Ergonomics: Not Just for Adults

Ergonomics: Not Just for Adults

Parents help ease the transition from summer fun to school routine.  Just as important (but perhaps not quite as much fun) as shopping for the right back-to-school fashion, parents can encourage positive health and ergonomic practices that reduce their children’s risk for developing repetitive strain injuries.

Several years ago, a youngster was referred to our hand therapy clinic with classic and debilitating symptoms of Carpal Tunnel Syndrome (CTS).  However, the physician, a generalist, was adamant that this young person did not have CTS as “16 year-olds do not develop these types of injuries”.  This patient’s parents sought a second opinion.  The patient was officially diagnosed with CTS upon physical examination with an orthopedic hand surgeon and nerve conduction examination, subsequently underwent surgical decompression of the nerve, and had a very successful recovery.

It is true that we don’t see many pre-teens and teenagers with symptoms of repetitive stress injury.   The flexibility and rapid healing rate of children allow them to get away with much more than adults when it comes to the repetitive and forceful nature and awkward postures of physical activity that create symptoms.

Unfortunately, the increasing role of technology in our lives, across all age groups, can not be ignored.  And formal classes in typing technique, posture and ergonomics are no longer offered in school as children begin using technology in their toddler years rather than learning to type in high school.  It is important for adults to be aware of the risk factors and to teach good ergonomic principles and work practices to our children in order to help keep the next generation pain-free.

Kids, Computers & Repetitive Strain Injuries (RSIs)

  • In a series of international studies, up to 60% of students across the globe reported eye-strain, neck & shoulder pain, wrist and back discomfort, headaches and fatigue. Symptoms were reported in children as young as in 4th grade.Repetitive strain injuries in children are highly correlated with the repetitive, awkward and prolonged postures they are using when they are working on computers or laptops.
  • Most computer stations are designed for adults or lack the adjustability needed for children who display a wide range of body sizes and body growth rates.
  • The portability of technology (e.g. laptop computers, video game players, mobile phones, iPads) allow for use in non-traditional settings and with non-traditional postures (for example, slouched in a couch or lying on a floor) that can increase the risk of injury.

General Guidelines to Promote Healthy Computing

  • Provide children the skills to understand what is good for their bodies so they can make good choices for themselves.
  • Teach healthy computer habits which can be carried into adulthood.
  • Encourage physical activity. Children who exercised during breaks from computer use had fewer pain complaints then those who were sedentary.
  • Encourage healthy habits including drinking plenty of water for tissue hydration and eating a variety of nutritious foods.

Computer Comfort & Ergonomics for Children

  • Chairs should be adjustable allowing for easy changes for growing children or for various family members of different ages and sizes.
  • The best chairs should have adjustability for chair seat height and depth. The back of the chair (providing lumbar support) should be able to be pushed forward. If the chair is not adjustable, use pillows or cushions to raise the child to the appropriate height or to support the back.
  • Position the child so that the eyes are level with the top of the monitor screen. The monitor should be placed directly in front of the child at about an arm’s distance away (about 12-14 inches) to prevent eye and neck strain.
  • Shorter legs should be supported on a footrest, sturdy box, or stack of stable books with hips, knees and ankles at about 90 degrees. There should be about 2 inches of clearance between the back of the child’s knee and the chair seat edge.
  • Increase type font on the monitor so that it is clearly visible to the child so they don’t have to squint or lean forward to read the screen. The screen should be clean and the brightness and contrast adjusted for easiest reading.
  • Reduce screen glare by placing the computer perpendicular to windows, having good room and task lighting, and, if necessary, using an anti-glare screen.
  • Teach your child to look away from the screen after every 15 minutes or so of typing to ease eye-strain.
  • Lower or remove chair arm rests so that child’s arms are loosely held at the side of the body, elbows bent at about 90 degrees, and the shoulders relaxed.
  • Place the keyboard and mouse within easy reach of the child so they do not have to stretch the arms out to use them.
  • Wrists should be flat and straight (in the neutral position) with fingers relaxed.
  • Teach the child to use the lightest touch possible on the keyboard.
  • Encourage the child to sit upright and not to twist, slouch or crouch in the chair while typing.
  • Encourage a typing break of 5-10 minutes for every 30-40 minutes of typing. Preferably the break activity should be active. A timer can be used to help the child learn to monitor himself.
A Parody of Holiday Decorating – with Safety Tips

A Parody of Holiday Decorating – with Safety Tips

Twas the week before Christmas
And all through the town
Holiday decorations were popping
up all around

Lights to be hung!
Tinsel galore!
All those boxes from storage
I stacked on the floor

To the desk chair I flew
Must have been such a sight
As I scrambled on top
To hang those bright lights

As I stood on my tiptoes
Oh! That rolling desk chair
It slipped! and I flew!
Should have been more aware

And as I was falling
And landing (real hard)
I spied another option
Outside in the yard

And so out I ran
Forgot all that clutter
And tripped in my hurry…
Such words did I mutter!

