How do you beat RSI?

Question

I've been worried more and more about RSI lately. Especially of the dreaded "Emacs Pinky" as I'm an avid emacs users. How do you guys beat RSI? I thought we could share ideas for beating this common problem.

EDIT: Advice here is not meant to replace advice from a medical professional. If you are having serious pain, go see a doctor.

Answer 1

Changing to dvorak is a common suggestion, however it doesn't doesn't prevent pinky strain if you are an avid user of modifier keys, such as ctrl.

Answer 2

For ctrl, I map the function of the ctrl key to the capslock key, which helps a lot. I no longer have a capslock key, but I never use it anyway.

The following article details how to do this on several platforms: Swapping Caps Lock and Control

Answer 3

Alternate keyboards are often suggested and as far as I can tell the one of the best is the Kinesis Advantage Pro. I'd be interested to hear how other suggestions

Answer 4

If I am forced to use a standard keyboard for more than an hour, my wrists get really sore. So, I never use anything but a Microsoft Natural Keyboard. It is the most comfortable that I've found. I only wish I could find a laptop with a "split" keyboard.

Answer 5

When I was having pinky problems a while back I wired up a quick and dirty footswitch for ctrl and shift keys.

Take a really cheap USB keyboard, or an old one that you don't want anymore, and pull the controller board out of it, a little trial and error and observation of the connection grid, and then wire up some momentary foot switches to the appropriate contacts.

Mount foot switches into foot rest, and there you have it. Not as quick as using the real keys, but can be helpful if you need to give your pinkies a break for a few weeks.

Answer 6

Take regular breaks from the keyboard. I've been trying out workrave, it seems to be not too intrusive and is quite customisable with a few nice features like exercises.

Answer 7

The Kinesis helped a little. The dvorak keyboard layout helped a little. Using emacs abbreviations helped a little.

The really huge factor was using xwrits to force myself to take a one minute typing break for every ten minutes of continuous typing.

Answer 8

I've started having issues with RSI recently. Here's what I've discovered so far; it seems to have helped a bit. Disclaimer: I'm no doctor, I haven't been advised by anyone. This is a synthesis of what seems to be the general internet consensus.

• The keyboard should be pretty close to your lap. Like, within two inches or so.
• On a side view of your body, joints should be at right angles, roughly. Feet on the floor, back straight, elbows at 90 degree angles.
• Take breaks at least every hour, preferably more.
• Some studies (which I found on Wikipedia, so take it as you will) have found that stress plays a factor in RSI. Mine appeared within weeks of starting my hardest college semester so far. Go figure.
• Get a good keyboard. The Microsoft Ergonomic Keyboard 4000 is fantastic.
• Get a good mouse. I've switched to a Logitech Trackman. Just be aware that from what I've found, there aren't really any "safer" mice. Just mice which use different muscles. You can get RSI using any mouse.
• Don't type with your wrists on the keyboard wrist pad. When typing, your fingers should be curved and below your wrists, like they would be if you played the piano.
• Don't use the feet on the back of the keyboard. If possible, tilt the keyboard away from you, like the Microsoft 4000 thing is.
• Laptops are horrible for this. You either have to reach up to the keyboard or bend down to the screen.
• It's not actually the strength of your wrists or whatever that plays a factor in RSI; it's friction. Find some good stretching exercises.
  • This is one which seems to work for me. Found it on usenet years ago.
  • hold your hands at arms length away from your body.
  • Spread out your fingers on a horizontal plane. You'll feel stretching. Keep them there for several seconds.
  • Now arch all your fingers upward for several seconds. More stretching.
  • Now make a fist and place your thumb perpendicular, curled below (but not within) your fingers. Arch your wrist downward at a 90 degree angle for several seconds.

Hope all that helps. :-)

Answer 9

I've never had it, mostly because i'm careful about desk height and always use a wrist rest, hard plastic or wood for keyboard, soft gel for mouse.

Also, i think being left handed helps. since i have to think a couple miliseconds more than most people about how to use my hands, i tend to use them wisely.

I switched to dvorak layout for a while, but it was far worse, my left pinky got sore in less than a week. i kept at it for a month, thinking it was temporary, but got worse, so i had to return.

