The 4 Es of Injury Prevention

When addressing injury prevention for computer users, four components need to be attended to in order to ensure success.  Here are the four Es that will provide a well-rounded ergonomic program along with links to additional information.

• Ergonomics – Ergonomics provides the optimal environment in which the body works.  Ergonomics places the body in the most efficient and least stressful working positions.  Without an appropriate ergonomic environment, the body will be at constant risk for injury.


• Ergonomic ABCs        


• Monitor Position & Ergonomic Tips     


• Top Ten Ergonomic Picks        


• Exercise – Warming-up muscles prepares them for work.  Warming-up increases blood and oxygen flow to the muscles and increases the muscle flexibility.  Stretching ensures that the muscle is able to contract and work to its fullest efficiency without placing stress at the point that the muscle or tendon unit attaches to the bone.


• Exercises for Preventing Hand Pain      


• Stretching for the Computer Athlete     


• Education – The work environment can be perfect but the equipment loses its effectiveness if it is not used appropriately.  Training programs must be developed to support ergonomic programs.


• Typing Style - Repetitive Injuries are NOT just about the Keyboard           


• Pain-Free Mousing      


• Monitor Position & Ergonomic Tips     


• Energy – Our body’s potential to produce work is a component of our fitness, health and well-being.  Practicing general healthy habits will help our bodies heal from the everyday wear-and-tear and help prevent the micro-trauma that leads to repetitive injuries.


• How to Develop Healthier Ergonomic Habits   


• The Effect of Smoking on Repetitive Strain Injuries       

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

 

Mouse Rest

The wrist rest is probably the most widely used and misunderstood piece of ergonomic equipment available. 

Placing a wrist rest in front of the keyboard has become synonymous with providing ergonomic adjustments to a work area. 

• When an ergonomic assessment is required, the very first item that is often checked off on the ergonomic modification checklist is provision of the wrist rest. 
  
• When clients tell me that they have made ergonomic changes to their computer desk, they often mean that they have purchased a wrist rest.

The Concept is Good, But….

My problem with the wrist rest is not with the concept.  Wrist rests can play an important role in wrist positioning for those using a keyboard or mouse.  The goal is to have a neutral wrist (the wrist being flat and straight, not bent forward or back or angled to either side).  A neutral wrist angle reduces stress and friction on the structures at the wrist and can help reduce discomfort and fatigue with typing and mousing activities.

However, I do have two issues with the wrist rest.  The first is in the name and the second is in the training (or lack of) for its use.

Purpose – Guide and Glide

In spite of the misleading name, the wrist rest is not designed for resting the wrist while typing.  The wrist rest should guide the wrist into a neutral position enabling the wrist to glide over the wrist rest while typing.  The wrist should only actually touch down on the wrist rest during typing breaks. If the wrists are actually planted down on the wrist rest during typing, the small finger muscles are isolated causing awkward finger positioning and movements and creating muscular stress. 

 Proper Wrist Rest Use

When typing, the wrists should be in a neutral position.  They should float over the wrist rest and hand placement for key reach should be initiated through the shoulder and elbow. 

See Neutral Position – Fingers, Wrist & Forearm

See Typing Style – Repetitive Strain Injuries are NOT Just About the Keyboard

Similarly, a wrist rest in front of a mouse causes the mouse to be activated by swiveling the wrist.  This can lead to repetitive strain injuries and tendinitis.  As with the keyboard, mouse movement should be initiated through small shoulder and elbow movements while the wrist is held in the neutral position.

See Pain-Free Mousing

The Bottom Line

Those who are responsible for providing ergonomic modifications to work stations should be aware of the proper function and use of the wrist rest.  They need to provide the appropriate training if they issue a wrist rest.  Otherwise, those who do not know better will revert to the function of this poorly named ergonomic piece of equipment and rest their wrists while typing - potentially increasing their work injury risk.

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.

Female and Fashionable

Women develop carpal tunnel syndrome, tendinitis and other repetitive strain injuries about twice as often as men.  Hormonal shifts, fluid retention, pregnancy, and menopause are known to increase the incidence of risk for repetitive strain injuries.  Also, women are typically smaller than men.  Smaller bones and muscles need to work harder to perform the same job increasing the risk of muscular fatigue and strain.  As women work with tools that are typically designed for larger bodies, they may be working on equipment that is too high or too heavy, causing the female body to work in awkward positions or perform forceful muscular exertions (two of the risk factors for developing a repetitive strain injury).

