Jason Rennie's Wrist Tendonitis and RSI Pensieve

I have tendonitis in my wrists. I've been typing most of my life. During the summer of 2004, I started to feel semi-regular aching in my wrists. It progressively got worse. It started to feel like needles poking the bottom of my wrists. Fall '04, I went to see a doctor about it. He diagnosed the problem as mild wrist tendonitis (not carpal tunnel syndrome, as I feared) and told me to take a 5 minute break every hour and gave me wrist stretching exercies to do (during the break). After playing computer games over the winter break, my wrists started acting up again...

7/21/06 - Workrave is the program I use in Windows to remind me to take rest breaks.
7/20/06 - Here's a comment (w/ corrections & slight modifications) I made on David Pinto's Baseball Musings blog after he mentioned that he's been having wrist pain:

I hope it's not carpal tunnel.
It's probably tendinitis/RSI. Carpal tunnel from typing is much, much less common than the media might have you believe.
David, just in case you haven't heard this before, the three keys to curing tendinitis are (1) frequent rest breaks, (2) posture/ergonomics, and (3) keeping your body healthy. When typing became painful for me, it took me a few tries before I found a doctor who knew what to tell me. The GPs I saw were useless. It wasn't until I saw a doctor that specialized in occupational injuries that I was given good advice. The specialist I saw (Dr. David Diamond, Head of Medicine at MIT; sees hundreds of RSI patients/year) said that my injury wasn't yet serious (even though I was experiencing semi-regular hand/wrist pain), and that there were some simple things I could do to alleviate the tendinitis (the three keys above).
He recommends a 30 second break every 5 minutes---stop typing, stand up, walk around, roll your shoulders, move your arms. The longer you type without a break, the greater the chance of serious injury.
Evaluate your ergonomics. When you type, your feet should be flat on the floor, your back should be straight, and your keyboard should be low and close to your body. If there is any tilt to your keyboard, it should be slightly negative (away from the body). Most of the products sold as ergonomic aids (e.g. wrist rests) aren't helpful, though your mileage might vary (YMMV). When not typing, don't lay your hands/wrists on the keyboard/desk, lay them in your lap.
Last, but not least, keep your body healthy. Eat a variety of foods & exercise regularly. The better you take care of your body the better it can heal any damage done by typing.
If the pain doesn't go away, get yourself to an occupational injury specialist who has experience with RSI patients. Hope you're feeling better!
10/28/05 - Haven't experienced any pain recently (a good thing!). Still occasional stiffness. But, it definitely feels like my wrists are pretty healthy (compared to what they used to be). I had been experiencing back pain recently. I identified two sources: my home computer chair, and my bed. Switched to using a 75cm "exercise ball" (like this one, only red and a bit bigger) as my chair. This keeps my back from getting stiff. It's not the most comfortable thing, but I've never had the shooting pain that I recently was experiencing with my old chair! As far as the bed was concerned, ours was getting old, six years old. It was a "firm" Sealy Posturepedic that we bought for ~$500. After much shopping and agonizing, we settled on a "Pillow-top Simmons BackCare" mattress at the bottom of the BackCare price-spectrum, $800. Simmons was the only brand that made my back semi-happy and the BackCare line was the only one that made my back feel truly comfortable. The salespeople pointed to two factors: (1) the five zones of support, including a soft zone for your butt and a firm zone for your lower back, and (2) the individually-wrapped coils, which are supposed to make the bed contour better to your body. When I lay on my back, it actually feels like it's providing lower-back support and keeping my spine straight. Anyway, after those two fixes, the lower back pain has all but disappeared. Still get a little aching while sitting on the exercise ball, but it's a major improvement over the previous situation!
10/4/05 - Pain is pretty much gone, but I still have stiffness and very occasional pain. One bad thing is that I've been playing some computer games recently (which don't have rest break reminders!) Damn computer games!
8/21/05 - Pain is back after I've used a laptop heavily for the past 4-5 weeks. And I was using windows and don't yet have xwrits-type software for windows, so I wasn't taking rest breaks as regularly as I should have been. I'm hoping that if I get back to my regular schedule & setup, I'll be able to get back to the little/no pain situation I had in the spring.
