Home Treatment for Repetitive Stress Injury

I think, dear readers, we could all use a stretch break! Here’s a new feature–every week I plan to post the Weekly Stretch. There are many many sites, books, videos and sources out there to learn good human stretches for whichever part of the body you want, so I’m going to do something a little different.

What is the Internet for? Well… if you believe in puppets, the Internet is for porn. But it’s also for those gloriously adorable fiends, the Lolcats. Who live in the Internet and like to block the tubes. How do they block the tubes? By stretching of course. Like this guy.

Photo credit: Joeyfoto on Flickr.

Lesson of the week is: remember to yawn and grimace while you stretch. Get those fierce cheek muscles moving! Even if you don’t have adorably sharp teeth.

Want your stretch featured on the blog? Just email your photo of a stretch from your favorite pet or person to amyhengst at gmail, and, if you want, include a caption and link to your site.

Question: Ergonomic mice, keyboards, and other products are made from the same basic materials as their standard, non-ergonomic counterparts. So why are they so expensive?

Answer: They aren’t mass produced in the same way as regular keyboards, mice, and so on, so the costs to make them are higher. When items are in high demand, they can be produced en masse in factories across the world at a lower cost, leading to something called “economies of scale”-at a higher scale of production, your cost per product goes down. You can buy materials in bulk for a discount, produce them in bulk in a dedicated factory, and as a result you can sell products more cheaply.

So the solution to the high cost of ergonomic products is to encourage demand, to vote with your cash and buy products that you think are valuable.

In the last few years, certain kinds of ergonomic products have become more popular, more common, and as a result more affordable. Great examples are some of the trackball mice or the split keyboards.

Less popular products can still be very valuable to a small niche of customers. The Datahand, for example, works well for typists looking for a radical keyboard solution, but it’s unlikely to become a standard because it’s so unusual. (I once got a lot of flack on this blog from a datahand enthusiast by calling it a “weird” keyboard.)

Only products that are really valuable to many people, and gain popularity, will be the ones to become cheaper and more universally adopted. Most likely, they will be products that are different enough to provide a real ergonomic benefit, but not so different that they’re really hard to use.

Debating whether to buy ergonomic products?

If you’re considering spending the cash on an ergonomic product, though, it’s not the dollar figure or popularity you should be looking at. What matters is how much it’s worth to you, holistically. If you’re in pain, losing work time, and spending money on therapy treatments, an ergonomic product that solves the problem could actually save you money.

But if you’re not sure, try to rent, borrow or try out the product before you buy, to see if it helps. Just be aware that first impressions won’t always be accurate. Sometimes it can take two weeks to a month to adapt to a new tool and see how it affects your working life. For example, I hated my Logitech trackball mouse at first, since it hurt my wrist-but after a few weeks it became one of the best solutions for my workstation and I’m still using it exclusively two years later.

What Ergonomic Keyboards and Mice Are Available?

A diverse range of keyboards, mice and other products exists already today. Take a look at these articles to learn more or browse our store.

• A Comprehensive List of Alternative Keyboards
• A Comprehensive List of Alternative Mice
• Comprehensive List of Mouse-like Solutions (Alternative Pointing Devices)

The first major storm of the season hit the San Francisco Bay Area today, causing freeway snarls, nearly-drowned cars-and a lot of stiffness in my joints.

Why does rain and weather change affect joint stiffness? I had to do some research to find out.

Arthritis sufferers in particular have been reporting this phenomenon for many years, and the first study was done in 1961. They used a small sample of only 12 subjects, and found that the combination of high humity and low barometric pressure caused the increased stiffness.

When air pressure is low, tissues in your joints can expand and put more pressure on the joint, which makes it harder to move. The cold can also slow down our bodies and make it a little harder to get around.

Creating Better Conditions

One patient felt so much better after a vacation that he allegedly decided to build a room in his house that replicated the ideal conditions of his trip. His new chamber controlled and increased the air pressure and helped him improve and get off his meds. As a result, his doctor conducted a study of 30 patients on a similar machine and reported that the increased air pressure helped patients feel better. However, there were side effects-ear pressure and sinus pressure among them.

What you can do

I certainly don’t expect that any of us will be building our own special rooms to get over our joint stiffness. But there are some simpler steps-

A while back I wrote about my vision for a future way of interacting with computers-a program that would let you use full body movements to control your mouse and keyboard. The program would accommodate your fitness level and help you get exercise and stay strong, healthy, and active while getting work done.

