Series: Repetitive Stress Injury
Article 1 of 5 in series
Hi. My name is Adam and I have carpal tunnel syndrome. It's a bit hard to talk about at first, especially for us guys because carpal tunnel syndrome (CTS) is not a real guy injuryShow full article
Hi. My name is Adam and I have carpal tunnel syndrome. It's a bit hard to talk about at first, especially for us guys because carpal tunnel syndrome (CTS) is not a real guy injury. Guys break bones parachuting from hang gliders onto oil rigs and the like. Guys do not get pains in their hands, wrists, and arms from typing a little too much while sitting in a bad chair.
Well, yes they do. So do women. Face it, if you are reading this on a computer then you may be at risk for CTS or some other repetitive strain injury. Perhaps the hardest part of dealing with these injuries is admitting that you have them. Tonya has a related problem, tendinitis, in her wrists, and after she admitted publicly at work that she couldn't do as much as she'd like, a number of colleagues came over individually and said that they too had occasional wrist pain. And this is from people who talk on the phone six hours a day (using headsets).
The first thing to do is to immediately send this issue to anyone you know who might be suffering from CTS or a related injury. I mean it. The State of Washington Department of Labor estimates that symptoms of carpal tunnel syndrome will develop in 10% of all employed adults in Washington sometime during their employment careers. Surveys of doctors suggest that these sort of injuries are now the major occupational hazard of the Information Age.
It's also expensive, for you or your insurance company, if you don't treat it immediately. A study by the American Physical Therapy Association claims that a mild case of CTS can cost between $5,000 and $10,000 in medical care and lost work time, and a serious case that requires surgery on both hands can cost $100,000. If you have bad furniture at work that hurts your wrists, statistics like the one above can help convince even the stingiest employer to replace it. After all, your employer will be paying the worker's compensation and a good bit of your health insurance premiums.
I'm not going to explain CTS in detail because that's best explained by a book on the subject or an unusual doctor with time to talk. The basic idea is that several tendons and the median nerve pass through the carpal tunnel, formed by three bones and some tough cartilage, in the forearm and wrist. When you repeatedly bend the wrist at bad angles, you irritate those tendons and the nerve. Irritation leads to inflammation, which in turn leads to more irritation since the carpal tunnel doesn't have much extra room and the inflamed tendons rub on each other and on the nerve. We're talking about vicious cycles.
CTS manifests itself in pain from the thumb and next three fingers (another nerve serves the little finger) all the way up to the elbow. We've found that overcompensation and stress can also cause pain in the shoulder, neck, and back, and it might even cause migraine headaches if you're unlucky. The pain can range from minor itching and stiffness (that's how bad I've got it) to flaming shots of white-hot pain searing up and down the fingers whenever you move them. Buttoning a shirt becomes impossible and sleep may as well. What can you do? Read on.
Article 2 of 5 in series
I'm not a doctor, but I've seen one and have researched this subject, searching for more information on ways of avoiding CTS and curing it once it has happenedShow full article
I'm not a doctor, but I've seen one and have researched this subject, searching for more information on ways of avoiding CTS and curing it once it has happened. If you believe that you have CTS, please go see a doctor right away, or at least after reading what I've written below. I concentrate on the easy things you can do, in part because they're cheap and easy, and in part because I feel that they are in the long run more effective than the drastic invasive measures that a doctor may recommend as a last ditch effort. Do note that the measures listed below are not in any specific order because I think they're all important, and none conflict with each other, unless you go under the knife.
Ergonomics -- The first thing you should do to prevent or treat CTS is to make sure that your computer environment is well-set up, ergonomically speaking. The basic principle involves right angles. Your feet should rest flat on the floor, your calves should be perpendicular to the floor and to your thighs, which should be parallel to the floor, and the angle between your thighs and back should be at least 90 degrees. Your arms should hang relaxed at your sides, and your forearms should project out straight in front of you, forming another 90 degree angle. Your wrists should be straight, not arched upward. You might adjust your keyboard for this, or you might have to adjust your chair and desk height. Standard typing height is supposedly 27 inches, but that will vary with your height. I had to saw an inch or so off my desk and buy an adjustable chair, both of which helped a great deal.
