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From: Dan Wallach <[email protected]>
Newsgroups: sci.med,sci.med.occupational,comp.human-factors,comp.answers,sci.answers,news.answers
Subject: Typing Injury FAQ (2/6): General Info
Supersedes: <typing-injury-faq/[email protected]>
Followup-To: sci.med.occupational
Date: 17 Oct 1995 07:52:18 GMT
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NNTP-Posting-Host: kastle.cs.princeton.edu
Content-Type: text/plain;
version=1.0;
title="Typing Injury FAQ: (2/6) General info"
Summary: information about where to get more information
Originator: dwallach@kastle
Xref: senator-bedfellow.mit.edu sci.med:148777 sci.med.occupational:4401 comp.human-factors:15143 comp.answers:14903 sci.answers:3278 news.answers:55418

Archive-name: typing-injury-faq/general
Version: $Revision: 5.23 $ $Date: 1995/10/17 07:41:35 $
URL: http://www.cs.princeton.edu/~dwallach/tifaq/general.html

Prologue

This FAQ may be cited as:

Wallach, Dan S. (1995) "Typing Injury FAQ: General Information".
http://www.cs.princeton.edu/~dwallach/tifaq/general.html

World-Wide-Web users will find this available as hypertext:

* http://www.cs.princeton.edu/~dwallach/tifaq/general.html
* (Dan Wallach's page) http://www.cs.princeton.edu/~dwallach/

Answers To Frequently Asked Questions about Typing Injuries

The Typing Injury FAQ - sources of information for people with typing injuries,
repetitive stress injuries, carpal tunnel syndrome, etc.

Copyright � 1992-1995 Dan Wallach <[email protected]>

[Current distribution: sci.med.occupational, sci.med, comp.human-factors,
{news,sci,comp}.answers, and e-mail to [email protected],
[email protected], and [email protected]]

Table of Contents:

1. Publications, mailing lists, newsgroups, WWW pointers, etc.
2. The ftp.csua.berkeley.edu archive
3. General info on injuries
4. Typing posture, ergonomics, prevention, treatment
5. FAQ's About Computer Ergonomics and Workstation Injuries
6. Requests for more info
7. References

-------------------------------------------------------------------------------

Publications, mailing lists, newsgroups, WWW pointers, etc.

(thanks to Rik Ahlberg <[email protected]> for parts of this info)

1. Publications

CTDNews is a monthly newsletter that covers cumulative trauma disorder.
It's a bit pricey ($146/year) but fairly concise. They'll send you your
first issue free, so you can look it over.

Address
CTDNews
PO Box 239
Haverford, PA 10941
Phone
215-896-4902, or 800-554-4CTD to order
Fax
215-896-1488
WWW
http://wanda.pond.com/mall/ctdnews/rsi

2. FTP & Gopher & WWW sites

world.std.com
The home of the Boston RSI Archive

ftp://ftp.std.com/pub/boston-rsi
gopher://gopher.std.com/11/FTP/world/pub/boston-rsi

Boston RSI changed its name to RSI-East, and the new archives are at
sjuvm.stjohns.edu (detailed below) The RSI Network Newsletter is a
bi-monthly online newsletter produced by Caroline Rose
<[email protected]> and distributed online by Craig O'Donnell
<[email protected]>

ftp://ftp.std.com/pub/rsi
gopher://gopher.std.com/11/FTP/world/pub/rsi

ftp.csua.berkeley.edu
Extensive anonymous ftp archive, including the typing injury FAQ
(frequently asked questions), alternative input device information
(descriptions, reviews, and GIF images), and some software.
Maintained by Dan Wallach <[email protected]>.

ftp://ftp.csua.berkeley.edu/pub/typing-injury

(more info below...)

sjuvm.stjohns.edu
A gopher site containing the Electronic Rehabilitation Resource
Center. Lots of disability information, including a searchable
database of national disability resources and access to other gopher
sites with geographically local disability information.

Also home to RSI-East, its message archive, and an archive of the RSI
Network Newsletter.

gopher://sjuvm.stjohns.edu/11/disabled

ftp.demon.co.uk
An ftp site containing the archives of RSI-UK.
ftp://ftp.demon.co.uk/pub/rsi

Also, Demon now mirrors the typing-injury archive:
ftp://ftp.demon.co.uk/pub/mirrors/csua/typing-injury

engr-www.unl.edu
A World-Wide-Web page with some good pictures of how to hold your
hands, MPEG videos of various exercises, and more.

http://engr-www.unl.edu/ee/eeshop/rsi.html

Other WWW sites:
The Ergonomic Page, from Applied Software Unlimited [- NEW!]
http://www.best.com:80/~ergoware/
Emacs keybindings and ergonomics [- NEW!]
http://www.santafe.edu/~nelson/ergo/
Amara's RSI Page [- NEW!]
http://www.amara.com/aboutme/rsi.html
MouseMitt International - padded lycra wrist braces [- NEW!]
http://www.mousemitt.com/
Workstation Environments - a company which designs high-end furniture
[- NEW!]
http://www.workenv.com/
Safety Related Internet Resources [- NEW!]
http://www.sas.ab.ca/biz/christie/safelist.html
Some human factors and ergonomics research by Alan Hedge
http://www.tc.cornell.edu/~hedge
TechTime articles on RSI Injuries
http://hoohana.aloha.net/~billpeay/TECHT08.html
A Patient's Guide to Carpal Tunnel Syndrome
http://www.cyberport.net/mmg/cts/ctsintro.html
Medical Matrix - A Guide to Internet Medical Resources
http://kuhttp.cc.ukans.edu/cwis/units/medcntr/Lee/HOMEPAGE.HTML
ErgoWeb - lots of information for designers of ergonomic tools
http://ergoweb.mech.utah.edu/
Oversensitivity to Electricity
http://www.isy.liu.se/~tegen/febost.html
Disability Resources from Evan Kemp Associates
http://disability.com/
Intergraph Workstation Furniture
http://www.intergraph.com/furn.shtml
Safe Computing's Internet Store - buy ergonomic products online
http://www.netmedia.com/safe/
The Martial Arts FAQ
http://www.cis.ohio-state.edu/hypertext/faq/usenet/martial-arts/top.html