Answer 10

Use a comfortable trackball, not a mouse--I use a Cordless Optical Trackman--and stay as far away from trackpads as you can. (And if you're using less than full size keyboard, stop it!)

Answer 11

I've had a lot of help in using a positionable keyboard tray ( like one of ones here: http://www.fellowes.com/Fellowes/site/products/ProductDetails.aspx?Id=8036101 ) - I found that careful positioning of chair and keyboard have really helped me out. Also, frequent breaks and a quality keyboard are similarly crucial. For a while I used a logitech marble trackball instead of a mouse; that helped a lot, but I haven't seen them on shelves for a long time.

Answer 12

The first step is to get a proper ergonomic keyboard. I like the Goldtouch. Secondly, make sure your desk height and chair are adjusted properly. Small adjustments can make a big difference. Google for "workstation ergonomics". The big thing is to make sure that there is no tension anywhere in your wrists and back/neck.

I also have an ergonomic mouse, it keeps the wrist turned closer to a 45 degree angle rather than parallel to the desktop.

If you work for a big company, they might even help you out. The company I work for even sent out an ergonomics expert (physical therapist) to evaluate my workstation and adjust my chair properly (which has like 20 different adjustments). All I had to do was ask. I think good HR departments realize that properly adjusted workstations = less sick people = less medical costs.

Answer 13

I had the beginning of some RSI from clicking too much. Then I switched to my left hand for the mouse, and it's totally gone.

Another LIFESAVER -- use the ' key in Firefox to find links. I touch the mouse only 30% as much because of this. Really try it.

Answer 14

Think more. Type less.

Answer 15

Another trick for avoiding emacs pinky is to map control to alt (or whichever key is next to the space bar) so you can use your thumbs for control. It works even better if you can get into the habit of using to opposite hand for the modifier.

Answer 16

In addition to the other tips, spend some time observing how you use Emacs and thinking about what commands you need to remap to minimize stress. For inspiration, see Erik Naggum's description of a fairly extreme remapping on comp.lang.lisp, and Steve Yegge's post on Effective Emacs. For example, you probably use M-x a lot, so it should be really easy to type; Yegge suggests C-x C-m, but I like C-; (control-semicolon) better, since it lets me keep my fingers on the home row. (I use a modified US keyboard layout though I am Finnish, because the standard Finnish layout moves a lot of characters relevant to programming behind a difficult combination.)

Answer 17

RSI veteran here. Disabled for 2 years.

One additional tip: Sticky keys. I wouldn't be using Emacs without this.

Sticky keys allow you to enter sequences of modifier keys without having to press them all at once. As an example, the way I do C-c C-x is this: I first press C and let go, then x, then C and let go, then s. I use x11-misc/accessx for this, but I've seen it in the gnome's usability app. too.

Why is this important? According to Dr. Pascarelli (author of The Complete Guide to RSI) is very important to maintain a neutral wrist posture, and avoid bending it so as to reach far-away keys with the same hand. Read the book, it's helpful.

I also did this, in order of importance:

1. Ditched the mouse on my right hand to an trackball on my left hand;
2. Adopted an ergonomically sound posture;
3. Bought a good split negative-tilt keyboard (Microsoft Natural Ergonomic 4000);
4. Exercise and stretches;
5. Never force my wrists while typing;
6. switched to a tiling window manager (Xmonad);
7. Use the mouse only when there's no alternative;
8. workrave breaks;
9. switched ctrl<->caps positions (not having Ctrl on the CapsLock is insane!)

The only thing that really, really made me a night and day difference using the mouse. Before I did physical therapy, a session of 15 mins using it would set off pain in my arm and shoulder.

PS: I've been in great shape for 3 years now, I even started to play metal on the drums. Most initial RSI problems will be posture related, and can recovery is possible. Nerve damage only occurs very late in the process.

Answer 18

Personally, I use a trackball and a standard keyboard. I like to rest my entire arms, from the elbows down, on my desk. This is what works for me. It probably won't work for your. Try a bunch of different equipment for about a week at a time, and try to figure out what your body finds most comfortable. There are no rules for ergonomics. Everyone's body is different. Do what feels comfortable to you.

If you really think the problem is due to the CTRL key, you should look at getting an old Sun keyboard. The CTRL key is in a much better position on those keyboards.

