I developed an RSI a few years ago, and I had to leave my job. It was devastating to lose both my career and my passion to an injury.
Since then, I've been working with a friend on a new voice coding app called Serenade [1] that aims to enable anyone to program by voice. With Serenade, you can speak natural English voice commands like "delete second function" and "add class person". Not only can this be faster than typing, but it also means you don't have to memorize the syntax details of every language or a bunch of editor keyboard shortcuts.
We found that cloud speech APIs and programs like Dragon weren't accurate enough for common programming words, so we built a custom speech engine (based on Kaldi [2]) that's designed specifically for coding. The app is still early, but we think the future of programming is working with these higher-level inputs rather than typing out code entirely by hand.
We're looking for people to give feedback, so if anyone is interested in giving it a try, you can download Serenade at [3] or email me at matt@serenade.ai.
Same boat, software engineer, my index and middle finger main knuckles on both hands inflame from the slightest use even after years of therapy, doctors visits, etc. Also tendinitis in both elbows/arms.
Note to those who are pushing off fixing your ergonomics, don’t. If you feel pain, numbing, tingling; do not ignore it. Listen to your body, don’t be like me.
I'm 23 and have been using computers very heavily for the last 10 or so years - probably an average of 6 hours a day. During a particularly intensive day of typing last week I started getting pain in my right hand. I had to resort to hunt-and-peck index finger typing to get the feature I was working on finished.
I'm horrified, it feels like I'm way too early in my career for something like this to happen, but I guess that's what happens when you do something so repetitive for tens of thousands of hours.
What in particular have you found success with that helps? I'm kinda in denial right now, it's already gotten better over Saturday but I know I shouldn't be ignoring it.
I can't be sure but it feels like a lot of people are discounting exercise here, I don't mean stretches but something more serious.
I've been staring at a desktop screen 6h+ daily for 8y+ and started feeling serious rsi symptoms on my right wrist at the old age of 19.
I tried bandages and wraps in the beginning, but once I started lifting all pains literally disappeared.
Heavy deadlifts (and maybe a press), done with correct form, is something that I'm quite sure will resolve the issue for the majority of people -- when your wrist starts being able to manage 200lbs+ loads then mouse-related issues feel like a joke.
I'd be interested in hearing stories where deadlifts didn't help. Would there be any?
I can vouch for deadlifts. Had wrist tendonitis flare-ups first at age 29 while doing lots of coding for a newly launched product. I'm 43 now and haven't had a flare-up in over 6 years (been doing heavy coding since 28yo). I do deadlifts once heavy a week, sometimes will add in an extra light set during the week. If you're starting out with deadlifts, be sure to check out a program like Starting Strength and practice correct form before adding heavy weight.
Things like bench press and working with heavy dumbbells have probably helped too since the weight forces your hand, wrist, and arm muscles to strengthen. I have also used a hand-held grip squeeze device which has helped over the years when I had flare-ups.
I tried those squeeze devices too, but in my opinion they're too weak unless you specifically shell out for the stronger / adjustable ones. Mine were from China and didn't do jack for the rsi pain.
It's deadlifts that whips forearms into shape, and then getting used to various presses seems to make the wrist more adaptable. I started with Phrak's Greyskull LP which is a modification on SS with less volume.
that's solid advice I think. I have pretty much the same story. I mean, I went all out with anabolics and such because I was also trying to get some hot babes, but I never had wrist issues after that.
Stop. Seriously stop. Don’t type thru the pain — you’ll do serious and permanent damage. I did that in lectures on an Apple Newton keyboard, and my hands never were the same since.
Install AntiRSI or workrave, and take breaks. But really pay attention and when your body gives out don’t take the chance. No feature or deadline is worth it. Probably even an hour break is enough to finish that feature.
I started to get pain in my right hand in my mid-20s (early 40s now) when I was spending a full working day programming and then spending most of my time playing fps games on my PC in the evening using KB+M. It progressed to the point that I would get stabbing pains on the top of my hand whenever I right-clicked my mouse.
After a few weeks of trying different layouts and avoiding my mouse as much as possible, I found the source of my issue was not my hand but a nerve in my elbow which was being crushed when using chair arm rests. I was also sleeping with my arms folded up on my chest which kept the nerve under tension when I was sleeping, preventing it from fully healing. I now avoid arm rests whenever possible and sleep with my arms to the side. The pain disappearred after about a week and I've been pain free ever since. I've also naturally reduced the amount of typing/mousing I do as I've got older and my career has progressed.
I had the same problem. I narrowed it down to moving my pinky to type things like (). Default keyboard layouts are awful for programming. You type a lot of symbols and they're on weak fingers that require weird hand movements.
Using a keyboard with a programmable firmware lets you move those keys elsewhere, and then you can type them with strong fingers. I use my left thumb to activate a layer that turns jkl; into ({}), which has helped a lot. (I also moved the shifted numbers down to qweruipo -> !@#$&*`~, and brackets to m, -> [].)
I also have keys for macros like := and !=.
Finally, backspace and common symbols like - and _ are on my pointer finger (ErgoDox EZ, so I get a few extra keys in the middle), and meta, space, and enter are on thumb keys.
It takes a bit of time to get used to, but I type faster than on a traditional keyboard now AND with less pain.
Would still like to completely kill the mouse from my life, however.
This is exactly what’s motivated me to finally learn https://bepo.fr, a lot of special chars are on the left on the keyboard with the altgr key modifier. So you have to use left fingers and right thumb to get things like curlies, pipe etc. So far my pinkeys are much better. Though i must admit that learning to touchtype on bepo was one of the must frustrating thing i ever had to do ^^
I had always used non-ergonomic mice and kbs, until one day I started noticing some wrist pain when in certain positions. After a few months the pain increased and I figured this wasn't right so I bought one of those Microsoft Natural Keyboards, and after a week or so, the pain went away.
Some time later I started with wrist pain again but now in positions related to the mouse use, so I bought an Evoluent mouse and again, after a couple of weeks the pain was noticeably lower, and so I was convinced that the position of my wrists was not ideal for thousands of hours of use.
So, my point is, you don't have to wait until it's too late to try to figure out a way to fix that. I don't think age is the only factor here, so just try out something on the affordable side and see if you get better, regardless of how young you are, begore things get worse.
A split keyboard is a huge win. When you sit with your hands in front of you, they don't naturally want to go in towards the center. They want to be offset a bit.
Below the desk keyboard tray -- Look up an ergonomics diagram. You aren't supposed to have your hands going up to get to your desk. It's supposed to be a 90 degree angle.
Going mechanical. I run Kailh Silvers, which are incredibly light and have a 1.1 mm travel distance before the key registers. It's like typing on air. I barely have to move my fingers. This, of course, takes some getting used to.
Going ortholinear. Staggered keys are just a remnant of old typewriters. Your fingers were built to go straight back and forth. Making them go sideways forces _a lot_ of extra wrist movement. Again, this takes some time to learn.
Curved keyboard well. Your fingers aren't all the same length. Couldn't we make something that puts all of the fingers closer to their keys in the resting position? Yes. See below.
After a little time with mechanical keyboards, I ended up just going all out and building myself a Dactyl. That's a split ortholinear keyboard with a curved keywell, and is basically as ergonomic as it gets. If you want advise on how to build one, I can help point you in the right direction. It took probably 10 hours. Otherwise the closest thing is an Ergodox or Kinesis Advantage. It only took a Sunday to get mostly used to it, and my typing speed has actually gotten way faster. I detailed the learning curve here: https://www.reddit.com/r/MechanicalKeyboards/comments/azkkpz...
The only disadvantage is that if you bring one of these into work, get ready to catch some flack :D
At this point I've got my own chair, standing desk converter, mouse and keyboard. I plan on coding for a long time, not just for the money but because I love it. So I look like a bit of a dumbass, but in 20 years I'll still be coding.
I should mention my issues have mainly been with wrist and neck pain.
This has completely gotten rid of the wrist pain. The split keyboard opened up my posture and helped a bit with the neck pain.
Since I got a new job that didn't have standing desks, the neck pain has started to come back a little bit. It's mostly because your neck gets weak when you sit for so many hours a day. Getting a standing desk converter can help keep your muscles from atrophying. It's also not great to stand all day. You want to alternate.
> Staggered keys are just a remnant of old typewriters.
It's true (the Sholes & Glidden introduced that) but just for the record, some quite old typewriters had ortholinear keyboards, like the Smith Premier:
I've noticed that wearing long sleeves when I'm typing helps.
I had RSI and panicked as well. But now that I wear long sleeves while programming (even a heavy sweater sometimes, even though it might be hot outside).
It was 5 years ago and my right hand was too painful to use so I switched to my left hand. Eventually, last year my left hand started to hurt too, and I started jungling between both. 5 months later, I had to stop completely for 2 months because of the pain.
If you ignore the pains for too long, it will do irrepairable damage to your nerves.
My timeline was this. I've been programming since 15. I've been on the computer for hours a day, making money freelancing in highschool. I didn't have a single issue. Then, at 22, I got a professional gig. My pain started immediately. Within months, the damage was done.
My right hand still isn't 100%, but since I've switched to using my last remaining good hand, I treat it much better than I did my right hand. It's all I got.
Carpal tunnel can absolutely be prevented. It isn't genetic or anything. You just have to monitor the warning signs and address them immediately.
So, yes, switching hands isn't a solution, but the damage is done, so it has to be done. But now I have the insight needed to prevent my left arm from ever falling into the same situation.
You can count yourself as one of the lucky ones as I had many classmates in college who lost the ability to type before they graduated because of RSI.
While I’m no medical professional, I’ve thus far avoided serious RSI by
1. Not typing very much. I spend most of my time thinking and a minority of time typing.
2. Periodically change work area. I have the luxury of having the option of typing in an office, a laboratory or outside under a tree and frequently move around. Even if you don’t have this much flexibility, try adjusting your chair up and down, move your monitor around, etc.
EDIT: I make no guarantees these things have any correlation with my avoidance of serious RSI symptoms.
The other posters have brought up a lot of important points, but if you're struggling to change, here's a first, really easy step for the lazy: Go to your nearest electronics store and buy a MS Natural 4000. Do it now.
Yes, I know, it might not be as high-quality, sophisticated and thorough in its design as specialized ergo keyboards. But: It's widely available, it's cheap, and - an often overlooked pro - it adheres to a standard keyboard layout, which means that it only needs minimal adjustment, both initial and when changing computers (if you don't want to lug it around everywhere or switch out every keyboard you are in contact with). All IMO deciding factors for doing that first step and sticking to it. :)
And: In my experience it still gets you there most of the way regarding ergonomics - split and curved keyboard, and especially negative tilt(!).
I only wish MS would rerelease a modern, higher-quality version the model (the current model is almost 15 years old now!). It is still servicable, but oh, what could be possible...
PS: The immediate next step should of course be checking and adjusting the geometry of your workplace. An ergonomic keyboard won't help much if you're hunching there like Quasimodo.
Don't discount resting. I limit my typing to 35 WPM and I try to be as even as I possibly can in my typing. I think while I type. Even then, I type for 30 seconds and rest for 30 seconds. In my rest period I'll read what I typed and think a bit more. I find that I am actually more productive this way because I don't rush.
- adapt a time management technique (i.e. pomodoro) to ensure frequent breaks from typing. Listen to it. Your code can wait. Grab some other objects during the breaks (lacrosse ball)
- get light dumbbells, ranging from 2 to 6 kg, and start doing wrist flexor exercises every day. Slow pace, good form, not too heavy weight, stop when it really hurts.
> What in particular have you found success with that helps?
* I bought two bathroom mats from Krogers, wrapped them around the arms of my office chair, and duct-taped them in place. Looks like hell, feels soft and cushy.
* I bought a bunch of those practice tennis balls (the wimpy kind that don't bounce worth a damn) and have one at home, one at work for squeezing when I take a break or watch TV.
* I wear one of those Ace bandage thingies around my right forearm.
* I have one of those ergonomic keyboards from Microsoft.
Huge improvement.
* THE MOST HELPFUL: I do curls and range-of-motion exercises with 10-lb dumbbells when watching TV. Nothing dramatic, a few sets of 30-40 curls plus rotating my wrists, and then some leaning-over pushups against the couch. You wouldn't believe how much better I started feeling.
I have an ergonomic support for my right arm. My elbow rests on a silk fabric "hammock", which is supported by a linear bearing slide, mounted on a vertical shaft. I bought it too many years ago to remember a brand. And hopefully the description makes sense.
Basically, my right arm feels ~weightless.
Edit: Also, I use a touchpad, not a mouse. If I use a mouse, my hand cramps. And it also helps, I think, that I never learned to type. So I've developed my own style that doesn't hurt me.
It's a BodyBilt chair, with their Linear Tracking Arm.[0]
The chair has a moderate tractor seat, which forces you to sit properly, and not slouch. But that also means that you can't really relax in the chair, because it hurts in the crotch. There's also an inflatable lumbar support.
I used an Aeron for many years. It's much cooler looking, but the BodyBilt is more comfortable for long term use.
I've noticed that wearing long sleeves when I'm typing helps.
I had RSI and panicked as well. But now that I wear long sleeves while programming (even a heavy sweater sometimes, even though it might be hot outside).
when i stopped studying and started working full time, i began to get pain in my wrists. so i got an ergonomic keyboard and a large trackball. i'm fairly sure it's replacing the mouse with a trackball that makes the most difference to the acute pain, but they both do make a difference. but everyone is different. act fast and change everythin,
I'm 38, and have been programming since ~16. I spend > 50 hrs / week typing. I've had several bouts of RSI and here is something to consider:
- It's very possible to go from your current situation to being completely pain free. Have some optimism. I haven't experienced RSI pain in 5 years.
- RSI is usually not _caused_ by typing (there is lots of data supporting this). Lots of typing usually exacerbates some other underlying condition. Don't fall into the attribution error trap or you might not find the underlying cause.
- In my various bouts of RSI I switched to various ergonomic keyboards. These mitigated some of the pain, but did not eliminate it. I went from a standard laptop keyboard to MS natural 4k, to a Kinesis advantage. Each time, pain improved but did not completely subside.
- I solved my RSI by finding the root cause.
Anecdotal stories:
I've had on and off weakness in my left pinky for years (decades). I'm an Emacs user and used to use that pinky heavily as a ctrl/meta activator; I just attributed the pain / weakness to that. I would also have pain in left wrist, which I attributed to having to baby that hand at times and use it in awkward positions. At times, the pain was so bad I could not type for days to weeks.
I'd seen a doctor about this a few times, and they usually advised me to take a week or two away from the keyboard to let it heal and then the usual 'take breaks while typing etc.' Sometimes that worked, sometimes not.
At one point, I started noticing that my grip strength was declining in that hand and I was getting muscle twitches when I had to grip things very tightly (e.g. a hario hand grinder). Twitching and weakness are clinical signs of a motor neuron problem. After researching various nerve compression scenarios... I happened upon a website similar to this: http://www.eatonhand.com/hw/hw007.htm. This described me exactly; habit of sleeping with my arms stretched out in a way that compresses the ulnar nerve.
I got a 15 dollar brace off Amazon and started being careful about what position I slept in. A month later, my hand was completely back to normal and I've been pain free since.
My brother (also a programmer) had a similar situation. RSI to the point he couldn't work. The root cause; a shoulder injury from his teens that wasn't properly addressed. Did PT to work on the shoulder and his RSI resolved within a few months.
The point is, don't focus on typing as the cause; look elsewhere. If you are injury free, you can type all day long and it won't likely cause a problem.
* Start going to the gym, and focus especially on free weight exercises. They make your arms and hands stronger, and the growth hormones released after working out promotes healing of any wrist injuries.
* Mouse sensitivity. Which is better, low or high DPI varies on a person-to-person basis but for me what worked was low as it forced me to use my hand to do large movements rather than my wrist.
* Mouse hardware. Again varies on a person-to-person basis, a mouse that is too large or too small for your hand can cause wrist pain.
* Sleep position. Sleeping on your back is probably the safest way, be sure to keep your arms relaxed on the sides. Having a pillow to hug might help as this feels somehow a natural position
* Don't play video games with a mouse. Yes this sucks as some of the best competitive multiplayer games are on the PC, but LoL, CSGO, Overwatch etc are known to cause RSI issues and lots of professional players have ruined their wrists permanently.
Switching to a console will stop any wrist problems from gaming
Can you elaborate on somethings you wish you had done.
I get a bit of pain after half a day of coding, mostly my right pinky after hitting enter multiple times. Also get pain after certain activities like rolling food into a ball for my toddlers.
I’ve joint pains here and there and the doctors have not yet found the cause and think it’s early onset of arthritis and have been told to take pain killers.
(35 now, this started at 33) I wish I quit my job when it started to get worse instead of continuing while I was doing PT. I was doing 8-10 hour days of coding in a startup, my hands and arms got worse and I started doing 4 hour days 3 times a week and doing physical therapy, dr appointments etc. It continued to get worse. I had a lot of faith in my doctors figuring it out. They kept telling me I’d get better, it’d heal. Well, we’re years from then and none of that came to fruition.
Not only that, the doctors misdiagnosed me multiple times, not able to come to an agreement on what it was. They still don’t. They call it RSI, arthritis, posterior interosseous nerve syndrome, and others that I cannot remember.
