Copyright © 1996-2013 Paul Marxhausen. THIS DOCUMENT IS
NOT AN OFFICIAL PUBLICATION OF THE UNIVERSITY
OF NEBRASKA-LINCOLN.
"We pray with our hands and often communicate with them. We use them to
eat, work, and make love. We employ them as marvelously sophisticated
instruments of flexibility and strength, and when they are damaged, we
anguish." 
- Keith L. Moore, Clinically Oriented Anatomy
As more and more work, education and recreation involves computers, everyone
needs to be aware of the hazard of Repetitive Strain
Injury to the hands and arms resulting from the use of
computer keyboards and mice.
This can be a serious and very painful condition that is far easier to
prevent than to cure once contracted, and can occur even in young
physically fit individuals. It is not uncommon for people to have to
leave computer-dependent careers as a result, or even to be
disabled and unable to perform tasks such as driving or dressing
themselves.
I've faced this problem myself since March of 1994, and
many friends are also affected to varying degrees. I am
not a health care professional, but I hope on this page to provide
a very brief introduction to RSI for the benefit of
students who may not
be aware of the potential for a life-altering injury. It includes
book references and links
to Internet resources that have been helpful in educating me about
this. Don't hesitate to get in touch by e-mail, but because I have to
limit my own computer use, please
take the time to consult the entire page and the listed materials at length
first.
-Paul Marxhausen
Repetitive Strain Injuries occur from repeated physical movements doing damage to tendons, nerves, muscles, and other soft body tissues. Occupations ranging from meatpackers to musicians have characteristic RSIs that can result from the typical tasks they perform. The rise of computer use and flat, light-touch keyboards that permit high speed typing have resulted in an epidemic of injuries of the hands, arms, and shoulders. Use of pointing devices like mice and trackballs are as much a cause, if not more so. The thousands of repeated keystrokes and long periods of clutching and dragging with mice slowly accumulates damage to the body : another name for the condition is Cumulative Trauma Disorder. This can happen even more quickly as a result of typing technique and body positions that place unnecessary stress on the tendons and nerves in the hand, wrist, arms, and even the shoulders and neck. Lack of adequate rest and breaks and using excessive force almost guarantee trouble.
You may have heard the term Carpal Tunnel Syndrome in connection with these injuries, but in fact CTS is only a small and dangerous percentage of typing injuries. Tendinitis, Bursitis , Tenosynovitis / DeQuervain's Syndrome , Tendinosis , Thoracic Outlet Syndrome, Trigger Finger/Thumb , Myofascial Pain Syndrome, Cubital Tunnel Syndrome, and several other related conditions may also be involved. All of these are serious and in advanced cases can cause great pain and permanent disability. In addition, patients injured by repetitive strain sometimes develop Reflex Sympathetic Dystrophy (RSD), discussed here and here .
Correct typing technique and posture, the right equipment setup, and
good work habits are much more important for prevention than ergonomic
gadgets like split keyboards or palm rests.
Figure 1
shows proper posture at the computer. (
Some current thinking suggests that
a monitor position lower and farther away may be better. In
addition, there are other opinions about what is
the "correct" position.
) Note that the chair
and keyboard are set so that
the thighs and forearms are level (or sloping slightly down away
from the body), and that the wrists
are straight and level - not bent far down or way back.
If the table is too high to permit this, you may do better to put the
keyboard in your lap. Also note that the typist is sitting straight,
not slouching, and does not have to stretch forward to reach the keys
or read the screen. Anything that creates
awkward reaches or angles in the body will create problems. Please note
that even a "perfect" posture may result in problems if it is held
rigidly for long periods of time: relax, MOVE and shift positions frequently.
This isn't just about your hands and arms, either: the use or misuse of your shoulders,
back and neck may be even more important than what's happening down at your
wrists.
More specifics:
While you are actually typing your wrists should not rest on
anything,
and should not be bent up, down, or to the side.