These are issues that we need to be aware of but may not be able to impact to a large degree.  However, the following two tips for female fashion divas are things that we as women can do to immediately reduce our risk of injury from repetitive strain.

Long Fingernails

Women typically have longer fingernails than men.  When fingernails are longer, typing style is affected.  The least stressful position for typing is with the fingers relaxed and slightly rounded - as if the hand is resting over a large ball. 

Typing should be performed by tapping the tip of the finger against the key using the least force necessary to activate the key. The longer the fingernail, the flatter the finger needs to be on the keyboard so that the pulp of the finger is hitting the key rather than the tip of the finger.  This places stress on the smaller muscles of the hand that run between the bones of the finger.  This also places stress on the muscles on the outside of the forearm. 

If you are experiencing pain in the forearm or the outside of the elbow, try trimming those fingernails and type with the hand in as relaxed a position as possible using the tips of the finger rather than the pulp.

For more information:

Typing Style - Repetitive Injuries are NOT just about the Keyboard

High-Heeled Shoes

High-heeled shoes push the weight of the body forward.  In order to maintain an upright posture, women use extra muscular effort, primarily in the lower back, to keep themselves from falling forward.  This exaggerates the arch of the lower back. 

In addition to possible back, knee and ankle pain, women who wear high-heeled shoes can develop shallow breathing patterns and tight neck and shoulder muscles from the extra effort that it takes to counteract the forward thrust caused by the shoes. 

Lower the height of those high-heels if you are experiencing pain or change into flatter-heeled shoes throughout the day or if you are going to be on your feet for any length of time.  If you do change between different sized heels during the day, take the time to adjust your office chair to compensate for the change in shoe heights.

For more information:

How to Develop Healthier Ergonomic Habits

Sources:

Repetitive Strain Injury; Stifling the Pain in a Pinch

mothernature.com

RSI on trial: More people suffering from repetitive strain injury are seeking compensation in court as fresh evidence comes to light about the symptoms and causes of this crippling disorder

Newscientist.com; 11 September 1993; John Ballard

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

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

Mouse Bridge

A mouse bridge is a simple way of bringing the mouse in closer to your optimal work space while working at the computer.  Typically, people tend to reach forward or out away from the body for the mouse.  Because the keyboard tray may be too small to accommodate both the keyboard and the mouse, the mouse is often placed wherever space tends to be available, often to the far side of the keyboard or on a desk surface.  Using a mouse bridge can make mousing activity more comfortable and less stressful on the body.  Although the mouse bridge does cover the numerical keypad and prevents its use, the bridge can be easily moved for access to the keypad when necessary.

How Does A Mouse Bridge Work?

Ergonomically, the mouse converts the numerical keyboard pad into a mousing surface.  This eliminates some of the awkward reaching or the awkward wrist angles that occur during mousing activity and that can contribute to repetitive strain injuries such as tendinitis and carpal tunnel syndrome.

What is a Mouse Bridge?

A mouse bridge is simply a thin piece of plastic or metal with shallow legs that fits over the numerical pad of the keyboard.  Depending upon the type and shape of the keyboard, the style of this bridge may vary.

Who Needs to Use a Mouse Bridge?

Using a mouse bridge is the perfect ergonomic adaptation for those who have short keyboard trays that do not have a mouse tray attachment or for those who have limited desk space that places the mouse more than a half an arm’s reach away from the body during use.  It is also helpful for those who have placed the keyboard and the mouse at different working levels.

When Will a Mouse Bridge Work the Best?

The mouse bridge is appropriate for right-handed mousers who spend a majority of time at the computer using a mouse but who do not use the numerical pad section of the keyboard.   It can also be used by those who have distinct work tasks that use either the keyboard or the numerical pad at separate times. 

What Styles are Available?

• The Standard Mouse Bridge has legs that rest on the same surface as the keyboard (on the desk or the keyboard tray).  It is larger as it fits around the keyboard and is good for those who have a standard style keyboard. 
  
• The Flat Mouse Bridge is the smallest bridge.  It rests on the keyboard itself.  It can be used with the Microsoft Natural Keyboard or with pull-out keyboard trays with limited space availability. 
  
• A Rear Mouse Bridge has legs that can be adjusted (raised) for extra clearance for higher keyboards or if the keyboard has a cable at the right rear. 
  