The Ergonomic Sciences Corp, Mountain View, CA.
http://www.internex.net/multipresence/ergonomics.html

The (USA's) Occupational Safety and Health Administration
http://www.osha.gov

Canadian Centre for Occupational Health and Safety
http://www.ccohs.ca

Repetitive Stress Injury Help Page (CMU)
http://http://www.cs.cmu.edu/afs/cs.cmu.edu/help/www/06-Miscellaneous/RSI/repstrTOC.html

Some other WWW indices to the typing-injury archive
http://www.santafe.edu/~nelson/rsi/typing-gif.html
http://alumni.caltech.edu/~dank/typing-archive.html

The FAQ for a2x (a program to interface an external keyboard or
speech synthesizer to an X window system) and the FAQ for
DragonDictate (a speech recognition system) are both available here.
http://www.cl.cam.ac.uk/a2x-voice/ (this should include
information on the new a3x software which works with Windows NT
instead of Unix and X)
ftp://ftp.cl.cam.ac.uk/a2x-voice/

Another RSI page in the works
http://dragon.acadiau.ca:1667/~rob/rsi/rsi.html

Magnetic Devices from Total Health Mktg., Nikken Independent
Distributors
http://www.icw.com/~total/health.html

3. Listserv Mailing Lists

Sorehand is a San Francisco-based listserv mailing list for people with
RSIs. Subscribe by sending mail with any subject to:

[email protected]

with the message body reading:

subscribe sorehand Your Name

C+Health (Computers & Health) is a listserv mailing list which deals with
the technologies causing injuries to folks who use them. Subscribe by
sending mail with any subject to:

[email protected]

with the message body reading:

subscribe c+health Your Name

RSI-East is the east coast's answer to sorehand, where users discuss their
experiences and offer support, referral, and treatment information to one
another. Subscriptions are available to anyone with an interest in RSIs,
but with the caveat that the list is intended as a regional resource for
networking. Subscribe by sending mail with any subject to:

[email protected]

with the message body reading:

subscribe rsi-east Your Name

RSI-UK is Great Britain's RSI mailing list, open to anyone. Subscribe by
sending mail with any subject to:

[email protected]

with the message body reading:

subscribe rsi-uk Your Name

Also, check out the RSI-UK Web page: [- NEW!]

http://www.demon.co.uk/rsi/

4. Usenet Newsgroups

misc.health.therapy.occupational
The successor to sci.med.occupational.

sci.med.occupational
A Usenet newsgroup which deals in occupational medicine. Lots of
practitioners read it!

comp.human-factors
Mostly software design, but occasional discussion of accessibility
issues for people with RSIs.

alt.support.arthritis
Support for those with arthritis. New as of 11/93.

bit.listserv.ada-law
Usenet feed of the ada-law listserv. Covers issues relating to the
Americans with Disabilities Act (ADA).

bit.listserv.dsshe-l
Usenet feed of the disabled student services listserv. Particularly
of interest to computer science students dealing with RSIs or folks
pondering a return to school and/or retraining after a disabling RSI.

5. Real-time chatting

If you've got an account on America On-Line, you might want to check out
the RSI Support Group, which meets every Wednesday night in the Equal
Access Cafe. This realtime chat starts at 9:15pm eastern time. Check the
current AOL schedule for the most current information.

6. Books / Literature

A large amount has been written in the popular press and the medical
literature, and more comprehensive bibliographies (rsi.biblio and
rsi.biblio2) are available in the typing-injury archive.

Here are some books you might want to check out:
o Emil Pascarelli and Deborah Quilter, Repetitive Strain Injury, a
Computer User's Guide, John Wiley & Sons, ISBN 0-471-59533-0.
+ The Pascarelli book is often cited in various on-line
conversations. If you buy only one book, this is probably the
one to get.

o Don Sellers, Zap! How Your Computer Can Hurt You-And What You Can Do
About It, Peachpit Press, Inc., 1994. ISBN# 1-55609-021-0. Author's
e-mail: [email protected]

o Stephanie Brown, Preventing Computer Injury: The Hand Book, Ergonome
Press, 1993, ISBN 1-884388-01-9.

o David Zemach-Bersin et al., Relaxercise, Harper Press, 1990, ISBN
0-06-250992-6

o Bonnie Prudden, Pain Erasure - The Bonnie Prudden Way. M. Evans &
Co., Inc., 1980; ISBN 0-87131-328-6 (hardcover). Ballantine Books,
Inc.; 1982 (softcover).

o Martin Sussman et al., Total Health at the Computer. Station Hill
Press, 1993.

o Don Aslett, Make Your House Do The Housework, Digest Books, 1986.
ISBN 0-89-879227-4. 201 pages.

o Sharon Butler, Conquering Carpal Tunnel Syndrome (& other RSIs),
Advanced Press (no ISBN, but phone 800-909-9795, pay $18.95 +
shipping). Author's e-mail: [email protected]

o A free packet of information is also available from the U.S.
Government. You might want to ask for:

Carpal Tunnel Syndrome
Selected References (March 1989)

NIOSH Publications Dissemination
4676 Columbia Parkway
Cincinnati, Ohio 45226

Alternatively, you can call NIOSH's 800 number: 800-356-4674
(800-35-NIOSH) or poke around their WWW page:
http://www.cdc.gov/niosh/homepage.html [- NEW!]
7. Societies / Support Groups [- NEW!] This section is new, so please forgive
it's incompleteness. Please send me mail so I can register your support
group.
o RSI patienten vereniging
Postbus 1222
NL-3800 BE Amersfoort
The Netherlands
phone (via FNV) (03480)87804
phone (abroad) + 31 3480 87804

-------------------------------------------------------------------------------

The ftp.csua.berkeley.edu archive

Check out the ever-increasing typing injury archive! Just use anonymous ftp or
WWW:

* ftp://ftp.csua.berkeley.edu/pub/typing-injury
* http://www.cs.princeton.edu/~dwallach/tifaq/archive.html

Informative files:

typing-injury-faq/
changes
changes since last month's edition
general
information about typing injuries
keyboards1 and keyboards2
products to replace your keyboard
software
software to watch your keyboard usage
furniture
details about various desks, chairs, etc.
adapting-at-home
some simple ways to make things like mopping and tooth brushing less
painful
alexander-vs-feldenkrais [- NEW!]
Mike Mossey compares two healing techniques
amt.advice
about Adverse Mechanical Tension
amt.more_info
e-mail from Dr. Peter Bower about this stuff
amt.references
a bibliography for more AMT info
ansi-standards
a note about ANSI/ISO, EC, and MIL-STD "standards"
armrests
how to correctly use armrests
arms-blurb
info about the Assoc for Rep. Motion Syndromes
back-exercises
three simple exercises for your middle back
biofeedback
learning to listen to your body
car-seats
replace your car seat with something more comfortable
caringforwrists.sit.hqx
PageMaker4 document about your wrists
caringforwrists.ps
PostScript converted version of above...
carpal.info
info on Carpal Tunnel Syndrome
carpal-myths
a discussion of what carpal tunnel syndrome is and isn't
carpal.explained
very detailed information about CTS
carpal-new-therapy
new treatments that don't involve surgery
carpal.self_care
excerpt from Rosemarie Atencio's book
carpal-steroid-therapy
abstract of a paper discussing steroid (cortisone) treatments for CTS
carpal-story
one person's story of CTS diagnosis, treatment, and recovery
carpal.surgery
JAMA article on CTS surgery
carpal-surgery-tips
some general tips for recovering from the surgery
carpal.tidbits
TidBITS article on CTS
ctdnews.info
info about the CTDNews publication
chord-keyboards
interesting facts and references to more
cumulative-disorders
Cumulative Trauma Disorders: Are They Preventable? Yes, No, Maybe - a
paper by Joy Linn
disability.keyboards
large list of keyboards, more relevant for users with motion disabilities
disability-mailing-lists
large list of mailing lists for a various disabilities
double-crush
double-crush syndrome, CTS, and more
dragon-vocab-size
should you buy the version with a bigger dictionary?
dragon-vs-kurzweil
a detailed comparison of both voice systems
dragon-vs-kurzweil2 [- NEW!]
an even more detailed comparison of the two systems
dvorak.info
lots of into about Dvorak keyboarding
exercise-discussion
exercise in the workplace
exotic-mice
info on some newer mice
feldenkrais-info
some background info on how the Feldenkrais method can ease stress
footswitch.doc
how to hack a footswitch into your computer
footswitch-sources
where to buy a footswitch
glare-control
hints about controling glare from your screen
glidepoint
lots of information on the GlidePoint trackpad pointing device
guitar-playing
RSI vs. playing guitar
handeze.info
info about Handeze gloves
hmo-advice
advice on picking a health-care provider in the USA
industrial-injury
one person's story of an injury
injury.factors
why some get injured and some don't
injury.profiles
statistics about what gets injured
internet-safety-resources
a huge list of pointers to Internet resources
keyboard-commentary
Dan's (increasingly ancient and outdated) opinions on the keyboard
replacements
keyboard-companies [- NEW!]
Simpson Garfinkel's article about companies building new keyboards
keyboard-trays
all about picking a good tray
kinesis-sun-mappings
some useful xmodmap calls when using a Kinesis Sun adapter box
martial-arts
using martial arts to combat RSI's
microsoft-vs-generic-split
comparison of Microsoft Natural and Taiwanese generic split keyboards
mouseless.mac
keyboard shortcuts and tricks
nervous-system-anatomy
basic information on how the human nervous system works
no-rsi-in-uk
info about British judge saying RSI isn't real
nonsurgical-treatment [- NEW!]
Various nonsurgical treatment options for upper extremity overuse injuries
office-safety
Worker-oriented solutions to office safety
pain-discussion
All about pain
piano-posture
Some observations about professional pianists
pointing-devices
advice if pointing devices are your problem
physical-therapy
explanations of different types of physical therapy
resellers
a short list of dealers and consultants
rock-climbing
lots of advice about how to climb without hurting yourself
rsi.article
Article in The Independent (London, UK)
rsi.biblio
bibliography of RSI-related publications
rsi.biblio2
another bibliography
rsi.dentists
stats on RSI happening to dentists
rsi.details
long detailed information about RSI
rsi-fda-seminar
Dr. Leo Rozmaryn of the US Food and Drug Administration's seminar on RSI's
rsi.foundation
an attempt to start a U.S. advocacy group
rsi.intro
basic article from FDA Consumer
rsi-network/*
archive of the RSI Network newsletter (currently, containing issues 1
through 19)
rsi.physical
study showing RSI isn't just psychological
speed-kills
it's better to type slower
sword.review
reviews a Mac program to reduce keystrokes
tendonitis.info
info on Tendonitis
thoracic-info
info about thoracic outlet syndrome (TOS)
thoracic-info2
more info about thoracic outlet syndrome
thoracic-info3
treatment info, exercises, and more (useful for many folks)
uk-rsi-resources
RSI resources in Great Britain
vibration-gloves
why anti-vibration gloves aren't necessarily helpful
vitamin-b6
possible links between vitamins and RSI's
voice-comparison
a brief comparison of recognition systems
voice-problems
how to avoid hurting your voice with overuse (as you might do with a
speech recognition system)
voice-programming
detailed information about the appropriateness of a voice dictation system
to programming tasks
voice-recognition-critique
all about using a voice recognition system as a programmer
workers-comp
dealing with insurance and lawyers
wrist-supports
picking your supports and splints

