Ask HN: Wrist Pain
Currently there's kind of a dull, persistent numbness 24/7. Also, when I bend my wrists too far forward or backwards, I feel a sharp pain on the back of my hands. I also occasionally wake up at night and notice that they're numb, which I've read is a symptom of carpal tunnel.
I've tried a few ergonomic changes including a new chair, adjusting the monitor position, and a wrist pad for my keyboard and mouse, and even a wrist brace a portion of the time, but the discomfort persists. I asked my doctor about it a few months ago and he gave me a 20 page packet with the usual diagrams showing where my head should be positioned in relation to my monitor and things like that, but not much of it was practical "do this" advice.
I'd like to work on a startup in a few years and this is a major concern.
I figure a lot of you have had similar problems. What worked for you?
108 comments
[ 5.7 ms ] story [ 137 ms ] threadI've experienced both, but I know that the second point is controversial. As for less wrist strain, I don't think there's as much (any?) controversy. As a personal anecdote, I'm able to touch type both Qwerty and Dvorak. I can feel my wrists get sore after ~15min on Qwerty, but I've been known to go for 2 hrs at a time on Dvorak with little/no discomfort.
That said, you only run into that problem if you're forced to switch between a QWERTY and Dvorak layout often.
I do switch often - mainly because other people's computer do not tend to have Dvorak activated on them. It's not much of a problem. Though I do get slower when I haven't used a layout for some time and have to get used to it again.
Although the research on this field has stopped since the first investigations from Dvorak. The empirical evidence is everywhere.
Highly recommended.
I just learned it for the same reason geeks generally use cutting edge stuff: Because I'm willing to try cool things out, and pay an initial learning curve cost on the chance that I might find something better to adopt and use.
I wrote more extensively on the Dvorak layout here: http://forums.gentoo.org/viewtopic-p-437068.html#437068
I agree that using Dvorak is something you do for long-term benefit or prevention. Switching now probably isn't going to help the immediate physical problems of the OP.
Squeezing out an extra hour or two of comfort does not address the problem. You'll just delay it by a year or so. Changing one's habits to minimize keyboard time is going to have a much greater impact.
:-(
http://www.youtube.com/watch?v=hUyMNyrOHJQ
Also, when I was having problems a few years back, I narrowed it down to my laptop. The touchpad style mouse was killing my hands and wrists. It sounds like you're on a desktop, but I thought I'd mention it just in case.
I've never had any major problems with my wrists, just some slight discomfort from time to time... but man, does that keyboard make a difference!
Also you could configure your desktop to be more accessible with keyboard only. Less switching between keyboard and mouse == faster work and fewer useless movements.
2. Use Vim as text editor.
3. Use left handed mouse at least occasionally. Keyboards are typically longer on the right hand side due to number pads so that places mice at a odd angle at times.
4. Though you have already adjusted your position, just ensure that your hands are not at extreme angles.
edit: I too had wrist pain and after doing the above changes, I dont have wrist pain anymore. YMMV obviously depending on what is causing your pain.
However, good point about Vim - cutting down on the need to switch from keyboard to mouse and back also seems to help with my wrists.
Don't use pads or braces without medical advice. You can actually injure yourself more by bracing your arms, wrists, or hands against things.
Don't assume your wrists are the problem. I have had occasional wrist pain or numbness for twenty years, most of which turns out to emanate from a nerve pinch in my shoulders. Doing certain shoulder exercises makes the wrists feel great. Again: find a doctor or a PT who will give you specific advice.
Don't think that gadgets and gimmicks are the whole solution. They can be useful -- I swear by my Kinesis Advantage keyboard, I have Ergotron monitor arms to put monitors precisely where they need to be, I have a keyboard drawer with an adjustable arm to adjust height, tilt, and distance and with an attached mouse support that I've tinkered with to get the height correct -- but this is secondary stuff. The real secret for me is exercise, strategically placed pillows and cushions [1] and, of course, rest breaks. Get some software that orders you to take breaks, like Workrave or AntiRSI for the Mac. Try not to learn to ignore the software.
Get into shape. You would be surprised at the extent to which walking and biking will improve the health of your wrists, not to mention the rest of your health.
EDIT: Oh, and codedevine is right: Be very careful using laptops, and don't use one for any length of time. They force you into specific postures which are generally terrible. I get away with using mine for one or two days at a time, but only because I've been diligent with my health.
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[1] For the back, not the wrists. Don't rest your wrists on things!
Btw, I met you last week at the HN Startup Bootcamp meetup. I remember you vividly because everyone else was like, "Hi, I'm Dan" and you came up and were like, "Hi, I'm mechanical_fish" Ha. I was sitting across from you for a good chunk of it :) Hope your Drupal endeavors are going well.
