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Stopping the RSI pain that almost destroyed my programming career (2016) (codewithoutrules.com)
251 points by jxub 6 months ago | hide | past | web | favorite | 225 comments



I'd like to throw my two cents in here: strength training.

I started having problems with RSI about five years ago, and I tried and failed to get relief from quite a few different things, including the Mindbody Prescription, but what ultimately helped me the most was arm and grip exercises: pull ups, deadlifts, farmer's walks.

If you're going to do _anything_ for 8 hours a day, even sitting, you should be taking measures to make sure it doesn't impact your health.


Every time I see someone mention strength training around here I have to jump in and agree - it is the single greatest improvement I've made to my lifestyle thus far.

Lifting weights has the best return on time invested I've experienced, period. You can make progress and eliminate 90% of physical discomfort with 3 hours in the gym a week. All you really need are the main compounds. Throw in a couple cardio sessions if you're feeling ambitious and you will gift yourself years back onto your life and avoid all sorts of aches and pains.


Make sure you're doing mobility drills, a la Kelly Starrett or the Limber Eleven or any number of mobility/stretching plans. I lifted in the past without doing so and got some seriously annoying back injuries. If you aren't prepared posture/mobility wise, doing lifts can cause more pain than they solve.


Do you have any sort of routine you can recommend?


Starting Strength and Stronglifts 5x5 are probably the two most popular. These programs are based on what's called beginner gains. You wills start with what will feel like a very light weight, but you increase it every workout until you can't lift it anymore. You'll be amazed at what your body can do after 6 months of this.

When the parent said compound lifts they were referring to lifts that (when you are doing them heavy and correctly) are whole body exercises: Deadlifts, squats, and bench are the three main lifts. Programs will typically mix in some other lifts to round out the program a little like power cleans, overhead press, and bent over rows.

Most beginner strength programs are three days a week, I've found most people do Monday, Wednesday, Friday, but it's flexible as long as you have at least one rest day in between workout days. If you don't mess around and just go to the gym to work you can easily be done in 30-45 mins so under 3 hours a week is very realistic.

You will absolutely feel uncomfortable when you start. Everyone does. Read a lot about form and pay attention to yours (gyms have lots of mirrors, lift near some especially when you're starting out). It's really easy to hurt yourself once the weight increases if you have bad form. Consider getting a good personal trainer to teach you the fundamentals of the lifts.


Can strongly recommend Starting Strength, started out reading the book (written by Mark Rippetoe) back in January - started the program in February using the android app* as my guide. I feel better than I've done in years (I'm in my mid thirties)

Remember to eat well and make sure you get enough protein, otherwise it's hard to follow the program.

* = https://play.google.com/store/apps/details?id=com.shabu.star...


Starting Strength is a great program, but I can't understand how beginners are doing power cleans without any kind of guidance from a trainer. Power cleans are really hard to learn - it took me months of going to Olympic weightlifting classes to get even close to good form on them. How did you manage to learn this from a book?

Also, you need to be doing them on a lifting platform for the end of the lift, when you have to drop the weight all the way to the floor. Not too many gyms (in the UK, at least) seem to have these.


I did crossfit 2-3 times per week for 1.5 years around 7 years ago at a gym where there was a lot of focus on technique, so it's been a while, but I didn't start from scratch with regards to technique.

That being said, I'm sure I have bugs in some of the exercises, I try to work them out via. videos and focusing on technique before I put more weight on the bar.

All the gyms I've been to here in Denmark have lifting platforms, squat racks, etc. so that hasn't been a problem for me.


The Starting Strength book is fantastic when it comes to showing a lift's mechanics


On form: reddit.com/r/fitness can be a good resource for form checks. You may hear varying opinions on smaller details, but overall they should be geared towards you not getting hurt.

They have a 'how to post a form check' guide: https://www.reddit.com/r/Fitness/wiki/rules#wiki_2._how_to_p...


I'll pop in since kettlebells usually don't get a lot of play when talking about strength training on here, at least as far as I've seen.

I'm an old school gym guy—squats, deadlifts, bench, pullups. I got curious about kettlebells a couple months ago after seeing how well they seemed to work on people I know who have used them. Now, after buying 3 kettlebells and a home pull up bar, I'm feeling pretty decent about sticking with these for the foreseeable future.

Lifting with them is far more ergonomic than using a barbell. Sure, you can't load as much weight but the payoff is that you are manipulating the weight through a larger range of motion. Pavel Tsatsouline's book was what I went with for the movements and of course there's endless content on YouTube showing the proper form. If I were really going hard, I'd do KBs four times per week and finish with a heavy barbell lift at the gym, but the laziness has taken over and I'd rather work out in my living room than walk to the gym.

Like anything, take it with a grain of salt but I have long been a skeptic of faddish exercise and these have been working great for me.


Pretty much all of the main routines focus around the main compound lifts which are bench press, overhead press, back squats, deadlifts, and bent over rows (or pull ups).

It kind of comes down to how much variation you want in your routine, and if you are focusing on body building or strength (or both).

Personally I started with Strong Lifts 5x5 which is a good intro. Has it's own app, easy to follow, and the guy who developed the program has a great website with video tutorials and written instructions for each lift. Personally I found it to be too much squatting (you do 5 sets of 5 squats every time you go, which adds up quick).

I then moved on to Greyskill LP, which is similar but instead of doing 5x5 for every lift you do 2 sets of 5 and then the last set until (almost) failure. I mixed in a bunch of accessories as well. Overall I felt this was yielding the same results as 5x5 but with less time spent in the gym each time. (once you start hitting the upper end of your strength, 5x5 begins to take between 1.5 - 2 hours each time when you account for warm ups and rest periods).

I have recently switched to 5/3/1 which is more for building mass than strength, and is a bit more complicated to keep track of.

reddit/r/fitness has a ton of good resources. It's easy to get lost in the weeds, but as long as you're hitting your main lifts and doing at least 3 sets of each, adding weight each time, you will make progress. Don't get too bogged down in adding accessories, as they are meant to help improve your weak areas when you get stuck on the main lifts.


"a bit more complicated to keep track of"

Note to new lifters: Most important tool to buy is a spiral notebook and ballpoint pen; plan out all your exercises, sets, and weights before going to the gym, do reps for each set till muscle failure then write down the number of reps achieved, and use that historical set data to design next gym visit, this is the worlds simplest lifting program.

Another general note about "programs" is lifting is much like diet in that there are some plans that are very simple and some that are very complicated and both CAN work well although which works best for which person requires experiment. For example there are extremely complicated diet programs with incredible attention to detail and discipline, and then there's "Don't eat it if your ancestors couldn't eat it" and both can work very well (although one sells many more books than the other...).

Likewise the ridiculous simple workout plan is, on the short term, do about three sets with a five minute break in between, a warmup, max, and somewhat less than max, and on the long term plan your workouts such that you get muscle failure at over a dozen reps on the warmup set, and about 7 reps on the max set and 3rd set. Barrels of ink have been spilled on the topic of do two sets vs three sets or aim for muscle failure at exactly 15 for warmup as opposed to 12 or power lifters should max at 4 reps vs body builders should max at precisely 9 reps. All of which is probably true for various individuals in various situations. A better use of your time than reading and researching all that, is make very small changes to that, then look at your spiral notebook and see what is working for you personally.

The only other programs or rules to follow apply to all plans, its very hard to hurt yourself by moving too smooth, or too light of a weight, but the opposite is not true.


There's probably people more qualified than I am that can respond, but I have heard a lot of recommendations for and enjoyed https://stronglifts.com/5x5/

Note: I see Starting Strength recommended here too, which I've also heard good things about from my experienced weightlifting friends. I think they're very similar programs, and that book has a lot of good detail on technique.


Stronglifts is a good beginner program, but people over 40 would benefit from reducing the volume (e.g. going from 5x5 to 3x5), as it becomes too much when the weights grow larger.

If you are over 35 (and sedentary), I'd really recommend reading "The Barbell Prescription" https://www.amazon.com/Barbell-Prescription-Strength-Trainin... — it will be a much better guide than most advice available online, which seems to be directed at youngsters.


Starting strength and stronglifts are strongly interchangeable the biggest difference is the volume - starting strength is a 5x3 and stronglifts is 5x5 and stronglifts has a row while starting strength has a power clean. For learning starting strength the book is invaluable as the author describes each lift in exhausting detail, and that's important to understand when you're starting - every day in the gym I see people squatting who should have read some instructions.

I'd argue that at the novice range the extra two sets of volume aren't required - you will literally adapt to anything at this point. That's why there are so many programs that people feel great on for the first three months before they stop making progress. I do, however, like the row instead of the power clean, as many gyms don't have a setup for a power clean, and it's a technically challenging movement. Many years ago when I first started I did starting strength with a row substituted for the power clean, and that took me a good 8 months before I stopped making progress, at which point I jumped over to a 5x5 intermediate program.


I’m a bit confused with the statement that “many gyms don’t have a setup for power cleans.” I use the same barbell and weights for bench, deadlift, squats, and cleans. I would assume where ever there is space for deadlifts, you could easily use that space for cleans.


You use the same equipment, but it all depends on how nicely you can put the clean down afterwards. If the gym doesn't have a platform and instead has iron weights and a concrete floor, you could be doing some damage to the equipment. The same could be argued with deadlifts, but they are much easier to gracefully put down.


