Repetitive Stress Injuries - A Personal Viewpoint
Lisa Balbes
Balbes Consultants
648 Simmons Ave.
Kirkwood, MO 63122 USA
E-mail: lisa@balbes.com
http://www.netsci.org/Science/Special/feature02.html
Repetitive Stress Injuries (including, but not limited to, carpal tunnel syndrome) are getting to be a common problem. So common, in fact, that I was surprised at how little trouble I had finding personal stories for this article. Virtually everyone I talked to either had problems themselves, or knew several others who did.
The main themes that recurred in every story I heard were:
- Prevention is the absolute key. Once the pain and problems
start, they never completely go away. Symptoms can sometimes be
reduced by changing lifestyle and work habits, but since problems
result from cumulative use, the sooner the proper techniques are
started, the better.
- To reduce the stress on hands and wrists, it is imperative to
use ergonomically designed equipment, which force good hand and arm
positioning, and to take frequent breaks during work sessions.
- It's not just keyboarding, but any type of repetitive or long
term action which will stress the hands and wrists. Piano playing,
hand sewing, sleeping with hands curled, among other things, all
stress the wrists, and contribute to problems.
- At the first sign of trouble, seek professional help. Splints to force proper hand position and anti-inflammatory drugs can help with some of the early symptoms, and perhaps eliminate the need for surgery. Not all doctors are familiar with this problem and its infinite variations, so seek out one who is. Do your own research as well, and don't be afraid to question your doctor's advice. If you work for a large company, their health services department may be more up-to-date than your personal physician.
Remember, no one else cares about your health as much as you do, so it's up to you to be pro-active and know you're not causing yourself long-term harm. The following are several personal stories that represent the range of problems and solutions various people have encountered.
Carolyn P.
(Technical Manager)
During the nineteen year span of her career, Carolyn has held a variety of technical positions, all of which required inputting data into a computer at least half the day. She has also played the piano for 10 years and so always uses proper keyboarding techniques. She has also been doing tapestry, cross-stitch or crewel embroidery for over 22 years.
About two years ago she started back into cross-stitch with a gusto, averaging 3 to 4 hours a day, in addition to the typing at work. Weekends meant no typing, but 8 hours of sewing. After several months of this schedule, her wrist was sore, but she found that taking a break from sewing for a couple of days eliminated the pain.
After an accident in February, she found that the pain in her wrists kept increasing and didn't go away when she quit sewing. The pain went from her finger up her arm when using the mouse, partially along the scar from a ganglion problem. Both wrists hurt, however, the pain appeared to be concentrated in the right wrist. She found that she couldn't cross-stitch anymore, had to open doors and work with her mouse left-handed, and couldn't open bottles. Eventually, she was unable to put any weight on it at all.
Since she gave up sewing completely and started taking physiotherapy twice a week, she has been able to continue working by using a split keyboard and a brace when typing. The brace has a metal strip under the wrist to prevent it from bending. After several weeks she was able to sew for limited periods of time by wearing a brace and by using special gloves and a stand to hold her work. While the extreme pain is gone, she states that her wrist still aches all the time.
What will happen when she finishes therapy is unknown. She hasn't been diagnosed with true carpal tunnel (because of the ganglion problem), but her life has changed considerably. Her wrists constantly ache, and while she used to have considerable upper body strength, she is now happy to be able to uncap soda bottles that have been previously opened.
Elizabeth R.
(Medical Secretary)
Elizabeth started having trouble with both hands and her elbows after working at the word processor for about six months. The keyboard was on the top of her desk, which felt a little high, and probably caused much of the problem. She experienced tingling in her hands most of the time and an uncomfortable feeling (not pain) in her elbows. Consultation with a specialist and a nerve conduction test indicated surgery was not required.
Instead, Elizabeth was advised to wear splints at work for about three months to support her wrists, and to have a pull-out drawer installed under her desk to lower the keyboard. This, coupled with a reduction in her workload, reduced the stress to her arms and wrists. After three months, she found that the tingling diminished to the point where it was no longer necessary for her to wear splints.
Today (3 years later), Elizabeth always uses a wrist support pad when typing, and is always aware of her wrist position. She has also found that she has to limit her activities. For example, if she does a lot of word processing (typing 3-4 hours), her wrists will begin to feel uncomfortable.
Kim J.
(Senior Software Engineer)
Kim graduated from college and started working on a computer full-time in June of 1984. A year or so later, she started having a lot of tingling and numbness in her right wrist. The discomfort continued to grow, and she eventually started having trouble holding objects for very long. For instance, she was unable to dry her hair with a hair dryer because her hand would get numb and she would drop the dryer.
Kim initially consulted a general practitioner. He gave her an anti-inflammatory drug to reduce swelling, and put her right arm in a splint which started just below the elbow and continued to the palm (stopping just before the fingers). The purpose of the splint was to immobilize the wrist and reduce the pressure on the nerve in the carpal tunnel. Kim wore the splint at all times (except when bathing) and took the medication faithfully. During this period, Kim learned that she had been sleeping with her hands curled which contributed to her problem. Unfortunately, wearing the splint on her right arm put all the strain on her left arm, so after a few weeks she started having the same problems with her left wrist. For another 6 weeks, she wore splints on both wrists, but had no noticeable improvement.