Answer 19

One excellent study of the incidence factors of RSI is:

A Prospective Study of Computer Users, by Gerr, Marcus, Ensor, Cohen, Edwards, Gentry, Ortiz, Monteilh, AJIM 41:221-235 (2002)

Over a period of 38 months, they followed 632 computer professionals who were pain-free at the beginning of the study. By observing who developed pain, and comparing their work habits to those of the pain-free workers, the study was able to measure the risk factors associated with many different postures or practices. Their recommendations were (starting with the most effective):

• Keep your elbows slightly open, at around 121° (reduced the risk by 84%)
• Leaves more than 12 cm between the edge of the table and the "J" key (... by 62%)
• Don't use your neck to hold the phone (... by 60%)
• Avoid keyboard wrist rests (... by 48%)
• Don't bend your wrists when holding the mouse. Keep it within 5° (... by 45%)
• Strike the keys with a light touch, with less than 48 g of pressure (... by 40%)
• Raise the screen so that your neck tilt by less than 3° (... by 36%)
• Rest your elbows or forearms on the chair armrests, or on the desk itself (... by 35%)
• Use a keyboard that is less than 3.5 cm thick (... by 35%)
• Keep the keyboard slightly lower than your elbows (... by 23%)
• Avoid resting your hands on the leading edge of your desk, or pad the edge (... by 22%)

Be especially careful if you are female, or over 30, or if you type more than 20 hours per week (and especially so if you are all three), as the risk factor of these groups was higher than that of the general population, by about twice.

A different study measured the impact of ergonomic keyboards:

The effect of alternative keyboards on musculoskeletal symptoms and disorders. Moore, J.S., & Swanson, N. (2003). In J. Jacko & C. Stephanidis (Eds.), Proceedings of the 10th International Conference on Human-Computer Interaction, Part I (pp. 103-107). Mahwah, NJ: Erlbaum.

They found that concave-well keyboards fared best, followed by standard (fixed) split keyboards, followed by adjustable split keyboards. All of them were an improvement over normal straight keyboards.

If, despite these precautions, you develop pain in your shoulders or in your wrists, stop typing and go see a doctor. Once in place, RSI snowballs very quickly. It is possible to progress from slight pain to a lifelong disability within two weeks. Better be careful. You may want to read my recommendations on how to react to the onset of RSI.

Answer 20

Another ergonomic keyboard design you might want to look at is the TypeMatrix.

Answer 21

I had similar problems years ago, when working on my PhD thesis. I solved them using the following techniques:

• think before you type. don't type anything that's not really needed, avoid re-writing.
• make fewer typos: how often do you use the "delete" key?
• pause every 15 minutes for 5 minutes, stand up, walk a little around.
• keep the weekend keyboard-free: one or two days of total keyboard abstinence
• try to type as soft as possible
• get yourself a keyboard that needs minimum force, especially for the pinky
• get yourself a good chair
• use an editor that is not so ctrl/shift/meta-heavy, or change the emacs bindings

I am not a fan of alternate keyboard layouts or "ergonomic" keyboards - not having learned to "proper" touch-type i sometimes use the "wrong" hand, which is a horror on split keyboards. I still use an old "flat" Microsoft keyboard and haven't had RSI problems for years.

Answer 22

When I had the same problem, I invested in the Fingerworks multitouch keyboard, the TouchStream - http://www.fingerworks.com/ST_product.html. The keyboard took a while to get used to, and longer to build up a decent typing speed, but after that was a great success. My wrists, elbows and thumbs were much less painful.

The TouchStream keyboard replaces keyboard and mouse, so that typing, pointing, clicking, and gesturing are combined seamlessly on the same overlapping area of the TouchStream's surface. (Gestures are multi-touches that map to keys - for example four fingers on the home row = shift.) Because the mouse is not needed, the hands stay in position on the keyboard, with a reduction in strain on the mouse wrist.

With no physical keys, the TouchStream is zero-force. Gestures and typing are effortless. Touch typists can achieve up to 70 wpm.

TouchStream keyboards are not made any more (the technology was acquired by Apple and is the foundation of the multitouch technology in iPhone) - but you should be able to find one on eBay.

