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Typing Injury FAQ (2/6): General Info

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Archive-name: typing-injury-faq/general
Version: $Revision: 5.23 $ $Date: 1995/10/17 07:41:35 $

See reader questions & answers on this topic! - Help others by sharing your knowledge

This FAQ may be cited as:

     Wallach, Dan S. (1995) "Typing Injury FAQ: General Information".

World-Wide-Web users will find this available as hypertext:

   * (Dan Wallach's page)

Answers To Frequently Asked Questions about Typing Injuries

The Typing Injury FAQ - sources of information for people with typing injuries,
repetitive stress injuries, carpal tunnel syndrome, etc.

Copyright  1992-1995 Dan Wallach <dwallach@CS.Princeton.EDU>

[Current distribution:,, comp.human-factors,
{news,sci,comp}.answers, and e-mail to,, and]

Table of Contents:

  1. Publications, mailing lists, newsgroups, WWW pointers, etc.
  2. The archive
  3. General info on injuries
  4. Typing posture, ergonomics, prevention, treatment
  5. FAQ's About Computer Ergonomics and Workstation Injuries
  6. Requests for more info
  7. References


Publications, mailing lists, newsgroups, WWW pointers, etc.

(thanks to Rik Ahlberg <> for parts of this info)

  1. Publications

     CTDNews is a monthly newsletter that covers cumulative trauma disorder.
     It's a bit pricey ($146/year) but fairly concise. They'll send you your
     first issue free, so you can look it over.

          PO Box 239
          Haverford, PA 10941
          215-896-4902, or 800-554-4CTD to order

  2. FTP & Gopher & WWW sites
          The home of the Boston RSI Archive


          Boston RSI changed its name to RSI-East, and the new archives are at
 (detailed below) The RSI Network Newsletter is a
          bi-monthly online newsletter produced by Caroline Rose
          <> and distributed online by Craig O'Donnell

          Extensive anonymous ftp archive, including the typing injury FAQ
          (frequently asked questions), alternative input device information
          (descriptions, reviews, and GIF images), and some software.
          Maintained by Dan Wallach <dwallach@CS.Princeton.EDU>.

          (more info below...)
          A gopher site containing the Electronic Rehabilitation Resource
          Center. Lots of disability information, including a searchable
          database of national disability resources and access to other gopher
          sites with geographically local disability information.

          Also home to RSI-East, its message archive, and an archive of the RSI
          Network Newsletter.

          An ftp site containing the archives of RSI-UK.

          Also, Demon now mirrors the typing-injury archive:

          A World-Wide-Web page with some good pictures of how to hold your
          hands, MPEG videos of various exercises, and more.

     Other WWW sites:
          The Ergonomic Page, from Applied Software Unlimited [- NEW!]
          Emacs keybindings and ergonomics [- NEW!]
          Amara's RSI Page [- NEW!]
          MouseMitt International - padded lycra wrist braces [- NEW!]
          Workstation Environments - a company which designs high-end furniture
          [- NEW!]
          Safety Related Internet Resources [- NEW!]
          Some human factors and ergonomics research by Alan Hedge
          TechTime articles on RSI Injuries
          A Patient's Guide to Carpal Tunnel Syndrome
          Medical Matrix - A Guide to Internet Medical Resources
          ErgoWeb - lots of information for designers of ergonomic tools
          Oversensitivity to Electricity
          Disability Resources from Evan Kemp Associates
          Intergraph Workstation Furniture
          Safe Computing's Internet Store - buy ergonomic products online
          The Martial Arts FAQ

          The Ergonomic Sciences Corp, Mountain View, CA.

          The (USA's) Occupational Safety and Health Administration

          Canadian Centre for Occupational Health and Safety

          Repetitive Stress Injury Help Page (CMU)

          Some other WWW indices to the typing-injury archive

          The FAQ for a2x (a program to interface an external keyboard or
          speech synthesizer to an X window system) and the FAQ for
          DragonDictate (a speech recognition system) are both available here.
      (this should include
               information on the new a3x software which works with Windows NT
               instead of Unix and X)

          Another RSI page in the works

          Magnetic Devices from Total Health Mktg., Nikken Independent

  3. Listserv Mailing Lists

     Sorehand is a San Francisco-based listserv mailing list for people with
     RSIs. Subscribe by sending mail with any subject to:

     with the message body reading:

          subscribe sorehand Your Name

     C+Health (Computers & Health) is a listserv mailing list which deals with
     the technologies causing injuries to folks who use them. Subscribe by
     sending mail with any subject to:

     with the message body reading:

          subscribe c+health Your Name

     RSI-East is the east coast's answer to sorehand, where users discuss their
     experiences and offer support, referral, and treatment information to one
     another. Subscriptions are available to anyone with an interest in RSIs,
     but with the caveat that the list is intended as a regional resource for
     networking. Subscribe by sending mail with any subject to:

     with the message body reading:

          subscribe rsi-east Your Name

     RSI-UK is Great Britain's RSI mailing list, open to anyone. Subscribe by
     sending mail with any subject to:

     with the message body reading:

          subscribe rsi-uk Your Name

     Also, check out the RSI-UK Web page: [- NEW!]

