The idea is to have two waterproof (plastic storage boxes work fine) containers. Each one  should be just greater in length than the distance from your elbow to you finger tips. These should be filled with water to a depth enough to cover your arms when fully submerged.

One container should be ‘hot’ – not too hot.  ie. no greater than 40-45^oC (104-113^oF)

The other container should be ‘cold’ – cold tap water with a few ice cubes (or an ice cooler pack) in it to chill further to no lower than 10-15^oC (50-60^oF)

You will also need to have a clock or timer handy with seconds/minutes easily visible. A kitchen timer or stopwatch is good for this purpose.

The procedure is simple, and involves submerging your arms into the ‘hot’ bath for 1 minute, followed by submerging them for 1 minute in the ‘cold’ bath. Then repeat this switching between baths for 10 to 15 minutes (longer if desired).

You can repeat contrast baths a few times a day if necessary, but it may be impractical to do this at work. You could also increase the time from one minute in each bath to two minutes in each bath if found to be more effective.

This temperature cycling should help relax any stressed out muscles a bit, and give some immediate pain relief. At the peak of my RSI condition after coming home from work every night, I would do contrast baths to get some pain relief. Its a low cost and self administrable procedure that can help reduce RSI pain.

Please check with your health advisor first if you have diabetes, heart problems or Raynaud’s Syndrome before doing contrast baths so that they can determine whether it is advisable for you to proceed.

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The RSI pain cycle once ‘locked’ into is a hard one to break free from. The common mistake is to address only one or two factors. If the sufferer is at an early stage of RSI, and is fortunate then one change eg ergonomic setup may be enough to break free, but any medium/long term sufferer who is trapped in this cycle should consider addressing most/all of the underlying trigger causes to allow the transition to an RSI free life. The second diagram (click image to enlarge) shows the key areas to address to break the cycle.

You can also download the 2 diagrams in Breaking The RSI Pain Cycle (pdf)

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In a nutshell, it combines a fairly physical activity encompassing muscle and tendon stretches from your head to your toes, with core conditioning and balance practices. This is coupled with controlled breathing techniques to allow the participant to focus their mind on the present moment. As well as the physical practice, yoga teaches techniques to promote deep relaxation and the ability to clear everyday thoughts from the mind with meditation. This powerful combination really can address a lot of the factors that lead to conditions like RSI (primarily driven by the overused micro-movements of muscles and tendons coupled with bad ergonomics and stressful working conditions).

Yoga practice can

• stretch out abused and injured arm muscles and tendons that have been used in a very poor/restrictive motion for numerous hours
• stretch out your neck, spine, and shoulders which most likely will have also been in a bad posture for hours at work, and can be the sources of a lot of RSI conditions
• enhance the blood flow to fatigued muscles
• enhance overall strength and flexibility
• stretch out tight tendons
• promote relaxation
• promote calmness through meditation
• make the participant feel good about their health
• make the participant decidedly fitter

I have only relatively recently delved into yoga. For those of you who think it’s an activity for girls and hippies, I can assure you it isn’t! It’s really a great practice for everyone and there truly are no age or gender barriers. It can be quite physically involved, which I didn’t realise before I tried it out! I really wish I had started practising at an earlier stage in life while my RSI was not as bad as it is now, when it could perhaps have helped me to address my RSI condition during its early stages.

There are many different types of yoga class out there. The class I currently attend is based on Ashtanga Yoga, and is fairly physical. It involves many stretches (some quite challenging) interspersed with vinyasas* which are physical sequences or “flows” between each Yoga pose. A typical class goes for 1 to 1.5 hrs, and follows a sequence of

• Controlled breathing practice (relaxation, focus of breath and readying self for practice
• Sun salutations (sequences of vinyasas to warm body up with)
• Standing stretch/posture sequences interspersed with vinyasas
• Seated stretch/posture sequences with vinyasas
• Reclined stretch/posture sequences with vinyasas
• Relaxation/meditation.