My advice, look up an ergonomics diagram, compare your setup to a proper setup. Then make adjustments to areas you’re having trouble with.
I use an ergodox ez keyboard w/ a 3m sort of joystick mouse (it doesn’t tilt though, you move it like a normal mouse).
I can get away with 1 hour working, then icing, stretching then repeat. For about 4 hours total for a day, but I wonder; does doing this cause more damage? I guess I’ll find out when I am older, as I have to pay my bills.
Lots of good advice here. Ergo keyboards (I like the kinesis advantage, and they last decades) and breaks worked for me. Dvorak is mostly useful because you have to relearn it, and might learn it without whatever broken ideas your body has about QWERTY.
Chair adjustments are huge. Get a steelcase chair—I like the leap. Have it adjusted by a pro, whose biggest advantages are being able to see what you really do as you type and knowing all the dials in advance.
And get stronger. A stronger back, shoulders, arms, grip will help you stay working in safe positions longer. Anything from tennis to deadlifts will work here.
There is a open source controller for the advantage that makes it fully programable and fixes some problems that the advantage 1 had with some ghost presses and stuck modifiers. I've modified two advantages to use it, it requires a bit of soldering and some willingness to compile your own firmware from qmk.
When I was trying to learn 10 finger my wrists started to have pain. I immediately stopped and to this day still do my made up three finger touch typing on each hand. I'm still paranoid, my right elbow and lower arm still feel sensitive. I switched to an ergo mouse that's vertical there. It's crazy to think I could go from XK/year to 0K/year over something so "simple".
Staying strong is a good idea - I will start more core / physical fitness.
I (25yo), also had pain in my right pinky and wrist, starting about 2 years ago.
I spoke with a friend who had surgery for Carpel Tunnel Syndrome, and knew a lot more about this than me. What he told me:
* Carpel Tunnel Syndrome affects the thumb/index-finger; pain in the pinky side of your hand could be caused by uthe ulnar tunnel or the cubital tunnel.
- I got a foot pedal, and put Alt, Ctrl, Shift, and Enter on it (and for a while pulled those keycaps off the right side of my keyboard, to force myself to learn to use the foot pedal). This allowed me to keep using a computer while I recovered, and allowed me to avoid stressing my pinky after I recovered. I wrote a bit about that on Reddit https://old.reddit.com/r/emacs/comments/7remed/has_anybody_u... .
- The tendon gliding exercises were very helpful. The other stretches didn't seem to make much difference. While I was recovering, I tried to do them hourly. I now only do them if it's acting up.
- I second his endorsement of those wrist braces. When using them, I wear them at night, and when typing if I can (I can use a desk keyboard with them, but can't use my laptop with them). While I was recovering, I used them all the time, now I only use them if it's acting up.
- More recently, I got a Keyboardio Model 01, which puts the modifiers on the thumbs, not the pinkies. The foot pedal is entirely unnecessary with it; it puts much less strain on my hands.
http://2.bp.blogspot.com/-cl-rpkmgPqI/UeUWdH4oMUI/AAAAAAAAAJ...
Nowadays, my wrist acts up maybe once a month or two.
you might want to look at the kinesis advantage keyboard, moves the backspace and enter to your thumbs cluster, and greatly improves ergonomics for your pinkie fingers.
For those in this thread, try mechanical keyboards without much actuation force, like Cherry MX clear.
Also try programmable keyboards or custom keymap layouts, which will allow you to map Return to the caps lock key to balance RSI a bit. I have issues with my right index which I almost completely blame on Diablo 1/2, swapping left + right click helps a lot.
I’ve also tried and wouldn’t recommend:
Dvorak (no noticeable difference)
Egrodox (extremely hard to learn)
Maaaaybeee tiled window managers, dunno where I stand on that one but it probably doesn’t help a lot ergonomics wise.
I really like my ergodox. I can't go back to a normal keyboard. The only upgrade I can think of is going to a kinesis advantage or dactyl. It took about a week to get comfortable with mine, longer until I was better with it than a normal keyboard.
My experience is different here... changing to Dvorak + changing mouse to a trackball in the left hand (along with a MS ergonomic keyboard) made a world of difference for me.
I can currently code a whole day without feeling anything... coming from not having enough strenght to hold a glass sometimes due to RSI -- 10 years since I did the switch already... having to type much slower when doing the switch to Dvorak also forces you to be slower and helps in the initial recovery.
As a note for people with issues, don't go to pain killers when you're still typing, you'll only make the problem worse... if you go to pain killers make sure you also stop typing/injuring yourself.
I have the same experience with Dvorak. Haven't got any pain issue anymore since i switched from qwerty to dvorak. My typing speed really suffer for the first week though. Also, now i can't type on qwerty anymore except on a phone on-screen keyboard.
It took 4 hours or so of constant typing tests to get up to 60 wpm. It took another week or so of working with the keyboard programming 8+ hours a day to stop having stupid mistakes.
It seems like it's going to be extremely hard to learn at first. Especially when you're hitting 5 WPM every time, but trust me, your brain will adapt. I was helped out by the fact that after spending a few days _building_ the keyboard, I wasn't about to back down. I was pleasantly surprised when it only took 4 hours.
Since then, my productivity is through the roof. Tons of thumb keys that are entirely programmable = heaven for an Ergoemacs user like me.
I’ll also mention that cherry mx blue are much to heavy for me, and brown hurt after a week of furious typing. My problem with clears is that if I rest my hands too much I press keys because they’re so light
You may have Gateron Clears, which are lighter than Gateron Browns. Gateron Browns are basically equivalent to Cherry MX Browns, but Gateron Clears are entirely different from Cherry MX Clears. This has tripped me up more than once.
If what you have is actually tendinitis in your elbows then that's fixable through physical therapy (progressively heavier slow loading of the joint in the form of concentric-only single-joint movements).
I've found that a mix of proper ergonomics, regular breaks, CBD oil (for inflammation), wrist braces and physical therapy exercises can do a lot of good.
I worked with a guy in 1999 who had severe RSI. He had spent a ton of time training whatever the highest pro version of Dragon Dictate was at the time, and then even more time setting up a bunch of macros to do complicated/repetitive tasks. It was impressive how fast he could 'type' (that is to say, it was really, really fast - faster than a keyboard) for the things he had trained it for. But, 20 years ago, none of the non-RSI people were tempted to follow his lead having seen how much work it took to get it set up.
But, fast forwarding 20 years, I can totally imagine that a product such as yours that is designed from the ground up for programmer types could be significantly faster for text input, but hopefully without all of that burdensome training and setup before you can be productive.
Reading the docs it struck me that your not far off from a vim or emacs like abstraction around text processing. Hopefully you are building this so it's easy to add commands in other languages and not a ton of specialized code. thinking something like command + regex matcher... Or really if you can integrating with the language server spec you'd have a quite powerful system if you just have users learn the ast parts of that spec as commands.
Didn't get to play with it as my computer died again right after I installed it. Not your fault, main ssd desoldered and cracked connector a week back while I'm in a month long road trip. I've been hobbling along on live USB distros (surprisingly fast) until last night when the boot USB torched.
I have rsi flare-ups that cause my fingertips and blades of hands to go somewhat numb or hurt. Usually goes away when I use my good ergo setup (appeared when I played about 40 hours of pubg over a weekend) and get some exercise around my hands / forearms.
Thanks for the feedback! We’re actively working on improving the speech engine, apologies it didn’t work well for you. We’re starting with editor plugins, but eventually want to expand to other apps as well. Definitely want to support customization down the line too.
Just today I heard about this guy with motor issues who can play competitive fighting games using only his tongue (not directly, using it to push his cheeks/skin) I would imagine combining something like that with voice recognition would be the best approach, something like press X before saying (on your mic) a variable name, or press Y before saying a control structure, such approach would remove a lot of ambiguity because the number of possible interpretations by the speech recognition software would be greatly reduced.
The snippets feature looks quite powerful and particularly like the enumeration conversion example. Are there any plans of making these kinda of transformations extensible?
I've recently gone into speech assisted video editing and came across Kald about a month ago, was interested specifically in its diarization feature ... it's quite daunting. How did you get up to speed on it ... I've talked to a few people who've worked with it but it took them months to feel comfortable with it.
Doing the good work. It keeps me up at night thinking that I might be in this position. So little has to go wrong.
I was actually VERY close to being in this same boat, one of my nerves in my shoulder was pinched so badly that it started to take damage. Took me a few months to regain full use of my left (dominant) hand with lots of physical therapy.
Seeing this gives me real hope that there is hope for everyone regardless of a sudden life altering possibility.
Currently I’m in Language Design Hell trying to devise a syntax that is as easy to speak as it is to type, but if/when I get that cracked I’ll take a look as this looks very relevant to my interests.
I was thinking along these lines. Wish i had time but good that you have made considerable progress.
My motivation was different though. I wanted to break barrier to code, make cleaner/efficient/consistent code, automated tests ingestion and for the ability to port code to other languages from metadata. If you could focus also on those lines too - it would be useful for the general community too.
What's the licensing for this? I feel very strongly that accessibility technologies must be free/open source software, so that the already disadvantaged community which relies on them can work together on improving them to give each other a leg up, or to adapt it to their specific circumstances.
little constructive criticism... no where on the site or in the document does it mention what the supported languages are. After a little bit I saw that this was only for python, but I think it would be better for you cause if you not only said what languages are supported, but maybe also how you can add other languages.
This won't help anyone who has lost the use of their hands, but I have some advice for touch typists who use a standard keyboard like a laptop or typical desktop keyboard: don't bend your wrists.
Of course most people know about the ergonomic advice to have your keyboard at the right height so your wrists don't have to bend up or down. But I often see people typing with a horizontal bend in their wrists so that their hands are pointing straight forward as they type, like this crude sketch:
If you do that, try this instead: don't bend your wrists to make your hands straight. Relax your wrists and let your hands be at the same angle as your arms:
Your fingers will still be able to find the keys, but it may take some getting used to if you've been using the "bent wrist" position. Once you get the hang of it, this may reduce the stress on your wrists.
I've been typing on standard keyboards nearly every day for about 50 years without any significant problems. I tried using the "bent wrist" position as a quick experiment and it was really uncomfortable. So while I can't say for sure that it will help everyone, I'm pretty sure the "straight wrist" position has helped me.
Better solution is to ditch the single-block-style keyboard and get a proper ergonomic one that's split into two parts. That allows you to keep your wrists at a natural angle but you also need to change the layout to use columnar staggering so the fingers are only moving vertically.
There's many things wrong with traditional keyboards and many solutions that I could write for years about. This one's mine and is focused at programmers/Vim/Linux users [1]. The main takaway is move the fingers less and leverage a programmable layout to overload fingers. Look at how the thumbs are used and the relation to common programming symbols. [2] and I mean it's programmable so if you don't like it, flash it.
That's a really interesting keyboard! I think I've seen one or two like it at the office - I will have to take a closer look.
It wouldn't work for me, because as I mentioned in another comment I am a TrackPoint fanatic. I've used ThinkPads for 20 years and even have a USB ThinkPad keyboard on my desktop at work.
But thank you for mentioning this option - everyone has different needs and I'm sure this will be very helpful for someone.
I did, My main Issue with the UHK is it doesn't go hard enough. I looks like a half-baked attempt the make a ergonomic board similar to Alice and the Mistel Barraco just with some extra doodads.
Cool that it's open-source. Why not leverage QMK and Via for a graphical configurator?
Edit: Not trying to shit on the UHK, but it seems like a _decent_ keyboard. My fault with it is that it's much too conventional and thus ends up falling into the trap that many boards already to (pinky overuse, wrist angling, gimmicks over form). It's great that you managed to create a product and bring it to market. But it doesn't really bring anything new to the table or deserve the name 'Ultimate Hacking Keyboard'.
The modules are a game changer of actual usability value which haven't been implemented by any keyboards yet. Ignoring their value and calling them doodads is unfair.
None of the open source firmwares support the modular architecture of the UHK or allow for the easy update of the configuration without using full-blown compilers so they are not suitable for us.
We'll release further UHKs of additional layouts, columnar included.
Seems easy enough to check if a device at a given I2C address is there and enable functionality. There few a few devices doing this already.
Via has been doing non-flashing keymap updates for years and is cross platform. Reach out and help contribute.
Here's hoping you can make a keyboard worth the name. Exposing interfaces to users can bodge on their own hardware would be a good start. Maybe getting a ergonomics nuts on the team as well.
You're vastly oversimplifying product design. It's not just about I2C. No other split keyboards allow for the attachment of extra modules in the middle.
You hardly ever used the UHK, yet you keep suggesting that we should use external firmware projects. We use ours because it offers certain benefits specific to our design. Even if you used the UHK, there's a good chance you'd ignore what it can offer because you're so biased toward columnar layout and other open source firmware projects.
I appreciate the value of columnar layouts, but the rest is bias towards your own preferences.
You're right, it's about prototyping, finding the right components that won't bust the BOM, stress testing, manufacturing molds and handling all the warts of production and fulfillment at scale. A broad range of engineering schools and non-eng talents are needed to bring a decent product to market and you've done that. So kudos.
I'd be curious to know why you didn't use QMK or add in the features seems like it would be a hell of a lot easier and allow for contribution. SplitCommon support has been around forever, and you can do dynamic keymaps removing the need for full board flashes. Worst case PRs, that's how Zeal does their boards for features that don't exist.
I am very biased, that is correct. I wouldn't have tried to design a modular/hackable keyboard otherwise. Sadly I'm a one man shop and busy as hell with everything involved so making gUnit 1u/2u modules and interconnect devices hasn't been given much time. If you look around hard enough you can find working trackball modules for Gergo and the interface is simple enough that you can easily bodge in gear with 15$ in prototypes off JLC.
It's very hacky, there's breakouts everywhere, members do all sorts of strange crap with their boards (look at some of the firmware for Georgi on GitHub, it's gross and beautiful colemak-dh on 2rows?), TrackPoints, balls, vibration motors and other goofy shit.
But that's the crux of it, it's _not_ a polished keyboard (I had 300$ and wanted to design a better keyboard), it's a keyboard meant for hacking on and extending with a focus on Ergonomics. If it doesn't have bodge wires flying off of it, you're doing it wrong.
For the record: A simple Y-splitter for a TRRS is all you need to get power/comms retrofitted on 95% of splits for extra modules.
QMK tries to be everything for everyone. I'm sure we could make it work, but the UHK firmware is designed in very specific ways dictated by our objectives. This includes everything, such as the binary configuration serialization format, the USB protocol, the module protocol, and the I2C scheduler and drivers. At the end, we would end up hacking the hell out of QMK, and probably still wouldn't meet certain goals we're after given the inherent design of QMK. It's great that QMK exists, but I'm confident our firmware suits our needs better.
Yeah Split Ortho with columnar stagger. Those are important features. Another one is the overall height of a board, the lower and lighter the switch the better. One of the current issues I'm having is simple MX switch height + a given profile. Tack on a case and suddenly your wrists are all bent!
On my personal boards I go caseless with Low-Profile Kailh Chocs and very low caps for them. It's not pretty but with 12g switches I haven't had rsi flaring issues in months. This is something I went a bit extreme with Georgi and chording, very comfy but very radical. [1] [2]
Wrist rests can help alleviate this issue, but a badly designed rest will do more harm then good.
I've found that most office desk & chair combinations I've had don't have enough flexibility for me to get in a completely ideal position for my wrists. In particular even with the chair maxed out, it's still an inch or two shorter of what I would need for my forearms and wrists to be parallel to the ground and at the keyboard height, so my wrists are always bent a little bit up. I've had occasional wrist and hand pain creep up, but luckily have always been able to manage it by typing a little slower and making an effort to sit up a little straighter and hit the keys a little softer, and it has always gone away in a week or two.
Desk and chair heights seem to be pretty standardized so even if there is a hodge-podge of chairs around they're all the same height. I'm definitely taller than average, but a quick search says only by about one standard deviation, so I can't be that unusual.
In general, it does seem like there's a stigma against office comfort, at least in small to medium startups that I've worked at. Usually everyone is using the same shitty, half-broken desks and chairs that came free with the office lease, and the already independently wealthy founders will brag about how scrappy the company is and how proud they are of not wasting any effort or money on something as banal as office comfort. In that environment if you ask for special equipment you're really made to feel like you're being difficult.
I hear you. I'm fortunate enough to have sit-stand desks at home and at work, and I notice if the height is even a fraction of an inch off. I also have them in standing position nearly all the time. I get sleepy if I sit too long.
There must be a way for you to solve this. For example, could you convert your desk to a standing desk by putting a sturdy box on top of it? I did this for a while using a wine box that happened to add just the right amount of height.
I was only using my ThinkPad at the time, no external monitors, so I didn't need to raise the whole desk. You could even accommodate a desktop keyboard and mouse using a bigger box.
If this works, your team will be impressed by your scrappy inventiveness! :-)
Yeah, I wish I had more options at work. At home I use an adjustable height sit/stand desk from Ikea, and I've a Lifespan walking treadmill (just the base) which really helps with body posture (it's impossible to rest in the wrong position when you have to keep stepping forward a bit at a time...)
I've suggested getting a treaddesk (treadmill desk) at work more than once, with co-workers, direct managers and company execs, but presumably as no one else has tried one, everyone looks at me funny when I ask. So I tend to split my work programming time between workplace and home as a compromise...