Various product literature and reviews:

apple-press
press release on the Apple Adjustable Keyboard
apple-tidbits
extensive info about Apple's Adjustable Keybd
bat-info
MacWeek review on the Bat
comfort-factors, comfort-features, comfort-letter, and comfort-survey
marketing info on the Comfort Keyboard
comfort-review
one user's personal opinions
comfort-review2
another user's opinions
datahand-review
detailed opinions of the DataHand
datahand-review2
follow-up to above
datahand-review3
another review of the DataHand
datahand-desc
description of the DataHand's appearance
dragon2.info
info about DragonDictate 2.0
in3-press
details about the IN3 Voice Commander
keyboard-phone-numbers [- NEW!]
Tom Bell's list of keyboard vendor phone numbers
kinesis-review
one user's personal opinions
kinesis-review2
another user's personal opinions
kinesis-summary
a collection of opinions on the Kinesis
kinesis-vs-maltron
a comparison of two similar keyboard alternatives
kurzweil-review
info about the Kurzweil voice recognizer
maltron-flyer and maltron-letter
marketing info on various Maltron products
maltron-review
one user's personal opinions
mskeybd-review
one user's personal opinions of the Microsoft Natural Keyboard
ncc-digital-dictate [- NEW!]
the Digital Dictate add-on for IBM VoiceType
vertical-info
marketing info on the Vertical
voicetype2-info
marketing info on IBM VoiceType
worksafe-australia.info
how to get more info from Australia's govt
workstation-setup
how to arrange your computer/chair/desk
wrist-rest-phone-numbers [- NEW!]
Tom Bell's list of wrist rest vendor phone numbers

Programs (in the software subdirectory):

UNIX/X Software:

(Note: a2x.tar and rk.tar are both from ftp://ftp.x.org/contrib/ so they may
have a more current version than ftp.csua.berkeley.edu.)

a2x.tar
a more sophisticated X keyboard/mouse spoofing program. Supports
DragonDictate.
a2x-RawPC-1.4.tar
a hacked version of a2x that can take input directly from PC keyboards via
the serial port and an adapter.
dcm.shar
Dragon voice macros to accompany a2x use
hsh.shar
a program for one-handed usage of normal keyboards
kt18.tar
generates fake X keyboard events from the serial port - use a PC keyboard
on anything!
rest-reminder.sh
yet another idle watcher
rk.tar
the reactive keyboard - predicts what you'll type next - saves typing
serkey.sh
like kt, generates fake X key events, but from a raw PC keyboard via the
serial port
spacebar_hacks.patches
patches for X11R5 to allow the spacebar to be both a spacebar and a
control key
timeout.zip
MS Windows break-reminder program
typewatch.shar
tells you when to take a break
xgdvorak.sh
turns your QWERTY keyboard into Dvorak
xidle.shar
keeps track of how long you've been typing
xwrits.tar
X-Windows program which pops up and tells you to take a break.
watch.shar
OpenWindows activity monitor / rest reminder

PC/DOS Software:

accpak.exe
a serial port keyboard spoofer for MS Windows
getup.com
getup.readme
simple TSR program - remind you to take breaks

Pictures (in the gifs subdirectory):

(Note: you can see inlined images of these keyboards in the keyboards FAQ
document)

howtosit.gif
picture of good sitting posture (the caringforwrists document is better
for this)
half-qwerty.gif (new name, same file as old 1handpic.gif)
keymappings for the Half-QWERTY
accukey1.gif
beautiful grey-scale picture
accukey2.gif
chord-mappings for the accukey
apple.gif
the Apple Adjustable Keyboard
bat.gif
the InfoGrip Bat
comfort.gif
the Health Care Comfort Keyboard
datahand1.gif
picture of the keyboard
datahand2.gif
key layout schematic
E2H_Grahl.gif
Grahl split-back ergonomic chair
E_Grahl.gif
Grahl normal-back ergonomic chair
ergologic.gif
the ergoLogic 7.1 keyboard (same as flexpro)
ergomaster1.gif and ergomaster2.gif
the Genovation ErgoMaster keyboard
ergomax.gif
the Maxi Switch ErgoMax keyboard
flexpro.gif
the Key Tronic FlexPro keyboard (same as ergologic)
fountain_hills.gif
the Fountain Hills keyboard
generic-split.gif
a generic keyboard, made in Taiwan
handeze.gif
hand size chart for Handeze gloves
handeze.ps
properly scaled Postscript of handeze.gif
kinesis.gif
the Kinesis Ergonomic Keyboard
lexmark.gif
the Lexmark Select-Ease keyboard
maltron1.gif, maltron2.gif, maltron3.gif, and maltron4.gif
several pictures of Maltron products
marquardt.gif
the Marquardt MiniErgo
mskeybd.gif
the Microsoft Natural Keyboard
mskeybd-proto.gif
... and a prototype that didn't make it
mykey.gif
ErgonomiXX MyKey
somers1.gif
Somers EK1 Ergonomic Keyboard
somers2.gif
schematic picture of the keyboard
tony.gif
The Tony! Ergonomic Keysystem
twiddler1.gif
Twiddler, "front" view
twiddler2.gif
Twiddler, "side" view
vertical.gif
the Vertical keyboard
wave.gif
the Iocomm `Wave' keyboard

