Feature Archive

Computer Jocks At Risk

Computer Injury? Me?

By Elaine Zablocki
WebMD Feature

Reviewed By Gary Vogin

Oct. 8, 2001 -- Any athlete knows you maximize performance by stressing a muscle one day, then giving it time to recover the next. Any athlete knows you stretch your muscles before you work out. Any athlete, that is, except for a computer jockey.

If you work at a keyboard for six hours or more, go home to play video games, and then wonder why your hands feel strange -- you are a computer jockey. Do marathoners train by running 26 miles a day, every day? No. But computer athletes type five days a week for years and then are surprised when they develop repetitive stress injury (RSI).

Some people have such serious RSI problems they must stop typing and even have trouble with everyday activities like turning a water faucet. But the first signs can be subtle, so it's important to pay attention to early warnings. If you have recurrent tingling, numbness, weakness, or pain in your hand, see your doctor for a diagnosis. That's the advice of Lynn Weiss, MD, chairman of physical medicine and rehabilitation at Nassau University Medical Center in East Meadow, N.Y.

"Carpal tunnel syndrome, which we've heard so much about, is a nerve injury, but there are many other potential problems," Weiss tells WebMD. "You use muscles, tendons and ligaments, and all of them can be damaged if you use them repetitively, in an awkward position, without taking a rest."

Victor Faradji is a staff neurologist at Miami's Baptist Hospital. He tells WebMD that conditions such as diabetes, hypothyroidism, and pregnancy put us at increased risk for nerve problems. Take any of these conditions, add repetitive work, throw in a dash of predisposition to injury -- and you've got a recipe for RSI, Faradji tells WebMD.

That means one secret to preventing RSI is paying attention to the way we work, and developing new, healthier patterns, says Brett Weiss, MPT, CEO of Remedy Interactive in Mill Valley, Calif.

"First, get up and move," Weiss tells WebMD. "At least one minute every hour, stretch to increase circulation to your hands, arms, and lower back. If you're experiencing discomfort, take longer breaks, more often. Walk over to someone's desk instead of sending an email. Rotate among different tasks."

Even if you have ergonomic equipment, the way you use it is critical. "Maintain a healthy, relaxed posture, with straight back and flat wrists," Weiss says. "Use wrist rests to position your hands when you're not typing, but don't rest your wrists or elbows on anything while you type. Position your chair so you don't have to reach for equipment. When you type, use a gentle touch, and let your whole hand float over the keyboard, instead of stretching out your pinkie. That way, you use the larger shoulder and arm muscles."

Using these methods, one of Weiss's corporate clients recently cut its RSI injury rate from about 4% per hundred employees to zero.

Don't use wrist braces while you're working, advises physical therapist Mary Ellen Modica. "The workstation should fit the employee, so arms and wrists are in a neutral position," she says. "Braces restrict motion and you press against them, adding to the problem. However, braces may be useful in keeping hands in a neutral position at night while you're sleeping." Modica heads the STEPS program of "training for the industrial athlete" at Schwab Rehabilitation Hospital in Chicago.

In addition, do regular aerobic activity to promote better circulation. "That brings more nutrition to the muscles and tendons," says Nancy Clogston, OTR/L, CHT, an occupational therapist at Orthopedic & Sports Therapy of Sacred Heart Medical Center in Eugene, Ore.

Relax Your Gaze

Looking at a computer monitor for hours overstresses your eyes and leads to headaches, sore necks, hunched shoulders, and eyestrain. "You're sustaining a near focus all day long, and that's a problem," says Lance Anderson, OD, an optometrist in private practice in Hillsboro, Ore. His advice: sit at arm's length from your screen because the closer you are, the harder your eyes must work. Every 20 minutes, take a 20-second eye break. "Take a deep breath, look out the window or at least across the office," he says. "When you gaze into the distance, the muscles in your eye are at rest."

Another problem is that eyeglasses designed for reading a book or driving a car aren't necessarily suitable for the computer. The PRIO Corporation of Beaverton, Ore., has developed a vision tester that simulates a computer screen, allowing optometrists to determine the best prescription based on each person's preferred distance from the monitor. Call (800) 621-1098 for a geographic listing of optometrists who offer this new technology.

Keyboards for all Types

When Chris Watts worked as an editor/reporter for the Associated Press in Washington, D.C., he wrote for hours and began getting pains in his forearms. "I had to take some action, so I tried several different ergonomic keyboards that were lying around the office," he says. "Eventually I switched over to a flat split keyboard that cost me about $25. I've continued to use it for the past five years, and haven't experienced major RSI pain."

As you sit at your computer keyboard, look at your forearms and hands. If you use a standard keyboard, you may have to angle your left hand to the left so your fingers line up with the home row keys, and angle your right hand to the right. That's called ulnar deviation, and when you type in this position, you're putting extra stress on the ulnar nerve. Chris Watts solved his problem with a split keyboard because it puts the keys at angle, so hands and forearms stay in a straight line, eliminating ulnar deviation.

Now place your hands so palm faces palm. "This is a neutral position, and forearm muscles are neither contracted nor stretched," Clogston says. "When you turn your hands palm downward to type, the pronator muscles on the underside of the forearm are working." If you type all day long, those muscles are working all day long. That's why manufacturers are now making keyboards with a hump or "tent" in the middle -- to reduce that stress.

It's unlikely that you'll find an ergonomic keyboard for $25 today. The widely available Microsoft Natural Keyboard Pro, which sells for about $75, has a gently humped shape and fixed split between left and right sides. "Since there are so many different needs, no one keyboard is right for everyone," says Edie Adams, MEDes, CPE, manager of hardware user research for Microsoft. "With a consumer product, you try to make something that will be right for most people."

For those who need a wider split or more variable tilt, Goldtouch Technologies, Inc. of Irvine, Calif. makes a keyboard that splits horizontally up to 30 degrees and tents vertically up to 30 degrees. Kinesis Corp. of Bothell, Wash., offers a similar design, plus a more expensive programmable keyboard that splits into two completely separate parts which each can tilt independently up to 90 degrees. They've also developed a contoured keyboard that uses the strongest finger, the thumb, to strike most-used keys like control, enter, and delete.

Prices for adjustable ergonomic keyboards range from about $130 to several hundred dollars. This may be worth it, but only if it solves your particular problem. The trick is finding the right one. "There isn't any single keyboard that fits everyone -- that's why there're so many different styles," says Brett Weiss. "Try one to see if it fits your body, and keep your receipts in case you have to return it."

Watts says some people can't get used to a new style of keyboard. "My advice is, start learning now," he says. "If you spend lots of time on the computer, you'll benefit."

Lynn Weiss warns that no matter what equipment you have, it cannot compensate for continuous activity. "You still need to take short, frequent rests," she says.

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