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|Don’t Push Through the Pain
|In 2004, I lost my web career. In a single day, it was gone. I was in too much pain to use a keyboard, a Wacom tablet (I couldn’t even click the pen), or a trackball. Switching my mouse to use my left (non-dominant) hand only helped a bit; then that hand went, too. I tried all the easy-to-find equipment out there, except for expensive gizmos with foot pedals. I had tingling in my fingers—which, when I was away from the computer, would rhythmically move as if some other being controlled them. I worried about Parkinson’s because the movements were so dramatic. Pen on paper was painful. Finally, I discovered one day that I couldn’t even turn a doorknob. The only highlight was that I couldn’t dust, scrub, or vacuum. We were forced to hire someone to come in once a week for an hour to whip through the house. You can imagine my disappointment. My injuries had gradually slithered into my life without notice. I’d occasionally have sore elbows, or my wrist might ache for a day, or my shoulders feel tight. But nothing to keyboard home about. That’s the critical bit of news. One day, you’re pretty fine. The next day, you don’t have your job—or any job that requires the use of your hands and wrists. I had to walk away from the computer for over four months—and partially for several months more. That’s right: no income. If I hadn’t found a gifted massage therapist, the right book of stretches, the equipment I should have been using all along, and learned how to pay attention to my body—even just a little bit more—I quite possibly wouldn’t be writing this article today. I wouldn’t be writing anything, anywhere. Most of us have heard of (and even claimed to have read all of) Mihaly Csikszentmihalyi, author of Flow: The Psychology of Optimal Experience, who describes the state of flow—the place our minds go when we are fully engaged and in our element. This lovely state of highly focused activity is deeply satisfying, often creative, and quite familiar to many of us on the web who just can’t quit until the copy sings or the code is untangled or we get our highest score yet in Angry Birds. Our minds may enter that flow, but too often as our brains take flight, all else recedes. And we leave something very important behind. Our bodies. My body wasn’t made to make the same minute movements thousands of times a day, most days of the year, for decades, and neither was yours. The wear and tear sneaks up on you, especially if you’re the obsessive perfectionist that we all pretend not to be. Oh? You’re not obsessed? I wasn’t like this all the time, but I remember sitting across from my husband, eating dinner, and I didn’t hear a word he said. I’d left my brain upstairs in my office, where it was wrestling in a death match with the box model or, God help us all, IE 5.2. I was a writer, too, and I was having my first inkling that I was a content strategist. Work was exciting. I could sit up late, in the flow, fingers flying at warp speed. I could sit until those wretched birds outside mocked me with their damn, cheerful “Hurray, it’s morning!” songs. Suddenly, while, say, washing dishes, the one magical phrase that captured the essence of a voice or idea would pop up, and I would have mowed down small animals and toddlers to get to my computer and hammer out that website or article, to capture that thought before it escaped. Note my use of the word hammer. Sound at all familiar? But where was my body during my work? Jaw jutting forward to see the screen, feet oddly positioned—and then left in place like chunks of marble—back unsupported, fingers pounding the keys, wrists and arms permanently twisted in unnatural angles that we thought were natural. And clicking. Clicking, clicking, clicking that mouse. Thumbing tiny keyboards on phones. A lethal little gesture for tiny little tendons. Though I was fine from, say 1997 to 2004, by the end of 2004 this behavior culminated in disaster. I had repetitive stress injuries, aka repetitive motion injuries. As the Apple site says, “A brief exposure to these conditions would not cause harm. But a prolonged exposure may, in some people, result in reduced ability to function.” I’ll say. I frantically turned to people on lists and forums. “Try a track ball.” Already did that. “Try a tablet.” Worse. One person wrote, “I still come here once in a while and can type a couple sentences, but I’ve permanently got thoracic outlet syndrome and I’ll never work again.” Oh, beauteous web, oh, long-distance friends, farewell. The Wrist Bone’s Connected to the Brain Bone That variation on the old song tells part of the story. Most people (and many of their physicians) believe that tingling fingers and aching wrists MUST be carpel tunnel syndrome. Nope. If your neck juts forward, it tenses and stays tense the entire time you work in that position. Remember how your muscles felt after holding a landline phone with your neck tilted to one side for a long client meeting? Regrettable. Tensing