Laptop Ergonomics

Laptop computers and portable technology have changed the way we do business.  With portable equipment, we are now able to work away from our primary office in a temporary or more comfortable location.  We now have the luxury of working in a secondary or off-site office, while traveling, from the comfort of our home, and while lounging on the couch.  However, in spite of their many benefits, portable computers, by their nature, increase the risk of developing repetitive strain injuries. 

• The keyboard and screen are attached in one unit.  Because they are unable to be adjusted independently, an ergonomic compromise is created on positioning and comfort of either the neck or the arm.
  
• Laptops are often used in cramped spaces compromising posture.
  
• Laptop keys are smaller than traditional, desk-top keyboards causing the potential for increased hand and finger strain.
  
• Laptop screens are typically smaller than standard causing potential eye strain.
  
• It is harder to adjust the laptop screen to reduce glare.
  
• Portable equipment is heavy to carry.

These shortfalls create the risk for pain, aching and muscular fatigue in the neck, shoulders, back, elbows, wrists and hands.  They also create the potential for eye strain, headaches, numbness and tingling in the arms.

Putting these simple ergonomic adjustments into practice can help you reduce the risk of developing injuries while working on your laptop.

Stretch often.

Be aware of posture.

Take frequent breaks, every 20-30 minutes if possible.

Change your position often.

Switch the laptop position from the lap to the table every 30 minutes. 

• Putting the laptop in your lap will relax your shoulders. 
• Putting it on the table will relax the neck and reduce eyestrain.

Limit the peripherals you carry to the bare essentials to reduce the weight you carry.

Use a carrier with padded straps and frequently change the shoulder that the bag is carried on; or use a backpack with both straps over the shoulders to distribute the weight; better still, use a carrier with wheels.

Follow standard ergonomic positioning for a keyboard as closely as possible.

• Keep the wrists neutral.
  
• Keep the elbows open to 90 degrees or slightly greater.
  
• The ears, shoulders and elbows should be in vertical alignment.
  
• The shoulders should be relaxed.  Do not round shoulders forward or hunch them up towards the ears.
  
• The head and neck should be relaxed.  Do not let head drop forward out of alignment with shoulders.

Use proper finger positioning, typing & mousing techniques.

• Use two hands for 2-key functions.
  
• Use the stronger fingers (modified hunt and peck) rather than stretching the fingers to reach for keys.
  
• Keep the fingers relaxed.
  
• Use a light touch while typing.
  
• Movements should come from the larger shoulder muscles.  Do not isolate the smaller wrist and hand muscles while typing by planting the wrists down.

Prevent eye-strain and headaches.

• Frequently look away from the screen and look at an object far in the distance.  Follow the 30-30-30 rule.
  
  
  • rest the eyes for 30 seconds
    
  • by looking 30 feet away
    
  • for every 30 minutes of typing


• Rub your hands briskly together until warmth is created and then place your warm palms over closed eyes.  Hold the position for 20 seconds.
  
• Frequently clean the screen using the appropriate antistatic cleaners.
  
• Adjust font for color, contrast and size so that reading the screen is comfortable.

If you use the laptop as your primary computer, it is especially important to be aware of your positioning.  

• When you are in your office or primary work environment, elevate the laptop using monitor risers so that the screen in an optimal position and you do not need to bend your neck when looking at the screen; then, connect a separate keyboard and mouse at elbow level to position the arms appropriately.
  
• When sitting in a chair without elbow supports or a couch, use pillows to support the arms whenever possible.  Keep the same general ergonomic positioning guidelines in mind even if you are in a relaxed work environment.

The following exercises will help you stay flexible and keep you pain-free.

• Stretch the thumb by gently pulling it back.  Hold for 20 seconds.
  
• Stretch the palm up.  Hold for 20 seconds.
  
• Perform basic forearm stretches. 
  
  
  • Place your hand out in front of you as if you are saying “stop” and pull the fingers gently back with the other hand.  Hold for 20 seconds. 
    
  • Now let gravity drop the wrist down and gently increase the stretch by pulling with the other hand.  Hold for 20 seconds.
  
  
• Stretch the triceps and biceps stretches.
  
• Perform shoulder and neck stretches.
  