You should be between 18 and 28 inches from your screen, and it should be adjusted so that it is between 15 and 30 degrees below your straight-ahead line of sight. If the screen is much lower than that, you'll probably end up slouching.
Wrist Pads -- By now you've probably seen the neoprene wrist pads that many people put in front of their keyboards. I highly recommend you buy one (about $10) because they help in two important ways. First, when you type, you shouldn't rest your hand on the desk, but many people do. The wrist pad is designed to remind you to lift up slightly so your hands don't rest on any surface as you type, because that angle can compress the carpal tunnel. Secondly, when you stop typing to think, you probably put your hands down, and it's better to rest them on a soft pad than on the hard corner of a desk, which can cut off circulation and compress the carpal tunnel.
I'm convinced that these pads, simple as they are, help a great deal. Microsoft gives a wrist pad to every employee. Microsoft's wrist pads are unimpressive compared with the one I've been using from Silicon Sports. Generic wrist pads consist of a piece of neoprene or similar rubber padding, whereas Silicon Sports has a better design with two layers of padding under the colorful top covering. The lower layer is the standard dense foam rubber, but the thinner layer on top is a softer foam than the generic pads use, and I found it noticeably more comfortable. Silicon Sports also has a pad for the PowerBooks coming out soon and a clever wrist pad/mouse pad combination that fits together like puzzle pieces and keeps everything compact. Get one of these wrist pads and use it. Depending on your office-mates, it might also be good for whacking them on occasion. (Kids! Don't try this at home!)
Silicon Sports -- 800/243-2972 -- 415/327-7900
Chill Out I -- Take a break and relax. I suspect you work too hard and put in too many consecutive hours at the keyboard. You should take a break every 45 minutes or so, and by a break I mean that you should actually do something different, like go hang around the water cooler or hassle a coworker (Dan Quayle's Council on Competitiveness will have me shot for that statement.). You can do some simple exercises as well, the easiest of which are (a) gently squeezing a rubber or foam ball in your upward-facing palm and (b) extending your fingers completely until you feel a stretch, then relaxing your fingers and curling them in toward your palms.
LifeGuard -- Visionary Software has a useful little DA called LifeGuard that can nag you into actually taking these breaks. It monitors how long you're typing or mousing, and then tells you to take a break. You set the length of both the work time and the break time, and it will give you either an audible reminder or a dialog reminder that suggests something else (which you can set) to do. LifeGuard also has a useful section on exercises (including the ones mentioned above) and another one on ergonomics. Lifeguard has a number of limitations, and I'd far prefer it if you could pick a set of sounds for it to choose from randomly and if it had an option to literally lock the screen to kick you off, but it's cute and useful.
Visionary Software -- 503/246-6200
Splints -- One of the easiest things you can do that a doctor will also recommend is to get wrist splints and wear them in bed, if not also during the day. Most drugstores should have them in different sizes and shapes, although all the ones I've seen are a vague tan color. I'd like to see them in black, bright blue, and even perhaps some fluorescent colors. There's no reason they have to be ugly, and it would be nice if their velcro wasn't quite so exposed. I hate sticking to everything!
The splints are generally called "cock-up splints" or something similar because the metal splint cocks your wrist at a 20 to 30 degree angle. This position is neutral, so in theory you aren't compressing the carpal tunnel while wearing them. I also find that certain life activities, like driving a car without power steering or pushing a shopping cart, are extremely hard on damaged wrists. The wrists splints provide welcome support in those cases, but I do wish they didn't look so stupid.
Vitamins -- My doctor recommended that I take vitamin B6. Apparently the omniscient "they" have done studies showing that vitamin B6, in doses of 100 mg daily, can help cure CTS. Apparently B6 plays a role in producing neurochemical transmitters, and that can help. You can find B6 naturally in brewer's yeast, wheat germ, and blackstrap molasses, but if you're like me, your diet doesn't include those three items regularly. Supplements are probably in order.
