Typing Made Easy By Saurabh Activation Key

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Repetitive Strain Injury (RSI) is a potentially debilitating condition resulting from overusing the hands to perform a repetitive task, such as typing, clicking a mouse, or writing. Anyone who uses a computer regularly is at risk and should know about RSI. Unfortunately, most people are uninformed and do not understand what RSI is or how serious it can be. This webpage is intended to educate computer users about RSI, and to provide useful suggestions for prevention and treatment. Much of the information provided here is also relevant for RSIs derived from other activities such as playing an instrument, gaming, or any other repetitive task. The page additionally contains a few specific pieces of advice for students.

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Type Fu and Master Key both include lessons for the Dvorak keyboard layout, which is the second most popular type of English keyboard. Licensing & installs If you plan to use your typing software on a single computer, there’s no need to stress over licences and installs.

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  1. Quickly learn the correct finger-to-key positioning and begin typing without looking at the keys. Includes positioning for standard keyboards, split keyboards & the 10-key numeric keypad.
  2. Instead, move your whole hand and use your index or middle finger to press the key. Don't use one hand when you need to hit two keys simultaneously, e.g. CTRL-X, SHIFT-Y. Think before you type: unnecessary retyping/editting can add up. Use a light touch when typing: don't pound the keys.
  3. Mavis Beacon Free. Mavis Beacon Teaches Typing is the best typing tutor ever made. With improve user interface, updated learning tools, and ever more features makes it the most comprehensive typing tutor that guarantee typing improvements in a very short time. Whether you want to learn essential keyboarding skills or improve overall.
  4. Here is a method by which you can easily find the serial key of any software on the internet. Mostly these are third-party software. And the product key is in turn paid for by the user, and at the end of the day, the software is freeware only for few days. But there is a method by which you can use this software for free.

This webpage was written and is maintained by Clay Scott. I have formatted the site as a single page in order to minimize clicking, and so that you can easily print the page if you prefer. You may feel free to contact me if you have questions that I might be able to answer (email preferred)). I have been living with RSI since 1997.

Disclaimer: I am not a medical doctor, and have no medical training. While every attempt is made to keep this page up-to-date with the best medical advice I have received, it is not a substitute for obtaining professional medical advice, diagnosis, or treatment.

Last modified Sept. 28, 2020.

What is RSI?If you develop RSI

(Adapted from Repetitive Strain Injuryby Dr. Emil Pascarelli and Deborah Quilter)

In simple medical terms, repetitive strain injury (RSI) isdefined as a cumulative trauma disorder (CTD) stemming fromprolonged repetitive, forceful, or awkward hand movements. Theresult is damage to muscles, tendons, and nerves of the neck,shoulder, forearm, and hand, which can cause pain, weakness,numbness, or impairment of motor control.

You may wonder how seemingly innocuous activities such astyping and clicking a mouse button could possibly be harmful.Fine hand movements, repeated hour after hour, day after day,thousands upon thousands of times, eventually strain the musclesand tendons of the forearms, wrists, and fingers, causingmicroscopic tears. Injured muscles tend to contract, decreasingthe range of motion necessary for stress free work. The sheathsthat cover delicate tendons run out of lubrication because theyaren't given time to rest, so tendon and sheath chafe, resultingin pain. Due to this abrasion, tendons become inflamed, and beginto pinch neighboring nerves. This can result in numbness,tingling, or hypersensitivity to touch. Unless this cycle isinterrupted, it repeats itself over and over, and a long-term,chronic problem results.

Repetitive strain injury can affect more than just your handsand wrists. Poor posture can lead to severe neck and backinjuries. Staring at a computer screen can lead to eye strain.Repetitive reaching for a mouse can lead to arm and neck strainas well as spinal asymmetry.

RSI is not a specific medical diagnosis, but rather a familyof disorders. Many people mistakenly equate RSI with carpaltunnel syndrome, even though CTS is only one particular form ofRSI. One recent study even reported that frequent computer usersare no more likely to develop CTS than non-computer users. Don'tlet this mislead you, though. Many other forms of RSI do come onas a result of frequent computer use.

Who is at risk?

