Check out "Repetitive Strain Injury: A Computer User's Guide" by Emil Pascarelli and Deborah Quilter. First published in 1994, I believe it has either been reissued or followed up by other books on the subject by the same authors. Also see if there is a local support group in your area for any of the conditions listed above.
Be as assertive as you can with your employers regarding adequate ergonometric furniture and computer parts. Wave keyboard. Correct height of components.
Try to use the least effort possible on the keyboard. If you're already getting pain, get it checked out - don't fool around. Check out Dragon Naturally Speaking - you may be able to avoid some keyboard use altogether. Be very careful in your selection of a mouse or other cursor mover - that can be very hard on your hands because it can require very find muscle coordination over and over to place the arrow correctly - more tension in your hands than simply typing (unless you learned to type on a typewriter - then try to lessen stroke impact).
How you sit is especially important: watch your posture - don't let your chin just forward. Be sure your eyes are level with the top of the monitor (sitting for hours with your neck crained upward in hell on neck and shoulders), fix chair height so your forearms are at right angles to your upper arm when you type and your knees are level or a tad lower than your hips (you may need a footrest to achieve this).
All these and many other factors can contribute to long term problems.
They are discussed at length in the book I recommended. It is MUCH easier to prevent these conditions than to fix them.
Carpal tunnel is just one component of problems that can affect computer users from the neck on down. I never developed carpal tunnel syndrom because that was understood fairly early and I protected my wrists (be sure you keep your hands level or pointing down when you type - fingers pointing up is very hard on the wrists; cheap easy assistance: tape layer of bubble wrap along any sharp edge (e.g. desk) that your wrist rests on). But I didn't protect my back and arms and so I am now disabled - I can't garden or embroider or do anything with my hands that I used to love to do.
Be warned. Be Careful. Be educated. If you have kids, be even more educated. I'm almost 60 and started using a keyboard when I was 14 (before computers). Kids are now using computers very early. They are often seated way too low relative to the keyboard and monitor. My 25 year old nephew already has very severe rsi problems and I know other young people who do as well.
Hope some of this is useful. If you're a bit scared: good. When you begin to experience pain there has already been a LOT of damage.
Prevention is better.
Submitted by: Cathleen C. of Berkeley, CA, USA
Where did you hear that "carpal tunnel syndrome and other computer-related injuries are becoming widespread?" If this was the topic of a recent story on the "Your Health" segment of your local news, do yourself a favor and dismiss that "health panic alert" as nonsense. You're dealing with the same folks that rely on sensationalism and mass hysteria for ratings - think widespread satanic cult activities, rampant child abductions, diet of the week, and miracle drugs that are praised as panaceas one week, and condemned as carcinogenic agents the next.
Despite looking very hard, I simply couldn't find any evidence of a sudden increase in the incidence of conditions like Carpal Tunnel Syndrome (CTS), much less resulting from computer use. On the contrary, about the only thing I can recall even remotely suggesting some sort of computer-related injury epidemic is a Southwest Airlines commercial in which actors suffered hand injuries from clicking their mice buttons - hardly the stuff that makes it into The New England Journal of Medicine. (As you'll see below, that commercial might posses a kernel of truth.)
Concerns about CTS and similar injuries are valid, though arguably exaggerated. There are some risks inherent in the interaction with computers, just as there are risks involved in riding a bike, driving a car, or walking down the produce aisle. Having said that, unless you own a HAL 9000 computer that greets you with a creepy voice every time you enter the room, there is no good reason to think your computer is actively trying to hurt you.
Just like not all headaches are migraines, not all discomfort experienced while sitting in front of your computer is related to CTS and other repetitive stress injuries - or even to computer use. Let's examine how common worrisome symptoms actually are, how often they can be attributed to CTS, and whether the numbers support any significant increase in new cases of Carpal Tunnel Syndrome and related maladies.
A 1999 article in the Journal of the American Medical Association (JAMA) concludes
"Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing."
The sources I examined estimated the prevalence of the aforementioned symptoms at about 15%. In the six years since the JAMA article was published, that figure has remained virtually unchanged. That means CTS continues to be essentially a low-prevalence condition, diagnosed in roughly 3% of the general population.
Notice that I wrote CTS is diagnosed - as opposed to present - in 3% of the population. There is some controversy surrounding the clinical tests used to diagnose this condition, so we must allow for the possibility of Carpal Tunnel Syndrome being currently under-diagnosed. But even assuming a worst-case scenario in which everyone presenting with the symptoms was found to have CTS, the condition would still have a relatively low prevalence: 15%.
