I've found that the biggest reason for neck and wrist pain is actually the mouse.
The position that most people use the mouse, off to the right side (if you're right-handed), causes your arm and your hand to twist unnaturally, since it needs to be flat to the table. This puts pressure on the nerves running down your arm, and for me, this is what caused the most amount of pain, to the point where I was worried my career as a programmer was over.
I've discovered that keeping the mouse to the left side of my body (I'm right-handed) and keeping my hand perpendicular to the tabletop as I use the mouse has all but alleviated my back and wrist pain, going on 15 years now.
To be clear, I don't hold the mouse normally. I have both my elbows on the table and keep the mouse almost all the way to my left elbow. I sort of cradle the mouse with my right hand, with my thumb and index finger on on the left button, and most of my hand on the right side of the mouse so that my hand remains perpendicular to the table. This mimics how my hand would be if I were writing with a pen, which is a more natural position.
I've been programming mostly pain-free ever since 1997 this way. I even use a regular mouse, I just hold it differently and use a posture that ergonomic specialist would probably reject, but it has completely worked for me.
+1 to mice being evil. I'm not convinced by ergonomic mice despite having used one for the past 4-5 years. They are less painful to use but I find they just hide the problem. Using any normal mouse these days becomes painful within a couple of hours for me.
Instead I use a Trackpoint basically all the time now. I have ThinkPads at home and a MacBook Pro with one of these http://www.amazon.co.uk/Lenovo-ThinkPad-Travel-Keyboard-Trac... at work. The best features are less waving my arms around and a much more convenient location for note paper to live that doesn't require stretching or sliding things around when I need to write stuff.
Sadly (due to what I assume is a patent issue) there aren't very many hardware options for static pointing stick devices and they are all either ex-IBM hardware or current Lenovo hardware.
I actually hacked a Trackpoint into my Kinesis this past weekend - hopefully it won't take me too long to adjust. I still haven't figured out a great solution to clicking - at the moment I have the right control key mapped to a click using mousekeys (linux), but I don't have a good way to right click.
Most of the imitations have movement in the stick it's self (and even a dead zone in the center sometimes) while the Thinkpads one is totally static and has only a rubber moulding to provide a little play.
Indeed, it's the mouse's fault. I switched to a trackball years ago and it's a vast improvement. Best one I've found so far is the Kensington "expert mouse" which has a wrist rest attached at the front.
Everyone thinks I'm crazy, but I still prefer to use a trackball as well. Particularly the "Microsoft Trackball Explorer", which unfortunately is no longer in production (so I'm treating mine like a prince so it never breaks)
As another data point, I use the mouse in a normal position (off to the right), plus I don't have an ergonomic keyboard, a special chair, or perfect posture. I've spent at least 5-6 hours a day on the computer since the 90s (and played an inordinate amount of video games), and I've yet to experience any wrist or neck pain.
An ergonomic specialist would reject everything I do, and you probably should too, regardless of how it works for me.
Yet another data point. I coded full time at work for 14 years without having any problems at all (an therefore not paying any attention to ergonomics either).
Then in 2005 I started having problems with my arms. It got so bad I thought I had to quit programming all together, but I managed to sort it out, and today I can work without problems.
The most important part of the solution for my was to start using a break program to force me to take regular breaks (preventing the problem in the first place instead of treating the symptoms). I also started to use a split keyboard without a numerical pad, and using a penclic pen-mouse.
Agreed. Have you tried Microsoft's Natural Mouse? The way you describe gripping your mouse is how this one is shaped: you pretty much just rest your hand on it.
I've been using it for about 5 years along with a mouse pad with palm rest and I've never had any wrist issues. Granted, I tend to use the keyboard as much as I can (even on Mac OS).
Incidentally, I also use Microsoft's Natural Keyboard, which is good enough for my typing habits. e.g. I don't hack non-stop for 6+ hours warranting a more expensive keyboard such as the Kinesis, and I tend to stretch and flex my fingers often.
Edit: Hmm, I just noticed the other comments regarding vertical mice. I'd never seen them before!
 I had it stored for a few months when I switched jobs and kept forgetting to taking it out, but it has lasted that long. I had to remove the gel pad a few months ago because it started to turn yellow and started to fall off. Otherwise, it's in perfect shape.
I use a left-handed Evoluent mouse, even though I used a right-handed mouse for years (funny enough, I'm actually left handed but it still took some getting used to). This made a huge difference when I was developing some issues in my right hand years ago. I also have a track ball that I used to rotate in occasionally, although I haven't needed it for a long time.
