Additionally, the mental component can sometimes not be ignored. Short story -- friend of mine had back pain all through his life, saw doctors, chiropractors, no help. I am randomly listening to the radio, hear Howard Stern comment that a Dr. Sarno completely cured his chronic, debilitating back pain and that it had been all mental. I recommend Sarno's book to my friend, he reads it, boom, back pain gone. Now whenever his back or neck starts acting up, he knows to check his mental health and make sure he is addressing stressors in his life.
I've been a climber now for at least a decade, and programming for just under that long. I only started getting pain in the last 5 months, almost directly coinciding with the startup I'm working for raising a round, moving cities, being acquired, and a personal decision to go from development to technical sales. It's probably been the most chaotic 5 months of my life, and I'm getting wrist pain for the first time ever.
I think this post will probably put me over the edge -- more vacations, and it may actually be time to go talk to a doctor.
I'm a huge advocate of treating the full condition, not just a single aspect of it. I personally see a therapist once a week, and pay out of pocket for the privilege of gaining some clarity about my life and my actions. I've tried various different modalities and settled on contemplative psychotherapy as a great fit for myself (it helps that I'm at the epicenter here in Boulder):
I will say that my experience has not emphasized the "religious" aspect that the article mentions, and instead focuses on the non-linear, ever-changing perception of self and how that relates to my actions and experiences.
I started suffering from pins-and-needles in my fingers a few years ago. As a programmer, I was totally terrified that my typing was ruining my wrists and, despite my best workplace ergonomical efforts, it wasn't getting any better.
After a few months of sporadic symptoms, I noticed that the bad days were really bad in the mornings and got progressively better over the course of a workday. Huh, why would that be? I started paying more attention to how I slept (pillow positions, spine positions, restlessness, temperature, etc.) and noticed that I was curling my wrists pretty badly when I got cold at night or when life was more stressful. I'd literally wake up with both my fists curled into a ball.
So, really, I was spending many nights with my wrists curled for hours at a time. That can't be good! To fix this, I started spending a few minutes each night consciously laying my hands flat with my arms at my sides and getting comfortable with a better sleeping position. It took a few months to make this effort a habit, BTW.
Here I am a few years later and guess what? No more pins-and-needles feelings in my fingers. I haven't read any other literature covering this type of sleep-related injury, but I know it exists and I'm sure there are others who suffer needlessly.
A friend of mine mentioned similar issues that resulted from pressure on the palms of the hands during long periods of typing (he's an editor for a magazine).
Hope that helps somebody out there.
In my opinion, the most important factors to consider are actually your diet and your lifestyle. RSI and similar types of issues can usually be traced to high levels of general inflammation in the body. It's not the usage you're putting on your body that's the culprit - it's how your body is reacting to that usage with an inflammatory response.
Programmers are very high risk group for factors which cause inflammation:
1) Toxic diets. E.g. high sugar, high processed carbs, high industrial seed oils, high intake of meat from unhealthy animals. Low intake of high quality fats and omega 3s. Poor gut health.
2) Lack of sleep / poor sleep quality.
3) Lack of movement.
4) Chronic stress.
Again, I am not claiming this wrong -- merely I've yet to hear any actual RSI suffers, MDs, or ergo specialists bring up this theory.
I can see some indirect link, e.g., high calorie diet and great deal of processed carbs leading to type diabetes-II which leads to general aches and pains, however.
First, by definition RSI is an inflammatory response. So, here's a good overview of what is meant by "inflammation" in the body:
And here are studies related to the causes of inflammation I mentioned:
You have a point, but this is the kind of single-cause, worked for me attitude the article warns about it and does people a disservice.
Stop stressing your poor wrists and hands.
Vary it up.
Stop stressing your poor wrists and hands:
If you take your hands off of your damned keyboard when you're not using it, and use your brain instead for a bit, you will not stress your hands. You can reduce stress to your hands by getting special keyboards, varying your sitting height, adding padding, etc. But just remove your hands from the keyboard, and there is no repetitive stress from keeping your fingers hanging in the air.
Vary it up:
Don't keep a static posture for too long. Doing exercise, etc, will strengthen your core and your arms, or whatever, but actually having something different going on as far as your body kinematics throughout the day is probably better. Drape a leg over that armrest. Squat. Lean back. Lean forward. Type with one hand. Humans are not meant to be statues.
And, the unspoken third rule:
If you are experiencing RSI, you need to ramp it down or take a vacation. RSI gets worse over time. You can treat inflammation with drugs in the short term, and you can point to mental components if you like, but the first two points don't mean very much if you don't give yourself time to heal, which means not hovering over a keyboard for an extended period of time.
