Stretching for the Computer Athlete

People often sit in poor or awkward postures while working on the computer, playing on gaming systems, using a laptop, and even manipulating hand held electronic devices. These postures can cause stress to the body. Over time, these body stressors may develop into repetitive strain injuries such as carpal tunnel syndrome or tendinitis.

Stretching and strengthening programs can be instrumental in easing the rounded shoulder and forward head postures that develop from computer or desk activities. A recent study shows that stretching may not only improve flexibility but can also enhance performance making people stronger and increasing their endurance (Chronic Static Stretching Improves Exercise Performance; October 2007; Medicine & Science in Sports & Exercise).

The study also suggests that stretching is an important part of an exercise program for those who are out of shape or just beginning an exercise program.

Here are a few recommended stretches for the computer athlete –
(Stretches should never hurt. Stop if you have pain. Hold the stretch gently. Do not bounce).

• Stretch the Pecs
  
  Face a corner with the forearms resting against adjoining walls, hands placed at about ear height. Put one foot in front of the other. Gently lunge forward (bending the knee of the leg in front) keeping the back straight. As the chest presses forward towards the corner, you should feel a stretch through the chest muscles. Hold for a count of thirty. Repeat three to five times.
  
  (see picture at toneyourbones.com)
  
  
• Squeeze the Shoulder Blades
  Place your hands gently on the table in front of you. Leaving your hands on the table and keeping your shoulders relaxed, squeeze your shoulder blades together. Hold for a count of five. Repeat five times.
  (see picture at toneyourbones.com)
  
  
• Chin Tuck
  Begin in a good, relaxed posture. Slide your chin back as if you are trying to give yourself a double-chin. Look straight ahead and do not tip your head up or down. Hold for five seconds. Repeat 5 times.
  (see picture at silvafamilychiropractic.com, position 1)
  
  
• Head Tilt (Scalenes Stretch)
  Begin in a good, relaxed posture. Tilt the right ear to the right shoulder. Hold for ten seconds. Modify position by slightly rotating the head as if you are looking at the ceiling. Hold for ten seconds. Modify position again by slightly rotating as if you are looking down towards the floor. Hold for ten seconds. Bring the head back to the starting position. Repeat on the other side.
  (see picture at silvafamilychiropractic.com, positions 2, 3 and 4)
  
  
• Triceps Stretch
  Place the right hand on the left shoulder. Place the left hand on the right elbow. Push the elbow towards your chin as if you are reaching for an object behind your left shoulder. Hold for 30 seconds. Repeat 3-5 times. Then repeat on the other side.
  (see picture at adam.about.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.

Helpful Products

Several programs are available that can cue you to take a break when working on the computer. These programs also provide stretching instructions and illustrations.

Helpful Resources

• ErgAerobics: Why does working @ my computer hurt so much?
  
• Yoga for Computer Users: Healthy Necks, Shoulders, Wrists, and Hands in the Postmodern Age

The Elbow and RSI

Repetitive Strain Injuries (RSIs) from computer use or desk work can cause headaches, eyestrain, and pain through the neck, shoulders, arms and back. "The Elbow" is part of a series that takes a closer look at the mechanism of injury and specific injury prevention techniques for particular pain areas.

Unlike the shoulder, the elbow joint has a tremendous amount of bony stability.  The lower end of the long bone of the upper arm (the humerus) meets the two long forearm bones (the radius and the ulna) at the elbow.  The majority of the muscles that bend the wrist and the fingers attach to the inner portion of the elbow.  The majority of the muscles that straighten the wrist and the fingers attach to the outer portion of the elbow.

The neutral position of the elbow, with the arm relaxed at the side of the body, is with the thumb facing forward and the palm facing toward the body.  With the elbow bent, this neutral position is the “handshake” position.

Factors that Contribute to Elbow Pain

• Repetitive wrist movement, especially with the forearm fully rotated palm-up or palm-down, repetitive rotation of the forearm, and repetitive elbow bending and straightening can all contribute to inflammation of the tendons as they insert into the elbow.
  