Ah, thanks for clearing that up for me. You absolutely don’t want to be damaging the equipment or the gym itself.


In case you missed the recommendation below, I'm gonna go ahead and second the GZCLP suggestion. It's much better than 5x5 and SS, deals with plateaus better and you can have more fun with it!

There's a subreddit for it and similar routines created by the same guy, too: /r/gzcl

It only requires 3 days/week at the gym and around 1hr per day


If you're starting out you probably need a trainer more than a routine. It's really easy to injure yourself and you can't necessarily learn the proper movements from watching videos online. Talk to the trainers at your gym and find one with legitimate certification.


This is extremely important. A qualified trainer (I'm one, but hate the work, too many people watched a program on a body builder and know all about it) will assess your strength and fitness, determine your goals, and then create a program to help you achieve them, as well as teach you to lift properly and safely.

Poor form can cause long term injuries, soft tissue damage, or even arthritis.


When I'm short on time I do the following routine that I got from my wife's fitness mag:

3 sets of 12 reps descending / ascending of:

* frog jumps - plank pushups

* reverse lunge with overhead press - spiderman crawls

* burpees - leg raise sit ups

Eg: do 12 reps of of frog jumps and one rep of pushups, then immediately do 11 reps of frog jumps and 2 reps of pushups, etc down to 1 rep of frog jumps and 12 reps of pushup. NO resting in between. When done, take a two minute rest, then immediately start the next set. The key to this routine is not resting, and maintaining good form. It offers me a great burning sensation when I do it correctly, and I'm done in less than 25 minutes flat.


Also if you are too lazy for that like myself currently you can achieve quite a lot by just some push ups, jumping and the like for a short period of time.


It probably goes without saying, but it is quite important. Proper technique is vital when strength training. Mobility work is also important. I have injured myself way more than I should because I yanked up a deadlift bar the wrong way, or damaged a shoulder because I didn't warm it up properly.

If you're gonna do it, do it properly.


Would also like to plus one this. I suffered from nagging back and shoulder pain in my mid-twenties until I started regularly lifting. I'd recommend a program like GZCL as an easy, short routine that can be added to over time: https://imgur.com/WIhiBOy


I'd recommend Starting Strength as well for a novice - it's incredibly simple to start out.

https://startingstrength.com/get-started/programs


I'd been getting a touch of RSI pain this year / last year, and I'm still pretty young (mid-twenties).

Taking up bouldering / rock climbing and doing that once or twice a week has improved my grip strength a lot, with the added bonus that I don't remember having any more RSI pain since I started doing it regularly.

So I definitely agree with the original post that environment makes a huge difference, and with this comment about strength training. And I'll say that rock climbing is awesome for improving your grip strength.

Edit: With that comes the caveat that pro rock climbers are more likely to develop arthritis earlier than the average person.. You have to be careful with how you load different parts of your body, and I'd argue it's easier to injure yourself than e.g. doing weights in the gym, if you're not careful.


I agree strength training is life changing, but it can aggravate some RSIs. My RSI was similar to tennis elbow and it was from irritating the nerves in elbow from movement. The only solution is to stop flexing the elbow (rest). I fixed it by using 1) trackball mouse, 2) keyboard without num pad (less movement to get to mouse), 3) vim text editor and excel without mouse.


I had exactly the same problem. Heavy tendinitis in my right elbow, mostly due to a regimen of squash, badminton, and rock climbing multiple times per week.

I similarly switched to trackball mouse and keyboard without num pad (I was already on vim).

But what helped me more than anything was a keyboard tray that goes below the desk, almost on your lap.

Whenever we move offices at work, it sometimes takes a day or two before the tray is installed and I notice that the discomfort starts coming back quickly.


I had a very similar experience. I stick to a 10 keyless keyboard (no numpad) but I gave up on the trackball. I use a wireless trackpad now because I ended up with pains in my thumb after a couple years of the trackball. I could probably have used a better quality trackball but the selection is/was limited.

vim support in IntelliJ is pretty good these days so that's a huge help too. I had to abandon emacs and my claw movements early in life...


Thanks for the “lower the keyboard” tip. I’ll try it out, although most likely will be raising my seat.


It's possible that both you and OP experienced relief for the same reason: you both found a way to increase blood flow.


For me it was rock climbing. I had been suffering for a couple of years. I had been to the doctor a couple of times, but I wasn't really getting much out of the exercises he prescribed or the medication. I happened to start doing indoor rock climbing and I noticed my symptoms slowly becoming less frequent. I climbed for about 2 years and during that time my symptoms got much better.


Upvotes are invisible, so I’m going to jump in and plus one this. If you’ve never gotten stronger, there is no better way you can spend 3 hours per week. Buy Starting Strength and change your life.


no need to even buy anything. youtube and reddit have great strength training learning materials freely accessible. r/bodyweightfitness on reddit is a great place to start without even needing a gym membership


Yeah, that’s one of common things people claim. Someone has said pushups would do the trick.

Tavis Rudd in this Programming by Voice video thought his rock climbing helped prevent issues before he got RSI.

https://youtu.be/8SkdfdXWYaI

I’ve cataloged lots of solutions:

https://github.com/melling/ErgonomicNotes


Never heard of it before but farmer's walk look like a nice exercise[1].

Any issue with doing them with dumbbells v.s. something slightly longer? Imagining the range of motion I feel like the dumbbells may sway and feel awkward.

[1]: https://www.bodybuilding.com/exercises/farmers-walk


Dumbbells work great for farmers walks. You get them heavy enough and it's your body that's swaying.


I find lifting relaxing and stress reducing, and the linked article mentions the author had other techniques for stress reduction of varying levels of success. Aside from stress reduction there is probably also some fraction of better muscles and tendons via lifting result in less RSI pain.

I think this explains the effect where a guy starts lifting and the pain goes away in a week, although it takes a little while longer than a week to obtain a professional powerlifter physique.

Something to consider is bro-science in lifting, which is rampant. I machine/circuit train lift because the odds of going out with a back injury from freeweight squatting is maybe 10% annually, but the odds of injury on the machines is approximately zero. If your whole point of lifting is becoming a world class athlete then you MUST freeweight and accept you'll spend some time in the ER and hospital due to injury because the machines don't have the capacity; I max out the leg press at 400 while the freeweight guys at the gym do much more. On the other hand if you merely want to be the strongest healthiest guy you know outside of the gym or want to prevent injury or improve lifestyle in general, the machines are more than good enough. Basically freeweights are for people trying to win a competition (and there's nothing wrong with that) whereas the machines are for injury and lifestyle improvement, so pick the right tool for the job. On the topic of bro-science, unless you're putting in lumberjack levels of effort and superman strength, ignore all the supplement and diet advice specific to lifting; I started doing bicep curls with 50 pounds and you don't need to eat 17 raw eggs per day or take 42 pills per day to curl 50 pounds, the exotic stuff is for people performing exotic activities. If you're trying to lose weight, its true that you can't outrun a fork, but weight lifting is an entirely different topic than either weight loss or aerobics, so bro-science for aerobics people or fat people isn't relevant ... although you probably should be eating paleo / low carb regardless of exercise routine.


Puts down bro-science. Then proceeds to bro-science. Classic.

"a back injury from freeweight squatting is maybe 10% annually, but the odds of injury on the machines is approximately zero"

Got a cite for this? My pure N=1 experience is that I've only ever been injured on machines forcing the body into unnatural movement patterns, while I've been squatting for 10 years with no issues. Sure I only squat a few hundred pounds, not like the 1000+ lb monsters.


Yeah, I've never injured myself doing squats either. I don't squat more than a few-hundred pounds and I warm up and stretch before lifting. The only injuries I've ever sustained were from lifting heavy without a warm-up set and some stretches first.

Squats actually require a lot of hamstring flexibility to perform correctly, and most people don't have that. The basic compound lifts are generally very technically challenging and can take years to master. If you approach it like a meathead, don't be surprised when you get meathead injuries.


Machines keep the weights on a track. With free weights, your muscles have to maintain the "track" all by themselves. My understanding is that doing so gives a much more comprehensive and well-rounded work out, as all of the stabilizing muscles must be utilized. It also provides more useful strength, as they aren't any "tracks" in regular life when we want to use our muscles for some activity.

The point about injuries, especially for squatting, is definitely a good one though. Although I would want to ask an expert about it.


Your point on stabilising muscles is on point.

This is why pistol squats are worth more than just a body weight * x two-legged squat. This is why yoga is valuable for more than just flexibility.

Isolation of a muscle is all great and can make you look strong, but your body is actually a non-trivial network of muscles distributed across your entire body.

Unless your aim is to lift a big number or look big in a specific way, a gymnasts are a better proxy for balanced strength and they rarely do more than BWEs.

Personally, I do love a good old fashioned barbell squat though...


I do not think the trigonometry works that way if you resolve the vector forces. Surely if I chest press away from my chest, I'm not working the muscles that lift upward in a shoulder press I agree with you on that. That would be awful for the development of my muscles that push upward, but they are not sentient about not getting exercise and they get an excellent workout when I do the shoulder press perhaps ten minutes later, although the shoulder press doesn't work my chest press muscles at all, on a long term scale it doesn't matter. To get a "push upward" stabilizing muscle workout at the same time as I do a chest press, I'd have to lift sqrt(2) times the weight upward at a 45 degree angle, and this is getting kinda ridiculous compared to just hit the shoulder press and the chest press. And of course there are incline settings on the chest press machine that I use...