I can honestly say the time goes by in a flash, and I always leave way more relaxed than before I arrived. It’s a great way to switch off from the working day. The Ashtanga class is fairly physical, and it may be a good idea for you to try to experience yoga at an easier pace first of all, and there are many classes to suit. You can also get many great yoga DVDs these days so you can try it out at home if you prefer (all you need is a yoga mat and motivation!), before jumping straight into a class. I do however recommend trying to aim for a physical version of yoga, since this is what will help you achieve core strength and conditioning, giving your muscles a helpful intensive stretch based workout, coupled with relaxation and the ability to refocus your mind.

It is perhaps the idea of channelling the hyperactivity of the mind into more useful positive energy and thoughts that is one of the key aspects of yoga. If we can control the over activity of our minds, we can achieve a positive state of mind and can face day to day stresses on a more even keel, ie. it can be adapted to many areas of your life. For example, are you perhaps over stressing a lot in the office? Then maybe a 20 min break away from your desk and a bit of controlled breathing and meditation can bring your mind back to a less stressful place, and begin to bring things into perspective, which can’t be a bad thing in these crazy busy lives we now lead now can it?

*”Vinyasa has since been thought of as a physically demanding practice, which can be successful at channelling the hyperactivity of … minds. This system can also be used as a vessel for helping calm ongoing chatter of the mind, reducing stress and teaching extroverted personalities to redirect their attention to their internal experience.” wikipedia

An article from the San Francisco Chronicle highlights the benefits of Yoga practice in the high tech industry.

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The common position for hands hovering above a keyboard is as shown on the right, which I refer to as the ‘claw’. This position elevates the tension in the aforementioned extensor muscles, causing them to become fatigued over prolonged periods of time. Typing whilst the hand/wrists are in this position (another common posture mistake) will further increase the muscle and tendon stresses making the situation worse.

What may not be so obvious is that moving the wrists into a more neutral ‘level’ position (see image) can still create enough continual tension in the forearm extensor muscles. This is not always apparent unless, like me, you already have a bad RSI condition and can notice the pain in already injured muscles.

This is a much better position than the ‘claw’, and the forearm extensors are far less tense. They are however still in tension which may lead to forearm extensor fatigue when held in this manner for long periods of time eg 6-8 hours a day hovering your hands over a keyboard at work.

The final image on the right shows a ‘hanging’ wrist position which, if adopted, places minimal stress on the forearm extensors, (they should in fact be relaxed in this position), and is a good posture to aim for when typing. You can then utilise the weight of your hands and fingers to type, lifting the arms from the shoulders and elbows instead of placing the burden on the forearm extensors and associated tendons.

You don’t even need to be at a keyboard to try out these different wrist angles. Just hold your hands in these positions for 2 minutes and observe the different tensions in the forearm extensor muscles. Start to imagine what it is like for your body to hold this tension for up to 8 hours a day at a computer, and ask yourself whether it may be more beneficial if you changed your posture to one that has far less muscle/tendon tension in it.

Note: In order to successfully utilise the ‘hanging’ wrist position you will most likely need an ergonomic computer set up with a drop down keyboard tray, perhaps even an adjustable position keyboard tray.

Related articles on forearm extensor muscles :

Typing with clawed hands

Forearm Extensor Muscle Overuse and RSI

Does forearm extensor trigger point massage offerer a potential cure for RSI?

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OK, so you are experiencing a long term RSI condition, ie it has gradually worsened for more than 2 years. You are in continual pain at work and find it difficult to do your job. You have perhaps gone through consultations with ergonomists, doctors, physiotherapists and just about anybody who’ll listen, but still you find no relief. You struggle to remember what it felt like not to associate pain with computer use. You may be wearing an arm brace (and probably have a large collection of them by now), and you probably have a sizeable collection of strange ergonomic mice at your computer that don’t seem to help. Your employer keeps expecting the same work output from you and you stress about how you can get through it. You get by by doing what you can, but generally come home each night from work and feel anxious about the situation and the searing pain down your arms. You wonder what you can do, and how you are supposed to live a normal life – you can’t remember what normal life was like before this injury!