• A side mouse bridge is also available for use with the Microsoft Natural Keyboard.

A Few More Tips

• When using an optical mouse, use a mouse bridge that is not transparent or place a mousing pad over the mouse bridge.
  
• A mousing pad on the mouse bridge may also help improve mouse movement (tracking) if needed or may help prevent the mouse from sliding if the bridge is slightly slanted.  Adjusting the legs on the mouse bridge or the slant of the keyboard tray can also help even the slope of the mousing surface.
  
• If the mouse bridge slides, use a non-slip padding material beneath the legs.
  
• If the mouse bridge is pressing on the keys of the keyboard, lower the legs of the keyboard so that it lies flatter.  Or you may need to look into a different mouse bridge such as the rear.

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.

ASHT News Bulletin Kids and Electronics

A majority of children are now using desk computers, hand-held electronics such as smart phones and PDAs, and gaming controls on a daily basis.  Parents should take an active part in teaching their children techniques that will help them prevent future injuries such as carpal tunnel syndrome and tendinitis. 

The American Society of Hand Therapists (ASHT) stresses the importance of developing good habits early on in children to prevent hand and wrist injuries in adulthood.  Healthy techniques learned at a young age can carry over into other aspects of life where there is a similar injury risk such as sitting in front of a computer or playing musical instruments. The ASHT Media News Bureau provided the following overall tips and health guidelines for kids and video gamers of all ages: 

Prevent Future Injuries such as Carpal Tunnel Syndrome and Tendonitis

• Tell your child to use a neutral grip when holding the controller. A neutral grip is when the wrist is straight, not bent in either direction (not strong or weak). It will allow for wrist motion in a plane where more motion is available in the wrist. 


• Ask your child to take a break every hour or switch to another activity. Overuse of repetitive motions, such as pressing buttons, can cause tendonitis of the elbow or lead to Carpal Tunnel Syndrome. 


• Don’t let your child sit back on his/her knees. Bending the knees this far is not only a hard position for the knee joint, but it requires your child to push most of his/her body weight up with his/her hands and wrists, placing increased pressure on these joints as well.


• Make sure the monitor is at the correct height.  While looking at the horizon, your child’s eyes should be looking at the top of the monitor.(this may vary if child wears glasses)


• If your child is typing, the keyboard should be at a height so that with his/her wrist/hands are straight, his/her forearms are parallel to the keyboard surface. 


• When using a GameBoy (or other hand held gaming devices), encourage your child to put pillows in their laps and rest arms on pillows. This will allow them to keep their head in a more upright position and therefore decrease neck strain.  The pillows will help support the arms so they do not have to be held up in the air.


• Whenever, possible your child should be sitting in an appropriate chair.  This would be a chair that allows your child to comfortably put their feet on the floor and also provides good back support. 


• When s/he is using a single control device (like a mouse), encourage your child to switch hands frequently.  This will allow the one hand to rest and reduce fatigue. 


• Have your child frequently focus on a distant object (away from the monitor) to help reduce eye fatigue.

The ASHT Media News Bureau is a central source for information on the specialized profession of hand therapy. ASHT members serve millions of patients nationwide, providing treatment for injuries and preventative care.  For more information about prevention technique and professional hand therapy, visit www.asht.org.
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing at the Hand Therapy & Occupational Fitness Center in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Pain-Free Mousing

When performing ergonomic assessments, the main factors that I have found that contribute to mousing pain include:

• Mouse Positioning
  
• Mouse Movement
  
• Muscular Tension When Activating the Mouse
  
• Forearm Positioning on the Mouse

Here are some tips to help reduce your risk of developing a repetitive strain injury or tendonitis from mouse use.

MOUSE POSITIONING

Causes of Pain

• Reaching forward for the mouse onto a desk that is higher than the keyboard.
  
• Reaching for a mouse placed to the far side of the keyboard.
  
• Planting the wrist down and swiveling the mouse using wrist motion.

Tips for Preventing Pain

• Position the mouse in a more comfortable and ergonomic location
  
  • Use an attachable mouse holder that adjusts to fit over numerical key pad (if you do not use the 10-key) or as closely to it as possible.
    
  • Or use a keyboard bridge over the numerical keys if you do not use the 10-key portion of the keyboard.
    
  • Or use a keyboard station such as the Contour Roller Pro which has a rollerbar mouse that is positioned immediately below the space bar of the keyboard.

