Tendonitis

So many folks have told me recently that they are suffering from repetitive stress injury (RSI). And like a big mama of tendonitis, I have found myself dispensing advice. So I found this blog entry I had written ages back and thought I'd share it.

Tendonitis is a repetitive stress disorder which is basically an inflammation of tendons. Fingers have tendons (muscle strands) which are not very strong. Human body was not designed to do a lot of work with fingers. These tendons collect together and run through the wrist, through the carpal tunnel, up through the entire arm. A nerve runs through the carpal tunnel to the hand.

Due to overwork, the tendons get inflamed. Small digression into morphology tells us that tendon and inflammation leads to the name tendonitis. In the least, it causes severe pain. In extreme, it can atrophy your muscles, press against the nerve causing carpal tunnel syndrome, cause disablility. ( trust me, I went through this ).

The best cure to this very painful and stressful disease is prevention. There is a lot of information available online but to bring a few salient points to your notice

• Workstation Setup: Adjust your chair such that your feet rest firmly on the ground with thighs sloping a little downwards and knees almost a little more than right angle. Back should be at almost right angles to the thighs and straight. Do not slouch. Chair should provide comfortable lumber support. Arms should be relaxed at shoulders. Upper arm should be in-line with the rest of the body and lower arm should be at right angles to it. Wrist must remain straight such that the rest of the hand is in the same plane as the lower arm. If you have aligned yourself in this position, move your arms at elbows like a car windshield wiper. It is in this area that you want keep all the accessories you reach for often – keyboard, mouse, phone, notebooks. Anything that you use the most often should be right in front of you. Head should remain straight (knowing typing helps here). Monitor should be such that the upper 1/3rd is at eye level.

 

• Typing: Never type with the wrist not in neutral position i.e. the wrist straight and hand in-line with the rest of the arm. Strike keys lightly, just enough to get the words out. Never reach out with your fingers, move your arms from the elbow and shoulder. Never twist your wrist to reach keys towards the ends of the keyboard, move arms. Do not press combination keys, as in Shift and other key, with one hand as if you do so, you are essentially reaching out with your fingers. Always use both hands to do key combinations, which is why there are two of such keys. Do not cross hands on the keyboard, use right for right half and left for left half. Avoid using number pad unless you are doing lots of number entry. Let your thumb not tuck under your hand while typing as this gives pain in base of thumb (happens very often, check out while you type). Do not use your thumb to press any key, not even the space bar. Do not look at the keyboard while typing and this relieves neck stress

 

• Mousing: Keep mouse within reach such that the hand doesn’t have to stretch at elbow to reach it (this is why the windshield-wiper zone is important). Stretching arms at elbow causes pain in elbow area. Number pad makes this mouse positioning difficult by placing the mouse away from your hand. If you don’t use the number pad, get a keyboard without a number pad. Mouse should be on the same level as the keyboard. Do not grab the mouse hard while moving it. Do not bear down upon your mouse, just let it move smoothly. Place the entire hand on the mouse while mousing and use the index and ring finger for the left and right clicks with middle finger for scrolling. Keep scrolling to minimum. Avoid using other buttons that need the thumb or little finger. Do not keep your hand on the mouse when not using it (by using I mean when you not are actually clicking or pointing at things)

 

• Relaxation: One thing I have learnt over time is that stress exacerbates the pain. Stay stress and tension free. If you are working long hours, keep time when you just relax mentally and physically. More importantly, do not be worried or stressed about hand pain - that positive reinforcement to pain. In addition, while working, take breaks after every hour. Use the program Workrave for reminders. Breaks are not when you stop work to browse. Get up from your seat and walk around. If your hand/back is NOT already hurting, do a few stretches. Bend backward a bit. Stretch your hands backwards from the wrist and flex your shoulder blades backward. Move your arms and neck. Exercise regularly to make your back, shoulder and arm muscles strong. Swimming is a great exercise to do this.

Good posture, good setup, good working habit and regular exercise will keep the pain away. If the pain starts, take a little break from work and relax. See a doctor and an ergonomic evaluator immediately. Procrastination will only make it difficult to cure. Follow whatever your doctor says, but just a piece of advice from my experience, doctors here tend to overuse of cortisone (used to reduce inflammation). While it relieves pain in the short term, it makes muscles weaker. Instead focus on getting yourself stronger with exercise and breaks.

And the bottom line if – prevention is always better than cure.