Keyboard Countermeasures
There Are Many Devices Aimed at Preventing Repetitive Stress Injury, but What Really Works?
Simply moving his fingers to type was excruciating for Baltimore physician Orn Eliasson. It got so bad that eventually he could not even hold a pen.
Long hours at the computer left Eliasson with a terrible case of repetitive stress injury (RSI). "I got tendinitis of both hands and forearms," said Eliasson, a specialist in internal medicine who also has studied occupational medicine. "It was so severe that I could not even write."
The explosive growth of computers in the office and the home means that more Americans are being sidelined with repetitive strain injuries, although exact numbers are not available. According to a three-year study by the National Institute for Occupational Safety and Health, about 20 percent of people who work primarily on computers suffer from RSI.
They spend millions of dollars each year searching for ergonomic devices that enable them to work without pain. Among the products that are touted to help reduce pain and injury are wrist rests, negative tilting keyboards, sliding mouse trays and an array of ergonomically correct keyboards that keep hands and wrists from contorting during typing. The goal is to make computer keyboards, workstations, office chairs and even the mouse and the trackball -- devices used to point and click on the computer -- more comfortable and hopefully less damaging during repeated use.
The trouble is that there has been little research and virtually no data to suggest that any of the devices soothe damaged tendons and muscles or prevent future injury. "What is the scientific basis for these devices?" asked Russell Windsor, who treats people with RSI at the Hospital for Special Surgery in New York. "There has been little actual scientific study."
To make matters more confusing, experts find that what may help ease one person's pain can worsen another's. "There is no one device that is going to solve the whole problem for everyone," said Emil Pascarelli, professor of clinical medicine at Columbia University's College of Physicians and Surgeons in New York and an expert in RSI. "These devices have to be looked at on an individual basis."
Most sufferers find relief only through a lengthy process of trial and error. Eliasson first replaced his office chair, opting for a top-of-the-line ergonomically correct seat. "That was helpful, but it still got worse when I typed and then got better when I didn't," said Eliasson.
Next, he looked into high-tech speech recognition systems that would allow him to dictate rather than type. "But at the time, they were not all that fast," Eliasson said. "And you can't dictate to the computer and talk to patients at the same time."
He then bought a three-piece keyboard that was designed to take some of the strain off his hands, wrists and arms. But when they still ached, Eliasson turned to a futuristic-looking keyboard device that cradles each hand and allows fingers to type with minimal movement. It provided relief but came with a $2,200 price tag.
The fact that there are so many different devices, each touted as the "answer" for RSI, "means that this is a very complex problem," Pascarelli said. "Any time there are a lot of purported solutions in medicine, it means that nobody really knows the answer."
Seeking early treatment for the first signs of RSI helps minimize damage and is key to a prompt recovery, according to experts. But that can be difficult because symptoms can vary widely and "there is no one symptom that seems to appear in everybody," said Jim Cone of the occupational health branch of the California Department of Health Services.
What computer users should not ignore is pain in the hand, wrist or forearms, numbness (especially at night) and a burning or tingling sensation that may stretch up to the elbows and even the shoulders. All can signal RSI and need to be checked out promptly by a physician, advised doctors who treat these injuries.
But bad posture, work habits and poor physical conditioning can also play a role, which is why many experts often prescribe special exercises to help lessen the effects of long hours at the computer. "People who use computers are essentially upper-body athletes," Pascarelli said. "They are making hundreds of thousands of key strokes."
While these movements may be small, they carry the risks and dangers of any athletic activity. "A shoulder or a thigh can take a great deal more use and abuse than can a tiny tendon in your hand," said Stephanie Brown, a concert pianist who is author of a method for preventing RSI from computer use, which is contained in "The Hand Book: Preventing Computer Injury." (Ergonomie;1993).
Experts say that warm-up and stretching exercises are essential to condition hands, wrists, arms and shoulders as well as the upper back and neck. "People who would not dream of going jogging or working out without warming up and stretching think nothing of sitting down at their computers and starting to type with cold hands and wrists," Brown said.
Among the exercises that can help is making a tepee with your hands by gently pressing fingertips of each hand against each other. "Use the fingers of one hand to gently push away the fingers of the other," Brown said. "You'll feel a good stretch all along the inside of your fingers."
Finger curls are another way to stretch tendons. They are done by resting one hand on a table with the palm up. Keeping the hand relaxed, gently push one finger at a time back toward the palm. "Go only as far as is completely comfortable," Brown said.
Simply rubbing hands together until palms and fingers heat up, followed by massaging the back of each hand thoroughly can warm up muscles and tendons prior to typing. Massage is also good for forearms, which often take the brunt of computer work. "Roll up your sleeves and gently rub up and down the upper side of your forearm, all the way from your elbows to your fingertips and back," Brown said. "Linger on any sore spots."
Frequent rest breaks help reduce strain, and the careful alignment of the workstation can also cut the risk of injury. As in tennis, Brown said, "if you do warm-ups and stretches but are gripping your racket incorrectly, you will still be at increased risk for injury," she said. "A computer user needs to use healthy keyboard habits and to do warm-ups and stretches so that they will not be at increased injury."
The computer monitor should be at or slightly below eye level, and elbows and legs should make a 90-degree angle with the body while the hands are on the keyboard.
"Start with a good chair," Pascarelli said. "It should have as much adjustability as possible and be easy to" adjust. The seat should not be so long that it digs into the back of the legs, and the chair's height should be adjusted so that the feet can touch the floor without dangling, he said.
To help improve posture, make a simple adjustment to the keyboard. Slip a board, about three-quarters to one inch thick, beneath the lowest side of the keyboard. This provides a "negative" tilt, taking some strain off the wrists, and "it encourages you to sit up a little straighter," Pascarelli said.
Many experts also favor touch pads instead of the mouse or the trackball, which often promote unnatural gripping actions that can cause injury. New devices are also available to attach the mouse or trackball to the keyboard to ease strain.
"Persons who have RSI symptoms can be helped by improving the workstation," said Edward Rankin, chief of orthopedic surgery at Providence Hospital in Washington and a spokesman for the American College of Orthopedic Surgeons. "They could change the desk height, change the chair, use a foam wrist rest."
But some experts believe that the use of wrist rests and splints may limit motion too much. "Tendons that move heal better," Pascarelli said. "They have to be able to remain supple."
By limiting how much hands and wrists move, "you can cause muscles to contract and tendons to shrink," he said. "People end up alleviating some of the pain, but they tend to put added stress on some of the other muscle groups. You really want a range of motion."
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