
Ask YC: What to do with repetitive strain injury problems? - mcfly
Hi everybody,<p>I have developed RSI problems (repetitive strain injury) in my lower left arm. At first, it only occurred after playing the guitar. I have since stopped doing that (1 year ago already). But now, my wrist/lower arm hurts even when I am only programming and it's getting a real problem for me. After all, I earn my living as a programmer. I was wondering:<p>Has anybody else had these problems? What did you do to get better? Was there a "magic trick" that worked for you? Is there a special keyboard you can recommend? Also, do you have experience with some kind of speech recognition software that you can recommend? Is it even possible to use speech recognition with Eclipse, for example?
======
testcase61
I had this really bad about a year ago, and I was really frightened, because
it got to the point that not only couldn't I work, I was getting pain just
sitting and watching TV! I had it very bad in my wrists, but the worst thing
was my elbows - I couldn't bend my arms, and I couldn't _not_ bend my arms. I
was really scared.

Anyway, I tried everything, new keyboard, different chairs, vitamins, rubs,
Dragon Naturally Speaking, you name it. I even had a kind of pulpit built for
my computer so I could work standing up. Since not being able to work would
have been a death sentence for me at that time, I spent well over $1000 on
this stuff. But none of this really made any difference.

Then, I sat down and thought about how the body works, and all I knew about
medicine and biology, and I worked out that the wrist pain was caused by poor
muscle condition. So I started exercising my upper body, particularly my arms
as someone else pointed out above. That nailed it!

Within a matter of days, all pain went away. I mainly concentrated on standing
pushups. Because I'm a woman, I have almost no upper body strength, so I could
barely even push myself off the wall on a 25 degree incline. But gradually,
doing this very gently every hour or so, I started to increase the incline and
get more movement back.

Now, I don't have any pain or problems at all unless I really spend 12 hours
in front of the computer. Then, if I get even so much as a twinge, I do the
above routine for a day or two and all pain goes away again.

------
philo
I encountered similar problems and found that Kinesis Advantage Keyboard is a
lifesaver. See it at: <http://www.kinesis-ergo.com/>.

If you are not use to typing on a split keyboard, I would switch to that
first, and than to the Kinesis as it can take a few days to get use to. I also
use a Logitech Wireless keyboard for gaming purposes, and due to numerous
people trying to do a quick google search on my computer and spending half an
hour trying to figure out the keyboard.

It's a bit expensive, although you can pick up a slightly used one on ebay for
less (that's what I did). However if you think of the amount of time you spend
typing and the fact that it is your career $300 is nothing.

~~~
sah
I know a bunch of people who swear by these. They helped me, but the Goldtouch
helped more.

The way the Kinesis Advantage lays out space, enter, and backspace so they're
all under your thumbs should become the standard keyboard layout. It's so much
better!

------
Hexayurt
Music physiotherapists, believe it or not, are The People To Talk To. In my
case, I had undiagnosed neck issues that were causing me to hunch in a way
that screwed up my wrists, and about six sessions fixed it. Gone, never to
return (as of 15 years later.)

The body will handle a lot if it is well maintained.

But it needs a specialist, and the people who work with musicians are the top
of the field.

------
parenthesis
Find a good physiotherapist. They'll be able to teach you exercises that you
can do yourself to help things.

That is what helped me when I got what sounds like pretty similar to you: Too
much guitar playing causing left hand/wrist/arm problems. Unfortunately it
still isn't entirely better, but fortunately typing doesn't seem to be a
problem with it.

Sort out your posture, wrist/hand position when typing. I'm sure someone else
can point you to decent information on this.

~~~
mechanical_fish
Yes, see a physical therapist. Don't just try to diagnose yourself, which is
what you seem to be doing right now. The pains in my arms and wrists were due
entirely to postural problems in my shoulders and neck, which was pinching the
nerves leading to my wrists. If I'd kept self-diagnosing I'd have tried
keyboard after keyboard, wrist braces, less wrist strain... and have
completely missed the small adjustments to my monitor and my chair that
actually make the difference.

Plus, PTs can prescribe proper massage, therapy, ultrasound and/or drugs to
speed up your healing.

------
tsuraan
For several years (starting with my senior thesis), I was having a lot of arm
and wrist pain when typing. I tried all sorts of things, but what finally made
the pain stop was rock climbing. I joined a local climbing gym, and all the
pain just went away. If I go for more than a few weeks without climbing my
wrists start getting stiff and then hurting again, but as long as I climb
regularly the pain stays away. Climbing is also a lot of fun!

~~~
pmjordan
Interesting. Can anyone explain why this works? My best guess is: by climbing,
you exercise your muscles in that area, thus making them more resistent to
damage from typing. But I don't really know anything about medicine.