your shoulders because your chair’s not designed properly puts you at risk for thoracic outlet syndrome, a career-killer if ever there was one. The nerves and tendons in your neck and shoulder refer down your arms, and muscles swell around nerves, causing pain and dysfunction. Your elbows have a tendon that is especially vulnerable to repetitive movements (think tennis elbow). Your wrists are performing something akin to a circus act with one thousand shows a day. So, all the fine tendons and ligaments in your fingers have problems that may not start at your wrists at all. Though some people truly do have carpal tunnel syndrome, my finger and wrist problems weren’t solved by heavily massaging my fingers (though, that was helpful, too) or my wrists. They were fixed by work on my neck, upper back, shoulders, arms, and elbows. This explains why many people have surgery for carpal tunnel syndrome and just months later say, “What?! How can I possibly have it again? I had an operation!” Well, fellow buckaroo, you may never have had carpel tunnel syndrome. You may have had—or perhaps will have—one long disaster area from your neck to your fingertips. How to Crawl Back Before trying extreme measures, you may be able to function again even if you feel hopeless. I managed to heal, and so have others, but I’ll always be at risk. As Jen Simmons, of The Web Ahead podcast and other projects told me, “It took a long time to injure myself. It took a long time to get back to where I was. My right arm between my elbow and wrist would start aching intermittently. Eventually, my arm even ached at night. I started each day with yesterday’s pain.” Simple measures, used consistently, helped her back. 1. Massage therapy I don’t remember what the rest of the world is like, but in Portland, Oregon, we have more than one massage therapy college. (Of course we do.) I saw a former teacher at the most respected school. This is not your “It was all so soothing. Why, I fell asleep!” massage. This is “Holy crap, he’s grinding his elbow into my armpit!“ massage therapy, with the emphasis on therapy. I owe him everything. Make sure you have someone who really knows what they’re doing. Get many referrals. Try a question, “Does my psoas muscle affect my back?” If they can’t answer it, flee. Regularly see the one you choose and after a while, depending on how injured you are, you may be able to taper off. 2. Change your equipment You may need to be hands-on with several pieces of equipment before you find the ones that don’t cause more pain. Many companies have restocking fees, charges to ship the equipment you want to return, and other retail atrocities. Always be sure to ask what the return policies are at any company before purchasing. Mice You may have more success than I did with equipment such as the Wacom tablet. Mine came with a pen, and it hurt to repetitively click it. Trackballs are another option but, for many, they are better at prevention than recovery. But let’s get to the really effective stuff. One of the biggest sources of pain is using your mouse. One major reason is that your hand and wrist are in a perpetually unnatural position and you’re also moving your arm quite a bit. Each time you move the mouse, it is placing stress on your neck, shoulders and arms, because you need to lift them slightly in order to move the mouse and you need to angle your wrist. You may also be too injured to use the trackpad all the time, and this mouse, the vertical mouse is a dandy preventative measure, too. Shaking up your patterns is a wise move. I have long fingers, not especially thin, yet the small size works best for me. (They have larger choices available.) What?! A sideways mouse? Yep. All the weight of your hand will be resting on it in the handshake position. Your forearms aren’t constantly twisting over hill and dale. You aren’t using any muscles in your wrist or hand. They are relaxing. You’ll adapt in a day, and oh, oh, what a relief it is. Keyboards I really liked doing business with the people at Kinesis-Ergo. (I’m not affiliated with them in any way.) They have the vertical mouse and a number of keyboards. The one that felt the most natural to me, and, once again, it only takes a day to adapt, is the Freestyle2 for the Mac. They have several options. I kept the keyboard halves attached to each other at first, and then spread them apart a little more. I recommend choosing one that slants and can separate. You can adjust the angle. For a little extra, they’ll make sure it’s all set up and ready to go for you. I’m guessing that some Googling will find you similar equipment, wherever you live. Warning: if you use the ergonomic keyboards, you may have fewer USB ports. The laptop will be too far away to see unless you find a satisfactory setup using a stand. This is the perfect excuse for purchasing a humongous display. You may not look cool while jetting coast to coast in your skinny jeans and what appears to be the old-time orthopedic shoe version of computing gear. But once you have rested and used many of these suggestions consistently, you may be able to use your laptop or other device in all its lovely sleekness during the trip. Other doohickies The Kinesis site and The Human Solution have a wide selection of ergonomic products: standing desks, ergonomically correct chairs, and, yes, even things with foot pedals. Explore! 