The three primary risk factorsare poor posture, poor technique, and overuse.These topics are discussed in depth in the section on prevention. In addition to these, thereare several other risk factors to be aware of. While they may notcause RSI on their own, they can increase your risk if youalready possess one of the three primary risk factors. Thefollowing list (adapted from Pascarelli andQuilter) lists several risk factors. You may be at risk fordeveloping an RSI if you:

  • Have poor posture
  • Have poor technique
  • Use a computer more than two to four hours a day
  • Have a job that requires constant computer use, especially heavy input
  • Don't take frequent breaks
  • Are loose-jointed
  • Don't exercise regularly
  • Work in a high-pressure environment
  • Have arthritis, diabetes, or another serious medical condition
  • Keep your fingernails long
  • Have an unhealthy, stressful, or sedentary lifestyle
  • Weigh more than you should
  • Don't sleep well
  • Are afraid to ask for better accommodations
  • Won't accept that you are at risk when you really are

Consult Pascarelli and Quilter for furtherinformation.

What are the symptoms of RSI?

The primary warning sign of RSI is pain in the upperextremities (fingers, palms, wrists, forearms, shoulders). Thepain may be burning, aching, or shooting. It could be local(e.g., fingertips) or diffuse (e.g., the entire forearm). Thepain will typically be increased after a long session of computeruse. Keep in mind, however, you can have severe RSI withoutexperiencing pain. The following checklist (adapted from Pascarelli and Quilter), can help you determinewhether you have RSI:

Do you experience:

  • Fatigue or lack of endurance?
  • Weakness in the hands or forearms?
  • Tingling, numbness, or loss of sensation?
  • Heaviness: Do your hands feel like dead weight?
  • Clumsiness: Do you keep dropping things?
  • Lack of strength in your hands? Is it harder to open jars? Cut vegetables?
  • Lack of control or coordination?
  • Chronically cold hands?
  • Heightened awareness? Just being slightly more aware of a body part can be a clue that something is wrong.
  • Hypersensitivity?
  • Frequent self-massage (subconsciously)?
  • Sympathy pains? Do your hands hurt when someone else talks about their hand pain?

In addition to these symptoms, RSI can also lead to behavioralchanges. You may not even be aware of these changes. For example,do you:

  • Avoid using the injured hand?
  • Use your nondominant hand more frequently?
  • Use your forearm, feet, or shoulder to open doors?
  • Avoid wearing or buying certain kinds of clothing because it is too difficult to put them on?
  • Change shopping habits because you can't carry as much as you once could?
  • Keep dropping things?
  • Find you can't chop food?
  • Not play sports you once enjoyed?
  • Have trouble hooking bras or putting on jewelry?
  • Not wear bracelets because your wrists are tender?
  • Have trouble with keys or brushing teeth?
  • Feel overly protective of your hands?

Repercusions of RSI

If you develop RSI, and do not take steps to correct theproblem, there may be serious repercussions. When my RSI was atits worst, I was unable to open doors, prepare my own food, dolaundry, drive, write, type, and shake hands. This lasted forhalf a year. I was unable to type regularly for about threeyears. Many RSI sufferers complain of similar problems. Inaddition to limiting your day-to-day functionality, thisdecreased independence can cause a significant emotional burden.

RSI can limit your ability to perform at work. Recent SupremeCourt rulings do not view RSI as a disability, and hence, RSI isnot covered under the Americans With Disabilities Act.(Apparently typing is not a 'major life activity,'according to a recent opinion authored by Sandra Day O'Connor,for those whose job requires significant amounts of typing.)Therefore your employer may fire you if you are unable to performyour job because of your RSI. The prospect of changing(radically, in many cases) your profession is obviously adaunting thought. For students, mostuniversities are willing to make accommodations, but lost productivity due to RSI could still delay yourgraduation one or two years. And once you graduate, your nextemployer may not be as accommodating.

As with all health-related issues, it is wise to eat well,exercise, listen to your body, and avoid destructive behavior.However, there are some specific precautions you can take to helpprevent the onset of RSI.

Why bother?

