my wrists and welcome to them

my wrists and welcome to them.
© 1999 Jamie Zawinski <jwz@jwz.org>

For several years I had pretty severe wrist pain, and it terrified me. I had these visions of me with withered stumps at the ends of my arms, trying to limp along using speech-recognition software, and my career being over.

These days my wrists are pretty much fine. People often ask me how I dealt with it, so I thought I might as well write it up.

First, if you are experiencing pain while typing, do something about it. This is incredibly important: this is not one of those problems that will just go away on its own. It will only get worse. And it will get worse.

Most hand/wrist problems are not really ``carpal tunnel syndrome'', that's a specific kind of ailment, and there are many others. Carpal tunnel syndrome is when there is pressure on the median nerve in your wrist (the channel it passes through on the way from your forearm to your palm is called the ``carpal tunnel.'') Much more common is tendonitis, which is when the various tendons in the arm, hand, and fingers become inflamed and swell. (Tendons attach muscle to bone.) It's extremely common for problems that cause wrist pain to not actually be in the wrist at all, but in the shoulders, neck, or back, and they are certainly exacerbated by crappy keyboards and bad posture.

But one thing is for certain: Do not fuck around. If you are experiencing any kind of pain, get to a doctor and get it diagnosed.

Pain is a signal that something is wrong, and is going to get worse if you don't fix it. It doesn't matter what that something is, you need to do something about it or you run the risk of permanently damaging your body.

The first thing you should do is read the Typing Injury FAQ. It's a wonderful document, full of very useful information.

But enough about you, let's talk about me. There was a period where my wrist pain was bad enough that I was unable to type for weeks. It was terrifying. I'm basically all better now, and here are the tools I used:

Acupuncture:
I went twice-weekly for a few months, then weekly or bi-weekly for a few more months. It took a few weeks before I saw any improvement, but then I saw a sudden improvement, and a steady increase, until it levelled off and stopped helping beyond a certain point.
Since you're probably wondering, no, it doesn't hurt. It feels very, very strange, but not unpleasant, and not at all like being stuck with needles. It feels more like mild electric shocks, or like a very low-grade version of bumping your funny-bone.
Chiropractor:
After I stopped seeing improvement from acupuncture, I started seeing a chiropractor, who also practices kinesiology. I saw her weekly at first, then monthly. I did this for a couple of years.
What chiropractors do, basically, is align your joints manually. The idea is that if your back or neck are out of whack, they are going to throw the rest of your body out of whack and cause problems elsewhere, as your body tries to compensate. These problems might be through simple mechanical stresses, or through pressure on your nerves.
Kinesiology is a related practice; it's a diagnostic technique based on observing various tensions in your body through touch. Chiropractors who use kinesiology are using massage-like techniques, the theory being that, if your back is out, and the doctor just jams it back into place, it's probably just going to go out again (because it probably went out in the first place because of muscle tension.) Whereas, if you relax the muscles first, then move the bones around, your body won't fight you.
If you search around on the web, you'll find that some practitioners of both Chiropractic and Kinesiology make all kinds of hard-to-understand and harder-to-believe pseudo-scientific claims, but I haven't encountered that side of things first-hand.
Get a keyboard timer:
I run a keyboard timer program religiously, and obey it. I have mine configured to start nagging me to take a five minute break after I've been typing for forty minutes. When I was experiencing pain, I was taking breaks every twenty minutes instead. The timer I use is called xwrits (yes, it's really spelled that way.) It's quite nice. The longer you ignore it, the more irritating it gets, which is very helpful.
Get out of the chair:
When the keyboard timer goes off, I don't just sit there and wait it out, I get up and walk around the room. I also do the usual recommended stretching exercises (again, go read the Typing Injury FAQ -- really. Go read it now. There is a ton of information in there.)
When it hurts, stop typing:
Yes, what you're doing is of earth-shattering importance, and it has to be done tonight, but think what your life is going to be like if you can't type at all. I have friends this has happened to. You seriously do not want to go there.
Get a better keyboard:
Despite the source, I'm a big fan of the Microsoft Natural keyboard (around $80), and used it for years.
I spent a couple of days trying out the Kinesis Contour keyboard (the one where the keys are down inside of two ``bowls.'') Lots of people seem to rave about that keyboard, but I just couldn't get used to it. I found it very uncomfortable, I felt like it was making my hands actually cramp.
For the last six months or so, I've been using the Interfaces by Cramer keyboard ($400), and I love it. This keyboard is a thing of wonder: it's basically a keyboard that has been cut in half, and you mount each half of the keyboard on the arms of your chair, so that you can type with your hands at your sides rather than on your desk. I also find that this makes it much easier to type while sitting in the chair properly: I tend to sit up straight instead of hunching forward.
The only complaint I have about the keyboard itself is that it only comes in a track-pad model (no track-point) and there are only two mouse buttons (I prefer three.)
As far as using it goes, it only took me a few hours to get used to it, and about a day to be back to my normal typing speed. However, if you don't touch-type, you'll have a problem. I've discovered that I never learned to touch-type the top row (numbers and symbols) so that tends to slow me down a little.
Get a better chair:
My favorite is the Herman-Miller Aeron (around $800). You might think that's a lot of money for a chair, but not when you take into account how many hours your ass is going to be parked into it, and that it's your health we're talking about here.
If you work for an employer with a decent HR department, they'll buy this stuff for you if you complain about pain. Why? Because if something really goes wrong with your body, they don't want to hear the words ``worker's compensation'' or ``work-related injury'' or ``law suit,'' so they will do what they can to help you avoid these things.
Set up your chair/desk properly:
This is pretty basic, but it really does help: make sure your chair is adjusted at the right height for your desk, and that your chair's armrests are adjusted for you, and so on.
It's all about posture. Keep in mind that it doesn't matter how well your work area is set up if you're still sitting funny: I often found myself perching or kneeling in my chair, or sitting on one or both legs, even though it seemed like it was set up right. Somehow it just wasn't comfortable to sit upright, and I would sit in odd positions. Eventually I found a solution: a foot-rest. (I have a plastic one, but a couple of phonebooks on the floor would do as well.) It turned out that when my chair was at the right height for my arms to approach the desk and keyboard from the right angle, my feet weren't resting flat on the floor. Once I put something down there to rest my feet on, I started sitting properly.
Also, if your office is cold, keep your hands warm (e.g., fingerless gloves.) Circulation is important, and when your hands are cold, the blood vessels constrict.
Exercise:
For me, it's bicycling. If you're generally healthy, your body repairs itself more readily. No really, it's true. You need to get off your ass, or your body will malfunction far more often.