I'm trying to think of a machine I used today with a "track" where the track would be unavoidable via other exercise or bad. For the leg press I don't want my knee flexing sideways if at all possible but my hips and ankles are movable so kinetically in an engineering force diagram how would my knees "know" that my back was pushing against essentially a chair as opposed to pushing to stand up? If for the sake of argument I accepted that my knees have stabilizing muscles etc, you and I know via cognition and vision that my back was pushing a chair up a track, but from an engineering stress and strain diagram my knees aren't sentient and can't know the difference. The bicep machine and pec fly machine and leg extension machine have a ridiculous array of ball bearings and axles such that I'm only constrained in the circular force direction and the other axes are free over at least a small range, think of like how a car suspension has the wheels continue to turn regardless of the angle the suspension components are hanging at; I could design an inferior machine to do pec fly but my gym thankfully doesn't own one like that...

The row machine is interesting in that via the magic of cables its even less constrained than the oars on my little rowboat where I actually use rowing muscles IRL... The lat pulldown is similar in that if I were to climb a tree I'd be more constrained than I am in the machine...

The leg press is another example of the trig not "working" in that if your lifting form is any good there won't be more than a couple pounds of sideways vector force on your knees if lifting free weights, so putting low/zero side load on the knee in a leg press machine is the same force on the knee. If you run the math on the forces the stabilizing forces are very small with proper free weight form... stand on one leg and hold the other leg out 20 degrees the force on my knee should be mathematically larger than a dead lift freeweight or a leg press.

Furthermore there is infinite ink spilled on the topic of proper form for freeweight lifting, but real world muscle use rarely permits perfect freeweight form, simplifying it to the same problem.

Surely, if machines provided an inferior more dangerous higher risk of injury workout, then people would use free weights to recover from machine injuries, yet that never happens, so inductively I find it highly unlikely.

In regular life I don't want to lift heavy objects. I like the general health benefits and stress reduction and bone density of lifting, I'm not training specifically to deadlift car engine blocks instead of using an engine hoist like a normal person. There are probably people training specifically for vocational purposes where that wouldn't apply, soldiers perhaps.


There are a lot of "what worked for me in here" and that's great, but I want to stress that people need to consider seeing a physician, and possibly an OTR/L several times. The anatomy of your arms are more complicated than you think and any number of issues can cause pain, weakness, tingling or numbness. These people work with these issues 40+ hours a week and are more equipped to target and fix the issue sooner than you are on your own.

Sometimes it's just one lifestyle choice you need to change to improve your health (e.g. posture), but for some people it's more complicated than that. Everyone's physiology is just a little bit different and responds differently to different treatments.


I’ve read lots of RSI stories and seeing a doctor never seems to solve the problem.

https://github.com/melling/ErgonomicNotes

One example is John Ousterhout, the creator of Tcl/Tk, has had RSI for decades:

https://web.stanford.edu/~ouster/cgi-bin/wrist.php


Primary care physicians are often switchboard operators - they hook you up with potential resources or referrals that may lead to a solution. The chances that any given PCP is going to know a lot about RSI is pretty small, they have literally the entire spectrum of human health to consider, not to mention the looming issues of obesity, heart disease, cancer, and other more damaging syndromes.

Personally, I found wrist pain to be of multifactorial origin: too much typing, driving, playing piano, not enough cardio, strength training, and relaxation vs. stress.


This is true, and I certainly don't blame PCPs for not being up to date on the specifics of low-frequency disorders like RSI.

But my frustration is that even the 'switchboard' component of PCPs seems to be broken on this topic - across several musculoskeletal issues, I've only ever gotten recommendations to surgeons (who then said "you're not sick enough yet"). PCPs didn't even know what kind of specialist to suggest for finding causes and reducing pain, and the internet wasn't much better.

At risk of saying "what worked for me", talking to a physical therapist was a huge help with each problem - they didn't have cures, but their education was much more relevant to saying "here are some common risk factors and pain reducers you could look into".

And yes - 'multifactorial' seems like the usual answer, so I'm not surprised everyone has a different fix.


I have the same experience. Doctors and physiotherapists were of no help to me - they had no experience with RSI. In the end I found my own solution that worked:

- Break program

- Split keyboard

- Pen-mouse

More here: https://henrikwarne.com/2012/02/18/how-i-beat-rsi/


Absolutely, but in the complete opposite direction, don't give up looking for answers.

The quality of people you see, and their willingness to look for answers, will vary DRAMATICALLY. There is joke, what do you call the person who finished last in medicine? Doctor.

If no one is finding an answer to your problem, dedicated research yourself is liable to be a LOT more effective than ten minutes with a trained professional who is not that interested or willing to do any real research.


There are a whole range of issues where PCPs tend to be very poor support. In particular, disorders which are not life threatening, have no clearcut sign or single 'cure', and don't have an obvious class of specialists to handle them. As someone else said here, PCPs are 'switchboard operators' - but these issues are rare requests with no obvious person to forward you to. It's not especially their fault, this is how triage works, but it means "go ask your doctor" has an unusually low success rate.

Joint and chronic pain definitely count, as do lots of intestinal issues, unclear-cause headaches, and so on. Maybe you need a surgeon, or else a physical therapist; maybe a nutritionist, or else an allergist; maybe a neurologist, or else a psychiatrist. These sorts of problems seem to require a willingness to try many things, talk to a bunch of different people, and potentially push back on a doctor who's only recommending one path.


I used to have RSI. Then I stopped using Emacs and it went away. It flared up one time when I had to do some data entry in Excel; but then I learned the hotkeys and it went away again.

Just stop using emacs, people. It's literally damaging you!

-vim user


I use Emacs but also completely 'hijacked' the way it works with keyboard shortcuts, making it similar to a GUI editor and ignoring/disabling typically emacs-y chords.

Good thing being that Emacs is powerful enough to completely change itself without much effort.


I am glad you shared that.

I did exactly this but was always too afraid to admit it publicly, because of Emacs 'purism' users.

I love Emacs exactly because of how highly customizable everything is (without other editors bloat) but equally because I can leverage the huge user-base to not spend an infinity amount of time on customizing.

Although I appreciate other people's experience may be different with vi/vim/emacs, in my personal case I don't have to remote into other machines so I can get away with a custom init.el on my machine.


Use sticky keys and then the deault Emacs key combos are trivial to press conveniently without any straining: https://en.wikipedia.org/wiki/Sticky_keys


Or give god-mode or evil a try.

I use god-mode but found that capitalizing letters using the shift key was the biggest cause of pain for me. I retrained my left hand to use the ring finger for shift and added a post-command-hook to turn ",x" into "X", and the problem is largely gone. I also make a point to swap _ and - and also ; and : in certain modes (ahem Python) . My right pinky is still too active (RET and punctuation, but I rarely get any pain, even with a tiny laptop keyboard


That's an interesting conclusion, I find I do a lot less chording than your average Emacs user. Maybe the problem is chording. I've not yet had any issues (though I am also a Dvorak user, and a buckling spring user). I think today's Emacs is set up in a way that could cause problems on keyboards where the left Ctrl is not on the corner.


I can't imagine using emacs and not swapping ctrl and caps lock. It's one of the first things I do on any computer I get.


I just made caps lock an additional control and made a couple shortcuts for my most frequently used keys. Though talking about how one uses emacs is hard, since no two emacs uses have the same workflow.


Similarly, I switched from vim to GUI editors for the same reason.


No one knows what causes RSI. It might be multiple problems.

Anyway, on Github I’ve collected several dozen articles and created a table of things people have tried.

https://github.com/melling/ErgonomicNotes

My personal feeling is that if programmers embraced voice input, simply not having to type when issues arise would help. Of course, most programmers will rant about how keyboards are so much more efficient, which they might be until you can’t use one.

Here’s the current state of voice programming:

https://github.com/melling/ErgonomicNotes/blob/master/progra...


Voice input helped me recover in the past. It was a challenge to get a workable setup, and getting back to the same speed takes a lot of tweaking and experimenting.

Sadly the CPU load and maintaining the setup with ever changing OSes has been too much. Though I do still maintain easier keyboard shortcuts almost religiously. AutoHotKey and Karabinder FTW.

Perhaps dedicated voice hardware can help.


I've designed Talon (my voice / alt input project) from the ground up for cross-platform scripts/configs. Once I port the OS layer to Windows/Linux you should be able to reuse mostly everything (with some app/os-specific stuff overridden at whatever abstraction layer it makes sense).

What sort of CPU load are you seeing? I'm able to dictate on battery, peaks averaging ~20% cpu. (Dragon is a different beast, peaking to >80% anytime it's over the noise threshold, so you need a really good mic to get good battery life).


I think that if you made a module that did voice commands for VLC media player that it could be quite popular. I've often wished I could just yell out "VLC pause" instead of having to walk over to the keyboard or mouse.


As you wish: https://youtu.be/49kv_E9XjpY

Script here: https://github.com/talonvoice/examples/blob/master/vlc.py

Alternate minimal script:

   from talon.voice import Context, Key
   ctx = Context('vlc', bundle='org.videolan.vlc')
   ctx.keymap({'video (pause | play)': Key('space')})


Your list is missing Talon, which is one of the newest voice input projects (mine): https://talonvoice.com/


I added it at the top.


I can see why people hold out against this; voice programming sounds slower in general, and vastly slower during the ramping up period.