4/18/05 - Well, it's been more than a month since I've written anything here. My wrists have been doing great. The frequent breaks that Dr. Diamond recommended really did the trick. Once or twice I've felt minor weakness and/or pain, but nothing like I felt earlier and the large majority of the time, my wrists have felt great. So, my recommendation to anyone who's at the computer 8+ hours a day: take a 30 second break every 5 minutes. And, don't try to regulate yourself---get a program to time you, like xwrits. Here's the command line I use (in my ~/.xsession file):
```
  xwrits typetime=5 breaktime=0.5 +mouse &
```
3/7/05 - Spent nearly all of yesterday at a keyboard. Followed Dr. Diamond's instructions---break every 5 minutes. Wrists feel pretty good today. Only nagging issue is that it feels like the tendon for my left middle finger is very tight. When I do the "fist" stretch, I always feel that one first; its the only tendon I feel when I do other normal activities (e.g. turn on a light switch).
3/4/05 - Met with Dr. Diamond. Most important things he said are: take a 30 second rest break every 5 minutes---get out of the chair, move the arms, shoulders, just get the body out of the sedandtary position. Do this religiously! He also said to not rest hands on the keyboard/desk, make sure keyboard is low, preferably at a negative angle. I'm currently typing with it on my lap---feels pretty good. The frequent breaks will help to rest the tendons/muscles/etc. and to help me keep aware of my body. He said many people get into a "zone" and become unaware of things the body is telling them. Knowing what your body is saying is very important. Related to that: supplements, icing, drugs, etc. don't solve the root problem, they just make you feel better for a while. Ibuprophin, glucosamine, icing, etc. just give you a temporary fix, make you feel better and can hide the problem, which can cause more damage b/c you don't feel what your body is telling you. It's all about posture, rest breaks and keeping your body fit and healthy. He said to keep up the exercise. Exercise keeps the body healthy and allows it to heal the damage you do to your body when you type. I have a nice light, fast touch on the keyboard (he had me type on his computer), but I tend to rest my wrists (I can feel myself doing it now). But, I'm not sure how to balance beteen relaxing the arms and not resting palms on the keyboard. Maybe I should shoot him an e-mail. Another thing: keyboard is very personal and isn't so important. He uses a standard old-school keyboard, nothing special. But, he has it on a keyboard tray w/ negative incline. Ah, another important thing is to rest hand in my lap when I'm not typing. Don't leave them hanging over the keyboard. Simply placing your hand in the usual keybording position puts strain on the muscles/tendons. Either put them in the lap (palms up) or hang them by my side. This is not a medical condition. It's an ergonomic one. Once you get the ergonomics right, the body can sustain keyboarding for very long time. There's no concern about wearing out the body after keyboarding for 10 or 20 years. You can type for the rest of your life if you take care of your body while typing. Another recommendation: try to avoid extremely long bouts of typing. It's better to type 6 hours a day, every day, rather than 18 hours one day, followed by two days of rest. I asked about caffeine and alcohol. He said that there is nothing conclusive about either one of them. It's not clear that drinking 3-4 cans of Coke/day makes RSI worse. What I'm doing right now (one can/day or lots of iced tea) is totally fine. There is nothing wrong with moderate alcohol consumption.
3/3/05 - Realized I've been feeling stiffness in my left elbow. Also, after falling down stairs, my right hand (particularly pinkie) felt numbness for quite a while after waking (even though I was lying flat on my back at night).
3/3/05 - Repetitive Strain Injury by Pascarelli and Quilter is an excellent book that describes misconceptions, symptoms, prevention and treatment.
3/3/05 - RSI Action is a Boston-area support group for people with repetetive strain injuries.
3/3/05 - The MIT RSI page has a nice brochure about RSI. There is also a web page showing the various exercises you can do at your desk. There are simple ways to prevent RSI.
3/3/05 - Dr. Diamond gave me a call. He suggested I visit the MIT RSI page, get the video and book available from Health Promotion (2nd floor of medical building, north end), and visit the MIT ATIC web site. We talked about what I do currently. He said that when I'm not typing, I should have my hands in my lap---not on the keyboard and/or mouse. It's better to take 30 second breaks every 5 minutes than to take 5 minutes break every 30/60 minutes. Also, icing is a temporary solution---it only treats the symptoms, not the root cause.
2/23/05 - My regimine of regular exercise (3 miles jogging, 4 times a week), and stretching and icing breaks every 30 minutes seems to be keeping the tendonitis at bay. Doesn't feel like the wrists are getting better, just not any worse. I still get stiffness and occasional dull pain, but nothing sharp and nothing severe.
2/18/05 - Pain off/on in middle of right palm; I severely limited my typing. Then, I tried icing during stretching breaks (which I haven't done for a while); it greatly reduced the pain, to the point that typing is okay again.