Then there's the Vivo Barefoot shoes I've been recently trying for increased awareness when walking, and better walking ergonomics... at this point it seems like a safe assumption that most things humans habitually do aren't ergonomically optimal. ;-)
The biggest change that helped when I developed temporary RSI when playing video games in my mid-teens was learning and switching to Colemak.
Natural keyboards (Microsoft-style) helped a bit, but the curved Kinesis Advantage really taught me that you should try to never raise your keyboard angle, and instead keep the keyboard flat at a height where your fingers rest on the home row, wrists straight and naturally held at a comfortable position in line with your lower arms. When done well, it’s like your fingers are hovering over the keys on the keyboard, pushing down, but it can cause strain in your arms as you don’t have any palm rests in this position without buying a Kinesis (and re-learning how to type on a straight column key layout). But by far the biggest difference was learning Colemak, it means my fingers rarely leave the home row and typing is less of a chore on my fingers, but still affects my wrists.
For your mouse hand, the Evoluent mouse may look (and feel) funny, but it certainly is less stress on your mousing wrist. You can fake this with a normal mouse (when you remember to) by rotating your hand, wrist and lower arm 90 degrees, placing your hand pinky side down next to the mouse, palm facing the mouse. Then keeping your wrist in that same vertical orientation, slowly move your thumb and first two fingers to cover the mouse. It’s a loose hold, not as easy to use as the normal grip, but it’s much easier on the mousing wrist. Don’t move the wrist in this position, when moving the mouse, try to remember to move your whole arm if possible. I’ll admit, I only use this mousing technique on days when I’m extra sensitive to RSI, normally my mouse movement is halfway between this extreme and a normal mouse grip—generally I modify the mouse grip to not cup it so tightly with a more horizontal wrist and that works okay...
Also watch out for wrist/finger/positional strain from non-computer activities you do regularly, including how you grip or put extra strain on your body when commuting or when using exercise equipment. There’s always a balance — you want stress to build tolerance, but you don’t want to take it too far and build injury instead. Listen to your body! :)
Kinesis Advantage was a game changer for me too. But when I type on my laptop for a day or two the pain is back. The pain also depends on the stress level, because it seems that I type with more tightened fingers (as is the whole body as well).
My wrist is in a natural position, and the only thing that moves is the thumb.
It was surprisingly easy to get used to. I initially didn't think I'd use it for gaming, but that turned out to be not a problem - once you're used to it it's just as effective.
I didn't try the trackballs that you use your fingers with. The thumb-controlled ones are pretty natural to use, as the left and right click actions and the scroll-wheel are identical to a regular mouse. I suspect the act of using the same finger for moving the ball and clicking the button would be more difficult (at least for me :) )
I haven't used a mouse in years, just Kensington trackballs and laptop trackpads. The trackballs are great; clicking is predominately with the thumb whereas pointing is with the fingers. Even when using fingers for both, it's not something I notice since I've never clicked and moved at the same time - maybe for a gamer it would be different
Ah yes, trackballs are good too due to the reduced wrist movement/strain, and much cheaper than the Evoluent. Trackpads can work, but hand and wrist placement matters similar to keyboarding...
I haven’t used the C yet, I’ve only used the 4 - I’ve a “For Mac” Bluetooth one which I returned because the 2.4GHz wireless version was performing much better. I suspect they made the Bluetooth one to sell in the Apple Store. As far as I know, they haven’t changed the basic mouse design in 5-6 years now. It still works and feels high quality, I’ve no complaints. (Except that it is definitely not “travel size” - and isn’t rechargeable, it takes an AA battery - but for all that, it has a nice high quality plastic feel and the design of the mouse means you’re not rubbing your palm all over the table as when trying to hold a regular mouse with a vertical wrist.)
The extra buttons require their driver but it works fine without and I don’t notice the buttons most of the time anyway.
I had every VerticalMouse so far (they don't seem to last for me for whatever reason). I prefer the C, it sits nicer in my hand, they changed the shape; I can't comment on the buttons as I under-utilize those.
Either way though, going to any VerticalMouse from a regular mouse is a huge improvement. The changes between 4 and C are probably hard to pick out for someone who hasn't exclusively used those mice for a decade.
Anecdata alert: For what it's worth, I am relatively sure that the key factor in developing (and then avoiding) RSI for me at least is sitting posture. This may in turn be impacting the wrist posture when typing, but I've systematically realised that when starting to feel RSI that it's coincident with having started slouching or hunching at my desk (or using a different physical layout). Fixing that (and taking it easy for a bit) managed to stave off disaster.
The other revelation has been that general stress levels massively impact one's posture; if I'm stressing about something the entire upper half of my body tenses up, causing me to hunch over the keyboard (and, almost without noticing it, type about 5x harder than normal). And this probably ends up being the root cause for me.
Just mentioning it in case anyone else had failed to spot a stress -> tensing up -> bad posture -> RSI -> stress feedback loop...
Yes, posture and stress tension are huge! I don't work sitting down any more, and I think that has helped me a lot. But one thing I've made a point to avoid is standing still in one spot like John Carmack giving a talk.
Instead, I'm always moving when I stand at my desk. At home I have a FluidStance Level:
They are expensive, but mine has already paid for itself in terms of feeling better and more alert and hopefully longer life. :-) I don't have one at the office yet, but in the meantime when I stand at my desk I'm always moving around - swaying from side to side, climbing an invisible ladder (raising each foot back and forth), etc.
As others mentioned, ergonomic keyboard helps with this. I'm using Microsoft Sculpt Ergonomic wireless keyboard (haven't tried Kinesis) which is IMO a good compromise between price, quality and size. One thing to be aware of though is that for security, the USB dongle is paired with the keyboard at the factory via a unique encryption key, so if the dongle breaks, you can basically throw the keyboard to the bin (contrary to other vendors which offer universal dongles that can be paired with existing keyboards).
Another RSI tip concerning mouse usage: try to learn using the mouse with your secondary hand. Initially it's very hard, but after few weeks you can do all but the most precise things with the secondary hand. Changing hands can significantly reduce the pain. I have two mice (that may look weird but I find it useful): an ergonomic one for the right hand, and a symmetric trackball for the left hand.
Great tips, thanks! I recommend your "secondary mouse hand" trick in particular for right-handers who use desktop keyboards with the typical cursor keys on the right. I did this before I switched to ThinkPads, and it was great being able to seamlessly work the mouse with my left hand and the cursor keys with my right. Putting the mouse on the left also made a much shorter reach to get to it.
For Windows users with desktop keyboards that have numeric pads, I also suggest turning on the Mouse Keys feature. One thing I always found most stressful with a mouse was dragging with the button down and trying to make precise movements. I felt like I was cramping my hand every time I did that. Mouse Keys makes precise mouse movements easy:
Or on a laptop keyboard - particularly on a ThinkPad - use my JKLmouse program (an AutoHotkey script) that does much the same thing without a number pad. Whenever you hold any mouse (TrackPoint) button or the Caps Lock key down, various keyboard keys turn into mouse movement keys. It works on any keyboard but is especially nice on a ThinkPad where you can press a TrackPoint button, use the TrackPoint to get the cursor about where you want it, and then - with your hand still on the home row! - move pixel by pixel with the keyboard.
I have my wrists straight when I type, but I used to have a problem with left hand's control key; every time I needed to press ctrl+<somekey> my writs bend and it started to cause pain. Then, one day I decided to map my capslock key to act as ctrl (found online that this was a thing) and once I learned to use it, all the pain was basically gone. It maybe took a week or so of learning to get used to it.
+1 on keyboard remapping, though I’ve never gotten used to it permanently myself. In Colemak, Caps Lock was originally changed to backspace, so for users who don’t need to hit Ctrl as often, that’s also an option. I suspect the only way I’ll remember the remapping permanently is to disable the original/bad mapping, such that every time I do the old way, I remind myself it doesn’t work that way and hit the new key instead.
I've heard some to map esc to capslock too, or even ctrl _and_ esc (tap for one, hold for the other). I don't think I would have learned the new mapping if it weren't for the pain.
i learned touch typing in school, but i never really picked up on it. it just felt uncomfortable. i could not get enough strength into my fingers to push down the typewriter keys we used and the wrist felt uncomfortable. i did get ergonomic keyboards when available, they definitely make a difference, but they were not always available. (i never even considered that, but i wouldn't have been able to carry them to school where i had to work on a random terminal instead of my own workspace using unix workstations which weren't even compatible)
so eventually i just started typing with the index fingers and thumbs only.
i don't actually see the point in touch-typing for programmers.
programming requires more thinking than typing. it also uses more special keys that touch-typing is not really adjusted to, so i don't feel like i am loosing any productivity by not being able to type as fast as a trained touch-typist.
and in light of the stories here, i consider my early uncomfort as a warning sign that stopped me from making things worse.
as others said: if you feel uncomfortable, fix the uncomfort, no matter how small
I was supposed to learn touch-typing in school, but all I learned was how to game the system. To this day I still type with pretty much only index and middle fingers, even the space bar.
I don't feel particularly restricted by my _maybe_ slower typing with more frequent mistakes due to looking at the keyboard. Like you said, my job is engineering, not typing.
right, i forgot about the looking at the keyboard part. that is a distraction, but in fact, i have been doing this for so long that i can type with just index fingers without looking at the keyboard. seriously, i am am trying this right now, and i am astonished how few mistakes i am making. it does feel awkward because i am not used to typing this way but apparently my muscle memory is good enough...
This is great advice. I really enjoy ergonomic keyboards, and having as little strain on your wrist as possible is key. On "regular" non-split keyboards I ignore the touch-typist tenets and keep my wrists relaxed, so my index fingers are on an arc roughly around `qwefjiop`. Much more relaxed than forcing your fingers to an unnatural "home" row.
Indeed, that is one of the purposes of those keyboards.
For myself, I love the TrackPoint so much that I can't bear the thought of using any other kind of keyboard with only a touchpad or a mouse. So standard ThinkPad keyboards it is for me. I even use a USB ThinkPad keyboard on my desktop at work!
I can type quite fast (easily 100 words / minute), but never had any official training. My hands are always positioned like your second drawing. Could it perhaps be that the standard way people are taught to type (i.e. fingers resting by default on the middle row with index fingers on the F and J key) makes people more inclined to bend their wrists which can lead to complaints?
This is how I was taught to position my hands on the keyboard in 6th or 7th grade (I can't remember) and to this day I thankfully don't suffer from any wrist pain or fatigue.
This story resonates. A few years back I was dealing with mild pain while coding. I stupidly ignored it for months as it got significantly worse, to the point where it became impossible to type for extended periods.
I tried lots of things. My doctor did a nerve conduction study, which apparently ruled out carpal tunnel syndrome, but he wasn't much help beyond that. He gave me some straps that I slept in and wore around to keep my wrists immobilized. I did some physical therapy. I got a split keyboard and ergonomic mouse. I even took a month off from typing, then returned, but the pain was worse than ever.
The double whammy of severe pain combined with the fear that you'll never code again is rough to say the least.
I resolved to just code with my voice. I never found Talon but found VoiceCode instead. It also relied on Dragon's NaturallySpeaking software, which I was dismayed to learn was still the best desktop software out there. My hopes and ambition for what VoiceCode could do always outpaced reality, but it was workable. I remember impressing some friends who witnessed me quickly and accurately writing code by speaking what seemed like gibberish.
As the author notes, the biggest problem quickly becomes that your voice tires out. You're not built to talk nonstop for hours on end every day. I was forced to become a much more efficient developer for a bit.
Eventually the pain began to subside. I remember when I first noticed it happening, because it was one of the happiest moments of my life. After a little experimentation and observation, it was clear that my recovery was positively correlated with consistency in going to the gym for heavy weightlifting sessions. Even today, pain in my hands and wrists is a reliable signal that I haven't been lifting in recent weeks, and when I start back, the pain goes away.
I had literally the exact same experience as your first two paragraphs. Where my experience diverged is when I met a doctor of some kind who explained that it's the same kind of pain that truckers often get for resting their arms on the armrests. Turns out it was because I was resting my arms on the keyboard or the desk between me and the keyboard. Stopped doing that, the pain went away completely within a few days, and hasn't come back since. That was like 4 years ago. Just don't rest your arms on anything, that's the trick.
This helped me too. It was combination of desk edge and sleeping on the hand that was causing it. Started sleeping on back or the other side and resting full forearm on desk (so not on edge; at least pressure's distributed) or the actual proper posture (not resting forearm anywhere), and it went away fairly soon.
That makes a lot of sense, the best cure for my wrist pain I found was deep massage on certain places in my forearms. Thinking back the area I hit most often was the point where my forearms lay on the armrests.
Thanks for posting this. The article, and your post, also resonated with me.
I have small fiber neuropathy in my arms and legs, which causes constant pain and a feeling of weakness. I've had this for a few years now, and I'm very aware that it's only got worse over that period, and that I may later get damage to the larger nerves used for motor control.
Like you say, the pain and fear that coding (which is my livelihood and passion) may become impossible is quite terrifying, and a constant, nagging presence in the back of my mind.
I haven't tried any dictation software since the days of Dragan Dictate, possibly 1-2 decades ago, but I'd like to hope it's come in since then. It sounds like you really persisted with it, and I have a few questions about your experience if you don't mind:
1. Was the pace much slower, and did you get frustrated with it? A mouse and keyboard allows me to operate closer to the "speed of thought" than I would guess dictation software would
2. What do you say to move the cursor around, or switch between open files?
3. I'd guess there's a big difference between dictating a document and coding or working on the command line, as you're not always inputting "real" words. How well did dictation work in that regard?
1. It was slower and I was frustrated, yes. I don't know about the newer Talon software, but with VoiceCode I spent a lot of overhead just configuring my setup and tweaking it, to say nothing of the slower coding speeds while using it. But once you get going, it's faster than you might think, and it feels vaguely futuristic. In fact I'd say some things are faster. I used a lot more macros, for example. Scrolling is slow. I often cheated and would type or use my mouse.
2. Honestly I can't remember the specifics of my setup. It was too long ago.
3. Above, I'm only really talking about dictating for code. You need a bunch of custom commands for that. Dictating for writing prose was pretty straightforward. If memory serves, VoiceCode had a different mode you could switch into for that.
4. Not sure. I believe I was using Atom at the time. I now use VS Code.
To other readers: Be very careful about weight lifting. It has a lot of risks, both of immediate trauma and longer-term excessive strain. So seek the guidance of relevant professionals, including a physical therapist and/or an orthopedics specialist physician, either before or during weight lift training. This is doubly true if you have been in serious pain.
I'm not suggesting that you _not_ lift weights - just take care.
All exercise has risks. Walking has risks. The question is not what the risks are, but do the benefits of the exercise outweigh potential risks?
For lifting weights, the answer is absolutely yes. Strengthening bones, improving mental health, better sleep, lower blood pressure, less injury prone as you get older, etc. etc. These are the benefits of regular strength training.
For otherwise healthy people, you do not have to consult a professional before starting a weight lifting routine.
I'm sure that your caution is well meaning, and people should definitely ease into a new exercise routine slowly, but recommending that people talk to a doctor or PT before they go to the gym is an overabundance of caution that will lead people to skip out on it altogether out of a misplaced fear of injury.
I started to have knee pain in my early 20s and my dad had both knees replaces sometime in his 60s. I was afraid I'd end up that way and went to a sports clinic (I do a lot of dancing). I had patilla bilat; basically the knee cap was off to the side instead of sitting squarely.
They said everything else on my knee looked good. Out of all the physically therapy exercises, the most significant was cycling. I started to do a lot of cycling after that, which builds the muscles on both sides of the knee and helps keep the kneecap centered.
I had a similar experience, where the knee pain would start to return if I slacked off on cycling. These days I cycle ~100km per week (12km per day to work and back and a bunch on the weekends) during the summer and still dance and haven't had the knee pain return in years.
An alternative grip exercise that can be done anywhere and avoids the injury risk of climbing, is to alternately make a fist and then open your hands as far as possible while spreading your fingers apart. Start slowly and gradually increase the speed and repetitions. Be sure to have at least one rest day between sessions (I actually think two rest days is better). After a couple of weeks, you should be able to do it extremely quickly for hundreds of reps until your forearms are completely fatigued. In each workout, try to open and close your hand more quickly than the previous workout. Make your fingers look like a blur of motion. It is surprising how completely fatiguing this can be after just a few minutes.
I did something similar quite often in my aikido classes. There was also a twist exercise - start with your fingers together palm parallel to the ground facing down, and rotate the forearm rapidly so the palm is facing up, and then back again. Repeat until you can't. Go back to the open close motion. Do those pairs 3x daily.
I stopped akido due to a knee injury, but yikes were my wrists strong for a while.
The closest thing I've found is called a "Fist Flex," so I just call this a "Rapid Fist Flex." I adapted it from a rehab exercise I was given after an injury, which instructed you to only do 10 to 20 slow repetitions. Once I was largely recovered from the injury, I found that doing 20 repetitions at a slow rate did little for me, so I experimented and determined that just increasing the rate and exercising to fatigue allowed me to continue to strengthen as effectively as any weight-bearing exercise I had done. I think of it as using acceleration/deceleration to generate force rather than using weights, which is similar to what sprinting does for the legs, core, and arms. Take a look at a 100m sprinter. Rapid movement is very effective at strengthening and it works your full range of motion. If you want some extra resistance, just put your hands underwater in the bathtub when doing it.