More anecdotal evidence here: I believe that many cases of RSI are in fact simply the first manifestations of a burnout. Not all, I bet, but many. If your RSI may be stress related, consider this possibility and discuss it with your doctor.
Just try it. I know it was never designed to solve RSI, but it really does work wonders. I had RSI in my mid-teens (18 hours a day on the PC since I was 8 years old), and I switched to Dvorak because I thought I'd type faster with it, and because I thought it'd be cool to type different from everyone else. Silly me. But glad I did, because I have never suffered from wrist problems ever again, 10 years down the line.
Don't just take it from me. There are thousands of people out there with a similar experience. The layout of a Dvorak keyboard presents much less strain for your tendons and muscles, and is far more relaxed and natural. Your body will thank you. It is worth the hassle, it is worth the inconvenience, and it is worth the the time it'll take to re-learn to touch type.
I managed to solve my wrist problems by getting a piano.
I'd actually recommend people to make the switch if you ever happen to take a two week vacation where you're still on the computer. Your hands will thank you.
It's even worth the continual comments from my coworkers - "What the fuck is wrong with your keyboard?". Actually, that's a lie, the 16-year-old inside me still loves those comments. :)
My first impression when revisiting qwerty is a revulsion at the placement of the "t". What a horrible location for such an oft used key. However, most qwerty users will have a similar response when typing "ls -l" on dvorak. Actually, a lot of unix commands were clearly written with qwerty in mind, their letters centering on qwerty's home row. The unix monikers get easier with repetition for dvorak typists, but dvorak's true power comes in writing English, which in my case is most of my typing. Vim works well with either layout, luckily. Most of the programming languages I use - SQL, golang, python, and c# - seem about the same in either layout.
Once you become fluent with dvorak it "rolls" off your fingers. You'll know what I mean once you're there. "The", "another", "masticate", "friend", and most other words with vowels and common consonants spend most of their typed lives on the home row. Both hands share evenly in typing. The common punctuation and quotes are right where you need them.
If you use RDP for most of your remote work the transition is surprisingly easy. Switching between layouts is simple in Windows and Unix. Hell, even my copy of Amiga 3.1 supports dvorak out of the box.
Some here seem to switch their keycaps to a dvorak arrangement. I did this in the past with my Model M but eventually set it back to querty. I'm not embarrassed to admit that I need to look at the keyboard now to type qwerty, thus having the keycaps set to querty serves as a convenient reminder. When typing dvorak I never look down.
It is by far the most annoying software imagineable, but saved my career, and is worth considering.
(Disclaimer: I have no affiliation with either AntiRSI nor WorkRave, but use both.)
- Vim for coding
- Vimperator in my Firefox
- Muttator in my Thunderbird
- Awesome WM as my window manager
Now I only need to use the mouse for graphics applications like Inkscape. It's been a dream so far.
Switching to using the keyboard instead of mouse helped me a lot (even for browsing: Ctrl-L, switching tabs, etc)
And also this: http://www.powerballs.com/
On the hardware side, I invested on a quality 27" screen that is at a good height w.r.t. head position. I use it with my laptop and my desktop computers. I also got myself a nice, more expensive keyboard, although I'm not quite sure it's the one I want to stick with.
On software, I invested time on finding an ergonomic keyboard-only user experience. I can live without the mouse but I need the keyboard for programming so the choice was obvious. I have almost completely changed the software (desktop, editor, browser, terminal) I use, but I did it gradually, one software at a time.
Regarding practice, I actually spent time practicing typing. I normally use qwerty-fi layout (the least ergonomic of all layouts) but I learned more ergonomic typing with the dvorak layout. I haven't used it before or a lot since, but I spent about a month doing dvorak exercises almost daily and in the end I wrote some boring documents with dvorak.
Finally, exercise. I play the guitar, which makes excellent exercise for the muscles in your fingers, palms, wrists and all the way up to the elbow. The bad thing about guitar playing is that it's asymmetric. I don't always play something musical, sometimes it's just geometric patterns when I'm watching the TV. Piano playing must be good too. Practice instensely until you can feel like your muscles have been exercising, and do stretching and mobility exercises in the end and remember to rest afterwards. (I like fast metal guitar so to build up speed and strength I do my exercise drills until my hand hurts like after gym all the way up to my elbow when doing strength training).
The first 3 weeks were really difficult... but after that, no more pain ever!
Another thing that seems to help a lot is keeping a natural arm pose on the keyboard despite not having a natural keyboard. My only problems these days are with the thumbs, for some reason they don't like the way they're resting on the keyboard.