(The low prevalence also explains why there aren't massive studies conducted every year. The energy and money is better spent on conditions such as cancer and diabetes!)
The obvious question is then whether cases of CTS and similar disorders are disproportionately found among computer users, that is, are you at a higher risk simply because of all those instant messages and e-mails you type? According to The Cleveland Clinic,
"Computer keyboard use has not been definitively associated with CTS."
That's the position of the Department of Orthopedic Surgery at one of the top four hospitals in the United States. Interestingly enough, a 2003 medical paper titled "Typing Rarely Cause of Carpal Tunnel" raises the possibility that your mouse is more likely to cause CTS than your keyboard. (http://my.webmd.com/content/Article/66/79761.htm) The same paper states that the onset of CTS-like symptoms is often times "related to an accident, other medical conditions and smoking." Thus, it would be a mistake to assume that pain experienced while working at your computer is inevitably a portent or evidence of CTS.
So what does this mean? It means that while the risks are real, there is no reason to panic. Simply spending a few hours answering e-mails or surfing the web might not lead to injury by itself.
Consider this real-life example: Recently, Chicago Cubs starting pitcher Carlos Zambrano had to leave a game early due to soreness in his forearm. The soreness was attributed to Zambrano spending five hours instant messaging his brother in Venezuela. It is easy to see how such a marathon IM session might have caused discomfort. But chances are pitching - an unnatural motion - contributed to the problem, and at least one team source felt the injury might have been related to the pitcher taking batting practice from both sides of the plate. Clearly, several factors seem to have played a role in Zambrano's injury, but what caught people's imagination and got blamed was his web surfing habits. Why a millionaire athlete must rely on instant messaging to avoid long-distance bills might've had something to do with the media's fascination with the story, too! (http://sports.espn.go.com/espn/page2/story?page=caple/050525)
Numerous epidemiological studies strongly hint at CTS (and other repetitive stress injuries) resulting from exposure to a combination of risk factors. Repetitive work and/or stress is just one of them. (http://www.ergonext.com/aa-studies/studies-cts.htm) You can learn more about these risk factors from the excellent Cleveland Clinic article referenced above, and by reading this short WebMD piece:
One risk factor worth mentioning here is posture. The position of your body relative to your workspace is arguably one of the most important risk factors when dealing with repetitive stress injuries. So much so, that the study of this relationship has evolved into the science of ergonomics. (http://my.webmd.com/hw/healthy_women/tr5916.asp)
Advice on "healthy computing" or "home office ergonomics" is both abundant and extremely easy to find. A Google search using either term as query will yield plenty of results - most featuring essentially the same general recommendations. These short ergonomic guides offer about as much information as most of us would need to see whether improvements can be made, or changes needed.
You may already have one of these ergonomic guides in your computer. If you have a Microsoft mouse, you might find a "Mouse Healthy Computer Guide" under START/ALL PROGRAMS/MICROSOFT MOUSE. This short document can also be accessed online through either of the following links:
Another excellent source of information is HealthyComputing.com:
By now you are probably thinking, "Hey, I wanted a one-stop source for everything from information to buying advice!" Sorry, but last time I checked we human beings do not come with a "One Size Fits All" tag attached to our necks.
Because ergonomics deals with the relationship of bodies to their surroundings, and there are about as many individual variations as there are bodies, there is no substitute for experience. The guidelines found in ergonomic documents are merely starting points, universal concepts that apply to most as written, but that might need to be tweaked here or there for others. The same holds true for "ergonomic products." There is no one chair that fits all, let alone do so comfortably or safely.
When it comes to ergonomic products themselves, your best bet is to get off your chair (breaks are healthy!) and try them on for size at a local retailer. National office supply stores like Staples, OfficeMax and Office Depot tend to carry a surprising selection of ergonomic products. You should also be able to find ergonomic products and services in your phone book or local newspaper, under "office supplies," "medical supplies" and/or "ergonomic products." The employees in some of these specialized stores might be able to offer excellent advice. However, don't just buy into the hype or be wowed by a long list of features. A task chair may have every conceivable ergonomic feature built into it, but if you are unable to sit on it comfortably, what good is it? Make sure to "test drive" products, as things might feel quite differently after you've been sitting on or holding them for 10-15 minutes.