In my case too much bouldering caused forearm pain that lasted for two years. Didn't stop me from typing, but it did have a significant impact on my daily life :/
I also suffered from hand pain from typing and took up climbing both inside and a bit of outside for a good 8 years solid.
I found bouldering to be way more intense than just top rope (eventually getting into lead) climbing. Most of my hand/arm injuries were from bouldering.
I concur with the previous response though... climbing, done well and not over doing it... was the 100% solution to my pain problem.
Sitting and typing all day, you lose muscle and strength, not just in your hands, but your arms, shoulders and neck. Climbing builds it right back and really helped more than any special keyboards or posture changes I tried.
Not the same especially with grip style but you can go a long way by strengthening your back. I'm talking of horizontal and vertical pulls (heavy rows, pullups, lat pulldowns, deadlifts to an extent).
In my unscientific observation, a lot of people have very weak posterior chains. My wrist pain has always (so far) been the result of a knot in my upper back or a weakness there.
Don't forget to foam roll, stretch and perhaps add in some periodic deep tissue massage to keep things from getting too tight cos that also brings problems
I used this as well. Same issue as bouldering. It tends to stress the joints too much.
For whatever reason, regular climbing is better. Probably because there is more 'levels' and thus less immediate stress. You can't really climb to the top of an indoor route until you can learn and get the strength to do it.
With fingerboards you try to see how much you can tolerate and tend to over do it. It also is more of a static movement. Grab and hold. Where top rope climbing is more dynamic... you're constantly moving up the wall in various poses.
"Make or Break" by David MacLeod has helped me fix a handful of climbing related strains - https://www.davemacleod.com/shop/makeorbreak - might not be relevant for you anymore, but I would recommend it for anybody who climbs
How much was too much? I can certainly imagine that bouldering could cause wrist injuries. But in my case, like above, it strengthened my wrists and improved the pain I was having from typing.
It just depends on how you are built. I tried to get into climbing for a while but the constant strain on the fingers caused more and more pain over time until I could barely use my hands. Took many years to get back to normal.
That’s why you should test a lot of advice if it works for you. Things that work for one person can be damaging for another.
As someone whose had RSI for about 6 years and managed it well enough for work; bouldering would be literally impossible for me.
Microsoft split keyboard, footrest and proper chair with adjustable armrests allow me to work with minimal pain, and I work long/after hours frequently. Prior to sorting out that setup I took a month of work because I was in so much pain, which returned as soon as I returned to work (without the ergo setup).
Playing games, playing guitar (sadly) or using tools like screwdrivers for even a short period of time does not end well for me. I absolutely still do each of these in moderation, and I would love to go rock climbing! It's just highly unlikely to be enjoyable after the first few minutes.
I had mild pain in my wrists in the late 90's I switched to ergonomic keyboard, got a good office chair, and switched to Dvorak layout. I did this for my work and home environment.
One additional step I had to take. I removed they armrests from each chair and have continued to do so with all chairs. I found myself leaning into the armrests too much to the extent of causing abrasions on my elbows. With removal of the armrests I work and play at the computer with better posture. I mention this only because what works will vary between people and I think it's an important change.
Also, I have no idea what to credit with the pain of my wrists going away. I suspect Dvorak, but it was probably a combination of factors.
>I mention this only because what works will vary between people and I think it's an important change.
I really like this because I took an alternative option. I decided "home row" thinking was too confining when writing code (I probably write more scripts), and I can't think as fast as I can type with that sort of approach. My colleagues call me a "hunt and pecker," while I actually simply refuse the home row. Muscle memory is quite odd and can be cultivated to encourage less repetition.
Learning to play the guitar is a surprisingly good way to increase your hand strength - mostly the left/off hand, but not exclusively. Learning to play the piano has similar hand strength benefits. Obviously overdoing it in both cases can lead to it's own RSI issues. But just getting past the beginner stage really adds a lot of strength & dexterity.
I've certainly read this before, however are there any studies that back this up?
I played guitar before I got RSI. Now, I can't play for more than a few minutes at a time without ending up in pain - despite my RSI being under control for work purposes.
Actually, there's nothing quite like playing guitar in terms of causing me pain well after finishing the activity. Certain things like lifting heavy furniture, or using a screwdriver cause pain quicker but it also goes away pretty fast. 5 minutes of guitar will result in pain and weakness until the next day. Granted, it's not an enormous amount of pain, but it's certainly enough to be annoying. It sucks, because despite not being very good, I've always enjoyed playing guitar.
I should add that I also certainly never overdid playing either; I've never played a live show in my life and have never taken it too seriously, was just a hobby.
I wasn't trying to say that playing guitar was a treatment or therapy for RSI symptoms. Obviously any type of hand exercise can make things worse while your hand/wrist/ligaments are inflamed or you're otherwise subject to flareups of RSI.
The general idea in this thread was that increasing finger/hand strength could be a preventative action for people worried about RSI, and I think that's a reasonable train of thought - and playing guitar certainly does improve hand strength.
I think it's fair to say that no preventative action is 100% effective for the kinds of things we're talking about. I'm pretty sure other activities and factors, including genetics and luck play a lot into whether that increased hand strength is enough to prevent RSI in any individual case.
I do think it's good to bring it up as a warning though - it's very possible for any activity that uses the hands a lot to contribute to RSI symptoms rather than help, and people should really pay attention to what their body is telling them :)
Sorry to hear you're not able to play as much as you'd like - it's been one of my favorite things to do when I need to get away from the computer, and I'm super grateful it hasn't caused my RSI to return.
If you have carpal tunnel, lifting weights can make things worse. It puts more stress in the narrow canal that your tendons go through, which cause the pain.
At the worst, I had continuous wrist pain and woke up in the morning unable to feel my arms. I couldn’t physically hold a mouse for more than about 15 minutes. When this happened I was also lifting weights.
I spent thousands of dollars on ergonomic chairs, keyboards, mice. It helped but didn’t solve the symptoms completely. I was unable to do things like use a laptop without pain.
Several years later I started doing basic body strength exercises. I thought I had permanent nerve damage by that point, but within about 4 weeks all symptoms were gone. That was 10 years ago.
I think a lot of these problems are related to shoulder, neck, and arm muscles. Stress, cold, seem to exacerbate the symptoms. Nothing I read in years of research had the right answer.
Can you describe what body weight exercises you found helpful? Why do you think those were different than what you were accomplishing with traditional gym weightlifting?
I think it was something related to the tight grip used in lifting weights.
I started with the beginning workouts from the book You Are Your Own Gym. In retrospect, 90% of the benefit was from the pushups, which I had completely avoided doing once I started getting severe wrist pain.
Surely a bespoke and custom solution is do-able with ML anymore?
At least for me, I’m down to Python, and Go as my daily driver languages. I lean heavily into reusable code and can solve a lot of problems with imports from git sources (everyone all on about DRY and write less code, right?)
Feels like a reasonably constrained problem set to organize a few sequences of voice commands around.
I once had a similar experience, except it was the muscles in my back, between my shoulder blades, that were causing great pain. I eventually realized that 1) the issue was due to long hours of keyboard work, and 2) when I added seated cable rows to my lifting routine, the pain went away completely.
>After a little experimentation and observation, it was clear that my recovery was positively correlated with consistency in going to the gym for heavy weightlifting sessions
This was my experience as well.
Started getting inflammation and pain on the top of both forearms that made typing for longer than 15 minutes very painful. I was convinced for a while that I had some sort of nerve entrapment that would need surgery to fix.
Ibuprofen helped a little, as did wrapping my forearms in braces, but the only thing that alleviated the pain long term was lifting heavy weights.
I don't have pain in my hands, but I get severe back pain from time to time. It's difficult to sit or stand (or be in any position, really) for a few days at a time.
I can do some things just fine, like type, but I certainly can't concentrate long enough to do any programming tasks because the pain is so distracting.
same here, and I will repeat csallen's solution: going to the gym and lifting heavy things (squat/deadlifts/etc with good form and comfortable pace) has turned my decades long back pain around completely.
It took about 6 months to really be sure it had improved, but it's been amazing, plus there have been significant cognitive benefits. Couple the gym with less sitting, and more standing -- couldnt be happier, wish I had done it earlier.
> It also relied on Dragon's NaturallySpeaking software, which I was dismayed to learn was still the best desktop software out there.
Sounds like a business opportunity especially with the barrier to AI being lowered. But I guess there is some real value in having been doing it as long as the Dragon team has.
A friend of mine has a different solution to this problem which I think is really great. Programmer salaries are more than enough to pay someone to type for you. But he doesn't just hire typists. He trains apprentices. https://blog.iangilman.com/2018/06/wrists-apprentices.html
Having a medical condition which causes bone density and arthritic issues, I’m certain my body will diminish far quicker than my brain will. Hiring a typist is the same conclusion I’ve come to as well, and ultimately it would inevitably become a pair programming session.
That story of how the doctors just dismissed her pain as delusion is terrifying. Doctors are supposed to be people of science, but one of the very fundamentals of science is to acknowledge that you don't know everything, that your current knowledge is just a theory that can be improved upon. I find there's a tendency among doctors to think they know every possible disease, and if someone comes along with one that doesn't fit in their system, they write it off as psychosomatic. They probably get their fair share of actual hypochondriacs, but I'll wager that more than half of the people who are dismissed this way, are actually suffering from a real, but rare or understudied illness.
You really don’t know how many hypochondriacs we get. And general anxiety disorder with a focus on healthcare. And totally reasonable people who start attaching every last twinge and twitch to their (real) core symptom, and want an answer that encompasses all of them.
And these people seek care. A lot. Literally orders of magnitude more than ordinary people do. You have your one story of (x). I can tell you about a score-plus of nuts I see in a regular week. Many of them are frequent fliers: I will get to see the same ones pretty soon with wildly different symptoms that in no way relate to their current symptoms. They certainly don’t relate to the crap they brought me a month ago.
I’ll take your wager for “more than half.” Dunning-Kruger is not your friend.
I do. I worked in healthcare and the overwhelming majority of patients are legit. Same with any category where people are cynical and project that cynicism onto the majority. When I became a patient I became a victim of this categorization. I've been labeled immediately as drug seeking or mental or whatever and things have gone ignored or dismissed until I pushed long enough and hard enough for testing etc. I've told the story over and over irl about working in inner city hospitals and seeing people consistently dismissed and joked about for hours until testing prove them legit and then watching people scramble mostly to CYA not out of any empathy. Was a major contributor to my burnout in the field.
Calling worried patients with scary symptoms "nuts" and their issues "crap" really sums up the sort of thing I am talking about and is what makes patients afraid their provider isn't going to do their best to help them. Empathy is required for good healthcare. I recently got another confirmed and terribly depressing diagnosis of an incurable issue, but the provider I was working with was so kind, caring, and informative it reduced the mental impact as much as is possible. A dismissive provider, who was ultimately wrong, a few weeks before had me in an even worse head space than normal until I got to someone good. When I reached out to the wrong one to notify them they didn't seem care at all and dug in harder despite the proof/labs etc.
"A few bad apples" isn't because of the few bad apples. It's because the farmer decides all the apples are rotten, and throws them all out with the few rotten ones, while telling others constantly about those rotten ones as if they are the norm.
I had a super serious reaction to an antibiotic. I have been to mayo clinic and somewhere around 60 physicians with different specializations by now.
At least 70% of physicians have left me angry, they were simply wrong. Some would not take all symptoms because it is too much to handle at one time. My experience with western medicine has been pathetic.
Also, when I was younger I had a sports hernia. It is almost like a inguinal hernia except there is no bulge. I struggled for 12 months. 4-5 months in I had a hunch it was a sports hernia from my research. I have seen total of about 6 surgeons and 4-5 doctors for the issue. All told me it is a strain, gave me NSAIDs, suggested I see a therapist. I found a great doctor in California. He performed the surgery and took images. I had completely ripped 3 different muscles in my inguinal area. By the way, the doctors I have seen were BIG name Chicago doctors from Northshore, RUSH.....it was one of the worst experiences of my life and I often feel hatred towards doctors. The shittiest thing is, that initially it was one side but they gave me a go ahead to go back and lift at work, so I ripped the other side. I was too young, broke and dumb to sue at that time, because now I would take them to the cleaners.
I would not be surprised if software engineers do more research than them.
You are required - ethically, perhaps even legally - to sort out the hypochondriacs/nuts from the bona-fide-condition cases using sound diagnostics. Now, for the person who complains about a couple of days or sore throat or a headache, you might dismiss them with something mild and symptomatic - but the person who tells you "I've had excruciating pain in my wrists for a year and I can't type", with the medical history to prove it, is definitely someone you should put through a battery of tests.
Let's try to remember that people with medically unexplained pain will be experiencing real, actual pain.
They're not inventing the pain. We can put them through fMRI and see the same bits of the brain light up.
The public have 3 incorrect beliefs about pain treatment.
1) Opioids work
2) The only acceptable outcome for pain treatment is elimination of all pain
3) Pain is either real (with a physical cause) or not real (psychologic, or made up).
It seems plenty of doctors believe (3) too.
Patients reject treatments that don't fit these beliefs.
As you know opioids are a good choice for some types of pain, but they're a poor choice for others. The patient will end up with an opioid addiction, and all the side effects from the opioid meds, and they'll still be in pain because they've got a tolerance to the meds.
So pain treatment now will try to eliminate pain if possible, but some people that's just not possible, and so HCPs will look at function. How well can the person live their life, even if they're in pain?
This leads to a multi-disciplinary approach to pain management, including physiotherapy but also importantly including a psychological treatment.
If this was a standard approach for all pain, obviously being tailored for different types of pain, patients would be less likely to reject it. Your "nuts" (a fucking horrible way to describe patients and incompatible with a professional registration in England) would be less likely to reject psychological treatments for pain if they knew that it was also being offered to cancer patients.
Getting a diagnosis when you don't have something easily understood can be an utterly soul destroying process.
I have fibromyalgia. Not as a label stuck to something that can't be understood, but firmly fitting to a disease that isn't yet fully understood. (Yay for me - I have every known symptom at one time or another.)
It took ten years, an enormous amount of pain, two neurologists, three GPs, a psychiatrist and a pain specialist before they were able to nail it down - and now they're able to help.
Unfortunately, there was a tendency to treat it as psychosomatic. Also unfortunately, treating it as psychosomatic promotes behaviours like "pushing through the pain" that are absolutely guaranteed to cause a flare up or major relapse in fibroymalgia.
This kind of story created fear for you. And it should, I'm sorry to say. For the most part, you will suffer alone and without understanding, and it's up to the sufferer to push their story along until they get an answer. I'd wish that process on nobody.
I feel you. I have RSD, a related disease, and even today half the doctors I see either dismiss it or do not believe in it. I went through YEARS of blame and denial before a very kind specialist in Europe spent time with me and gave me answers. By then it was too late to put it in remission, but their treatments did reduce it some, for which I am grateful as I'd not have lasted beyond that time without it. But day to day its still life altering. It's taken so much from me, that I cannot even afford to deal with it well anymore, let alone the other inevitable medical things and aging.
Pain is too often ignored, dismissed, miscategorized. While psychosomatic issues and stress positively make things worse, it's not always the root of all issues and too often it's projected as such. It will ultimately be the end of me as there is no realistic way to get enough back to survive long term.
Diagnosis is a diagnosis of exclusion. Eventually with my set of symptoms it became clear that only two illnesses fit well enough. Fibromyalgia or multiple sclerosis. A clear MRI eliminated MS as an option.
---
Treatment is a multi-pronged attack.
I have a drug cocktail aimed at desensitisation of the nervous system. It works well enough to take the edge off, but not during a flare up or relapse. It's the least important and least effective part of treatment.
I have a psychologist, aimed at pain management. The mental techniques around dealing with pain and stress on a daily basis. This becomes more important during a flare. It is also probably the most important part of treatment.
I have a physiotherapist. I need to maintain a certain level of physical activity or the illness can rapidly get worse, whilst at the same time, too much activity can also cause the same process.
---
I should also point out that if I became completely resistant to treatment, a possibility for the future if things get worse, then my pain specialist is also involved in a series of trials using ketamine that usually results in desensitisation of the nervous system over the course of a couple weeks.
Point being, there is always hope for increasing quality of life, even if there is currently no hope of cure.
I know someone who also had suspected MS, and a clear MRI. Just to be sure, they also did a lumbar puncture. That actually confirmed the MS (presence of inflammation) despite the clear MRI.
Point being that a clear MRI does not totally eliminate MS.
Psychosomatic diseases are a real thing though. You can have real physical symptoms. Last year my muscles started to « shake », with lots of skipped heartbeats (extrasystoles). After all the checks the doctors said the classic « it’s stress ». Well then I took a real break and embarked on multi month road trip on another continent. The symptoms disappeared nearly overnight. I think I experienced a burnout but it manifested through physical symptoms.
Edit: needless to say the medical response was very frustrating and hard to believe. In the end they were right that it was not a physical cause, but apart from that it really felt like they had no idea. Also it could be a multi-level cause like gut flora causing anxiety causing be physical symptoms but it’s beyond what a doctor can diagnose I think.