• Stretch the back.
  • Gently interlace the fingers behind the neck and arch your upper back as if you are trying to look up at the ceiling (be careful not to pull the head forward).  Hold for 20 seconds. 
  • Place your hands on your hips and arch the lower back as if you are trying to look up at the ceiling.  Hold for 20 seconds.
  
  
• Perform 15-20 minutes of daily cardio activity to improve circulation and oxygen flow to the arms for improved conditioning and better healing.
  
• Perform core strengthening exercises to improve general postural stability.

Check out these samples of a laptop stand, ergonomic carrier and wheeled carrying case available from Amazon.com.

And a very cute laptop charm -

Marji Hajic is an occupational therapist and a certified hand therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Global Warming and Barometric Pressure

The Center for American Progress has listed the Top 100 Effects of Global Warming. Global warming is being blamed for everything from killing the planet with glacial melting to threatening species of animals and negatively impacting our agricultural production. We are being warned that global warming will threaten our health with an increase in heat stroke, heart attacks, infectious diseases and smog/allergy related conditions. I would like to (jokingly) add an increase in carpal tunnel syndrome and other computer-related pain syndromes to the top 100 list of global warming effects.
Increases in severe weather are predicted as a response to global warming. Weather.com now offers a link to an aches and pains forecast that predicts how weather factors affect the way people feel. According to weather.com, the connection between weather and health dates back to Ancient Greece when the effect of hot and cold winds on pain and illness were described over 2,400 years ago.
Although recent studies are inconclusive, all of us know of that elderly relative who accurately predicts rain because of an aching knee or shoulder joint. Some people appear to be more weather sensitive than others. For most of us, the sensitivity to weather occurs as a result of the change in weather rather than from any specific weather condition. Personally, I know that barometric pressure changes will bring more reports of pain on any given day in the therapy clinic.
Barometric pressure is the measurement of the weight of air molecules around us. When the weather changes the weight of the air molecules change. A rapid fall in pressure signals the onset of stormy weather. This change is highly correlated with an increase in body aches and pains. As the barometric pressure drops, the gas and tissue around injured or inflamed joints can increase resulting in more pain.
So, if you are prone to computer-related pain, plan to weather the storm by taking extra precautions during the time of barometric pressure changes. Be particularly aware of your posture, positioning and work methods; take frequent breaks; stretch often; and use you choice of over-the-counter anti-inflammatory medications as needed. Heat or cold packs can also be helpful.
And it certainly won’t hurt to live green.
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Related Articles

The Top 100 Effects of Global Warming

Weather.Com Aches and Pains 101

Cleaning Green – BellaOnline.com

Ways to Celebrate Earth Day – BellaOnline.com

Gaming Ergonomics

Away from the formal constraints of the work environment, we may find ourselves relaxing at home in front of the computer or television or on the couch in positions that are not necessarily healthy for our bodies.  Does anyone run through the checklist of proper ergonomic positioning and practices prior to beginning a leisure activity?  It just doesn’t seem right that activities we enjoy should increase our risk of developing carpal tunnel syndrome (CTS) or a tendonitis.  But, as many gaming enthusiasts have discovered, repetitive strain injuries (RSIs) do not occur only during work hours.

The gaming industry is currently in a period of explosive growth.  According to a Global Entertainment and Media Outlook 2004 – 2008 study by PricewaterhouseCoopers, the video game business was accurately projected to outsell both the movie and the music industries by 2006.  A compound growth rate of 20% annually projects 55 billion USD in video game revenue by the end of 2008.  It is estimated that 50% of the population plays video games

 

Gamers are at increased risk of developing RSIs.  Games are most often enjoyed after work or school activity when muscles may already be fatigued or when tendons and nerves may already be stressed or inflamed.  The gaming environment may be spontaneously chosen and is not likely to be set up for ergonomic comfort.  Players may unwittingly end-up in awkward and unhealthy positions (for example, lying on the stomach with the neck craned up to see the television screen).  The practice of playing is repetitive.  Achieving game tasks and goals may promote nervous and muscular tension.  The controllers may cause mechanical pressures with sustained holding and with additional features such as force feedback (for example, vibrating to enhance the game in relation to the activity on the playing screen).  And pain signals may be ignored because the enjoyment of the game overshadows them.

