Harris RSI -- LISA '99 1 Look, Ma, no hands! Coping with Repetitive Strain Injury Trey Harris Mail.com [email protected] http:// metalab.unc.edu/ ~harris/rsi
Jan 05, 2016
Harris RSI -- LISA '99 1
Look, Ma, no hands! Coping with Repetitive Strain Injury
Trey [email protected]://metalab.unc.edu/~harris/rsi
Harris RSI -- LISA '99 2
A disclaimer I’m not a medical practitioner This talk is for informational
purposes only, and is not intended to diagnose or treat any illness or disease
Follow my suggestions at your own risk
Harris RSI -- LISA '99 3
Myth #1 “I don’t type a lot, so I can’t
get RSI.”
Harris RSI -- LISA '99 4
Myth #1 “I don’t type a lot, so I can’t
get RSI.” Fact: Anyone who types more
than two hours a day is at risk for RSI
Harris RSI -- LISA '99 5
Myth #2 RSI is mostly psychosomatic
Harris RSI -- LISA '99 6
Myth #2 RSI is mostly psychosomatic Fact: Though usually invisible,
RSI is a soft tissue injury susceptible to medical diagnosis and treatment
Harris RSI -- LISA '99 7
Myth #3 “I don’t touch type, so I can’t
get RSI.”
Harris RSI -- LISA '99 8
Myth #3 “I don’t touch type, so I can’t
get RSI.” Fact: though hunt-and-peckers
are less likely to develop RSI, certain habits (such as holding up the thumbs or making a fist while typing) can cause serious ailments
Harris RSI -- LISA '99 9
Myth #4 Carpal tunnel syndrome is the
most common kind of RSI
Harris RSI -- LISA '99 10
Myth #4 Carpal tunnel syndrome is the
most common kind of RSI Fact: CTS is actually one of the
rarest forms of RSI, and its over-diagnosis and over-hyping can be a barrier to effective treatment for RSI patients
Harris RSI -- LISA '99 11
Myth #5 “My symptoms have been like
this for years, so I guess it won’t get any worse.”
Harris RSI -- LISA '99 12
Myth #5 “My symptoms have been like
this for years, so I guess it won’t get any worse.”
Fact: RSI is progressive, and even if the pain doesn’t get worse, permanent disability is possible if the injury gets bad enough
Harris RSI -- LISA '99 13
Myth #6 “If my hands get really bad, I
can always switch to voice dictation until it gets better.”
Harris RSI -- LISA '99 14
Myth #6 “If my hands get really bad, I
can always switch to voice dictation until it gets better.”
Fact: Current voice dictation systems are a poor substitute for the keyboard, especially for technical workers
Harris RSI -- LISA '99 15
My story Binge typing Poor posture and awful
ergonomics Years of incremental
adjustments Denial Finally, a scare
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A week of terror inability to type excruciating pain soreness and heaviness clumsiness hyperawareness & an “injured
feeling”
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I’m going to fix this! Appt. w/doctor Braces Voice dictation
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Down and dirty with dictation Training
and frustration I don’t do Windows!
more frustration How do you pronounce “s/^\
S+([^:])*/$1.old/”? even more frustration
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A demonstration Dragon NaturallySpeaking
Professional Only available from certain
consulting vendors Teen, Standard or Preferred won’t
work “conversational” speech system
This laptop 300 MHz Intel Celeron 96MB RAM
How it’ll work (It’s going to be excruciating)
Harris RSI -- LISA '99 20
Troubles in voice-land Passwords? Curses/cbreak programs are
dangerous Many GUIs don’t work well with
speech The command line is doable, but hard X is near impossible Errors Discrete systems are better except
when they’re worse Laryngitis is an RSI
Harris RSI -- LISA '99 21
A disturbing prognosis Diagnostics
The Poking Test The Prodding Test The Shocking Test The Numbing Test
So what is it, anyway? Treatment: braces -- and
maybe surgery Did you say permanent???
Harris RSI -- LISA '99 22
A friend steps in Pascarelli & Quilter, Repetitive
Strain Injury (John Wiley & Sons, 1994)
I do a lot of self-education
Harris RSI -- LISA '99 23
What is RSI? Repetitive Strain Injury RSI != Carpal Tunnel Syndrome Umbrella term for Cumulative
Trauma Disorders (CTD) stemming from hand movements that are: prolonged repetitive forceful awkward
Harris RSI -- LISA '99 24
What does RSI affect? Involves damage to:
muscles tendons nerves
In the areas of: neck shoulder arms hand
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What does RSI feel like? Great variability between sufferers,
but commonly reported symptoms include: Pain
acute (stabbing) or chronic (soreness)
shooting or localized brief or long-lasting
Weakness Numbness or other neurological
symptoms (referred pain, etc.) Motor impairment (clumsiness, etc.)