They're real, but doctors often do a half-assed (if not downright negligent) job of ruling out other possibilities before settling on somatoform disorders (or any other psychiatric diagnosis, for that matter). Especially when it comes to women presenting with chronic or recurring pain or fatigue as their primary symptoms.
> Psychosomatic diseases are a real thing though. You can have real physical symptoms.
+1. Several people at work have reported that "The Mindbody Prescription: Healing the Body, Healing the Pain" helped their wrist pain go away.
YMMV. But just as doctors shouldn't dismiss the idea symptoms are due to a "real" (read: physical) condition, folks suffering shouldn't dismiss the idea they can be cured (or greatly improved) through non-physical means, even if there is some physical origin.
I haven't tried this book myself. I've had wrist/forearm/hand problems (weakness, tingling/numbness, pain, loss of flexibility, diagnosed as carpal tunnel and tendonitis), but they largely went away before I'd heard of the book. I think a bunch of things helped me, including wrist exercises suggested by a physical therapist, TENS (administered by the physical therapist), time, Qi Gong, meditation/relaxation techniques (I'd always had a lot of muscle tension, including tension headaches), and (later on) resuming rock climbing and weight lifting. So some combination of physical and mental changes.
Unfortunately for most people taking a break like that is impossible. I’m sure stress is a major factor in many of my health problems but the biggest break I can take is an hour or two to myself once a week.
Regardless of whether you think the advice from the GP is sound or not, the best way to get a doctor to listen to you is to listen to (and follow) their advice first.
Cursing at them out of frustration only makes your situation worse.
>Regardless of whether you think the advice from the GP is sound or not, the best way to get a doctor to listen to you is to listen to (and follow) their advice first.
It's been shown that it's very hard to prove that you're not mentally ill if you're labeled as such. Getting treatment just means you'll be put on essentially random psychiatric medications (which have their own side-effects) or have to spend years in useless therapy (while your actual disease may progress).
If a doctor isn't willing to do the proper testing or evaluation the first time then they won't do it a second time either but just claim you haven't gotten the right psychiatric treatment yet.
> It's been shown that it's very hard to prove that you're not mentally ill if you're labeled as such.
But what if you do have a condition that requires therapy? You're unlikely to recognize it yourself. Would you always refuse treatment and just go with painkillers instead?
> Getting treatment just means you'll be put on essentially random psychiatric medications (which have their own side-effects) or have to spend years in useless therapy (while your actual disease may progress).
The patient in this case would not see a psychiatrist since he's not depressed or mentally ill.
Instead he would be sent to a psychologist who can only recommend further therapy. Ofcourse if the symptoms become worse you should immediately see the GP and not wait for therapy.
> If a doctor isn't willing to do the proper testing or evaluation the first time then they won't do it a second time either
If your symptoms become worse the doctor will definitely recommend testing. Therapy is something to do as part of diagnosing your ailment.
>The patient in this case would not see a psychiatrist since he's not depressed or mentally ill.
Severe pain due to psychosomatic causes sounds like mental illness to me.
>Instead he would be sent to a psychologist who can only recommend further therapy.
No, they can also strongly recommend that they see a psychiatrist for potential medications.
>The patient in this case would not see a psychiatrist since he's not depressed or mentally ill.
Every health system I've dealt with funnels to medication pretty strongly. Therapy is a slow process and medication allows a patient to not be in distress during the years it can take.
>Therapy is something to do as part of diagnosing your ailment.
Therapy is a slow process that in the best of cases can take years to work and longer in other cases. It is a shitty approach to diagnosis.
>Because patients often insist on medication because they do not accept that the ailment can't immediately be diagnosed.
Not my experience both personally and with those I know regarding mental illness. Doctors are quick to diagnose mental illnesses (correctly or not) and prescribe medications for them (even if the patient is hesitant). Some health systems even make it nearly impossible to get a therapist (we can see you once a month starting in two months...) but not a psychiatrist.
The GP didn't give 'advice' so much as they said "your medical records? ha, right... you're crazy." And then proceeded to shut down all avenues to further care and pain management.
Honestly it sounds like the GP is so cynical about the hot garbage they perceive UK healthcare to be that they basically said "please go away so that our utter inability to help you doesn't weigh on my conscience any further... oh thank god you invoked the loophole that lets me kick you out now and pretend it's all really your fault"
> The GP didn't give 'advice' so much as they said "your medical records? ha, right... you're crazy." And then proceeded to shut down all avenues to further care and pain management.
That's a patient's perspective, but how about a doctor's perspective? You've got a patient refusing treatment for what could very well be a psychosomatic condition and instead demanding opiods that are very likely to result in addiction.
There is a large stigma around mental health, but there's no such thing as a person who's completely sane. Just because a doctor is saying you might have a psychosomatic condition is not the same as him saying you're deranged.
I support your point, but there's also one more thing to consider. Some MDs share the social stigma around mental health, and won't waste the opportunity to make the patient feel like it's their fault because they don't want to get better, and that they should make space for patients who have real conditions.
> the best way to get a doctor to listen to you is to listen to (and follow) their advice first.
No. Because sometimes their advice is "nothing can be done, you'll need to manage." Or - "Wait for a few more weeks and if it doesn't go away, we'll rethink things".
Hmm? Lots of ailments do just get better if you leave them alone. That's probably the case for the majority of things that people go to the doctor for. If your knee hurts, you may as well wait a few weeks to see if it gets better before you start running a bunch of tests.
Thanks for caring so much that you would let me spend weeks in pain. I think I'll look for a doctor who actually wants to treat his/her patients' conditions.
I'm not a doctor. Of course one could prescribe medication for the pain. But many ailments are difficult to diagnose and fix themselves after a few weeks, so it makes no sense to rush into things.
More broadly, it's a mistake to measure how much your doctor "cares" by how eager they are to throw lots of tests and treatments at you. Modern medicine isn't magic, and there isn't always that much that a responsible doctor can do for you.
That has the possibility of working out disastrously if the doctors first recommendation is surgery, when physical therapy (rest + strengthening) ought to have been the first prescription.
I think this is something that happens more in the UK.
The NHS has a "policy" on these issues. If you have anything that is falls into the category of "poorly understood neuro", you are mad...according to NHS policy. What is even more disturbing though is that the research is fairly clear that these problems aren't psychological...but doctors within the NHS, usually non-researchers, are utterly convinced that it is which has massively hindered the amount of research on this within the UK.
And the massive irony of this is that most doctors in the UK, usually not in primary care, will happily accuse patients of being mad...but there is almost no investment in psychological services in the UK. The doctors are seeing an epidemic of mad people...but don't think they need treating...logical.
Btw, I look after a relative who has something like this and it is fucking terrifying (and upsetting watching someone get sicker every day with no professional help or even interest in help). These problems are usually genetic, if I get sick then I have no-one to look after me, and I know if I get sick there will be no professional help. Let's hope I am lucky.
Yes, this has happened to several family members in the US, though thankfully mine was diagnosed properly because I could point to family history. Initially they wanted to write it off to migraines (I can't blame them since it's more common and can have similar symptoms at first) and now nine years later it's painful to use my hands and I've mostly given up martial arts.
It would almost certainly be worse if I hadn't had the family history to point to and actually convince them to do the tests that would confirm the diagnosis. For chronic illnesses defined by random irreparable damage the sooner you start treatment the better your outcomes are likely to be.
I am surprised that four doctors in a row did this, that's shocking. Usually a second or third opinion is enough that at least one of the doctors is paying attention.
One of the doctors took them seriously, did a biopsy, and gave them a diagnosis.
They did not like their diagnosis because “idiopathic” means “we don’t know what causes this,” which the patient translated as “go the fuck away.” As if all human disease is deeply understood and an admission of ignorance is equivalent to laziness. They then continued going to additional doctors.
Hi, I wrote the post! I'm actually very grateful to my neurologist who gave me my idiopathic diagnosis, because he was the only doctor to figure out the mechanism of action. He's been enormously helpful.
It doesn't change the fact that, as a patient, an idiopathic diagnosis is not a satisfying outcome if it doesn't point to a course of treatment. And it's certainly not something I view as a "final diagnosis" -- I'm patient, and technology and medicine are still improving and I hope it'll be possible to identify the cause and treat it in the future.
As a fellow patient -- accepting that sometimes life is uncontrollable can bring a lot of peace. Even if there is no treatment, acceptance does a lot for happiness.
Nonetheless, know that your post is appreciated. For now it's mostly handling small fasteners that gets me, typing is usually mostly okay. But since I do hardware prototyping I had to learn to ask for help a lot more than I was used to.
I also find it's sometimes helpful to wear a cloth around the more painful hand to kind of remind people that the pain isn't obvious... well, plus if it's a little wet it helps the pain a lot so it's functional too. But invisible pain means my coworkers frequently assume I'm feeling about how they are. And I feel bad saying no to stuff since technically I can still do it... it's just painful to do.
Indeed. Especially in neurology, where the tissue is non-regenerative. Hopefully we can find ways to slow tissue destruction - often we cannot - but that’s a far cry short from reversing it.
I wouldn't worry if it's little stuff, migraines really are weird. Don't anxiety yourself or anything, I just have a propensity for immunological stuff. In my case it was early symptoms of multiple sclerosis.
I've had better experience with older doctors who no longer care about maximizing their billings. Extra points if they consider most other doctors to be idiots and like to prove them wrong. Unfortunately to find good ones like that takes time, determination and being ignored many many times.
>That story of how the doctors just dismissed her pain as delusion is terrifying.
The frightening thing to me is that from my reading there is little recourse for her since the UK has a centralized health system controlled by GP referrals.
My experience is that in particular cases where multiple disciplines need to work together in order to reach a diagnosis fail. It is up to the patient to relay information between specialists. In my experience, they don't even look at the records and images their colleagues produce.
I suspect anti-american bigotry by the British doctor.
It is a cliché that Americans are hypochondriac* (especially women) so I can imagine some stuck-up British guy being so completely unprofessional and damaging.
* Why is it not HYPERchondriac? I wish medicine would replace hypo with another prefix: how many deaths and how much damage occurs by miscommunications due to mixups of opposites? Edit: hypochondrion means "below the cartilage" where the Greeks though the "seat of emotion" organ was - arrrgh.
In this case yes because then the patient could seek further experts who might be able to identify a cause. By labeling it psychosomatic you are forcing a path of treatment even if it's not the right path.
Fibromyalgia And idiopathic disease are not terms for "go away".
They mean "I've tried what I can think of and theres no further testing we can recommend"
Notably, a positive punch biopsy for small fiber neuropathy IS diagnosis with treatment that works fairly well. Ideopathic simply means that the base cause is unknown.
The author need to educate themselves further about what doctors can do and what words mean. He has a good scientific diagnosis, and he's outright dismissing it based on some misdirected anger.
I'm sorry, but at least in the UK and on the NHS, fibromyalgia is very much a diagnosis of "go away".
I had to battle with my neurologist to get a skin biopsy, despite very clear symptoms of neuropathy, and a very clear trigger.
He eventually ordered it, very reluctantly. It came back normal, which for him for conclusive proof that I had fibromyalgia.
When I asked him about fibromyalgia, it was immediately clear that he literally had no idea about it - when I said that it disproportionately affected women, he actually laughed at the idea. When I said I didn't have pain in the tender points associated with fibromyalgia, and I didn't have flare-ups that are typical of fibromyalgia, he just filibustered. It really was his way of saying "I dunno, you're probably a wacko, go away".
I did a lot of reading of papers, and was convinced I did have small fiber neuropathy. I requested a copy of my medical notes and discovered 2 very interesting things - firstly, the neurologist was indeed convinced it was all in my head, that no physical cause would ever be found, and he'd influenced and biased other medical professionals I was involved with by telling them this at every opportunity. Secondly, the biopsy sample had been taken from the wrong place, and had later gone missing - there were no results!
I insisted on another biopsy, and sure enough it found small fiber neuropathy in my arms and legs. He didn't even apologise for what I see as clear negligence.
In the author's case, he had a biopsy diagnosis from the US, but said the UK docs didn't accept that, and he doesn't even have any pain meds - he absolutely should outright dismiss that in anger!
My advice for the author: you're in a profession where you can afford to self-fund private healthcare - put aside principles and just pay to see a private neurologist. If needed, they can repeat a skin biopsy, and you will absolutely not be left without any pain meds.
For neuropathic pain, the best pain meds for most people are Gabapentin, Pregbalin and tricyclics. If those don't work, SNRIs such as duloxetine, might. Opioid medications don't work well on neuropathic pain for the majority of people, but can help some, especially if nothing else works. Sativex (basically a cannabis tincture) also helps some people, and is very easy to get privately now if you have proven SFN (let me know if you want to try this and I'll tell you where to get it).
I had an identical experience to you, however Fibro is diagnosis of exclusion. When the doctor doesn't know what else to do, and you match the symptoms... Boom, Fibro.
I think that hanlon's razor applies: "Never attribute to malice that which is adequately explained by stupidity."
In my case, after seeing dozens of specialists, the doctors simply had no clue what to do. Thus what was left was fibro (which few understand) or psychosomatic causes.
I much rather frame a response of "I don't know" as just that, they don't know. It allows me to proceed further with a more knowledgable source.
Early in my experience I took it as "Go Away" or "You're faking", which made me combative. Combative against a source that lacked the knowledge to help me further. It was a COMPLETE waste of time.
If I took "We don't know" as just that, I would have much more quickly moved towards finding a proper specialist with the knowledge to do proper testing and followup care.
It's really easy to think that Doctors are being malicious because, hey! They're doctors, they're not dumb, right? Except they are. Even the most educated of generalists lacks significantly more medical knowledge than they possess. Doctors know a lot less than they know, and almost always best to recognize those limitations in an individual as soon as possible so you can find the right person for your care.
In part, yes, but there are actually well-defined criteria for fibromyalgia[0]
> I think that hanlon's razor applies: "Never attribute to malice that which is adequately explained by stupidity."
sigh, I agree. In my (unfortunately vast) experience with NHS doctors, it seems the majority have never had any training or even read a paper since they became doctors, and that they are trained to diagnose the obvious and write everyone else as a nutjob.
For example NHS endocrinologists mainly know about diabetes (even if somewhat outdated) and thyroid cancer - anything else, forget about it, you need to go private and see a specialist that doesn't have tunnel vision.
> and you will absolutely not be left without any pain meds
Based on what I've learned, over-the-counter pain medication, such as Tylenol and Advil, is most effective for pain. It's also cheaper, doesn't require a prescription, and isn't addictive. You should consult with a doctor for high doses and long-term usage.
When I had opioids after surgery, I could not concentrate. Specifically, I could not concentrate to read for pleasure, or do the kind of reading needed for our profession. Everything came back as soon the last dose wore off. Since then, even with minor dental surgery, a few high doses of Advil work much better than Valium. (The Valium just leaves me hung over the next day.
It's unsurprising that Advil (Ibuprofen), an anti-inflammatory painkiller, would work better for pain than Valium (Diazepam), an anti-anxiety medication with no pain relieving properties of any kind, and certainly not an opiate. Perhaps you meant Vicodin? In either case you undercut your position to give advice about choice of painkiller.
Not in the UK. Almost all doctors don't like to prescribe benzos at all nowadays, and if they do it will be literally a few as a one-off for something like anxiety.
> Notably, a positive punch biopsy for small fiber neuropathy IS diagnosis with treatment that works fairly well. Ideopathic simply means that the base cause is unknown.
What is the treatment you claim?
Wikipedia claims that "Treatment [for small fiber neuropathy] is based on the underlying cause, if any." Given that idiopathic means having an unknown cause, that seems to contradict your statement.
SFN sufferer here, can confirm that there is no treatment. There are some promising research chemicals, but we are a long, long way from seeing anything available.
There must be some miscommunication here. Gabapentin and Pregabalin are both used successfully for SFN and are first line treatment options.
For severe cases, things like mexiletine can be used if you're willing to tolerate the side effects. Sodium-channel blockers like lidocaine + epinephrine can be used for localized treatment during sever pain.
It's a fuzzy distinction because SFN is almost always a sign of an underlying cause (even if unknown), and symptomatic treatment IS medical treatment.
Apologies, I meant "treatment" to mean "treat the condition", as in "make it better".
Gabapentin, Pregabalin etc can help with the pain, but not the underlying cause.
I haven't come across mexiletine before, but after a quick glance if looks like it's unlikely to be prescribed in the UK (I'm in the UK :).
I must have tried dozens of medications over the past 4 years or so, but it seems I have some dodgy genetics, as I can't tolerate most, or I have an atypical response (gabapentoids make me feel drunk, SNRIs nauseous, and tricyclics do absolutely nothing). I also tried topical gabapentin and capsaicin, but neither did anything.
> It's a fuzzy distinction because SFN is almost always a sign of an underlying cause (even if unknown)
For me it started when taking immunosuppressants for another condition - within a couple of weeks, the pain started and has been there every minute of every day for years since. I have 3 other immune-related conditions, one of which is rare, and I do believe all of these is related - but I'm resigned to the fact that I'll never find the underlying cause.
I'm not sure if it will help, but I also felt rather poorly on Gabapentin (and Pregabalin).
I did two rounds of it and decided it was a terrible medication. I could barely even walk (I distinctly remember my poor father helping me down some stairs at ikea the first day I took it, unknowing what was to come).