In 1978, Space Invaders was released, and it became the first game to receive the distinction of having a medical condition named after it – Space Invader’s Wrist, a tendonitis caused by wrist and forearm movements required to maneuver the spaceship.  Pac Man’s Elbow followed closely behind along with Slot Machine Tendinitis.  In 1989, Gameboy introduced a whole new era in gaming with handheld gaming.  Currently popular maladies are Nintendinitis, Nintendo Thumb, Atari Thumb and Blackberry Thumb.  Although the names of these repetitive strain injuries do not necessarily invoke the seriousness of the condition, symptoms can be quite debilitating and range from pain and aching to tingling, numbness, and muscle spasms and cramps.  Symptoms can be severe enough to cause a loss of function in self-care, leisure and work activities.  Many gaming guides, such as Microsoft’s X-Box Healthy Gaming Guide, now offer information and suggestions on avoiding gaming pain.

Here are some ergonomic tips for remaining pain-free while playing the game:

First and foremost, if you are having pain while playing, you need to rest from the activity.

If painful, use cold packs for 10-15 minutes after play to control inflammation and spasms.

• Take 10-15 minute breaks for every hour of play.


• Stretch often.


• Perform 15-20 minutes of cardio activity daily to improve circulation and increase oxygen flow to the arms.
  
  


• Use pillows to support the arms when playing.
  
  


• Use the lightest touch possible when activating the controller.
  
  


• Try to keep the arms relaxed and the controller positioned close to your lap rather than having your arms fly up towards your chest.
  
  


• Try to alternate more intense games or play sequences with those that are less intense.
  
  


• The room should have adequate lighting.  There should be no glare on the screen.
  
  


• Prevent eye strain by following the 20-20-20 rule.  For every 20 minutes of play, focus for 20 seconds on an object 20 feet away.

When setting up to play, be aware of your positioning and environment.

• If playing on a PC, check out Ergonomic ABCs for computer ergonomic tips.  The same principles apply when setting up for leisure activities as well as work activities.  If not sitting formally in a chair, use pillows and lapboards to help achieve neutral positioning.


• If playing on a smaller handheld device such as a Blackberry or SmartPhone, check out SmartPhone & PDA Ergonomics.


• If playing on a console game system using the television as your screen, avoid twisting or crimping the neck by positioning the couch or chair so that the screen is at eye-level and directly in front of you.  Support your arms with pillows.  Have good back support.  Turn off the vibration feedback from the controller or limit the time it is used.  Use pillows and lapboards to help achieve neutral positioning.

Special Considerations for Children

• The content of games should be appropriate for the child’s age.


• The controllers or keyboard should be appropriately sized for the child’s developmental age – small enough to fit comfortable in petite hands but with buttons large to be manipulated by those who are less coordinated.


• Check out ergonomic tips specifically for children at Kids & Computers - Ergonomic Guidelines


• Encourage physical activity daily.


• Promote healthy habits.

If you are experiencing pain, these are the best cold packs on the market.  We use them all the time in the clinic.  They are durable, do not leak, will not puncture, are comfortable, and conform well to bony areas.  The Velcro strap is a nice addition to hold them in place when you are on the move.

Using a lap desk can help position your arms comfortable while gaming on the couch.

Common Sense Repetition 1

Patient: Doctor, it hurts when I do (….insert work, home, or leisure task…). Doctor: Well, don’t do that.
I’ve had many clients who are frustrated, having heard this, knowing that they cannot stop working or performing the activity that is painful. Although it is helpful to work with an ergonomic specialist who can show you specific ways in which to make your work less stressful on the body, a common-sense approach to activities can also make a difference.
This multi-part series will offer some common-sense tips - based on the ergonomic principles of avoiding repetition, force and awkward postures - that can help you avoid pain while working.
REPETITION
I worked recently with a graphic designer who was having pain in both arms. Working long days to complete a complicated project, a mouse-click counter showed that he was clicking the mouse between 10,000 to 15,000 times per day. The graphic designer researched available software and was able to purchase a new program that reduced his mouse clicks to 3000 to 4000 clicks per day. By the time he attended his first appointment with me, this client was already well on his way to recovery because he had intuitively related his pain to mouse use, confirmed this with the mouse-click counter, and taken steps to reduce the repetition by researching alternative software packages and changing to a program that demanded many fewer clicks.
Methods of Reducing Repetition

Look for ways to break up the repetitive components of a job. For example, after an hour of so of typing, make a few phone calls, walk down the hall to consult with a co-worker (rather than e-mailing), stretch or get a drink of water.