I would also recommend researching items of interest before buying. Online reviews from customers who have purchased the exact or similar items might give you an idea of durability issues, lack of features, or whether that state-of-the-art ergonomic wireless mouse is a good fit for a lefty or that "natural" keyboard too big for the sliding tray on computer desks. Reviews may also mention alternative or similar products that might be worth checking out. Amazon.com (www.amazon.com) seems to have user reviews on every product ever made, so it might be a good starting place. Another site you should check is Epinions (www.epinions.com). The websites of the aforementioned office supply retailers might prove helpful in this regard, too. Keep in mind, ergonomic features come at a premium, so it makes sense to spend your money on products that fit your needs and can withstand the wear and tear of daily use.
Ultimately, your best "one-stop source" is your head. (http://my.webmd.com/content/Article/70/81133.htm) Even if the risks of injury are small, it pays to be proactive. Your body will let your brain know when something does not feel right. Pay attention to it, and chances are your computer sessions will be productive and pain-free. If something really worries or bothers you, or if discomfort persists, seek a physician's advice. If an ergonomic product does not feel as comfortable as its "regular" counterpart, stick with the latter. As you will see from the ergonomic guidelines recommended above, healthy computing does not require your changing every piece of computer equipment and furniture you own. In fact, beware of any ergonomics expert trying to talk you into changing everything from your keyboard to your toothbrush. Aristotle exalted moderation as one of the nobler human virtues. I'll take his track record over that of any self-proclaimed ergonomics guru any time. Very few things could be considered as ergonomic as awareness and common sense.
Incidentally, if you do own a HAL 9000 with a creepy voice, Carpal Tunnel Syndrome is the least of your problems...
Submitted by: Miguel K. of Columbus, Ohio
Ergonomics and the Computer 101
With people spending more time at the computer concerns about ergonomics should be on their minds. While Doug wants to do the right thing for his body, purchasing the best ergonomic computer equipment isn?t necessarily enough. Actually, most of the time you can use the components and/or furniture you already own and concentrate on more important ergonomic issues. If your body isn?t in the proper position in relation to the keyboard, mouse and monitor it doesn?t matter what equipment you are using or what you are doing, your body will suffer the consequences.
The chair needs to be adjustable. The person seated should have both feet flat on the floor with knees bent at about 90 degrees. If the chair?s limitations won?t allow for this posture another chair should be used that can be adjusted. For a short person a footrest will solve the problem.
Working Height is the height in which the hands are located most of the time. For offices and workstations, this is usually the keyboard and mouse height. Working Height is elbow height with the forearm bent at 90 degrees or slightly lower (Max 2" lower). NOT HIGHER! This is why many keyboard trays are mounted below the work surface.
Generally, eye height is from the center of the monitor/document to the top of the monitor/document. This may involve chair adjustment but if the chair is adjusted properly as stated above then the monitor, document stand/holder and/or working height needs to be adjusted. This may involve purchasing a more adjustable workstation or even having one customized to your ergonomic requirements. People who have to tilt their heads back to look through the lower lenses of their bifocals need to get the monitor lower, even if it requires cutting a hole in the work surface to set the monitor in. It may be easier or preferred to get prescription glasses specifically designed for use at a computer.
Monitor and keyboard should be directly in front of the user. The monitor should be 18" to 28" from the user. If your desktop is just wide enough for the monitor to sit on and the keyboard is on a slide out tray below, you are too close. A good way to get the monitor far enough away is to use a workstation designed for a corner. You could try placing your standard desk across a corner and push the monitor back to get away from it.
There is more to ergonomics than what I have touched on here but these suggestions will definitely help keep your body happy.
Submitted by: Don S.
Dear CNet & Doug,
Of course ergonometry has the technical answer to your question. The problem is that ergonometry is different for every human being; there are a bunch of tips?
Myself, I have been in front of a computer since Windows 3.1
Thank you everyone for your great submissions this week!
Doug, while Dave's answer comes directly from his experience, we also have a bunch of great answers in the honorable mentions and other advice from our members section below. Hopefully you'll find the information provided helpful and if you have a moment please swing by and join the discussion. I'm sure you have other questions to ask and please share with why this question came about.
Members, if you have additional advice for Doug, or would like to share some of your experiences or advice in regards to computer-related repetitive injuries, please feel free to post them in this thread below. Have a great weekend and please take care!