Got untangled from tinsel
Just to stumble and sprawl
Into those ornament boxes
Out of which I slowly crawled

Gradually worked my way over
Closer to the shed
But the pathway was blocked!
and I had nowhere to tread

Pushed and pulled all those boxes
Out of the way
Ouch…Twisted my back!
“Lumbar Sprain” Doc would say

But then what to my wondering
Eyes finally appeared
A ladder with safety labels
(Which I promptly ignored..having no fear)

The spirits had cheered me
And tasted ever so good
I was feeling kind of tipsy
Certainly not being as safe as I should

So, I climbed to the tip
To the very top rung
Carrying those decorations up the ladder
That needed to be hung

And finally, just had one
final bling to be placed
Thought I could..reach….the……top
This job would be aced!

But I reached too far over
And fell off the ladder
And on the way down
Made such a clatter

The neighbors all ran
To see the damage I had done
And as the ambulance drove off
I missed the cookie party fun.

Injury statistics are reported
And now I am one
Unfortunately for me
The joyful season is done

In my sad story
A lesson can be learned
Benefit from my mistakes
And healthy redemption be earned

This holiday time
Be safe when you decorate
And use common sense
Or share the same fate

Be careful this season
Follow those safety rules
Have Happy Holidays
And choose the right tools!

Be safe!… I proclaim
When decorating at heights
Remember ergonomics and
Have a healthy Christmas night!

According to the Center for Disease Control and Prevention (CDC), 8,700 people were treated in emergency departments in 2002 specifically for decoration-related ladder injuries. Don’t become a statistic this year. Follow these tips for a healthy and happy holiday season.

As you hang lights and decorations, use a step-stool rather than furniture for items that are slightly out of reach. Never stand on any furniture that is not stable. Make sure that the stool is locked into the open position. For higher tasks, use a ladder that is in good condition. For every 4 feet that the ladder reaches up, the base should be 1 foot away from the wall. Follow all height and weight restrictions that are posted on the ladder. Do not climb above the maximum height posted. The ladder top should extend 3 feet above the surface you are trying to reach. When climbing the ladder, face it directly. Keep balanced over the middle of the ladder. Do not overextend your reach. Place the legs on a solid and level surface. If the ground is soft or uneven, use a plank of wood to provide stability.

Use proper body mechanics to avoid back pain when lifting boxes. Ask for help when lifting heavier objects. Hold objects close to the body, not at arm’s length. Do not lean forward at the hips when picking up items from low surfaces; rather, squat down, hold the item close, and use the strength of your legs as you stand up to lift the item. Do not twist or turn at the waist. Your toes should always face the surface that you are lifting the object from or placing it on.

Avoid excessive clutter that can cause you to trip. Place electrical cords away from general walking pathways or tape them down. Do not overload electrical circuits. Keep walkways clear of boxes and decorations. Avoid rushing through the holidays. Perform activities requiring the most safety awareness when you are alert and relaxed.

Be safe!  Be Healthy!  Happy Holidays!

Cheers, Marji

12 Days of Ergonomic Christmas

12 Days of Ergonomic Christmas

Had some fun with this a few years back.  For all the computer users out there….Enjoy!

The Twelve Days of Christmas with an ergonomic twist…

On the first day of Christmas, the ergo specialist said to me
Keep those fingers relaxed on keyboard keys.

On the second day of Christmas, the ergo specialist said to me,
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the third day of Christmas, the ergo specialist said to me,
Wrists should be straight,
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the fourth day of Christmas, the ergo specialist said to me,
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the fifth day of Christmas, the ergo specialist said to me,
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the sixth day of Christmas, the ergo specialist said to me,
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the seventh day of Christmas, the ergo specialist said to me,
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the eighth day of Christmas, the ergo specialist said to me,
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the ninth day of Christmas, the ergo specialist said to me,
Keep shoulders from tensing
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the tenth day of Christmas, the ergo specialist said to me,
Avoid repetitive typing
Keep shoulders from tensing
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the eleventh day of Christmas, the ergo specialist said to me,
Don’t squeeze the mouse too tightly
Avoid repetitive typing
Keep shoulders from tensing
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the twelfth day of Christmas, the ergo specialist said to me,
Use a keyboard tray
Don’t squeeze the mouse too tightly
Avoid repetitive typing
Keep shoulders from tensing
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

Hand Pain? Top 10 Gift Ideas

Hand Pain? Top 10 Gift Ideas

Planning on doing some shopping for the holiday season?   Black Friday and Cyber Monday are upon us.  Here are some shopping suggestions to help you choose the perfect gift of health for family, friends or co-workers who suffer from the pain of carpal tunnel syndrome, tendinitis, or arthritic hand joints.  Or maybe you deserve to treat yourself??