Another vitamin that may help is vitamin E, in 400 IU doses before bed. My doctor mentioned it as well, and my father had excellent luck with it clearing up his arthritis in his mid-thirties. I've taken it on and off when I'm running competitively because I find that I tend to get shin splints otherwise. Medical science is still undecided about vitamin E, and the only things they've proven, I believe, are that it reduces free radicals (a laudable goal) and it prevents impotence in rats (an equally laudable goal).
Chill Out II -- This time I mean it literally. Current medical thought believes cold is much better than heat for aiding healing. The basic idea is that cold reduces inflammation, whereas heat may reinforce it. Also, since nerves are extremely sensitive to heat, heating aching hands may feel good, but it's deceptive because all that's happening is that the nerves that were transmitting pain impulses are now sending heat signals.
Probably the best way of applying cold to your arms is via ice massage. If you freeze water in paper cups, you can then rub your arms with the frozen cup, gradually tearing the cup away as the ice melts. It's messy and not terribly ecologically-conscious, but it works and lots of athletes use it to reduce pain and swelling after exercise.
A tidier method is to go to a sports store and pick up four or five of those ice bags that have some sort of blue gel in them. They're cheap and they work well. Don't overdo the cold. Frostbite isn't fun.
Massage -- Gentle massage on the hands, wrists, arms, and shoulders (which may often be tight and sore too), may feel good, especially if someone else does it, and you can also use a hand lotion that has vitamin E in it, just in case some vitamin E is absorbed through the skin. No clue if that's true, but I've had good luck with using it in massage.
Exercise -- When I first admitted that I had CTS, I thought a bit about what I could do that doesn't involve my hands. Other than being a couch potato, which I don't approve of, all I could think of is running. It was an excellent excuse to get out on the trails regularly. My doctor agreed that exercise was excellent, in part because it doesn't use the hands, and in part because it helps relax both the body and the mind. I'm not going to recommend that you all immediately become distance runners, but exercise-induced endorphins are good stuff (now I'll have a drug czar on my case).
Standard warnings about overdoing it apply here too. You may not think about it normally, but if you're having trouble with your hands and wrists, be careful not to clench your fists when you run, and avoid shaking your hands at the wrist. Of course, walking is good, and swimming may be, although I find that it tends to put a bit too much pressure on my wrists, depending on which stroke I use. Bowling is right out.
Alternative input devices -- Definitely look into alternative input methods that will reduce strain on your hands and wrists. The most common of these devices is the trackball, and next week we'll look at two well-designed trackballs, the CoStar Stingray and the Curtis MVP Mouse and Footswitch. Trackballs are often more comfortable because the mouse click & drag action requires a significant downward pressure, and that pressure requires additional force to move the mouse horizontally. Also, moving the mouse with your wrist and arm is more likely to compress the carpal tunnel than similar movements with a trackball, which requires only the use of the fingers.
More esoteric input devices include chord keyboards and voice controllers. Chord keyboards may help reduce CTS problems because you don't have to move your hand at the wrist to reach all the keys. A chord keyboard arrays its small number of keys so your fingers are always on the correct keys, and all you have to do is press the proper combinations. It may sound awkward, but I'll bet it took you more than an hour to learn to touch type on a standard QWERTY keyboard. We'll have more on Infogrip's BAT chord keyboard in a future issue, and you can get more information from the files stored on our fileserver.
Voice controllers are definitely neat, but they must be trained, are sensitive to changes in your voice, and can only do the sort of things you can do with QuicKeys. The Voice Navigator demos are impressive, with the slick salesman quickly drawing their logo by voice. He sounds like he swallowed an auctioneer. However, the problem is accuracy, not speed. Apple's Casper technology promises to be pretty snazzy when it ships with the next generation of high-end Macs, but I'm not holding my breath. Finally, none of these systems will do dictation - for that you need a costly speech recognition system.