So I was lucky, and it turned out that my pain was from mild tendonitis, and muscle tension in my hands, which was in turn caused by neck and back tension resulting from poor ergonomics, lack of sleep, lack of exercise, stress, and just too damned much typing. These things heal if you treat them early enough.

Why did I do acupuncture? Well, I tend to place more faith in Eastern medicine than Western for things like this, both because you tend to get more personalized care (your HMO is going to misdiagnose you and put you on the wrong assembly line) and because the holistic approach just makes more sense to me -- your body is good at healing itself, if its healthy. You need someone who is going to look at the big picture. It's easy for their terminology to scare you away, with talk of Qi flowing and being blocked and so on, since we know that's not really what's going on, but look at it this way: Newtonian mechanics isn't really what's going on either, but it's a model, and it works really well almost all the time.

But there is a lot of empty-headed new-agey snake-oil out there, too, as any web search on these topics will reveal. Skepticism is also healthy.

But whatever: if you go the Western route, and are lucky enough to be diagnosed properly, what will happen is that you'll end up seeing a physical therapist for a few hours a week, doing all kinds of exercises to strengthen the parts of your body that have been taking a beating (wrists, back, neck, whatever it happens to be.) That will work too.

However, another argument in favor of acupuncture is that the other sort of physical therapy hurts, not to mention is much more time-consuming.

I know folks who have done both. Do what you're comfortable with.

Some people will tell you that mice are the root of all evil, and that the key to avoiding wrist pain is to stop using the mouse and learn to use keyboard equivalents for everything. Well, in my case, I found it to be just the opposite. I used to be one of those people who never used a mouse unless absolutely necessary; now I use the mouse as much as possible. (It's the act of switching back and forth between the mouse and keyboard that you want to minimize, for efficiency.)

This is a very personal thing, it depends on your body, your chair, your keyboard, your usage patterns, all kinds of things. There's no one source of the problem, and no one quick fix. What works for you won't work for everybody.

Some random other bits of advice; your mileage may vary:

Beware of wrist braces.
A lot of people try to self-diagnose themselves, and will pick up a cheap set of wrist braces at a drug store and just wear those while typing. Wrist braces can help, but they can also do even more damage. You shouldn't wear them for too long. What they're good for is providing relief to stressed-out muscles and inflamed tissues (removing weight and letting them relax). Sometimes doctors will prescribe that you wear them to bed, to prevent you from sleeping with your wrists all torqued out under your body with the circulation cut off. But, if you wear them for too long, your muscles will just atrophy, and your problems will get worse. There's a balance between overworking a muscle and not using it at all.
Beware of keyboard pads.
Remember, you're not supposed to be resting your hands/arms on the desk at all while you're using the keyboard or mouse. A padded surface might just be making it more comfortable for you to type improperly.
Your keyboard has two Shift keys for a reason.
Learn to use them! Use the opposite hand for chording. For example, if you type Shift-A, your right hand should shift and your left hand should do the A. If you do it all with your left hand, you're going to be crunching your hand up into a funny position.
Try remapping your keys.
It's complete lunacy that modern keyboards give up choice real-estate to the Caps-Lock key, while tucking a tiny control key away in the bottom left. If you use Control more than Caps, swap them.

The bottom line is, don't ignore the pain, do something about it. I've had friends damage themselves permanently. (For example, read about Ben Wing's struggles.) If it hurts, find out why, and do something about it!

Good luck...