(Figure 2) Your
arms should move
your hands around instead of resting your wrists and stretching to hit
keys with the fingers.
(palm rests give you a place to rest your hands only when pausing from
typing, NOT while you are typing.) When you stop
typing for a while, rest your hands in your lap and/or on their sides instead
of leaving them on the keyboard.
Ctrl-C or Alt-F,
instead of twisting one hand to do it. Move your whole hand
to hit function keys with your strong finger instead of stretching to
reach them. For additional excellent instruction on healthier typing technique
read
MOTION BASED ERGONOMICS KEYBOARD RETRAINING and Mouse Retraining.
We all have occasional aches and pains that go away in a day or two, especially when we overdo anything. But if you have the symptoms listed above regularly when you are using the computer, run, do not walk, to your doctor or health care provider RIGHT AWAY. Dealing with this early is critical to limiting the damage, and to spare you a world of hurt , trouble, and frustration. You are not overreacting: by the time you have symptoms there has already been some damage done, and if you try to ignore the pain you may sustain a serious injury. If your doctor doesn't seem to know much about RSI, find one who does. When you find one, listen to them and check with them about any changes you intend to make or therapy you want to try. (See UN-L RSI Resources about the Health Center.) In order to be an educated patient, take time to read the other resources linked to on this page, or the books below. Remember that "RSI" is a mechanism of injury, not a diagnosis. Where or how seriously you are injured, and how best to treat it, varies immensely from person to person. Also, many systemic disorders such as diabetes can mimic or exacerbate RSI, and these can be ruled out by medical tests, so don't go chasing a treatment you may have heard about UNTIL YOU'VE SEEN A DOCTOR.
Healing can happen but it may take months, even years. That's why it's important that you . . .
Don't give up.
By the way ... these books are pretty much listed in the order I became aware of them, not in order of quality or relevance. Some of the ones I personally consider indispensible are way down the page.
Widely regarded as the primary reference
book on RSI is:
REPETITIVE STRAIN INJURY: A COMPUTER USER'S GUIDE
Dr. Emil Pascarelli & Deborah Quilter
(ISBN 0-471-59533-0)
If you use any kind of computer regularly,
check it out and read it, whether you are already injured or not.
Your career could depend on it. Let me
repeat one more time: it's easier to prevent RSI than to remedy it later.
Deborah Quilter now has a
web site with info on RSI, her publications, and her presentations.
Order RSI: A COMPUTER USER'S GUIDE from Amazon . . .
Dr. Pascarelli's Complete Guide to Repetitive Strain Injury : What You Need to Know About RSI and Carpal Tunnel Syndrome
Dr. Pascarelli has written a new book (2004) on RSI recovery. Here's some of what one reader said about it:
"This 4th of July weekend I took a look at Dr. Emil Pascarelli's new book
which was just published. . . . He spends some of his time discussing issues that affect musicians which is
something that we have discussed on Sorehand. He also has excellent points
on what RSI is not. One thing that alarms me a lot as a victim of CTS is
that colleagues are think that they have this as well. Most people do not.
In fact most people in my support group have TOS and the Dr. has a good
discussion of this.
He does emphasize the whole conservative treatment philosophy and a good
section on biomechanics as well as one also on how to beat RSI.. One issue
that affects a lot of my co-workers that the Dr. also discusses is vision in
addition to ergonomics and dealing with pain. The section on emotions is
not as extensive as the one that was in his earlier book with Deborah
Quilter on Repetitive Strain Injury in general. But I found the book really
helpful and others may wish to read it as well. . "
Order DR. PASCARELLI'S COMPLETE GUIDE from Amazon . . .
IT'S NOT CARPAL TUNNEL SYNDROME!
CARPAL TUNNEL SYNDROME
It promises a lot, and some of the stuff is debateable . . . but it is chock
full of practical information that I've found helpful and effective in
my own situation.
