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Followup-To: sci.med.occupational
Summary: information about where to get more information
Newsgroups: bit.listserv.c+health
Date:         Sun, 10 Jan 1993 17:43:01 PST
Reply-To:     Dan Wallach <dwallach@cs.berkeley.edu>
From:         Dan Wallach <dwallach@ZONKER.CS.BERKELEY.EDU>
Subject:      FAQ: Typing Injuries (1/3): General Info [monthly posting]
Comments: To: c+health@iubvm.ucs.indiana.edu

Archive-name: typing-injury-faq/general
Version: $Revision: 4.20 $ $Date: 1993/01/05 02:59:42 $

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

Copyright 1992,1993 by Dan Wallach <dwallach@cs.berkeley.edu>

The opinions in here are my own, unless otherwise mentioned, and do not
represent the opinions of any organization or vendor.  I'm not a medical
doctor, so my advice should be taken with many grains of salt.

Changes since previously distributed versions are marked with change        ||
bars to the right of the text, as is this paragraph.                        ||

[Current distribution: sci.med, news.answers, and e-mail to
                       c+health@iubvm.ucs.indiana.edu and
                       sorehand@vm.ucsf.edu]

Table of Contents:
    ==1== Mailing lists, newsgroups, etc.
    ==2== The soda.berkeley.edu archive
    ==3== General info on injuries
    ==4== Typing posture, ergonomics, prevention, treatment
    ==5== Requests for more info
    ==6== References

==1== Mailing lists, newsgroups, etc.

USENET News:
-----------
comp.human-factors occasionally has discussion about alternative input devices.
comp.risks has an occasional posting relevant to injuries via computers.
sci.med and misc.handicap also tend to have relevant traffic.

There's a Brand New newsgroup, sci.med.occupational, chartered specifically
to discuss these things.  This would be the recommended place to post.

Mailing lists:
-------------
The RSI Network: Available both on paper and via e-mail, this publication
    covers issues relevant to those with repetitive stress injuries.  For
    a sample issue and subscription information, send a stamped, self-
    addressed business envelope to Caroline Rose, 970 Paradise Way, Palo
    Alto CA 94306.

    E-mail to <crose@applelink.apple.com>

    $2 donation, requested.

    All RSI Network newsletters are available via anonymous ftp from        ||
    soda.berkeley.edu (see below for details).                              ||

c+health and sorehand are both IBM Listserv things.  For those familiar
    with Listserv, here's the quick info:

    c+health -- subscribe to listserv@iubvm.ucs.indiana.edu
                post to c+health@iubvm.ucs.indiana.edu

    sorehand -- subscribe to listserv@vm.ucsf.edu
                post to sorehand@vm.ucsf.edu

Quick tutorial on subscribing to a Listserv:
    % mail listserv@vm.ucsf.edu
    Subject: Total Listserv Mania!

    SUBSCRIBE SOREHAND J. Random Hacker
    INFO ?
    .
That's all there is to it.  You'll get bunches of mail back from the Listserv,
including a list of other possible commands you can mail.  Cool, huh?  What'll
those BITNET people think of, next?

==2== The soda.berkeley.edu archive

I've started an archive site for info related to typing injuries.  Just
anonymous ftp to soda.berkeley.edu:pub/typing-injury.  (128.32.149.19)
Currently, you'll find:

Informative files:
    typing-injury-faq/
        general           -- information about typing injuries
        keyboards         -- products to replace your keyboard
        software          -- software to watch your keyboard usage

    keyboard-commentary   -- my personal opinions on the keyboard replacements
    carpal.info           -- info on Carpal Tunnel Syndrome
    carpal.surgery        -- JAMA article on CTS surgery
    carpal.tidbits        -- TidBITS article on CTS
    tendonitis.info       -- info on Tendonitis
    datahand.review       -- detailed review of the DataHand
    datahand.review2      -- follow-up to above
    datahand.desc         -- description of the DataHand's appearance
    rsi.biblio            -- bibliography of RSI-related publications

    rsi-network/*         -- archive of the RSI Network newsletter

    comfort-*             -- marketing info on the Comfort Keyboard         ||
    maltron-*             -- marketing info on various Maltron products     ||

Programs:
    (With the exception of accpak.exe, everything here is distributed as    ||
     source to be compiled with a Unix system.  Some programs take advantage||
     of the X windows system, also.)                                        ||

    hsh.shar              -- a program for one-handed usage of normal keyboards
    typewatch.shar        -- tells you when to take a break
    xdvorak.c             -- turns your QWERTY keyboard into Dvorak
    xidle.shar            -- keeps track of how long you've been typing
    rest-reminder.shar    -- yet another idle watcher
    kt14.tar              -- generates fake X keyboard events from the      ||
                             serial port -- use a PC keyboard on anything!  ||
    accpak.exe            -- a serial port keyboard spoofer for MS Windows  ||

    (Note: a2x.tar and rk.tar are both from export.lcs.mit.edu:contrib/     ||
     so they may have a more current version than soda.)                    ||

    a2x.tar               -- a more sophisticated X keyboard/mouse spoofing ||
                             program.  Supports DragonDictate.              ||
    rk.tar                -- the reactive keyboard -- predicts what you'll  ||
                             type next -- saves typing                      ||

Pictures (in the gifs subdirectory):
    howtosit.gif          -- picture of good sitting posture
    accukey1.gif          -- fuzzy picture
    accukey2.gif          -- fuzzy picture with somebody using it
    bat.gif               -- the InfoGrip Bat
    comfort.gif           -- the Health Care Comfort Keyboard
    datahand1.gif         -- fuzzy picture
    datahand2.gif         -- key layout schematic
    datahand3.gif         -- a much better picture of the datahand
    kinesis.gif           -- the Kinesis Ergonomic Keyboard
    maltron[1-4].gif      -- several pictures of Maltron products
    mikey1.gif            -- the MIKey
    mikey2.gif            -- Schematic Picture of the MIKey
    twiddler1.gif         -- "front" view
    twiddler2.gif         -- "side" view
    wave.gif              -- the Iocomm `Wave' keyboard

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

If you're unable to ftp to soda, send me e-mail and we'll see what we
can arrange.

==3== 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).

==4== 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 -- here are 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. -- dwallach]

. 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.

==5== 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 list of chair/desk vendors.  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.

==6== References

I completely rewrote the information section here, using 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 <richardd@hoskyns.co.uk> for reviewing this posting.


Mailing date: Sun Jan 10 17:43:00 PST 1993
--
Dan Wallach               "One of the most attractive features of a Connection
dwallach@cs.berkeley.edu  Machine is the array of blinking lights on the faces
Office#: 510-642-9585     of its cabinet." -- CM Paris Ref. Manual, v6.0, p48.
Comments: Gated by NETNEWS@AUVM.AMERICAN.EDU