Eventually I found a rheumatologist that understood. She started me on 100mg Gabapentin in the evenings. I did that for 2 weeks. I slept better, which was nice.
Then I added 100mg in the morning with a dose of magnesium citrate. Gabapentin is absorbed in the lower GI tract and magnesium citrate increases intestinal motility. This effectively makes the 100mg dose therapeutically equivalent to 20-50mg.
After a week, I'd have my morning dose normally.
Then 200mg in the evening after a week. Then 200mg in the morning. Then 400mg in the evening... Etc...
It took me a little over 3 months to get to the appropriate therapeutic dose, but I managed without experiencing any unpleasant side effects. I then switched to Pregabalin without any titration, and it's more effective for me.
I spent at least 5 years rolling back and forth between pregab/gaba before a sensible doctor walked me through a tolerable process. Hopefully this might help you communicate a similar system with your healthcare professional so you can try it again.
I really persisted with both Gabapentin and Pregbalin, as everything I've read points to them resulting in the best outcomes for patients that tolerate them.
I actually do take magnesium citrate daily anyway (200mg twice a day), but it didn't seem to help me here.
I even tried taking 2 weeks off work and took the minimum dose for the entire period - it was a horrible couple of weeks, where I felt drunk, dizzy, disoriented and anxious for the whole time. I just really can't tolerate them :( I had a similar experience with SNRIs, and also experienced horrendous withdrawals with them - I've tried about half a dozen of them, but after my last experience I accept they are not for me, and will never try another! I guess it all comes down to genetics.
Anyway, all that said, your advice seems good, and I'd encourage others to try to persist and slowly titrate up.
Just curious, have you tried any kind of autoimmune diet? It seems a bit strange to me that RSI never seemed to be a thing before the past few decades.
I don't have RSI, I have SFN (Small Fiber Neuropathy), as very different condition.
At some point after this happened to me, I switched to a low-carb diet (but not because of the SFN, because of a rare auto-immune condition; didn't make any different to the SFN pain, not that I expected it to).
At the beginning of the story I empathized with the author, myself having had to deal with pain in my hands that required injections to resolve.
But their attempt to make their article more “funny” and dramatic at the expense of their doctors rubbed me the wrong way. It’s not cool to use other people like that to get more clicks.
The tipping point for me was the author making their doctor ask them to leave their office. It’s just as bad as people being rude to retail workers who can’t accept a refund.
I don't think the author is trying to exploit doctors to get clicks. I think they're expressing genuine anger and frustration with the healthcare systems they've encountered and the dismissal they've experienced from doctors in those systems.
A doctor telling you they don’t know what the root cause of your problem is is not dismissal, unless all of the author’s doctors are acting in bad faith.
I was sad to hear that because of my bone structure in my wrists I will have to be very careful when typing for the rest of my life in order to avoid the pain coming back. I didn’t swear at my doctor when he told me that.
> I went away to the UK. I brought my medical records from America, but my British neurologist did not read my records or perform examinations. [...] My GP read the note and informed me: He would not prescribe me painkillers. He would not send me for a second opinion from a neurologist, or treatment from any other specialist.
"Bad faith" is a vague term. Is not reading medical records evidence of bad faith? I don't know. But I'd sure feel dismissed if a doctor who hadn't read my records concluded without examination that the root cause of my problem was psychological and my GP refused to allow me to seek a second opinion.
I think you may be confusing the American diagnoses (which were of the "we don't know the underlying cause" variety - fibromyalgia, idiopathic neuropathy) with the UK diagnoses (which I'd paraphrase as "you don't have a non-psychological problem and we won't allow a second opinion").
It wasn't just that, but the doctor was also closing down all of her options, eliminating pain management, and ignoring all her medical records and telling her she's delusional.
I'd say it's bad faith to so boldly screw someone over like that when you know they physically can't punch your face in for it.
For anyone in a similar boat who can't get their doctor to take them seriously, ask for a referral to physical therapy. Doctors don't push back on that because it's not "drug seeking," and PTs and physiatrists are much more qualified to handle these types of issues than regular MDs. I started having this issue when my EDS led to Thoracic Outlet Syndrome, which caused nerve pain down my hands, and only exercises to release the entrapped nerve in my shoulders helped.
I second going to a PT, but I went through a number of PTs before I found one that actually knew about referred pain and trigger points and specifically worked on treating those in addition to strengthening. Just doing strengthening only made the trigger points worse.
My career in Software would be over if it wasn't for voicecode.io and now Talon.
I go through periods where typing does not bother me at all and long periods of intense random pain in forearms, wrists, palms and top of my hands.
Certain aspects of controlling your computer by voice are way more efficient than using a keyboard, others not so much. Lucky for me using a mouse does not bother me that much so I continue to use that for scrolling and mousing and alternate clicking by voice or mouse. I probably work by voice about a 1/3 of the time right now, ideally it would be more like 2/3 of the time.
There is definitely a big learning curve to using voice control and like they said in the article you have to be careful about voice strain.
- light years ahead of where voicecode.io was with speed and accuracy
- free
- can be used without Dragon (although accuracy with Dragon is much better)
- currently only works on Mac OSX, but has plans for Linux and Windows support
I have pair programmed off and on, both in person and remote; yes it helps because you are typing less, but sometimes you end up being the driver for long sessions so it is not perfect.
The stuff about doctors in the UK is quite amusing.
I actually look after a relative who has similar but not identical issue. Like OP, the diagnosis is madness and advice to see a clinical psychologist (ironically, this person was a psychologist themselves). Like OP, the doctor is actually actively intervening to prevent a second opinion from a neurologist (which is slightly redundant as the conclusion will most likely be the same...although sometimes you get lucky).
In what is probably not a massive coincidence, my relative probably saw the same people as OP (I live in the Edinburgh area). This unit got handed a massive stack of cash recently...BMWs all round for the boys.
Recently, as my relative's condition has deteriorated, I think about this a lot (they are basically a parent to me).
Doctors in the UK are, by and large, arrogant. If you want to know if someone is a doctor in the UK, talk to them...they will tell you within the first ten seconds...multiple times. Most outside primary care seem to actively dislike patients. I know multiple people who became doctors...none did anything for anyone but themselves (amazing given that almost everyone at my school was strongly encouraged to do charity work). I went to a university with a huge, well-regarded medical school...nothing that I experienced at university altered this view. There is something fundamentally, one could even say psychologically, wrong with the kind of person who becomes a doctor in the UK.
But there is also something utterly wrong with the incentives: the NHS has no capacity for care outside a narrow boundary. They have "policy" in areas where this makes no sense. In this area, there is a clear medical consensus that these issues aren't psychological...outside the UK. Inside, there is "policy"...if you have any of these problems (fibro/CFS/ME) you are mad. Say what you will about the US healthcare system but in these cases, i.e. infrequent, then you actually get a decent result, doctors are paying attention to research, and they are actually willing to consider the possibility that you aren't "putting it on".
The only exception is MS...unf, as it is often clear where the boundary lies between MS and some of the other things in this group, this is a largely redundant distinction to everyone but the doctors.
It looks like you’ve had some bad experiences with doctors. I myself am a doctor in the UK, and my experience differs from yours. I would say like all humans, some of my colleagues are arrogant, and some are not. I would agree we tend to mention it early in conversation, but more because for many their whole life revolves around it (it makes discussing your life difficult if you ignore it!).
The term used commonly is functional. Some people (like yourself and the article author, as well as some doctors) take this to mean they are ‘mad’. This is not the meaning of functional. It implies a lack of recognised organic pathology, with a likely cause within the brain. This is a very heterogenous category due to the lack of known biological pathology, and includes those with rare and undiscovered diseases, those with true psycho local issues causing somatisation , and those simply lying. Due to the difficulty in treating these diseases, often people attempt one of the treatments that can work for some of these people (somatisation): psychotherapy. Of course this doesn’t work for everyone, but given the low risk it poses it is worth trying.
As for American healthcare, there is an incentive to overinvestigate and overdiagnose. Not all pathologies found are relevant or explain the clinical findings.
> I would agree we tend to mention it early in conversation
Username checks out.
Contrary to the above I've always found UK doctors perfectly reasonable to deal with, but we're definitely having some big problems in this country arising from them being absurdly overpaid. Some AI competition can't come soon enough.
The degree of reasonableness heavily depends on context.
In my personal experience as a patient, I have found doctors to be largely reasonable too. I am a young male, I am in good health...what could possibly be the issue? I wouldn't report total satisfaction but within the bounds of reasonableness...and why would I even care? If someone is rude to me on the bus, I think "wow, that person is hurting"...and move on with my life.
When you are an elderly, vulnerable woman suffering from chronic pain, and your lifespan is affected by these decisions...the situation takes on significance.
It is the kind of casually ignorant view of other people's lives that Brits seem to specialise in. Oh, you are poor? Well, my dad once forgot to transfer money into my bank account for a few days when I was at uni...it can't be that bad. Oh, you are black? Well, I haven't experienced any racism...it can't be that bad.
Skin in the game. If you want to find out about something, you don't learn from the sidelines.
Yes mate, it is my experience that is the problem. I would look at the research on organisational behaviour within hospitals, this is a problem with doctors everywhere and has measurable impact on people's health.
And I am fairly happy with the idea that this is particularly true in the UK because my sample is not small. Your response to this is odd in itself. Why do you think I would be convinced by what you say? Why tell me you are a doctor (I can tell you: without the appeal to authority, there is no argument)? Literally, in the post you have replied to I have said...doctors in the UK tell you straight away...it took you ten words. How little self-awareness do you have? It is comical that you actually wrote that and, presumably, had some thought that it was a good idea to say any of that (again, the only reason to think that is because you think your arguments don't require justification).
And great...you have wasted your life writing a paragraph explaining to yourself why you are a doctor but are choosing not to help someone who is sick. The significance of this to me, let alone some who is sick, is zero...again, lack of self-awareness...why write this at all? I am sure it is a nice thing that helps your self-image...you failed to prove its consequence in the real world (i.e. you skilfully explained what is but left out why it should be).
To highlight two points again. The issue with OP and my relative is that doctors are often actively attempting to prevent further care. No-one denies that psychological therapy is helpful for chronic pain. The issue is that, for most people, it isn't going to solve anything...but it is presented as the cure even when alternatives exist. Even suggesting that people could be lying or that it is psychosomatic is wrong-headed. If that is the case, then that is another condition (lying isn't a medical condition, you don't adjust medicine conditional on the probability that someone is lying). Again, there is an obsession with people lying that is truly unhealthy here and quite contrary to practice outside the UK (indeed, my experience within the UK has been, as you have just done, that almost every doctor will start talking about the possibility of lying completely unprompted when these particularly conditions are mentioned...random?).
The other issue is that this has profoundly stunted research in the UK. It is not particularly hard to find ample research on these issues. You are saying that psychological therapy is a treatment...well, read the research. Is there a known biological pathology? No. But there are possibilities (and none of those possibilities suggest the current treatment will have a significant effect...CBT, in the case of people with psychological conditions, is only effective 20-30% of the time). And is it appropriate for the "policy" to be in cases when there is no known pathology that psychological therapy (or, presumably, a lie detector test) be the only course of action? No. That isn't logical (and, again, it is why there are people who are helping people who you have actively chosen to abandon). Somewhat amazing that you go onto criticise the US system for "overdiagnosis"...so no diagnosis is better than overdiagnosis? Again...you are a doctor, right? You are just saying: I would prefer to do no work at all than hard work. Feeble, and unbelievably arrogant (it is feeble to justify doing no work, it takes arrogance to criticise others for doing work).
Truly, I hope this will help you. Stop. Think it through. Think whether what you wrote helps yourself more than other people.
Btw, it is often very clear in these cases (and in life, generally) when someone is or is not lying because lying usually requires motivation (I have never come across someone who was obsessed with other people "lying" for anything other than self-interested reasons). Most people who have these conditions have their lives destroyed...to suggest that someone is motivated to destroy their own life is just stupid. To suggest that this must be the case to cover up your own personal failings (competence, lack of sympathy, ending up in a job that requires sympathy when you only possess avarice, etc.) is something far worse.
EDIT: just to add actual info, because we are actually talking around some of the issues here...the UK uses the Oxford criteria for ME/CFS, this is a measure that was designed by psychiatrists, and has been shown to be a statistically significant treatment in samples selected using that criteria...one issue...all these studies have massive selection bias (some of these therapies wouldn't actually be possible for people with CFS/ME to undertake, imo) and the Oxford criteria wildly overstates incidence of ME/CFS (compared to Fukuda). The Lancet, a UK medical journal, continues to publish guidance that this is a psychological condition (again, not what is said above, that there are no biological pathologies...the Lancet is saying this can be cured by psychological therapy) despite the NIH (and others) showing that this is likely not the case (and suggesting that it is actually damaging research funding to suggest it is a mental condition).
> Why tell me you are a doctor (I can tell you: without the appeal to authority, there is no argument)? Literally, in the post you have replied to I have said...doctors in the UK tell you straight away...it took you ten words. How little self-awareness do you have?
Uh, the fact that they noted that part and explained why they mention that so quickly shows self-awareness, not lack of it. You can't lampshade something you're doing without being self aware.
Also, what's wrong with mentioning your career? It's an important part of your life? What person in a respected profession doesn't?
> Why tell me you are a doctor (I can tell you: without the appeal to authority, there is no argument)?
Because a discussion about a profession should have the input of people from that profession? Because otherwise you're just attacking people and giving them no right to reply?
> And great...you have wasted your life writing a paragraph
Says the person who's written a much longer screed. How little self-awareness do you have?
As someone with multiple mental disorders who is in a constant struggle to get properly seen by the NHS, I'm glad my experiences haven't turned me into as much of a cunt as you.
If anyone is having difficulty typing for whatever reason, you may want to check out the dictation-toolbox organization on GitHub [1]. About a decade ago I began developing symptoms from excessive typing on a MacBook Pro (that short key travel distance is a killer). The pain is still pretty persistent, but I have ways of managing and part of that was relying on dictation. When I got started with dictation, I saw several people were solving different parts of the same problem in different ways. The dictation-toolbox organization is my attempt to collate all of that work together.
Unfortunately, there's not a great out-of-the-box solution and there are several tools in there that still "compete" in some sense. But, at least they're all centrally located and devs from the various projects bounce ideas off each other. Each of the devs is very responsive and will help you get started. Pull requests are always welcomed, but even just suggestions for overall improvements are well-received.
Whether due to genetics or environment, an injury/condition can be annoying enough. Having it also potentially compromise your source of income is just additional stress. I won't say dictation is a silver bullet, but it really helped me out. Hopefully it can help you out as well.
Please feel free to reach out to me if you have questions, need help getting started, or want to get involved.
I got RSI like 15 years ago. The only thing that's worked for me long term when I'm actually doing coding all day long, is a combination of:
a) a keyboard holder below the desk - something similar to https://kw.pricenacdn.com/files/images/products/original/14/... - I got mine from IKEA a long time ago - unfortunately they discontinued that product - the key thing here is the get the keyboard as close to your legs as possible, i.e. enabling your arms to be purely horizontally oriented while typing - or ideally even sort of downwards-pointing.
I love the MS Natural Keyboards and agree about the durability. I had one of them so long the little nubs on the J and F keys actually wore away and I couldn't place my hands by touch any more. (I scored the two keys with an old soldering iron.)
I've tried the Sculpt keyboard, and just not as good for me. I do use the silver media and other keys along the top quite extensively, plus being a Vim user, the escape key seems to be a bit too dodgy.
As they've been harder to buy, when my last one finally died (which is when I found I don't like the Sculpt that much) I ended up trading fixing someone's printer configuration for their barely used Natural keyboard that had been sitting in a corner for ages as they didn't like it. Going to be very sad when I can't find one any more.
That's awesome that you were able to solve your issues with changes to your equipment. I wish I could do the same. Unfortunately, some of us have tried all types of ergonomic devices, and none of them work, thus the emergence of "alt" input like Talon. That being said, I personally fall back to an ergo keyboard like the one you posted for short bursts as needed, or use a stylus to peck at keys.
Fun fact (or myth?): Your tongue is one of the few muscles in the body that can't get RSI. I played around prototyping a tongue-switch a while back using a flex sensor.
Kudos to this guy’s bravery; he is living my worst nightmare. My biggest fear is losing eyesight or ability to use hands, and articles like this confirm my beliefs that our current technology is no way near mature enough where disability isn’t a concern anymore. And these doctors, what can I say about them. It looks like they are getting worse, or just lazy, with every passing day. If you are a doctor and you don’t want to do anything that requires more effort than prescribing painkillers, do this world a favor and get retired because you are actually damaging the medical industry.
One theory I've heard is that too many people were pushed into becoming doctors for the money, and now the profession is full of people who hate it, are deep in debt, and see no way out.
Close. The bigger issue is that reimbursement has fallen precipitously while documentation requirements have risen greatly. People who loved the job when they had 20 mins with a patient and two minutes of charting and had a comfy life with a hope of a retirement fund, are now seeing patients for 7 minutes, documenting for 10-15, and unable to pay off their debts before retirement (never mind sending their kids to school, or paying their own retirement.)
The job has changed, the pace has changed, and yes, going from “comfortable living” to “oh fuck” has an element to it.
I know very few who went into the field just for money though. It’s never been a good career for that, relative to all the school debt and the lost decade of life to education/training.