Simple Drugs -- Doctors will recommend aspirin or ibuprofen early on. They may also provide a prescription for more potent stuff like Feldene, which is much stronger and has more side effects. Remember, drugs merely treat the symptoms, and unless you're in a situation where the symptoms prevent the body from healing itself, drugs may provide only temporary relief. You can't take this stuff for the rest of your life.
Relaxation -- OK, you've read all of my suggestions, but I will venture into left field here and claim that none of it will help unless you reduce your stress level. Since I've had CTS, I've talked to a number of people who have successfully defeated it in interesting ways. One swears by Tai Chi, a martial art that involves slow, deliberate movements and heightened consciousness of your body. Another had CTS so badly that they hospitalized him and gave him morphine for the pain. Surgery cured the CTS, but didn't reduce the pain. It wasn't until another doctor put him on a stress reduction program that he started to recover.
Another name for CTS-type injuries is cumulative stress injuries because you are essentially stressing a certain part of your body thousands of times an hour, and the body can't handle the stress. Mental stress will cause physical reactions as well, and the guy I spoke of above who had surgery didn't experience reduced pain until he was able to relax and break the stressful mental pathways he'd built up.
Support for this theory also comes from a study showing that early symptoms of CTS were twice as a common among communications workers who were electronically monitored than those who weren't, possibly because of lower stress levels in unmonitored workers.
I suggest that you can and must reduce your stress level to allow your body to heal. From what I've read and heard, you have a variety of choices on how to go about this, be it yoga, Tai Chi, meditation, a non-violent martial art, or even acupuncture. I suspect it will be hard for many of you, being rational computer-types like me, to try one of these methods wholeheartedly, although I gather people become much more accepting when the alternative is the knife. I also highly recommend that you look for a book called "Freedom From Stress: A Holistic Approach" by Phil Nuernberger (ISBN 0-89389-071-5). It combines well-explained scientific evidence along with advice on ways to reduce stress using the theories of yoga as a base. Do with that advice what you will - I'm trying it.
Icky things -- I don't want to talk about this much, but if you let wrist pain progress too far, Western medicine will almost certainly want to give you drugs or cut you open The first move is a cortisone injection into the wrist. This is painful and doesn't always work. Doctors generally try injecting you up to three times at intervals of three weeks. If you're lucky, the pain will recede by three days after the injection. Some people have great luck with this treatment. Others don't.
If you're not lucky, you progress to surgery. The basic principle is that the doctor can release the pressure in the carpal tunnel by slitting it so that it can expand slightly. Some people do well after this process and return to normal work several months later. However, if you don't treat the causes of CTS, you can just get it all over again. So do yourself a favor and try the stuff I suggest above wholeheartedly before you submit to the needle and the knife. It can't hurt, and I sincerely hope it helps a great deal.
Article 3 of 5 in series
As you know, both Tonya and I suffer from wrist problems, carpal tunnel for me and tendonitis for her. Our special issue on the subject is in the making (special issues are a bear to get out), but we recently put something together for people who either have or are at risk from the same problemsShow full article
As you know, both Tonya and I suffer from wrist problems, carpal tunnel for me and tendonitis for her. Our special issue on the subject is in the making (special issues are a bear to get out), but we recently put something together for people who either have or are at risk from the same problems. Along with our graphic designer friend Jon.Hersh, we've created a double-sided page that you can post near your computer to remind yourself of things you know you should do to help your wrists.
In a slight break with TidBITS tradition, we make this file freely redistributable and copyable by anyone in any medium, commercial or not, as long as the page stays in its original form, though we would appreciate a message if you wish to place it in a commercial publication. We strongly encourage everyone to make copies and give them to anyone, encouraging them in turn to distribute the page. The point is to help as many people as possible.