This book appears to have been updated and released as
END YOUR CARPAL TUNNEL PAIN WITHOUT SURGERY, available from
Amazon.
I've read this and it's still a useful resource. Most recent editions, additional information
and articles can be found at the Body Maintenance 101 website.
Recommended by many on the 'Net is . . .
STRETCHING IN THE OFFICE(Previously "Stretching At Your Computer or Desk") This book quickly provides the maximum useful information for computer and desk workers, explaining work hazards, when to stretch, where to stretch, the benefits of stretching, and how to stretch within the first eight pages. Subsequent stretch routines are applications targeted to real-life situations: "Stretches for Keyboard Operators", "Office Meeting Stretches", "Stressed Out Stretches", etc. and are followed by an overview on avoiding repetitive strain injuries; an explanation of good habits for body usage; in-depth instructions on the individual stretches; and concludes with an excellent bibliography and indices. The unambiguous message is that stretching should be part of one's day right where one is, not something requiring leotards, a gym membership, and a chunk of one's vanishing spare time.
Shelter now also publishes a break program based on this book, which runs
on both Macintosh and PC platforms. (Notably, it can successfully provide
breaks during CD games on the Macintosh, to help your kids learn safe computer
use.)
Order STRETCHING IN THE OFFICE from Amazon . . .
Carpal Tunnel Syndrome: How to Relieve & Prevent Wrist
"Burnout!"
COMFORT AT YOUR COMPUTER :Body Awareness Training for Pain-Free Computer Use
The Computer User's Survival Guide
Zap!
REPETITIVE STRAIN INJURIES
I think the real strength of what Dr. Tim has written is his emphasis on
an interdisciplinary treatment approach. In contrast to consulting a single practitioner
who may have limited perspective and treatment preferences,
Dr. Tim advocates for a team effort that *includes* standard medical
professionals but brings in other practices such as chiropractic, acupuncture,
massage, and others. Also, I think the book gives a decent basic rundown on
the physiology of RSI, and includes good rehab information. While I
consider some of the therapies presented here to be very questionable,
at a minimum you will learn what each method claims to achieve
for you from a writer who is not trying to sell one of them over the other
but hopes to draw something from each.
Order REPETITIVE STRAIN INJURIES from Amazon . . .
THE REPETITIVE STRAIN INJURY SOURCEBOOK
CRS - COMPUTER RELATED SYNDROME
Chronic Musculoskeletal Injuries in the Workplace
LIGHT AT THE END OF THE CARPAL TUNNEL
Dr. Fried has evidently written a second book, THE CARPAL TUNNEL HELPBOOK: Self-Healing Alternatives for Carpal Tunnel and Other Repetitive Strain Injuries which I have not read. He also has a website for his medical practice on-line at http://nervepain.com
SITTING ON THE JOB
PAIN-FREE TYPING TECHNIQUE
FULL CATASTROPHE LIVING
MANAGING PAIN BEFORE IT MANAGES YOU
THE EGOSCUE METHOD OF HEALTH THROUGH MOTION
PAIN FREE : A Revolutionary Method for Stopping Chronic Pain
by Pete Egoscue, Roger Gittines
In "The Egoscue Method", Pete Egoscue has a very accessible manual for identifying dysfunctional habits of posture and motion that are the source of much musculoskeletal pain and disability. His book also lays out a series of exercises to correct these problems. Very readable, do-able, recommended by RSI recoverees. Egoscue's clinic also has a Web Site.
PAIN FREE in some ways simply revists the same material in THE EGOSCUE METHOD, and includes many of the same "E-cises" recommended in the earlier book. However, it organizes itself by body section, working from the feet up to the head, and thus it's easier to get to the material that applies to your particular pain. All these areas are functionally related, as Egoscue continually points out, and the same corrective postures and "E-cises" may apply to different pains. Like many authors presenting a personal approach to wellness, Egoscue is very optimistic about his ability to remedy a great many problems; but on the other hand, his methods are very reasonable and rational and he explains physical problems and his proposed remedies in careful detail, so I haven't got any quarrel with him. There's nothing "off-the-wall" here.