When you first notice symptoms of RSI, you have already donesubstantial damage to yourself. RSI can take months, even yearsto develop, and you can expect it to take at least twice as longto heal. It has been several years since my RSI was at its worst,and even now I must limit my typing. Even if you feel no pain orother symptoms of RSI, you would do well to heed the followingadvice for RSI prevention, especially if you meet one of the risk factors outlined above.

Good posture is crucial

What is good posture? For our purposes here, good posture is when you are positioned in a way that minimizes the strain on your body. To put it another way, good posture maximizes your ease.

I used to think good posture involved sitting in a chair with lots of adjustable parts. After all, what better way to minimize strain than to have the chair support your body for you? This page used to have an extensive section on how to identify a good office chair and how to adjust it to your body.

Over the years, I have come to realize that there is more to good posture than finding the right chair. The issue is that when you sit in a conventional office chair, in order to hold your spine in a neutral position, you need to overwork your hip flexors (e.g., the psoas). After enough sitting, your hip flexors become chronically shortened which leads to a condition called 'anterior pelvic tilt.' This can lead to a variety of other problems like head and neck pain, back pain, and knee pain. Sitting in a conventional office chair also makes it difficult to properly engage your core muscles, whose job it is to hold your spine in a neutral position.

I am not saying you shouldn't use an office chair. But I would recommend a setup that allows you to change positions. For example, I use an adjustable desk that allows me to go back and forth between standing and sitting. I also will sit in a recliner when I'm doing work that isn't too keyboard intensive. This approach allows me to change positions whenever certain postural muscles are fatigued.

If you do prefer sitting, you might try some simpler seating arrangements before investing in an expensive office chair. One option is to find a stool with a flat seat and put a yoga block on it. Sit on the yoga block with your feet flat on the floor. The yoga block raises you up so that your knees are below your pelvis, which makes the angles at your hips and knees slightly greater than 90 degrees. This makes it easier to engage your core muscles and avoid tightening those hips flexors. You will not need a backrest or armrests. 'Ball chairs' are based on a similar premise.

Setting up your workstation

There are three pieces of equipment that require specialattention:

  1. Keyboard: positioned above your thighs, you shoulder be able to reach the keys with your elbows at your side and bent at 90 degrees, and your forearms roughly parallel to the ground. If your elbows are at more than a 90 angle, it will surely tire you out quickly.
  2. Mouse: just to one side of your keyboard, so that you don't have to lean, stretch, or hunch to work it. Many people have one shoulder noticeably lower than the other - this can be caused by repetitive stretching for a mouse;
  3. Monitor: directly in front of you (not off to the side), such that your eye level is somewhere between the top of the screen and 20% from the top. The screen should be about 15-25 inches from your eyes.

This last point is very important, but can be problematic ifyou only have one desk, and like space to write. In this case, Isuggest one of three possibilities: (i) Find another place towrite, such as the library; (ii) Get a cheap computer desk if youhave room in your office; (iii) Find a rolling or sliding tray toput your monitor on, so you can move it aside when you need towrite. If you don't position your monitor correctly, it can leadto severe neck strain over time. For example, if your monitor istoo far back on your desk (or if your font is too small), youwill have the tendency to hunch forward and jut your head out, ina subconcious effort to see the screen better. This leads toanother key point: Don't use reallysmall fonts! It leads to poor posture and eyestrain.

If you use a laptop, you will find it is vitually impossible to use good posture. This is why I strongly recommend against the use of a laptop as an everyday computer. I used a laptop all through college, and I know it contributed to my RSI. If you do most of your work on a laptop, you really need to find a separate keyboard so that you can put your laptop on a box or some books, and have your monitor at eye level. You could alternatively find a separate monitor, but laptop keyboards tend to be too small. Another novel solution is the lightweight and highly portable Roost Stand.

Proper technique: typing, mousing,and writing

There are three keys to proper typing technique.