So it’s exciting to see this new experiment from Tokyo University of someone moving, bounching, and playing with a floating holographic ball, and actually being able to feel pressure from the holograph.

The researchers apparently used Nintendo Wii controllers to track hand movement, and the pressure that can be felt is created with ultrasonic waves.

I can see this being used to control a mouse-instead of holding your hand on a button all day on your desk, you can lift your arm and point at the screen or holographic buttons. When that gets tiring, you could move the controllers around and find a more comfortable way to work.

For the nearer future, the researchers have other practical applications in mind for the new technology-such as creating virtual switches in hospitals to maintain sterility and hygiene.

Computer users aren’t the only ones who get Repetitive stress injuries. Many people who do crafts and tasks with their hands, such as knitters, crocheters, or other creative people, tend to get repetitive injuries too.

But you don’t have to give up your after-computer hobbies just because they’re also hand-intensive. You just need to give your hands, shoulders, and arms a little TLC and the opportunity to stretch properly.

Yoga is a great tool for easing the tension and getting a little mental serenity as well. So check out this blog entry over at the Crafting in a Green World blog — it’s called “Yoga for Crafters” and these stretches would be helpful for anyone who has repetitive stress problems in their hands and arms. You don’t have to be a blanket-making wizard to benefit from some yoga-stretchy goodness.

The Huichol tribe of central Mexico has a rich cosmology embodied in stories, ceremonies and art. They believe in animal spirits, and when they are sick rely on their shamans to heal them and cast out negative spirits. In college, one of my classes was visited from a man who grew up in New York and later went to visit the Huichols to learn from them. One thing I always remember is this saying, Remember the eagle with each breath you take.

I no longer remember what significance this had for the Huichols, though I know that Eagle is an important figure for them. For me, it has become a sort of mantra that conjurs a connection with the natural world, spirituality, and a place of deep relaxation. It reminds me to take deep breaths, think of something outside myself, and consider the primal needs of the animals and the world around me.

I’ve never been religious, but my spirituality rests in nature and the balances in ecological systems. The universe, whether or not there is a consciousness behind it all, finds a way to create a balance through the efforts of so many diverse creatures that have different motives, drives, and needs. So many systems are at play, working against and for each other. This is a miracle whether or not there is a conscious god behind it all. Eagle is an important spiritual figure for many native peoples, and according to wikipedia, eagles are also used in symbolism for many nations. As a predatory bird, eagles fill an important niche and help control the populations of smaller animals that might otherwise be pests.

I am blessed to live in a time and place that’s open to many beliefs, religions, spiritualities, and even the lack of religion. What is most important for humanity, it seems, is that we believe in something beyond ourselves. Something that helps us transcend the daily mundane, the toil, and the suffering that we know here. In many healing programs such as Alcoholics Anonymous, followers learn to believe in something outside of themselves –mostly God– to restore balance and happiness in their lives. Once I read a woman’s story who began a 12-step program, struggled with it because she was an atheist, and began to think of the ocean itself as her higher power.

I think faith, and an awareness of something transcendent, are just as important in healing from a debilitating physical injury as from an emotional one. Much has been written on the power of prayer. I don’t know if I believe in that–I’ve certainly never heard an answer when I’ve tried to pray. Then again, I’m a skeptic.

Did you know that neck pain and lower back pain are often the result of the same underlying causes?

Of all the repetitive stress injuries, neck and back problems may be the most debilitating and despiriting. Not only do they hinder our ability to be productive at work and worry us about job security, but they make us worry about what our friends and families think of us as we slow down and lose energy for life.

Fortunately, chronic neck and back pain can often be reduced or eliminated by correctly positioning one set of joints–the hips. In order to do this, all you need is the right chair, or to make a few tweaks in the setup of your current chair.

Chair Design and How We Sit

Leading ergonomists and physical therapists agree that the standard 90 degree angle chair seat is one of the worst things to happen to human health and physical well being. Furthermore, studies by A.C. Mandal, M.D., a Copenhagen-based researcher of New Ergonomics, revealed that the common approach to fixing low back pain–lumbar support–doesn’t actually fix the root cause.