But my experience since that last post has suggested that a lot of ergonomics is about overall health. The guy who advocates moderate weightlifting as the solution is probably on to something. When I'm healthy and well-rested and getting even moderate exercise, I can get away with breaking my own ergonomic rules... by, say, using a laptop for more than fifteen seconds at a time.
You can't actually do nothing but sit and type for 14 hours per day, every day, for the rest of your life. All the better reason to make your keyboard hours count. ;)
At the moment, the top-rated post pooh-poohs purely technological solutions and says the OP should exercise. I think the keyboard/mouse combo should be used in conjunction with exercise, rather than as an either/or.
You don't want the heavy velcro braces: again, they're for immobilization, not for pain mitigation.
1. Got a Microsoft Natural Ergonomic Keyboard 4000 and used that instead of my laptop's keyboard.
2. Got a mouse (Microsoft something, I think?) and used that left-handed instead of my laptop's touchpad.
3. Wore wrist splints.
4. Refused to lift anything heavier than my (5 lbs) laptop.
After about 3 months my wrists were back to normal.
I'm not sure which of the above helped, and I don't want to re-injure myself in order to be able to conduct properly scientific trials; but I suspect that the largest factor was keeping my wrists straight (not bending my hand up or down OR left-to-right) with the wrist braces mostly serving just to get in my way and prevent me from unconsciously lifting anything heavy.
Hope this helps -- sorry I can't be more specific.
First off, you should see a qualified physical therapist (someone who knows the wrist) immediately. She will help you change your setup to be more ergonomic and probably give you some light exercises. Another benefit is that she can measure the problem, allowing you to track your progress and the effectiveness of any treatment.
Next, I can recommend a few products that have really helped me out:
Number one, make sure your keyboard is big enough if you're using a laptop. I used to use an IBM Thinkpad X31, the keyboard was way too small and that was the beginning of my serious wrist problems.
Next, for mice, I heartily recommend the Evoluent Vertical Mouse. There is a bit of a price premium, but these are great optical mice for those with wrist issues. I have two, one for right and left that I switch between if I feel any pain or tingling.
For keyboards, I've stuck with the Microsoft Natural Keyboard Pro. Once you have it at the right height, and you're using it at the right angle, this makes a fine keyboard.
Best of luck. I got over this completely and so can you.
And a somewhat ugly experience. After my first big project I had a visible 'bubble' (size of a big coin) beneath my skin at my wrist. As every idiot would do, I ignored it. It did not disappear after some weeks and I went to see the doctor: 'We need to cut that open!' .. so.. as a good coward would do, I assured the doc that I would come back.. and stayed home.
Now comes the ugly part: After living with my bubble for several more weeks, I made a certain movement... and this bubble thing cracked inside my wrist and I felt the fluid rushing into my arm. I paniced a bit.. but I am still alive and my wrist is fine. No pain at all, btw.
I told a friend about my experience. He took me to my office, asked me to show my 'programming position'. Then he told me the same stuff your doctor told you. (I guess.) And he was right.
I would suggest that you pay more attention to your body. I know it from myself, that sometimes you really want to make that last test case pass, before paying attention to the pain in your back. This is not good.
I do most programming on a big sofa, where I can easily change position. When forced to work in an office I never use the keyboard sitting on the desk. I find it much more comfortable to let it rest on my lap.
General rule: If you do not feel comfortable, change it.
More advice: Never write tec on a german keyboard. :)
Take this serious and try to see another doctor.
Hope you get better soon.
You need to work out.
Over a year ago, I was starting to get the beginning stages of RSI. I smoke and was really overweight. I had never been to a gym.
The thing that fixed my wrists was pushing weights. Putting aside the other workout stuff I do (biking, rowing, and moderate running) because they don't pertain to this discussion, moderate weight lifting is key.
The muscles and tendons in your wrist are weak. Mine certainly were. Adding to that the 8-10 hours a day of keyboard typing, you develop RSI.
When I started using weight machines, my wrists were numb and I had flexibility problems. Simply using upper-body weight machines for several months quickly helped to increase my upper body strength, but more importantly let my wrists develop strength they didn't have before. Ever since my wrist problems have completely vanished.
So yes, ergonomic keyboards are definitely useful, even though I don't personally use one. The text editor you're using has absolutely to fucking do with problems with your wrists. Get an ergo keyboard if you feel like it. It won't hurt and will probably help.
However, if you absolutely want to solve your pain you need to work out. Pushups and upper-body workouts are what you need. No body-building crazy shit, just moderate strength training 2-4 times a week for a half an hour at a time.