Answer 23

The tips on exercise and regular breaks are good, and I wont reiterate them.

If the Kinesis keyboards are out of your price range, I love the Microsoft Natural Keyboards. You may also consider a trackball. I have both a trackball and a mouse connected so I can mix it up. Being able to use with either hand would also be a bonus (something I've not yet trained myself to do).

As kotlinski said, using Vim or work method that can reduce mouse usage for keyboard usage can help. You may also consider swapping the Capslock and Ctrl keys.

I keep a stress ball on my desk, that I give a good squeeze every now and again to loosen things up.

I would also bone up a little on ergonomics and make sure your overall posture is correct, including having your monitor at the right height so your head isn't tipped forward or backwards all day, which can cause neck, shoulder and arm problems (which is why I hate working on laptops).

Answer 24

Not to be provocative, but here goes: Start using Vim or ViEmu for Visual Studio. It keeps down the amount of times you need to reach for the mouse or do uncomfortable key combinations. A life-saver.

Answer 25

I use workrave, microsoft natural keyboard and the microsoft natural mouse. And I actively seek out code generation techniques to avoid repetitious typing.

Answer 26

I have been struggling with RSI since late 2002. It is one of the scariest things you can never go through -- it really seems like the end of your career right there, on the spot.

Fortunately, it really can be dealt with successfully.

A lot of the answers given here are excellent, but in my opinion are rather standard. (Although, the answer that James gives is outstanding -- I would also adhere to his advice carefully. He's dead on.) The ergonomic modifications being suggested, such as a proper line of sight to the monitor, your posture when sitting, having your elbows at a 90° angle with the keyboard on your lap, etc., are all correct, and should be done, but are only the very beginning...

Again, all that advice should be followed, but I think most of this advice is being given by people who have not actually had RSI.

I will say, however, that with the correct adjustments, you can get past it, or at least survive pretty well with it.

My key advice, in order:

(1) See a doctor, if you have carpal tunnel syndrome, as opposed to a more general repetitive stress injury (RSI), then there is a simple surgery that can take care of this easily. Most people have a more generalized RSI, however, but this would be your first step, and worth checking out.

(2) Absolutely, positively, do not pass go, do not collect $200, and get yourself a Kinesis Keyboard. You do not have to get the most expensive version -- all the high-end macro support is probably a bit much for most people, but I would recommend that you get a keyboard where you can swap the keys. This allows you to use a Dvorak arrangement, or a modified/custom arrangement if you prefer. (My keyboard is fully customized this point.)

Changing to dvorak is a common suggestion, however it doesn't doesn't prevent pinky strain if you are an avid user of modifier keys, such as ctrl.

No, not true. Take a look at the Kinesis Keyboard. You will notice that a lot of the major keys are put on the thumb, including the alt and ctrl keys. This takes some getting used to, but is not very hard, and the thumb is a very strong digit, as opposed to the pinky, which is quite weak.

In addition, if you get a swappable keyboard, you can adjust some of the other keys: for example, I have customized mine to be similar to to the Dvorak arrangement (but not identical) and I have swapped the shift keys to be up one row -- along the same line as the home keys, instead of being out and down from the home-key line. This is an obvious adjustment, that all keyboard should do (except for the fact that it is nonstandard, and would drive people crazy at first). But for those with bad hands, reducing the travel distance for frequently used keys is critical.

(3) Trigger-point massage. If you buy books on RSI you will find that a lot of their advice involves trigger point massage along the arms, shoulders, upper neck, and back. But the key I found for me is to focus on the area below the elbows. Use a simple massage tool, or even something like a golf ball, to massage into your forearm. You will find where it hurts: press there and hold it. Slowly roll over the tight muscle and then back again, slowly. If you do this at night while watching TV, you will find it very easy to do, and your hands will be in much, much better shape next day. I am still shocked by how well this works.

(4) Voice recognition software. At first I thought this was absurd: you certainly cannot use voice recognition for programming. And you can't. However, you can use voice recognition for dictating e-mails, notes to yourself, etc. I even sometimes dictate my XML comments -- I type the occasional angle bracket myself, but otherwise you can dictate it directly. And you can certainly dictate forum replies -- I am dictating this one right now.