  1. Keep your wrists straight: the straighter your wrists, the less strain you put on the tendons and nerves that run through your wrist. A split keyboard may aid you in keeping your wrists straight.
  2. Let your hands float: This means don't rest your wrists on the desk, keyboard, or a wrist rest when you are typing. Let them hover over the keys. This has three advantages: (i) You allow the big muscles in your back to share some of the work; (ii) It allows you to keep your wrists straight, which is impossible if they're planted on a wrist rest; (iii) It's easier to reach the hard-to-reach keys (next item).
  3. Don't strain your fingers: When you need to press a hard-to-reach key, like CTRL, SHIFT, BACKSPACE, etc., don't stretch out your pinky. Instead, move your whole hand and use your index or middle finger to press the key. Don't use one hand when you need to hit two keys simultaneously, e.g. CTRL-X, SHIFT-Y. Think before you type: unnecessary retyping/editting can add up. Use a light touch when typing: don't pound the keys.

An ergonomic posture reminder that you can post near your computer was created by Clemens Conrad.

There is another keyboard layout, in addition to the standard QWERTY layout. Called the Dvorak layout, it was designed to minimize the movement of your fingers as you type. In contrast, QWERTY was designed to maximize the amount of finger movement, so as to avoid jammed levers in old mechanical typewriters. Most operating systems allow you to switch your keyboard to this format (in Windows, try Control panel -> Regional and Language Settings -> Languages -> Details). When I switched to the Dvorak layout, there was about a month of transition time where I wasn't able to type as fast as I used to. Now, I have less pain in my hands than before I made the switch. You can find Dvorak typing tutors online.

In addition to Dvorak, there is yet another layout called Colemak that is designed to improve upon Dvorak. For example, Dvorak has the 's' and 'l' letters typed by the right pinky which puts execive strain on this digit. It is not currently standard in operating systems like Dvorak is, but you can download the software from the link above.

Using a mouse can be even more harmful than typing. Here arethree reasons why this is so:

  • All the work is done by one finger. Double clicking and dragging can be especially straining.
  • Modern windows-based machines rely heavily on the use of a mouse.
  • Users often do not position the mouse properly. Instead, they stretch for the mouse, which can lead to increased strain, a drooping shoulder, and pain extending up into the shoulder and neck.

My solution for these problems has been to switch to a trackball. This has the advantage that the mouse is stationary: you don't have to move your whole arm to move the pointer across the screen, which reduces strain on the arm, shoulder, back, and neck. It also has extra buttons, which can be programmed to double-click or drag with a single click. Moreover, the work is more evenly distributed among the fingers. Actually, I have two mouses. One is a trackball on the left, and the other is a standard mouse on the right that I use for scrolling and moving but never clicking.

Standard mouse

Trackball

Another option is RollerMouse, a stationary mouse that sits in front of your keyboard. It eliminates the need to reach for and grip a mouse allowing your hand and wrist to maintain a neutral, relaxed position. You can control the cursor by gliding your fingers over a rollerbar and lightly pushing on the bar to perform a left-click. Other added benefits include the ability to effortlessly switch between right and left hand or share the work load between the two. The mechanical click has been replaced with a digital click to help users avoid trigger finger. Users can also enjoy a frictionless scroll wheel and 7 customizable buttons to program often used hotkeys.

Another solution is to use key commands to operate in awindows environment, rather than the mouse. Once you learn thecommands, this method is often faster than mousing. A solution that will not work is switchingwhich hand you use to click the mouse. This may provide temporaryrelief, but soon your other hand will be as bad as the first.

In addition to typing and mousing, writingcan add significant strain to your hands. It is importantto hold your writing utensil lightly. Someone should be able topull it out of your hand when you are writing. It also helps touse a writing utensil that doesn't require you to push down toohard. Ball point pens should be avoided. I recommend soft leadpencils, or the Dr. Grip Gel Ink pen.

Stretching and strengthening

In this section I offer some specific recommendations for stretching and strengthening exercises that have helped me. These fall under the category of prevention as well as recovery. Most of them you can easily do in your office during breaks, which you should take every hour or so.

Wall stretch:This is my favorite stretch. It is great for stretching out theshoulder, arm, wrist, and hand all at once. Extend the arm alonga wall, with arm parallel to the ground and palm facing wall.Attempt to open chest so that shoulders are perpendicular to arm.Extend fingers and palm away from wall as much as possible. Yourhand may tingle - this is OK. Hold for 30-60 seconds. Try withthe arm at different angles. Repeat on other side.