  4. Usenet Newsgroups
          The successor to
          A Usenet newsgroup which deals in occupational medicine. Lots of
          practitioners read it!

          Mostly software design, but occasional discussion of accessibility
          issues for people with RSIs.
          Support for those with arthritis. New as of 11/93.

          Usenet feed of the ada-law listserv. Covers issues relating to the
          Americans with Disabilities Act (ADA).

          Usenet feed of the disabled student services listserv. Particularly
          of interest to computer science students dealing with RSIs or folks
          pondering a return to school and/or retraining after a disabling RSI.

  5. Real-time chatting

     If you've got an account on America On-Line, you might want to check out
     the RSI Support Group, which meets every Wednesday night in the Equal
     Access Cafe. This realtime chat starts at 9:15pm eastern time. Check the
     current AOL schedule for the most current information.

  6. Books / Literature

     A large amount has been written in the popular press and the medical
     literature, and more comprehensive bibliographies (rsi.biblio and
     rsi.biblio2) are available in the typing-injury archive.

     Here are some books you might want to check out:
        o Emil Pascarelli and Deborah Quilter, Repetitive Strain Injury, a
          Computer User's Guide, John Wiley & Sons, ISBN 0-471-59533-0.
             + The Pascarelli book is often cited in various on-line
               conversations. If you buy only one book, this is probably the
               one to get.

        o Don Sellers, Zap! How Your Computer Can Hurt You-And What You Can Do
          About It, Peachpit Press, Inc., 1994. ISBN# 1-55609-021-0. Author's

        o Stephanie Brown, Preventing Computer Injury: The Hand Book, Ergonome
          Press, 1993, ISBN 1-884388-01-9.

        o David Zemach-Bersin et al., Relaxercise, Harper Press, 1990, ISBN

        o Bonnie Prudden, Pain Erasure - The Bonnie Prudden Way. M. Evans &
          Co., Inc., 1980; ISBN 0-87131-328-6 (hardcover). Ballantine Books,
          Inc.; 1982 (softcover).

        o Martin Sussman et al., Total Health at the Computer. Station Hill
          Press, 1993.

        o Don Aslett, Make Your House Do The Housework, Digest Books, 1986.
          ISBN 0-89-879227-4. 201 pages.

        o Sharon Butler, Conquering Carpal Tunnel Syndrome (& other RSIs),
          Advanced Press (no ISBN, but phone 800-909-9795, pay $18.95 +
          shipping). Author's e-mail:

        o A free packet of information is also available from the U.S.
          Government. You might want to ask for:

          Carpal Tunnel Syndrome
          Selected References (March 1989)

          NIOSH Publications Dissemination
          4676 Columbia Parkway
          Cincinnati, Ohio 45226

          Alternatively, you can call NIOSH's 800 number: 800-356-4674
          (800-35-NIOSH) or poke around their WWW page:
 [- NEW!]
  7. Societies / Support Groups [- NEW!] This section is new, so please forgive
     it's incompleteness. Please send me mail so I can register your support
        o RSI patienten vereniging
          Postbus 1222
          NL-3800 BE Amersfoort
          The Netherlands
          phone (via FNV) (03480)87804
          phone (abroad) + 31 3480 87804


The archive

Check out the ever-increasing typing injury archive! Just use anonymous ftp or


Informative files:

