Prevention for Carpal Tunnel Syndrome

Ask most people about carpal tunnel syndrome, and they'll tell you it's pain in the wrist caused by spending too much time at the computer keyboard. But before you rush out and buy an "ergonomic" keyboard, let's ask some questions:

• where does it hurt?
• Is it one hand or both hands?
• If it's only one hand, which hand is it?

Many people will answer that it's only one hand. And that hand is - their mousing hand.

Now, if it was the keyboard causing the problem, both hands would be equally affected. So the truth is that for most people, it's the computer mouse, not the keyboard, that causes wrist pain.

When mice were first invented, most commands were still keyboard shortcuts. You used your mouse rarely - you'd grab, move and click, then bring your hand back to the keyboard to continue typing. The mouse was never designed to be held continually - which is something we all do these days.

Take a look at the picture on the right. Can you see the angle between the wrist and the hand? That's a major cause of wrist pain.

If you over-use your muscles (at an aerobics class for instance) they get sore and inflamed - and if you don't allow enough recovery time before exercising again, you"ll end up with an injury. The same thing happens with your wrist - you work it for hours every day, and overnight isn't enough time for it to recover.

However, just because you have wrist pain, doesn't mean you have carpal tunnel. You certainly have some kind of RSI (Repetitive Strain Injury) caused by over-use of the tendons and muscles in your hand, arm and shoulder. That can lead to carpal tunnel, but you may not be there yet.

To avoid your pain progressing to something more serious, you need to take action now. That takes a three-pronged attack:

• change your desk setup including the way you sit
  
• do arm and hand stretches to loosen up tight muscles and tendons.
• take regular breaks during your work day (every half hour until the pain eases, and every hour or two once you're back to normal).
  

One frustrating thing about pain is that we don't always feel it where the problem really is. For many people, the true root of their wrist pain lies in the arm and shoulder. That's why correct desk setup and posture is so important, to remove stress across that whole area. It's worth trying some exercises to ease a stiff shoulder and neck- if they ease the pain in your arm, you'll know the problem is bigger than just your wrist.

Put your hand on your mouse and look at your arm. If you can see your elbow, you're giving yourself RSI. The further you reach forward with your hand, the greater the tension, all the way from your hand, through your shoulder, to your neck. Tension causes muscle spasm and inflammation. Result - RSI.

The same applies to your keyboard. If you can see your elbows, your keyboard is too far away.

If you're going to have any chance at all of recovering from RSI, your shoulders and upper arms must be relaxed while you type. The only way that can happen is if your arms are hanging loosely from your shoulders.

Try it now. Stand up and let your arms hang by your sides. Now leave your shoulders and upper arms exactly where they are, and raise your hands in front of you at a 90 degree angle. You should feel your elbows lightly touching your body near the waist. That's the correct position for keyboarding and mousing. As soon as your elbows lose contact with your body while you're working, you're putting yourself at risk of RSI.

If you sit down at your desk and put your arms in that position, you'll see that your keyboard and mouse need to be on or near the edge of your desk. That'll probably surprise you, because you don't often see mice in that position - but then, how many of your colleagues have sore wrists, or stiff necks and shoulders?

That's why wrist rests aren't a good idea, because you need to move your mouse and keyboard further away to make room for the rest.

You may find your desk is too high, so you can't get a proper straight line from the elbow to the back of the hand. In the early days of computers, office desks had a keyboard tray screwed under the desk, to bring the keyboard and mouse down to an ergonomic level. That's still a good idea - the only reason you don't see them in offices now is cost-cutting, not because they don't work.

You'll probably need to bring your monitor closer, as well. You should be able to touch your screen easily with your fingertips. If it's too far away, you'll create tension by craning your neck forward.

Take a look at the desk on the right - it's a good illustration of all the things that are wrong with modern office desks.

The monitor is pushed all the way to the back of the desk. The user can't read the screen without poking their neck forward - which not only causes tension all the way down the arms, it will affect their posture while they're standing and walking, as well. Try standing against a wall - the back of your head should touch the wall. If it doesn't, you're developing a permanent "turtle" neck and a hump back because you're spending all day with your head craned forward. Bring that monitor closer!

The keyboard and mouse are also pushed back. The user has bought wrist rests, but to get his wrists onto the rest, he still has to reach forward.

I know, I know - sitting up straight doesn't look nearly as cool as an artistic slouch. But trust me, once you've experienced the pain of RSI, you'll be prepared to look uncool to avoid it happening again!

Generations of typists have used the same design of keyboard all over the world for over 100 years - and before the computer was invented, RSI was virtually unknown. It only became an issue among secretaries with the advent of word processors, and flowed into the general working population as computers became an essential piece of equipment for almost everyone.

On manual typewriters, there was nowhere to rest your hands on the machine. Electric and electronic typewriters had super-sensitive keys, so you didn't dare rest your fingers on them - the process of erasing a mistake was too laborious! If a typist needed to stop and think, she would drop her hands into her lap or rest them on the desk, safely away from the keyboard.

By contrast, computer users frequently rest with their wrists on the edge of - or worse, on the desk in front of - the keyboard, creating the same dangerous angle as using the mouse. You can even buy a wrist rest, to encourage you to do so!

In the old days, typists were trained in proper posture. It simply wasn't possible to attain the speed and accuracy they needed for their jobs without it. Like a concert pianist, they had to get their fingers in a position where they had optimum control. Computer users don't need that accuracy because mistakes are so easy to correct, so there's no impetus to learn correct posture.

The introduction of flat screen monitors has made things even worse. CRT monitors had a big, boxy back and often, they sat on top of the hard drive. All that equipment took up a lot of space on the desk, so users didn't have much choice but to keep the keyboard and mouse near the edge.

The temptation is to push a flat screen "neatly" all the way to the back of the desk, and everything else moves back with it. The result is dreadful posture!

Laptops are an even greater curse - an ergonomic disaster, unless you put them on a stand and use a separate keyboard and mouse.

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All text copyright Marisa Wright. Desk photo courtesy RossJamesParker on Flickr