You'll notice below that there are two files posted in most locations. The first is a PageMaker 4.2 file that you can download and use if you have PageMaker 4.0 or later and a PostScript printer. The second file is larger (and it gets really big when you expand - StuffIt Deluxe 3.0 compressed it from about 1.8 MB to less than 300K), but it is a straight PostScript file that you can download to any PostScript printer (I hope) with the free LaserWriter Font Utility that comes on the System 7 disks. If you use System 6, I suppose something like SendPS would work too. So, if you have PageMaker 4.0 or later, download the first file. If all you have is access to a PostScript laser printer, get the second file. Sorry, but the design and methods of distribution preclude us from making it available for QuickDraw printers (but see below).
We posted the files to various places, including the Macintosh Hardware Forum New Files library on America Online, ZiffNet/Mac's ZMC:DOWNTECH Reference library (#7) as TBWRIS.SIT, MAUG's MACCLUB Magazines library (#8) on CompuServe as TBWRIS.SIT and TBWRPS.SIT, in the GOODHEALTH forum's Issues at Work library (#15) on CompuServe as TBWRIS.SIT and TBWRPS.SIT, and on <sumex-aim.stanford.edu> for anonymous FTP as:
The front of the page... -- For those of you who don't have access to a PostScript laser printer in any way, here are the reminders from the front of the page. Print them out in a large typeface and post them on your wall to look at while you work.
- Take a break every hour. Relax, stretch, or talk with someone.
- Massage your hands, forearms, and the muscles in your neck.
- Evaluate your environment for ways to reduce stress.
- Learn to change your reactions to unavoidable stress.
- Watch your posture.
- Don't crane your head and shoulders forward.
- Use a keyboard wrist rest properly.
- Drink plenty of water regularly.
- Squeeze a soft ball (don't do this if it hurts!).
- Stretch and curl your fingers.
- Drop your hands to your sides and shake them gently.
- Breathe deeply, exhale slowly. Yawn.
- Stretch your neck.
- Rest your eyes.
Article 4 of 5 in series
As many of you know, I suffer from a mild case of carpal tunnel syndrome, one of the many conditions collectively called repetitive stress injuries, or RSIShow full article
As many of you know, I suffer from a mild case of carpal tunnel syndrome, one of the many conditions collectively called repetitive stress injuries, or RSI. Although I haven't had too many queries on it (and thanks - the extra email is often hard to handle), some people have wondered how I managed to write a book without seriously damaging my hands. It's a good question, and in fact, I can say that my pain level has declined since I started the final chunks of the book after Macworld Boston. How? The Handeze gloves.
These $20 finger-less gloves are made from stretch Lycra subjected to a special process called "Med-A-Likra" that expands the individual fibers in a thread, thus reducing the space between threads and working better to hold body heat. The cuffs are double-layer Lycra and help keep the hand in a neutral position while allowing flexibility, unlike wrist braces. The strangest part of the gloves is that they only have four holes for the fingers - the middle finger and ring finger share an opening. I don't know the rationale for that design.
I saw them displayed at Macworld Boston, and being interested in anything related to RSI, asked the guys at the booth for more information. They talked about them for a while, then handed me a pair of them and a stack of photocopied letters of recommendation from satisfied users and doctors and reprints of magazine articles. "Just try them," they urged. So, when I started the home stretch of the book, I figured I had nothing to lose and started wore them. After a day or so of break-in time (the seams irritated my skin), I couldn't believe how little pain I had given how much I was typing, although I couldn't say why my hands felt better. In fact, I'm curious about how the design works at all.
The New England Therapeutic Research Group designed the gloves to help relieve pain in three specific ways - by providing warmth, support, and massage. I have poor circulation in my hands and feet so they're frequently cold. The gloves help warm my hands, although my fingers still get somewhat cold. The support makes sense - the gloves are form-fitting down to the Lycra cuffs, so you have to order the right size for your hands. In theory, the Lycra material massages your hands, although I'm not so sure about that. I suppose that the stretchy Lycra pulls on different parts of your hand as you move your fingers, so I guess that could count as massage.
