Re: Typing recommendations (was RE: keyboard recommendations? )

Subject: Re: Typing recommendations (was RE: keyboard recommendations? )
From: "Peter Neilson" <neilson -at- windstream -dot- net>
To: techwr-l -at- lists -dot- techwr-l -dot- com
Date: Tue, 07 May 2013 15:54:13 -0400

The Free Software Foundation's guru, rms, had carpal tunnel problems starting many years ago. He took up using an early version of Dragon Dictate.

On Tue, 07 May 2013 15:41:59 -0400, McLauchlan, Kevin <Kevin -dot- McLauchlan -at- safenet-inc -dot- com> wrote:

Would you three - and anybody else who has had the carpal-tunnel thing - be willing to describe how you got into that predicament?

It's a fairly safe bet that everybody on this list does quite a bit of typing and mousing, so we are all candidates to greater or lesser extent. Knowing what to look for, before it gets serious, might be a big help to many people. Their/our livelihoods depend on it.

It might be useful if we tell other folks the kind of work environment we were using, what we first noticed, and what helped, or made it worse.

For example, I've never had it so bad as to need surgery, though that was probably next. My understanding is that the changes you have to make in the aftermath of surgery are pretty much the changes that would have reversed the problem, if you had started sooner. (Same idea for heart problems and for many sports/work overuse injuries that go under the knife and then need a long period of physio and re-training.)

I used to sit at a desk (with or without tilt-adjust tray), rest my wrists on the edge of the desk/tray, and type away. Or I would mouse, with my wrist or distal forearm as the pivot. My wrists were always cocked somewhat in two axes:
- the hands were tipped up/back a bit
- the hands were skewed in the outboard direction.

That is, my forearms were angled from my elbows, in toward the centerline, because the home position on the keyboard needed my hands to be close to my vertical midline, while my anatomy (er,... vast bulk) caused my elbows to hang a good twelve inches (30cm) farther apart than the hand placement.

Eventually, I was getting the carpal tunnel symptoms in both hands, but more on the right - the mousing hand.

Those symptoms included general achiness in wrist and hand, tingling and numbness, mostly in the outboard fingers, sharp aches and stabbing pains, a "thick" feeling, where the hand felt and acted like it was swollen and puffy, even though it was not. The "real" symptoms were swelling, heat, ache in the wrist area... specifically, in and around the carpal tunnel, where all those forearm-to-hand tendons and nerves and blood vessels passed through a cuff of fascia, and were being constricted. The symptoms in the hands, themselves, were referred pain, due to the constriction and annoyance of the nerves serving the hands.

Icing helped - on the wrists, not the hands... even though it was mostly the hands that hurt. But it was always very temporary, because I kept returning to the activity that caused the problem. Hard to avoid when it's a major part of your livelihood.

I began researching, and then I tried the various keyboard and mouse "solutions". I started with "natural" and curved, and then partially split keyboards. I also tried successively more radical mice, meaning that they permitted a less and less pronated position of the mouse hand.

The final solution on the keyboard side was a truly split keyboard, where the two splits were tipped perpendicular to the desk. My hands could 'rest' in the home row position while my palms were facing each other in neutral alignment at the ends of my arms. Also, there were several inches of air between the two vertical keyboard halves. There were even swing-out mirrors for viewing finger position and the less-used keys (which had reversed numbers and symbols on them...). At the same time, I had a big, clunky, yet curvaceous mouse that fit my hand, cupping the outboard pad of the palm (the part you'd use to do a classic "karate chop").

This worked. Over the next couple of years, my symptoms gradually disappeared. I also got even better at touch-typing.
I also got much entertainment when people visited my desk and tried to use the keyboard.
Eventually, it was damaged, and I didn't replace it. I don't know if they ever made a USB or wireless version.

My situation changed a bit, not long after, and my back wanted me to stand more. So I cobbled a "standing" workstation, using boxes and other materials on my cubicle desk, to raise my keyboard, mouse, and displays.

The problem did not come back, even though I was back to using an ordinary keyboard and mouse. I've been carpally pain-free for six years or so.

Eventually, I bought myself a Kangaroo Sit-Stand workstation, which has several advantages, including much more ability to fine-tune height than is accorded by boxes and old books and packing materials.... Looks better, too.

It turns out that I just never sit down to work anymore, so the Sit-Stand workstation is always in the 'stand' position, and at the top of its range. This leaves me with my forearms slanting 15 to 20 degrees down toward the keyboard and mouse pad, which does put a slight cock in my wrists. But, it also ensures that I use the front of the keyboard, or of the laptop, as merely a touch reference for the heels of my hands, and NOT as a rest. It also means that there is no contact between my wrists and ... anything. That's what seems to be my solution to the carpal tunnel irritation.