MOUSE MOVEMENT

Causes of Pain

• Excessive wrist or arm movement when activating the mouse.
  
• Planting the wrist down placing pressure against the carpal tunnel.
  
• The wrist bent backward (estended) when using the mouse.

Tips for Preventing Pain

• The mouse should be at about the same level of the keyboard and positioned as closely to the keyboard as possible.
  
• Avoid reaching forward, up, or out to the side when using the mouse.  Position the mouse to avoid these movements (see mouse positioning tips).
  
• Activate the mouse by using small movements from the shoulder and elbow muscles rather than the wrist muscles.

Ergonomics

• Keep the shoulders relaxed.
  
• The elbow should be held loosely at the side in a direct line under the shoulder.
  
• The wrist should be held in a neutral position (not bent forward or back or angled to one side or the other).
  
• Do not plant the wrist down on that desk or on a wrist rest.  Glide the wrist over surfaces always maintaining the neutral position.

MUSCULAR TENSION ACTIVATING THE MOUSE

Causes of Pain

Forcefully squeezing the mouse between the thumb and small finger.

Forcefully activating the mouse buttons or switches.

Tips for Preventing Pain

• Hold the mouse as lightly as you can while still maintaining control.
  
• Keep the fingers held loosely against buttons and switches, not floating tensely in the air.
  
• Do not pound mouse buttons or forcefully squeeze switches.  Use only the lightest force necessary to activate controls.
  
• Using a wireless mouse can eliminate the tension of pulling against the cord (even these small tensions add up by the end of the day).
  
• Use a mouse and mouse pad that can be switched easily from right to left hand to share the work load between the two hands.
  
• A keyboard station such as the Contour Roller Pro that incorporates a rollerbar mouse eliminates the need to hold the mouse.
  
• Research mousing options such as the NoHands foot-activated mouse or a head-activated mouse placed in a baseball cap.
  
• Perform forearm and wrist stretches throughout the day.
  
• Gently stretch the thumb into the “hitch-hiking” position.

FOREARM POSITIONING

Causes of Pain

• The forearm rotated into the palm-down position for long periods of time.

Tips for Preventing Pain

• Vertical mice are good choices as the “hand shake” position with the forearm neutral rather than palm down can relieve forearm stress.
  
• Stretch into the palm-up position throughout the day.

Related Articles

Ergonomic ABCs

The Wrist and Repetitive Strain Injuries

DeQuervain’s Tenosynovitis – Repetitive Strain Thumb Pain

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.

Samples of Products Mentioned in this Article

ASHT Guidlines for Hand Held Devices

According to The American Society of Hand Therapists (ASHT), heavy use of hand held electronic devices can lead to hand ailments.  In this national consumer education alert - initially issued in January of 2005 and recently reissued - professional hand therapists offer tips for preventing injuries caused by the extreme use of small personal music devices, smart phones and PDAs.

The excessive use of scroll wheels and frequent text-messaging associated with portable electronic devices are causing thumb, finger and wrist pain. “We are giving our thumbs, wrists, and elbows a real workout with heavy use of hand held electronics like blackberries and iPods,” said former ASHT president Donna Breger Stanton.  Injuries such as carpal tunnel syndrome, “BlackBerry Thumb” and tendinitis are being seen with increasing frequency as the use of these popular devices is increasing.

ASHT GUIDELINES FOR HEALTHIER USE OF HANDHELD ELECTRONIC DEVICES – A SUMMARY

Respect Pain.   If you have pain while using a hand held device, stop and take a break.  Pain is the body’s warning sign that something is wrong.  Pain may be indicating that you are straining muscle groups.

Be aware of wrist positioning.  Hold the device with the wrist in a neutral position (not bent forward or back or angled to either side).  Even a small amount of wrist angulation can increase tension on the tendons and nerves.

Take a break.   Every 20 minutes or so, take a micro-break (stop the activity for one or two minutes, stretch, or switch to another activity).  Repetitive motions such as pressing small device buttons can cause inflammation of the tendons or cause nerve irritation.

Relax your arms.  If possible, place pillows in your lap and rest your arms on the pillows.  Or use the device with the forearms supported on a desk or tabletop (however, do not lean the elbows onto a hard surface or press the elbow or forearms onto the sharp edge of the desk).   This will allow you to keep your head in a more upright position than if the device is held in your lap and therefore decrease neck strain.  The pillows or desk will help support the arms so they do not have to be held up in the air.