But I wonder if we'd be better off enabling voice input sooner, before we're in serious trouble, and using it sporadically. Mixing voice and keyboard input at need looks like a way to substantially reduce typing while still using a keyboard whenever voice work is too inconvenient.


This is one of my huge goals with Talon. I want to convince people who have no symptoms that using voice + eye tracking + etc is cool and will help them in useful / exciting ways. I think RSI is a kind of silent epidemic, and we won't ever solve it by only treating people who already show major symptoms.

On the other hand, it's really not much slower with the state of the art, especially when you mix in stuff like eye tracking at a really core level (we're playing stuff like autocompleting based on a symbol you just looked at!). I'm not far enough along with Talon to be pushing the benchmarking side of things heavily yet, but one early test was about 2/3 the code input performance of a 90wpm typist on the same code, with a lot of obvious places to improve. I think good application of continuous recognition, resumable grammars, and really context-specific helper code can push specific workloads way past what a keyboard/mouse can do (which calls back to the goal of impressing people who aren't injured yet).

Then there's the professional app space - e.g. Photoshop, CADD, and video/audio production tools could really benefit from voice workflows (imagine using a pen tablet augmented with voice + eye tracking instead of complex UI).


Here's one for your list that worked for me within 1 week of starting: dropping wheat from my diet. Noticed you don't have diet as a category even.

For more detail, I was sleeping in two wrist braces every night and doing stretches and strength exercises for an hour or more a day before the diet changes. Now I don't need any exercises or braces.

When I regress for a day or two it comes back, but not as bad.


I’ve never seen an article on that. If you write one with your experience, I’ll include it.

Why did you omit wheat? Was it in direct response to RSI?


Maybe a more general article on an anti inflammatory diet would be better. A quick search should gives results from some reputable liking sources.

There is also this: https://news.ycombinator.com/item?id=17109010


I don't have citations at the moment, but I have heard of gluten as having inflammatory effects on the body, which could certainly make RSI worse.


weird that you're getting downvoted. The only explanation I can come up with is that some people's gut reaction to testimony against wheat is a result of addiction.


It couldn't possibly be that too many people have seen wheat/gluten blamed for a litany of unrelated ills with no data or scientific backing, supported entirely by placebo-effect sensitive anecdotes.


Interesting, voice programming would also solve the open space office problem.


I'm afraid of the pressure happening the other way - I think open office plans reduce the chance of people trying voice programming. People in the community specifically talk about working from home or asking for private office space. There's also the Stenomask, which I've heard works great for dictation.


IMO, the current state of voice recognition in general is absolute garbage for anyone who doesn't speak American English natively. Dragon for Windows is touted as having great voice recognition, but it often fails to understand 'page up' / 'page down' and other simple commands. The built in system to OS X is ok if dictation with mistakes that need correcting by hand (aka keyboard) is something one desires; I can't imagine it ever is. Interestingly enough, the mobile voice recognition features seem to work a little better, but systems like Siri and Google's assistant are completely useless for getting actual work done. The accuracy of all these systems is such shit, that I have turned them all off as they are not even useful for dictating a plain English message into slack, let alone driving a computer and doing productive programming and system administration work. On the other hand, I've seen native speakers do exactly that which is impressive and also, I admit, makes me jealous as I don't expect to have access to this technology for many years to come.


Are you on macOS? I'd love a chance to change your mind about this.


Yes I am.


Can you join the slack linked at talonvoice.com or send an email to the address in my hn profile?

I'd probably start by asking for audio samples of you saying a couple of sentences and commands in english

Then I'd try them locally against a couple of speech recognition engines

Then talk about potential issues and ways to influence recognition accuracy

Then I can help you try out Talon for both dictation and command input

As an anecdote, I've heard from some of my non-english-native users that they need to avoid certain word sounds in commands (by changing the command trigger words) because their accent doesn't emphasize them enough for good accuracy.


Reading Dr Sarno’s book “The Mindbody Prescription” was what cured me. There was no physical cause. I haven’t had issues since 2001, and I don’t do anything specific to address the physical, the solution is purely psychological (though the symptoms were physical).


Chiming in because this book saved me too. Step one (as prescribed in the book) is to get thoroughly medically checked out. If a physical cause cannot be found, try this. Doing the free course on the TMS wiki sorted out my problem within a few weeks.


I had disabling back problems. I even had a setup where I could lay on my back and type with a monitor above me(!). I read the "The Mindbody Prescription" and it went away pretty quickly. It comes back briefly once or twice a year, but it's very minor and I have confidence it will pass. According to this book, it's not "all in your head". These are real, physical symptoms. But healing can be done mentally.


Ditto. I suffered for a year until a nerve conductivity test revealed nothing abnormal. That made the Sarno diagnosis (TMS) easy to accept, and within a week of reading his book my pain was 90% gone, and within a month it was no longer noticeable. Now and then I'll get pins and needles, but in general I can type in any position I want for hours.

Recently I have been struggled with other health issues, and it took me a long time to realize that they may be psychosomatic as well. Once I started applying the same techniques, I saw real, permanent improvement in my symptoms for the first time. It's not an overnight cure, but if you stick with it, the results are just astonishing. Has anyone else in this thread cured non-RSI issues using the Sarno method?


I'm probably about to try this out. In my initial perusing it seems similar to a past insight I had.

Long ago, I was in a slightly altered state and it occurred to me that I was semi-consciously clenching muscles in my upper back and shoulders in a weird stress response... to the point where I couldn't unclench them easily. I found that trying to 'loosen up' and distract myself eventually gave me more control back, and relieved some of the discomfort.

I find it completely plausible that many of us may be channeling difficult emotions into maladaptive movements without realizing it. Restless leg comes to mind, also.


Did you really just read the book or did it also tell you to also do something about the "psychological", which you then did?


As strange as it sounds. I think people really improve just by reading the book.

Imagine one day you find an itch on your little pinky on your left foot. You never notice it before. Now spend all day thinking about it. Every day. It will be magnified, it will become unbearable. I think the book teaches you to shift your attention.


It's bizarre. I tossed the book away in disgust because it's crazy pseudoscience....and it still worked.


Sometimes just reading the book causes things to change — in my case, symptoms shifted to a different area (a-ha!). Think of it as "telling" your mind that the game is up: you know what it's up to.


I had very painful RSI for 4 years which was hampering my career and preventing me from playing any video games for more than 15 minutes at a time. It went away within a week of reading "The Mindbody Prescription."

... not that playing video games has been good for my career...


I also dealt with RSI problems that haven't occurred since I read The Mindbody Prescription.


Around 2004 I started having a sore right wrist. I saw a specialist who said it was a repetitive stress injury and not carpal tunnel. He prescribed some exercises but it didn’t work. I moved to using my left hand to use the mouse, switched to ergonomic keyboards, tried a trackball, fancy ergonomic nice, adjusting my seat height, adjusting my desk height, and nothing worked. When I switched hands, my left wrist became sore too. Finally, finally, I tried using a pen tablet and the soreness disappeared. Turned out the motion that was killing my wrists was clicking the mouse with my finger and pushing my whole hand down to depress the pen instead worked out. I’ve been coding pain free ever since. The way to make a repetitive stress injury heal is to figure out a way to stop making that motion over And over again.


I had this wrist pain 2 times in my life. If I would put pressure on that wrist (eg to do pushups), it would hurt like hell.

I was always able to fix it by using the keyboard shorcuts more. Navigating to menus with alt etc.


pen tablet (wacom pads) work for me too. Wouldn't use mouse for a long period anymore


Hmm, this article makes me think some people's RSI problems may be caused by Raynaud's Disease.

https://www.mayoclinic.org/diseases-conditions/raynauds-dise...

It's more a description of symptoms than a description of cause, but being able to put a name on it makes it easier to ask about and Google. Basically, anything that can help treat this might be able to help with related RSI.


Both my wife and youngest daughter have Raynaud's. It's really obvious due to the external signs - though, as you say, I'd never have known what it was and that it was a thing before my wife told me about it.


Worth pointing out that 90% of cases of Raynaud’s occur in women. My wife has it and wears fingerless gloves at her computer in the winter.


I did a few things to stop my RSI pain:

1) Use an alt keyboard layout. Use colemac. It's easier to learn than dvorak and decreases finger travel at the keyboard

2) Stop using a mouse. I used a trackball for a while but it has its own issues. I use a cheap wacom bamboo tablet now. It's far and above more ergonomic than any other device I've used as a pointer.

3) Use a kinesis advantage. Blank keycaps for style points.

4) Use your left hand. I use the wacom bamboo tablet with my left hand (I'm right handed.) This has had amazing results for me personally with the wacom because my left wrist does not bent/turn at all - I move entirely from my elbow primarily because I'm not that dextrous with my left hand.

I did them in that order but I'd recommend swapping the keyboard and mouse first, as they have the biggest bang for the buck in terms of ergonomics. The alt keyboard layout is marginal. Left hand was big for me personally.

All of these items take some time and effort, in particular learning another keyboard layout. And the kinesis also has a relatively steep learning curve relative to other keyboards. Don't do it all at once - it's a multi year journey but hey - no more hand pain! I still use a regular tenkeyless mechanical keyboard and mouse at home in the studio, and obviously carry a laptop for work, but my use of these is fairly infrequent relative to the 40+ hours a week at my desk at work.


How long did it take you to learn colemac?