The next step in Kim's therapy was to consulted an orthopedist, who advised that the only way to fix the problem was surgery to open up the tunnel. Kim chose to have both wrists done during the same surgery in order to reduce the total recovery time (about 10 days). The surgery lasted about an hour, and left her with scars about one and a half inches long on each wrist. After surgery, she had bandages and new splints. Initially, she also had quarter sized dead areas in the palms of her hands. These shrank to a pea-sized area over 4 to 8 weeks, and disappeared completely after a few months.
The surgery did improve her wrists, and she's glad she had it done. However, she does still have problems when she keeps her wrists in a bent position for an extended period of time, and has learned the hard way to be careful with what she does.
Martha Beth L.
(piano teacher and author)
Martha Beth believes her problems were caused by a combination of excessive typing and piano playing. As a professional piano teacher, she has good, flat wrists, so overuse, not hand position was probably at fault. A contributing factor was a change in computer keyboards, to a stiffer one, which required typing harder. This constant jarring, and the increase in quantity of typing, probably precipitated her problems. Her symptoms originally included an ache in the elbow (tennis elbow tendinitis), and later progressed into a burning pain in the wrists and forearms.
Martha Beth has found a few things that help relieve her pain. A physical therapist told her about some exercises to use before starting an extended session of keyboarding (put palms together in front of the body at chest height, then lowering them while keeping the palms together). She takes a break every 10-20 minutes or so while working, and pays close attention to hand position at the keyboard and while sleeping. She also uses spandex gloves (HandEze) and wristband supports (Pro) on both hands. An orthopedist suggested that during particularly bad times, Advil and ice packs (or a bag of frozen peas) on the wrists in evening can help reduce the inflammation. By far the best prevention from her flare-ups is judicious use of the keyboard.
She thinks that "One thing that would help is if keyboard manufacturers would pay attention to downweight of the keyboard (how many grams of pressure are necessary to make the key go down). If they'd make keyboards requiring less downweight, then list the downweight as part of the specs, they would save people lots of pain and probably boost their revenue in the process."
Mickey C.
(homemaker and needleworker)
In September of 1994, Mickey and her husband bought a computer. After getting it home, they got hooked up to the internet and the WWW. Mickey's downfall was live chatting. She would stay on-line for up to 4 hours in a single session, typing as fast as her fingers could fly across the keyboard. After 2 months with the new computer, in addition to cross stitching and crocheting, she was in constant pain. Even the smallest things were affected. It hurt to staple papers together, and eventually she became unable to staple at all with her right hand, she couldn't open a new jar, and even wringing out a wash cloth hurt.
The pain got so bad that she finally went to the doctor. By this time, her major symptoms were severe pain on the inside of the wrist and the palm of the hand, burning in her fingers, wrist and palm, pain on top of her arm near the elbow and cramping in her little finger. The doctor did some mobility and stress tests, and then diagnosed carpal tunnel syndrome. Mickey was given a brace with a metal piece down the inside of the wrist, to wear for 6 weeks. It helped the wrist and hand, but made the pain in the top of her arm worse. She then switched to a Night Timer Brace - a band with velcro around the wrist, with a loop that goes around the middle finger to keep the wrist from bending. This one does seem to be helping. Her next step will be to see a specialist.
Sue M.
(Systems Analyst)
Sue's right hand started tingling during the day, and going numb at night. The first time it happened, it went away after a few days, so she assumed she had just strained just something. The second time it happened, a month later, she decided to get it looked at, even though she had just had a complete physical.
After listening to Sue describe her symptoms, and finding out she was a programmer, the doctor immediately diagnosed carpal tunnel syndrome. The doctor was unable to provide anything other than clinical information about the syndrome. Sue was told there was nothing she could do, except wear a wrist splint at work and at night.
Upon returning to work, Sue contacted her company's Health Services department. She was pleasantly surprised at how helpful and attentive they were -- much, much better than her own doctor. Sue learned that there were alternative diagnoses, and that there was a lot she could do to prevent further damage to her hands. She immediately got a wrist rest for both her keyboard and mouse. The company's on-staff physical therapist visited her office and not only examined her wrist, but also adjusted her workstation and chair to the correct heights. The therapist told Sue to wear the splints only at night, to see if that and the height adjustments eliminated the problems. She got information on exercises to loosen up her hands, and lots on ergonomics and things to do to relax/stretch during the day.
Sue says "I think my work "life" has actually been improved by this, because I now know that I'm working in a way that's hopefully not going to further damage my body over time. This has made me more aware of how I work, and how these things really do have an impact over time. I've been programming for about 8 years, and I hope to be able to do this for a lot longer! A computer really is a tool, and we simply need better education about how to use this tool, so that we don't hurt ourselves in the process of doing our work."
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