Sit in an appropriate chair.  This is a chair that allows you to put your feet comfortably on the floor and also provides good back support.

Switch hands frequently and vary the finger being used for texting or activating the electronic device.   This will allow the one hand or other fingers not being used to rest for awhile and reduce muscle fatigue.

Don’t forget the eyes.  Frequently look away from the screen and focus on a distant object to help reduce eye fatigue.

Download the ASHT Alert

The American Society of Hand Therapists is a not-for-profit organization seeking to advance the specialty of hand therapy through communication, education, research and the establishment of clinical standards. ASHT’s 3,000 members in the United States, Canada and around the world strive to be recognized leaders in the hand therapy profession. For more information about hand therapy or to find a hand therapist in your area, visit www.asht.org.

Marji Hajic is a member of ASHT and 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

PDA & SmartPhone Ergonomics

Laptop Ergonomics

PC & Video Gaming – Ergonomic Tips

Wi-itis and Other New Repetitive Injuries

Epicondylitis

Epicondylitis is pain at either side of the elbow where the finger and wrist muscles originate at the bony bumps of the humerus (upper arm bone). 

Although frequently mistakenly thought of as a tendinitis, epicondylitis is caused by the accumulation of microscopic tearing and damage.   The gradual accumulation of tearing and scarring that can be caused by repetitive trauma initially causes inflammation;  However, eventually, as the body is unable to heal the build-up of daily injury, the condition changes from one of inflammation to one of degeneration.  A physical change in the cellular structure of the tendons occurs including disorganization of the collagen fibers, calcifications, and loss of blood flow to the area. 

The proper classification of this injury is a tendinosis, a failed healing of microscopic tissue tears.  This can become an important distinction in prevention and healing of these injuries.  In the early stages, treatments for inflammation such as the use of cold packs and the use of anti-inflammatory medications may be helpful.  In the later stages, however, the goal may be to improve circulation to promote healing in addition to specific conditioning exercises to help organize the tissues around the elbow.

Tennis Elbow

• Lateral epicondylitis, commonly described as tennis elbow, is caused by injury to the outside edge of the elbow. 
  
• The damage is specific to the tendons of the muscles that straighten the fingers, pull the wrist back, and turn the palm up. 
  
• Only 20% of lateral epicondylitis is caused by actually playing tennis.

Golfer's Elbow

• Medial epicondylitis, or golfer's elbow, is caused by injury to the inside edge of the elbow.
  
• The damage is specific to the tendons of the muscles that close the fingers, bend the wrist forward, and turn the palm down.
  
• Golfer's elbow occurs only 10-20% as frequently as tennis elbow.

SYMPTOMS

Classic Symptoms

• Tenderness at the sides of the elbow over the bony protuberances. 
  
• Localized swelling at the point of tenderness.
  
• Pain may radiate from the elbow down the forearm and into the upper arm in more severe cases. 
  
• Activity increases pain. 
  
  • Tennis elbow is aggravated by gripping objects with the wrist bent backwards. 
    
  • Golfer's elbow is aggravated by gripping objects with the wrist bent forward.

Other Possible Symptoms

• A loss of full elbow and wrist motion because of pain.
  
• A feeling of weakness in the arm muscles because of pain.
  
• Generalized swelling of the elbow.

COMPUTER-RELATED CAUSES OF EPICONDYLITIS

One of the most common causes of tennis or golfer’s elbow for computer users can be positioning of the mouse.  

• Reaching forward for the mouse onto a desk that is higher than the keyboard.
  
• Reaching for the mouse placed to the far side of the keyboard.
  
• Gripping the mouse tightly while using wrist motion to activate.
  
• Planting the wrist down and swiveling the mouse using wrist motion.

OTHER OFFICE-RELATED CAUSES OF EPICONDYLITIS

• Reaching frequently for the phone or to take heavy manuals or binders down from high shelves.  
  
• Pulling thick files out of densely packed cabinets or drawers.

CAUSES OF EPICONDYLITIS RELATED TO TRAVEL

Those using laptops or traveling frequently on business are also at high risk.

• Carrying heavy objects such as a suitcase, briefcase or back pack.
  
• Lifting these objects onto surfaces with the palm down and the elbow straight (such as swinging them onto the security table at an airport).

PREVENTION FOR COMPUTER, OFFICE & TRAVEL RELATED CAUSES OF EPICONDYLITIS

Mouse use

• Activate the mouse by using the shoulder muscles. 
  