I really appreciated this article as it presents the kinds of challenges that all sorts of people can find them with unexpectedly, and shows how perseverance and the help of technology can be a way round them.
More specifically I was interested to see that the version of Dragon for scripting isn't available any longer. However this might be something where Mozilla's recent efforts with speech recognition could help and as a bonus the project is open-source and adaptable.
The WER they've achieved is already good for general recognition and through experimenting with narrowed domains / language models it can be made extremely accurate. For anyone interested, there's a walkthrough I did of steps needed to set up a narrow domain LM on their forum below with a video showing it working. I'm guessing that a programming scenario would be somewhere in between: it would be a fairly defined range of words but that list would be quite a bit broader than the example I show.
Oh, and as a follow-up, if you want to indirectly help make the recognition better, especially for non-English speakers or minority accents, contributing voice samples here is a great way help (no coding/technical skills, so share it with family and friends if you like!)
Thanks, this is helpful. I'm building a similar system to Talon but based on Deepspeech (I don't have an OSX device, and I'd like to use it on Linux without having to run dragon in a VM which in my experience is an absolute pain).
Wow, Talon looks very interesting. For those who have gotten up to speed with it (or something similar like VoiceCode), how long did it take you to get reasonably productive?
Also, is anyone out there working on a voice control VSCode plugin with deep TypeScript integration? I'd imagine the TS language server and programmability of VSCode could allow you to do some amazing things with voice.
Talon is great. It practically saved my career as a coder. There is a learning curve, but it's aided by the #help channel in Slack (https://talonvoice.slack.com/messages/C7ENXA7C4), which is a good starting point after installing the (currently Mac-only) package at https://talonvoice.com/. It took me a while (several months) before I could be reasonably productive, but that's because I was trying to avoid usage of my hands altogether, the available community commands were still fledgling, and I was transitioning from another voice control system.
It'll be easier if you can still mostly use your hands since you can incrementally move over to voice coding/control, and the built-in functionality and community commands have truly progressed. There's also the eye tracking functionality if it's difficult for you to use a mouse/trackball etc.
There is a community-maintained Talon VSCode plugin, but no explicit TypeScript integration. That's a great idea, though! I think some folks use VSCode snippets to help their workflow. I personally want to get to the point where I can utter commands that can write the correct code in whatever language/context I happen to be in, and maybe something even higher level than that. The Talon author and community members are already thinking along those lines, as evidenced by upcoming APIs that make Talon easier to use and even more configurable/extensible than it already is.
Voice programming takes a fair amount of effort to get started with, however once you have your microphone dialed and are getting good recognition you can take 'baby steps' and start augmenting your workflow to include voice.
i.e. with Talon the alphabet is custom, so once you learn that you can do a lot with just `cmd+tab` `cmd+A`, `cmd+ C`, etc... and it is customizable using python scripting so you can simplify many common tasks.
I believe there is a VSCode plugin for Talon, I personally use Atom.
Certain things are tedious with voice coding, like typing common abbreviated words like `args`; with Talon you have a few options, spell it out: `arch red gust sun` or use the `shrink` command `shrink arguments` or if you use it a lot you can come up with your own customized word for it; also words that sound the same but are spelled differently: `two`, `to`, `too` or even `2`
When I was in college (almost 20 years ago), I was studying music (piano and electronic music/synthesis) which involved many hours at both a piano keyboard and computer keyboard. In my junior year I had intense pain in my wrists and had to ask my CS profs and music profs for extra time to complete assignments. They obliged, and it took about a year of visiting several PTs, doctors and finally a body worker trained in PT to resolve it. She knew that my pain was "referred" pain from nerve issues in my arms and torso (caused of course by bad ergonomics). The wrists were not damaged, only "feeling" the pain from nerves further up the arms that had become constricted. Through simple stretches and good desk ergonomics I have been pain free since.
I highly recommend the book "Comfort at Your Computer: Body Awareness Training for Pain-Free Computer Use" by Paul Linden. Also "The Trigger Point Therapy Workbook" for info on referred pain and self massage techniques to help alleviate it.
I thank "The Trigger Point Therapy Workbook" and the PT that recommended it to me for finally breaking the cycle and beginning my recovery after 6 years of severe RSI. Learning about trigger points have also helped me self-treat my chronic neck pain and various other aches and pains. I can't recommend it enough.
It's interesting if and how the reverse task is possible: if we can type with our voice, can we hear back the feedback?
Hearing back the gobbledygook we pronounce might be a start to a mental disorder. Should the feedback be isomorphic to the input? There could be different levels of abstraction, starting from audio tty and ending with a high level commands. The usable solution would be non-trivial, what should I hear after running make -j? There could have been a commands like "give me the first five warnings", "navigate to the first warning".
Blindfolded navigation in the code tree would also be interesting. I could say commands like "list modules with route handlers", "go to function X", "get the type signature", "summarize function".
If the sane audible feedback would be feasible, it'd open a door into coding for people with visual impairments, or coding while wandering around, or pushing commits with a headset from the beach.
> My GP read the note and informed me: He would not prescribe me painkillers. He would not send me for a second opinion from a neurologist, or treatment from any other specialist
In a real Healthcare system, a second opinion doesn't require the consent of your doctor. It is despite them, not at their descretion.
Something I’ve always wondered about the programming / software development profession: do people buy insurance for their hands?
My sister is a denturists and she has insurance for her hands. Curious if this is something people in our profession have considered to protect from incidents like this.
I do. One easily searchable phrase for it is "own-occupation disability insurance". It covers anything that prevents me from working in my profession, although there are payout time restrictions on hard-to-verify mental health ones to prevent malingering.
Automatically qualifying events include loss of sight, hearing, voice, use of any two hands and/or feet. After qualifying, I get paid $5k/mo until age 65.
I've learned touch typing before I've even learned coding, and I think it saved me from most of RSI that I could get. (Most RSI would be coming from punching the keyboard too hard when under stress / on a lot of coffee.)
My only serious RSI experience was on Laptops, with the task switching combo - Alt+Tab (or Cmd+Tab/Cmd+`) - which was really killing my left palm with severe pain.
Since that time I'm remapping left-Alt/Cmd+Tab to left-Alt/Cmd+Spacebar (Karabiner on Mac, Sharpkeys+Autohotkey on Windows), and I'm constantly amazed how good and productive that combo is. And that it should have been used for computers instead of Alt+Tab from factory.
I'll share the configs gladly ofc if anyone's interested.
2. run the program, and install "Anti-RSI App Switch" config from the internet repo (or anything else you prefer):
Menu bar icon -> Preferences -> Complex Modifications -> Add rule -> Import more rules from internet -> search for "rsi" -> Anti-RSI App Switch -> Import (you may have to go through the "Add rule" a few times to enable all parts of the rule, but the internet import happens only once)
Tavis Rudd's Using Python to Code by Voice [0] is also interesting.
Looking up that URL, I came across the more recent Coding by Voice with Dragonfly [1]. Haven't seen that one yet, but just quickly skimmed through. Unfortunately the live demos are silent (you can't hear speaker Boudewijn Aasman talk to the computer), but it seems worth checking out if you're interested in setting up some recent voice recognition software with your own custom voice command syntax.
About six years I was on the losing end of a head-on motorcycle vs. SUV collision, breaking both of my wrists (as well as a broken right femur and several other injuries that were minor in comparison).
I had "casts" that wrapped around my arms from mid-bicep to the tips of my fingers. Additionally, I couldn't walk due to the broken leg. There were a few months where 99% of my time was spent lying down in bed.
The solution to my "can't type" problem was a pair of standard #2 pencils. I had them pushed up into the ends of the casts so that the eraser end was sticking out and basically just "hunted and pecked" with my "two fingers" until all of the surgeries and subsequent healing were complete.
After a while I got pretty good at it too. I wasn't doing "touch typing" at ~120 wpm obviously but it was probably close to the days when I sent and received Morse code at ~18 wpm.
Luckily, this only lasted for a few months and then I was all healed up and back to normal. My doctors said I should expect arthritis at a relatively early age, though, and that carpal tunnel was certainly a good possibility too, so at some point I may need to come up with a better solution than a couple pencils -- something more like what the author here managed. Hopefully I've got a few more years left and the technology and available tools will continue to progress in that time.
Yikes. As a motorcycle rider and software engineer, this type of story does scare me a bit, but I’m glad to hear that you’re all healed up! I hope that you didn’t give up on riding, but I understand if you did. Much love and respect!
A few tips from my RSI journey. I had developed a severe case ~8ish years ago. It took 1.5 years before I could code full-time again. Was a very painful period. It's still difficult for me to code beyond 40 hours a week, which makes side projects difficult.
The most effective techniques for my (partial) recovery, and for keeping the severe pain at bay for the last 6 years:
- I never ever use standard computer mice, and try to avoid the trackpad as much as possible. For me, they were worse than the keyboard. Instead, I've been using a Wacom tablet (with pen) for years. I've gotten several colleagues who were experiencing pain to use pen tablets as well, with uniformly good results.
- Further reducing the need to leave the keyboard by switching to vim and also using spectacle for window management. I found vim-adventures.com very effective for learning vim - not affiliated with the project in anyway, just a very happy user.
- Always coding with my elbow a touch over 90 degrees. I find that placing the keyboard on my lap is the most comfortable (although that maybe dependant on body proportions). In my opinion most desks are way to high for comfortable ergonomics, my lap happens to be everywhere I am, so that's convenient.
- Plenty of exercise developing back muscles (which I had completely neglected prior)
One of the input devices I was working with was a sip-puff switch: a breath operated device controlled by tongue movements to create small air pressure or rarefaction.
I was working, among other things, on a sip-and-puff operated text viewer/editor, and a kind of boot screen that would allow people with different disabilities and input device requirements to share the same PC.
We had a driver (then for MS-DOS) which allowed an encoding derived from Morse code to produce any key code that a PC-101 keyboard could produce, right down to the three finger salute.
I wanted to know what this is really like, so I decided to spend time with my hands off the keyboard, learning how to use it. After a while I was able to write code.
The Morse code entry method encodes input symbols in terms of sip (negative pressure corresponding to Morse dash) and puff (positive pressure, Morse dot), which are sampled in relation to a fixed time base.
As you get faster at producing the symbol patterns, you can crank up the clock speed to shorten their duration. Some of the fastest users were able to type 40 wpm, which is faster than "hunt and peck" typists.
This is totally my fear of what might happen to me. Not specifically the ailment that the author has, but I am worried what will happen to me if/when I no longer can type, in my case possibly due to rheumatism.
My mother has severely swollen finger joints due to rheumatism, my grandmother on my father's side (Farmor in Norwegian, so much easier to explain) also suffered with it, and my older sister is now complaining of painful fingers. My paranoid hypochondriac traits are certain I am genetically guaranteed to suffer from rheumatic fingers.
I depend on typing fast not just for my job but also my hobby and how I perform a lot of tasks in real life. (As I expect it is for many on HN).
Not being able to type much in the future seemed terrible. However, this article and comments have made me realise I might be able to work around it. But still daunting. (If it ever becomes an actual problem).
I already suffer from some RSI tinges due to my mouse which has led me to now own a plethora of different Kensington and Elecom trackerballs and a penguin mouse. And I own two MS Sculpt ergonomic keyboards and plan to buy a Keyboard.io split keyboard soon, to prevent typing RSI.
Guess I can further buy myself out of tomorrow's typing problems with some eye-trackers, microphones, foot paddles, VR goggles etc.
I have a very similar issue. I tried to use Vocola and it worked for a while but then i kept straining my voice. I recently had to quit school because I've strained my voice and hands too many times to count. But its not just my hands anymore. Anything that involves any amount of real effort for more than a few minutes usually ends up injuring a muscle group.
Has anyone successfully come back from something like this? Life is getting pretty bleak.
I was in a similar boat a few years ago. I had to leave my job a because of an RSI—it was devastating to lose both my career and my passion to this injury. My solution was to switch to coding by voice, and I've been doing that full-time for the past year. I did notice some voice strain at the start, but it went away after I started speaking more naturally (i.e., pretending I'm talking to a person and not a computer).
I'm working on a new voice coding app—developing it entirely by voice—that I hope can help people in this situation: https://serenade.ai. I'd be happy to chat more with you; my email is matt@serenade.ai.
I try walking 5 minutes a couple times a day which is ok. I tried doing DDP yoga, the routine you do in your bed, and i got hurt the first time. it took months for my abdomen to stop hurting.
Could it be that the nature of your day to day programming workload has an impact on your susceptibility to RSI?
My current project is full stack dev almost exclusively in Typescript, and I find myself actually hands-on-keyboard typing for much less than half of an average workday. The rest of the time, I'm reading (documentation, library code, blogs / presentations / etc) or debugging. Granted, I drive the debugger with keyboard shortcuts but surely keeping one hand on F8-12 and pressing a key every once in a while is less of a risk than prolonged full-keyboard touch typing.
My last gig saw me spending a lot of time writing server-side Java and maintaining the systems it ran on via SSH. More active typing, less reading, mousing, etc. It's just one data point, but I definitely had to take more steps to avoid wrist pain then than I do now.
I wonder if risk could scale inversely with the level of language you use. I imagine it most pronounced among kernel hackers who spend their whole day writing hundreds of lines of C, debugging in an editor subshell, hands never leaving the keyboard -- Real Coders Don't Use The Mouse, after all. Is this crazy?
Well this problem sounds familiar! I solved it in a different way as voice coding was much more difficult 15 years ago.
I have Ehlers-Danlos Syndrome (Hypermobility Type), and associated nervous system pain. I lost my ability to type in 2002, and began my PhD in 2004 (in applied maths - lots of programming).
I did the whole thing typing with mice, trackballs, and modified versions thereof, mainly using predictive on-screen typing software I wrote. When touch screens became widely available I adapted the software to them and did my typing that way.
Since ~2016 I've finally been able to type useful amounts on two very specific keyboards with low travel and high springyness (Surface Pro keyboard cover and Bluetooth Surface Keyboard; Surface Book keyboard is okay but not as good; HP has some keyboards that might be good but don't sell them individually).
I use dictation software for prose, but haven't tried it for programming, Latex, etc. Talon seems worth investigating though, as there are periods I need to minimise my typing.
My story is not a million miles away from this. I was fobbed off - despite being hospitalised for a year in my teens - as being 'psychosomatic'.
Quite why, in this day and age, doctors can't just fess up straight and say 'I don't know' is baffling.
Wind forwards to my mid twenties, and guess what, I am genetically diagnosed as having a recognised, hereditary muscular problem. Suddenly, everything slots in to place, and it turns out I'm not actually a lazy bugger at all...
To the OP: I cannot recommend pain management programmes enough -- the NHS run them, and I learnt a huge amount about managing both chronic pain and the associated medication. They also do sleep management programmes. The Occupational Therapists are also really helpful, they run so-called 'rehabilitation programmes', which are basically all about working out how you can maximise your capabilities within your limits.
Best of luck.
Right at the beginning of my career, Symantec was approaching a bunch of little companies for some community outreach project they were doing that I can hardly remember.
Because they sent us a rep with severe RSI and I was so fascinated by her setup we barely talked about the project (and then my boss changed directions like he did 5 times a week).
This was just months before I briefly developed RSI myself and switched to Dvorak. The next time it resurfaced I learned about pinched nerves in the neck and started taking better care of my spine. Now I only get problems when I'm working at a properly shitty desk or in a crap chair.
Anyway.
She was using an early Wacom tablet instead of a mouse, and a pretty complicated macro system. Next job I met a guy who tried a BAT chording keyboard, never liked it, but set it up next to his regular keyboard and with a ton of programming macros for idiomatic code (define function, for loop, if/else if, etc).
Probably around that time I encountered an article about how French CS people were tut tutting about how ubiquitous computers were bad for us because we used to have to think before coding, so you thought about the problem instead of just throwing stuff at the wall to see what sticks.
From all of this and a bunch of other experiences I've sort of developed a thesis it really is worth it to spend at least 10% longer on a task thinking about ways to avoid grunt work and sources of human error. When new programmers ask me how to get better I point out that nobody is going to notice if it took them 4 hours or 4 and a half to do a task. After you think you're done ask yourself what you could do better with another 20 minutes and do it. (eventually you start doing this class of work preemptively, and you add other new things in).
And for those with RSI, this is existential. On any project there are a group of tasks for which it's more important they are done right the first time than that they are done quickly. Throw yourself onto those tasks.
Don't try to be a spaghetti hurler if you are struggling with RSI. Make yourself available to help and mentor junior people (it's amazing what you can learn about a system and about your own programming skills by observing all the bits people struggle with the most).
Michaelangelo is said to have spent a great deal of time in contemplation before starting work. We don't always get to do art but sometimes it's called for.
I'm pretty sure typing for even just 4 hours a day is not going to end well for anybody.
I should try to measure the time I spent typing, but in fact I'm not sure I could even find a way to just have enough things to type for 4 hours, every (or just most) days.
On the rare occasions I've typed e.g. ~ 1000 LOC per day during a few days, I sometimes ended up with temporary RSI. But, at least for me, this is not a sustainable rate for other reasons, anyway.
If some people manage to type huge loads of code (or doc or whatever) in a sustainable way, I'm curious to know how they do it? For example do they only ever work on new code and with low rate of interaction with other people? How much is their typing vs. code review ratio (on my side I think is roughly 50/50 and if I could change things I would probably do even more / longer reviews)?