Harris RSI -- LISA '99 26
Warning signs of RSI Pain during typing Difficulty with ordinary chores Opening doors with shoulders or feet Stiffness, weakness, or lack of
endurance Heaviness Lack of coordination, dropping things Cold hands Hyperawareness of hands Frequent self-massage or “cracking”
Harris RSI -- LISA '99 27
Causes of RSI Repetition Ignorance of proper use of the
hand Poor posture Holding still Being out of shape Forced speed Overwork Excessive monitoring Lack of job satisfaction
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RSI isn’t a fracture RSI is a soft tissue injury, so:
it comes on very slowly it takes a long time to heal rest alone will not affect recovery it rarely comes back to 100% relapses are par for the course endurance is the last thing to return symptoms poorly differentiate—a
successful treatment of one ailment often reveals other undiscovered ones
Harris RSI -- LISA '99 29
Types of RSI Muscle & tendon disorders Cervical radiculopathy Epicondylitis & ganglion cysts Tunnel syndromes Nerve & circulatory disorders Other associated disorders
Harris RSI -- LISA '99 30
Muscle & tendon disorders Muscle and tendon disorders
Myofascial damage Tenosynovitis Stenosing tenosynovitis
DeQuervain’s disease Flexor tenosynovitis (trigger
finger)
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Tendinitis Shoulder tendinitis
Bicipital tendinitis Rotator cuff tendinitis
Forearm tendinitis Flexor carpi radialis tendinitis Extensor tendinitis Flexor tendinitis
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Cervical radiculopathy “phone shoulder syndrome”
Harris RSI -- LISA '99 33
Epicondylitis & ganglion cysts Epicondylitis
lateral (tennis elbow, bowler’s elbow, pitcher’s elbow)
medial (golfer’s elbow) Ganglion cysts (“bible bumps”)
Harris RSI -- LISA '99 34
Tunnel syndromes & CTS Tunnel syndromes involve three
nerves: median (middle) radial (thumb side) ulnar (pinkie side)
Median nerve -- Carpal Tunnel Syndrome Dynamic (RSI) Passive (rheumatoid arthritis,
gout, diabetes, hypothyroidism, etc.)
Harris RSI -- LISA '99 35
CTS is rare Carpal tunnel syndrome is one
of the rarest forms of RSI 15% of office workers have
some form of RSI < 1% have CTS
So why is it so prevalent in discussion? Obvious treatment options Medically less controversial Profitable for surgeons
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Radial and ulnar tunnel syndromes Radial Tunnel Syndrome Ulnar Nerve Disorders
Sulcus Ulnaris Syndrome Cubital Tunnel Syndrome Guyon’s Canal Syndrome
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Nerve & circulatory disorders Thoracic Outlet Syndrome Raynaud’s Phenomenon
Harris RSI -- LISA '99 38
Other associated disorders Reflex Sympathetic
Dysfunction or Dystrophy (RSD)
Focal Dystonia (writer’s cramp)
Osteoarthritis Fibromyalgia Dupuytren’s Contracture
Harris RSI -- LISA '99 39
I take control Get rid of the braces Insist on a better diagnosis Abort the path towards
surgery Start aggressive physical
therapy and bodywork
Harris RSI -- LISA '99 40
The traditional medical team General, family or adult practitioner Physical therapist(s) Specialists:
Orthopedist Hand surgeon Neurologist Occupational/sports medicine
doctor Physiatrist Rheumatologist
Pain management specialist
Harris RSI -- LISA '99 41
The alternative medical team Massage therapist(s)
neuromuscular therapy Swedish or shiatsu Rolfing or Hellerwork Feldenkrais
Osteopath or chiropractor Acupuncturist Naturopath Yoga instructor
Harris RSI -- LISA '99 42
Medication Non-steroidal anti-
inflammatories (NSAIDs) ibuprofen or fenoprofen Butazolidin, Indocin, Voltaren
Pain medication OTC: aspirin, acetaminophen Painkillers: codeine, Perkocet,
hydrocodone Cortisone
Harris RSI -- LISA '99 43
Splinting Splints are controversial Often indicated for CTS or
DeQuervain’s syndrome NEVER use them while
typing!!! “Braces” aren’t much better
Harris RSI -- LISA '99 44
Surgery Is it really necessary? Is surgery efficacious for this
condition? Have all nonoperative
techniques been eliminated? Is it a quick fix? Get a second opinion (and a
third, and a fourth…)
Harris RSI -- LISA '99 45
Physical Therapy Deep-tissue massage Phonophoresis Iontophoresis Ultrasound Transcutaneous electrical
nerve stimulation (TENS) Upper body exerciser (UBE)
machine Neuromuscular stretches
Harris RSI -- LISA '99 46
Occupational Therapy Work hardening is a no-no for
RSI Posture retraining Preventative exercise
Stretching Strengthening
Harris RSI -- LISA '99 47
Alternative therapies Acupuncture Spinal manipulation Massage therapy Vitamins Yoga
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What not to do Don’t self-diagnose! Don’t exercise without the advice