• The mouse should be at about the same level of the keyboard and positioned as closely to the keyboard as possible. 
  
• Don’t reach forward or out to the side. 
  
• The shoulder should be directly positioned over the elbow.  Keep the shoulders relaxed.
  
• Hold the mouse lightly.
  
• See Ergonomic ABCs for additional information.

Mouse Positioning 

• Use an attachable mouse holder. 
  
• Or use a keyboard bridge over the numerical keys if you do not use the 10-key portion of the keyboard.  
  
• Or use a keyboard station such as the Contour Roller Pro which has a rollerbar mouse that is positioned immediately below the space bar.

Mouse Style

• Use an ergonomic mouse.
  
• Vertical mice are good choices as the “hand shake” position with the forearm neutral rather than palm down can relieve stress on the tissues . 

Office & Travel Tips

• Avoid repetitive and strong gripping, especially with the elbow straight.  (for example, move the heavy manuals and binders down off the high shelves of the computer desk).
  
• Place frequently used objects within easy reach (between eye and hip level and within an easy arm’s reach to prevent excessive stretch).
  
• Use a wheeled suitcase, laptop or backpack.
  
• When using a backpack, place both arms through the straps to distribute the weight evenly across the back.  This takes the stress off the arm.
  
• Pack lightly.  Take only the needed laptop accessories to lighten the load.

General Tips

• Use both hands when lifting to share the load between the arms. 
  
• Keep objects in close to the body. 
  
• Use the strong leg muscles to help with the lift, not the back.
  
• Try to lift heavier objects with the palms up (as if you are scooping up the object).
  
• Take micro-breaks and rest the arms during repetitive or stressful activity.  
  
• Stretch often.
  
• Use heat for comfort, to improve flexibility and to increase blood flow.
  
• Use cold for inflammation or acute injury.

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.

Samples of Products Mentioned in this Article

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Choosing & Adjusting an Ergonomic Chair

The human body was not designed to keep still for long periods of time. And yet, the majority of American workers spend hours sitting in a chair while performing job activity. While sitting, the large muscles of the back, shoulders and neck contract to support the active movement of the arms and hands. This constant contraction can lead to fatigue and trigger points in the muscles. A good seating system can help alleviate this risk.

A good seating system allows for adjustability between body types. However, one size does not always fit all. A worker who is petite or larger may need to seek out special chair sizes that accommodate their body frames.

Here are some common adjustments that your office chair should be able to make.


1. Height - The chair should be able to be raised and lowered easily. Height is the first adjustment that should be made. When looking at the proper height of the chair, the elbows should be slightly higher than the work surface (desk or keyboard) so that the elbow is opened slightly greater than 90 degrees. The feet should be placed flat on the floor and the work surface adjusted (such as with an adjustable keyboard tray) if possible. However, if the work surface is not adjustable then the height of the work surface dictates the height of the chair. In this case, a footrest may be necessary to support the feet.

2. Depth of Seat Pan - The seat pan should slide forward and back to accommodate for differences in thigh length. If the seat pan is too shallow then body weight will not be distributed evenly through the thighs. If the seat pan is too deep or too narrow, you will be more likely to sit forward on the edge of the chair rather than taking advantage of the support of the chair back. The seat pan should also be rounded so that sharp edges do not press into the thighs and impede circulation. You should have a space of 2-3 fingers width between the edge of the chair and the back of the knee so that pressure is not placed on the nerves of the leg.

3. Back Support - The back of the chair should be able to be adjusted higher or lower to accommodate for a variety of heights. Proper lumbar support will help maintain the natural curves of the back and reduce the risk of back pain.

4. Seat Pan Tilt - Tilting the pan of the seat will allow you to accommodate for a variety of job tasks while still maintaining lumbar support. It will also allow you to vary working postures throughout the work day. Recent studies are now showing that a mild recline in a supported position is healthy for the back and reduces back pain. Slouching, however, reduces spinal disk height causing wear and tear on the lowest two spinal levels.

5. Arm Rests - The arm rests should raise and lower so that they support the forearms without causing the shoulders to be lifted towards the ears. A good chair will also have arm rests that can swivel or be pushed out of the way if needed. Arm rests should be broad and padded so that the forearm does not press into sharp edges.