So what are the options then? Well I remember a great bit of advice from my father (that’s what fathers are for after all). It was at the stage where I was still living in the US and wanted to return home. The prospect of a new computer intensive job and a new situation was looming, and I wondered how I’d cope because my injury was getting worse. The stress of the situation wasn’t helping either and changing countries of residence can be a very anxious time. I just wasn’t sure whether I could go on working with computers any more. I phoned my father and told him the situation, fully expecting him to tell me to stay with the job. I was, however, surprised when he said rather straightforwardly, “Well, you’ll need your arms and hands for everything else you decide do in life”. In other words, it wasn’t really an option to keep doing something that could ultimately make me any more disabled. I knew then that I had to consider doing something else.

Before coming to any radical decisions, I really strongly recommend trying to adopt all the suggestions in RSI – What to do? (Part 2 – RSI Dealing With Progressive Symptoms) in the majority of cases you will see improvements.

In addition I’d recommend -

• Eliminating as much computer interaction as possible at work, home and elsewhere
• Eliminate text messaging entirely
• Eliminate use of games consoles if you use them
• Get as physically fit as possible, go swimming
• Use meditative techniques to relax and ease the pain, maybe as part of a Yoga class
• De-stress your life wherever possible
• Get at least 8 hours of sleep a night
• Stick to core work hours – if you are in really bad, continual pain, consider medical leave
• Talk over options with your employer – there may be something else less computer intensive that they can find for you to do
• Find a good physiotherapist who can do deep tissue massage
• Find a RSI support group and share your experience with others. Hear what has worked for others and get free helpful advice
• Consider a career change – it’s tough to do and can be stressful in itself, but there are still jobs out there that don’t require computer use, or at the very least involve less computer use. I am now a self employed picture framer!

RSI conditions can be tricky to get rid of. I have been away from my computer intensive career for two years now, and I still have bad RSI symptoms. Interaction with a computer for 5-10 minutes can make it start to hurt badly, so these conditions are not easy to shake off. There is no ‘magic bullet’ to fix them.

Look after your arms and hands, remember you will need to use them in any new career you decide to take. Good luck with finding a solution that works for you.

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RSI symptoms are very often the result of extremely tight (overused) forearm extensor muscles. These muscles are located in the upper forearm region. They are used to raise the wrist and fingers, which is the primary motion involved in unergonomic keyboard and mouse driven activities such as having the hands bend backwards and fingers raised while hovering over a keyboard ready to type.

The tight and potentially knotted extensor muscles end up being over used, and don’t get the chance to recover. This leaves them in a permanently fatigued state, tightly tensioning the forearm tendons to which the extensor muscles are attached, causing referred pain down the tight tendons into the hands, wrist and fingers.

The forearm extensor muscles consist of five main muscles and are shown colour coded in their approximate position in the image above. The image is meant for indication only, and I recommend you search for a more detailed anatomical diagram for a more accurate placement.

The five forearm extensor muscles are -

1. Extensor carpus radialis longus which attaches to the index finger but controls bending of the wrist towards the thumb as well as bending the wrist back.
2. Extensor carpi radialis brevis which attaches to the middle finger and again controls the raising of the wrist.
3. Extensor digitorum which attaches to all four fingers of the hand but controls the straightening of the 3rd, 4th, 5th fingers.
4. Extensor carpi ulnarus which attaches to the 5th finger and is used to cock the wrist outwards, for example reaching for a far away key on a keyboard.
5. Extensor indicis attaches from not far behind the wrist to the index finger and is the primary control muscle of that finger.

The extensor muscles exist at different depths in the arm and some are hard to precisely locate.

Over use strains along any of these extensor muscles from bad ergonomic practices (like having a clawed wrist at a keyboard) can lead to them developing knots (solid tissue that is scarred). This scarring results in pain (to press on at the location of the knots) but is mainly noticeable as referred pain down the forearms into the back of the hands and fingers – which is a classic RSI symptom. The extensor muscles (apart from the extensor indicis)  attach to various bones around the elbow joint, and some pain symptoms can also be found close in to the attachment points.

You can do a check to see how fatigued your forearm extensor muscles are. Using your left hand to check your right forearm extensor muscles press down firmly with the thumb onto the full area of the various forearm extensor muscles, move the position of the thumb over these muscles and check for pain. Repeat the diagnosis with the left arm extensor muscles and your right thumb.