3. Stop clicking, at least for a while Use keyboard shortcuts, but use them slowly. This is not the time to show off your skillz. You’ll be sort of like a recovering alcoholic, in that you’ll be a recovering repetitive stress survivor for the rest of your life, once you really injure yourself. Always be vigilant. There’s also a bit of software sold by The Human Solution and other places, and it was my salvation. It’s called the McNib for Macs, and the Nib for PCs. (I’ve only used the McNib.) It’s for click-free mousing. I found it tricky to use when writing markup and code, but you may become quite adept at it. A little rectangle pops up on your screen, you mouse over it and choose, let’s say, “Double-click.” Until you change that choice, if you mouse over a link or anything else, it will double-click it for you. All you do is glide your mouse around. Awkward for a day or two, but you’ll pick it up quickly. Though you can use it all day for work, even if you just use this for browsing LOLcats or Gary Vaynerchuk’s YouTube videos, it will help you by giving your fingers a sweet break. But here’s the sad news. The developer who invented this died a few years ago. (Yes, I used to speak to him on the phone.) While it is for sale, it isn’t compatible with Mac OS X Lion or anything subsequent. PowerPC strikes again. His site is still up. Demos for use with older software can be downloaded free at his old site, or at The Human Solution. Perhaps an enterprising developer can invent something that would provide this help, without interfering with patents. Rumor has it among ergonomic retailers (yes, I’m like a police dog sniffing my way to a criminal once I head down a trail) that his company was purchased by a company in China, with no update in sight. 4. Use built-in features That little microphone icon that comes up alongside the keyboard on your iPhone allows you to speak your message instead of incessantly thumbing it. I believe it works in any program that uses the keyboard. It’s not Siri. She’s for other things, like having a personal relationship with an inanimate object. Apple even has a good section on ergonomics. You think I’m intense about this subject? To improve your repetitive stress, Apple doesn’t want you to use oral contraceptives, alcohol, or tobacco, to which I say, “Have as much sex, bacon, and chocolate as possible to make up for it.” Apple’s info even has illustrations of things like a faucet dripping into what is labeled a bucket full of “TRAUMA.” Sounds like upgrading to Yosemite, but I digress. 5. Take breaks If it’s a game or other non-essential activity, take a break for a month. Fine, now that I’ve called games non-essential, I suppose you’ll all unfollow me on Twitter. 6. Whether you are sore or not, do stretches throughout the day This is a big one. Really big. The best book on the subject of repetitive stress injuries is Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program by Sharon J. Butler. Don’t worry, most of it is illustrations. Pretend it’s a graphic novel. I’m notorious for never reading instructions, and who on earth reads the introduction of a book, unless they wrote it? I wrote a book a long time ago, and I bet my house, husband, and life savings that my own parents never read the intro. Well, I did read the intro to this book, and you should, too. Stretching correctly, in a way that doesn’t further hurt you, that keeps you flexible if you aren’t injured, that actually heals you, calls for precision. Read and you’ll see. The key is to stretch just until you start to feel the stretch, even if that’s merely a tiny movement. Don’t force anything past that point. Kindly nurse yourself back to health, or nurture your still-healthy body by stretching. Over the following days, weeks, months, you’ll be moving well past that initial stretch point. The book is brimming with examples. You only have to pick a few stretches, if this is too much to handle. Do it every single day. I can tell you some of the best ones for me, but it depends on the person. You’ll also discover in Butler’s book that areas that you think are the problem are sometimes actually adjacent to the muscle or tendon that is the source of the problem. Add a few stretches or two for that area, too. But please follow the instructions in the introduction. If you overdo it, or perform some other crazy-ass hijinks, as I would be tempted to do, I am not responsible for your outcome. I give you fair warning that I am not a healthcare provider. I’m just telling you as a friend, an untrained one, at that, who has been through this experience. 