~~~
mechanical_fish
It isn't even just the muscles in your hands. As I mentioned elsewhere in the
thread, my wrist pain is caused by inflamed neck and shoulder muscles.
Anything which builds torso strength can improve your posture and solve a lot
of second- and third-order problems.

Plus, exercise helps muscles heal and stay healed. They like moving around.
Exercise helps keep the blood and lymph flowing through muscles, both directly
(I believe that moving around keeps fluids sloshing about and causes blood to
be directed to the moving muscles) and indirectly (exercise builds
cardiovascular health, which leads to better circulation and oxygenation). It
even improves your sleep, which has many excellent side effects.

------
sah
jwz's writing about his wrist problems is helpful:
<http://www.jwz.org/gruntle/wrists.html>

I have continuing RSI myself, but I've gotten it to the point that it's
manageable. Here's what helped me:

\- Less stress, more happiness. This was probably the biggest issue for me.
Stress made everything worse. Do whatever you need to do to get happy. I quit
my job and went on vacation for a month. I also became less willing to do
things that made me unhappy.

\- Less typing. A lot of people just can't type 12 hours a day, everyday. Come
to grips with it, and put yourself on a schedule. Find other things to do. Cut
out non-essential typing like IM, etc. Take regular typing breaks. If you can,
take some time off and don't even look at a computer for as long as possible.

\- More exercise. I'm not sure it even matters if you're exercising the
problematic muscles. Just improve your overall health.

\- Goldtouch keyboards. These split into an A-shape, so I don't have to
pronate my wrists while typing, which was a problem for me. I tried a lot of
keyboards, and these are the ones that helped me. Go ahead and spend a bunch
of money trying unusual keyboards and desk setups, it's worth it.

\- Acupuncture seemed to help a little. I tried pretty much everything anyone
suggested. Most other wacky alternative medicine didn't help.

\- Tiger Balm. Excellent tingly sensation! Also seems to reduce swelling,
which was causing problems for me.

Here's what didn't help me:

\- Wrist stretches. I think these may have actually made things worse for me.

\- Chiropractic. This made impressive popping noises, and produced no other
effects I could discern. Also, it has an adjective for a name.

\- Dvorak. The Dvorak layout is designed for speed, not necessarily wrist
health. The independent finger movements needed to hit those home-row vowels
hurt me bad.

\- Doctors. I recommend you see one, but in my case they weren't very helpful.
I was diagnosed with CTS, but reading about it, my symptoms didn't remotely
match. Wrist braces did nothing. Physical therapy did nothing. Maybe I didn't
see very good doctors.

~~~
fish
>> Take regular typing breaks. If you can, take some time off and don't even
look at a computer for as long as possible.

GNOME has a feature that'll lock the screen every certain number of minutes
for a certain number of minutes, and only way to get out of the lock is to
ctrl-alt-backspace. Nice if you are having a hard time breaking away from your
computer. (System > Prefs > Keyboard > Typing Break)

~~~
sah
I used xwrits.

------
gunderson
I've tried 5 different keyboards, none of which have made much difference.
Others have posted some of these but I'll share my list of what has worked:

\- take frequent typing breaks -- even 10 to 15 second breaks work wonders.

\- stay happy and relaxed, stress is bad. Also, RSI pain can increase stress.
Breaks and a chill frame of mind help address this.

\- massaging the fingers/wrists under hot tap water first thing in the morning
and several times during the day. this feels great and helps focus your mind
on relaxing the muscles.

\- anti-inflammatory drugs (your doctor may want to prescribe one to help the
healing)

\- don't pound on the keys. My years using an "M" keyboard got me pounding
them pretty hard. I've had to try to unlearn this technique and just use a
softer touch.

------
utefan001
Suffered horribly, now cured. I won't bother you with the steps that did not
work, just the steps that did.

-main thing is to force yourself to use a posture holding your shoulders back and your head / neck back. Laptops are the worst because they force you to look down. As I understand it, the wrist pain is actually neck pain, shoulder pain, arm pain and wrist pain. Your neck, shoulder and arms unconciously make adjustments to relieve pain and the wrist bares the brunt of it because it cannot adjust and pass the pain down the line anymore.

-indoor rock climbing (bouldering) about 20 times helped a ton. I don't go anymore, but the stretching and strength building helped a ton.

-going to yoga about 10 times help also.

-I still don't mouse with my right hand, left only.

The #1 thing for me is to not look down toward the monitor and hold your
shoulders and head/neck back. When I read about holding my shoulders back, I
did it for 2 days straight and had extremely sore back muscles the next day.
The sore muscles got better in a few days and the difference was huge.