One reader of his books has commented: "I find the Egoscue exercises helpful and pain-relieving if done carefully, but the arguments in the book contradictory. (For example, are the injuries occupational, or aren't they? Should you worry about equipment set ups, or not? He's not clear.) A grain of salt is indicated. Here's another caution -- the exercises ask you to activate your lower back/hips -- but many of us are prone to over-extension in that area. I forgot about this and threw my back out doing his exercises. Look at how over-extended the lower backs are in the photos of the models. So my advice is proceed with the help of a physiologist or therapist who knows their stuff. I'm not sure it's entirely safe to try at home, especially if your injuries are complicated and old."
Have heard Egoscue has a new title: PAIN FREE AT YOUR PC. I assume it covers
the same ground as the previous titles. A SOREHAND reader comments on it:
'I got the "revolutionary method" one from the library, and had trouble figuring
out which were the right exercises for me, tho his arguments seemed convincing
and some of the exercises felt good.
Then I decided to try the new one, "...at your PC". It's relatively inexpensive
(about $12US). It has sets of exercises for those in pain, 3 levels of computer
users (power user=1-2 hours per day!) as prevention, Office Therapy for Power
Users, Breaking the pattern of pain - I'm not clear on when he recommends this.
I've been doing the Office Therapy ones - mostly because I can't make myself do
the home series which starts out at 1 hour, goes down to 30 minutes after you
reach a threshold with the "Supine Groin Stretch", which is just very awkward
for me to do, with a makeshift "step ladder".
However, I do think at least one of the stretches (arm circles) has helped
quite a bit with my Pronator Teres Syndrome. when I first did it, 25 each way,
it immediately produced a flareup. I waited a few days, and then built up from
5 each way, and I can type longer without pain. Long enough that I'm tempted
to do too much.
So, tho I haven't really followed all his instructions, I do think its helpful.
For what it's worth. I feel it has moved my plateau a bit in the right
direction.'
Order THE EGOSCUE METHOD from Amazon . . .
Myotherapy : Bonnie Prudden's Complete Guide to Pain-Free Living
Exercise expert Bonnie Prudden presents her method of releasing the
muscular spasms, called "trigger points", that are believed to underlie
much chronic muscle pain. She covers both the "quick fix", which is to
"release" the spasms with firm manual pressure, and the long-term fix,
which involves exercise and fitness to keep trigger points at bay. Many
RSI patients mention this kind of therapy as being helpful and it is becoming
a part of neuromuscular massage across the country. Prudden's institute also
has a Web Site.
Order MYOTHERAPY from Amazon . . .
CARPAL TUNNEL SYNDROME AND REPETITIVE STRESS INJURIES:
I have only read the 1st edition, which was not too impressive, but
evidently it has undergone substantial expansion
and revision and sounds like a more comprehensive resource. Bear this in
mind if you go looking for this in the library.
Order CARPAL TUNNEL from Amazon . . .
THE REPETITIVE STRAIN INJURY HANDBOOK:
Jack Bellis says: "As for coping, I got tho following book from my library, and it had the best
"coping" info I've seen among 6 books I've read, about 75 pgs from a female
sufferer, down to the most intimate details."
Order THE REPETITIVE STRAIN INJURY HANDBOOK from Amazon . . .
Relaxercise : The Easy New Way to Health and Fitness
"I am really getting some good help from a book my Feldenkrais practioner
recommended: "Relaxercise" by David Zemach-Bersin
The current thinking about my injury is that much of it is coming from the
neck and shoulders. The exercise for relaxed shoulders has helped me
tremendously. I wish I could comment on the exercises, but the relaxed
shoulders exercise is the one I gravitate toward whenever I need help. I
think I have gotten my money's worth." (quote: Judy L.)
Order RELAXERCISE from Amazon . . .