However, for me the most important component was to start using a break program. I get so into programming that I completely forget to take breaks, so the break program is crucial for me.
I've written about my experience here: http://henrikwarne.com/2012/02/18/how-i-beat-rsi/ and I have also reviewed different Mac break programs here http://henrikwarne.com/2012/02/26/mac-os-x-break-programs-re...
Discussion on HN: http://news.ycombinator.com/item?id=3635692
* Use a REAL ergonomic keyboard, such as the SafeType (http://safetype.com/), which addresses 3 major causes of wrist pain: extension, deviation, and pronation. The slanted keyboards, such as the one mentioned in the article do not really help all that much, as they do not properly address the 3 major causes.
* Work standing up. This contributes to better blood flow, and improved posture, which can alleviate RSI.
* Decrease caffeine consumption.
* Decrease alcohol consumption.
* Get proper sleep
* Eat healthy. Avoid junk food.
* Exercise at least 30 minutes per day.
I've been around the block a few times – enough to practically A/B test the various treatments out there.
I think this post covers things pretty well, although I have not had any luck with the psychosomatic approach, despite trying that too.
For the past 10 years, I've been retreating, so various things have worked at various times. I can't praise the kinesis keyboard enough, but unfortunately I'm too far gone for that. I currently use Dragon NaturallySpeaking for practically all of my typing, a bamboo tablet for mouse input, and a capacitive touch keyboard called a "cleankeys" for typing (it's made for dentist offices), although this is forcing me back to hunt and peck typing.
I've also had some limited success with some herbal and vitamin supplements at various times (and some definite failures).
However, my issues have not really improved a great deal until about nine months ago when I started a real strength training program (starting strength), although I have a few caveats for that program if anybody decides to pick it up.
I also believe that my upper extremity numbness is coming from some sort of thoracic outlet syndrome exacerbated by tight pectoralis minor muscles (I recently injured my pectoralis minor lifting weights and have noticed that my upper extremity numbness has gone away while I have been doing rehab stretching). I also had a nerve conduction test which came out perfect, so there's no impingement in the extremity itself.
Be careful with standing desks, because my shoulder tendinitis developed after switching to a standing desk and typing with my arm unsupported for a few months.
Not be self-promotional, but as a hobby I put together a website where I do reviews of RSI equipment for beer money: www.RSIinformation.com Most of what I would write in this comment is already elaborated quite a bit on the site.
The one thing that I would pass along is that tendon injuries do not heal correctly without stress. This means that tendinitis/tendinosis and a lot of other RSI issues will not heal simply from rest; you must "rehab" the tendon with exercise, but make sure it's the right kind.
I only wish that I knew 10 years ago when I know now, so if anybody is having issues, hit me up via email and I'm glad to help. I probably know more than your doctor does about RSI at this point.
My experience has been virtually identical to Aaron's: after years of struggling with RSI, my symptoms disappeared within a few weeks of starting the treatment in The Mindbody Prescription, and they haven't returned in over two years. To quote Aaron: "Now I can type for as long as I want, on any keyboard, in any position, without stretching or taking breaks, all without any pain."
The Kinesis keyboards are very popular, and with cause. However do note that some have reported problems due to the lack of motion that is necessary when using one. Making good use of breaks to stretch and move is absolutely crucial.
For my part, my mild problems were in large part alleviated by switching to an upright mouse as well as a tenkeyless keyboard, reducing the distance the arm needs to travel to reach the mouse. The keyboard also happens to be superb (Filco mechanical), but it is not built or marketed as an ergonomic product.
I've found that with this setup my wrist pain basically disappears. I haven't run any kind of controlled experiment to see if it's that or just getting up and switching to laptop-on-the-couch-mode every few hours, though.
I had serious issues myself and switched both the general posture and my mouse. Using a 'vertical' mouse from a company called Evoluent in this case. It made a big difference for me.
The Kinesis Advantage (Pro) is next on my list, but too expensive for now, and it isn't easy to get in over here as well.
The Kinesis is ONLY useful for "home-row" typists. If you are a "sprawl" (and likely self-taught) typist like me, not only will the Kinesis be next to impossible for you to use, it likely won't fix whatever issues you're having, as "sprawl" typing does not require bent wrists like "home-row" typing does.
I didn't really consider a trackball, mostly because the table gets the advantage that nobody can use your machine which is helpful sometimes.
Because of my typing style, it is very difficult for me to type on a non-standard keyboard. For example, on any split keyboard, fingers either hand will often strike the center divider in an attempt to strike a key which is in fact on the opposite side of the divider.
