Managing Wrist Pain
I've had several friends who were forced to stop working in front of a computer. They ignored all the warning signs, until eventually the pain in their body became unbearable. I've been actively managing my own pain since 1997 because I really didn't want to repeat their mistakes. Most of the times I went to a doctor for help, the only advice I got was "spend less time in front of a computer". I wasn't impressed.
I use the phrase "wrist pain", even though hunching over a computer for years can cause pain nearly anywhere in your body. I do this because as far as I'm aware, all of the the other terms (RSI, OOS, carpal tunnel, etc) seem to be known only by certain people in certain countries. Despite being a misnomer, when you say "wrist pain" people understand what you are talking about.
The bottom line is that the only thing which is guaranteed to make your wrists hurt less is spending more time moving your body, and less time hunched over a computer. Anything which gets you away from your computer, and moving your body in a wide range of motion, will be a dramatic help. Movement acts as both a preventative and a source of healing. In addition to this, there are many other things which may help prevent pain and encourage healing.
This article is based on one I wrote in 2003 but updated with recent experiences. There is no guarantee that what worked for me will work the same way for you, but hopefully it will provide you with some good starting points for experimentation. Happy experimenting!
Please use your common sense, I am not a doctor.
Experiments
Exercise
I cannot overstate how big a difference regular exercise makes. The more active my lifestyle the better my body handles the abuse. I've found that Aikido and yoga make an especially huge difference. When I was at my worst, working really long days, I found that if I did Aikido three times a week, my body could take nearly any amount of work without complaining. When I had a lot of pain and a ganglion cyst in my wrist, six months of physical therapy and ultrasound only made it worse. Three months of yoga and the cyst was completely gone, and with it with most of my pain.
Just don't let it get really bad before you start or the first classes can be pretty unpleasant!
Take Regular Breaks
This is the only thing I've tried which made a huge and measurable difference almost immediately. I was never disciplined enough to force myself to take regular breaks, so it wasn't until I found micropause software, which could periodically lock me out of my computer, that this became an effective option for me. I messed around with the timing of pauses for a long time. When I had a lot of pain locking me out of my computer for one minute every 15 minutes worked very well. When I was healthier I used five seconds every five minutes and one minute ever hour. It's important that when the timer goes off, and you are locked out, that you sit up and stretch. Move your body, even if you don't get out of your chair. Shake your arms, twist your neck and look out the window. If you sit slouched in the same position, waiting for you computer to unlock, you aren't doing yourself any good.
Be prepared though, it's unbelievably annoying to have your work day broken up like this. For me though it was the difference between being able to work and not able to work. Also, make sure that you put it on all your computers. For a long time I resisted installing it on my laptop, which was a mistake.
Regular Massage
Weta Digital had a superb in house masseur. When we were working stupid hour weeks for months at a time, getting a weekly massage was the only reason I could continue to work. It is some of the the best money I've ever spent. Even if you're not lucky enough to have a masseur that comes to your workplace, find somebody and get to know them! Masseurs are a good safety check. A good one will let you know when your body is getting really tired, it is especially easy to miss the warning signs when you're stressed.
Ergonomic Keyboards
I never liked the cheap ergonomic keyboards, however Pixelworks purchased a Kinesis Contoured keyboard for me. The first week was massively frustrating as I relearned to touch type, but after that my typing speed improved quickly. I believe that it's made a small but consistent improvement, especially when managing my pain was a daily struggle, it really helped.
I got this keyboard in 2002 and I'm still using that same keyboard in 2011, they are build to last!
General Ergonomics
There's lots of ergonomic guidelines online (my Kinesis keyboard came with some excellent instructions). Following these guidelines helped me with general neck, back and shoulder pain. After working at a place that provides Aeron chairs I have admit that despite all the dotcom mockery, they are *amazing* chairs. If you can afford one, or can convince your work to buy one, I highly recommend them!
Posture
I've found that over the years of working in front of a keyboard my posture has become awful. I slouch in front of the computer, I slouch on the couch, I slouch when I eat. On the days which I pay attention to my posture at work, I feel a lot better at the end of the day. One thing that makes it easier to avoid hunching is to increase your font size so you can read comfortably from a distance. Getting a large monitor can also help dramatically, but only if you use it to make things bigger rather then jam more into once screen.
Standing Desks
Several people at Weta have standing desks and swear by them. I tried it for a few months and it didn't work very well for me. I found I was more inclined to end up slouched on my elbows then when I sit in a chair. I also got a tall chair so I could sit when required, but I ended up using it most of the time and it was a much worse chair than the Aeron.
Back at Earthlight I had a standing desk which was also the counter I did hardware repairs on. Being able to move seamlessly between responding to email and standing at the desk while pulling computers apart was wonderful. If I'm ever in a job like that again I think I'd go back to a standing desk and try and avoid a chair all together.
You can also buy "sit-stand" desks which are motorized and periodically move from a sitting height to a standing height. If ever my pain got really bad again I might try one of these. The forced movement and varied work position can only be a good thing.