          changes since last month's edition
          information about typing injuries
     keyboards1 and keyboards2
          products to replace your keyboard
          software to watch your keyboard usage
          details about various desks, chairs, etc.
     some simple ways to make things like mopping and tooth brushing less
alexander-vs-feldenkrais [- NEW!]
     Mike Mossey compares two healing techniques
     about Adverse Mechanical Tension
     e-mail from Dr. Peter Bower about this stuff
     a bibliography for more AMT info
     a note about ANSI/ISO, EC, and MIL-STD "standards"
     how to correctly use armrests
     info about the Assoc for Rep. Motion Syndromes
     three simple exercises for your middle back
     learning to listen to your body
     replace your car seat with something more comfortable
     PageMaker4 document about your wrists
     PostScript converted version of above...
     info on Carpal Tunnel Syndrome
     a discussion of what carpal tunnel syndrome is and isn't
     very detailed information about CTS
     new treatments that don't involve surgery
     excerpt from Rosemarie Atencio's book
     abstract of a paper discussing steroid (cortisone) treatments for CTS
     one person's story of CTS diagnosis, treatment, and recovery
     JAMA article on CTS surgery
     some general tips for recovering from the surgery
     TidBITS article on CTS
     info about the CTDNews publication
     interesting facts and references to more
     Cumulative Trauma Disorders: Are They Preventable? Yes, No, Maybe - a
     paper by Joy Linn
     large list of keyboards, more relevant for users with motion disabilities
     large list of mailing lists for a various disabilities
     double-crush syndrome, CTS, and more
     should you buy the version with a bigger dictionary?
     a detailed comparison of both voice systems
dragon-vs-kurzweil2 [- NEW!]
     an even more detailed comparison of the two systems
     lots of into about Dvorak keyboarding
     exercise in the workplace
     info on some newer mice
     some background info on how the Feldenkrais method can ease stress
     how to hack a footswitch into your computer
     where to buy a footswitch
     hints about controling glare from your screen
     lots of information on the GlidePoint trackpad pointing device
     RSI vs. playing guitar
     info about Handeze gloves
     advice on picking a health-care provider in the USA
     one person's story of an injury
     why some get injured and some don't
     statistics about what gets injured
     a huge list of pointers to Internet resources
     Dan's (increasingly ancient and outdated) opinions on the keyboard
keyboard-companies [- NEW!]
     Simpson Garfinkel's article about companies building new keyboards
     all about picking a good tray
     some useful xmodmap calls when using a Kinesis Sun adapter box
     using martial arts to combat RSI's
     comparison of Microsoft Natural and Taiwanese generic split keyboards
     keyboard shortcuts and tricks
     basic information on how the human nervous system works
     info about British judge saying RSI isn't real
nonsurgical-treatment [- NEW!]
     Various nonsurgical treatment options for upper extremity overuse injuries
     Worker-oriented solutions to office safety
     All about pain
     Some observations about professional pianists
     advice if pointing devices are your problem
     explanations of different types of physical therapy
     a short list of dealers and consultants
     lots of advice about how to climb without hurting yourself
     Article in The Independent (London, UK)
     bibliography of RSI-related publications
     another bibliography
     stats on RSI happening to dentists
     long detailed information about RSI
     Dr. Leo Rozmaryn of the US Food and Drug Administration's seminar on RSI's
     an attempt to start a U.S. advocacy group
     basic article from FDA Consumer
     archive of the RSI Network newsletter (currently, containing issues 1
     through 19)
     study showing RSI isn't just psychological
     it's better to type slower
     reviews a Mac program to reduce keystrokes
     info on Tendonitis
     info about thoracic outlet syndrome (TOS)
     more info about thoracic outlet syndrome
     treatment info, exercises, and more (useful for many folks)
     RSI resources in Great Britain
     why anti-vibration gloves aren't necessarily helpful
     possible links between vitamins and RSI's
     a brief comparison of recognition systems
     how to avoid hurting your voice with overuse (as you might do with a
     speech recognition system)
     detailed information about the appropriateness of a voice dictation system
     to programming tasks
     all about using a voice recognition system as a programmer
     dealing with insurance and lawyers
     picking your supports and splints

Various product literature and reviews:

     press release on the Apple Adjustable Keyboard
     extensive info about Apple's Adjustable Keybd
     MacWeek review on the Bat
comfort-factors, comfort-features, comfort-letter, and comfort-survey
     marketing info on the Comfort Keyboard
     one user's personal opinions
     another user's opinions
     detailed opinions of the DataHand
     follow-up to above
     another review of the DataHand
     description of the DataHand's appearance
     info about DragonDictate 2.0
     details about the IN3 Voice Commander
keyboard-phone-numbers [- NEW!]
     Tom Bell's list of keyboard vendor phone numbers
     one user's personal opinions
     another user's personal opinions
     a collection of opinions on the Kinesis
     a comparison of two similar keyboard alternatives
     info about the Kurzweil voice recognizer
maltron-flyer and maltron-letter
     marketing info on various Maltron products
     one user's personal opinions
     one user's personal opinions of the Microsoft Natural Keyboard
ncc-digital-dictate [- NEW!]
     the Digital Dictate add-on for IBM VoiceType
     marketing info on the Vertical
     marketing info on IBM VoiceType
     how to get more info from Australia's govt
     how to arrange your computer/chair/desk
wrist-rest-phone-numbers [- NEW!]
     Tom Bell's list of wrist rest vendor phone numbers

Programs (in the software subdirectory):

UNIX/X Software:

(Note: a2x.tar and rk.tar are both from so they may
have a more current version than

     a more sophisticated X keyboard/mouse spoofing program. Supports
     a hacked version of a2x that can take input directly from PC keyboards via
     the serial port and an adapter.
     Dragon voice macros to accompany a2x use
     a program for one-handed usage of normal keyboards
     generates fake X keyboard events from the serial port - use a PC keyboard
     on anything!
     yet another idle watcher
     the reactive keyboard - predicts what you'll type next - saves typing
     like kt, generates fake X key events, but from a raw PC keyboard via the
     serial port
     patches for X11R5 to allow the spacebar to be both a spacebar and a
     control key
     MS Windows break-reminder program
     tells you when to take a break
     turns your QWERTY keyboard into Dvorak
     keeps track of how long you've been typing
     X-Windows program which pops up and tells you to take a break.
     OpenWindows activity monitor / rest reminder

PC/DOS Software:

     a serial port keyboard spoofer for MS Windows
     simple TSR program - remind you to take breaks

Pictures (in the gifs subdirectory):

(Note: you can see inlined images of these keyboards in the keyboards FAQ

     picture of good sitting posture (the caringforwrists document is better
     for this)
half-qwerty.gif (new name, same file as old 1handpic.gif)
     keymappings for the Half-QWERTY
     beautiful grey-scale picture
     chord-mappings for the accukey
     the Apple Adjustable Keyboard
     the InfoGrip Bat
     the Health Care Comfort Keyboard
     picture of the keyboard
     key layout schematic
     Grahl split-back ergonomic chair
     Grahl normal-back ergonomic chair
     the ergoLogic 7.1 keyboard (same as flexpro)
ergomaster1.gif and ergomaster2.gif
     the Genovation ErgoMaster keyboard
     the Maxi Switch ErgoMax keyboard
     the Key Tronic FlexPro keyboard (same as ergologic)
     the Fountain Hills keyboard
     a generic keyboard, made in Taiwan
     hand size chart for Handeze gloves
     properly scaled Postscript of handeze.gif
     the Kinesis Ergonomic Keyboard
     the Lexmark Select-Ease keyboard
maltron1.gif, maltron2.gif, maltron3.gif, and maltron4.gif
     several pictures of Maltron products
     the Marquardt MiniErgo
     the Microsoft Natural Keyboard
     ... and a prototype that didn't make it
     ErgonomiXX MyKey
     Somers EK1 Ergonomic Keyboard
     schematic picture of the keyboard
     The Tony! Ergonomic Keysystem
     Twiddler, "front" view
     Twiddler, "side" view
     the Vertical keyboard
     the Iocomm `Wave' keyboard

Many files are compressed (have a .Z ending). If you can't uncompress a file
locally, will do it. Just ask for the file, without the
.Z extension.

General info on injuries

First, and foremost of importance: if you experience pain at all, then you
absolutely need to go see a doctor. As soon as you possibly can. The difference
of a day or two can mean the difference between a short recovery and a long,
drawn-out ordeal. GO SEE A DOCTOR. Now, your garden-variety doctor may not
necessarily be familiar with this sort of injury. Generally, any hospital with
an occupational therapy clinic will offer specialists in these kinds of

The remainder of this information is paraphrased, without permission, from a
wonderful report by New Zealand's Department of Labour (Occupational Safety and
Health Service): "Occupational Overuse Syndrome. Treatment and Rehabilitation:
A Practitioner's Guide".

First, a glossary (or, fancy names for how you shouldn't have your hands):
(note: you're likely to hear these terms from doctors and keyboard vendors :)

     Repetitive Strain Injury - a general term for many kinds of injuries
     Occupational Overuse Syndrome - synonym for RSI
     Cumulative Trauma Disorder - another synonym for RSI
     Work-Related Upper Limb Disorders - yet another synonym for RSI
     Carpal Tunnel Syndrome (see below)
     Marked bending at a joint.
     Turning the palm down.
Wrist extension
     Bending the wrist up.
     Turning the palm up.
Wrist flexion
     Bending the wrist down.
Pinch grip
     The grip used for a pencil.
Ulnar deviation
     Bending the wrist towards the little finger.
Power grip
     The grip used for a hammer.
Radial Deviation
     Bending the wrist toward the thumb.
     Moving away from the body.
     Opening the fingers out wide.

Now then, problems come in two main types: Local conditions and diffuse
conditions. Local problems are what you'd expect: specific muscles, tendons,
tendon sheaths, nerves, etc. being inflamed or otherwise hurt. Diffuse
conditions, often mistaken for local problems, can involve muscle discomfort,
pain, burning and/or tingling; with identifiable areas of tenderness in
muscles, although they're not necessarily "the problem."

Why does Occupational Overuse Syndrome occur? Here's the theory.

Normally, your muscles and tendons get blood through capillaries which pass
among the muscle fibers. When you tense a muscle, you restrict the blood flow.
By the time you're exerting 50% of your full power, you're completely
restricting your blood flow.