If your job requires a variety of duties, switch frequently between tasks rather than completing each one before moving on.

Do some research and find a different tool that makes the job easier (such as the different graphic design program in the example above).

Let the tool do the work instead of the body. Use power tools (for example, an electric screwdriver or tools with special ratchet devices) or automation when possible.

During the work week, be open to discovering leisure activities that have different physical demands than work activities. Enjoy leisure activities with similar physical demands on the days that you do not work.



Definitions
Job Enlargement is the process by which a worker is provided with a greater number of tasks to perform so that repetition of any one particular movement in reduced.

Job Rotation is the process by which employees are rotated through different jobs. This works well when the demands of the job itself can not be changed (for example, assembly line work). The key is to rotate employees every few hours between jobs that require different physical demands.



Next Week – Methods for Reducing Force & Awkward Postures
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Typing Styles

The goal of ergonomics is to reduce the force, repetitiveness or awkwardness of activities so that the body performs tasks most efficiently and with the least amount of stress.  Many excellent resources are available that describe ergonomic modifications for the office environment.  Because of this information, most people now have some general knowledge of the healthiest location for the keyboard and monitor.  Less commonly known is that typing style can be the cause of injuries.

Typing Style

In their book Repetitive Strain Injury: A Computer User’s Guide, Dr. Emil Pascarelli and Deborah Quilter describe a variety of typing techniques that can lead to painful symptoms and repetitive injuries (see book review).  Even the best and most expensive ergonomic keyboard will not eliminate pain caused by the following typing methods.

Resters – Resters lean the base of the hand upon the desk or the wrist rest.  This can be harmful for the following reasons: 1) It places point pressure against the carpal tunnel; 2) It isolates the small muscles of the hands and forces them to do the work of the larger shoulder and elbow muscles; and 3) It can promote wrist postures that are not neutral.

Leaners – Leaners type by placing their elbows on the desk or chair arms.  This puts pressure on the ulnar nerve, the superficial nerve at the elbow.

Loungers – loungers slump in their chairs leading to compression of the spine and low back pain.  Lounging also promotes forward head and rounded shoulder posture.

Clackers or Pounders – Pounders hit the keys with excessive force potentially leading to pain and tingling in the finger tips and finger joints.

Pressers – Pressers hold down keys (for example, while scrolling) with excessive force placing pressure on the small joints in the fingers.

Pointers – Pointers are hunt-and-peckers who hold their arms poised in midair.  Pointers are at risk from awkward positioning if they hold their fingers stiffly rather than in a relaxed position or if the keyboard is not positioned correctly.

Thumb or Pinkie Extenders – Extenders hold one finger stiffly out while the others perform the work.  This separation causes excessive strain on the tendons of the fingers.

Grippers – Grippers hold tightly to the mouse or use too much force when clicking. 

Typing Style Ergonomics

The following typing tips describe work-style modifications that will help prevent injuries and maximize the benefit of that ergonomic keyboard.

• When typing, keep the fingers relaxed and slightly curled as if they are resting over a large ball. 
  
• Tap lightly with the finger tips rather than with the pulp of the finger. 
  
• Keep fingernails short – longer nails require that the fingers be tensely extended so that the key can be tapped with the pulp of the finger.
  
• Keep the thumb relaxed – not held stiffly over the space bar. 
  
• Use the lightest touch possible on the keys.  
  
• Don’t stretch the fingers to reach keys that are far from the home row.  Move fingers closer to the key by moving the whole arm.
  
• Don’t stretch the fingers wide to activate a two-key command with one hand.  Use one finger from each hand to activate these commands.
  
• Maintain a neutral wrist position.
  
• The mouse should be held loosely.  Control of the mouse should come from the larger muscles of the elbow and shoulder, not from wrist motion.
  