• Bony and ligamentous grooves and tunnels near the elbow through which the three main nerves that provide power and sensation to the hand pass.  The shearing motion or compression of the tendon and nerves as they pass through these tight areas can contribute to repetitive strain injuries.
  
• The degree of the elbow carrying angle (the angle of deviation of the forearm bones in relationship to the upper arm bone when the arm is held at the side with the palm facing forward). 
  
• Maneuvering the arms around a larger upper body when placing the hands on the keyboard is also a factor.

Cubital Tunnel Syndrome

When you hit your “funny bone” you are actually hitting the ulnar nerve as it passes through a bony groove at the inside of the elbow.  The nerve is particularly vulnerable as it passes through this superficial groove.  Bending the elbow stretches the nerve through this groove tautly.  Holding the elbow bent for prolonged periods, such as when holding a phone to the ear or sleeping with the elbows bent, can cause this nerve to become irritated.  If you experience aching along the small finger (ulnar) aspect of the forearm and hand, or if you have tingling or numbness in the ring and small finger, it is especially important to avoid positioning the elbow in a bent position, either with activity or at night.  Avoid repetitive elbow bending and straightening.  Contact a medical professional for treatment.

Tennis Elbow (Lateral Epicondylitis)

Tennis elbow initially begins as an inflammation where the muscles attach to the outside edge of the elbow.  Activities that contribute to this inflammation include repetitively pulling back (extending) the wrist and the fingers; repetitively rotating the forearm palm-up and palm-down, especially when holding an object in the hand; and lifting objects with the forearm rotated in the palm-down (pronated) position.  Carrying a suitcase, briefcase or laptop backpack are activities that can cause tennis elbow.

Golfer’s Elbow (Medial Epicondylitis)

Golfer’s elbow is similar to tennis elbow, except that it begins as an inflammation where the muscles attach to the inside edge of the elbow.  Activities that contribute to this inflammation include repetitively bending the wrist and closing the fingers; performing fine motor activities with the wrist bent, and repetitively rotating the forearm.


The farther away from the body that you perform activity, the more tension that is placed on the tendons where they insert into the elbow.

RSI and Prevention
Positioning

• Avoid sleeping with the elbow bent more than 90 degrees to reduce the amount of stress on the nerve. 
  
• Don’t sleep with the hands placed behind the head. 
  
• Avoid sleeping on your stomach.
  
• Use soft pillows under the arms.
  
• Wear a sleeve with a pad that protects the elbow such as the


Heelbo® Heel and Elbow Protector.
Or use an ace wrap around a soft cushion.

 
Computer Use

• Position the keyboard so that the elbows are open more than 90 degrees.
  
• Pad any sharply angled surfaces that the arms rest upon. For example, the Pillow Ergonomic Support.
  
• Don’t lean on the elbows.
  
• Avoid repetitive elbow bending and straightening, excessive wrist movement or repetitive forearm rotation.
  
• Use a split keyboard, especially if you find that you need to deviate the wrists out of the
  neutral position (middle finger in line with the forearm bones) when placing the fingers on the keyboard.  This is particularly important if you have a large elbow carrying angle or a larger upper body. Check out the Microsoft Natural Keyboard Elite
  
  
  
• Move the mouse from the shoulder, not the wrist.
  
• Take frequent micro-breaks.
  
• Stretch often.

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.

 

 

Cubital Tunnel

Everyone now knows about carpal tunnel syndrome. The term has become a mainstream name. Carpal tunnel syndrome is the most commonly occurring nerve compression of the upper extremity. It can cause numbness in the thumb, index finger, middle finger, and partially in the ring finger. It can cause weakness in the muscles at the base of the thumb and cause pain that radiates up the arm into the shoulder and neck. Like the older sibling who gets blamed for all wrong-doing, carpal tunnel syndrome has become synonymous with all hand pain.