I envy and truly admire people who suffer such adversity and who live good lives. I don't know if its because they usually never knew any different so can't compare, or if they just have an innate mental strength I do not. After losing my health and life I've had an extremely hard time accepting such a huge reduction in QOL that just seems to get worse and really wish I had their ability/outlook.
I had a similar experience with RSI, starting in 2012 right before my CS PhD. I somehow got through the PhD. Afterwards I’ve redirected my career towards education, so currently not coding as much.
My advice: slow wrist curls with heavy weights (5 seconds up/down, 5kg) keeps it away for me, it seems that this knowledge only just arrived at physical therapists a few years ago, but is still not common knowledge for ordinary physicians. Don’t do rubber and exercises or other exercises with low weight.
Whenever I stop my training (e.g. on vacations), the pain quickly returns.
Also, I always use ergonomic keyboards - my preference is those from Microsoft. I always have a Microsoft Sculpt in my backpack when out of office.
I had severe rsi on my forearms from too much coding with bad posture and no exercise. It got me for more than 3 years. It was a muscular issue the nerves were fine. I lost endurance in the forearm / wrist muscles and it didn't seem to come back no matter what I tried. Doctors therapy exercise etc. It was a nightmare. I went on a leave. I barely kept my job. At times I couldn't use the computer for more than 10 minutes before my Muscles were exhausted. Gradually but very slowly things improved. Today I can manage it pretty well. My recovery started with reading this book and I recommend it to anyone going through chronic pain:
The Mindbody Prescription: Healing the Body, Healing the Pain
There is a device that worked wonders for massaging my forearm muscles: The "Arm-Aid": https://armaid.com/
It was not a panacea by any means, but even though I'm fully recovered from my RSI today, I still pull out the arm-aid when I've typed a lot or done something else that has caused my arm muscles to tighten up. (It's apparently a big hit with climbers, too.)
You can also use it to massage your calf and shin muscles. Incredibly painful if you're anything like me, but very helpful. Use it in combination with the "Trigger Point Therapy Workbook" mentioned elsewhere.
I've often wondered about possible getting into that situation sometime in the future. It's a bit scary how your livelihood and even your entire sense of identity relies on good typing skills and reasonable eyesight.
Also, I can sympathize with the author regarding the horrid way some medical practitioners (or perhaps even "the system" in general) have treated him/her. It's incredible when you first realize many doctors will simply not be bothered to get uncommon conditions properly diagnosed! This also has some financial motivation, in that non-trivial diagnostics require a bunch of costly diagnostic procedures (think MRI for example).
I think that's pretty awesome!! I've been working on cp since preschool. I never took a computer class, but I tested out of computer class in 7th grade. So, I never learned to keyboard. I can peck fast, but I have been trying to get the money for Dragon, haven't yet. But I have been learning to code to not give away my app and software ideas away. I networked my high schools computers in San Diego when I was 12. So, I know quite a bit but this is Definitely the highlight of my the month. I will be checking you out. Maybe we can work together. I have a tremendous idea, just needs thoughtful spirits like this.
Speech recognition developer here - I hear many people complaining about the accuracy of speech recognition hindering multiple use-cases. I work for a lesser known speech recognition company Speechmatics [1] and accuracy is our top priority. We do have a real-time speech recognition API available, adding it as an alternative speech recognition provider for some of the tools mentioned here might improve the experience for end-users. I've got in touch with our team to see if there is any way we can get involved.
Great discussion on non-manual options. However, the most sound solution is to fix the hands. The most common problems relate to tightness, which will manifest as pain, numbness or weakness. The solutions lie in the yoga-taichi-chigong type of pursuits. The common denominator being mindful breathing in conjunction with lengthening maneuvers, expanding on the exhales, maintaining on the inhales. Our hands are healthier when we use them, witness the rapid decline with casting or other immobilization. So the answer to tightness, whether from fatigue or other factors, is deep breathing & lengthening.
Started getting fairly severe RSI about a year ago. It's at a manageable level now, but was really scary there for a while. The things that I credit (this is difficult to measure) as most helpful, in descending importance:
1. See a physical therapist and get a stretching/nerve glide regime from them.
2. Take lots of breaks to do the stretches.
3. Ergonomic keyboard (I'm using a Kinesis Freestyle 2).
4. Use foot pedals for CTRL, shift, and meta. I rigged up a simple 2-pedal Arduino solution for myself. Code here [0]
Dunning-Kruger applies to medicine as fully as it does to any other technical field. When people say things like “all (highly technically trained specialists) are idiots these days, they have no idea how to (do their jobs, which I am untrained to evaluate)”, that statement says a lot more about the intellectual humility of the speaker than it does about the people they’re criticizing.
In the last few years I've reached zen with keyboard comfort. The 2 biggest changes have been:
1. Get the flattest, lowest keyboard you can. I use an external Mac keyboard and keep it flat to the desk.
2. Move the keyboard as far away as possible from you. This extends your arms out further so your wrists aren't compensating by bending for being so close.
I've recently started using a standing desk and found it useful to bring it in a position just below my armpits so it supports my outstretched arms.
It sounds a bit odd, but I have no pain, discomfort or tiredness.
Switching to Dvorak saved my career. It forced me to type extremely slow for awhile, which helped my pain subside. I haven't had a problem since. Qwerty is such a terrible layout.
I believe you, but I don't think qwerty is inherently a problem. Typing extremely slowly for a while helps. I've developed pain in my wrists multiple times over the years, and have always switched workflows as a result. Went from a wireless apple 'magic keyboard' to a model m to a goldtouch (split, elevated pyramid keyboard) with a left handed mouse, and every time I've found relief from the pain (later on with the use of wrist braces for a few weeks to prevent unconscious wrist flexion). The common element has been a forced change in computing activity - the pain would not cease immediately, so a combination of pain, the changed input layout, and in some cases the wrist braces meant less of doing anything at all with the computer. There's the magic potion for RSI for me - less repetitive stress, enforced by a changed computing environment. Changing the size of the input devices, the layout (from right handed to left handed mouse, from a mouse to a trackball, to a touchpad, to a vertical mouse.. whatever) changes the type of stress too. I won't be surprised when I have to repeat the process of changing to anything else at all. I've already returned from the goldtouch to the model m, but I won't be unhappy when I have to switch back.
> My GP read the note and informed me: He would not prescribe me painkillers. He would not send me for a second opinion from a neurologist, or treatment from any other specialist. The only referral he would write would be to a psychologist to help me “resolve the underlying issues behind my pain”.
People like that deserve torture. Perhaps there's a hack to induce fibromyalgia or idiopathic small fiber neuropathy, and if there is, they deserve to acquire it.
If it were me, I'd likely be buying opioids from dark markets.
Question, for anyone with physical typing limitations... How hard would sign language be for you? Is that less/more painful than typing? I'm wondering how practical it'd be to set up a computer that could recognize hand motions and/or sensors.
Also, I wonder how long it'd take me to learn to type with my toes. Apparently people do it!
I was fortunate my first job out of college was a large defense contractor. The last thing they do to get your cube set up is take your measurements and set the desk, keyboard, monitor and seat heights appropriately. I’ve been using those measurements ever since.
I was also fortunate to have taken an entire year of typing in high school. Not only did I get my wpm over 90, but the teacher was a stickler on posture and hand position. That discipline has stuck with me 25 years.
Boy, did I misread that headline. I thought it was about hunt-and-peckers, and who cares? Why I know people quadriplegic/missing hands/nervous system problems, and they write code for a living. Turns out, that’s exactly what it’s about. Interesting read to broaden your thinking on who uses your stuff. An encouraging read as well: your life doesn’t end if you can no longer wiggle your fingers in pre-determined patterns.
I have been lucky to not be impacted by hand or wrist pain. I did experience chronic back pain for years due to a pinched sciatic nerve, it can be debilitating and depressing. Chronic pain is a large precursor to suicide, if you have it, you need to get it fixed.
My interest in this is from a FutureOfProgramming perspective, how can we interact with computers in different, higher order ways. What does the Mother of All Demos [0] look like in 2020?
Travis Rudd, "Coding by Voice" (2013) [1] this uses Dragon in a Windows VM to handle the speech to text. This was the original, "termie slash slap", a kind of Pootie Tang crossed structural editing.
Coding by Voice with Open Source Speech Recognition, from HOPE XI (2016) [2]
Another writeup [3] that outlines Dragon and a project I hadn't heard of called Silvius [4]
It looks like most of these systems rely on Dragon, and Dragon on Windows at that due to not having the extension APIs on Mac/Linux. Are there any efforts to use the Mac's built in STT or the Cloud APIs [5,6]?
Talon actually uses Mac's built in STT if you don't have Dragon.
James from http://handsfreecoding.org/ was working on a fork of Dragonfly[0] to add support for Google's speech recognition, but I'm not sure if he still is. There are several barriers to that working well though: additional latency really hurts, API usage costs and (as far as I know) an inability to specify a command grammar (Dragonfly/Vocola/Talon all let you use EBNF-like notation to define commands, which are preferentially recognized over free-form dictation).
> After selecting a particular phrase using my cursor control commands, I say “clip [foo]“, and every time I want to enter the same phrase after, I say “paste [foo]“. I therefore only have to dictate a particularly obnoxious variable name once.
A simpler solution might be an editor with an auto-completion feature where completion items can be selected using abbreviations or full names with small errors.
I still use DragonDictate for Mac to do all of my dictation, whether that is writing Hacker News comments, writing emails, having meaningful discussions (okay arguing) on Twitter or writing code.
One of the most useful features of DragonDictate for Mac is the Auto-text feature where you can use single words to trigger larger blocks of text, this is great for filling in empty functions et cetera. There are also some really great Sublime Text plug-ins like auto complete all which makes writing code so much easier.
I mainly like to work in Python, but also have a huge library of Bash scripts to iron out lots of the little wrinkles that pop up when you cannot use your hands and you're trying to use a computer efficiently. Honestly there are so many of them that I have been using so long that I am not sure I could enumerate them off the top of my head!
I have played with Talon a little bit but never really got to grips with it, I don't know whether that's because I'm too used to using my method or that Talon was a little overcomplicated. I am however so pleased that there is work being done in this area, I am really happy that developers and industry are starting to understand that Accessibility does not just mean "works with a screen reader" as it has in the past.
One of the main problems and trying to solve at the moment is how to write mathematical notation using the tools I have at hand, which is a Mac, Sublime Text and DragonDictate for Mac.
> One of the main problems and trying to solve at the moment is how to write mathematical notation using the tools I have at hand, which is a Mac, Sublime Text and DragonDictate for Mac.
Sounds like LaTeX should be an option. When I write LaTeX I use vim and the KDE PDF viewer Okular. When I save the file I let a script compile it and Okular automatically updates when the new PDF file is ready.
While I do all that with a keyboard, I guess it shouldn't be that hard to set it up with voice commands (judging from the video in the blog post). I don't know how PDF viewers act on a Mac, but using sublime instead of vim should be no problem. To speed up the creation of formulas you might want to take a look at this post (it uses vim, but maybe there are some good ideas you can make use of):
I've been here with an L&I claim for RSI. Extreme pain.
Doctors are _very_ reluctant to tell you to take a break for work. Even for a while. What if they are wrong? Massive lawsuit. The best advocate and the one with the final say is yourself. You must become an expert on the subject and be prepared to make big changes in life for your happiness and health.
Very interesting read. I've spent some time on that particular what-if now and then. I imagine a lot of people making a living at a keyboard do. Glad to hear that, much as I've imagined, it doesn't mean the end of the line. It will make things a lot harder but it doesn't have to be the end of life as someone doing programming.
I had a similar pain problem that affected my back, neck, arms, wrists and fingers. I ended up having to cut out most carbs from my diet to reduce the inflammation that was causing the pain. No breads, rice, beans, starches, bad sugars, etc. It's been more than 2 years now, and I've have zero pain whatsoever since I started that.
All these people talking about repetitive strain injuries and other joint issues have a deeply valid stance on this issue.
My best advice is that prevention is better than cure (or treatment). Remember, if you are computer-locked, to aim to do wrist stretches as well as look out your window (or any far distance) to exercise your eye muscles.
Interesting post. I’ve been dealing with RSI on and off for the past 5 years. Natural keyboard, standing desk, reducing keyboard use in my free time, lots of breaks, almost no hobby activity, stretching and exercises helped, but the pain keeps coming back after while.
Man, this is so inspiring but also a reality check! I just looked at my hands and realized just how much I love and rely on these babies. I’ve had similar feelings when I’ve met blind software engineers (yes, they exist). This is why you should aim to never take anything for granted.
^ the voice coding (and eye tracking) system referenced by the author. I use it every day. It's actively developed, has some unique capabilities, and the community is great!
I'm sorry to hear about the pain many of you suffer from. Please consider reading a book from Dr. Sarno. He will challenge the mechanistic view of the human body many of you erroneously hold. More importantly, he will cure you if you're willing to be cured.
The interlude is very familiar.. I have several relatives who have gone through "the fibromyalgia experience". I can totally understand that one responds to what is effectively a refusal to acknowledge that you are actually experiencing pain with curses.
>It is easy to respond to anyone who has overcome adversity with one of two reactions: “It can’t be that hard,” or “I could never do that”. Move past both reactions. It is that hard. You can do it.
What a lovely way to look at the world. Thank you for this!
It is interesting to consider how the ability to speak code with the specificity necessary for a computer to know what to do would probably also vastly improve your ability to communicate in pair-programming type situations.
Take posture seriously. Get an ergonomics assessment, invest in ergonomic input devices. And listen to your pain... if you are in pain and not already injured you are doing something wrong.
Long ago my hands started hurting. By the end of each week my hands hurt a great deal. Eventually I figured out a solution for me:
- first and foremost, use sticky keys
Sticky keys is an accessibility technology you
can look up that ultimately means I can avoid
"ulnar deviations" -- twisting the hands
outwards at the wrists. Others may be able to
use sticky keys to avoid other deviations.
- second and foremost :), never ever rest my
forearms or wrists on anything (such as a
desk) while typing
Typing moves your tendons from the elbow all
the way to your fingertips! Resting your
wrists or forearms while typing means pressing
on your tendons and the sheaths they move
through, and this is one cause of RSI.
This means, among other things, not having arm
rests on my chairs.
- type with keyboard on lap
- put monitor at head level
The first three items help me avoid hand/forearm injuries. The last two items (note overlap) mean I can better control my seated posture to avoid neck/shoulder/back injuries. With my keyboard on my lap I don't have to make as much effort to hold my arms up, thus alleviating shoulder strain, which also reduces the need to rest my forearms while typing. Having my monitor(s) high up means I can sit up straight (which reduces back strain) and keep my head balanced over my neck (which reduces neck and back strain).
I should probably add that I avoid Emacs keybindings like the plague, as those involve lots of modifier keys, which are the source of my ulnar deviations. Yes, with sticky keys I can avoid them, but I'm not sufficiently disciplined about not ever pressing modifier keys and modified keys together to make Emacs keybindings acceptable to me. It won't surprise anyone that modal keybindings (VIM!) are my preference.
I should probably also mention that using text-based applications as much as possible helps me avoid using the mouse. The mouse too is a source of deviations.
Ever since I discovered this solution, I have not had the sort of pain that might make me quit the industry.
A talk on RSI inspired me to look for solutions. In particular, that talk taught me about various "deviations", and I immediately recognized ulnar deviations as one of my key problems, which is what led me to find sticky keys.
NB: I'm not suggesting the above will work for anyone other than myself. What I am suggesting is that anyone struggling with RSI symptoms might be able to find a solution for themselves. The speaker in the linked video clearly found a solution that works for her.
Also, I've tried many keyboards. My favorite are curved keyboards with no builtin wrist rests, but these are hard to find. Nowadays I use compact gaming keyboard (Arvo) with cherry mx browns -- compact means I don't have to move my hands a lot, "gaming" means N-key rollover (all the keystrokes will be emitted even if they happen close enough in time to overwhelm the buffer on non-gaming keyboards), which together with "cherry mx" means I get enough haptic feedback that I can know about and correct typos without even having to look at what I'm typing.
I just want to caution against this advice as it's very likely to be dangerous and counterproductive for anyone who actually has real issues with their hands. The solution is to stop typing immediately.
That's a rather long advert, do you perhaps instead have links to something less "BUY MY BOOK! SIGN UP FOR MY NEWSLETTER! SUBSCRIBE!" and a little more scientific research?
Since then, I've been working with a friend on a new voice coding app called Serenade [1] that aims to enable anyone to program by voice. With Serenade, you can speak natural English voice commands like "delete second function" and "add class person". Not only can this be faster than typing, but it also means you don't have to memorize the syntax details of every language or a bunch of editor keyboard shortcuts.
We found that cloud speech APIs and programs like Dragon weren't accurate enough for common programming words, so we built a custom speech engine (based on Kaldi [2]) that's designed specifically for coding. The app is still early, but we think the future of programming is working with these higher-level inputs rather than typing out code entirely by hand.
We're looking for people to give feedback, so if anyone is interested in giving it a try, you can download Serenade at [3] or email me at matt@serenade.ai.
[1] https://serenade.ai
[2] http://kaldi-asr.org
[3] https://serenade.ai/download