7. Follow good habits Develop habits like drinking lots of water (which helps with lactic acid buildup in muscles), looking away from the computer for twenty seconds every twenty to thirty minutes, eating right, and probably doing everything else your mother told you to do. Maybe this is a good time to bring up flossing your teeth, and going outside to play instead of watching TV. As your mom would say, “It’s a beautiful day outside, what are you kids doing in here?” 8. Speak instead of writing, if you can Amber Simmons, who is very smart and funny, once tweeted in front of the whole world that, “@carywood is a Skype whore.” I was always asking people on Twitter if we could Skype instead of using iChat or exchanging emails. (I prefer the audio version so I don’t have to, you know, do something drastic like comb my hair.) Keyboarding is tough on hands, whether you notice it or not at the time, and when doing rapid-fire back-and-forthing with people, you tend to speed up your typing and not take any breaks. This is a hand-killer. Voice chats have made such a difference for me that I am still a rabid Skype whore. Wait, did I say that out loud? Speak your text or emails, using Dragon Dictate or other software. In about 2005, accessibility and user experience design expert, Derek Featherstone, in Canada, and I, at home, chatted over the internet, each of us using a different voice-to-text program. The programs made so many mistakes communicating with each other that we began that sort of endless, tearful laughing that makes you think someone may need to call an ambulance. This type of software has improved quite a bit over the years, thank goodness. Lack of accessibility of any kind isn’t funny to Derek or me or to anyone who can’t use the web without pain. 9. Watch your position For example, if you lift up your arms to use the computer, or stare down at your laptop, you’ll need to rearrange your equipment. The internet has a lot of information about ideal ergonomic work areas. Please use a keyboard drawer. Be sure to measure the height carefully so that even a tented keyboard, like the one I recommend, will fit. I also recommend getting the version of the Freestyle with palm supports. Just these two measures did much to help both Jen Simmons and me. 10. If you need to take anti-inflammatories, stop working If you are all drugged up on ibuprofen, and pounding and clicking like mad, your body will not know when you are tired or injuring yourself. I don’t recommend taking these while using your computing devices. Perhaps just take it at night, though I’m not a fan of that category of medications. Check with your healthcare provider. At least ibuprofen is an anti-inflammatory, which may help you. In contrast, acetaminophen (paracetamol) only makes your body think it’s not in pain. Ice is great, as is switching back and forth between ice and heat. But again, if you need ice and ibuprofen you really need to take a major break. 11. Don’t forget the rest of your body I’ve zeroed in on my personal area of knowledge and experience, but you may be setting yourself up for problems in other areas of your body. There’s what is known to bad writers as “a veritable cornucopia” of information on the web about how to help the rest of your body. A wee bit of research on the web and you’ll discover simple exercises and stretches for the rest of your potential catastrophic areas: your upper back, your lower back, your legs, ankles, and eyes. Do gentle stretches, three or four times a day, rather than powering your way through. Ease into new equipment such as standing desks. Stretch those newly challenged areas until your body adapts. Pay attention to your body, even though I too often forget mine. 12. Remember the children Kids are using equipment to play highly addictive games or to explore amazing software, and if these call for repetitive motions, children are being set up for future injuries. They’ll grab hold of something, as parents out there know, and play it 3,742 times. That afternoon. Perhaps by the time they are adults, everything will just be holograms and mind-reading, but adult fingers and hands are used for most things in life, not just computing devices and phones with keyboards sized for baby chipmunks. I’ll be watching you Quickly now, while I (possibly) have your attention. Don’t move a muscle. Is your neck tense? Are you unconsciously lifting your shoulders up? How long since you stopped staring at the screen? How bright is your screen? Are you slumping (c’mon now, ‘fess up) and inviting sciatica problems? Do you have to turn your hands at an angle relative to your wrist in order to type? Uh-oh. That’s a bad one. Your hands, wrists, and forearms should be one straight line while keyboarding. Future you is begging you to change your ways. Don’t let your #ThrowbackThursday in 2020 say, “Here’s a photo from when I used to be able to do so many wonderful things that I can’t do now.” And, whatever you do, don’t try for even a nanosecond to push through the pain, or the next thing you know, you’ll be an unpaid extra in The Expendables 7.