Lurking in the shadow of carpal tunnel syndrome's fame is its counterpart, cubital tunnel syndrome. Cubital tunnel syndrome is the second most commonly occurring nerve compression of the upper extremity. It is caused by the ulnar nerve becoming pinched at the elbow. When you hit your "funny bone", you are actually hitting this nerve. The ulnar nerve is responsible for sensation in the small finger and partially in the ring finger. Trauma to the ulnar nerve can cause pain in the small finger side of the hand that radiates into the forearm towards the inside of the elbow. It can cause weakness to the small muscles in the hand and, if severe, loss of coordination.

It is time to bring cubital tunnel syndrome out from behind carpal tunnel syndrome's shadow and into the light. If diagnosed correctly, there are simple modifications that can be made to help relieve the symptoms of this frequently overlooked nerve compression.

Avoid bending the elbow for any length of time. This stretches the nerve tautly through the cubital tunnel. Activities that can irritate the nerve include:

sleeping with the elbow bent - use pillows for support; wrap an ace wrap or towel loosely around the elbow to keep it from bending; avoid sleeping on the arm or sleeping with the hands positioned up behind the head.

holding a phone to the ear - use a head-set.

blow-drying hair.

driving - adjust the seat position so that the elbows are open and relaxed; avoid resting the arms on the elbow supports or window sill.

computer work - position the height of the keyboard and mouse so that the elbows are open a bit more than 90 degrees.

playing the guitar (because of the positioning of the fretting hand) - warm-up prior to playing, take frequent breaks, stretch often.

Don't lean on the elbow.

Don't lean on the forearm, especially if it is placed over the hard edge of a desk or table. Place a soft support or cushioning under the forearm.

Position the mouse and the keyboard in front of you so that you do not need to reach forward or out to activate them.

The mouse and keyboard should be low enough that the shoulders are relaxed.

Activate the mouse by keeping the wrist solid and using shoulder movement for positioning.

Keep the wrists neutral. The wrists should be flat over the keyboard, not bent forward or back. The wrists should not be angled towards the small finger while typing. Using a split keyboard or a vertical mouse may help position the wrists correctly and relieve tension in the forearms.

Avoid repetitive elbow bending and straightening.

Avoid over-developing the triceps during gym and sports activities.

The ulnar nerve runs from the side of the neck, into the armpit, down the arm, through a groove on the inside aspect of the elbow, into the forearm, and into the hand through a small tunnel adjacent to the carpal tunnel (Guyon's canal). In addition to being vulnerable to forces at the elbow, the nerve is vulnerable at the level of the wrist. The following activities can cause an irritation of the ulnar nerve at the wrist:

heavy gripping

repetitive wrist and hand movements

performing activity with the hand bent down and angled toward the small finger

compression on the small finger side of the wrist (for example, cyclists who lean onto the handlebars, heavy machine operators and use of jack-hammers, weight-lifters, use of crutches, typists who rest the wrists on a hard surface)

Here are a few more tips to protect the nerve at the wrist.

Avoid leaning on or placing pressure against the wrist.

Do not use the base of the hand as a "hammer" (as when snapping a hubcap into place or freeing up the last remnants of smoothie from the blender).

Use vibration-reducing, gel-lined gloves when performing sports or work activities that can compress the nerve

As with other injuries, it is important to:

take frequent breaks when performing repetitive work.

gently stretch the forearm muscles.

warm-up prior to performing strenuous activity.

avoid or modify activities that cause pain.

use cold packs to control post-activity pain when necessary.

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

Recommended Ergonomic Products

The Microsoft Natural Ergo Keyboard positions the wrist in a neutral position. An added bonus - it has a detachable support that allows you to angle the keyboard in a negative tilt (or reverse slope) which can ease strain in the wrists and forearms.
Microsoft Natural Ergo Keyboard 4000

The Evoluent Vertical Mouse fits comfortable in the hand and reduces forearm stress by placing the arm in a more neutral rotation. Evoluent VerticalMouse 2 - Optical Computer Mouse

These Fox cycling gloves have gel padding in the palm and fingers for protection and comfort.
2006 Fox Reflex Gel Cycling Glove