Doorway: Thisstretches the pecs and shoulder. Hold elbow at a right angle, andplace forearm along door frame, as shown. Lunge forward, keepingchest and pelvis facing squarely forward. Hold 30-60 seconds. Tryholding arms at different angles. Repeat on other side.

Back and neck strengthening: The other thing I do that really helps is an exercise that involves one of those big exercise balls, a long dowel rod, and a couple of 3 (or 2) pound dumbbells. You get on your knees, lay your chest on the ball, put the rod on your back so that it makes contact with your rear, back, and head (to keep the spine neutral). The ball should be big enough so that the rod is sloping slightly up. Then just slowly raise the dumbbells off the ground and lower back down. You can have the arms at different angles, but start with them extending behind you, as that is easier. Also try turning your head from side to side occasionally as you go, to activate the neck muscles. You do not need heavy weights for this exercise to be effective, and heavy weights may in fact strain your already fatigued muscles.

Correct breathing: It's amazing how stress and computer use can corrupt our natural way of breathing. I highly recommend Barbara Conable's short little book on breathing called The Structures and Movement of Breathing: A Primer for Choirs and Choruses . Don't worry that it is written for choirs, there's a lot of useful info for everyone.

Eye palming: A relaxation technique for the eyes is to place your fingers crossed over your forehead and cover the eyes with your palms. Do not apply pressure to the eyeball. Just concentrate on the blackness for a while. Another simple but great technique is to just look out the window at a distant scene.

The above exercises are primarly geared towardrelieving/preventing the symptoms of RSI. If you want toeliminate the root causes of RSI, you must focus more onstretching, strengthening, and re-educating the core muscles of your bodyresponsible for maintaining proper alignment and posture. It isnot possible for me to explain how to do this here. However,there are several practices/techniques that aim at this goal,including yoga, Pilates,the Alexandertechique, the Feldenkraismethod, and T'ai Chi. You can probably find a group class in the$10-20 range in your area if you live in a large city or near a University. Yoga andPilates can also be learned from books and videos, but it isusually better to learn from a teacher and to practice with agroup. Personally, I have derived benefit from yoga, Pilates, and especially the Alexandertechique.

More articles on posture, balance, etc. may be found at Core Awareness.

Ten easy ways to reduce your risk ofdeveloping RSI

  1. TAKE BREAKS! when using your computer. Every hour or so, get up and walk around, get a drink of water, stretch whatever muscles are tight, and look out the window at a far off object (to rest your eyes).
  2. Use good posture. If you can't hold good posture, it probably means it's time for you to take a break from typing. If you are perpetually struggling to maintain good posture, you probably need to adjust your workstation or chair, or develop some of the support muscles necessary for good posture.
  3. Use an ergonomically optimized workstation to reduce strain on your body.
  4. Exercise regularly. Include strengthening, stretching, and aerobic exercises. I find yoga and Pilates especially helpful.
  5. Only use the computer as much as you have to. Don't email people when you could walk down the hall or pick up the phone and talk to them. It's not only better for your hands - it's friendlier. Think before you type to avoid unnecessary editting.
  6. Don't stretch for the hard-to-reach keys, e.g. BACKSPACE, ENTER, SHIFT, CONTROL... basically everything but the letters. Instead, move your entire hand so that you may press the desired key with ease. This is crucial when you are programming or typing something in LaTeX, where non-letter keys are used extensively.
  7. Let your hands float above the keyboard when you type, and move your entire arm when moving your mouse or typing hard-to-reach keys, keeping the wrist joint straight at all times. This lets the big muscles in your arm, shoulder, and back do most of the work, instead of the smaller, weaker, and more vulnerable muscles in your hand and wrist. If you find it difficult to do this, then your shoulder and back muscles are probably too weak. It is OK, and in fact a good idea, to rest your elbows/wrists when you are not typing.
  8. Use two hands to type combination key strokes, such as those involving the SHIFT and CONTROL keys.
  9. When writing, avoid gripping the writing utensil tightly. Someone should be able to easily pull the writing utensil out of your hand when you are writing. If your pen or pencil requires you to press too hard, get a new one (my favorite is Dr. Grip Gel Ink)
  10. Realize that you are not invincible. RSI can happen to you. Don't be afraid to ask for help.