Back in 2001 I started having serious pain in my right wrist and solved it by switching to a trackball mouse. Laptops with touchpads are ok too as long as I don't pivot my wrist when I use them. Basically I've trained myself to keep my wrist pretty stable as I do things on the computer and that works well.
I suggest building some muscle in your arms. It's amazing how much strength does to combat the physical horror of sitting at a keyboard all day. Wrist curl, reverse wrist curl, overhead press, bench press, deadlift, pull-up. All these helped me immensely.
PS: steve8918 is right about the mouse. Build some strength, and stop flicking your wrist sideways to reach the mouse. A laptop's trackpad is a huge improvement.
If you go the weight route, make sure you don't just train grip strength (wrist flexors) but also balance a bit with wrist extensor exercises or you'll just move the pain around. It can be as simple as wrapping a rubberband around your fingertips and expanding your hand a few times.
I found this balance issue important when I started working on my deadlift and my grip got a bit out of control. Also, if you have wrist problems, you might consider avoiding alternated grip deadlifts and just pulling hook grip.
This is what worked for me too. Natural keyboard, moving mouse position, seating position, etc. all helped a bit, but after a day or two in gym my wrists simply stopped hurting and felt "healthier". When I stopped gym for 2 months and the pain returned, once I resumed my gym routine the pain stopped again within one or two sessions.
Can't agree enough to this! If you can't make it to the gym there's always the ever-dependable push-up. It is a really simple equation - good exercise routine -> better exercise posture -> better general posture -> no annoying pains.
I occasionally get wrist pain. I have found that a lot of changes are not necessarily the ones the ergonomics experts sell. YMMV but these work for me:
1) If I need to, I take a break and soak my hands in hot water.
2) I program in Perl and tend to find that my hands shift positions. In particular my right hand tends to shift at least one place over compared to typing prose. I find standard keyboards, not ergonomic ones, accommodate this best. But the keyboard needs to be at a low, relaxes angle (on one's lap is best) and ideally a wristpad helps.
3) Mice are the root of most wrist pain! Ditch the mouse and get a trackball. This one really is close to universal. I know a number of others who have found this to be true.
4) Pay attention to your body.... If your wrists are bothering you stop and relax them before proceeding. Also pay attention to your arms and make sure they are relaxed. This should be common sense but....
5) If your wrists hurt for more than a little bit, prompt medical attention is a good thing. Chances are if you catch things quickly a wrist brace may even allow you to keep working or at least it did me when I started to develop carpal tunnel briefly. Early attention is very important.
I have tried ergonomic keyboards and found they did more harm than good. I also found that wrist pads did more good than harm at least for me. YMMV which is why I keep coming back to listen to your body.....
Agreed, switching to a trackball is the only thing that solved my wrist pain issues.
Its worth spending money on a decent one, and I'd avoid Logitech units if you have a choice. The main things to look for are ball size and extra buttons - yes, you can get two-button trackballs with no scrolling ability or third button.
I highly recommend the Kensington Slimblade, which has a massive ball and lovely twist-to-scroll mechanism. Ignore the reviews saying the software is terrible on OSX, all the problems have been fixed.
One slight oddity is the hardware "clicker". Twist-to-scroll feedback is achieved by a tiny piezo speaker inside the unit that clicks whenever you scroll. Its worth spending ten minutes with a screwdriver and soldering iron removing it if you want to keep your office mates sane.
I have extremely RSI resistant hands and especially knuckles (due to a genetic quirk). I can type all day on a rectangular non-ergo keyboard with my wrists on the table, and in fact used to do data entry for 60+ hours a week doing just that, with nary an RSI worry. But using a mouse for, say, 12 hours straight or through a regular 40 hour work week would definitely cause me pain, in the shoulder, wrist, etc. Here is the solution:
Period. Especially at work. It's vastly better ergodynamics. It has a little bit of a learning curve but it's not that bad. And for clicking and dragging windows around and whatnot, it's just fine. And it doesn't stop you from using a mouse if you need to use photoshop or play an FPS game or somesuch. I have a mouse and a trackball on my home computer. If for some reason you spend all day in photoshop then you should probably switch to using a stylus input tablet.
Totally agree. I've been using a Logitech Trackman trackball for about 10years now. During the periods when I wasn't using it I'd get wrist.forearm pain and bursitis on the wrist (I have plates there from a car accident). Stretching is still important but the trackball is a major leap forward.
