Wrist Pain: Prevention Is the Best Cure
Too much time on the computer can cause repetitive strain injuries; the fragile wrist is especially vulnerable
In 1998, Howard Egerman injured his wrists taking disability claims, an irony that was not lost on the 65-year-old Social Security Administration representative. For years Egerman filled out the intake forms longhand. Then his whole office in Oakland, Calif., got computerized, and his troubles began.
Like most people with developing wrist injuries, he initially shrugged off his aches and discomforts. Within a couple of years, however, his pain was so fierce it would wake him up in the middle of the night. A doctor diagnosed deQuervain's disease.
It didn’t stop there. Egerman developed carpal tunnel syndrome. The injuries, like a set of falling dominoes, kept on coming. He would get better for a while, then new problems would arise. Three surgeries and multiple rounds of rehab haven’t helped. “It depresse the hell out of me when I think about the stuff I used to be able to do,” he says today.
Among his limitations: He can drive only if he’s going straight because turning the wheel is agony. So is throwing out the garbage — or opening a bag of chips. He doesn’t use a mobile phone because he can't press the buttons. He still types for work, but at a cost. “First my fingers tingle, then my hand goes numb,” he says. “After a while, I lose all feeling.”
Sadly, Howard Egerman's story is all too common, and increasingly so as the cumulative damage of repetitive activities, especially keying, catches up with us. Rather than continue to ignore the warning signs, we need to be proactive as quickly as possible.
Wrist Pain: A Primer
According to the Bureau of Labor Statistics, musculoskeletal disorders (many of which are repetitive strain injuries, or RSIs) are the leading occupational illness in the country. In 2010 they accounted for nearly one-third of all workplace injuries and illnesses requiring time away from the job.
Wrist injuries need to be taken seriously because of the role the hand plays in virtually every occupation and activity. Most people dismiss their pain when they first start to experience it, but this is precisely the time it could be turned around. The longer you live with an injury, the more difficult it becomes to treat or reverse.
Sometimes wrist pain stems directly from hand-intensive activities — like knitting, gardening or playing a musical instrument — but not always. Sitting for eight hours with a forward head posture, plus the unnatural positions we assume at the computer, put tremendous stress on our entire system. Over time, this can lead to muscle, tendon and nerve injuries all over the upper body. Typing and mousing require you to hold your arms in a static position while your forearms and fingers are making multiple repetitive movements. This is very fatiguing and eventually the soft tissue can become inflamed and scarred.
Regardless of the cause, the problem doesn't develop overnight. Cumulative trauma to the soft tissues happen over the course of months and years of overuse.
When it heals, the scar tissue is stiffer and less resilient than normal tissue, making it more prone to re-injury, leading to a vicious cycle of injury and relapse. In the extreme situation, people can become permanently disabled.
Thus we learn to adapt and live and work in pain, which aggravates the condition. People try to address the problem with massage, chiropractic, splints, painkillers, acupuncture, vitamins, supplements and ointments. Unfortunately these remedies do not offer lasting relief, and some can actually make matters worse. When people do seek medical attention, all too often their doctors aren’t knowledgeable or helpful.
What does help is avoiding the offending activity, which means staying away from the computer or whatever caused the problem. Once people feel better, they can begin to work (or play) again, but not at the previous levels because of the likelihood of recurrence. This is important, but most of us don't take that prescription seriously enough.
Your doctor can’t take breaks for you. Your physical therapist can’t do your exercises for you. Only you can make the lifestyle changes that will lead you out of pain and toward recovery.
A Checklist to Save Your Wrists
Since prevention is the only “cure” for such injuries, the best plan is to protect your hands from overuse in all daily activities by keeping yourself strong and well rested and to avoid actions that abuse them. Here is a list worth saving. And pay attention to early symptoms so you can turn things around before they become intractable.
- Limit your hand activities. Howard Egerman uses the “Hand Bank” concept I wrote about in my Repetitive Strain Injury Recovery Book. He decides how much hand energy he has for the day and allots it according to his priorities. For instance, he can do the laundry or spend hours online, but not both. Think of it as having a daily "hand budget" and not being able to "overspend."
- Work with a knowledgeable physical or occupational therapist. Find someone who understands wrist injuries, i.e., who won’t have you lift heavy weights or do wrists curls, which exacerbate the condition. If your therapist pushes you into pain, find someone else.
- Do appropriate exercise. When you’re at the keyboard, you're like an athlete, and you need to “train” the same way other pros do: strengthening and elongating the appropriate muscles and taking frequent breaks. Stop using the mouse, keyboard or any handheld device every 20 minutes (sooner if you have an injury or are fatigued). Some people find certain yoga poses helpful — but avoid any that strain the wrist, like cat curls, downward dog, sun salutation, headstands or shoulder stands.
- Keep your wrists neutral. This means that no matter how you use your hands for computing, playing the piano or chopping vegetables, you need to keep your wrist straight (i.e. not bent upward, downward or sideways). Do not rest your wrists on any surface while you are keying or mousing. When not keying, rest them palm-side up.
- Use soothers and supplements. Nothing works for everyone. Some people find acupuncture helpful for pain. Others take vitamin B6 for carpal tunnel syndrome (though high doses can bring on the very symptoms you're trying to alleviate. The Merck manual advises no more than 500mg daily, supplementally). For some people, Boswellia reduces their pain; hyaluronic acid is sometimes recommended for joint healing. But the bottom line is that supplements are not a substitute for proper technique and posture and good ol' rest!
- Get an ergonomically designed keyboard. I like Kinesis' Maxim and Freestyle2 models.
- Dictate. You can use a voice dictation program to alternate with your hands. Just remember that they aren’t perfect, so always proof your work before you send it out. For additional information, visit the rsihelp website.
Deborah Quilter is an ergonomics expert who has lectured internationally about repetitive strain injury to business groups and conferences.