Be prepared to make some changes in your lifestyle and yourcomputer habits. In particular, make an extra effort to followthe guidelines laid out in the previous section on prevention.Following these guidelines can decrease your recovery time, andhelp you avoid relapses in the future.

STOP TYPING!(?)

OK, it's not always quite that easy. Very few people have the luxury of being able to avoid typing altogether. However, if you think carefully, you'll find there are many ways to eliminate unnecessary typing from your life. For example, instead of sending e-mail, use the phone, or better yet, get out of your chair, walk down the hall, and speak face-to-face to the person. Drop out of your fantasy baseball league. Rely on newspapers and books for information, and stop surfing the Web so much. Instead of playing solitaire on the computer, buy yourself a real deck of cards, and play it the old-fashioned way. Just check your email twice a day. Et cetera. In general, eliminate unnecessary computer use from your life. And a whole lot of it is unnecessary. It may seem like a sacrifice, but your health is worth it.

One technique I use is the following: when I am at my office, throughout the day I use an index card to record all of the e-mails I wish to send. I keep the index card in my back pocket. Then as soon as I get home from work, I will use my dictation software to compose all of the e-mails in one sitting. This has many advantages: it saves me from the tendency to type quick e-mails with my hands while at work; I am less distracted by e-mail at work; if you don't respond to an e-mail right away, sometimes the need to ever respond goes away; once people learn that you don't respond to e-mails right away, they send you less e-mail.

For typing that you just can't avoid, consider using voice activated software, or arrange to have someone type for you. Grad students, you might ask your deparment coordinator if there are any clerical assistants that you could borrow.

When to seek help

If you believe that you may have developed RSI, the firstthing you should do is to implement all of the preventionstrategies outlined above. If you find that your situationcontinues to worsen, you should consider seeking professionalmedical advice. A general rule of thumb is that if your handsstill hurt a couple of days after you last typed, you need to seea doctor.

Finding a good doctor or therapist

If you have RSI, finding a good doctor or physical therapist isdefinitely worth the time and money.

Unfortunately, finding a doctor who is competent to diagnoseand treat RSI can be a challenge. Some doctors doubt theexistence of RSI, and many others dismiss it as an insignificantproblem. Some doctors don't know the first thing about treatment,while others encourage their patients to undergo unnecessary (andpossibly dangerous) surgery in hope of a quick fix. With that inmind, know that you must be careful and selective when choosing aphysician.

Most general practicioners will be unable to give you specific advice. However, your primary care physician can still be a valuable ally. If he or she can recommend a good physical therapist, and is willing to write you a prescription for PT, that is often the best way to go. The PT can diagnose you and formulate a treatment plan.

If you or your insurance or PCP insist on seeing a specialist, in my experience, the best doctors are physiatrists,sometimes listed under Physical Medicine and Rehabilitation.Check with your health-care provider to find physicians in yourarea.

In general, your doctor/therapist should prescribe treatment that focuseson the cause of your symptoms, rather than the symptoms themselves. In otherwords, the treatment should not be focused on pain management, although thatmay be one aspect. Rather, it should be focused on correcting your posture,and improving your anatomical function, so that, with time, your body willheal itself. Treatment should typically consist of visits to a physicaltherapist, coupled with a home exercise program. The focus of this programis to stretch overly tight muscles, and strengthen weak ones. Rememberhowever, that no amount of physical therapy and strengthening/stretching canovercome excessive typing, poor posture, a bad workstation, or poor typingtechnique.

When you first visit with any health care provider, be sure to ask them about their experience in treating RSI. If they do not seem knowledgable, ask for a referal to someone with more experience.

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Relief

In terms of short term relief, there are some simple things I've found that help me. One is to massage my forearms with a tennis ball. Put the tennis ball on the ground or some non-slick surface (like carpet) and press down on it with your forearm and roll it around. Try a variety of positions and movements, and also be sure to massage the top of your forearm, applying the ball with your other hand.