If you have to use a mouse, please don't use an Apple mouse. They are generally far too small and don't provide any support. I'm still amazed that a company which does great hardware aesthetics completely fails to understand ergonomics.
As an active programmer and bass player, I used to suffer cramps and wrist pain after extended hours. After a friend suggested it I bought a metal NSD powerball to train the micro-muscles in my hands. I spend about 20 minutes a day training it and after about 3 months the pain stopped and went away - I still regularly use it in 3 minute on, one minute rest intervals.
The vast majority of desks simply aren't the right height. Your hands should be comfortably pointed down and not over your wrist. Had some issues with wrist pain a couple years ago, never had any problems since.
I definitely second both of these. The nature of my work means I end up using my computer in all sorts of places. Even just one day of trying to type on a desk that's too low, too high or too far away (i.e. there isn't room to get your legs under the desk) and I get problems. My back has to be vertical, and arms have to be horizontal.
Or go to a physiotherapist. Now. Just to get you on the right track before you do yourself further damage.
(I had a bout of pain that lasted about three weeks, with a longer period of discomfort that followed. If I typed at all, it was with two pencils; I paired with a guy I was training and he did all the typing for that period. I was only able to get back into it after a month of physio appointments, directed exercises and remedial massage. I know I'm just a single data point, but I don't see how at least getting a professional opinion just in case would be a bad thing.)
The best-selling books on Amazon on RSI both recommend getting deep tissue massages. I've gotten a bunch, and they seem to help more than anything else I've tried, but I've still been unable to type for more than an hour without getting symptoms for the past eight months.
This has completely ruined my life, so I recommend taking wrist pain seriously. Preventative measures are probably best. Here is a nifty sit/stand keyboard tray that will significantly improve the ergonomics of your desk and also allow you to stand to work whenever you want to:
Go to the doctor, tell them you have cubital tunnel syndrome, go to PT, and it improves rapidly.
That's my story, and it sucked, but it worked. Once you're at PT, if you're lucky they'll use ASTYM on you, which works wonders. Leaves you bruised as hell, but absolutely the only thing that worked for me.
I used to have severe RSI problems. The solution I found was first to use a trackball which reduced 80% of the pain and then start doing some exercises. I use the Logitech Marble. The powerball is an amazing gadget for exercising the wrist and if someone's a bit more adventurous you could try cliff climbing.
I've been fighting this on and off for years. I've come to the conclusion that whenever I become lazy my hands and neck and eventually my back hurts. Lazy, meaning that I don't stretch and take breaks often enough. Also more importantly exercising, it's is the biggest and best solution. I don't mean lifting weights/running, I'm talking about something like Yoga. Call it girly all you want, it does miracle work for lazy folks like us that spend way too much time in a chair.
As far as stretching goes, take a look at this:
and just google "wrist stretches for carpal tunnel" and you'll get plenty of useful results as well as video tutorials on youtube.
Keyboards, Mice... I've used pretty much all of them. I even went out and bought a ~$1k ergonomic chair, changed desks...etc.. I figured that if my career was in danger I would need to invest a significant amount of money to recover it so that I could continue to work. So I've probably spent hundreds in different mice and keyboards. Ergonomic devices and furniture are great, but they are a temporary solution. For long term results, just don't be lazy.
Do three things to help and get rid of wrist pain:
1. Take small breaks throughout the day (or find a Rob).
In my opinion, these help the most.
One note, if you're just starting to try and remedy your pain and you can't work at all, try switching the mouse to your left hand. This helps a ton and it'll only take you a bit to get used to it.
Only solution I found (after trying almost everything else) was installing AntiRSI/WorkRave. They are intensely irritating, forcing you to stop typing every three minutes. But, you get used to it, and, it saved my wrists.
I suffered from a lot of wrist pain (RSI) for a number of years, tried everything including alternative keyboards and trackball mice.
The only physical 'device' that improved things was getting a proper chair with actual armrests (which I assumed would make things worse by constricting arm movement).
When I read an article mentioning a book called 'The Mind Body Problem' (I didn't actually read the book), the penny dropped.
My mental state of agitation, of needing to 'get shit done' was translating into increased tension in my wrists. Just recognizing this has pretty much solved my RSI problems (going strong for over a year). This explains why some people can work on laptops etc. in the most contorted positions without ever having any adverse physical effects - they are not under any mental stress.
