Typing Style – Repetitive Injuries are NOT just about the Keyboard

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 STYLES

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. 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.

Advertisements

Top 10 Ergonomic Picks

Here are my top 10 picks for ergonomic health that can help reduce the risk of carpal tunnel and other repetitive injury pain when working at the keyboard.

1. An Ergonomic Keyboard – Positioned with a wedge-shaped inverted “v” (also described as a “gable”), the split-keyboard places the wrists in a more neutral position than smaller, standard keyboards.

2. An Ergonomic Mouse – The Evoluent Vertical Mouse and the 3M Ergonomic Mouse are two styles of mice that place the forearm in the “handshake position” easing stress and tension on the muscles, tendons and nerves of the arm.

3. An Adjustable Under-the-Desk Keyboard Tray – Allows you to easily position your keyboard at the appropriate height. A must for any workstation, at home or in the office, that has multiple users. Many trays now also adjust for keyboard tilt allowing improvement for wrist angulation.

4. An Adjustable Monitor – Allows you to easily position the monitor at the appropriate height easing neck and shoulder pain. Once again, a must for any workstation that has multiple users.

5. Computer Glasses – Anyone who wears glasses, especially bifocals, is at high risk for neck and shoulder strain while working on the computer. Purchase a new pair of glasses that is prescribed specifically for computer use.

6. A Stretch-Break Program – You can not over-stretch while working (as long as you respect pain when performing the stretches). A program such as StretchSmart can cue you to take stretch breaks. You can customize the frequency and duration of the stretching sessions. You can also set the program to provide stretches for your specific high risk pain areas.


7. A Copy Holder
Eases neck strain caused by looking repetitively from the monitor to the desk while working from copy. If working with thicker stacks of copy, an on-the-desk model that fits in front of the monitor works well. Single sheets of copy can be placed directly to the right or left of the monitor.8. An Ergonomic Pen

The majority of people who I see for ergonomic assessments have a tendency to hold their pens too tightly causing thumb and hand pain when writing. Hold the pen lightly, using a roller-ball or felt-tip pen so less force is needed.9. A Good Chair

Your office chair should be adjustable for height, seat-depth and seat-tilt. It should have adjustable arm rests and good lumbar support. For petite women, a full-length lumbar back support may be helpful to improve the fit of the chair.10. A Good, Durable Cold Pack

We all have aches and pains now and again. The key is to keep an injury from progressing and settling in. Have a good cold pack readily available for use at the first sign of inflammation or pain. The ElastoGel Cold Packs are a clinical therapeutic favorite. They are durable, will not leak, and conform comfortable around bony areas. A cold “wrap” comes with Velcro straps attached that allow you to strap on the pack when you are on the go.

Smartphone Ergonomics

Since their inception, the push has been to make computers smaller, smarter and more portable. Functions that once took banks of computer hardware are now performed on electronic gadgets that fit in the palm of our hand.1973 heralded the birth of hand held computers with the first programmable calculator. Within 2 years, a primitive and portable computer organizer was developed with a calculator, alarm clock and scheduling feature. The first “palmtop” with DOS was developed in the mid 1980s. John Sculley of Apple Computer officially coined the term PDA (personal digital assistant) in 1992 when he introduced the Apple Newton. The mass market appeal of these small devices was realized with the introduction of the Palm Pilot in 1996. About the same time, the first “smartphone” (a combination of cellular phone and PDA) was developed. The popular BlackBerry was introduced in 1999. Currently, 2.14 billion people worldwide subscribe to mobile phone service (en.wikipedia.org/wiki/mobile_phone).

In a piece of electronic equipment the size of the palm of our hand, we now have the ability to make phone calls, take pictures and videos, access calendars and address books, check email, surf the web, perform office tasks and develop business documents with mobile versions of word processors and spreadsheets, locate areas of interest and avoid traffic jams with GPS, play games, and entertain ourselves with music and video downloads.

The following ergonomic and safety tips will keep you healthy and pain-free when using your handheld device.

“BlackBerry Thumb”

Text-messaging and miniature or keyboard functions can take their toll on the thumbs. “BlackBerry Thumb” is a commonly used term to describe a painful and debilitating tendonitis of the thumb tendons caused by repetitive use.

    • Limit your typing time to no more than 10-15 minute sessions.
  • Stretch often.
    • Turn your palms up.
    • Open the thumbs wide as if you are hitch-hiking.
    • Using your other hand, gently push the thumb back until you feel a nice stretch.
  • Use a portable keyboard attachment when possible.
  • If using a stylus, use one with a larger grip handle.
  • Support your arms on pillows while typing.
  • Hold a pencil and use the eraser to push the keys to give your thumbs a break.
  • If your thumbs feel sore, use cold packs after typing. Take a break from using your thumb keyboard. Seek medical attention if the pain does not go away.

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 Using the Mouse
  • Forearm Position

Here are some tips to help reduce your risk of developing a repetitive strain injury or tendinitis 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.

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 and swiveling the mouse using wrist motion.
  • Planting the wrist down placing pressure against the carpal tunnel.
  • Bending the wrist backward (extended) 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 WHEN USING 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 the right to the 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.