Many files are compressed (have a .Z ending). If you can't uncompress a file
locally, ftp.csua.berkeley.edu will do it. Just ask for the file, without the
Z extension.
-------------------------------------------------------------------------------

General info on injuries

First, and foremost of importance: if you experience pain at all, then you
absolutely need to go see a doctor. As soon as you possibly can. The difference
of a day or two can mean the difference between a short recovery and a long,
drawn-out ordeal. GO SEE A DOCTOR. Now, your garden-variety doctor may not
necessarily be familiar with this sort of injury. Generally, any hospital with
an occupational therapy clinic will offer specialists in these kinds of
problems. DON'T WAIT, THOUGH. GO SEE A DOCTOR.

The remainder of this information is paraphrased, without permission, from a
wonderful report by New Zealand's Department of Labour (Occupational Safety and
Health Service): "Occupational Overuse Syndrome. Treatment and Rehabilitation:
A Practitioner's Guide".

First, a glossary (or, fancy names for how you shouldn't have your hands):
(note: you're likely to hear these terms from doctors and keyboard vendors :)

RSI
Repetitive Strain Injury - a general term for many kinds of injuries
OOS
Occupational Overuse Syndrome - synonym for RSI
CTD
Cumulative Trauma Disorder - another synonym for RSI
WRULD
Work-Related Upper Limb Disorders - yet another synonym for RSI
CTS
Carpal Tunnel Syndrome (see below)
Hyperextension
Marked bending at a joint.
Pronation
Turning the palm down.
Wrist extension
Bending the wrist up.
Supination
Turning the palm up.
Wrist flexion
Bending the wrist down.
Pinch grip
The grip used for a pencil.
Ulnar deviation
Bending the wrist towards the little finger.
Power grip
The grip used for a hammer.
Radial Deviation
Bending the wrist toward the thumb.
Abduction
Moving away from the body.
Overspanning
Opening the fingers out wide.

Now then, problems come in two main types: Local conditions and diffuse
conditions. Local problems are what you'd expect: specific muscles, tendons,
tendon sheaths, nerves, etc. being inflamed or otherwise hurt. Diffuse
conditions, often mistaken for local problems, can involve muscle discomfort,
pain, burning and/or tingling; with identifiable areas of tenderness in
muscles, although they're not necessarily "the problem."

Why does Occupational Overuse Syndrome occur? Here's the theory.

Normally, your muscles and tendons get blood through capillaries which pass
among the muscle fibers. When you tense a muscle, you restrict the blood flow.
By the time you're exerting 50% of your full power, you're completely
restricting your blood flow.

Without fresh blood, your muscles use stored energy until they run out, then
they switch to anaerobic (without oxygen) metabolism, which generates nasty
by-products like lactic acid, which cause pain.

Once one muscle hurts, all its neighbors tense up, perhaps to relieve the load.
This makes sense for your normal sort of injury, but it only makes things worse
with repetitive motion. More tension means less blood flow, and the cycle
continues.

Another by-product of the lack of blood flow is tingling and numbness from your
nerves. They need blood too.

Anyway, when you're typing too much, you're never really giving a change for
the blood to get back where it belongs, because your muscles never relax enough
to let the blood through. Stress, poor posture, and poor ergonomics, only make
things worse.

Specific injuries you may have heard of

(note: most injuries come in two flavors: acute and chronic. Acute injuries are
severely painful and noticable. Chronic conditions have less pronounced
symptoms but are every bit as real.)

Tenosynovitis
an inflamation of the tendon sheath. Chronic tenosynovitis occurs when the
repetitive activity is mild or intermittent: not enough to cause acute
inflamation, but enough to exceed the tendon sheath's ability to lubricate
the tendon. As a result, the tendon sheath thickens, gets inflamed, and
you've got your problem.
Tendonitis
an inflammation of a tendon. Repeated tensing of a tendon can cause
inflamation. Eventually, the fibers of the tendon start separating, and
can even break, leaving behind debris which induces more friction, more
swelling, and more pain. "Sub-acute" tendonitis is more common, which
entails a dull ache over the wrist and forearm, some tenderness, and it
gets worse with repetitive activity.
Carpal Tunnel Syndrome
the nerves that run through your wrist into your fingers get trapped by
the inflamed muscles around them. Symptoms include feeling "pins and
needles", tingling, numbness, and even loss of sensation. CTS is often
confused for a diffuse condition.
Adverse Mechanical Tension
also known as 'neural tension', this is where the nerves running down to
your arm have become contracted and possibly compressed as a result of
muscle spasms in the shoulders and elsewhere. AMT can often misdiagnosed
as or associated with one of the other OOS disorders. It is largely
reversible and can be treated with physiotherapy (brachial plexus
stretches and trigger point therapy).
Others
for just about every part of your body, there's a fancy name for a way to
injure it. By now, you should be getting an idea of how OOS conditions
occur and why. Just be careful: many inexperienced doctors misdiagnose
problems as Carpal Tunnel Syndrome, when in reality, you may have a
completely different problem. Always get a second opinion before somebody
does something drastic to you (like surgery).