(Please note: I have no financial interest in or reimbursement received from promoting any of the following products.  They are items that I just truly believe can be helpful.)

Split Keyboard

As computers and portable devices have become smaller so have keyboards.  This makes it more difficult to maintain a good, neutral wrist posture while typing.  Those keyboards that have the inverted “V” down the middle help align the fingers with the forearm easing tension on the sides of the wrist and preventing wrist pain and tendinitis.

ergo keyboard sktetch

A Vertical Mouse

Using a mouse that is turned onto its side places the forearm in a more neutral position and can ease mousing pain.

vertical mouse pic

A Laptop Stand with a Free-Standing Keyboard

Although the portability of laptops make them a wonderful choice for those on-the-go, inherently the design will place either stress on the arms or stress on the neck.  When at home, turn your laptop into a more ergonomically friendly desktop device by using a stand with an accessory keyboard.

laptop stand pic

A Large-Barreled Pen or Ergonomically Designed Pen

Many people write with tension.  Using a larger barreled pen such as the Dr. Grip, a felt-tip pen that writes smoothly, or an ergonomically designed pen such as the PenAgain can ease thumb pain and hand cramping.

ergo pen

Paraffin Bath

For an at-home-spa treat, a paraffin bath is not only good for relaxation but can help ease the deep ache caused by many hand injuries.  Also, heat is good for increasing the flexibility of joints, easing joint pain caused by arthritis, and enhancing the softness of a thick scar.


Therapeutic Tape

Seen on many athletes, therapeutic tape does not bind the joints for support the way athletic tape does but rather lies on the muscle belly.  The oscillating pattern of the adhesive, as well as mild stretch, lifts the surface of the skin, increases lymphatic and blood flow to the area, and relaxes the tissues around the superficial free nerve endings – providing some instant pain relief for most people!  Instructions for application are usually provided in the box.  There are also multiple online videos that show proper application.

therapy tape pic

An Electric Can-Opener

Or, for that matter, any electronic gadgets that can ease the work that the hands do….electric can-opener, electric jar opener, electric knife. Often these products can be found at discounted prices during this time of year.

electric kitchen pic.JPG

Gadgets and Gizmos

The OXO brand is a good example of a company that has designed products specifically for arthritic joints and those with hand pain.  The handles are larger and softer.  Bed, Bath and Beyond usually has a large display of the various kitchen tools. is a website with a paper catalog that offers functionally based produces.


Lazy Hands

I’m really liking this new product that provides a sure grip while easing the tension of holding larger smart phones.

lazy hands.jpg

A Good Book

Dr. Pascarelli, one of the leading experts on repetitive strain injuries, has written several easy-to-read but informative books including the Complete Guide to Repetitive Strain Injury: What You Need to Know About RSI and Carpal Tunnel Syndrome or Repetitive Strain Injury: A Computer User’s Guide


And a Few Bonus Gift Suggestions:

A Good Hot or Cold Pack

Both heat and cold can temporarily change the way that pain signals travel along the neural pathway to be recognized by the brain.  Cold is great for acute inflammation while heat can be good for more chronic pain, particularly a nervy type of pain.


Download an App or Subscribe to a Program

Head Space, Breathe 2 Relax, Desk-Yogi, Stretch Break programs – there are many free and paid apps and subscriptions that can provide guidance in relaxation techniques, meditation and mindfulness programs, deep breathing techniques and stretching programs and stretches that will help reduce muscular stress and tension.

app pic

Enjoy your Thanksgiving break.  Happy shopping!  Marji

How to host Thanksgiving Dinner with a Hand Injury

How to host Thanksgiving Dinner with a Hand Injury

The American Society for Surgery of the Hand has published some good tips on avoiding a hand injury while preparing your Thanksgiving meal (; Turkey Carving Safety). But…. what if you already have hand pain from a tendinitis, or arthritis, or carpal tunnel syndrome, or a recent hand or wrist sprain/fracture/injury?  Anticipating a full day of hand intensive activity when you are already in pain can be intimidating and anxiety-producing. Here are some survival tips to help those with hand injuries host the big event  without increasing pain. 

