keep in mind that a split-keyboard like the Goldtouch might mitigate wrist
deviation and pronation, but it does not eliminate them completely. If you
want a completely neutral wrist position, I recommend the SafeType keyboard (
<http://safetype.com/> ).

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gotrythis
There is a video here of someone just pointing at the screen to control the
mouse. This site hasn't been updated since 2009. There must be something even
better out there by now, right?

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

~~~
finnw
Similar, but without specialised hardware:
<http://info.ee.surrey.ac.uk/Personal/Z.Kalal/tld.html>

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eli
Switching from a mouse to using a Wacom tablet full time made a _massive_
difference for me. Learning curve is a bit steep, but I think I'm actually
faster now with most tasks. And using photoshop is definitely more fun.

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gotrythis
Anyone know if there is a pen mouse like the one he shows, where you tilt it
up/down/left/right instead of using a wheel motion? That wheel motion can't be
good for your finger over long periods of time.

~~~
henrik_w
The wheel is only a scroll wheel. To move the cursor, you move the whole pen,
just like you move a regular mouse.

~~~
gotrythis
I get that. But the wheel motion on any mouse is bad and I use it a lot. It
seems to be on a lot of "ergonomic" mice as well and I'm looking for some
other method of wheeling too.

~~~
henrik_w
I see. Yes, this one uses traditinal "wheeling", but I don't use that a lot,
so it's been fine for me.

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dsrguru
Is it bad that I thought this was going to be a joke about quitting emacs?

~~~
spudlyo
I know you're joking, but it's not the fault of emacs that the de facto PC
keyboard layout has the control key in a stupid position.

If you've been a heavy user of emacs (or any tool that requires a lot of
control key sequences) for any amount of time, you've likely already remapped
it.

I use a Kinesis Advantage keyboard which has a cluster of keys positioned for
the left thumb to use where I have important modifier keys (control,
meta/option, command) mapped. Besides being fast, I can hack all day and my
hands/wrists/forearms don't hurt.

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hp
A standing desk eliminated my arm and wrist pain, for whatever reason. I think
I move around more when standing and maybe tend to rest some body weight on my
arms when sitting.

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tennis
It also helps to remap mouse buttons to some keys on the keyboard (moving
left/right click to the left hand, if your right has rsi pain).

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georgieporgie
I developed bilateral De Quervain syndrome (tendinitis in the wrists, starting
near the thumb, spreading across the wrist) in college. I went out into the
work field and suffered so much pain that I could barely shift my car on the
way home from work. I was absolutely panicked.

I got physical therapy (where they told me the exact type of tendinitis I
had), learned stretches, did strengthening exercises, and started tracking
down better keyboards.

In the end, the Kinesis Classic contoured keyboard proved to be the one that
saved my wrists. You'd be amazed at how much of a difference consistent, light
keystrokes make. The other major element was stretching and light friction
massage. By working on several wrist stretching exercises throughout the day,
and making them part of my unconscious routine, my pain was alleviated within
about six months. I also wore high quality wrist braces for the first couple
of months, which provides an important rest for your joints.

Several years later, I discovered rock climbing. As pointed out by another
commenter, this is _fantastic_ for wrist health. The stretching and
strengthening of the wrist (while having fun) is hard to match anywhere.
Within about two months of beginning rock climbing, I ceased to have _any_
wrist pain at _any_ time. Not even a twinge.

Another few years later, I developed a bulged disc in my neck (ironically, it
may have been initiated by a couple of preventable climbing accidents!). The
entire left side of my neck and left shoulder became a bundle of tensed
muscle, in a vicious cycle of self-defeating automatic body response to
injury. The solution was ultimately to do more things that improved my
posture. I've done weight training, focusing on my back and rear shoulders,
and perhaps most importantly I've started _walking_ more. Walking has an
almost magical ability to reset your posture, provided you break out of your
old habits of slouching. The other huge key for me was a Steelcase Criterium
chair. The amount of relief provided to my neck and shoulders by having proper
back and elbow support is simply indescribably.

If I point out that someone is slouching, or using devices that are an
ergonomic catastrophe, many people respond with things like, "but I've been
sitting like this for years without any problem." Well, I used to think that,
too. Certainly, there are people who go their entire career slouching,
leaning, and mousing on their outstretched arms. But here's the catch: you
don't really know if you're prone to these issues _until you've already
developed them_. So, for the sake of your future, I encourage all of you to 1)
exercise 2) stretch and 3) get an ergonomic setup and use it properly.