We now know that the thigh is only capable of rotating upwards about 60 degrees in the hip socket for most of us, which is well below the “thighs parallel to the ground” position advocated by the old ergonomics. When we raise our thighs the extra 30 degrees to parallel, our pelvis tilts backwards to compensate. The pelvis pointing backwards also points the natural head spine line backwards.

Try leaning your body backwards and then holding it there. Doesn’t take long to get uncomfortable and tired, does it? So we end up compensating by curling our spine into a C shape with the lower back protruding and head jutted forward, in order to maintain our balance. Both of these are unnatural positions, and voila, we wind up with neck and back pain.

The simple fix is to correct our hip angle by allowing the thighs to drop below parallel to 120 degree or a greater angle with the torso. This restores the pelvis to its natural upright position and allows us to sit effortlessly in a great posture. Restoring the pelvis to its natural position also automatically restores the curve in the lower back making lumbar support largely a non-issue. With our head-spine line now pointed vertically instead of leaning backwards, the head now easily rests atop a long, clean body line. By simply correcting our hip angle, we have now eliminated both poor body positions that create neck and back pain in one fell swoop.

How To Readjust Your Chair

First off, you need a chair that allows you to make these adjustments. Look for chairs with adjustable tilt (make sure it goes forward) and sliding seat pans. Many newer, quality chairs offer these features, but if your current chair doesn’t have them I highly recommend getting a new chair. Many people find that the Humanscale Freedom Chair personalizes to the best overall fit for their body. Kneeling chairs, though not for everyone, are also great options as they come purpose built for the correct hip angle. The best ones are made by Varier and Jobri.

[Editor's note: You can also find kneeling chairs at many thrift shops or yard sales at inexpensive prices.]

Once you have your chair, slide the seat pan back so you have a good 4 inches or more space between the edge of your chair and the back of your knees. You may need more room if you are taller. The key is to make sure that you can feel your two sit bones planted firmly on the seat, and that the seat pan is far enough back that you can feel your thighs comfortably drop.

Next, you will want to tilt your seat slightly forwards. You want to find the balance between tilting your seat enough that you feel the curve in your lower back open up and too much to the point that you slide off of your seat.

In the correct position you should feel yourself sitting effortlessly upright with a long, clean body line and your head easily balanced on top. You may also consider a monitor arm or stand to raise your screen since correcting your seated position usually increases your seated height.

Healthy Posture Increases Confidence

If you’ve made it this far, congratulations on taking your first steps on your way to stopping neck and back pain. When we start correcting the poor positions that cause us to experience pain we actually experience something more than pain relief. Good body positions re-inforce strong, confident posture, and in turn foster feelings of emotional strength and confidence.

When I first started getting into ergonomics and taking control of my personal workspace, I had a classic case of stooped “computer neck” and was well on my way to developing a fine hump. The first change I made was getting a kneeling chair. Within a couple of weeks I started to notice a huge difference. At the end of my work day I was still walking tall and proud. Not only did I not hurt, I genuinely felt more confident about myself. I wish the same for you.

Source: Brian owns and operates Body Correct Living, a specialist store for ergonomic chairs and accessories. Brian also offers ergonomics, health, and fitness tips on the Body Correct Living Blog.

Sorry I have been MIA lately: I have been out enjoying my pain-free life. I remember how devastating and debilitating it was to be in constant pain, and wondering if I would ever get free of it, or whether I would be weak and suffering forever. I guess when you’re 24, a chronic injury seems like the end of the world-luckily it’s not!

Well in the last five years, my arm strength and career have come a long way and life is beautiful again. I’m not entirely pain free, to be honest, since I did pull a calf muscle while waltzing the other night (following an overly energetic dance partner). But my chronic arm pain is long gone.

I’ll admit that I still get twinges here and there. And I’m constantly amazed by the amount of friends I have, all around my age in our twenties, who also have ongoing arm pain. Many of them are in various stages between denial, putting up with it and treating it as best they can, or physical therapy. I can understand the feeling of not knowing what to do, and combatting it whenever it flares up. But I encourage anyone out there, even if just having a small wee bit of pain and twinge of discomfort, to do whatever possible to avoid that pain when it’s not present, and reduce it when it is.

Most people know already the basic platitudes and the list of “top ten tips” for getting rid of repetitive stress injuries, which mostly boil down to a mix of ergonomics, exercise, ice, rest and breaks. I think that a strategic combination of all those is most effective. But, often times those empty lists fail because they don’t really get to the heart of what’s wrong.