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Typing posture, ergonomics, prevention, treatment

The most important element of both prevention and recovery is to reduce tension
in the muscles and tendons. This requires learning how to relax. If you're
under a load of stress, this is doubly important. Tune out the world and breath
deep and regular. Relaxing should become a guiding principle in your work:
every three minutes take a three second break. EVERY THREE MINUTES, TAKE A
THREE SECOND BREAK. Really, do it every three minutes. It's also helpful to
work in comfortable surroundings, calm down, and relax.

If you can't sleep, you really need to focus on this. Rest, sleep, and
relaxation are really a big deal.

There are all kinds of other treatments, of course. Drugs can reduce
inflamation and pain. Custom-molded splints can forcefully prevent bad posture.
Surgery can fix some problems. Exercise can help strengthen your muscles.
Regular stretching can help prevent injury. Good posture and a good ergonomic
workspace promote reduced tension. Ice or hot-cold contrast baths also reduce
swelling. Only your doctor can say what's best for you.

Posture - some basic guidelines

[I so liked the way this was written in the New Zealand book that I'm lifting
it almost verbatim from Appendix 10.]

* Let your shoulders relax.
* Let your elbows swing free.
* Keep your wrists straight.
* Pull your chin in to look down - don't flop your head forward.
* Keep the hollow in the base of your spine.
* Try leaning back in the chair.
* Don't slouch or slump forward.
* Alter your posture from time to time.
* Every 20 minutes, get up and bend your spine backward.

Set the seat height, first. Your feet should be flat on the floor. There should
be no undue pressure on the underside of your thighs near the knees, and your
thighs should not slope too much.

Now, draw yourself up to your desk and see that its height is comfortable to
work at. If you are short, this may be impossible. The beest remedy is to raise
the seat height and prevent your legs from dangling by using a footrest.

Now, adjust the backrest height so that your buttocks fit into the space
between the backrest and the seat pan. The backrest should support you in the
hollow of your back, so adjust its tilt to give firm support in this area.

If you operate a keyboard, you will be able to spend more time leaning back, so
experiment with a chair with a taller backrest, if available.

[Now, I diverge a little from the text]

A good chair makes a big difference. If you don't like your chair, go find a
better one. You really want adjustments for height, back angle, back height,
and maybe even seat tilt. Most arm rests seem to get in the way, although some
more expensive chairs have height adjustable arm rests which you can also
rotate out of the way. You should find a good store and play with all these
chairs - pick one that's right for you. In the San Francisco Bay Area, I highly
recommend "Just Chairs." The name says it all.

Keyboard drawers, wrist pads, and keyboard replacements:

There is a fair amount of controvery on how to get this right. For some people,
wrist pads seem to work wonders. However, with good posture, you shouldn't be
resting your wrists on anything - you would prefer your keyboard to be "right
there". If you drop your arms at your side and then lift your hands up at the
elbow, you want your keyboard under your hands when your elbows are at about 90
degrees. Of course, you want to avoid pronation, wrist extension, and ulnar
deviation at all costs. Wrist pads may or may not help at this. You should get
somebody else to come and look at how you work: how you sit, how you type, and
how you relax. It's often easier for somebody else to notice your hunched
shoulders or deviated hands.

Some argue that the normal, flat keyboard is antiquated and poorly designed. A
number of replacements are available, on the market, today. Check out the
accompanying typing-injury-faq/keyboards for much detail.

Lately, a number of people have been having luck with gloves. You may want to
try some light gloves, possibly with the fingers removed if they're too warm.
Many seem to like the Handeze Gloves, available for around $20 from
Patternworks, P.O. Box 1690, Poughkeepsie, NY 12601 (800/438-5464). See the
typing-injury archive "handeze.info" for details.

Another place you may be able to get stuff: a company called Enrichments has a
catalog of ergonomic products you may find interesting. Their phone number is
800/323-5547. Or, you might want to contact AliMed at 800/225-2610 and ask for
their Ergonomics catalog.

Here are some sources for fancy keyboard drawers:

Ergotron, Eagan, MN, 800/888-8458. A wide tray that mounts under a desk and is
adjustable, has a wrist rest, and is wide enough to accomodate a mouse pad.

Ergo Systems, East Hartford, CT, 203/282-9767. They make keyboard trays and a
retractrable mouse pad, too.

Rubbermaid makes a simple $20 plastic keyboard tray that works well. I found
mine at CompUSA, so check your local computer store.
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FAQ's About Computer Ergonomics and Workstation Injuries

Copyright � 1992-1995 Jonathan Bailin, Ph.D. <[email protected]>

Question Categories

General Info, Monitor, & Desktop Accessories......................1-6
Wrists, Body Posture, & Chair Features............................7-13
Active Breaks, Microbreaks, & Excercises.........................14-15
Varieties of Computer Injuries.....................................16
Kinesiology for RSI................................................17
Emergence of RSI...................................................18
Lifestyle Changes and Reducing RSI Risk............................19

1. Q. What is "ergonomics"?

A. Ergonomics is the science of adjusting your work environment to fit
your body and make it most comfortable.

2. Q. What is the best room lighting to help reduce eye strain?

A. A mixture of fluorescent and incandescent light is usually most
pleasing. The most important aspect of lighting is to reduce glare and
bright reflections from your screen, nearby glass, or shiny surfaces.
Since light conditions change during the day this may require several
adjustments while working. If you smoke while keyboarding, be sure to
clean your screen frequently as water vapor and smoke make a potent film
forming process.