If you are in any doubt about what these muscles do, press your thumb on your arm as above and raise your wrist up as if you were about to type. Also raise and wiggle your fingers. With your thumb, you should be able to feel the various extensor muscles tightening as your wrist and fingers raise.

If you find the extensor muscles to be in pain with the above procedure then these muscles are fatigued. It also means that ergonomically, you are not using your keyboard properly and are probably typing using the claw, which causes this type of problem. This type of condition is one of the most common mechanisms for RSI pain, but can easily be addressed by changing the way you type.

If you are experiencing pain in these muscles, it is time to try to relieve them which can be done by massage, icing and rest. Consult your doctor or a trained physiotherapist to find out the best techniques which may include ultrasound. You should also read my post about Trigger Point  Therapy on extensor forearm muscles which describes my findings from an excellent book for self help in RSI diagnosis and massage techniques. You may also want to try to find a knowledgeable Trigger Point massage therapist.

It is also time to re-assess your typing technique otherwise you may be placing yourself at risk of an RSI type condition. This may send the forearm extensor muscles into a more permanently fatigued state, from which recovery may be difficult, and in some extreme cases may be impossible.

In my own case, forearm muscle fatigue is the primary mechanism for my RSI pain. Unfortunately for me, I learned of the prevention techniques several years after my symptoms began, when these symptoms had already become more persistent.  I do however still get some much needed temporary pain relief these days from massage of the forearm extensor muscles and tendons, just not very long  lasting , but my injury is after all a long term one.

Related articles on forearm extensor muscles :

Typing with clawed hands

Forearm extensor muscle overuse wrist position and RSI

Does forearm extensor trigger point massage offerer a potential cure for RSI?

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The following is relevant if you have been experiencing RSI symptoms for a few months and they are now persistent in nature.

The rate of success in dealing with RSI symptoms is proportional to the speed that a sufferer can diagnose the causes of those symptoms, and their understanding of the corrective actions required to avoid further injury.

The onset time for RSI injuries can be fairly rapid (in my own case I went from having initial symptoms to intermediate symptoms within 3 to 4 months. It is therefore vital that sufferers glean RSI knowledge as fast as possible, try to understand the causes of their symptoms, and make the necessary adjustments to their working practices.

So the scenario for this article is of a worker who has had RSI symptoms for a few months, and is experiencing any of the following -

• wrist, arm, hand, finger, wrists, shoulders, neck pain
• numbness of fingers, back of hands, wrists, thumbs
• swelling of arm, hand tissues

on a regular basis and predominantly after working with computers. Typically, you may be regularly coming home after a day at work, with one or more of the above symptoms. You may or may not have reported the injury to your employer, and you may or may not have consulted a your doctor about your symptoms. You may also have decided to keep the injury to yourself in the hope that it would go away, and that you would not have to disclose it to your employer.

The danger to you at this stage is that by letting the condition(s) go unchecked for a few months you have made the RSI injury more difficult to get rid of. However there is still hope that your condition can be diagnosed, addressed, relieved, and ultimately cured. It may however involve making several radical adjustments in your life.

You have to continue to believe that there is still a lot you can do to help yourself.

Progressive Symptoms of a computer (over)use RSI condition

Progressive RSI symptoms can be varied, this is because RSI is a collective term for a number of different musculoskeletal conditions.

Progressive symptoms will be similar to those described in the Initial Symptoms Article but will be more persistent in nature ie. you may be coming home every night after work and experiencing some of the following -

• tingling/numbness in back of fingers, thumb, hands
• sore (fatigued) arm muscles including upper forearm
• sharp pains in joints or wrists
• sore shoulder /neck
• coldness of hands
• loss of strength in hands/arms
• abnormal swelling on parts of the arms and hands

What to do?

Since you have been experiencing RSI symptoms for a while, you need to try to urgently diagnose the mechanisms causing your pain to occur before they get more permanent, and try to make the adjustments to your working practice to reduce or eliminate the factors that are causing you pain. You still have a great chance to get rid of these symptoms with a little research and modifications to lifestyle, but it will take a more dedicated effort on your part to make those changes happen.