I don't even play a doctor on the nets, but here's my devil's advocate analysis of those claims. As far as I'm aware, much current medical thought indicates that cold is better than heat for helping healing, no matter how much better heat may feel temporarily. Support too is nice, especially the way the gloves encourage your hands to remain in a neutral position, but compression could reduce blood flow to the hands, and blood flow is necessary to promote healing. Finally although there's seldom a problem with massage, it isn't obvious how the gloves manage to massage your hands.
The fact that I can't adequately explain the gloves is frustrating, because they're a stunning success for me. I don't care how they work, as long as they do, but intellectually I have doubts. Nevertheless, within three days, sitting down at the Mac without the gloves felt wrong, much like driving a car without wearing a seatbelt feels wrong to me. For whatever reason, I quickly became accustomed to the feeling.
The next test was to see how well they worked for Tonya, who has tendonitis, another RSI with a different origin. She ordered a pair in the right size (3) and ordered me another pair as well (I wear a size 4), and after avoiding them for a week or two because they felt too tight, started wearing them. Every night she came home with a glowing report of how much better her hands felt, and then one day she realized that she'd been wearing the pair she got for me, even though they were too large. We decided not to worry about it, but after another few days, the larger gloves stopped helping as much, so she moved down to the correct size, and they have made a tremendous difference for her.
Although ideal for computer users, the company that sells the gloves, Dome, notes that they have been used successfully by musicians, farmers, carpenters, seamstresses, and dentists, along with people in many other occupations susceptible to RSI. Although it may seem odd to wear gloves to write, it isn't in the slightest bit unusual for dentists to wear thin rubber gloves, for farmers to wear thick leather gloves, and so on. People wear gloves for many reasons, even some as specialized as swinging a baseball bat. In that sense, it doesn't feel out of place to put on gloves before I start typing in the morning.
You can supposedly machine wash the gloves if you're careful, but my first pair lost their elasticity in the cuffs, possibly due to that washing. I think I'll stick to hand washing for my newer pair, although I still wear the old ones a fair amount - the loose cuffs don't particularly bother me. Some of the seams have loosened slightly, and I had to mend one on the older pair. It's possible they were just a bum set, but with anything that you wear as much as I've worn these gloves, it's inevitable that they'll break down. I can live with that if they continue to make my hands feel better - I'll do a great deal to avoid the carpal tunnel surgery, which has a low success rate.
For the fashion conscious, the gloves come in two colors, a melanin-challenged flesh tone (which looks foolish to my eyes since, like many types of women's nylons, they're obviously a different color than skin) and a bluish-grey with dark blue cuffs. Neither is exciting, by any means, and I think Dome would do well to make some in bright colors and black, or add some minor frills. [I want black ones with black lace -Tonya] If you have to wear these gloves, why not make a statement other than "I look like a dork." I stick with the blue pair in public to assuage my vanity.
In the final evaluation, I can't say precisely why they work, although I can tell you that I seldom even touch the keyboard without them, and I like wearing them driving as well. They're cheap at about $20, and even if they don't work for you (I have no idea what the necessary variable for success might be), if you're experiencing hand and wrist pain, I think it's worth trying the Handeze gloves. As soon as you compare that $20 with the cost of disability, physical therapy, or even surgery, it shrinks rapidly. Do note that wearing the gloves doesn't allow you to otherwise abuse your body by not taking breaks or working in a destructive position, ergonomically speaking.
You must get the right size for your hand, and the sizing is best done on paper. So follow along, and if all else fails, call the Dome folks and ask them for help. Draw a two-inch vertical line on a piece of paper with a ruler and pencil. At the one-inch mark on that line, draw a five-inch perpendicular line to form a T on its side, making hash marks on it every half-inch. Place your right hand palm down on the paper with your first finger (the pointer finger) along the vertical line (so you can just see the line). Using your left hand, mark the right edge of your right hand on the horizontal line. Now measure the distance along the horizontal line from the vertical line to that mark you just made. If it falls between 2" and 2.5", you're a size 2. If it fall between 2.5" and 3", you're a size 3. If it falls between 3" and 3.5", you're a size 4. If it falls between 3.5" and 4", you're a size 5. And finally, if it falls between 4" and 4.5", you're a size 6. For the last three sizes, those measurements aren't quite accurate, so if you're just a bit over 3.5", you may still be in the 4 size range, and the same goes for sizes 5 and 6.