Muscle Pain Relief in 90 Seconds: The Fold and Hold Method
This book is a self-help manual of a form of soft-tissue care
that is called strain-counterstrain or preferred position release.
I've seen this touted by a number of therapists and it seems
reasonable. I haven't found it to be a "magic bullet" when I
get pain or cramping but it does seem to be a useful additional
tool for muscle pain control. I'm thinking it probably relates to 'myotherapy' or 'trigger
points', addressed in other publications.
Order MUSCLE PAIN RELIEF from Amazon . . .
The Trigger Point Therapy Workbook :
New Harbinger Publications, 2001 ISBN 1-57224-250-7; U.S. $19.95 8 1/2 x 11; 267 pages; 318 illustrationsThere's an emerging concensus among those who treat cumulative trauma injuries that part of what produces the pain, and keeps it around for so long, are something called "trigger points": tight, inflamed "knots" in your muscles and soft tissues. A number of treatment options aim at unlocking and releasing these points. One such approach is in Clair Davies book, which stands out in taking the approach that the injured person themselves should be able to locate and treat these painful areas. The book is thorough and accessible, and I've found the information indispensable in keeping me operational after my problems with musculoskeletal pain. This should be part of your "RSI first aid kit". - PMx
Soft Tissue Massage for Pain Relief: How You Can Massage Away the Pain from 37 Health Conditions
A reader opines: "Ten Star rating on this book.....Simply explained, easy to do and it seemed
to me very effective. I happened to see it in a health food store.
Well worth the $18 cost. Try it.....you learn a lot from doing the massage
yourself, how to feel for where the spots/tightness are, how to listen to
your body--what it says so you can adjust how you are doing things.. I used
it in conjunction with myofascial massage by a professional. But they are
different, mentally and physically.....BOTH....together are good."
Order SOFT TISSUE MASSAGE from Amazon . . .
Computering & Exercise: Escape The Aches
And Pains Of Computer Work
WOUNDED WORKERS:The author says:" Wounded Workers is sort of a Whole MSI Catalogue. It reviews the medical, WCB, legal, union/management, ergonomics, computer workstations, self-help and legislative ramifications of work-related upper extremity disorders, lists tons of resources online and in the real world, and generally provides a map for the labyrinth in which so many MSI patients find themselves. U of T Press arranged for the manuscript to be peer-reviewed twice, to ensure that the scholarship is accurate & up-to-date--but the text is written for the general public & provides translations for many technical terms."
I've read this: it is extremely thorough, and it
advocates for workers concerns without trying to
demonize anyone.
Order WOUNDED WORKERS from Amazon . . .
COPING SUCCESSFULLY
WITH RSI
Paperback: 128 pages
Publisher: Sheldon Press (January, 1999)
ISBN: 0859698114
Order COPING SUCCESSFULLY from Amazon . . .
One-Handed in a Two-Handed World
" For those RSI sufferers who've got one "good" hand, Tommye-K's tips
for managing, presented in a user-friendly tone, enable resting the
damaged hand while it recuperates as much as possible, while still
maintaining an active lifestyle."
Order from
Amazon.
One Hand Typing and Keyboarding Manual This manual on one-hand typing can be ordered or downloaded from Ms. Walters' Web site . Not having read it myself I'll just comment that two-handed people with one RSI-injured hand should be cautious about trying to make their one as-yet uninjured hand take up the whole load of typing without making other changes in work load, breaks, etc. etc. A good portion of this book can be previewed for free.
Living Well With a Hidden Disability : Transcending Doubt and Shame and Reclaiming Your
Life
Haven't read this one but sounds good. Dealing with RSI means more than
just sorting out medical and ergonomic issues, there are heavy emotional
and social impacts as well, and many RSI patients tell me that the
"hidden disability" aspect of RSI is tough to deal with.
Order LIVING WELL from Amazon . . .