Voice recognition isn't perfect; this reply is error free only because I had to re-read through it from top to bottom to correct silly errors like "form" instead of "forearm" or the like. But dictating takes a huge amount of pressure off your hands, which is the key.

Voice recognition is built into Windows Vista, so it does not have to cost you a dime (if you have Vista). Dragon Naturally Speaking is $100-150, and is what I use. The voice recognition on Windows Vista is quite capable, but Dragon NaturallySpeaking 10.0 is even better, and it's worth the difference. [Update: The voice recognition on Windows 7 is even better and now is almost identical in capability to Dragon NaturallySpeaking. I would no longer pay for Dragon at this point. You can find speech recognition under Windows 7 by searching for "Windows Speech Recognition". -- MR]

(5) Change your mouse. Experiment with roller-balls, track pads, etc. Mice are relatively inexpensive (compared to keyboards, anyway) and can be rotated through: as you become sore with one mouse, swap it in for another type. You can also switch hands, if your mouse hand becomes too sore. (Yes, using a mouse with your wrong hand is more difficult, but is generally worth the switch is needed.) By rotating the mice I use, I have no problems.

So those are the key points: (1) see a doctor, (2) get yourself a Kinesis Keyboard, (3) trigger point massage, (4) voice-recognition software, and (5) change your mouse.

In addition, I would follow all the other advice involving ergonomics as to your chair, keyboard positioning, monitor height, etc. The are all worth doing, but I think that the five points that I have laid out are the most critical.

They have certainly been the most important ones for me.

Answer 27

Now there's a tough question, with many answers --- and many long answers. There seems to be a lot of good advice in the other answers, but I hope the following points also help. Note that they're based on my own experiences, so "YMMV" :)

• Seeing a doctor is always recommended, though not always that useful, in my own experience.
• Depending on how comfortable you are with them, some more or less alternative therapies may help:
  • Physical therapy, and similar therapies. Relatively mainstream. Make sure your therapist teaches you exercises you can do yourself at home --- just "massages" don't work in the end, and only provide temporary relief.
  • Some people I know have been helped a lot with acupuncture. Some acupuncture therapists are even specialized in RSI and related issues, so try to find one like that first.
  • ...
• Stress is often a major cause, combined with long stretches of computer work, of course. You probably won't be able to heal if you don't change some of your working habits. Try to relax more often, do more exercise, etc.
  • Not for everyone, but yoga and/or meditation are a great way to relief stress. Yoga may seem too "granola", or you may not like the "spiritual" aspects of it. In that case, just find yourself a yoga studio that doesn't focus on those aspects! Yoga is what you make of it, and it can be very down-to-earth. In the end, though, it's an absolutely great way to relax your body and mind, and to build up strength and flexibility without injuring yourself even further. (That last thing is extremely important, as that tends to go wrong if people engage in more competitive sports or fitness. In yoga, you learn to respect your body and its limitations). I've been doing yoga for a year now, and it's the only thing I've tried thus far that has really helped me!
  • Go out for a walk regularly. Very hard to make this a habit, at least for me (oh, the Zone!), but it might actually make you more productive.
  • Have you tried working while standing?
• There's lots of things one can say about ergonomics, and many other people here have already done so, but I'd like to add this:
  • Perhaps see an expert, who can actually sit down with you. It's a cliché, but every body is different!
  • What helped for me is a mini keyboard (without the numeric keypad, so you can use your mouse in front of your body --- that's supposed to be extremely important) and the Handshoe Mouse.
  • Personally, those timer programs annoy me a lot. A huge lot, that is. But it might just work for you :)

Answer 28

For starters as a quick hack try Green Tea with Soy milk. It reduces pain and gets you moving again, ( might be that it soaks up cortisol IIRC?)

Then switch to a harder keyboard. nobody ever got RSI on a mechanical typewriter. IBM model H, UNICOMP customizer, Cherry's sprung keys model.

Try an evoluent vertical mouse.

YMMV.

Avoid touch pads, laptop keyboards, cheapo keyboards.

Answer 29

I have a very short span of attention.

