Computer Health – Hands/Wrist/Forearm

Repetitive Stress Injury

Repetitive Stress Injuries (RSI) are health problems that affect any part of the body which moves in a certain way either excessively, to a limit of natural movement, or both.  Wear and tear on the soft tissues of the muscular/skeletal system can cause inflammation, soreness, and ultimately disability.  The most common RSI injury of the hands and arms is “carpal tunnel syndrome”.

With computer usage, most at risk of RSIs are your hands, wrists, and forearms. Discomfort while working, especially after a day’s rest can indicate a problem.  The onset of RSIs can be quick.  One startling statistic is that recently, approximately 20% of all claims for compensation due to RSIs in (tech-savvy) California, have been for children.  You’ll note that there is a health warning affixed to most keyboards; it’s warning will be something like “use of a keyboard or mouse could be linked to serious injuries or disorders”.


Not Just "Touch" Typists

The first thing to note is that the single biggest cause of RSIs of the hands can be improper "touch typing" (the kind of typing you may have learned in elementary school). And since most students now-a-days don't type this way (they have their own hovering, half looking/half not looking style) you probably don't have to worry about this. But any repeated movement on a computer can cause RSIs, so consider the general theory of what causes RSIs, rather than any one particular situation.

Risk Factors of RSI:

The two main risk factors for RSIs when working at a computer are:

- Repetition of the same motion exactly the same way many times

- Motions at the extreme end of natural movement
But it is the combination of both of these which is the surest path to an RSI.


Three Common RSIs of the Hands/Fingers


Joints of Fingers and/or Thumb - this can develop regardless of how you hold your hands on a keyboard/mouse/touchpad. It will result from simply too much typing/clicking. And so rest is the best solution.


Outer Wrist - If you think of your wrist as a hinge that can swivel several ways, this concerns the part of the hinge that moves only slightly outward if you were to hold your hands flat on your lap. Issues here can develop particularly if you are a touch typist (i.e. you always keep your fingers coming back to the home keys) using a normal keyboard. Your hands end up being "cranked out" unnaturally to the limit in order to have the tips of your fingers touch straight across ASDF JKL; The only solution for touch typists for this one is getting an ergonomic keyboard which has keys on both sides of the keyboard angled the way that your hands would naturally fall if placed on your lap.


Top of the Wrist - This also is most likely for touch typists, but only for touch typists who don't follow the advice of their keyboarding teacher! You should keep your wrists up so that there is a flat plane across the top of your hand in line with your forearm. When typing or mousing, if you let the palms of your hands rest on the keyboard or table, then your wrists are "cranked back" to the limit of that movement. One solution is to put something like a custom make mouse pad under your wrists, but this does not solve the fundamental issue. Better is to keep your wrists up in the proper position; in the beginning this will feel sore, but that is because your muscles are getting tired, not because of something that can cause permanent damage. The more practice you have keeping your wrists up, the easier it will be to do as your wrists become stronger.


To begin with, the simple awareness that you can harm yourself in this way is important.  You should be ready to note the signs of a problem before it gets out of control. Meantime:

1. Vary your activity (don’t sit at the computer for long stretches of time)

2. Take regular breaks & stretch when needed

3. Assure proper body posture (feet on the floor, and with upper arms relaxed, lower arms parallel to the floor when fingers are on the keyboard)

4. Assure proper hand position (see below)

5. Keep generally healthy (well rested, well nourished, fit, and flexible)

6. Use a variety of input devices – for example alternate between mouse & trackball

*NOTE that all these points help you avoid back problems as well.

Proper Hand Positions


(First of all, to know what is the ideal "neutral" position for your hands to be in, just think of how they are when they are relaxed hanging by your side when you are standing - this should be the ideal "shape" of them to aim for, whatever kind of typing style you use.)


10-Finger "Touch" Typist:

You are actually most prone to RSIs, but only if you don't adopt good finger/hand positions. Keep your wrists in their natural position, which when held on a keyboard is UP.  Your hands should make a flat plane going from the top of your arm straight through the top of your hands to your knuckles.  It takes some practice, and also some strength-building, but if the palms of your hands are touching the table, you are arching your wrists back in an unnatural position.  Think of how your hands are when they are resting beside you as you stand; this is how they should be when you are typing. And by being a touch typist you have the advantage of being able to put the keyboard (an extra external one if you are using a laptop) on your lap and not having to constantly look down at it, which is not good for your neck and back. And when your keyboard is on your lap, an ergonomic one is even more important, so try to get one, with the two half of the keys separated.