Job-Damaged People:
" This book teaches injured workers what they must do if they are to get out
of the workers compensation system with their health and incomes intact. . .
This book presents the information you need to stop being a victim and start
receiving the benefits you are entitled to. "
Order from
How to Apply For and Win Social Security Administration Disability Benefits
PUBLISHER: MARCH 3RD BOOKS RING BOUND Pages:304 ISBN#: 0-9646998-0-X
"This is the 2nd edition of the first manual written for the non-attorney ever
published. It reveals the standards of judgment SSA uses to determine disability and tells
exactly what must be done to make it easy for SSA to grant benefits. "
CALIFORNIA WORKERS' COMP
Publisher says: "This is the only book that shows you how to handle a California workers' compensation claim from start to finish. Workers'
Compensation expert, Attorney Christopher Ball guides you through handling your legitimate claim from start to finish. "
Nolo Press web site also has resources for other states, spend some time searching there ...
Order TAKE CHARGE from Amazon . . .
HEALTHY COMPUTING WITH MUSCLE FEEDBACK
Publisher's blurb says: "A clear intervention blueprint for the successful management of repetitive motion injury and pain. It recognizes the
big picture (muscular sensory awareness, stress management and optimal performance), while simultaneously
attending to specific clinical and educational interventions (ergonomic assessment, surface EMG sensor placement
and trainee training strategies). A comprehensive how-to-do workbook for consultants and clinicians focusing on
the prevention and treatment of muscular skeletal pain disorders."
Order LIVING WELL from Amazon . . .
Repetitive Strain Injury? Rx: Yoga!
Pamela writes: "A reminder that there are special yoga tapes available that are targeted specifically to RSI patients. Information can be found at www.rxyoga.com. The author of Rx:Yoga! is Dr. Gail Dubinsky, who treats soft-tissue orthopedic injuries, and is also a long-time yoga practitioner. I reviewed the tape for MC Journal , and found it to be extremely appropriate -- I suffer from carpal tunnel and tendonitis, and found the yoga poses to be very doable and helpful."
Overcome Neck And Back Pain
"I'm 34, programmer, and am in the same boat as you: lots of neck and shoulder pain, and being diagnosed with arthritis in the neck as well . . . I started doing a lot of exercise focused on shoulders and neck, and I have had some good results with that. By making the shoulders and neck stronger, I can go longer behind the PC. Also, doing a lot of stretching, and keeping the time behind the PC to a minimal (if possible) has helped as well . . . I can recommend: Buy the book 'Overcome Neck and Beck Pain' by Kit Laughlin, and do the stretching exercises he describes in his book. For me, focusing on the neck and back, but also focusing on the hip and leg exercises has helped a lot. "
(Paul adds: yes, people think of hands and arms first when they hear
about RSI or "carpal tunnel" but neck/shoulder/back problems are at least
as common and can contribute to the pain in hands and arms, too.)
Order OVERCOME NECK AND BACK PAIN from Amazon . . .
Terry Slade has compiled a very useful and diverse bibliography of \
"body" books worth reading for anybody recovering from, or trying to avoid, musculoskeletal injury.
More pertinent books (mainly aimed at musicians)
here . . .
Injured people may really need legal help. Legal resources are here.
SUBSCRIBE SOREHAND firstname lastname
in the body to
listserv@listsrv.ucsf.edu
With these pages I've tried to provide access to everything I've heard about RSI, but I'm not an "expert". Everything here has come to me from other people. If you have more good resources, corrections to what is here, or encounter dead links, please let me know so it benefits the unexpectedly large number of people who find this site when they are looking for help.
My own experiences with treatment are necessarily limited. If you
have questions about RSI, in addition to seeing a doctor and reading
the resources above I strongly suggest you tap into one of my main
resources, the
SOREHAND e-mail list. You can subscribe
by sending mail with the line
SUBSCRIBE SOREHAND firstname lastname
in the body to
listserv @ listsrv . ucsf . edu