6. Chair Base - Any rolling office chair should have a 5-point base of support for safety and stability.


A few more tips to help you remain pain-free while sitting at your desk or workstation -


* Visit an office supply store and take the time to sit in a variety of chairs to get the feel for one that is comfortable for you.

* Look for suppliers who have sample chairs that you can test for several weeks in the office environment.

* Learn to use the adjustments.

* Get up often and stretch frequently to increase circulation and reduce muscle fatigue.

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.

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.

Trigger Finger

Mouse and keyboard use can cause finger pain. One common cause of finger pain is called trigger finger. Trigger finger is a swelling of the tendon or tendon sheath in the palm of the hand of the tendons that bend the fingers. This swelling prevents the tendon from gliding smoothly through the sheath and the "pulley" (ligament) which holds the tendon to the bone. Trigger finger occurs most frequently in the middle finger and the ring finger, but it can occur in any finger or the thumb.

SYMPTOMS

• A locking, snapping, popping or catching sensation in the finger while making a fist.
  
• This "triggering" of the finger can be quite painful at times.
  
• The finger may "lock" into a bent position.
  
• There will most likely be pain or tenderness in the palm of the hand over the site of the pulley which holds the tendon close to the bone.
  
• There may be joint stiffness and pain in the affected finger.

OCCUPATIONAL CAUSES

• Repetitively gripping or bending and straightening the fingers (e.g. - mouse clicking)
  
• Sustained gripping
  (e.g. - squeezing the mouse forcefully or holding a pen in a "death grip")
  
• Using tools that have handles with sharp or hard edges

ERGONOMICS

• Avoid repetitive grasping and releasing of objects. Modify the activity if you are unable to avoid it. Look for ergonomic mice or larger barreled pens. Change your typing style so that your fingers are relaxed on the keyboard and mouse.
  
• Avoid sustained grasp.
  
• Keep the fingers relaxed over the keyboard. Do not plant your wrist down on the wrist rest while typing as this causes excessive and stressful finger movements to reach all the keys. Rather, the wrist should glide over the wrist rest, allowing the fingers to be positioned over the keys in a relaxed manner.
  
• Purchase tools with padded, comfortable handles.
  
• Handles should have some texture for easier holding. Slippery surfaces require more forceful grasping.
  
• Minimize repetition. Periodically rest the hands during repetitive or stressful activity. Stretch frequently during repetitive activity.
  
• Slow down!
  
• Use the lightest grip possible (on tools, pens, the mouse, the steering wheel, etc.) that still allows you to maintain good control.
  
• Use the least amount of force necessary during the activity.
  
• Use the appropriate tool for the job.
  
• Use ergonomically designed tools if available (modified or padded handles, larger grips with good traction, handles with modified designs).
  
• Make sure that tools are in good condition and that cutting edges are sharp (reduces the force needed to use the tool).
  
• Alternate work activities so the hands are not performing any one task repetitively for any length of time.

This ergonomic mouse can help relieve hand, wrist and elbow pain.

And here's an example of an ergonomically designed tool - scissors - that can help take the stress off the fingers.

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.

