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. 

Preventing Elbow Pain

Traumatic injuries may be unavoidable.  However, the risk of pain caused by stressful, forceful or repetitive activities can be controlled.  Sportsinjuryclinic.net offers nine tips to reduce the risk of elbow injuries related to sports.  I have modified these injury-prevention tips and applied them to the computer athlete or the desk jockey.

1.  Warm-up before working.  Warming-up increases the temperature of a muscle preparing it for work.  It also increases the oxygen and blood flow to a muscle enabling it to work more efficiently with less risk of injury.

Use of Heat & Cold to Relieve Repetitive Strain Pain

2. Make sure you are using good technique.  Sportsinjuryclinic.net provides tips for those playing sports.  For the computer athlete or the desk jockey, this means looking at your ergonomic set-up and work methods.  For example, avoid reaching forward for the mouse.  Place it at keyboard height with your arm relaxed at your side and your elbow at a 90 degree or slightly greater angle.  Keep the wrist neutral when using the mouse and manipulate the mouse through small elbow and shoulder movements rather than swiveling at the wrist.

Ergonomic ABCs

3.  Make sure that you have the correct equipment.  Again, in racket sports, this may mean having the correct racket size, grip size and string tension.  For the computer athlete or desk jockey, ergonomic equipment and an appropriately fitted ergonomic chair can help prevent pain.  Awkward positioning increases the stress on the body and makes the work that the body does less efficient, awkward and more prone to injury.

Top 10 Ergonomic Picks

4. Get a massage.  Whether for the athlete or the computer athlete, massage can help relax the arm muscles and break down any scar tissue and trigger points.  Massage along the length of the forearm muscles moving from the hand towards the elbow.  Knead the bulk of the forearm muscle below the elbow joint.  Plant two or three fingers from the opposite arm at the bony prominence of the elbow and perform small oscillating movements across the bone to improve blood supply to the location that the muscles insert on to the bone.

5. Strengthen.  Strengthening the forearm, upper arm and shoulder muscles takes some of the strain away from the elbow joint.

6. Wear a brace around the muscles just below the elbow. This can help by taking some of the pressure off the attachments at the elbow and distributing stress throughout the arm.   Sportsinjuryclinic.net explains the use and purpose of a clasp, support and sleeve.

7. Don't overtrain or suddenly change your training routine or daily activities.  For the computer athlete or desk jockey, a change in routine, new desk set-up, or special project requiring long hours to complete can have an impact on pain level.  If you notice an increase in arm fatigue or soreness, stretch often, use cold packs and take mini-breaks frequently. 

8. Stretch.  Stretching the muscles around the elbow keeps them flexible which helps to reduce the strain placed on the muscle attachments surrounding the joint.

9. Apply cold packs.    For the early stages of elbow pain, whether caused by a sports-related injury or a repetitive or cumulative injury from the keyboard, cold can help reduce inflammation and help relieve muscle pain and spasm.

 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.
 

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.