With more people spending more time in front of their
computers, carpal tunnel syndrome and other computer-related
injuries are becoming widespread. Do you have suggestions for
using computers in a way that avoids these problems? Where do
I go for one-stop information about ergonomics and products
that can lessen ergo problems, such as reviews or tests of
different products (chairs, mouse trays and pads, keyboards)?
How about advice regarding posture and seating measurements
relative to the monitor and desk?
Submitted by: Doug J.P.
I may be an extreme case of PC-induced problems. As a software engineer, I had worked 10-hour days at computer terminals and PCs for more than 15 years when I began having RSI problems. I ended up having carpal tunnel surgery as well as lower back surgery for a ruptured disk. As a result, I began reading everything I could find on ergonomics. The lower back problems left me partially disabled and eligible for state aid in preparing myself for an alternative career. I decided to take my work experience and start my own Web site design business. It allowed me the flexibility of working fewer hours and scheduling my time over the entire week. I put together specifications for an ergonomic workstation and consulted with an ergonomic specialist for pointing devices and voice recognition software.
Here is the hardware and software I've found helpful for avoiding musculoskeletal pain and a recurrence of carpal tunnel syndrome.
The "Dilbertville" workstation I spec'd included a height-adjustable corner section that can be raised from a 27 inch seated position to a 45 inch standing position. This allows me to work at the PC standing up. This flexibility was invaluable when I had prostate surgery and was unable to sit comfortably for a month afterwards.
- Keyboard/mouse platform
The workstation also has a height-adjustable keyboard/mouse platform. The mouse platform that can be pivoted in front of the right side of the tray or swung completely out of the way. Being able to position the mouse in front of the keyboard tray helps prevent hyper extension of the arm and shoulder. Yet I can move the mouse completely out of the way when I need to do keyboarding.
I use a Herman Miller Aeron chair and consider it crucial for preventing computer-related pain. I had months of physical therapy after my lower back surgery, and my therapist came to my house and was able to make adjustments to the chair settings to optimize my seating position to minimize existing pain and prevent problems with stress to my upper back, neck and shoulders. I've had this chair over 5 years, and it's still going strong, unlike other office chairs I'd had that broke down after only a year or so.
- Alternative mice
My initial mouse substitute was a touchpad. It eliminated most of the wrist and arm movement. I worked for about a year with a touchpad from Cirque (http://www.cirque.com/), but its movement wasn't sensitive enough for graphics work. I did more research and found that the key attribute to my mouse alternatives was to avoid having the hand in the extended palm-down position, so the forearm wouldn't be rotated.
Keeping this in mind, my next alternative mouse was the Renaissance Mouse, now provided by 3M as its Ergonomic Mouse. (http://www.3m.com/us/office/myworkspace/mos_ergo.jhtml). It looks like a joystick, but it keeps the hand in a more natural vertical position. Its size can make it difficult to do fine movements, but you can get around this by taking the hand off the joystick and moving the base. It comes in 2 sizes, depending on your hand width.
The Ergonomic Mouse worked fine for several years, and by the time I was ready to try something else I discovered Evoluent's Vertical Mouse 2 (http://www.evoluent.com/). This optical mouse is the one I currently use and is the most comfortable mouse I've ever used. It looks like a tall version of a standard mouse, but it's designed to keep the hand in a handshake position. It comes in right hand and left hand models. It has a scroll wheel and 5 buttons, 4 of which are programmable.
I use break reminder software from Chequers Software (http://www.cheqsoft.com/). It's free for personal use. It neutralizes the mouse and keyboard, forcing me to take breaks - though there is an override option which allows me to cancel the break. It's very customizable, with short duration pauses of 5 to 60 seconds and rest breaks from 1 to 60 minutes long. It also has 3 presets for degrees of safety, depending on how much pain I'm experiencing. I tend to get so involved with my PC work that I lose track of time - and end up with back, neck and wrist pain. This software is invaluable for getting me to pause, stretch and get up from my workstation.
The Dragon Naturally Speaking voice recognition software was recommended by the ergonomics consultant to reduce stress from typing. I started with their version 4 Mobile, which came with a portable digital recorder. This allowed me to record notes and reminders while away from the PC. I use the software most often for e-mail.
I hope my experience will be helpful and am looking forward to other responses you get to your question.
Mansfield Web Designs
Mansfield Center, CT
Submitted by: Dave D. of Mansfield Center, Connecticut