Of that list, the most important is probably movement-not just exercise-but allowing your body to move naturally, change posture and position while working, and letting your body settle back into a loose position after working in a tense, cramped way for too long. Ergonomics addresses that by putting the body in a better position for movement; exercise challenges the body; rest breaks allow the body to move more naturally. There are many other tools that can help, ranging in categories from healing techniques like chiropractics or massage, to excercise like martial arts or a gym, to preventative physical therapy and ergonomics, to restorative movement like yoga. But they are just tools.

Troubleshooting the human body isn’t like working in construction where there is a “right” tool for the job. Everyone’s body is different, and people mentally respond to activities in different ways as well. So people need to find exercise programs that motivate them, and ones that feel good, as well as challenge the body. I think that’s why I ended up getting into dance and poi spinning and enjoying self-defense classes-they aren’t just about “getting exercise,” but about learning a new skill for fun and they fulfill a social need too.

Humans are not just automated machines, designed to do a task repeatedly, then follow a regimen of exercise and healing routines. We are social creatures specially adapted to, well, adapting, and changing up our routines and skills. So, maybe the best way to heal from a chronic injury is breaking the routines that are causing pain, and trying new things. Mostly, these need to include active activities that challenge the body to move in a new way-and in doing so, move the mind.

This is a post about my struggle and healing from foot pain, which turned out to be a different kind of repetitive stress injury: posterior tibial tenosynovitis. Scroll to the bottom if you’re looking for a list of good brands for arch support and good shoes.

(Or you can read the full version for all the juicy details on the different treatments I’ve been suggested over the years.) This story starts with the question many patients have asked…How hard is it to find a doctor who actually listens?

Before I had arm pain, I had foot problems. It may have started when I walked around barefoot in my college days on the UC Santa Cruz forested campus, or maybe it was just the structure of my feet from the beginning. The area beneath my ankle bone, on the inside of my feet would swell up and ache, and the swelling would spread throughout my feet. Ow. For a long time I slept with my feet on pillows to help the swelling drain, and wondered what to do. I had a lot of health problems for a 20-year old…

I did find solutions, but it’s an ongoing process…

Over the years I talked to doctors to find out what was going on. There was a Planned Parenthood doc I saw once, when I was sans insurance. She said the foot thing could be a venous insufficiency, meaning my veins were leaking blood and not pushing the blood back to the heart properly.

So I started wearing diabetic compression stockings, to help the blood move through the legs. They helped, a little, but mostly compressed other areas of my legs rather than my feet. Strangely, they started giving me bruises, in areas where the blood was less compressed and pooling. That was…less than ideal.

The next doctor I asked just told me I ought to stretch my calves more. He was also the doctor that gave me asthma inhalers that made me stressed and nervous all the time… basically, useless advice. To be fair, there are some kinds of foot pain that result from leg tension, but my case was far beyond that.

That was about the time I was working and my arm pain was getting very bad from the repetitive stress junk. I finally quit the job that was stressing me out and causing pain, and took some time off.

Ironically the catalyst for solving my problem was a terrible acute foot injury. One night I was watching movies with some friends one night, and making tea. I had this travel mug that I’d carried everywhere (even to Germany for 8 months), and the mug’s handle had had enough. I’d just poured the tea, the handle broke off, and boiling water spilled on my socks and feet. I had blisters the size of small pancakes.

I ended up at the hospital overnight, signed up for Cobra insurance the next day, and took the next doctor they assigned me, wishing for the best. She happened to be attentive, caring, and knowledgeable. She didn’t stop with healing my blistered feet. She found inhalers that controlled my asthma, gave me the right meds for my allergies, and sent me to physical therapy for my ongoing foot pain. Basically, she restored my faith in the medical system.

Her first diagnosis was plantar fasciitis. That’s the swelling of the area on the center of the bottom of the foot just above the heel. It’s common in older people, but not younger people. My PTs didn’t think that was right, and their treatments only helped a little. So I got sent to a podiatrist.

Podiatrist dude spent half an hour watching me walk, then telling me my feet were just flexible and flattening, and the solution was arch supports. He wanted me to get custom supports, but I never followed up because the simple solution-over the counter Superfeet brand supports-started relieving the pain from day 1.