The following are some general recommendations to counteract progressing RSI symptoms -

• Follow through on the recommendations in my Initial Symptoms Article
• If you havn’t done so already , alert your own doctor, employer and company doctor about your symptoms,
  take on board any recommendations and if they advise you to take time off work to rest, do so.
• If you havn’t done so already, get an ergonomic consultation (it’s never too late for one of these), and listen to everything that the Ergonomist recommends and try to adjust your practices accordingly. This may mean changes to your desk, chair, keyboard, mouse/input device, or adjustments of your posture or other working practices.
• read up on some common causes of RSI conditions such as my articles on typing with clawed hands, and lateral wrist deviation, and work had to eliminate these bad habits from your working practice.
• consider using different input devices. At this stage, you need to be trying out a variety of them to find out which ones are less uncomfortable for you to use.
• Try click generating software (if your injury is mouse use related)
• Cut down on mouse usage by learning keyboard shortcuts for your O/S or software package
• Try voice recognition software if you type a lot of text documents.
• You need to eliminate all non-essential interaction with computers and computer like devices including organisers and mobile phone messaging.
• Eliminate or severely restrict use of home computers.
• Eliminate all video game use including games consoles.
• If you have a hobby that aggrivates an RSI eg Piano playing, reduce practice for a while to help your RSI heal.
• You must take up a physical pastime that exercises your musculoskeletal structure in a fluid, healthy way. I would recommend anything that gets you away from a desk/chair and doing non-stress movements. Swimming is an ideal low impact fluid motion activity. Try looking into Yoga, it has a very good fluid movements/methods for stretching muscles and tendons in a healthy way, whilst promoting relaxation (it also actually can get you fit, and no, it’s not just for girls!). Physical pastimes are also very good for getting your mind ‘into the moment’ of what you are doing (the physical exercise) and away from stressful every day factors (work, injury symptoms, other problems in life etc), and can help break the negative thought cycle that can accompany persistent injuries. Other sporting activities can be good, but they should be avoided if they worsen your symptoms. Physical pastimes are also good for getting blood circulating around your body, and blood circulation helps heal fatigued muscle tissue.
• If you are still working on a computer you should be taking a minimum of 5 minutes rest and stretch breaks every 30 minutes, even if your symptoms start to feel better. Install a take a break reminder to remind yourself to take breaks. Get up and walk around for a break, don’t take a break surfing the web!
• Take all company allowed breaks including tea and lunch breaks. If you work in an office, leave your desk. If you have hour long lunch breaks, get away from the office environment completely.
• Research and obtain a good stretching routine, to stretch out muscles of the forearms, upper arms, shoulder and neck, as well as the wrist and hand tendons. Consult a Physiotherapist for the best stretches for your condition.
• Use pain reduction techniques, like hot/cold contrast baths, physical therapy (ultrasound, massage etc), TENS machine, or a hand held heat massager.
• Keep hydrated.
• Adopt a healthy diet.
• Take measures to de-stress your life
• Consider getting your back structure analysed by a Chiropractor or Osteopath for potential problems.
• Research your problem extensively, learn as much as you can, and consult as many doctors, physiotherapists and specialists as you can. Knowledge about these conditions can vary widely in the medical community.
• Find out fellow sufferers though internet forums, or even your own workplace to share learnings. It is often very beneficial to learn from what other sufferers have gone through.
• Don’t take painkillers and continue to work as before. Painkillers will just mask the symptoms (pain) whilst allowing you to continue to worsen the problem and can lead to further worsening of your injury!

Keep in mind that very rarely is there a ‘magic bullet’ fix for RSI type conditions. Usually, a combination of factors have lead you to experience RSI pain, and it is up to you use every resource that you can to identify as many of these as possible, make changes to your lifestyle and work practices that can reduce and ultimately eliminate your RSI symptoms.

By this time you should need no further motivation to address your RSI symptoms. The main driving factor now being to avoid your injury worsening and potentially becoming a permanent disability (like mine has), which can ultimately have disastrous consequences to your career!