• Don’t rest the wrist on the table or wrist rest.  Use the wrist rest as a guide that the wrist slides over.
  
• Don’t lean on the elbow when typing, talking, contemplating, or holding the phone.
  
  Pad any sharp edges that the forearm rests against.
  
• The keyboard and mouse should be positioned so that the arms are at the sides (do not reach forward or out to the sides to activate either), shoulders relaxed, elbows opened up slightly more than 90 degrees. 

Repetitive Strain Injury: A Computer User’s Guide offers more tips and exercises to help correct typing styles.  Find it at Amazon.com. 

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Ergonomic Process - When it Goes Bad

Last week I had the opportunity to work with several injured workers in their office environment. Both spend 8 hours in front of a computer performing extensive keyboard and mouse work. Both are in serious pain with repetitive injuries that cause aching within 30 seconds of sitting down to work. Both have seen doctors, therapists, and had ergonomic interventions with the best equipment issued. One has already been scheduled to undergo a carpal tunnel release in the near future.

Speaking to and observing the work habits of these women has affirmed my belief that ergonomics is a multi-faceted process requiring teamwork to be successful.

• The doctor may diagnose and offer expertise in prescribing medications to calm down the inflammatory process of injury.
  
• The therapists can perform modalities such as massage, ultrasound and the use of heat and cold to promote injury recovery. Skilled in observing how bodies work, they can discover areas of weakness, tightness and muscular imbalances that can be corrected with therapeutic exercise.
  
• The ergonomic specialist can provide the equipment, work-site modifications, and work-style recommendations that create a comfortable and less stressful working environment.
  
• Management can provide a supportive environment that allows healing, promotes employee good-will, but also ensures productivity.
  
• And the injured worker needs to believe in the program and take an active part in their recovery. This is not always an easy thing to do – it requires persistence, even a bit of obsession, to attend medical and therapy appointments, take medications on schedule, change work habits, stretch, take frequent micro-breaks, and use cold packs throughout the day – all while trying to get the job done, frequently under the microscope of management and co-workers who may not believe that an invisible injury can be so painful.

If any aspect of the team process is impaired, recovery may be impaired. Communication and education are critical throughout. So is observation, follow-up, and accepting feedback. My observation of the two young women last week shows how the process can break down in spite of good intentions. It also highlights one of my ergonomic pet peeves – the wrist rest.

Both women had wrist rests in place, and both demonstrated their typing skills using the wrist rest, believing that they were using them correctly and showing me what I wanted to see. Neither had received instruction in the proper use of the wrist rest and they were probably continuing to create inflammation through its improper use.

The wrist rest is not inherently a bad piece of equipment, but it is improperly named. Logically, because of the name, most people feel they need to rest their wrists. Most plant their wrists down on the nice soft surface while typing and feel they are doing a good thing - an ergonomic thing - that will help them prevent injuries. In actuality, they are isolating the work of the fingers from that of the upper arm.

The finger muscles are too small and weak to perform constant movement throughout the day. In addition, the isolated movement is often more extreme than typical to make up for the loss of positioning movement over the keyboard often performed by the shoulder. As the muscles of the fingers and wrist originate at the elbow, pain often begins radiating from the fingers into the elbow.

If ergonomic equipment is issued without warning, - I’ve worked with employees who just showed up one morning to find their work environment changed and ergonomic equipment in place - consent, or instruction in the proper use, it will either be rejected or used in what is thought to be the correct manner. However, the equipment itself is not the answer, but only a tool that enables a worker to be safe if it is used properly.

It would be much better to call the wrist "rest" a wrist "guide" as the wrist should float over it. The wrist rest should "guide" the wrist into the neutral position. It is okay to rest down lightly during typing breaks.

Here are some additional ergonomic keyboard work-method recommendations.

• The hand should be positioned over the keyboard using small shoulder and elbow movements.
  
• The shoulders should be relaxed and not elevated (drawn up towards the ears).
  
• You should be in close enough to the work surface so that your ears, shoulders and elbows are in line.
  
• The work surface should be low enough that the elbows are open slightly greater than 90 degrees.
  
• The fingers should be relaxed and slightly curved as if resting over a ball.
  
• Hit keys lightly with only the minimal amount of force necessary to activate the keys.
  