Without fresh blood, your muscles use stored energy until they run out, then
they switch to anaerobic (without oxygen) metabolism, which generates nasty
by-products like lactic acid, which cause pain.

Once one muscle hurts, all its neighbors tense up, perhaps to relieve the load.
This makes sense for your normal sort of injury, but it only makes things worse
with repetitive motion. More tension means less blood flow, and the cycle

Another by-product of the lack of blood flow is tingling and numbness from your
nerves. They need blood too.

Anyway, when you're typing too much, you're never really giving a change for
the blood to get back where it belongs, because your muscles never relax enough
to let the blood through. Stress, poor posture, and poor ergonomics, only make
things worse.

Specific injuries you may have heard of

(note: most injuries come in two flavors: acute and chronic. Acute injuries are
severely painful and noticable. Chronic conditions have less pronounced
symptoms but are every bit as real.)

     an inflamation of the tendon sheath. Chronic tenosynovitis occurs when the
     repetitive activity is mild or intermittent: not enough to cause acute
     inflamation, but enough to exceed the tendon sheath's ability to lubricate
     the tendon. As a result, the tendon sheath thickens, gets inflamed, and
     you've got your problem.
     an inflammation of a tendon. Repeated tensing of a tendon can cause
     inflamation. Eventually, the fibers of the tendon start separating, and
     can even break, leaving behind debris which induces more friction, more
     swelling, and more pain. "Sub-acute" tendonitis is more common, which
     entails a dull ache over the wrist and forearm, some tenderness, and it
     gets worse with repetitive activity.
Carpal Tunnel Syndrome
     the nerves that run through your wrist into your fingers get trapped by
     the inflamed muscles around them. Symptoms include feeling "pins and
     needles", tingling, numbness, and even loss of sensation. CTS is often
     confused for a diffuse condition.
Adverse Mechanical Tension
     also known as 'neural tension', this is where the nerves running down to
     your arm have become contracted and possibly compressed as a result of
     muscle spasms in the shoulders and elsewhere. AMT can often misdiagnosed
     as or associated with one of the other OOS disorders. It is largely
     reversible and can be treated with physiotherapy (brachial plexus
     stretches and trigger point therapy).
     for just about every part of your body, there's a fancy name for a way to
     injure it. By now, you should be getting an idea of how OOS conditions
     occur and why. Just be careful: many inexperienced doctors misdiagnose
     problems as Carpal Tunnel Syndrome, when in reality, you may have a
     completely different problem. Always get a second opinion before somebody
     does something drastic to you (like surgery).


Typing posture, ergonomics, prevention, treatment

The most important element of both prevention and recovery is to reduce tension
in the muscles and tendons. This requires learning how to relax. If you're
under a load of stress, this is doubly important. Tune out the world and breath
deep and regular. Relaxing should become a guiding principle in your work:
every three minutes take a three second break. EVERY THREE MINUTES, TAKE A
THREE SECOND BREAK. Really, do it every three minutes. It's also helpful to
work in comfortable surroundings, calm down, and relax.

If you can't sleep, you really need to focus on this. Rest, sleep, and
relaxation are really a big deal.

There are all kinds of other treatments, of course. Drugs can reduce
inflamation and pain. Custom-molded splints can forcefully prevent bad posture.
Surgery can fix some problems. Exercise can help strengthen your muscles.
Regular stretching can help prevent injury. Good posture and a good ergonomic
workspace promote reduced tension. Ice or hot-cold contrast baths also reduce
swelling. Only your doctor can say what's best for you.

Posture - some basic guidelines

[I so liked the way this was written in the New Zealand book that I'm lifting
it almost verbatim from Appendix 10.]

   * Let your shoulders relax.
   * Let your elbows swing free.
   * Keep your wrists straight.
   * Pull your chin in to look down - don't flop your head forward.
   * Keep the hollow in the base of your spine.
   * Try leaning back in the chair.
   * Don't slouch or slump forward.
   * Alter your posture from time to time.
   * Every 20 minutes, get up and bend your spine backward.

Set the seat height, first. Your feet should be flat on the floor. There should
be no undue pressure on the underside of your thighs near the knees, and your
thighs should not slope too much.

Now, draw yourself up to your desk and see that its height is comfortable to
work at. If you are short, this may be impossible. The beest remedy is to raise
the seat height and prevent your legs from dangling by using a footrest.

Now, adjust the backrest height so that your buttocks fit into the space
between the backrest and the seat pan. The backrest should support you in the
hollow of your back, so adjust its tilt to give firm support in this area.

If you operate a keyboard, you will be able to spend more time leaning back, so
experiment with a chair with a taller backrest, if available.

