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.

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The symptoms have been described by a few physicians to me as tennis elbow like in nature. The tight and spasming extensor muscles and tendons 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 and fingers.

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 upper forearm extensor muscles (see image below), move the position of the thumb slightly 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 your 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. 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 permanent. To this day I still have not been able to understand what condition these misused muscles are in, but I suspect permanent damage. 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 lasting , but my injury is after all a long term one.

See also my other article on forearm extensor muscle overuse and wrist positions.

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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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Having been an RSI sufferer for the best part of a decade, and having come from an identical background to my colleagues (and no doubt had been prone to thumping keyboards in my time), I fully realised the implications of the use of excessive force as people interacted with their keyboards.

Keyboard thumping (the act of hitting the keyboard keys with exaggerated force or heavy pounding) can be barely noticed by the user, but is usually attributable to them being overly frustrated with the computer/piece of software being used or or emotionally involved with an angry ‘flame’ mail etc. During these times it is not unusual for this anger and stress to build up and be vented in this way. There is really no place for emotional frustration and computer use. Your body needs to be ergonomically positioned, relaxed and fluid when interacting with computers in order to minimise the exposure to RSI causing effects, and not demonstrating emotional reactions like the guy below!

Click here to view the embedded video.

In reality the keyboard (although it may well be suffering long term wear and tear from such actions) isn’t what’s ultimately paying the price, it’s the user’s health in the form of forearm/wrist/hand tendons/muscles, coupled with joint impact, especially if this behaviour becomes habitual.

The best approach for users when frustration and anger creeps into computer use, is to take a break (mental as well as physical), go cool off somewhere and let the emotions settle down. Rarely are any problems solved by emotional responses to computers or for that matter ‘flame’ emails, and ultimately you need to be aware that you are risking your health if you do. Try to recognise when you exert heavy pressure on keyboards, ask yourself why you are doing it, and if the cause is anger or frustration, go take a break.

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