------
pg
Since wrist strain is probably a function of characters typed, it would
presumably help to program in more succinct languages.

I mean this quite seriously. I've consciously tried to make Arc easy to type.

~~~
sah
I find that a very large fraction of the typing I do while programming is not
code entry. An amazing number of keystrokes go to navigating between and
within files and directories, running tests, and looking up documentation. A
good example of this is debugging -- it's possible to spend hours debugging
without entering much code at all.

This also assumes that you'll use your greater productivity per character
typed to type less, rather than just maintaining your typing at the same
level, and increasing your productivity. Changing your habits is possibly more
essential with RSI than changing your tools.

~~~
pg
In Lisp dialects you debug mainly by typing expressions.

------
egilliam
I highly recommend a form of physical therapy called Active Release Techniques
(<http://www.activerelease.com/>). I have had tendinitis in both hands/arms
for several years, and regular visits to my ART practitioner have, over a
year, improved my situation maybe 50%.

Also I have been using (on and off) the DataHand keyboard, which is wonderful
for English text, but unfortunately inconvenient for programming because
symbols are a pain to type.

------
mtrimpe
One thing that has always worked for me is increasing your awareness of the
muscles and tendons in your hand and arms. Whenever I feel RSI coming up I
start typing more slowly and make sure that every movement becomes very soft
and gentle.

You'll also learn that when you type more slowly you can still get as much
done because your mind has more time to think the problem over while you're
typing the code you've already decided you are going to type.

You'll start to notice the little stresses you've learned to ignore and every
time you notice a little bit of stress you'll adjust your movement into a more
gentle way of interacting with your computer.

As you do this more and more you'll find that your shoulders start relaxing,
your neck becomes more relaxed; your breathing slows down and you adjust your
computer so that your arms feel featherlight and then your wrists start moving
in more fluid movements and your fingers start moving across the keyboard with
less resistance until the point at which you might notice that the only
stressor left is the tactile pressure of your keyboard and the curvature of
your wrists; and then you're ready to try out the keyboard that works best for
you and your problems are gone.

When you do this it will become automatic and you'll learn to speed up and
slow down back into this mode whenever you feel stress building up again.

------
s3graham
The one thing the really exacerbates it for me is stupid notebooks. I find I
end up being much more hunched over, and having my wrists in awkward positions
vs. a normal keyboard, monitor at a reasonable distance, etc.

Also, I stopped playing guitar for the most part :( because there's just too
much overlap in muscles (I guess).

Really, the only answer that works long term though, it just get off the
computer. If you're having withdrawl problems (I certainly did) order a whole
load of good [computer] books.

------
qwph
If you're looking for something inexpensive to try, you could try installing
anti-rsi software like Workrave (Windows/Linux) or AntiRSI (OSX).

They monitor your computer usage and lock you out at regular intervals, so you
can have a break, and relax your arms/hands/fingers. Works for me.

<http://www.workrave.org/> <http://tech.inhelsinki.nl/antirsi/>

~~~
sah
Thanks for pointing out Workrave! I used to use xwrits when I used Linux, and
have been looking for something similar for Windows for a long time.

------
jwr
Here's some tips from someone who went through 2-3 months of not being able to
type at all:

1\. Get a split keyboard and make sure your wrists are straight when you type.
For best results, get a FingerWorks keyboard on ebay and learn to use it. Stop
using laptops at all.

2\. Type less. Seriously. Turn on dabbrev-mode in Emacs, use SLIME completion
when coding Common Lisp. Find a solution. Code the hell out of your editor
(Emacs exceeds here). And don't participate in silly online forums.

3\. "RSI" doesn't mean anything. Go see a doctor. Your pain could be tendons,
muscle, nerves, or joints. It was joints in my case. If you can, see a doctor
that specializes in treating sports injuries.

4\. Dictation works for E-mail and documentation, but not for coding. If you
want to use it, buy Dragon NaturallySpeaking (or MacSpeech dictate, same
engine), forget everything else. Then get a microphone that costs at least
$100. I use a Sennheiser ME3 from emicrophones. If you can't spend that kind
of money, forget dictation.

In my case, cryotherapy, anti-inflammatory medication and typing less helped.
If I'm careful, I can now work normally, but I still have to be careful about
the amount of typing that I do.

------
andrewf
Type slower.

How much of your time in front of the machine do you spend thinking, as
opposed to typing? You may find that you can drop your typing speed
significantly while having a negligible effect on your overall productivity.

You didn't mention which hand you used to mouse. If you mouse left-handed, try
switching hands. I did this - the first few days are hell, but after that
you'll be able to mouse effectively enough with the other hand.

------
raju
Hi. First, sorry to hear about your problem. I too develop a mild pain in my
lower left arm every now and then when working long hours, so I can empathize
with you.

As far as getting better, I don't believe there is a magic trick. It all boils
down to posture and taking appropriate breaks. There have been several
discussions on HN about keyboards and desks [<http://searchyc.com/keyboard>]
but it takes a while to find a keyboard that suits you well. I personally have
gone through several keyboards and have come to the conclusion that I will
have to spend the money to get a really good one.

The other issue, as I mentioned earlier, is taking breaks. Getting up from
your desk at regular intervals is good both for your arms, and back as well as
your eyes. There are a variety of exercises you can perform while at your desk
[<http://tinyurl.com/rttqm>].

I haven't used any speech recognition software, so I am afraid I can't help
you there. In all honesty though, catching this early and doing something
about it helps.

Good luck and I wish you well.