[Now, I diverge a little from the text]

A good chair makes a big difference. If you don't like your chair, go find a
better one. You really want adjustments for height, back angle, back height,
and maybe even seat tilt. Most arm rests seem to get in the way, although some
more expensive chairs have height adjustable arm rests which you can also
rotate out of the way. You should find a good store and play with all these
chairs - pick one that's right for you. In the San Francisco Bay Area, I highly
recommend "Just Chairs." The name says it all.

Keyboard drawers, wrist pads, and keyboard replacements:

There is a fair amount of controvery on how to get this right. For some people,
wrist pads seem to work wonders. However, with good posture, you shouldn't be
resting your wrists on anything - you would prefer your keyboard to be "right
there". If you drop your arms at your side and then lift your hands up at the
elbow, you want your keyboard under your hands when your elbows are at about 90
degrees. Of course, you want to avoid pronation, wrist extension, and ulnar
deviation at all costs. Wrist pads may or may not help at this. You should get
somebody else to come and look at how you work: how you sit, how you type, and
how you relax. It's often easier for somebody else to notice your hunched
shoulders or deviated hands.

Some argue that the normal, flat keyboard is antiquated and poorly designed. A
number of replacements are available, on the market, today. Check out the
accompanying typing-injury-faq/keyboards for much detail.

Lately, a number of people have been having luck with gloves. You may want to
try some light gloves, possibly with the fingers removed if they're too warm.
Many seem to like the Handeze Gloves, available for around $20 from
Patternworks, P.O. Box 1690, Poughkeepsie, NY 12601 (800/438-5464). See the
typing-injury archive "" for details.

Another place you may be able to get stuff: a company called Enrichments has a
catalog of ergonomic products you may find interesting. Their phone number is
800/323-5547. Or, you might want to contact AliMed at 800/225-2610 and ask for
their Ergonomics catalog.

Here are some sources for fancy keyboard drawers:

Ergotron, Eagan, MN, 800/888-8458. A wide tray that mounts under a desk and is
adjustable, has a wrist rest, and is wide enough to accomodate a mouse pad.

Ergo Systems, East Hartford, CT, 203/282-9767. They make keyboard trays and a
retractrable mouse pad, too.

Rubbermaid makes a simple $20 plastic keyboard tray that works well. I found
mine at CompUSA, so check your local computer store.

FAQ's About Computer Ergonomics and Workstation Injuries

Copyright  1992-1995 Jonathan Bailin, Ph.D. <>

Question Categories

General Info, Monitor, & Desktop Accessories......................1-6
Wrists, Body Posture, & Chair Features............................7-13
Active Breaks, Microbreaks, & Excercises.........................14-15
Varieties of Computer Injuries.....................................16
Kinesiology for RSI................................................17
Emergence of RSI...................................................18
Lifestyle Changes and Reducing RSI Risk............................19

  1. Q. What is "ergonomics"?

     A. Ergonomics is the science of adjusting your work environment to fit
     your body and make it most comfortable.

  2. Q. What is the best room lighting to help reduce eye strain?

     A. A mixture of fluorescent and incandescent light is usually most
     pleasing. The most important aspect of lighting is to reduce glare and
     bright reflections from your screen, nearby glass, or shiny surfaces.
     Since light conditions change during the day this may require several
     adjustments while working. If you smoke while keyboarding, be sure to
     clean your screen frequently as water vapor and smoke make a potent film
     forming process.

  3. Q. What is the best position for the monitor at my workstation?

     A. Many make the common mistake of putting the monitor, the keyboard, or
     both off to one side on a desk. If you perform more than a few minutes of
     keyboarding a day, the keyboard and monitor should be placed directly in
     front of your normal sitting position. The screen should be 18-30 inches
     from your eyes or about an arm's length.

  4. Q. Is there an optimum height for my monitor?

     A. Yes. The top of the monitor should be at eye level because the eyes are
     at their most comfortable position straight ahead but slightly downward.
     This is why reading lenses in bifocal glasses are placed just below the
     horizontal plane.

     On the topic of eye correction, make sure your eyes are 20/20 and hat if
     you do need correction your optometrist should know about the amount of
     your monitor use and its distance from your eyes. A correction just for
     monitor use may be necessary. Be sure to look away from your screen at
     least every 30 minutes and focus on something over 20 feet away.

  5. Q. Is there an optimum screen brightness and color scheme to help prevent
     eye strain?

     A. Black characters against a light gray background are often easiest on
     he eyes for long periods. Contrast and brightness should be adjusted to
     create the brightest screen without blurring.

  6. Q. What other accessories and placement are important?

     A. Frequently used items should be within arms reach from your keyboarding
     position. A document holder should be at the same height and distance as
     he screen so that your eyes don't need to change focus frequently.
     Frequent telephone use should utilize a headset to avoid bending the neck
     while keyboarding. Remember that many RSI's begin with nerve insult in the
     neck and shoulders.