> 3) Use a kinesis advantage. Blank keycaps for style points.

These keyboards are quite expensive, but totally worth it. My previous employer offered them as one of several keyboard options. I went with it due to some pain, it took maybe 6 weeks to used to the layout. Ended up buying one a few months later when they went on sale (usually 10% off around black Friday), as my pain had gotten dramatically better. The company that makes them is also pretty hacker friendly - they sell spare parts and they've been willing to help people who want to make custom controllers for their keyboards.

I actually hacked a trackpoint (harvested from an old IBM desktop keyboard) into my kinesis and used that for a while, but due to the way the sensor works it really needs a solid mounting to work well which I just couldn't achieve.

I personally have had decent luck with a vertical mouse (anker makes a cheapish one that works fine).


> How long did it take you to learn colemac?

Not the guy you replied to, but I switched to Colemak last year. It took me about 3 weeks to get to a "usable" state, and maybe 2 months to get within 75% of my previous speed with qwerty. My progression was roughly:

0-1 weeks: Can't type anything without looking at the key map. I would switch back to Qwerty if I needed to type something long out (emails mainly).

1-2 weeks: Weird phase. I can't effectively type in either qwerty or Colemak unless I really "focus" on it. It's hard to describe, but this week was terrible for productivity :)

3+ weeks: Forced myself to use Colemak exclusively. During this time I started doing real typing exercises, and turned off autocomplete in my IDE, since I found that was detrimental to learning. I also wrote a ton of documentation for a couple of my projects, which involved a lot of typing.

Before I switched, I would get intermittent pain in my wrist (maybe twice a month), which has since completely disappeared. When I need to type in Qwerty now, it is very uncomfortable, in a way that Colemak never was.


I can confirm all of this learning Dvorak. Having seen this with myself and others, it really is like a short version of learning a language and seems to use the same part of my brain. There's that period where you're not good in either layout and you need to get something done like you're saying (but after all the fun initial gains) and that's when most folks quit. If you can push past that week or so, it seems you're good. It's painful though.

And yeah, I can still touch-type in Qwerty too, but it feels like contorting my hands in knots. I can type it in fine, I just never noticed before how crazy you have to move your hands to do it.


yeah it took a couple weeks of daily practice at home, row by row. Then I switched at work once I could type about 20-30wpm (down from 112wpm or so on my best tests)

It was incredibly painful to start using it full time but I built good habits from the start as I re-learned touch typing. It's a very valuable experience watching the brain learn a new keyboard layout as an adult.

From there it took me maybe a month or two to be very confident. I then was unable to type in qwerty without looking at the keys for a couple years. Now my brain is pretty happy switching back and forth. It's odd but I find Ive learned things like typing one handed with colemak on keyboards that are qwerty (eg my macbook) and odd things like that so the brain keeps learning to work in a pinch in the edge cases years later.

Colemak is _incremental_ to qwerty so is significantly easier to learn and get started with full time than dvorak for a software engineer.


I bought my kinisis used I should say! It was $200 plus I think $50 and several months to get the blank keycaps ordered (was hard to track them down in canada - had to go through another supplier as kinesis won't ship them direct and it was a special order)


My experience was definitely different. Just switching my keyboard layout to Dvorak was enough to slay my RSI. It's been 15 years with no pain since. I've done all the others on this list, they didn't seem to have an impact for me.


I will experience wristpain if I use my tenkeyless w/ colemak. My laptop keyboard doesn't seem to bother me as much though.


This post is for those who believe that they will never get RSI symptoms. Don't be foolish. I spent my teens and twenties pounding away at a keyboard with a slouch and bad posture. No pain. Eventually it got to a point where my forearms experienced soreness after a long binge of typing. Luckily, a night of rest "solved" the problem. Then, the recovery period became longer - a weekend, three days, using a heat pack. Finally, and this is the reason why I am writing this, the soreness never went away. Once you pass a certain point with active denial, your body gets damaged. Like another poster mentioned, at that point you need to spend equal time counteracting the effects of what you did with something like functional fitness or strength training. RSI once it reaches a certain point, like most problems in life, does not go away. It can only be managed. All the advice and personal experiences shared here is good but keep in mind that the best time to manage RSI is before symptoms appear. Don't fall for the premise that there is a solution for RSI without addressing the root cause, continually and daily.


My RSI ended up being due to an anomaly in the structure of the sheath my tendons pass through. I went through doctors, NSAIDs, cortisone shots, physical therapy, and all the ergonomic adjustments you can think of. Finally, a surgeon just 'fixed the glitch'.

All the other advice is still good advice -- but sometimes you have a mechanical problem, so dropping conversations with doctors just because their first treatment failed may not be the right move - there are further actions to explore. And if nothing is working, it is worth finding out whether there is a deeper underlying problem to resolve.


Can you elaborate on how the issue was found? I've been through similar treatments, even had carpal tunnel release just to see if it would help (it didn't).

How would you describe the pain? All of mine is in the fingers, exclusively. No wrist pain.


I initially went in because my wrist was hurting when I coded all day, sometimes shooting up my forearm. At the first appointment, they had me put my thumb inside my fist, and try to move my hand down (Finkelstein's test) - I had no motion and lots of pain, so the diagnosis was easy - DeQuervain's syndrome... totally different than carpal tunnel, but still an RSI coders get. For most people, it heals easily, but not in all cases:

We went through the standard steps for this problem - rest, ergonomic changes, a cortisone shot, then physical therapy. Nothing worked, so I consulted a surgeon, who gave me an additional shot with more expertise in exactly where to give it. That actually helped for 6 months, but when I called back after the pain recurred, they said surgery is the last resort, but also the best option in my specific case, as it is a simple fix and almost always works. During the surgery, they found that my tendon sheaths were bisected, leaving less room than normal for movement through the wrist.

As far as the pain, it was very focused on the side of my wrist at the base of my thumb, in particular when moving the hand to the outside of the wrist.

All that being said, the bigger lesson I got from it all is that not all RSI pain is the same problem. Hand specialists know how to tell the difference between all the problems and can give you guidance on which treatment will help. At the same time, general practitioners do not have the same level of knowledge, and may waste your time running you through treatments that won't work. So if you are having problems... ask a hand/wrist specialist for help.


"At some point during this period I read one of Dr. Sarno’s books. His theory is that long periods of pain are not due to actual injury, but rather an emotional problem causing e.g. muscles to tense up or reduced blood flow. There are quite a few people who have had their pain go away by reading one of his books and doing some mental exercises. [... it works, then it stops working, author makes tenuous connection to the cold in their office...] I started wearing a sweatshirt and hand warmers at work, and I avoided caffeine on the days I went to the office. The pain went away, and so far hasn’t come back."

Good for them. Sounds like a particular case, but I guess if you feel uncomfortably cold in your office, you should do something about it.


It might be for them that they didn't feel cold as such, just that it was cold enough for blood flow to the extremities to be restricted.


I used to get RSI, then I switched to a Microsoft Natural Keyboard about a decade and a half ago (I'll be sad if this line ever goes away), and my issues went away. At every job I've had, I find the same thing happens. I start, and have a normal keyboard. Within a few weeks the RSI is back again. I expense a Natural Keyboard, switch to it and the RSI goes away again.

This last job change was way more dramatic. They gave me a magic keyboard. Those things are a cramped, ergonomic nightmare. My RSI came back within a single day of typing on the damn thing. I had to get rid of the magic mouse for similar reasons too (arching your finger and wrist, like you need to do to tap it, is similarly bad)


It really can not be overstated how inhumane Apple's desktop peripherals are. I honestly can't think of worse mice or keyboards.


I've found the Microsoft Comfort Curve 3000 to be a good hybrid between a standard keyboard and a natural one. It has the curve that puts your wrists in the better posture, without the split so it's easy to get used to, and I like that the keys don't have as much travel so you don't have to press down as hard.

Unfortunately they seem to have discontinued it. I had picked up two a few years back for $20 each on Amazon, but now they're going for $100 on Amazon and eBay which makes no sense for a basic wired keyboard. It must be because of scarce supply and high demand.


Couldn't agree more. Use both the keyboard and the mouse and have stockpiled a few extra sets. Without them, there is no way I can log 30+ hrs of Wakatime tracked programming per week. But I also know, from a previous stint in muscle rehab for my back, strength training can solve all the problems.


I went from a regular keyboard to the Microsoft Sculpt. A few year later, most people of my group at work have switched to them too.

It's not perfect: the ESC key is a flimsy little knob and I'm a heavy vim user, but you get used to it, and it's still a huge improvement over not having one.


I found that when I started using a mac mini pinkie finger started to ache so got an old ps2 ms mouse the curved soap bar type and a usb to ps adaptor I also swapped to an old zenith keyboard from 20 years ago.


I've never had RSI severe enough to have to stop working because of it, but the minor issues I once had were completely cured by taking up indoor rock climbing.

Of course I don't know exactly why it worked, but my guess is that a) it massively increases blood flow into your forearms and hands, and b) it strengthens all the small muscles and tendons in your forearms and hands so much that typing and other movements don't even register as "strain" anymore.

If you start climbing, start slow and easy and build very slowly, especially if you are an athletic person who is used to improving fast and pushing yourself. The tendons in your fingers get stronger much more slowly than you expect.