• Don’t hitch-hike by holding the thumb tensely over the spacebar.

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

What is Writer's Cramp?

Technically, “writer’s cramp” is not an overuse syndrome.  Writer’s cramp is a problem of incoordination and loss of control of movement arising in the basal ganglia of the brain.  Its cause is unknown.  The symptoms are localized, sustained muscle contractions that cause twisting and repetitive movements or abnormal postures when a person performs a specific, fine motor task such as writing.  Pain and cramping is uncommon, although discomfort in the forearm wrist and fingers may be present.  (Sources: www.dystonia.ie;  en.wikipedia.org/wiki/dystonia)

WRITING CAN CONTRIBUTE TO RSIs

Although true writer’s cramp is a rare syndrome, hand pain, muscle fatigue and cramping from repetitive writing is not.  Even if writing is not a large part of the job, writing can contribute to the development of repetitive strain injuries.  Forceful gripping of the pen and pressing the tip onto the paper, awkward positioning of the pen or the paper, contact stress from holding the pen or leaning on the wrist or forearm are all risk factors of musculoskeletal disorders.  In addition to addressing the keyboard and mouse as contributing factors to hand, wrist and forearm pain, writing technique should also be considered.

HISTORY

As early as 1700, Bernardino Ramazzini, considered to be the founder of occupational and industrial medicine, wrote that "the incessant driving of the pen over paper causes intense fatigue of the hand and the whole arm because of the continuous . . . strain on the muscles and tendons." (Source: www.whonamedit.com/doctor.cfm/428.html) 

In 1995, almost 300 years after Ramazzini described the occupational hazards associated with writing, the first ergonomic pen was introduced to the mass market.  The Dr. Grip pen, with a rubberized and wide-body barrel was designed with the purpose of increasing writing comfort.

Several other wide-body pens followed quickly thereafter including the PhD and the BIC XXL.  All of these styles followed the quill, stick-style design.

Recently, the ergonomics of writing have been addressed with alternative pen designs that fit the hand better and reduce the pressure and tension of writing.  These pens are breaking away from the standard stick-pen look.  Such designs include the EZ Grip, the PenAgain, the RingPen, and the EvoPen.

A Review of Ergonomically Designed Pens

WRITING TECHNIQUE - ERGONOMIC TIPS

The following are some writing tips to reduce your risk of hand and arm pain.

To Reduce Force

• Use the lightest grip possible while writing.  
  
  
• Use ergonomically designed or wide-barrel pens.  
  
  
• Use a rubberized grip or increase traction by wrapping a rubber-band around the pen barrel.  
  
  
• Use a felt-tip pen, gel pen or roller ball so that the tip glides easily over the paper.  
  
  
• Do not plant your wrist or forearm on the desk.   Glide over the surface of the desk using your shoulder to initiate the movement of writing.
  

To Avoid Awkward Postures

• Keep the wrists neutral.
  
  
• Position the elbow so that it is open at more than a right (90 degree) angle. 
  
  
• Keep the shoulders relaxed.
  
  
• Keep the hand relaxed and avoid forceful bending or hyperextension of the finger joints or thumb when holding the pen.
  
  
• Position the paper you are writing on about 2 inches above elbow level while sitting with your shoulders relaxed. 
  
  
• Use a sloped desk to reduce the need to bend the neck or round the shoulders forward.
  
  
• Place the paper in a position that is easily accessible. 
  
  
• Use a microdesk writing platform above the keyboard. 
  
  
• Get in close to the work surface.
  
  
• Don’t reach around objects placed on the desk while writing.
  
  
•  Don’t hold a pen while typing. 
  
  
• Use a headset if you need to type and speak on the phone at the same time.

To Reduce Contact Stress

• Consider one of the new ergonomically designed pens. 
  
  
• Use the lightest hold possible while still maintaining control of the pen. 
  
  
• Don’t lean on the wrist or the forearm, especially on the sharp edge of a desk. 
  
  
• Use a round, not a triangularly-shaped, rubberized grip.
  
  
• To reduce repetitive writing movement
  
  
• Take microbreaks.
  
  
• Stretch often.
  
  
• Vary work tasks.
  

For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.