I started to get wrist pain when I was about twenty, and did some reading on it. One thing I saw recommended at the time was to make sure never to sleep with the wrist bent in (i.e. a "limp wrist" position), but always straight or bent back (as if signaling someone to stop). Over a period of a few weeks I trained myself to always sleep with my wrist bent back by adjusting it to that position whenever I was aware at night, and have slept that way since. I'm now in my mid-thirties, and have had no further trouble with wrist pain.
I certainly do other things to keep my wrists healthy, such as trying to maintain good posture while typing, sitting in a good seat, etc., so I can't attribute sleeping position with all of my continued good health. But I certainly won't go back to sleeping with my wrist bent in; it's an easy thing to maintain and it seems to help a lot.
To my understanding this kind of pain will come due to stiffness in the muscles in hands,shoulders,neck.This stiffness radiates the pain to wrist.After some months of pain i visited a famous doctor (http://www.deepaksharan.com/ (india)) he asked to take 6-7 session of Myotherapy (http://en.wikipedia.org/wiki/Myotherapy) and also suggested few exercises , good posture which has removed the pain from my wrist and hands.
If you want i can send you scanned copy of those exercise posters.(rama.vadakattu at gmail dot com)
I feel you should also consult a professional and get rid of that pain by myotherapy ,regular exercises and good posture.
It is defintely curable (although they may be few exceptions).
The first, and really critical, piece of advice is go see a professional
I was skeptical about this, a friend eventually all but carried me to an osteopath. It is instant and amazing relief.
BUT the most important thing about seeing a professional is that they will be able to tell you specifically what is causing your problem - wrist pain, in particular, has numerous causes and comes in many forms. An expert will be able to diagnose the cause and recommend ways to avoid it - in my case it was largely posture based, and getting a better chair has basically eradicated my problem.
1) I switched from a mouse to a trackpad. On my PC I have an old Fingerworks trackpad I got off eBay, and on my Mac I have a Magic Trackpad from Apple. The trackpad allows me to completely relax my hand between my use of the pointer--which is most of the time. When I do move the pointer, and click, I can do it with a single semi-relaxed finger. Whereas a mouse, or even a trackball, required me to hold most of my hand in tension to move or click. On the trackpad I exclusively use tap-to-click...mechanical buttons are bad for fingers and wrists because they require a lot more force.
2) I go kayaking regularly. Gripping and manipulating the paddle gives my wrist and fingers a low-impact workout through a wide range of motion. It helps keep the muscles and tendons healthy. Plus being healthy in general helps improve almost any physical ailment.
Edit to add: With the trackpads I have had to train myself to let my right hand completely relax when I'm not pointing the mouse. When I started trying to pay close attention to my right hand, I realized that I was holding it in tension most of the time even when sitting back--sort of anticipating the next mouse usage. I've had to consciously focus on completely relaxing it whenever I'm not mousing or typing.
been using dvorak for > 15 years. switched because of pain from coding 12-14+ days at startups. also used a kinesis advantage for ~10 years. am now on a topre realforce, which i very much prefer over the kinesis, and have been for 6 months without the pain returning. so, half-splitting the problem, i don't think it's the keyboard.
worth mentioning: i can't imagine typing in qwerty now. it just doesn't have that buttery flow that dvorak does. i'm quantitatively 20% faster at typing now as well.
however, i've come to the conclusion that of all the changes i made at the time, buying a good chair and desk made the biggest impact, because in the process of doing so i did enough research to realize i had to correct my body position.
at the time i had an anthro fit console cart and a humanscale freedom chair. these two were the perfect combination.
i am now using an aeron chair (not because of the herman miller guide above) with an anthro 60" adjusta unit for my computer workstation and a 48" standard unit as a return desk. the main reason i switched to an aeron is that the freedom chair wasn't good for my needs, which changed (i have a fairly high metabolism and stay very warm during the day, so the cooling the aeron offered was very welcome).
i was using the freedom chair with a fit standard cart for a while, and the pain returned. immediately purchased a desk with a height adjustable keyboard tray that would allow me to have my keyboard in such a way that my shoulders were relaxed and my elbows were neutral. pain went away immediately.
Edit: sorry for the edits, i've had a little bit of wine.
One datapoint: I used to get sore wrists if I didn't take breaks, changed to a Dvorak variant, haven't had sore wrists since then. Used notebook keyboard for years, now have a MS Natural, both fine. Used similar before Dvorak, had issues. Have Herman Miller Embody, which I adore, but it hasn't magically improved my posture - still some work to do.