Dome -- 800/432-4352
Article 5 of 5 in series
Last week's quiz on our home page focused on ways of reducing or eliminating repetitive stress injuries, or RSI. Years ago, Tonya and I suffered from tendonitis and carpal tunnel syndrome respectively, and we recovered completely thanks to adjusting how we work and liveShow full article
Last week's quiz on our home page focused on ways of reducing or eliminating repetitive stress injuries, or RSI. Years ago, Tonya and I suffered from tendonitis and carpal tunnel syndrome respectively, and we recovered completely thanks to adjusting how we work and live. Although not all of the nine items offered as quiz answers are necessarily effective for any given case of a repetitive stress injury, we were pleased to see nearly 80 percent of the quiz respondents answered that all of the items can be effective.
Back in 1993, TidBITS and local designer Jon.Hersh created a Caring for Your Wrists poster which covered the basics of preventing RSI. The poster was designed to be printed and posted next to your (or your co-worker's) computer as a reminder of good computing practices. The versions designed for print are still available (in PDF and PostScript format, as well as for an old version of PageMaker); we've also converted the document to the Web.
Here's a brief description of how each quiz response can help prevent or reduce the severity of repetitive stress injuries.
Regular exercise: Exercising - particularly in ways that don't use your hands or arms excessively - helps relax the body and the mind, and can both distracting you from your RSI problems and improve your overall health.
Ergonomic Keyboard: Although the standard QWERTY keyboard is almost ubiquitous, alternatives do exist (and we've written about several over the years). Be sure to test any keyboard that makes claims of increased ergonomics to make sure it works for you.
Some folks also use the alternative Dvorak keyboard layout, which was supposedly designed to be more efficient than QWERTY (although there is some question if that's a computing myth). Mac OS 8.6 and later include two Dvorak keyboard layouts, accessible via the Keyboard control panel.
Trackball: The ergonomics of the mouse can be problematic for some people, since the weight of your hand adds to the force you need to apply to move the mouse. Plus, moving the mouse with your entire wrist and arm can be less comfortable than manipulating a trackball with your fingers (especially with large screens and multiple monitors). Some folks get good results from changing the behavior of their pointing devices with various third-party mouse drivers.
Proper Desk & Chair Setup: If you spend many hours in front of your computer, you owe it to yourself to set your desk and chair so they conform to basic ergonomic principles and are comfortable for you. See our Caring for Your Wrists document linked previously for a diagram of an ergonomic setup.
Staying Aware of Problems: Self-awareness is an important aspect of avoiding RSI - if you notice tingling or numbness early on, you may be able to change your behavior and environment before you experience real pain, which can make simple tasks like buttoning a shirt or brushing your teeth excruciating.
Diet & Vitamin Supplements: Various nutrients, including vitamin B6 and E, have been found effective in helping with RSI problems in some studies. It's worth taking a look at your diet to make sure you're getting enough of these vitamins. Also, make sure to drink plenty of water to keep your body properly hydrated (and the resulting bathroom breaks will force you away from the keyboard regularly).
Massage: Aside from the fact that it just feels good, gentle massage can help relax the muscles in your hands, wrists, and arms so tense muscles don't exacerbate your discomfort.
Relaxation & Stress Reduction: Although everything here can be useful, it's perhaps most important that you learn to control your reactions to stress, since mental stress can have a significant impact on your physical well-being.
Handeze Gloves: Since we first wrote about them back in 1993, we've heard from numerous people who have had good luck with the form-fitting Handeze gloves reducing hand and wrist pain. The results aren't universal, of course, but the gloves are definitely worth a try. You can find important sizing information and an order form on the Handeze Web site.