When you start out fine, but resting your wrists/forearms while you type, then find yourself wanting a gel wrist-pad some years later, that should be your big warning that you are in a poor typing position. Adjust your entire setup until you either have air under your forearms, wrists and palms, or have only the barest whisper of a touch on the heels of your hands... NOT on your wrists or forearms. It doesn't take much external pressure to add stress, and eventually strain to a carpal tunnel that would otherwise have happily accommodated millions of characters of typing with nary a problem. Anyone who has had orthodontistry will be familiar with how mere ounces of force, over an extended period of time, can radically move and re-align body parts (in that case, teeth and bones) - the same is true of injury. It doesn't take much, if it goes on and on, day after day.

Similarly, learn to swing your mouse (or stylus) from your elbow or shoulder, not from a wrist that is pivoting on a surface (even a gel-padded surface).

The pressure of resting your hands/wrists/forearms will likely be the more damaging component for some people, while the deviation of the wrist/hand joint from a neutral position - cocking the wrists, either back, or laterally - will be the killer for other people... and some lucky souls will be undone by both irritants.

The action of extremities that causes nerves, tendons, vessels to be repeatedly pulled through a confined area is called "flossing". You can inflict similar excitement on another important nerve bundle by sitting on a table and alternating swinging your legs forward and back under the table. In that case, you are flossing the sciatic nerves where they exit the spine and where they transit the piriformis. This is used to temporarily free (or highlight) impingement, to tell a therapist which bits are misaligned or inflamed, and are pinching the nerves.

Oh... for a while, I used to squeeze one of those squishy balls (like gel-foam or micro-beads covered in spandex), with my hands in neutral position. That might have helped, though I think the biggie is getting my wrists off of anything more solid than air, while I type.

The foregoing might be of some help to people who [are starting to] have carpel tunnel symptoms similar to what I had. If you fall into a different category (you never rest your hands/wrists/forearms while typing and mousing) but still experience the problem, then maybe somebody else has a parallel path to recovery, for your type of injury, that doesn't go involve slicing and dicing. While we all have certain anatomical commonalities, we do still have differences, so what worked for me is likely to work for some/many, but unlikely to work for all.

Void where prohibited.
Prohibited where void.

-----Original Message-----
From: Ward, Teri A
Sent: May-07-13 11:36 AM
To: Cardimon, Craig; 'Becca'; 'tech2wr-l'
Subject: RE: keyboard recommendations?

I have the user guide and it just calls it "Logitech Illuminated Keyboard." I went to Best Buy and picked the one that took the least effort to activate the keys. That was my main concern. And it was a huge improvement over my previous keyboard. Much less pain to type. Sorry you're experiencing the same thing. But it does get better ...

-----Original Message-----
From: Cardimon, Craig [mailto:ccardimon -at- M-S-G -dot- com]
Sent: Tuesday, May 07, 2013 5:01 AM
To: Ward, Teri A; 'Becca'; 'tech2wr-l'
Subject: RE: keyboard recommendations?

I'm in the same boat regarding the surgery. Amazon offers several different models. Do you know which model you bought?

-----Original Message-----
From: Ward, Teri A
Sent: Monday, May 06, 2013 4:17 PM
To: Becca; tech2wr-l
Subject: RE: keyboard recommendations?

After I had carpal tunnel surgery 2 years ago, I found my fingers would still get unpleasantly tingly after typing for a while. So I bought a soft-touch keyboard - the Logitech Illuminated Keyboard. It's holding up well, and very easy to type on. I wasn't looking for one with backlight, but now that I have it I love it. I don't remember the price. It's just really comfortable to use.

Tammie in Seattle

-----Original Message-----
From: Becca
Sent: Monday, May 06, 2013 12:51 PM
To: tech2wr-l
Subject: keyboard recommendations?

I need a new keyboard for my PC. The letters on my old one have pretty much worn off (fortunately I'm mostly a touch-typist).

I'm looking for an ergonomic one, but I'd like one with a fairly light touch, so I'm not feeling like I'm pounding on the keyboard (which may mean re-training my hands to a lighter touch). And it should be fairly fast... I think I'm typing faster than my current cheap-o one can deal with, because I'm noticing a lot of transposed letters (or maybe I'm just overly tired right now, and the error is in my fingers.)

For once, I can say that price is no object, if the quality is there. I'm finishing up The Project From Hell, and I'll be paid well for it.

Any suggestions?

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