3. Q. What is the best position for the monitor at my workstation?

A. Many make the common mistake of putting the monitor, the keyboard, or
both off to one side on a desk. If you perform more than a few minutes of
keyboarding a day, the keyboard and monitor should be placed directly in
front of your normal sitting position. The screen should be 18-30 inches
from your eyes or about an arm's length.

4. Q. Is there an optimum height for my monitor?

A. Yes. The top of the monitor should be at eye level because the eyes are
at their most comfortable position straight ahead but slightly downward.
This is why reading lenses in bifocal glasses are placed just below the
horizontal plane.

On the topic of eye correction, make sure your eyes are 20/20 and hat if
you do need correction your optometrist should know about the amount of
your monitor use and its distance from your eyes. A correction just for
monitor use may be necessary. Be sure to look away from your screen at
least every 30 minutes and focus on something over 20 feet away.

5. Q. Is there an optimum screen brightness and color scheme to help prevent
eye strain?

A. Black characters against a light gray background are often easiest on
he eyes for long periods. Contrast and brightness should be adjusted to
create the brightest screen without blurring.

6. Q. What other accessories and placement are important?

A. Frequently used items should be within arms reach from your keyboarding
position. A document holder should be at the same height and distance as
he screen so that your eyes don't need to change focus frequently.
Frequent telephone use should utilize a headset to avoid bending the neck
while keyboarding. Remember that many RSI's begin with nerve insult in the
neck and shoulders.

7. Q. What is the most healthy posture for my wrists while typing?

A. The best position is neutral. In other words, the knuckles, wrist, and
op of the forearm should form a straight line.

8. Q. Can a wrist pad sitting in front of the keyboard be used during
keyboarding?

A. The neutral position described in #7 can not be achieved while in
contact with most commercial wrist pads. For this reason keyboarding is
best performed from a "floating" wrist position. Contact wristpads for
rest periods only. Frequent rest becomes necessary with floating wrists
because it tends to emphasize shoulder muscle contraction. Don't forget to
use the lightest possible finger pressure during keying.

9. Q. What is the best elbow and shoulder position while keyboarding?

A. The elbows should form a 90 degree angle while *hanging* at your sides
from the shoulders. Rarely do chairs with armrests allow this position. It
is *very* important that the shoulders remain relaxed in a lowered
position during keyboarding (see #6).

10. Q. What is the best seat height for keyboarding?

A. It is most important that seat height should allow the upper body
postures described in #7, #8, and #9. This upper body posture is most
responsible for reducing risk of injury. Once this is accomplished, the
feet should be flat on the floor.

If the resulting seat height prevents the feet from resting flat on he
floor, a foot rest is necessary. This should allow the lower legs to be
vertical and thighs horizontal.

11. Q. What should I look for in the backrest of a chair?

A. Expensive motors and adjustable sections are not necessary if the
backrest has firm support for the inward curve of the lower spine (lumbar)
and outward curve of the upper spine (thoracic). Wether you need upper
body support to help keep your torso and head vertical is a matter of
preference.

12. Q. What other characteristics of a chair are important?

A. The seat of the chair should be large enough to accommodate frequent
changes in position and firm enough to allow your weight to be supported
hrough the buttocks not the thighs. If others will use your chair, easy
height adjustment is a must.

13. Q. How often should I change positions and take breaks during keyboarding?

A. You should change your sitting position at least every 15 minutes.
Active breaks should be taken at least every 30 minutes especially for
those who perform more than 2 or 3 hours of keyboarding a day. Microbreaks
should occur more often.

14. Q. What is an "active break" and a "microbreak"?

A. An active break occurs when you stop keyboarding to do other things
like ake phone calls, file papers, or get up to get a drink of water. An
active break should also include specific exercises. These exercises
should also be done during keyboarding microbreaks which occur while
seated at your workstation.

15. Q. What are some of the best exercises for keyboarding microbreaks while
seated?

A. The "Shoulder Blade Squeeze" is performed by raising your forearms and
pointing your hands to the ceiling. Push your arms back, squeezing you
shoulder blades together. Hold for at least 5 seconds and repeat 3 times.

"Eye Palming" is performed by placing your elbows on your desk, cup your
hands, close your eyes, and place your eyelids gently down onto your
palms. Hold this position for 1 minute while breathing deeply and slowly.
Then uncover your eyes slowly.

The "Arm & Shoulder Shake" is performed by dropping your hands to your
sides then shake your relaxed hands, arms, and shoulders gently for at
least 5 seconds and repeat 3 times.

"Spanning" is performed by placing you arms straight in front of you and
spreading your fingers as far as possible for at least 5 seconds and
repeat 5 times. This exercise was made famous by pianists. With the arms
extended in front of you spanning can be combined with a "Forearm Stretch"
by turning the hands so that their backs touch then turning them so that
the palms face the ceiling.

These are only a few key exercises. Many more are useful for preventing
repetitive strain. Try to find the best series for your areas of ension
and particular relaxation needs. Frequent breaks yield better long erm
productivity!

16. Q. I've heard many names for keyboard injuries. What do they all mean?

A. Repetitive Strain Injury (RSI) is a description of an injury associated
any repetitive activity such as hammering, piano playing, truck driving,
computer use, or even shaking hands. Occupational Overuse Syndrome (OOS),
Cumulative Trauma Disorder (CTD), and Work Related Upper Limb Disorders
(WRULD), are all equivalent expressions to RSI.