For Emacs users, common wisdom is to swap control and caps. I urge you to try swapping left control with left alt instead. Thus you can use your left thumb to hit control and right thumb to hit Meta (alt). Map Esc to capslock if you use Evil-mode. Linux commands for x windows:

  setxkbmap -option 'caps:escape'        
  setxkbmap -option 'ctrl:swap_lalt_lctl'
This works well for me and would probably work even better if my keyboard had big alt keys.

Edit, as another user said, everyone should probably be using sticky keys. On linux I run

  xkbset sticky -twokey -latchlock
on login with Xorg. Sorry, not sure how to do this under Wayland.


Great advice. Hitting modifier keys with the thumb is how Emacs is meant to be used, in my opinion. It's the strongest finger, after all.

> For Emacs users, common wisdom is to swap control and caps.

This is terrible advice and it causes so much unnecessary pain.

- The pinkie is the weakest finger.

- Stretching sideways is a terrible movement. Try it several times and compare it to moving a finger up, or curling the thumb. Stretching sideways should be reserved for infrequent actions -- hitting a modifier key is much too frequent for Emacs users.

- You should have modifier keys on BOTH sides of the keyboard. Using Emacs with just one Ctrl key is just... awkward. There are so many common keybindings (like C-x C-c) that are difficult with this scheme. With Ctrl to the left and right of the keyboard, however, I can just curl my right thumb a bit and then press x and c.

If you have RSI, maybe one of your hands is overworked (i.e. you only use Shift with one hand). Big opportunity for improvement there. Unfortunately not all modern keyboards have modifier keys on both sides of the keyboard, so you definitely have to watch out for this when e.g. buying a laptop.

With the key system you suggest, Emacs bindings are even better even than Vi modal editing, in my opinion. Pressing/lifting a thumb is much easier than changing editing modes.


Definitely agree that if you are using thumbs to execute all Emacs commands, it's just as comfortable as modal editing. Since I started using Evil a year or so ago I have become very used to it and I'm now using a strange combination of vim keybindings for text manipulation and Emacs bindings for everything else (saving files, switching buffers, etc.)


Honestly, I never use Caps, so I just

    setxkbmap -option 'ctrl:nocaps'
As far as sticky keys go, I'm going to pass. That's a modal change that I don't want interrupting me.

As far as Wayland goes, keyboard layouts are handled by the compositor (window manager), and have to be supported and configured by each compositor. That's probably the main design flaw that has been keeping me away from Wayland.


Excellent advice. I also swap control and alt on both sides. This means I can reduce the amount of chording needed and use alternate hands together.


I never want to reach for control again. I map alt to CapsLock, and control to alt


Interesting. How do you hit the Meta key if you swap on both sides? With a pinky?


Normally, I use a Kinesis, so it would be thumbs for both. But on my laptop, yes I would use pinkies for both shift and alt.


The #1 thing that has always worked for me, and I've been addressing this for years .. since 1983 .. has been to switch things up.. Change my keyboard at least twice a year.

You know that whole vim vs. emacs debate? Actually, thats really healthy for you. If you don't wanna have sore knuckles every week, use both.

It really helps to switch it up.

In 1984, I was mostly a user of 8-bit style keyboard systems. Had MSX, had British-8bit, had a bit of American..

In the 90's I had a lot of American. I mean, who hasn't had a bit of IBM or Cherry or two, amirightkids?

All through this period, there were periphery effects where I could observe my hands saying, enough is enough. Please do something else for a while so pathways can be repaired.

So, I did it. I've pushed all kinds of switches in response. Turns out, this is good for all kinds of other reasons too (pollygots ftw) and so on.

But every year I think to myself, how well are my hands behaving? And the answer always comes back to, did I upgrade my main machine this year?

(Disclaimer: ready to ditch Apple and go with someone else, unibody..)


I did something similar back in 1997 or so. Instead of switching keyboards or input programs, I switched keyboard layouts. I switched to dvorak, and (after a month or two where I couldn't type well in either layout) the pain went away and hasn't come back. I use qwerty at work and dvorak at home now.


I wholeheartedly recommend the excellent Kinesis Advantage 2. It's relatively expensive for a keyboard, but absolutely worth the money for anyone who uses a keyboard professionally for hours every day. It also has featureful firmware and the ability to remap keys in hardware. I wish I had purchased one years ago. My typing is faster and feels like much less effort.


I want to get me one of those, but I tend to use my mouse a lot; it's more aimed at people that can actually use keyboard-only interfaces I think.

I've got a (tenkeyless) wireless mac keyboard, the low profile really works for me. Wouldn't mind if it was a split keyboard though.


The Advantage layout is definitely one that sort of insists on two hands if you want to reach anything that the right hand types regularly and/or you want to use the arrow keys. The keywells are open on the outside edge, so it is pretty easy to slide one's hand over onto a mouse or trackball, but I agree that a conventional layout has at least some advantage there (I think a split keyboard would fall somewhere in the middle).

I don't find it to be much of an issue in practice, because I use the Advantage 2 along with a CST L-Trac trackball, which sits right beside the keyboard and can be operated with just a couple of fingers. They have a model which can accept external buttons, which is the one I got, so I also have duplicated the LMB and RMB next to the other side of the keyboard. In this way I could theoretically use the cursor with my left pinky and click with the right pinky without taking my hands off the keyboard, although it's not particularly effective (or necessary).

FWIW I am someone who uses mouse-driven interfaces all the time, although I guess emacs more than makes up for it with the amount of keyboard activity it demands.


Kineses also has something called the Freestyle, which you might consider looking at. I have one for work and one for home.


I wish these good split keyboards had staggered rows like a regular keyboard instead of a grid layout. I have an Ergodox and couldn't get used to the grid.

I know Kinesis has other split keyboards but they don't have mech switches.


Part of what makes the grid work well for the Advantage is the keys are indented to correlate with the length of your fingers.


I may just be imagining things, but it seems a disproportionate number of RSI-suffering programmers use emacs. From my own experience, I suffered the worst RSI of my life while using vim. It subsided a bit when I moved to Sublime and almost completely went away from I switched to VS Code. Obviously correlation does not imply causation and I have taken a number of other steps to fight RSI (ergo keyboard, heavy keyboard remapping) throughout the years.


Did these editor changes correlate with any other life changes, e.g. job change?


I've been using a keyboard for over 20 years and I'm fortunate enough to not have any pain or RSI related issue. I've always used regular stock keyboards and whatever mouse felt comfortable to me (Logitech's G400 fits my hand like a glove).

This is even with many years of hardcore clicking and "worst case scenario" things when playing massive gaming sessions back in the day.

But, one thing I've always done from the beginning is to make sure my forearms are parallel to the floor. I always make sure my hands are well supported on the keyboard[0], and my elbows are well supported (on a chair's arm rest).

One thing that sucks about a standing desk (something I've been using for 2.5 years) is you lose that elbow support since your forearms tend to dangle.

[0] This doesn't necessarily mean resting them on the home keys. I don't know how to type properly and over the years developed my own crazy system. I'm pretty sure if anyone saw my typing, ergonomic is the last thing they would describe it as.


My main issue with standing desks (and most regular desks actually) is that I like to have the keyboard relatively low (forearms parallel or slightly downward) and the display at eye height (well, top row at eye height, maybe a bit higher); most screens don't go this high. Luckily most of my workplaces have had printers, and where there's printers there's the best monitor stands you can get: packs of A4 paper ;). Anyway I need a few more of those for a standing desk.

I'm not a fan of actually supporting elbows, that (for me) would lead me to leaning on them, which leads to 'hanging' and shoulder / neck issues.


When I had a sit down desk, I always tried to get desks with the keyboard pull out draw.

I also much prefer having the keyboard / mouse low, but then I just adjust my chair to also match that height so my forearms rest naturally.

Funny enough that's exactly what I used to prop up my monitors too. It's so good because you can fine tune the height by just removing a chunk of sheets.

If you sit up straight, the weight should be pretty evenly distributed. It felt like floating on air.

In the end I guess that's what matters. Try to find a set up that puts absolutely no strain on your forearms, wrists and hands.


You can get articulated forearm supports for desks (says Google). https://theergonomicstore.com/collections/arm-elbow-supports


Damn $122 for the clamp on rests. That's more than double what I paid for my entire standing desk set up[0].

[0]: https://drive.google.com/open?id=1uuC3UMEaaa-lcTMsh4xMIg8Rbt...


You could create something similar with a pad of cheap industrial memory foam (can buy pre-cut on the web dirt cheap), double-sided tape, and some 68mm downpiping, but it wouldn't be adjustable to the same degree.


I had bad RSI in 2010/2011 that I cured. Then it came back in a mild but tolerable form for several years. Last summer it exploded again, and I took steps to solve it more permanently. Here's what has worked for me:

* Highly skilled physio who did MAT. Most physios did nothing for the problem. But, I found one who had been the physio for the local pro football team. Unlike the others, he didn't use ultrasound.

* Trigger point therapy massage. Far more effective than regular massage. Hard to find a good practitioner

* Handshoe mouse. A lot of my troubles were causes by mousing or trackpads. This mouse has been astonishingly comfortable. I think it forces you to use the shoulder and have good wrist flexion

* Using the keyboard I used while recovering. I tried any number of mechanical and ergo keyboards, but then remembered that in 2011 I had comfortably types a million words while recovering. I checked and found I had used the logitech MK320. I bought it again and have been able to type more. No idea why this cheap rubber dome keyboard has been so good for me

* External monitor raised up. After recovering, I switched to a mac and used laptops. Using it as a laptop was dumb; while recovering I had an external raised up. I did this again and I think the improved neck posture helps.

