In It for the Long Haul – Part Two

Part One| Part Two

Part Two

By: Jean Johnson for Shoulder1

Advice from an Expert: Check Your Work Station (And Think Twice Before Swimming the English Channel)

Occupational therapist and certified hand therapist with Providence Milwaukie Hospital Rehabilitation a suburb of Portland, Oregon, Sybil Fisher says there are some things people can do at home before they make an appointment with the professionals.

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Tips to avoid repetitive strain injuries at the keyboard: Keep your wrists straight like you are playing a piano. Avoid resting your wrists on the wrist pad while typing. The wrist pad is for resting when not typing! Keep your elbows by your side at the ribs. Make sure your forearms are parallel to the floor. Keep the mouse alongside the keyboard so you don’t have to reach out for it.

“The first thing I tell people is to check their work station if their hands or arms are irritated from using the keyboard,” she said. “You can stretch and ice, but if you go back to the same bad position, you’re going to have a problem.”

Fisher should know. She is the only Oregonian to have successfully swum across the English Channel in August 2003.

“I knew I had tendonitis half way through the Channel. Both shoulders and wrists, screaming with tendonitis when I was around nine hours in. I kept saying to myself to ‘push past the pain,’ something I would not recommend to my clients. Then again, it was a one-day thing I was doing.”

Aside from the English Channel ordeal, Fisher’s life has been marked by numerous other repetitive strains and stresses. “Being a swimmer I’ve had my share of tendonitis, so I can empathize with my clients. In my case, though, the problems never become chronic because I know exactly what to do.”

How does she manage her problems? Basically an irrelevant question, Fisher says, since each situation is different and requires a specialized approach. She does, though, offer the following tips on self care.

Advice from an Expert: Avoid Lazy Wrists; Use Correct Arm and Hand Position at the Keyboard

“The most important thing is for your elbow to be next to your ribs. You don’t want it reaching forward or shoved back. Also your forearm should be parallel to the ground,” Fisher said. “And then you kind of want to follow your forearm out to your wrist. Many people think the wrist rest on the keyboard is something to rest the wrist on while typing.

“That’s wrong, and is one of the big culprits. It just puts pressure on the nerves and tendons. Carpel tunnel is compression of the median nerve, right where you rest your wrist on the wrist pad.

“Wrist rests are for resting when not typing. Ideally you want to type like you’re playing the piano, with your hands floating and arms moving from the shoulders. Your wrists should be straight and fingers slightly curving down to the keys, since curving the wrists down can also create problems.”

Of course, once we’ve developed a bad habit, change is going to feel odd. Fisher says not to worry, though. “When people make the adjustment, they usually feel awkward and uncoordinated for a week or two until their brains develop new motor memory. Then it will get better. It’s the same as changing the seat position in your car. At first it feels a bit strange, but after while people get used to it.”

But back to the keyboard where we spend so much time and can do so much damage. “The other important area where a lot of people make a mistake is with the mouse. It needs to be along with your keyboard so that your elbow can remain at your ribs and your arms parallel to the floor when you use it. If you are reaching forward all the time to move the mouse, it can cause elbow tendonitis.”

The point is, said Fisher is that “you don’t want to repeatedly use something in an awkward position. Just because your body can do something doesn’t mean it should.”

Advice from an Expert: 30-30 Rule and Beyond

What we all have to do, Fisher said, is “work smarter not harder.”

Thus, even though she says that rest is usually the best remedy, for those who have to continue working while they’re treating a repetitive stress injury, she suggests approaching things intelligently.

Wearing wrist splints at night can be helpful, Fisher said, since “a lot of people will get into a fetal position when they sleep and curl their hands and wrists.” There are even elbow splints available for those that need them.

On specific exercises, Fisher says be cautious and remember that professional advice can be invaluable. “The general rule of thumb for people doing things without medical advice is ‘Try it; if it helps, great, it’s a bonus. If not, see a physician.’” She cautioned though, that “If exercises ever increase pain or symptoms, patients should immediately stop doing them.

“One of the most common myths out there, especially about carpal tunnel,” she said, “is that people need to work with a squeeze ball. The reason people get clumsy and weak is not due to lack of strength. It’s because their nerve is getting compressed. Also, the muscles you would strengthen for grip strength are already strong and usually too tight and need to be stretched not strengthened. Getting a squeeze ball just makes things worse.”

It’s a tough one, certainly, for those who are trying to resolve any repetitive strain problems at home without going in to see a physician. “The best advice is be aware of what your body is telling you,” said Fisher. “Listen to it. If it’s hurting, change positions or take a break or switch hands. This works when you’re watering or hoeing in the garden, and it’s so important. People get lopsided and wear one side out.”

And what Fisher calls 30-30 rule? “Yes,” she said. “For every 30 minutes of repetitive work, you need to stop and stretch for 30 seconds. If you’re sitting, stand up. Bring your arms out and neck back.”

It sounds like a swan dive pose to us – and we’ve been on this keyboard at least 30 minutes. Excuse please, we’re off to give it try.

Last updated: 20-Sep-06