Tendonitis and tenosynovitis are characterized by inflammation of tendo ns
or their surrounding sheaths, respectively. Both of these RSI disorders
usually begin as mildly aggravating and, given bad habits, may quickly
progress to be severely debilitating. These common RSI injuries also add
to he difficulty of proper diagnosis and deserve greater recognition.
These endon inflammations usually occur before full blown Carpal Tunnel
Syndrome.

Carpal Tunnel Syndrome (CTS) is a specific, severe, and debilitating form
of RSI which describes a squeezing of the median nerve as it runs to hand.
The nerve is squeezed by swollen tendons surrounding it as they cross
hrough a tunnel made by ligaments at the inside of the wrist.

The National Center for Health Statistics estimates at least 1.89 milli on
people have Carpal Tunnel Syndrome. Many experts feel that CTS is also
associated with nerve compression symptoms in the chest or shoulders.
**All RSI symptoms should receive immediate medical attention from
physicians experienced in RSI.**

17. Q. Advice by Health Care Practitioners often includes a collection of
erms from a kinesiology course. Which ones do I need to know to help
identify my own workstation ergonomic problems?

A. Standing with the arms at your sides, palms facing forward, "flexion"
is folding of any joint of the body so that the angle between the parts
decreases in the forward direction, except at the knee and toes. Returning
he joint to its straight position requires "extension".

A joint which continues its extension past its straight posture is in
"hyperextension". This occurs in the hand and wrist when you pull the
fingers back.

Standing with your arms at your sides, palms facing forward, "pronation"
is the turning of your hand so that you thumb points toward your leg.
"Suppination" is the opposite movement.

18. Q. Why does it seem like RSI from keyboarding has become such a big
problem recently?

A. One reason why RSI is becoming more prevalent is because computers are
now allowing us to do more office tasks which formerly allowed us to
change activity. For example, a typewriter at one time required using a
return carriage, "white out" for mistakes, breaks for paper installation,
and getting up to file papers in a cabinet.

Computer word-processing now eliminates these "microbreaks". In short,
computers have greatly simplified office activity, an advance that has at
least one important disadvantage. The danger is found in the possibility
for long duration, continuous, and relatively motion free, precise,
muscular activity called "static exertion". Humans were not well
"designed" for this.

19. Q. What lifestyle changes can I make to reduce the chances of RSI?

A. Two main themes permeate ergonomic study of RSI prevention; posture and
relaxation. Appropriate postures are necessary to keep the strain of
performing work in a near stationary position (static exertion) to a
minimum. But even the best postures can fall prey to overload when with
bad habits.

Relaxation is critical to the body's resilience, its ability to recover
from keyboarding. Office workload dynamics can have a great influence on
the risk of RSI. Try to promote office policies which emphasize steady
work load schedules and avoid, or at least distribute, crises deadlines.

Stretching and strengthening active muscles promotes relaxation.
Relaxation is as important for prevention of RSI symptoms as it is for
general well-being. Take a new, more active role in promoting your general
fitness both at and away from work. If you don't exercise regularly and
your over 40, get clearance from a physician to add walking, bicycling, or
swimming to your weekly schedule on three separate days.

Cut down on stimulants like coffee, sweets, or nicotine and spread healthy
snacks and water intake throughout the day. Keep water at your desk as it
makes for a smart microbreak. The first symptom of dehydration is fatigue,
not thirst!

Fruit and vegatable snacks prevent mid-morning and mid-afternoon blood
sugar drops. These dips can effect alertness, mood, productivity, and
decision making. A diet emphasizing complex carbohydrates, reliable
sleeping patterns, and time for yourself can do wonders for 9 to 5
productivity, not to mention your own well-being. All habits and practices
hat promote relaxation are necessary to stop the threat of RSI. Good Luck.

During doctoral research in Exercise Physiology/Biomechanics at the University
of Southern California, Jonathan completed groundbreaking electromyographic
(EMG) research on repetitive strain injuries to the forearm. He currently
moderates seminars, writes and speaks on ergonomic topics, consults for Los
Angeles firms, and continues further research at USC. Dr. Bailin can be reached
at 310/390-8309 or [email protected].
-------------------------------------------------------------------------------

Requests for more info

Clearly, the above information is incomplete. The typing-injury archive is
incomplete. There's always more information out there. If you'd like to submit
something, please send me mail, and I'll gladly throw it in.

If you'd like to maintain a list of products or vendors, that would be
wonderful! I'd love somebody to make a comprehensive list of mice. I'd love
somebody to make a list of doctors. I'd love somebody to edit the above
sections, looking for places where I've obviously goofed.
-------------------------------------------------------------------------------

References

Much of the information here is derived from a wonderful guide produced in New
Zealand by their Occupational Safety & Health Service, a service of their
Department of Labour. Special thanks to the authors: Wigley, Turner, Blake,
Darby, McInnes, and Harding.

Semi-bibliographic reference:

* Occupational Overuse Syndrome
Treatment and Rehabilitation:
A Practitioner's Guide

Published by the Occupational Safety and Health Service
Department of Labour
Wellington, New Zealand.

First Edition: June 1992
ISBN 0-477-3499-3

Price: $9.95 (New Zealand $'s, of course)

Thanks to Richard Donkin <[email protected]> for reviewing this
posting.
--
Dan Wallach Princeton University, Computer Science Department
[email protected] http://www.cs.princeton.edu/~dwallach/ PGP Ready