Answer 30

• Use two mice. (I use a traditional mouse on the right, and a track ball mouse on the left. Each wrist then shares the load of one full day. It is weird at first, but you get good at it.)
• Avoid stress, if you can. Stress really makes it worse.
• Use a big table to allow your elbows to rest comfortably.
• Use ibuprofen for flare-ups.
• Excercise. Blood flow helps.
• Limit computer work at home. Relax, read books, or listen to StackOverflow podcasts.

(I first started having RSI issues at my first job after graduating in 2002. I was fearful I would have to give up programming as a career. These tips have helped me tremendously, and I am thankfully still a developer.)

Answer 31

See a doctor or a chiropractor and have them evaluate you. The arch in my right hand has fallen due to too much mousing while resting my wrist on the table. Chiropractic adjustments have helped reduce the discomfort. Make sure you get a responsible chiropractor, and not one that tells you she can cure other diseases. Chiropractic care has it's place, specifically for addressing structural problems. No sense in supporting quacks who give people false hope based on pseudo-science. (OK, enough ranting.)

My chiropractor also gave me some stretching exercises, such as the ones seen here:

Lifehacker: Exercises that Protect Against Carpal Tunnel Syndrome

A couple other things she told me to try:

• Rubber band exercise
  • Bring all your fingers and your thumb together and place a rubber band around them near the first knuckle.
  • Open your hand, with the rubber band providing resistive force.
• Massage the muscles on the inside of your forearm just below the elbow. These muscles are actually heavily involved in moving your fingers. To find them, just place your other hand on your forearm while wiggling your fingers. When you feel movement under the skin, you've found the muscles that are active in moving your fingers.
• Get a wireless mouse and switch hands.

Answer 32

You know, that's a good question (+1'd) and deserves some discussion. I don't have a good answer for you, but somehow I've avoided it without trying. I've been coding almost daily since 1980. That's right, about 29 years, and I've never had a problem. It's not genes - my dad and both sisters have been treated for carpal tunnel, including some surgery. And they're not computer geeks. It's really strange.

The only thing that comes to mind is that I never learned to type "right." I'm not a hunt-and peck typer, but sort of somewhere between that and the whole home-row approach that's taught. I use about 4-6 of my fingers. I change positions very frequently - because I'm rarely sitting still. Perhaps I've never had a problem because my wrists are not constantly in the same position - they're all over the place while I'm typing.

Don't know if this helps, but maybe it'll give somebody some ideas.

Answer 33

Some exercises for helping with RSI that I have found helpful.

• Put your palms together in front of your chest. Interlace your fingers and close them bring your elbows together now role your joined hands around at the wrist.
• Clasp a tennis ball in your hand repeatedly.
• Go on your hands and knees fingers of both hands pointing forward. Now with a bit of wait still though your palms lift the wrist and back part of your palm off the floor

Also I have heard that foot pedals (that act like the control, alt and shift keys) can be good for serious emacs users. I have a friend who has some (who has had problems with RSI from programing with bad poster and also playing piano with bad posture) and he thinks they are great.

Answer 34

Don't use a mouse. Spend $150 on a small, simple Wacom graphics tablet, add a soft pad for your wrist, and work all day.

I use the Wacom pen in my right hand to hit the keys instead of using my fingers, and after a bit of practice I'm very fast without ever using the fingers of my right hand on the keys.

Answer 35

First, go see a doctor. A good one!
A lot of very sound advice has already been said so I won't repeat that. I'll just add that a number of people finds exercising with an handheld gyroscope, like this: http://www.powerballs.com quite effective for this kind of problems.

Answer 36

Use the Right-hand Control or Shift keys instead of the left.

You can enforce this by removing the actual keys from your keyboard.

This means that for cut/copy/paste, you are using two hands, but your littlest left finger does not get strained and you don't have the repetitive 'rocking' motion on your wrist.

Answer 37

RSIBreak is a great utility you can use to remind/force you off the keyboard at regular intervals or according to certain criteria. I haven't personally used it, but I've heard it's done a lot of good for a friend of mine.

Answer 38

I have been using Imak Smart Gloves for four years and though I type as much (if not more) than I used to, I never have wrist/finger pain if I remember to use them. They have these bean-bag things that lift your palms a little bit. I tried all manner of strange-looking keyboards, but these gloves (pricy at $20 each, they do NOT come in pairs) have worked quite well for me.