On the broader workout subject, weight lifting is the fun part of the workout for me. The biking/rowing bit are just tedious calorie burners. When you lift the weights, you're immediately releasing endorphins into your system. So after a good session, you actually feel good.
You could also see a physiotherapist.
A good one will give you exercises you can do to strengthen the muscles in your wrist. Mine gave me things I can do while I'm sitting in my chair thinking, or just on a quick break while still in the office.
Anyway, I agree with the parent: gadgets might help, but the real fix is likely exercise.
It's possible that different underlying issues alter the effectiveness, but I think the general advice of "exercise" is a good one. I'd also add that there's potential to hurt yourself more, so I'd rewrite the parent comment as "you should also see a physiotherapist."
Take a broom handle and just rotate it in your hands for a minute. Add a string on that and a _small_ weight, and continue adding weight slowly (rolling the weight up to the bar and then back down). (edit: slowly being weekly)
Squeeze a stress ball for a solid 5 minute session in the morning.
Pushup type motions focusing on rotating through wrist angles once you are able.
I would recommend these to the healthy - if you are severely injured go to a doctor and get better first.
I found that regular mice gave me a lot of wrist problems after years of playing FPS games with a "death grip." I use trackballs and trackpads now. I understand that other people have trouble with trackpads so YMMV.
Specifically, rock climbing absolutely puts your wrists through the gamut. The strength and flexibility building you'll go through will demolish RSI.
I used to work out a while back, 3 to 4 times per week, and one of the things that made me stop (besides boredom to be frank) was that I felt quite a bit of pain in the wrists. I've kept that exercising schedule for 4 months at a time, but the pain didn't go away in those periods. My thought was that I was damaging my wrists in some way.
How long was it until you stopped feeling numb? Did you use any restraining device (gloves or something like that) while working out?
But I have absolutely no problem doing barbell or dumbbell exercises where I have control over the angles. I would suggest to anyone starting out to avoid machines if at all possible.
but try not to get caught up in the hype of gadgets. pushup bars and ab-machines usually just collect dust. jogging, crunches, and pushups are fine. If there's a college nearby, grab your sweats and run their stadium on the weekends.
also-- crossfit.com has a new workout everyday which is short and intense. good if you don't have very much time.
rock climbing is also fun, great for your hands, and a good way to meet cool people.
along these lines, the best workout is the one you don't notice. you'll run more in a pickup soccer game and have more fun than if you go out for a jog.
I have similar wrist pain that comes and goes, and when it gets bad I just take it easy and make sure to drink a lot of water and that tends to ease the pain.
Also taking over the counter anti-inflammatories can help in the interim period until you gain some wrist strength. I don't take any drugs regularly, and I notice that 2 ibuprofen in the morning usually takes care of it for 24 hours. Obviously you're not going to want to take them every day for a long time :)
Lastly try to pay attention to what you do with your hands when you sleep. If you tend to curl your fingers under your pillow or something it can make the muscles cramp up overnight and make the pain worse.
When I had problems with my wrists, I started to play the piano, a lot. I would bang on the keys fortzando and make a lot of noise (the noise got better over time :).
I also had a small stress ball that I would squeeze as hard as I could several times throughout the day.
After two or three months, the pain, numbness, and swelling were gone, and have never come back these last dozen years.
Paying attention to your body is much closer to the problem than gadgets - but I believe that "work out" often isn't close enough. For every story of "working out" helping someone, I suspect you will find a couple stories of it injuring someone. Sadly, normal computer use general involves considerable insult to the proper use of your body. Putting further strain on your arms and legs through weights and other devices has often resulted in a further problems for people.
Certainly there are some bodies that are helped by this - one must always keep in mind how much variation in bodies there is in we biological humans and not assume one person's solution will automatically work for another person, meaning you.
That said, what I'd strong suggest is that you need is to become aware of the proper use of your own body. One good resource for this: "The Alexander Technique". Another: qigong in general and http://www.qidao.org in particular. Yoga has helped some though I'm dubious - Yoga is also more harsh disciple, people say good things about Feldenkrais. Another very good thing to try is Tai Chi. There various solutions out there aren't mutually exclusive but approaches that are gentle and gradual tend to be best in my opinion. Gentle and gradual - if nothing else, remember that.
If your muscles and tendons are struggling, the last thing they need is more to do. I would strongly recommend doing whatever you can to give your hands a break for a while, and then start strengthening. And for giving your hands a break, you should absolutely feel justified in getting whatever ergonomic gadgets you think will help.
If you are suffering from numbness, that means your nerves (ulnar nerve, etc) are irritated. There are indications that this is not just a hand problem, but is due to postural problems in the upper back and neck from sitting statically in front of the computer for long hours. Google "thorassic outlet syndrome".