Governor Schwarzenegger's Prevention & Wellness Proposal - Ergonomic Impact

On February 6, 2007, California Governor Arnold Schwarzenegger, supported by a diverse group of leaders representing labor, business, consumer, insurer, senior, ethnic and medical professions, outlined the prevention and wellness aspects of his comprehensive health care reform proposal. The Governor stated that prevention is the least expensive and most effective way to cut down health care costs.
The Governor proposed five areas of focus for promoting health and wellness. Two of the five will cover programs and public awareness campaigns that fight obesity and tobacco use. A third encourages a Diabetes Prevention and Management Initiative. The fourth plan focuses on increasing patient safety and reducing medical errors in health care facilities and through more clearly written prescriptions. Lastly, Governor Schwarzenegger hopes to reward Californians who take personal responsibility for preventing disease and illness through the practice of healthy lifestyle choices. Benefits and incentives such as insurance premium reduction will be offered to those who reach certain healthy living goals.. The Governor does clarify that those who are overweight, smoke or have diabetes will not be penalized by increased premiums.
Governor Schwarzenegger’s prevention and wellness proposals were supported by several high-ranking executives during his presentation. Harold Goldstein, the executive director for the California Center for Public Health Advocates, emphasized that the solution to every major health challenge in modern history has been prevention. Steve Sanger, CEO of General Mills, summarized programs that have been effectively implemented by General Mills. Employees are provided with a Health Number Program that provides tools to help manage a healthier lifestyle through education and motivation. Their Lodi plant offers an on-site fitness center that supports the Physical Fitness and Anti-obesity Initiative that was proposed previously by Governor Schwarzenegger. Steve Burd, CEO of Safeway, discussed the redesign over the last two years of Safeway’s health care plan for non-union workers. The new plan, which focuses on prevention, wellness and positive behavior changes, is based on the belief is that 50-70% of health care costs are driven by behavior.
The key to this reform, and to the programs implemented by some of the largest employers in California, is that prevention is the cornerstone to saving lives, improving quality of life, and reducing health care costs.
Although the proposed prevention, health and wellness initiatives do not specifically address ergonomic issues, the plan does suggest that help will be given for employers to integrate wellness programs into employee benefits plans and worksites. It makes good sense that improving the general fitness and health of employees will help to improve work safety and reduce work injuries.
Medically, we know that obesity, smoking, and illness place additional stress on the body. Excess weight increases friction and tension on the body’s tissues, increases muscular exertion, and causes more rapid fatigue. Nicotine depletes the body of needed oxygen for muscular endurance and for healing of the daily microscopic damage caused by activity. Those who are suffering from or pre-disposed to heart-conditions, diabetes, and other illness and disease may be more prone to injury and heal more slowly.
A fit body is better able to withstand work demands. With the Healthy Action Program providing vouchers for health-related services such as gym memberships and weight management programs, employers could gently encourage, or even provide, healthy lifestyle management services in the work environment. With easy access to the programs, employees may be more likely to participate in such programs. The benefit to the company is a healthier, more productive employee who is less prone to injury and repetitive strain injuries.

Hand Health Resources

Using Ergonomics to Reduce Work Place Costs and Prevent Injuries

Using Ergonomics to Reduce Work Place Costs and Prevent Injuries



50% of all workers are at risk of developing a repetitive stress injury such as carpal tunnel syndrome or back pain. 1 in 10 will develop an injury severe enough that it interferes with work, home and leisure activities. Symptoms may include pain, numbness and tingling, weakness and clumsiness. At its worst, those who experience these injuries are unable to work, unable to pursue musical and artistic hobbies, unable to perform simple household tasks, even unable to hold and care for their babies.

In addition to the pain and disability experienced by the individual, the cost of these injuries can be tremendous. The carpal tunnel release is one of the most commonly performed surgical procedures in the United States. An individual case, including medical, therapeutic and work-related expenses, can cost up to $29,000. According to the U.S. Department of Labor, the direct and indirect costs of all these types of injuries can total as much as $20 billion dollars a year.

If we or a loved one are not personally affected, why should we care? As a consumer, for every purchase we make, for every service we need, these costs are passed on to us. As an employer, these costs have a significant impact on our business expenses and practices.

Most of us have either experienced symptoms ourselves or know of someone who has hand pain or had surgery on the hand. We see people daily, on the streets, in our offices, at the grocery stores, wearing wrist braces or back supports. Yet few of us are able to say what causes these injuries or, more importantly, to plan strategies for prevention.

Repetitive injuries occur when daily microscopic damage exceeds the body’s daily ability to repair tissues. The damage accumulates gradually until eventually we have a deficit in healing and symptoms become evident. Demanding work activity or poor work practices (such as excessive or repetitive work, forceful movements, poor posture and awkward positioning) can all contribute to the development of injuries. Anything that slows the body’s ability to heal can also contribute: stress, poor health or illness, not taking care of your body.

The earlier that repetitive injuries are treated, the better the chance of recovery. However, the very best defense is to prevent the injury from occurring in the first place.

Ergonomics is the art and science of creating comfortable and user friendly work environments and work practices. Maintaining a work environment that is ergonomically sound and developing work practices that place the least amount of stress on the body are important to preventing injuries.


This site is dedicated to ergonomic practices. It will help you look at how you perform your work tasks as well as the environment in which they are performed. It will provide you with tips to making small and inexpensive changes. For example, take steps to reduce the noise around you and maintain a comfortable work temperature. Modify activities that require awkward positioning, forceful movements and repetition. Using a glare screen and a telephone head-set, changing the position of the mouse or the monitor, and varying your tasks performed throughout the day, can all significantly reduce body stressors.


For complete injury recovery and prevention, it is important to also look at general health and fitness practices and to perform an exercise program that targets the muscles most at risk for injury. For more information, visit