  1. Ask for help. Although this seems like common sense, it is often hard for a host to request help from his or her guests.  However, most family and friends would be more than happy to lend (a literal) hand. And don’t some of the best holiday moments actually take place in the steamy, fragrant kitchen?  Generate a party atmosphere -sipping something bubbly while chatting and sneaking food tastes- all while sharing the tasks of chopping, stirring and dish washing. Enlist someone who is strong and injury-free to lift the turkey out of the oven or perform the turkey carving. When someone offers to help with the dishes, accept gracefully. 
  2. Cut corners.  Less work=less hand stress=less pain. Thanksgiving should be about enjoying time with family and friends.  However, often Thanksgiving becomes all about the food. Large quantities of food. So much food, that we are obligated to overeat.  Be creative in finding ways to minimize the amount of work you actually need to do. Would anyone really be heart-broken if there were  fewer dishes on the table (as long as Mom’s famous stuffing is front and center)? Would anyone know if you used onions that were purchased already chopped?   Or if that apple pie was made from pre-sliced apples and prepared pie dough? Or, better yet, bought at a local bakery?  How about throwing tradition out for one year and planning a potluck?  Or purchasing a packaged dinner from the grocery store?  Could you use bottled gravy?   Can the butcher pre-cut the turkey so that smaller and lighter pans can be used for cooking?  Or, if it’s a small gathering, how about purchasing a turkey breast rather than the whole beast?
  3. Preparation is key. Plan ahead so hand intensive and possibly pain producing activities can be spaced out.  Design a menu that allows you to perform some early meal preparation over the 2-3 days preceding the holiday. Include house cleaning tasks and preparation into your Thanksgiving plan as well.  Perform heavier activities early in the week and complete only 1-2 a day.  The more you can pace your activities, the less physical and emotional stress on Thanksgiving day. 
  4. Gadgetize.  Dust off those kitchen tools. Use food processors, electric can and bottle openers, even an electric knife to reduce physical stress on the hands. 
  5. Minimize.  Ease stress on the body by following some general principles of joint protection and energy conservation: use leverage rather than grip (such as those “Y” shaped bottle openers); push rather than pull; slide rather than lift (use a dish towel on the counter to slide heavier pots and pans closer to the stove so you don’t have as far to carry them); use comfortably bigger and cushioned handles (the Oxo kitchen tool line is a good example). 
  6. Be practically festive.  Bring in some holiday cheer with a themed paper tablecloth and napkins (less laundry) and sturdy, decorative paper plates and paper or plastic glasses and stemware (fewer dishes). 
  7. Take time to care for yourself.  If, in spite of all your preparation and planning, your hands are more painful or swollen by the end of the day, sit for a few minutes, put your feet up and apply a cold pack.   Perform only the most necessary clean up. And aim to have a relaxing day the following day. Intending on carrying a bunch of shopping bags on Black Friday?….although fun, perhaps not the best timing for the hands.  

Wishing you and yours a healthy and happy Thanksgiving. 

Best, Marji

Top 10 Ways to Avoid Computer-Related Pain

The following recommendations make my top ten list for avoiding carpal tunnel syndrome, tendinitis and other computer-related strains and pains.

    1. Don’t squeeze the mouse too hard. Keep a loose grip.
    2. Don’t swivel the wrist while using the mouse. Move through the shoulder and elbow.
    3. Keep the wrists neutral. And try going vertical (with a vertical mouse).
    4. Don’t reach up or outward for the mouse. Keep it on the same level as the keyboard and keep it in close.
    5. Don’t rest your wrists on the wrist rest. This places pressure directly over the carpal tunnel and isolates finger movement causing too much strain on small muscles.
    6. Type lightly. Keep the fingers relaxed. Float over the keyboard.
    7. Open the elbows slightly greater than 90 degrees. Use an under-the-desk keyboard tray to position the keyboard at the correct height. Or, if you need to raise the chair seat, make sure your feet are properly supported.
    8. Avoid the rounded shoulder and forward head posture. Sit properly with the ears, shoulders and elbows in vertical alignment.
    9. Place the monitor at eye level so you don’t strain the neck and shoulder muscles by looking down at the screen.
    10. Don’t use bifocals. Peering under the lens can cause awkward head positioning and promote neck strain. Obtain special glasses for use only on the computer that are prescribed for the distance between your eyes and the monitor.

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.
  • 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.