I was already doing weight lifting, so the "get strong" advice you commonly see in these threads didn't apply. Though I think the problem would have been worse without it.

Also, I find mobile phone use can contribute. I hold mine with my pinky, and this leads to strain. I haven't figured out how to hold them well, because they should be up near eye level to prevent neck strain.

Can anyone tell me how to make lists that doesn't format as a code block? Double spacing seems to be the only way not to have list items all on the same line.


I was spending an hour a day doing stretches and exercises and sleeping with two wrist braces.

Then I dropped wheat from my diet and it went away within a week. I was the true skeptic going in, so I returned to wheat a few times and the pain comes back every time within a day or two.


Interesting. I don't have that, but goes to show why trying a variety of things is smart.

I tried a bunch of stuff that didn't work. The stuff that did work always made a differece very quickly. Often within a day or two. Becomes startling when a problem is otherwise intractable.


What does the Handshoe mouse do that makes it cost > £100?


It's very large, so your hand just sort of rests on it. You don't need to grip it, unlike other mice.

Also due to the form I find I'm forced to keep my wrist in a good position, and basically can't use it to move the mouse. Instead I have to use my shoulder.


Even healthy people should turn on sticky keys: https://en.wikipedia.org/wiki/Sticky_keys

Pressing, Ctrl, Shift, etc. combos strains your hand. With sticky keys you can press key combinations by hitting the keys one after the other, instead of simultaneously.


A couple of years ago I heard that one should press Shift/Ctrl/Alt using one hand and other key(s) of the combination using the other hand. At first, it was awkward. I had felt that I was soooo slow. But after a week or two I got used to it. Now I can't even imagine going back to using just one hand for the combos and for sure the stress on my wrists is lower.


Pressing, for example, Ctrl+C is simpler with the left hand only and if one uses sticky keys then it's two separate keypresses, no stressing of the wrists needed.


sticky keys is a nuisance


There might be something to the cold hands thing. Handwarmers are a ubiquitous accessory in the esports community.

http://businessinsider.com/esports-hand-warmers-2015-8


Having been a gamer (long ago), and a developer now, cold hands directly impacted reaction time and precision, which in turn made one "get pwn'd". But I didn't feel like it hurt more (or at all, no RSI problems here, cross fingers).


I attribute my initial RSI to typing a large amount (live transcription) in a very air conditioned room on a table that was too high.

Within three days I couldn't type without pain. The height and volume alone may have done it, but the cold felt like it was bad for my arms.


My experience:

1. Get ibuprofen for the pain.

2. Cut down on time at the machine. Use the minimum you need.

3. Stop using your phone/tablet so much.

4. Start walking as much as possible. You will not believe how much this helps.

5. Change your mouse. https://www.amazon.co.uk/Wireless-Vertical-Ergonomic-Optical...

6. Go see a physio for advice on exercises.

7. Swimming for long-term strength and prevention.

It's worth adding that stress can be a significant factor, so if you're stressed you should address that too.


Good keyboards and pointer devices are not as expensive anymore, both in money and learning time terms. My picks:

Kinesis Freestyle Edge (never mind the "Gaming" slant): https://gaming.kinesis-ergo.com/edge/

A big-ball trackball (not the thumb-operated ones): https://www.kensington.com/us/us/4493/trackballs


A prioritized list:

0. If you are in pain, stop immediately.

1. Posture: get an ergonomic assessment at work, follow it. A proper posture should not injure you. While typing your wrist should not be at an angle.

2. Stretching: physical therapy will train you to do it correctly. poor stretching will harm you even more.

3. Wrist braces help preventing injury. Ice and ibuprofen can help managing pain. But pain is useful to understand what is harming you.

4. Get ergonomic hardware. A mechanical keyboard can be softer than a regular one.


Mechanical ergonomical (angled) keyboards are currently very expensive / rare. I read that many coders are enjoying the Microsoft Sculpt as an alternative.


Expensive relative to what? Certainly not expensive relative to the rest of your computer and your office chair. It's a great shame that so many of us are willing to put up with the ten dollar keyboards that come complimentary with desktop machines. The keyboard is the primary input device used for many hours every working day. We deserve better.


> Expensive relative to what?

It would cost me half my monthly salary, if I didn't get taxed. For something that I might not even get used to and have no one to sell it to in the local market.


Yes and no. The escape key is hot garbage. That can be fixed by key remapping. I've also had it drop the first keystroke after a period of inactivity. Finally, more than once it has exhibited stuck keys without any underlying physical reason. It really sucked when the stuck key was 'delete' and Outlook had window focus.

Other than that, yes, it's great.


A keyboard that is soft really helps, not necessarily mechanical.

A short keyboard (no numpad) is preferable too. It prevents having to open your arms for mousing and typing, which is a frequent cause of mousing RSI.


This is what helped me the most - shortening the distance between the home row and the mouse. The next best help is to use Vim everywhere which reduces the need to reach for the mouse.

I use a leopold 660m which is a 60% keyboard that has arrow keys tucked close.


> Mechanical ergonomical (angled) keyboards are currently very expensive / rare.

Yes. Paid close to €400 for a Kinesis Advantage 2, to replace the previous model. Hurts the wallet but better than nerve pain.


You'd think an employer would be willing to pay for that too - it's a much better deal than loss of an employee or reduced productivity due to injury.

I mean we live in a market where beginning developers make (and by extension, cost the employer) over $100K.


And yet they have to sit in open offices to save $50/month by killing 50%+ of their productivity.

So he gets a cool keyboard, means 99 other employees are going to demand their cool little expense like the espresso maker or the dog walking area outside, and because its penny wise and pound foolish, the company would rather infuriate hundreds while destroying productivity, than spend 1% of their salary budget making the employees happy and productive.


Workers with RSI will get a doctor to prescribe a proper ergonomic workstation / peripherals. In fact, it's almost impossible to see a doctor for RSI without getting that. Afterwards, the employer will be forced to comply with that prescription. Even if they don't legally have to comply (in many places they do), the threat of a lawsuit should take care of that. This also solves the jealousy problem of other coworkers wanting gadgets because their disabled colleague is getting the equipment he desperately needs to work as they would need to be prescribed by a doctor or other health professional.


I just build ergodone from aliexpress(copy of ergodox) for $200


I have been using Microsoft and Logitech ones.

Apple was one of the precursors of ergonomic keyboards and now I wonder how anyone can use those keyboards 8h a day.


This worked for me a while ago. Emphasis on physical therapy with a specialist.


> a Kinesis Advantage keyboard

There are a lot of nice alternatives to this, too.

If you are happy spending >$300 on a keyboard, https://shop.keyboard.io/ is definitely worth looking into.

If you are feeling more frugal, there are all kinds of options. Anything "ortholinear" is an improvement. We don't need typewriter-staggered layouts. Anything that puts modifier keys near the thumbs instead of palms is also helpful.

Here are some great open-source designs:

https://olkb.com/planck

https://www.ergodox.io/

https://github.com/adereth/dactyl-keyboard


I had the same kind of problem. For me resolving the issue was as simple as learning and using the dvorak layout. Having a different and entirely more efficient way to type completely resolved the problems I was having. This in combination with a typematrix keyboard has ensured that I never once experienced hand pain in more than ten years working with code.

Before, when using QWERTY on a regular keyboard, I reached a point where I could no longer type at all without pain. Although I code I mostly write prose and messages. After switching I can type on QWERTY without pain as the original injuries healed, but I can feel after several hours how difficult and uncomfortable it is to type on that layout.

If you're at a point where you can no longer type why wouldn't you consider changing the layout of your keyboard? Even if it's to something substandard in many ways it at least ensures you use your hands and arms in different patterns. It's also a nice exercise for the mind.


I solved my problem by getting serious massage therapy. For a long time I thought I had carpal tunnel, but the real problem was super tight muscles in my back and shoulder. After one painful massage the burning, tingling and pain in my hand and wrist was gone. Outside of getting an occasional massage, the answer was a regular routing of weightlifting.


Pretty much as a rule, you will find Emacs users with wrapped wrists. When you point out that editor of choice might be the cause, you will hear all kinds of explanations and excuses. They are also biggest market for Kinesis and other ergonomic products.

I had few times wrist pain and it is usually due to mismatch of height of the desk and the chair.


As a data point, I had "RSI" wrist pain for many years, and finally determined that it was psychosomatic. Sarno is spot on — I've been pain-free for the last 10 years after understanding the real cause.

If you have symptoms which are not easily explainable, and especially if they vary, it is worth taking the effort to read his books.


Failed Solution #1 has mostly worked for me. I regularly wear a wrist guard and bought an Evoluent vertical mouse and have seen great improvements. The wrist guards actually caught on a bit at my last workplace. I think maybe people were afraid it looked dumb then once it started people realized they should just go for it.


The cause of my RSI was using arm rests on the chair and resting the wrists on the desk. It led to scrunching up my shoulders which ended up causing severe neck and shoulder soreness. This setup also caused pain in the underside of my forearm when using the mouse for extended periods of time.

So I got rid off arm rests on my chair and put the keyboard and mouse on a tray and put the tray on my lap. That was the neutral resting position for my arms. And it got rid of my RSI for the most part.