I highly recommend you check out the following books:
"It's not Carpal Tunnel Syndrome", http://www.amazon.com/Carpal-Syndrome-Therapy-Computer-Profe...
"Trigger point therapy workbook", http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...
I give these books a lot of credit for my almost complete recovery.
Trigger point therapy is worth looking into...
One of the major things I notice when my wrists start getting irritated is that if I sit up straighter it helps. There are nerves running from thumbs to mid-back, and posture affects them immensely. Simply sitting correctly may (or may not, depending on how bad you habitually sit) be easier than exercise and provide more immediate remedy.
Still, exercise. Definitely.
So, I spent some time searching the web, and came across this link: http://podolsky.everybody.org/rsi/ which outlines some of Dr. John Sarno's ideas on RSI, its psychosomatic origins, and how to treat it.
I doubt it's the right diagnosis for everyone, but I have to say, it worked incredibly well for me- I've been pain-free for two months now, with plenty of hardcore typing sessions in the meantime.
One strange advantage of having had this injury is that I can tell the difference between carpal tunnel-like pain and other sorts of muscle fatigue. So, I can feel that I've been over-doing it with, say, a laptop keyboard and take corrective action.
For me, the Microsoft "natural" series keyboards have been a huge benefit. If I use a regular keyboard for more than a few days in a row, I start to feel wrist pain.
Another commenter suggested seeing a physical therapist. At least in the US, you might be better served seeing an occupational therapist who specializes in hand/wrist injuries. My wife is a PT, and her education did not include any special training on repetitive stress injuries.
However, as suggested by this same poster, your first stop ought to be a physician who actually gives a damn. You might call a hand surgeon's office and which physicians tend to send RSI referrals and then make an appointment with one of them.
Now, I'm on to picking out a good chair...
http://safetype.com/
http://www.evoluent.com/
Although I do recommend you exercise more and have a more thorough evaluation by a doctor, as others are recommending.
I've found that switching to a Dvorak layout helped a lot - because I had to touch type (I didn't physically change the keys, and didn't get stickers or anything for them), my hands naturally floated over the keyboard. Also helps if your elbows are above the keyboard. Various ergonomic keyboards may help too.
You have to give the gloves a chance to work though. For me, the pain went away after a week or two of constantly wearing the gloves each time I used the computer.
It's hard to do, though!
My pinky and half my ring finger were going numb from the bottom of my wrist sitting on either the desk or the laptop, and the exercise that worked for me involved holding my arm straight out away from me and repeatedly twisting it at my shoulder.
I found a good doctor in Chinatown, NY who recommended the book and suggested stretching daily instead of looking to any of the various surgeries suggested by other doctors.
http://www.med.umich.edu/1libr/sma/sma_wristten_rex.htm
This fixed it within a couple months and I haven't had a flare-up since.
Don't work so hard.
I do notice that if I'm not doing much work (i.e. more browsing with the mouse) things are worse than when I'm working hard (i.e. more Vim)
It would be foolish to treat it as the only solution.
(I did much the same thing, but that's because I totally ruined my right wrist by working through searing pain. I needed at least three years for my right wrist to recover to the point that I could use it to mouse at all.)
http://www.powerballs.com/rehab.php?m=Benefits
http://cow.org/r/?603b
(Disclosure: that's got an affiliate link in it.)
Lots of people get misdiagnosed, have surgery, and end up right back where they started.
The authors explain that most people with persistent strain disorders are suffering from a combination of nerve adhesions, inflammation, and microscopic muscle spasms (tender points or knots) that cause pain, weakness, numbness, and so on. Actual carpal tunnel syndrome is much rarer than commonly thought.
Their primary thesis is that treating a symptom does not help. Cutting your carpal tunnel will only shift the problem elsewhere. Adjusting your position will, at best, move the problem elsewhere. You need to treat the (several) root causes, working your way along the chain until you're nearly pain free.
For example: pregnant women often get the symptoms of carpal tunnel syndrome. Advocating surgery for pregnant women is obviously insane, but it's commonly suggested for us programmers when the ol' "try wearing a wrist brace at night" trick doesn't work. Perhaps hammering away at a keyboard for thousands of hours might have something to do with it, rather than an actual problem with the carpal tunnel?
The authors have a ton of material on the web, so you can read before buying the book:
http://www.rsirescue.com/
My personal approach: I use an ergonomic keyboard, of course. I eat better than I used to. I take breaks. I massage my forearms. I lift weights and exercise. I don't take ibuprofen. I don't stretch too much (my arm joints are hypermobile).
Seriously, go read the book.