RSI - My Problem Child: 10 tips for recovery

Laptop keyboard by DarkSideXSeeing a few recent posts on repetitive stress injuries on Hacker News, I've decided to finally collect all the replies I've written over the years in one place.

About 9 years ago I developed a classic case of RSI.  I was working on an ASIC design, and one task involved the non-automatable editing of a large number of logic cells.  Repeating the same motion for hours, then days, wrecked havoc on my wrists, and they began to be infused with a dull pain, when then became a sharp pain all hours of the day.  It was so bad that each keypress and mouse-click caused a sharp sting, and I could not sleep at night from the aching.  All I got from seeing a specialist was that I did not have Carpel Tunnel Syndrome, and that I should rest my wrists.  Since I rely on my wrists for work and play, I took drastic action...

1. Cut out all recreational computer use.

It's what caused the problems in the first place.  The wrists won't heal if they can't rest.

2. Use wrist braces.

Braces maintained my wrists in the proper position, so that I cannot twist them into angles which exacerbate the injury. I chose ones with a built-in splint to further prevent improper motion (Amazon link to similar ones).

3. Switch to an ergonomic keyboard.

I discovered from my online research that the wrists' natural position is thumbs-up, but when typing on a typical keyboard, the wrists have to pronate (turn face-down), causing pressure on the nerves.  I purchased an ErgoLogic keyboard (unfortunately no longer made, but you can see a picture here) which can rotate so that the keypads are vertical.  Not only was it good for my wrists, it finally forced me to fully touch-type.

4. Use a trackball.

Problems with using a mouse: I had to pronate my wrist, and I had to pick up and move the mouse, which rotated the wrist.

My first trackball was the Finger Mouse (Amazon link).  It avoided both the pronation and rotation problems, but was inconvenient due to my having to repeatedly pick it up and put it down.  Once my wrist healed enough, I switched to the Logitech Trackman Mouse (Amazon link) due to it being left/right symmetric, which is a feature I wanted for my next action.

5. Learn to use a trackball with either hand.

If you must compute, and your mousing hand is killing you, switching hands will give you some temporary relief until your other hand's injuries catch up with you.  However, sometimes that few minutes is all you need to get the job done.  Just don't abuse the privilege.

6. Add foot pedals to the trackball.

At one point, clicking mouse buttons were levels more painful than typing, so I took the soldering iron to the trackball, added wires to the left and right buttons, connected the wires to 1/4" mono jacks, and plugged in sustain pedals (Amazon link).  I was then able to do mouse clicks with my feet.  If you're are even more engineering-inclined, you can try building a full footmouse.

7. Switch to a more efficient keyboard mapping.

I switched my keyboard mapping to Dvorak, which had two benefits.  One, the main reason for switching to Dvorak, is that finger travel distances were shorter and stronger fingers typed the more frequently used keys, which meant more efficient typing.  But the second reason was just as helpful, that learning a new mapping made me type slower.

When people think about alternate keyboard mappings, Dvorak is usually the first that comes to mind.  However there are now several other mappings which may be even better.  Take a look at carPalX to see an analysis of some new layouts.

8. Get a proper computer chair.

If you're spending 3 or more hours a day in that chair, you should make sure it's good for your body.

I don't recall what chair I purchased, but it fit my requirements: adjustable height (so my feet can comfortably touch the floor when I'm sitting properly), good lumbar support (to maintain proper lordosis), arm supports (for me to rest my arms without too much motion), locked seat back (so leaning back still maintains proper posture), and upper back support (for comfort).

9. Use speech recognition software.

We're note quite at Star-Trek-voice-recognition levels, but there are free software available now which will launch applications and drive web browsers for you.  Back in my day, I had to install several pieces of software to do this, but nowadays speech recognition comes built-in starting with Windows Vista.  It's not perfect, but every keypress avoided is helpful.

There are also alternative options such as Dragon NaturallySpeaking (Amazon link), which may have a better recognition engine than the built-in Windows one.

10. Chondroitin / glucosamine / MSM.

My coworker, who had chronic RSI pain, took these supplements regularly to promote collagen repair and reduce swelling, based on advice from his doctor.  I took them for several months as well, although it was difficult to tell what degree they contributed to my recovery.

Even with all the changes I made, it still took about 3 months for the pain to fully subside.  From then on I kept a careful lookout for that familiar ache and used it as a signal to rest, which would periodically return if I was careless about my posture, or if I did not take sufficient breaks during crunch time, or if I went on an MMORPG binge.  Eventually I realized that there was something more I can do.

11. Exercise / eat right / get enough sleep.

For long term healing, the most basic thing to do is to make my body as healthy as possible.  Stronger muscles meant better posture, and being able to hold the posture longer.  Eating right and getting proper sleep meant that I could make my muscles stronger and increase and improve my healing abilities, not to mention all the other benefits such as looking better and being more active and energetic.

I will discuss exercise and food and sleep in future posts, but as a quick preview, exercising for proper posture involves working the core muscles, which are the muscles that hold you upright.  When those muscles are weak, it can lead to all sorts of problems (as pointed out by a recent link on Hacker News).

Eye of the Tiger by varunsuresh
At time went on and I learned to listen to my body, I found myself needing fewer of the techniques I listed.  I currently am only using the trackball/keyboard/chair, in addition to exercising & eating right & properly sleeping.  I have not had any major episodes in the past 7 years.  This experience reminded me that, like any complex machinery, the human body needs constant maintenance and supervision if it is to endure for the multiple decades that it needs to work for; there are no shortcuts, there are no free rides.

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