They’re relatively cheap, fit in all my sneakers and some nice shoes too, and made most of the pain disappear. However, finding supports for dressier shoes and sandals has been an ongoing issue. Over the past four years since I saw the podiatrist, I’ve visited biomechanic shops that specialize in supports, and had them sell me orthotics that hurt terribly. And I’ve purchased many shoes hoping they’ll work with my supports, only to find they don’t.

But orthotics and arch supports are becoming more popular, and more brands are available now than before. I’ve seen the drugstores like Longs and Walgreens start to sell more varieties and solutions over the past few years, and some of them help a little in dressier shoes.

Mostly I have been pain-free, but I tend to have arch pain right around my monthly period, and anytime I try to wear shoes without significant support. Lately this is a problem since I have been trying to go to dances, especially Friday Night Waltz or the Gaskell’s ball, along with a local irish Ceili dance. Nothing like 6 hours of waltzing and standing around to make your feet into balloons.

So, sitting with my feet up earlier this week, I finally dug out some old medical records. A couple years back, a cousin of mine needed my medical records and I had the docs’ offices send me a copy. So it was only incidentally I ever got a copy of my podiatrist’s report, and I was really surprised when I found that he had actually made a diagnosis instead of merely suggesting arch supports.

I’m sure he didn’t share the diagnosis with me because he didn’t think it would help much, but being me, I like to know these things. So the verdict is something called Posterior Tibial Tenosynovitis, and apparently I tend to walk in a way that leaves my feet shuffling out and pronated, because I have flexible flat feet. All this seems to mean from the consumer perspective is that it’s mechanical support I need, rather than any medications.

Below I’m going to share my list of helpful foot and arch support brands, for anyone else looking for solutions.

I’ve also looked into making my own, and found one potentially useful web site that describes how to do so by making a cast of your foot with cheap sculptural supplies. Another web site I saw suggested using Sculpey, the clay material you can harden by baking it in an oven, but I suspect that would get brittle and fall apart too quickly.

So here is my list of helpful brands…

Sneakers–New Balance supposedly has some models very good for flat feet
Nicer shoes – Ecco, Dansko, Clarks
For higher arch support, I’ve found a couple Dansko models work but mostly those brands don’t give enough support for me.

For better support, I’ve had luck with Finn Comfort for high-quality casual sandals, and Naot for some VERY comfy, and nicer sandals. They aren’t cheap, but it’s worthwhile.

I recently found a local store in Berkeley that has other good brands. I suspect the key is shopping around to find those stores that have really supportive shoes, and trying on new styles regularly, until I can find the ones that are both cute and comfy. It’s rare, but I’m beginning to suspect it’s not as impossible as I once thought. Hurray!

Now if I can just find good dance shoes with arch supports I will be a happy camper…or dancer, really.

Apple just introduced a wired, compact keyboard that gets rid of the number keypad on the right, making it more ergonomic for users. From my perspective it’s a great step, but not everyone agrees — some rely heavily on those number pads and don’t want to be without one.

The new compact keyboard certainly isn’t Apple’s first attempt toward ergonomics. Early in the 1990s, Apple had an adjustable and compact keyboard (pics here). The early model split in the middle to match the natural spread of a typist’s hands, and didn’t have a side number pad. It wasn’t received well by users, however, in part because it apparently wasn’t durable. Or as Macworld put it, “the most comfortable position for the Apple Adjustable Keyboard was as far away from the user as possible, dooming Apple’s ergonomic wonder to obscurity.”

A while back Apple reintroduced another compact keyboard, but as a wireless keyboard it’s a bit pricier than the new, wired version. The wireless version costs $79, while the new wired version is a good bit less at $49, the same price as the regular number-pad-included keyboard. Check out the Apple store to see them both.

Both keyboards appear similar to other compacts on the market, which range widely in price. For example, you can check out some in our store here for comparison, ranging from off-brand styles at $12, to recognized brand names that come with separate keypads and other features at $82 to $129, like this Kensington one.

Even though lots of third-party options are available, it’s nice to see Apple stepping up in its own style to meet the ergonomic needs of users. It’s funny, too, to compare the Apple compact keyboard to Microsoft’s ergonomic, split keyboard. Apple’s is scaled-back, simplistic, and cut down on features, while Microsoft has extra buttons falling off the edges, and a very wide footprint. The different keyboards really illustrate the two very different company’s overall styles.

Being small myself, and a Mac user anyhow, I happen to like Apple’s compact idea better.