  7.  Q. What is the most healthy posture for my wrists while typing?

     A. The best position is neutral. In other words, the knuckles, wrist, and
     op of the forearm should form a straight line.

  8. Q. Can a wrist pad sitting in front of the keyboard be used during

     A. The neutral position described in #7 can not be achieved while in
     contact with most commercial wrist pads. For this reason keyboarding is
     best performed from a "floating" wrist position. Contact wristpads for
     rest periods only. Frequent rest becomes necessary with floating wrists
     because it tends to emphasize shoulder muscle contraction. Don't forget to
     use the lightest possible finger pressure during keying.

  9. Q. What is the best elbow and shoulder position while keyboarding?

     A. The elbows should form a 90 degree angle while *hanging* at your sides
     from the shoulders. Rarely do chairs with armrests allow this position. It
     is *very* important that the shoulders remain relaxed in a lowered
     position during keyboarding (see #6).

 10. Q. What is the best seat height for keyboarding?

     A. It is most important that seat height should allow the upper body
     postures described in #7, #8, and #9. This upper body posture is most
     responsible for reducing risk of injury. Once this is accomplished, the
     feet should be flat on the floor.

     If the resulting seat height prevents the feet from resting flat on he
     floor, a foot rest is necessary. This should allow the lower legs to be
     vertical and thighs horizontal.

 11. Q. What should I look for in the backrest of a chair?

     A. Expensive motors and adjustable sections are not necessary if the
     backrest has firm support for the inward curve of the lower spine (lumbar)
     and outward curve of the upper spine (thoracic). Wether you need upper
     body support to help keep your torso and head vertical is a matter of

 12. Q. What other characteristics of a chair are important?

     A. The seat of the chair should be large enough to accommodate frequent
     changes in position and firm enough to allow your weight to be supported
     hrough the buttocks not the thighs. If others will use your chair, easy
     height adjustment is a must.

 13. Q. How often should I change positions and take breaks during keyboarding?

     A. You should change your sitting position at least every 15 minutes.
     Active breaks should be taken at least every 30 minutes especially for
     those who perform more than 2 or 3 hours of keyboarding a day. Microbreaks
     should occur more often.

 14.  Q. What is an "active break" and a "microbreak"?

     A. An active break occurs when you stop keyboarding to do other things
     like ake phone calls, file papers, or get up to get a drink of water. An
     active break should also include specific exercises. These exercises
     should also be done during keyboarding microbreaks which occur while
     seated at your workstation.

 15. Q. What are some of the best exercises for keyboarding microbreaks while

     A. The "Shoulder Blade Squeeze" is performed by raising your forearms and
     pointing your hands to the ceiling. Push your arms back, squeezing you
     shoulder blades together. Hold for at least 5 seconds and repeat 3 times.

     "Eye Palming" is performed by placing your elbows on your desk, cup your
     hands, close your eyes, and place your eyelids gently down onto your
     palms. Hold this position for 1 minute while breathing deeply and slowly.
     Then uncover your eyes slowly.

     The "Arm & Shoulder Shake" is performed by dropping your hands to your
     sides then shake your relaxed hands, arms, and shoulders gently for at
     least 5 seconds and repeat 3 times.

     "Spanning" is performed by placing you arms straight in front of you and
     spreading your fingers as far as possible for at least 5 seconds and
     repeat 5 times. This exercise was made famous by pianists. With the arms
     extended in front of you spanning can be combined with a "Forearm Stretch"
     by turning the hands so that their backs touch then turning them so that
     the palms face the ceiling.

     These are only a few key exercises. Many more are useful for preventing
     repetitive strain. Try to find the best series for your areas of ension
     and particular relaxation needs. Frequent breaks yield better long erm

 16.  Q. I've heard many names for keyboard injuries. What do they all mean?

     A. Repetitive Strain Injury (RSI) is a description of an injury associated
     any repetitive activity such as hammering, piano playing, truck driving,
     computer use, or even shaking hands. Occupational Overuse Syndrome (OOS),
     Cumulative Trauma Disorder (CTD), and Work Related Upper Limb Disorders
     (WRULD), are all equivalent expressions to RSI.

     Tendonitis and tenosynovitis are characterized by inflammation of tendo ns
     or their surrounding sheaths, respectively. Both of these RSI disorders
     usually begin as mildly aggravating and, given bad habits, may quickly
     progress to be severely debilitating. These common RSI injuries also add
     to he difficulty of proper diagnosis and deserve greater recognition.
     These endon inflammations usually occur before full blown Carpal Tunnel

     Carpal Tunnel Syndrome (CTS) is a specific, severe, and debilitating form
     of RSI which describes a squeezing of the median nerve as it runs to hand.
     The nerve is squeezed by swollen tendons surrounding it as they cross
     hrough a tunnel made by ligaments at the inside of the wrist.