In Part 3 I discuss dealing with a long term (2 years or more) RSI condition.

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The danger with this is that, if symptoms are left unchecked, it can lead to their rapid worsening and the long march to a more debilitating (and difficult to treat) condition.

This need not be the case. There is a lot you can do at this early stage of RSI symptoms to help yourself.

Initial Symptoms of a computer (over)use RSI condition

Initial RSI symptoms can be varied, this is because RSI is a collective term for a number of different musculoskeletal conditions.

Symptoms can include (but are not limited to) the following -

• tingling/numbness in back of fingers, thumb, hands
• sore (fatigued) arm muscles including upper forearm
• sharp pains in joints or wrists
• sore shoulder /neck
• coldness of hands
• loss of strength in hands/arms
• abnormal swelling on parts of the arms and hands

What to do?

The first thing to remember is don’t panic. The fact that you have diagnosed a problem at this early stage is a good thing. You have a great chance, with a little research and modifications to lifestyle, to get rid of these symptoms. The following are general recommendations to counteract initial RSI symptoms -

• Stop doing the task that is causing you to experience the symptoms (remember, the symptoms you are experiencing are your body’s way of sending a signal that something that you are doing is wrong and letting you know that you need to do the task differently or make adjustments to your working practice)
• Research and analyse specifically what is causing the symptoms to occur
• Go on a ergonomics awareness course
• Obtain an assessment by a professional ergonomist who will advise you about posture, techniques of correcting bad posture, and the possibility of a change in equipment (eg chair, desk, keyboard height etc)
• Listen to what the ergonomist says and try to implement any changes they recommend
• Maximise rest time away from the keyboard (avoid surfing during break time, eliminate home computer use etc)
• Keep in mind that this period of time is the best stage to stop the injury worsening, so it’s also the best time to rest too!
• Consult your doctor or company doctor about the symptoms
• Try to make changes to your working practice or daily life to reduce exposure to other computer/keypad/mouse devices including laptops, organisers and texting on mobile phones etc
• Take frequent rest breaks when you have to use a computer
• Keep well hydrated
• Consider physical therapy
• Develop a habit of doing stretching exercises on the affected limbs (consult a physiotherapist for recommendations)
• Consider a low impact physical fitness program like swimming, yoga, tai chi
• Don’t take painkillers and continue to work as before. Painkillers will just mask the symptoms (pain) whilst allowing you to continue to worsen the problem and can lead to further injury!

The key to dealing with initial RSI symptoms is don’t ignore them however slight they are. Even slight pain is your body’s way of telling you that you are not doing something correctly, and that you urgently need to make changes to your working practice before the symptoms get worse.

In Part 2 I discuss dealing with progressive, lingering RSI symptoms.

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The biggest problem with the invention of the mouse, and for that matter all current GUI based computer systems, is that they force a user to do a very repetitive motion that had up until their invention not been done before, ie the repetitive small movement of the index fingers to send a ‘click’ to the computer to say ‘do this’. Sometimes this repetitive task can be very intensive (depending on the application being used). This has over the last 15 years or so led to a large increase in cases of Repetitive Strain Injuries (RSI).

So what alternatives to standard mouse ‘clicking’ exist right now for the computer user? (Note: the following is by no means an exhaustive list)

• keyboard short cuts
• voice recognition software
• foot pedal clicking
• graphics tablet/tablet PC pen “taps”
• software generated clicks
• touch screen monitors

Each of the above have their own set of positive as well as negative points. The following is a brief summary of what I’ve found from my experiences with each of them -

• Keyboard shortcuts -these are quick access (single or combination) keyboard strokes which activate a command without moving (or clicking) a mouse and can greatly reduce the amount of mouse use required to do certain tasks. There are keyboard shortcuts available for most of the operating system versions around including Windows (9x, 2000, XP, Vista), Linux (KDE, Gnome) and Mac, as well as most of the applications that run on these operating systems. I have indeed found many keyboard shortcuts to boost my efficiency when using some software applications. Indeed without these shortcuts I would have been only 50% as productive at my job as I was! However the biggest limitations to keyboard shortcuts are as follows -
  • They are not well publicised, and as such there is a general ignorance out there as to their existence
  • The shortcuts may be common in a certain operating system, but not always transferable from one platform to another.They are rarely common across applications apart from very common tasks eg copy and paste etc.
  • A lot of applications could be more productive if more of their menu commands were available as keyboard shortcuts
  • There is a lack of ability for a user to customise the shortcuts in these applications.
  • You often have to continue to click a button to activate things, eg hit ‘return’ key or mouse click.
  • You still have to use your hands on the keyboard
  • Keyboard short cuts themselves are also repetitive in nature, and can cause RSI conditions in their own right.