and consent of your practitioner Don’t rush to surgery Don’t look for an easy way out Don’t let your doctor talk you
into treatment options you don’t want
Don’t fall for “ergonomic” gimmicks
Harris RSI -- LISA '99 49
Your recovery Stop (or at least reduce) the
injurious behavior See a doctor trained in soft-tissue
injuries Start medical treatment Investigate alternative care, if
appropriate Develop new long-term work and
living habits Develop a maintenance plan
(exercise and massage)
Harris RSI -- LISA '99 50
First step: stop hurting yourself Take a break Take the day off Take vacation Take disability leave Take unemployment Whatever it takes -- don’t let
RSI become something worse Permanent disability can set in
within weeks or months if you don’t do something now
Harris RSI -- LISA '99 51
But is it really that serious? It is, if you experience any of the
following: Pain
bad enough to bring tears that doesn’t go away with a break,
that you go to bed with, or wake up with
that wakes you up at night that changes your daily routine
Neurological symptoms Clumsiness, or an “out of control”
feeling Numbness or paralysis
Harris RSI -- LISA '99 52
Rest Refers to the temporary
cessation of injurious behavior, not to stopping activity with the injured part entirely
Gentle motion is necessary Therapy begins during the rest
period
Harris RSI -- LISA '99 53
Patience! RSI takes a long time to heal Endurance is the last thing to
return Keep a log
Harris RSI -- LISA '99 54
Living and coping Reduce and improve overall
hand and arm use, not just typing
Take frequent breaks Pay attention to the signals
your body is giving you
Harris RSI -- LISA '99 55
I learn to live Services, services, services! You don’t look injured…. The bag, the book, and the
handshake Dealing with doors Flex those schedules!
Harris RSI -- LISA '99 56
Prioritize What uses of your hands are
really important to you? Work Household chores Driving Recreation
Find ways to eliminate or reduce the less important ones
Harris RSI -- LISA '99 57
Dealing with flare-ups Ice Heat Frequent breaks Stretches
Harris RSI -- LISA '99 58
Ergonomics 101 Goal: free, effortless movement of
body Everyone is different The injurious positions:
pronation ulnar deviation dorsiflexion
Tense, constrained movements are never good, no matter how “correct”
Even the best positioning needs to be changed frequently
Harris RSI -- LISA '99 59
Ergonomics 101 Get your chair up! Get your keyboard down! Put down those kickstands! Get rid of your wrist rest (for
awhile) Keyboards are bad Mice are worse Trackballs are awful Adjustability is essential
Harris RSI -- LISA '99 60
The keyboard Fancy keyboards aren’t always
the best
Harris RSI -- LISA '99 61
Ergonomic keyboards
Comfort Keyboard too adjustable?
Harris RSI -- LISA '99 62
Ergonomic keyboards
Microsoft Natural Not adjustable Requires
radial deviation
Forward tilt is good
Harris RSI -- LISA '99 63
Ergonomic keyboards IBM Options
separate pieces allow for infinite adjustability
but discontinued...
Harris RSI -- LISA '99 64
The mouse An ergonomic nightmare Options to think about
Cordless mouse New Microsoft Intellimouse
Avoid using the mouse whenever you can
Harris RSI -- LISA '99 65
Alternate pointing devices Trackballs are bad Graphic tablets are pretty
good Avoid pronation, dorsiflexion
and ulnar deviation
Harris RSI -- LISA '99 66
An example of bad ergonomics Logitech Trackman Marble FX
Harris RSI -- LISA '99 67
What about laptops? You can use a laptop
ergonomically Lighter vs.. bigger keyboard Move around!
Harris RSI -- LISA '99 68
Ergonomic furniture 101 The table The chair The keyboard tray
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The table Sit/stand stations are the best Flat if you have a keyboard
tray Sectioned if you don’t Easy resetting to presets Does it float?
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The chair Height Forward tilt Lumbar support Armrests
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The keyboard tray Get one
Evaluate knee clearance Adjust it carefully; for best results,
get an ergonomist to do it for you Non-adjustable trays are
unacceptable and ergonomically the same as a fixed table
If your table is sufficiently adjustable, you can use it instead
Does it hold your mouse too?
Harris RSI -- LISA '99 72
The ideal ergonomic setup (IMHO) Good chair Flat sit/stand station Keyboard tray w/mouse pad Graphics tablet LCD screen
Harris RSI -- LISA '99 73
Random ergonomic nostrums
Wrist rests Forearm rests Cording
keyboards Weird input
devices
Harris RSI -- LISA '99 74
Web sites for more info The Typing Injury FAQ --
www.tifaq.org Deborah Quilter’s
www.rsihelp.com
Harris RSI -- LISA '99 75
Slides http://metalab.unc.edu/
~harris/rsi