~~~
gtani
mentioned 3 exercises: wrist curls, spinning ball thing and i don't know what
the 3rd is called (finger abductors?: expanding your curled fingers outward)
in this thread

<http://news.ycombinator.com/item?id=185743>

<http://www.fitter1.com/Catalog/Category/35/HandWrist.aspx>

Make sure you don't cock wrists at funny angles when you're driving a car,
using power tools, sleeping (don't sleep on your side). And elbow and heel of
hand supported weight-wise at all times when working mouse and keyboard.

------
hsuresh
Have you tried myotherapy? <http://en.wikipedia.org/wiki/Myotherapy> Ive had
problems more in the shoulder area and upper back. This treatment for just a
week brought in so much relief to me. Of course a permanent cure is not
possible in a short time and it involves better posture, exercises, breaks etc

------
bigbee
I used to suffer from RSI in both my wrists years ago. Switching to ergonomic
keyboards solved the problem. I'm using the "Microsoft Natural Ergonomic
Keyboard". Just to prove that this was indeed the cause, whenever I travel for
a while with my laptop only, my wrists start hurting again.

------
jgrahamc
John Ousterhout and I worked together for years... he talks to his computer.
See his description here: <http://home.pacbell.net/ouster/wrist.html>

~~~
sah
I talked to my computer for about six months. It was a much-needed break for
my wrists, and a lot more practical than I expected.

I found I had to be very careful not to hurt my voice, though. Talking to a
computer puts more strain on your voice than normal conversation.

I used Dragon NaturallySpeaking, by the way. It's a ridiculously bug-ridden
pile of crap, but it's basically the only game in town. You can use it for
just about everything on Windows, though apps that use native GUI widgets are
much easier to work with than those that don't.

------
axod
1\. Never ever contemplate using a conventional desktop keyboard (How anyone
types on those things is beyond me). Use a laptop style keyboard with small
key travel and easily pressed keys. 2\. Use a touchpad instead of a mouse.

Also personally I'm one for using a laptop so you can get pretty comfy in a
ton of positions - lying on bed, lounging on a sofa, lying on the floor,
sitting at a table (Rarely).

------
utx00
1\. take typing brakes (xwrits, workrave) 2\. exercise -- specially try to
make your shoulders, forearms, and fingers stronger (in that order) 3\.
stretch -- yoga can help, take a class 4\. get in better shape (run, bike,
elliptical, ...) 5\. don't type more than 4 hours a day (workrave can help
here) 6\. DON'T GET SURGERY!!!!! quit first, and reassess things.

------
prakash
one of my friends tried yoga and that helped him get rid off all the pain.

ymmv.

~~~
Tichy
I also have the impression that Yoga helped me a lot. I still have some
problems, but in general my hands feel much better.

------
srau
Hi - I have had good luck with these two things - the Evoluent vertical mouse
& the Goldtouch split keyboard. Try using the left hand mouse for a day and
switch to the right hand mouse to relieve pain.

------
pistoriusp
I had similar problems as well, got myself a better keyboard (Apple) and carry
it everywhere. Do not type on your laptop's keyboard!

Also, don't assume that you can code for hours on end, take a break.

------
wallflower
Hi. There is no magic cure. I've found that swimming helps because it involves
whole body movement. The most important thing you can do is to take restbreaks
(I use WorkPace software)

------
mcfly
Not sure if anybody reads this since the thread is already off the first page,
but still: Thank you all! I think there is some great advice and I am positive
that it will help me.

------
eru
Typing on a Dvorak keyboard layout can help prevent RSI. At least I did not
have any problems with it after switching.

------
tokipin
for me:

1\. Microsoft split keyboard

2\. Dvorak

3\. Wacom tablet instead of mouse

i would add Vim but i'm not sure it helps with those things. it's certainly
more efficient for code editing. anyways, i haven't had so much as an inkling
of pain in years