If you've tried other options for your RSI and still can't find respite, check if typing from your lap alleviates pain. You can test this using a laptop. If using your laptop on your lap for long periods feels less stressful as opposed to typing and mousing from your desk, it means the least stressful position for your arms is at the level of your lap.


The cause of RSI is bad blood flow in your arm (starting at your neck).

So you have to figure out why blood flow is bad. And this might be different from person to person.

Some personal experiences:

  * Bad posture.
  * Stress causing neck muscles to block blood flow.
  * Working too long.


My experience of eliminating RSI:

1) Consider getting a big trackball and learning to use it with your wrong hand,

2) Get a better keyboard,

3) Work slower,

4) Walk as much as you can,

5) Lose weight,

6) Manage stress.

In common with many others, I believe there's an emotional and/or stress context to pain, and you need to fight conditions such as RSI on multiple fronts.


other useful books along these lines are Becoming a Supple Leopard, The Body Keeps The Score, anything by Joe Despina

In my estimation, especially on the east coast, most people are more tense than they consciously realize

I enjoyed that you pointed out avoiding caffeine as a way to detense


that should say Joe Dispenza


I still don't understand why palm-pressing[1] the Ctrl key in Emacs is not a thing. No pain, no stretching, and you can make use of both left and right Ctrl. Lately I'm even using a Ctrl+Shift combination, both pressed with the palm at the same time. Xah Lee was not wrong about it. It was actually the most important thing I've learned from his website. Take it, use it, learn it and I promise you, after a month or two, it's muscle memory, it's natural and pain free.

[1] http://ergoemacs.org/emacs/emacs_pinky.html


I'm not sure how much I agree with this post but what personally worked for me was simply using the mouse with my left hand instead of my right. I play a lot of video games and 15 years of intense clicking has taken its toll on my right hand so I just limit the mileage I put on it now.

That's not to say never use your right hand at all - If I was playing some FPS I'd happily switch to using my right hand again but giving it extended periods of rest (by not using the mouse) and hitting tough key combos with my left hand (Cmd + Shift + 4 + Space for a screenshot anyone?) were what made things better for me.


I've had RSI 20 years ago for about 1 year. At the time, my life basically revolved around two activities, both known to have an impact on RSI (and more specifically, CTS): programming / surfing the Web, and playing the bass.

Cold temp, as in the OP, was probably one of the issues. It went away, and didn't reappear since, by using open glove when typing / playing the bass, and doing some hands / wrist stretches before / during work and practice.


I've used Workrave (http://www.workrave.org/) with success for light RSI symptoms. It's a small piece of software that prompts you to take regular breaks from the computer. It's a bit cumbersome, but being forced to move away from the computer every now and then also has its advantages.


The Sarno thing worked for me and for another friend of mine. I can personally vouch for it.

It was seriously bad and now I don't even have it.


I couldn't use a computer for 9 years. Then I followed "The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief" by Clair Davies. Within 3 days I could type for 1 minute, within 9 months I could work again, but with occasional relapses. It is still the best $30 I ever spent.


What helps me:

1. Ergonomical keyboard and vertical mouse

2. QFMLWY instead of QWERTY [1]

3. Massaging forearms with a Lacrosse ball

4. Strength training: climbing or "rolling" a long barbell held behind back.

5. Theraband exercises

[1]: http://mkweb.bcgsc.ca/carpalx/?full_optimization


Ergonomics help, using the mouse less help but what really helped me was https://en.wikipedia.org/wiki/Gyroscopic_exercise_tool

(It takes a bit to get the hang of it though)


Mousing should not injure you if done properly. Try using your shoulder rather than elbow. A short keyboard (no keypad) can help too.


Despite much attention to posture, mice and scroll wheels were a major cause of RSI for me.

After switching to the handshoe mouse, I have no mouse pain even if inattentive to posture. (I don't use the scroll wheel though)

It basically forces you to not use your wrist, and to use your shoulder.


If you get a 'vertical' mouse (either one that looks like it stands on its side or one that is like a sliding joystick), you basically have no choice but to use your whole arm - I've used one of those for a while, interesting experience.


Can you explain the biomechanics of what you mean? Not sure how elbows and shoulders relate to proper and improper mousing.


I was told myself that you should set your mouse sensitivity to the highest setting possible, so that you basically aren't moving the mouse, so there is no movement of your arm.


This is advice given to me during an ergonomic assessment.


Yes, but what was the advice?


0. Sit straight, arms to the side. Adjust desk and chair so elbows are in a 110 degrees angle.

1. Use a short keyboard (no keypad) so mouse and keyboard can be closer and arms can be facing forward.

2. Move mouse using shoulder rather than elbow.


I started getting RSI in the early 2000s and switching to a Kinesis Advantage fixed it all. Occasionally I get sore when I use my laptop without the Kinesis for extended periods of time, but the Kinesis is all I need. I think also using a trackball helps a lot as well.


When I saw RSI in the title, first thing I thought was "emacs!" Sure enough, emacs.


As a software solution there's a free program called Workrave that will help time micro breaks, stretches, etc.

I find it's helpful to have actual timers and reminders and it sort of helps me keep pace on how fast the day is going and how much time I have left.


I used to get bad pain in my right shoulder from using a mouse. I switched to a keyboard that doesn't have a num pad so that I don't have to reach so far to use the mouse and haven't had pain since.


I was starting to have RSI related issues. My pinky and ring finger were going numb, tingles up my wrist, and sore wrists. A lower desk and an ergonomic chair did wonders and I no longer have issues.


I felt the first twinges of carpal tunnel years ago and switching from the crappy “free” keyboards you get with any PC to a quality Cherry keyboard cleared it up immediately. G80-11900 is my favourite.


Which switch did you use? I find that mechanical keyboards often cause more pain since many keys require a lot of force to activate.


Using black at the moment, I have also used red.


Thanks, I may try one of those. Which did you like better and why?

I'm used to using Browns, which I find to be okay, but I really dislike Blue switches.


I think on balance I like the Black better, but the switch isn’t the only factor - the layout of the Touchboard on which I have black is different from the MX Board in which I have red.


Related content from a former colleague: http://www.amlie.name/how-i-beat-rsi/


For me it was riding a motorcycle again: pressing the clutch over and over again healed it, although I don’t recommend it because I almost fell a couple times.


My advice is get a soft silicone wrist rest and a silicone mouse rest. I used to get RSI until I got some of these rests and since then I haven't had any issues.


Everyone has a different anecdotal experience.

I hurt the ulnar nerve in my left hand in 2013 bicycling. The doctor put me into a brace and put me on some strong muscle relaxants for 2 weeks. I went to work and typed with the brace on under the influence of the drugs. I already had a long history (20+ years of regular weight training) and was really fit. I had previous moments of discomfort over the years from bad keyboards or overly cold office environments and such but nothing serious. This was at a point where I'd been on the computer a lot for 20 years or so.

When I got out of the brace and off the drugs I immediately had full blown RSI in both arms. According to the doctor it looked like I had tendonitis in the flexor muscles.

I went through everything they asked and nothing worked. I could "manage" but was annoyed every day at work. All kinds of keyboards and pointing devices didn't help much. The most helpful thing was using a foam roller to massage the muscles of my forearms. This was not something suggested by the doctors or PT, which was really annoying. The foam roller works better than having a person massage your arms or use the ultrasound treatment on your arms. Most of the physical exercises they prescribed & stretching made things worse!

At some point I discovered drinking black/green tea was causing the muscles in my arms to tighten up. It was causing it throughout my whole body but for some reason that didn't really cause any symptoms in other parts of my body.

When I eliminated the tea the symptoms started going away within a day or two and then my forearms slowly got stronger and stronger over time. I was able to get back to all the exercise/weight training/cycling, etc.. pretty quickly. I had never really stopped the exercise anyway but it always caused inflammation until I got off the tea. Maybe the tea had a circulatory effect on me, who knows.

It was not caffeine. I can drink all the coffee/soda/energy drinks I want without the symptoms returning. I don't drink that much of them but whatever it was, it's not caffeine, it's one of the other compounds in tea, of which there are a lot and of which most are not that well understood.


Eliminating the use of a mouse and replacing it with a Wacom tablet dramatically improved my symptoms. So much for my backup career as a eSports gamer.


Best advice that worked for me: make sure the daily repair is more than the damage. For me that meant more exercise and regular breaks every hour.


What worked for me was to do more stretches on the forearms there was one that was particularly useful in helping to release the ulnar nerve.


I’ve heard of docs that prescribed serotonin and anti depressant medications to attempt to fix pain issues


Kinesis keyboard was a lifesaver for me.


TL/DR: "I started wearing a sweatshirt and hand warmers at work, and I avoided caffeine on the days I went to the office. The pain went away, and so far hasn’t come back."

I understand that keeping back this information is a rethorical tool to force the reader to read the article to the very end, but I believe it is a dishonest strategy of keeping people reading.


It's probably a retorical tool but not used to trick you into doing something you didn't want to do in the first place but instead used to asure you that all the "ordinary" remedies were visited but they were unhelpful.


Probably the point of the article is not simply to relay information in the simplest information possible but to couch it in a narrative to make it seem more memorable, more enjoyable, and more reliable.


Do you feel the same way about books?


The books I read have non-trivial content and are written in an engaging fashion, so, no, I don't.


If you're trying to skim the article you really ought to read the beginning and end first.


Roberts Space Industries was more known to me then Repetitive-Strain-Injury and fits too.




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