Update Sep 2011: A new Cornell study shows that standing and sit-stand desks are ineffective. Sit to do computer work. Sit using a height-adjustable, downward titling keyboard tray for the best work posture, then every 20 minutes stand for 2 minutes AND MOVE. The absolute time isn't critical but about every 20-30 minutes take a posture break and move for a couple of minutes. Simply standing is insufficient. Movement is important to get blood circulation through the muscles. Research shows that you don't need to do vigorous exercise (e.g. jumping jacks) to get the benefits, just walking around is sufficient. So build in a pattern of creating greater movement variety in the workplace (e.g. walk to a printer, water fountain, stand for a meeting, take the stairs, walk around the floor, park a bit further away from the building each day).
Swiss Ball Chairs
Lots of people (including physiotherapists) think that using a Swiss Ball as your chair is a great technique because it makes it hard to slouch and you are constantly exercising your core muscles. Maybe I have super slouch abilities, but I found that I still managed to slouch on a Swiss Ball. I did like the constant movement though and would do this again. The only downside for me was that I got a really sore bum for the first few weeks.
Dr. John Sarno
I have several acquaintances who suffered horribly from wrist pain and found their salvation in Dr. Sarno's "mind body medicine". I discredited it for ages because I found the notion that my mind was inflicting the pain on my body due to unhappiness somewhat insulting. However after having the idea in my head for several years, I had to admit that it made a certain amount of sense. More importantly, I can actually track how bad my wrists are with how much I'm enjoying my job.
Alternate Keyboard Layouts
Dvorak, Colemak and Maltron layout of keyboards are supposed to help but I've never tried. I've never tried any of these because the idea of relearning to touch type isn't very appealing. Several friends have moved to Dvorak keyboards though and swear by it. These days I think I'd give the Colemak keyboard a try first but that's based more on impressions then actual research.
Trackballs
I never suffered from mouse arm, so this has never been a priority for me. Also from some of my reading trackballs are actually worse because they encourage movement even less then a mouse. However if mouse arm is your thing, it's worth a try.
Advice
The one great piece of advice I got from a doctor was when I asked "when do I need to get seriously worried about the pain in my wrists"? Her answer was "if the pain starts waking you up at night, then you need to do something drastic immediately". I've repeated this advice more times than I can count. While I have no idea how technically correct this is, it's been a very useful metric for me to gauge the seriousness of peoples pain. It also seems to make sense to people and has provided a stick for me to encourage employees to take their health seriously.
Sadly, other than that one wonderful piece of advice, all the rest of the doctors I've been to see have not be very helpful. If you are struggling with any form of pain which you think comes from sitting in front of a computer, my recommendation is that you need to take your health into your own hands. Research on the internet, talk to friends and associates about their experiences and experiment.
Remember the story about boiling a frog? We'll we're the same. Our brains are good at noticing sudden change, but not so good at noticing gradual change. Because this type of pain builds up gradually it's easy for it to get quite bad without realising it. The lesson is awareness and patience. Try and cultivate a routine where you check in with yourself once a day about how you are feeling, where do you hurt, how bad is it. Awareness is hardest, and especially important, when we are stressed so be careful.
Patience is important because we heal slowly. When you are experimenting, change one thing at a time and give it a few weeks to see if it makes a difference. It can be helpful to keep a journal as our memories can play tricks on us.
Coffee, tea, soda and juice are not water, and our bodies need water to heal. You don't need to go crazy, but try to drink water during the day. I find having a bottle of water on my desk makes it easy to sip when I'm thirsty without breaking my concentration.
Stress makes everything worse, one of the best tools we have against stress is meditation. I've found meditation to be an immensely rewarding practice. Find a teacher or a local sitting group and give it a try.
Anecdotes
After many years of managing pain, I ended up with my left wrist so bad that it wouldn't hold my weight and I'd get shooting pains up my arm from any sort of vibration. Months of going to doctors and hospitals, having X-rays, MRIs, ultrasound and physio only made it worse. The eventual diagnosis was a mixture of a ganglion cyst and tendonitis, and they all said there was nothing which could be done. I got on with my life but several years later I tried a yoga class. To my amazement, after three months of regular yoga, the cyst was completely gone, and with it the majority of the pain. I also found that, just like Aikido, regular yoga practice kept the pain away!
When I first started working at Weta, I was very apprehensive about the base 50 hour work week. I was having enough problems managing my wrists with a normal 40 hour work week. Surprisingly, I managed the 50+ hour weeks with very little problem, and after a few months realised that I hadn't even bothered to setup my micropause software. Eventually it caught up with me, but I managed lots more work with roughly equivalent symptoms. I've never been sure exactly what to credit with the difference, but my best guesses are desks with adjustable legs, the Aeron chairs, and having a job I enjoyed.
As a side note, if you are in New Zealand there is a local company called Formway which makes similarly adjustable chairs, for much less money. I don't personally like them quite as much as the Aeron, but they are better value for your dollar.