     The National Center for Health Statistics estimates at least 1.89 milli on
     people have Carpal Tunnel Syndrome. Many experts feel that CTS is also
     associated with nerve compression symptoms in the chest or shoulders.
     **All RSI symptoms should receive immediate medical attention from
     physicians experienced in RSI.**

 17.  Q. Advice by Health Care Practitioners often includes a collection of
     erms from a kinesiology course. Which ones do I need to know to help
     identify my own workstation ergonomic problems?

     A. Standing with the arms at your sides, palms facing forward, "flexion"
     is folding of any joint of the body so that the angle between the parts
     decreases in the forward direction, except at the knee and toes. Returning
     he joint to its straight position requires "extension".

     A joint which continues its extension past its straight posture is in
     "hyperextension". This occurs in the hand and wrist when you pull the
     fingers back.

     Standing with your arms at your sides, palms facing forward, "pronation"
     is the turning of your hand so that you thumb points toward your leg.
     "Suppination" is the opposite movement.

 18.  Q. Why does it seem like RSI from keyboarding has become such a big
     problem recently?

     A. One reason why RSI is becoming more prevalent is because computers are
     now allowing us to do more office tasks which formerly allowed us to
     change activity. For example, a typewriter at one time required using a
     return carriage, "white out" for mistakes, breaks for paper installation,
     and getting up to file papers in a cabinet.

     Computer word-processing now eliminates these "microbreaks". In short,
     computers have greatly simplified office activity, an advance that has at
     least one important disadvantage. The danger is found in the possibility
     for long duration, continuous, and relatively motion free, precise,
     muscular activity called "static exertion". Humans were not well
     "designed" for this.

 19.  Q. What lifestyle changes can I make to reduce the chances of RSI?

     A. Two main themes permeate ergonomic study of RSI prevention; posture and
     relaxation. Appropriate postures are necessary to keep the strain of
     performing work in a near stationary position (static exertion) to a
     minimum. But even the best postures can fall prey to overload when with
     bad habits.

     Relaxation is critical to the body's resilience, its ability to recover
     from keyboarding. Office workload dynamics can have a great influence on
     the risk of RSI. Try to promote office policies which emphasize steady
     work load schedules and avoid, or at least distribute, crises deadlines.

     Stretching and strengthening active muscles promotes relaxation.
     Relaxation is as important for prevention of RSI symptoms as it is for
     general well-being. Take a new, more active role in promoting your general
     fitness both at and away from work. If you don't exercise regularly and
     your over 40, get clearance from a physician to add walking, bicycling, or
     swimming to your weekly schedule on three separate days.

     Cut down on stimulants like coffee, sweets, or nicotine and spread healthy
     snacks and water intake throughout the day. Keep water at your desk as it
     makes for a smart microbreak. The first symptom of dehydration is fatigue,
     not thirst!

     Fruit and vegatable snacks prevent mid-morning and mid-afternoon blood
     sugar drops. These dips can effect alertness, mood, productivity, and
     decision making. A diet emphasizing complex carbohydrates, reliable
     sleeping patterns, and time for yourself can do wonders for 9 to 5
     productivity, not to mention your own well-being. All habits and practices
     hat promote relaxation are necessary to stop the threat of RSI. Good Luck.

During doctoral research in Exercise Physiology/Biomechanics at the University
of Southern California, Jonathan completed groundbreaking electromyographic
(EMG) research on repetitive strain injuries to the forearm. He currently
moderates seminars, writes and speaks on ergonomic topics, consults for Los
Angeles firms, and continues further research at USC. Dr. Bailin can be reached
at 310/390-8309 or

Requests for more info

Clearly, the above information is incomplete. The typing-injury archive is
incomplete. There's always more information out there. If you'd like to submit
something, please send me mail, and I'll gladly throw it in.

If you'd like to maintain a list of products or vendors, that would be
wonderful! I'd love somebody to make a comprehensive list of mice. I'd love
somebody to make a list of doctors. I'd love somebody to edit the above
sections, looking for places where I've obviously goofed.


Much of the information here is derived from a wonderful guide produced in New
Zealand by their Occupational Safety & Health Service, a service of their
Department of Labour. Special thanks to the authors: Wigley, Turner, Blake,
Darby, McInnes, and Harding.

Semi-bibliographic reference:

   * Occupational Overuse Syndrome
     Treatment and Rehabilitation:
     A Practitioner's Guide

     Published by the Occupational Safety and Health Service
     Department of Labour
     Wellington, New Zealand.

     First Edition: June 1992
     ISBN 0-477-3499-3

     Price: $9.95 (New Zealand $'s, of course)

Thanks to Richard Donkin <> for reviewing this
Dan Wallach                  Princeton University, Computer Science Department  PGP Ready

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