• Voice recognition software – In my own experience, voice control software has always had great potential for relief of over-used arm and hand muscles, however, the effort involved in learning how to use the software, ie teaching the software to recognise your voice is a soul destroying and often futile task (I have had a lot of frustration in my numerous attempts!). Unless someone comes up with a version for a low toned, Scottish speaker, I see it as of little practical use to me personally. The last thing you want to do around an office is talk in a loud distinct and clear voice anyway! You will start to get strange looks from your co-workers!
• Foot pedal clicking is certainly a viable option. There are a few foot controlled ‘mice’ out there. Whilst I can’t be enthusiastic about mouse movement control with a foot mouse (my ankles started to hurt when I tried this motion), the clicking action could easily be done by foot, although double click timing could be an issue.

• Graphics tablets/tablet PCs – these input devices give the user an option to use a special pressure sensitive pen to move about a ‘tablet’ surface. This action is akin to holding a pencil whilst writing. This a relatively natural position which we have been used to ever since we learned to write. The clicking action is either controlled by clickable switches on the side of the ‘pen’ or by ‘tapping’ the pen tip against the tablet. This is indeed a complete change from standard mouse clicking action, but still involves many small repetitive movements (mainly wrist based) for clicking, coupled with a tight grip holding onto the pen. I also find the tablet surface (and edge) itself to be a cold and hard surface to rest my hand, wrist and arm upon. They can also take a bit of getting used to. Personally, as an RSI sufferer, I found the wrist motion to control the pen taps to be too painful to use on a regular basis. My injury may well have progressed too much by this stage, and the continual need to grip the pen also didn’t work for me. It may, however, be a viable alternative to a mouse for many other computer users.
• Software generated ‘clicks’ – This method has intrigued me for a long time. There is software available that can be used to generate a mouse click. The trigger for a click is the movement of the mouse followed by the stopping of the movement for a pre-determined time. This is usually indicative of the user hovering the cursor over a button etc that needs a click to activate. The software can be user controlled to send left, right, centre, double etc mouse clicks, which can be an absolute life-saver for some RSI sufferers (myself included). One such piece of software available (for free!) is ‘Point-N-Click‘ by Polital Enterprises. The use of this type of software is great for certain types of common applications eg web surfing. They can of course detect an unintentional mouse movement and send an unintentional ‘click’. This is often not important, but can have implications if, for example, you accidentally send out a mail message to someone prematurely (as I have done). Fortunately, there are sensitivity and delay controls available to tailor the software’s response to your individual needs. ‘Point-N-Click’ also has a built in “take a break” reminder alarm, which is very useful. Even better, the software is currently free, so you can try it out for nothing!
  Alternative mouse click generation software are ‘Nib‘ (formerly free software called mousetool) by Designer Appliances, and ‘Gentle Mouse‘. Neither of them are free, however you can evaluate both with time limited demo versions. Gentle Mouse has the added benefit of not sending clicks until you move the mouse a second time to choose either left or right clicks, the advantage being the reduction in the number of erroneous clicks you send.
• Touch screen monitors – I have not yet experienced a touch screen monitor. They certainly may be a very usable option for an RSI sufferer. I personally still feel that I’d be tapping my fingers against a surface yet again, which for me would still most likely lead to pain. It could, however, be a viable solution for many computer users out there, and looks like a promising development in computer input devices.

As is often the case, there may not be a single solution to combat RSI. It may be more sensible for an individual to choose a few different methods of control, and switch between using them. The key thing is to avoid doing any one repetitive action all of the time.

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