At that point I could change the pain in my wrists into a feeling of anxiety in my chest.
I then bought the book (this step isn't nessacary) - "The Mind Body Experience), and now when I get pain I can sort of concentrate on the area it happens and it will dissapear - it also helps to think of things that might be stressing me at the time.
His theory is along the lines that the mind tries to distract you from stress by making you get pain at the site of old injuries, or RSI etc.
I'm sure that it doesn't work exactly like he says it does, however after about 10 years of RSI I can pretty much control it by just concentrating on the area in pain, whic is pretty cool.
Still, this will probably sound pretty odd.. note: I don't ascribe to any other alternative medicines and am pretty sceptical in general.
This cured me of 3 years of horrible RSI pain. I did go to Doctors, physiotherapists, chiropractors and acupuncturists and had anti-inflammatory creams, you name it. Nothing worked for more than a couple days... and this was a last resort. I wish I would have tried it sooner, but I doubt I would have given it a shot if I wasn't desperate.
I read about Sarno on HN a while back and can vouch for its weirdness but also success. Like you, I didn't read the book, just read some of his core theories on the web. All I did was stop thinking about the pain and it actually worked. It's like a placebo of some sort.
One thing that people overlook when trying to improve their work ergonomics is where they are resting their hands and elbows. You can subtly pinch the nerves in both your hands and elbows leading to restricted blood flow and eventually pain or numbness.
I had pain/numbness in my ring and pinky fingers a few years ago that was progressively getting worse. I switched to a Kinesis Advantage keyboard and left-handed mouse but only saw modest improvements. It was only after nearly a year that I realized that I had been resting my elbows on my chair all day, and that was pinching my ulnar nerve and restricting blood flow. After lowering my elbow rests, I saw an dramatic improvement within weeks. Today I have zero issues.
I never saw a professional, but may have saved myself a lot of pain and worry if I had.
I had a bit of wrist pain too earlier. I stopped resting my entire hand on my wrist and it stopped hurting in a few days. I raise my hand up over the keyboard like a magician saying abracadabra or a DJ with a turntable. It's a bit weird at first and your forearm might hurt after a bit but not only has my wrist pain disappeared, my typing speed seems to have improved. The forearm pain is the good sort (like after an intense workout) from the effort of holding your hand up with no support from the table and gradually reduces as you get more used to typing this way.
And I completely agree with the other comments about the mouse causing wrist pain. I have learned more and more keyboard shortcuts to keep myself from using it too much.
Recently I've been seeing a number of good HN posts auto-killed because of a post or series of posts from the author a while back got them shadowbanned. There must be a better way of dealing with people who aren't obvious BUY WATCHES ONLINE spammers.
Get vim/emacs and learn it inside out so you do a minimum of mousing and keystrokes. Also learn to code in your head as much as possible and only sit down at the computer to dictate your design. This is surprisingly effective once you get the hang of it. I spend about 60% less time in front of the computer now and I'm way more productive. Also get something like StayFocusd for your browser and add in all your distraction sites. If you have downtime while compiling or whatever, get away from the computer and rest your eyes/hands.
I started having some pain in my wrists and the top of my hands earlier this year.
I feel that switching my keyboard and mouse to Apple keyboard and mouse helped (especially the mouse), because of their low design, preventing my wrist from bending too much.
I also started practicing indoors climbing and this helped a lot for the flexibility and strength of my hands. I didn't feel any pain since then. You don't mention any physical activity in your blog but I'm convinced any sport involving the hands practiced regularly would help.
Treating trigger points saved me. I had terrible wrist pain and then I read about trigger points. I found some in my upper arms, massaged them out over a few days, and the pain was gone. Look for spots painful under a little pressure, massage it for 20 seconds. Repeat several times for a few days. Done.
i tried many things, herman millers, gym, creams, massage, antiRsi tool. They all helped and i'm still using them, but everytime i fixed one thing 2-3 months later i got pain again. it travelled from backpain to neckpain, wrists, underarms and now to shoulder/arm-pits.
i'm now practicing alexander technique. i've got my 6th lesson and i start to understand how all these things that i've been doing were simply work-arounds. alexander technique shows you how to get a proper and relaxed posture. i now see how tensed up i am in many areas (keyboard, some projects more some less, eating, walking, everything).
i can recommend it. and it's cheaper then being forced to work half-day for a few months.
I used to have constant problems with wrist pain until I switched to a stand up desk. I have no idea how/why the standup desk helps this, but it did for me. Anyone have any insights into why this helps?