However, I credit typing in this manner with a near-total lack of keyboard-related RSI after 20 years of active computer use. (I have had issues with using a mouse, due mostly to grip stress, but switching to a trackball cleared those up.)
I've met at least one other person who types this way (and I haven't asked that many people) so I figure it must be common enough, especially among those who grew up with access to a computer (like I did). I don't know how easy it is to learn if you first learned home row typing.
I rarely type at the manic rate I see in home-row typists but have never had RSI symptoms in 18 years. I did cause myself temporary soreness by constantly using Ctrl-Z, Ctrl-X and Ctrl-C by holding Ctrl and doubling my left thumb under my palm. That was the one conscious adjustment (switching to my little finger for Ctrl) I have ever made, and once I started using Mac keyboards (Command instead of Ctrl), I switched back.
I'm interested in your editor choice. I've always used CUA editors (currently TextMate) and recreational Emacs. Also, I have no interest in the Dvorak layout since I already get by being wildly inefficient. My only doubt is whether I'm missing the flow state in vi that is accessible to home-row typists.
I'm curious -- have you ever tried typing using two full keyboards, one for each hand? Your sprawl style seems like it might work well with such a setup. Before I got my kinesis ergo I was typing using two keyboards and I found it quite comfortable since I was able to place them apart from each other so that my arms stay nice and comfortable.
I'm so paranoid about the company going out of business - they seem sort of small and niche - that I keep TWO spares at any time.
1) Pay attention. Frequent stretches. Frequent breaks. I highly recommend this "Hand stretches for guitarists" vid http://www.youtube.com/watch?v=TSrfB7JIzxY Once you learn the routine, it's fast, easy and feels noticably better.
3) I was 1-finger hunt-n-peck typing the whole time. Hands pretty much hovering and lax for minimal tension. Careful about not touching the desk with my arms.
2) 2 keyboards and 2 mice. One keyboard on my desk and one on my lap. One mouse on my desk on the right. Other mouse under my desk on a platform on my left. Changing postures very frequently.
It was a pain in the ass. But the random, shooting pain in my hands eventually went away. Totally worth the hassle to avoid cutting my wrists.
* I started using a nice keyboard - MS4K - and my hands started to feel far less 'stressed' after working on a keyboard for a long time. I don't plan to switch from this.
* I use a thumb-based trackball at work, but I'm not wholly satisfied, it makes my thumb tight.
* I spent a lot of quality time reworking emacs keyboard bindings for maximum finger-ease and happiness. This way I don't stretch my hands in funny ways when coding. This actually is something that has to be iteratively examined as your hands and typing habits change.
* I've found that laptops are really really crappy for ergonomic typing. Serious work should be done with a keyboard if at all possible.
I also find that doing other things with my hands - guitar for instance - will help relax them.
BTW, I was a dedicated yoga follower during my RSI/back pain period; switching to weights was a huge win.
Does anyone else have outer shoulder/lower shoulder blade pain from using laptop keyboards? I seem to have issues starting and I believe that a narrower keyboard combined with my wide shoulders is leading to it. Does anyone have similar experience, and if so, did you have any solutions?
I've got a twiddler2 that I've been trying to use, but its a bit slow learning it. And it sucks for vim keybindings which I tend to like a lot, but may need to be abandoned if its going to lead to pain.
Getting rid of this shock makes my hands pain free, whereas if I have to move back to a membrane style keyboard, my hands start to ache after a few minutes of typing.
It's an incremental step in a positive direction, at about 1/3rd the cost of a Kenesis, and without the odd key layout the Kenesis imposes.
Interestingly, that article recommends a different book by John Sarno.
That said, despite the utter silliness, somehow I believed his premise that "there's no actual physical problem there, it's just in your head" and _magically_ I stopped having RSI issues. I can type curled up on a chair on my ThinkPad with no pain - before, I needed all sorts of fancy tables with nice ergo keyboards.
So, it's worth starting to read his book (Mindbody Prescription), even though you'll toss it in disgust after an hour, just on the off-chance that you, too, end up tricking yourself into not having pain.
Also, this book is very good and covers a wide variety of bases to help you understand your problem:
It mapped I,J,K,L to the arrow keys, U to the home key, O to the end key, N to backspace, M into the del, and etc... Did wonders for my wrists.
Then I read http://www.amazon.com/Its-Carpal-Tunnel-Syndrome-Professiona..., which led me to trigger point massage therapy.
And that worked. YMMV :)
- using Divvy and Alfred on the Mac (reduce the mouse)
- switching the mouse (left/right hand) when it starts to hurt a bit
- yoga once a week
- making sure I'm properly seated