"Hovering" 6-10 Finger Typist:

This is the one somewhere between a touch typist and a hen-pecker, in which you have to look down occasionally, but hover your hands above the keys in a spread out way. Most current high school students fall into this category. This, in fact is optimal for your fingers and hands; the more relaxed you can keep them the better. But for your back and neck, there are issues. You will either have the keyboard on your lap (or somewhere low in front of you) in which case your neck will be at risk as you look down frequently, or you will have the keyboard out in front of you and so exacerbate "rounded back" and shoulder issues (refer to the back and neck health page.) Variety of postions of the keyboard will be key.


1-4 Finger Hen-Pecker:

The big thing here is to assure that you use light depresses to activate the keys.  Don’t tap from above; rather, as much as possible, from a touching position, lightly push down.


When using a mouse, it’s the same thing: keep your wrist up.  Cushions and purpose-made devices, including the keyboard itself, can be bought to keep your wrists up.  But building up enough strength to do it on your own is preferable.  You should try to obtain an alternative to your main mouse, like a track ball, so you can vary how you manipulate the mouse pointer.

Laptops And Desktop Computers


The frequent use of a laptop can raise some altogether different issues, and alleviates others. On the plus sides, you can vary your position much more easily, and you can keep the keyboard generally lower and closer to your body, so you don't have to strain you shoulders, neck and back so much in reaching forward to it. But you may have to be extra conscious about your hand position; you may find that the laptop keyboard and track pad are more cramped than a normal keyboard, let alone an ergonomic one. Note that you can obtain a laptop "cushion" from stores such as IKEA to help with your overall posture when using a laptop.


More on this later, on the back health page, but here are the three basic situations you'll find you self in:


Desktop Computer
The keyboard can be in a good position, either on a keyboard tray, or on your lap. And the monitor can be in a good position; relatively far away and slightly down from the level of your eyes. One negative is that you are probably using a mouse rather than a touch pad.

Laptop on Your Lap
This should be good for your shoulders, forearms and hands, but may be bad for your back and neck since you can end up curled forward, and will have your head looking down. A keyboard cushion can help.

Laptop on a Table
This should be better for your neck and back, if you are sitting up with good posture. But it will not be as good for your shoulders, forearms and hands, as you will be reaching forward. Plugging in another keyboard and putting it on your lap is a very good solution.

And, again, variety is the key, so if you have both a desktop and laptop to work on, switching between them will be good. And switching between sitting with the laptop on your lap, and at the table (preferably with an extra keyboard) will be good.

The Cure

It is not very likely that you will encounter repetitive stress injuries to your hands and arms, if you observe some or all of the suggestions in this document.  But, should you experience an RSI due to computer use, addressing the situation is straight-forward, if not necessarily super easy.  

Firstly, you will need to change the way you are using the computer.  It shouldn’t be too difficult to figure out the thing you are doing that is causing the dis-comfort.  So the change could involve a slight alteration in the way you hold you hands on the keyboard or mouse.  It could require re-arranging the physical layout of your computer station.  Or perhaps you will have to buy a new ergonomic keyboard or second mouse/trackball.  

One way or another, you will have to reduce the time you spend agitating the situation.  Rest of the affected area is the number one key. One funky way to get you to adjust your time on the computer is to get one of those applications that automatically logs you out, or at least suggests logging out on a regular basis. 


And if you reach the point where your changes and rest aren't enough, you could try voice recognition software. With this kind of software, you talk in your text to the computer, rather than type it in. The best on the market for the Mac is called MacSpeech. After a period of training it to your voice, it works remarkably well. The academic version of MacSpeech sells for around $100 USD.

If the RSI were to become serious, or not go away with rest and adjustments, then you would need to seek medical advice.  The most likely outcome of a visit to the doctor would be the acquisition of a brace that would prevent you from moving your hand/arm in the position that causes the pain.  But, again, following the advice herein will prevent that situation from ever occurring.  Prevention, as always, is better than the cure.

The Cost of Good Health

Some of the easiest measures for preventing computer health problems will cost you money.  A good ergonomic keyboard available at most malls in Prague goes for about 1000 Kc, and a alternative mouse or hand-held trackball for about 500 Kc.  A keyboard tray for your desk, which will lower your keyboard to a more ergonomically correct level, is available at many office supply stores in Prague.  And if you use a laptop, you should consider acquiring an external keyboard to plug into a USB port, along with an external mouse, and a laptop "cushion"; this will go a long way toward making your laptop computing more healthy.  

Your family has probably already invested a large amount of money in your home IT resources, and so they may be hesitant to make even more purchases.  But you have to keep in mind that it is your family’s health that is in question, and so such purchases should be seen as a wise investment.