2/17/05 - Sharp pain in middle of right palm. Also notice small circle of redness where pain seems to be coming from.
2/10/05 - Felt my wrists yesterday, stiffness in the wrists and minor pain along the length of the forewarm. Nothing serious, though. Also, I've discovered a cut in my right thumb where it was hurting a few days ago. I think it developed as a result of dry skin. A band-aid has helped to mostly heal it; pain is gone now. Latest pain episode in my thumb was almost definitely cause by the cut, not typing.
2/8/05 - Stayed up late typing again (about 8 hours w/ dinner break). No major problems. Wrists were very stiff by the end of the night, but no real pain, no pain the following morning.
2/7/05 - Starting to get the numbness in my right thumb again; actually, it's more like something in my thumb is being pinched---like a nerve inside my thumb is being pinched. I'd also compare it to having a "deep" splinter in my thumb. It's on the right side of my thumb, near the right edge of my fingernail.
2/7/05 - Went to see Dr. Firn. He checked my hand strength, said it was very good. I have excellent grip strength, excellent finger strength. No pain in motion or in a position that would indicate a serious condition (back of hands pressed together, fingers pointing down). He says that people who need surgery usually experience loss of strength or pain in movement. He says to keep up the exercise: don't stop playing tennis, don't stop running. Exercise is good for me.
2/4/05 - Three more miles. Hands feel pretty good at the moment. Stiff as usual, but no pain, only a faint numbness in my thumb. Before exercising, I noticed tingling in my fingers.
2/3/05 - Ran 3 miles on treadmill today. Have limited my keyboarding. Numbness seems greatly reduced, faint at the moment. I'm going to try exercising more (3 miles every week day). Hoping that will help.
2/1/05 - Just took a long walk, numbness has lessened significantly. Realized that the "numbness" feels more like something is pinching a nerve in my thumb. (!)
2/1/05 - Spent last Friday night/Saturday morning working on a SIGIR submission. Wrists were not happy afterwards. I took the weekend off---didn't even touch a computer. BUT, now (and I think I may have had this before too, just didn't recognize it) I have a numbness in my right thumb. Numbness is one of the symptoms of Carpal Tunnel!!! Ahhhh!!! What am I doing to myself?!?!?
1/21/05 - Wrists have been feeling a lot better. Have xwrits set to 25 minutes of typing time. I'm doing all three wrist stretches (up, down, fist-down) for 30 seconds per hand. I tried doing just the "up" stretch for a few days, noticed that the tendons on the back of my hand became tight. I ice when I feel pain, but I haven't had pain recently, mostly just stiffness, which the stretching seems to lessen. Oh, and caffeine + typing is worse than typing alone (Coke is bad). Also, I occasionally raise my hands above my head for a few minutes during breaks---seems to help some.
1/13/05 - Two types of tendinitis I don't have: Flexor (fingers) and DeQuervain's (thumb side of wrist).
1/13/05 - Discovered that the purpose of stretching is to help the tendons glide more easily. No wonder one of the autobiographical stories said that only the "up" stretch did any good: that one stretches the tendons on the bottom of the wrist which allow the down-pressing motion, which typing using almost exclusively. The reason for using ice is to reduce inflamation of the tendon(s).
1/13/05 - Discovered that tendinitis can be spelled with either an `o' or an 'i'. Also, one thing recommended for any tendinitis injury is elevation. I wonder if elevating my hands during rest periods may help.
1/7/05 - Met with Dr. Firn, my primary, told him that I had been doing the stretches & wrist breaks, that they had helped, but pain was still there. He suggested more breaks, then gave me a pamphlet with measurements for an ergonomical workstation. I asked about ice; he said that ice is great, I should definitely try it. One minute application w/ the "sheet" ice I have is great. He even suggested, 2-3 minute applications of single ice cubes on the bottom part of the wrist (or wherever I feel the pain). I've lowered my desk and arm wrests @ MIT in response to the ergo information. I think that will help reduce general stress in my arms & shoulders. Dr. Firn also recommended excercise. I should make sure to keep up with my running routine, 3 miles, 3 days/week. Dr. Firn said that I should return if the pain gets any worse. His main two recommendations were proper ergonomics ("neutral position") and more breaks. Honestly, I think I'm taking enough breaks, but I should work to make sure that my workstation position is as neutral as possible. Dr. Firn confirmed that what I most likely have is tendonitis.

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Jason Rennie
Last modified: Sun Sep 17 14:55:34 EDT 2006