I also recommend the tennis ball self massage to the muscles in between the spine and shoulder blades. Stand up against the wall and find a tender spot, and hold/breathe into it for 3 cycles. Then move to a new spot and repeat. As you get used to it you can stay longer in those trouble spots. (Thanks to Henriette Bruun for this suggestion).

Another thing is a hot/cold water bath. Fill two sinks or buckets, one with water as hot as you can stand, the other with water as cold as you can stand (use ice). Soak your arms and wrists in each bath for 2-3 minutes at a time, and alternate baths about 3 times each. This is very good for numbness/tingling kinds of discomfort.

Keeping your hands warm while you type is critical. When it's cold, consider wearing a pair of thin liner gloves with the fingertips cut off. Or take occasional breaks to run your hands under warm water.

Finally, the wall and doorway stretches above can provide some degree of relief.

Surgery?

Is surgery ever the right choice? Recall that there are many different types of RSI. For one particular form of RSI, namely carpal tunnel syndrome, a minimally invasive and effective surgical procedure has been established. Look for a hand center in your area to consult with a physician about this option. To determine that you have CTS and not some other RSI, they should perform a nerve conduction study, known as an electromyogram. Also keep in mind that even if you have surgery and it is successful, your symptoms may return if you do not improve your computer habits.

For other forms of RSI, surgery may not be an appropriate treatment. Even if you have CTS, you may wish to consider nonsurgical options (workload reduction, improved ergonomics, physical therapy; see above). Without surgery, recovery is still very much possible. In my case, I did not have CTS, and never considered surgery. At it's worst, the severity of the pain in my hands/wrists was about a 9 out of 10, and I could barely grip even the lightest objects (e.g., I would turn faucets on and off using my elbow). Now, I play tennis and the banjo regularly, and do a minimal amount of typing, relying on dictation software for the rest. I still have occaisonal pain when my workload increases, but it goes away with a couple days rest. It's not a complete recovery, but it's sufficient for my lifestyle.

Recovery and maintainence

Here are five general tips that I have found to be helpful. If you don't think you are able to spare the time or money to implement these ideas, think again. You are probably underestimating the value of a healthy body.

  1. Rest as much as possible (from the activity causing your injury). Many aspects of your injury can only heal with rest and time.
  2. Excercise regularly, including stretching and strengthing of core muscles (abs, gluts, hamstrings, etc.). For some specific stretches, see the section on stretching and strengthening. I have found yoga and Pilates to be beneficial. Aerobic excerise is good as long as it doesn't aggravate the injury.
  3. Find a good doctor and stick to his or her program for you.
  4. Work hard to develop discipline regarding your posture and typing habits.
  5. Be patient and persistent.

Voice activated software

There are several voice activated applications intended for document composition. I have used Dragon NaturallySpeaking for several years. However, Google now provides their cloud-based voice recognition tool in Google Docs, and I have been using this more and more.

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If you purchace voice activation software, you don't need the most recent release; an earlier version should serve your purposes at a lower cost, and place less demand on your computer's cpu and memory.

I have found that the microphones that come with NaturallySpeaking break easily and are highly sensitive to ambient noise. Therefore I recommend purchasing your own headset separately. I use this model made by Logitech. With this microphone, I have no trouble using NaturallySpeaking in my office, where the air vents make it too noisy for the cheaper microphones to work effectively.

Those who do not have an American accent may want to take extra care, since these programs may be designed around an American accent (I'm not sure). Do not expect to be able to use dictation software to do computer programming;As for composing technical documents, i.e., documents that use specialized jargon or equations, I haven't found any application well-suited to this problem yet. Make sure your computer's processor speed is 20-30% faster than the recommended speed for good perfomance.

Coping with RSI

An advanced case of RSI can cause a significant emotionalburden. Because of your limited use of your hands, you'llconstantly be asking other people for help just to get by inlife. It can be quite challenging, for example, to ask someoneyou don't know to give up their seat on the bus for you becauseyour hands are too weak to hold the hand rail. On the other hand,you will find that most people are willing to help you out inyour time of need. Take advantage of close friends and mentorswho would be willing to listen to your struggles, and help yousort out your thougts and feelings. Universities often have Counseling Centers that are free to students.

Resources for students

Most Universities now have a Disabled Student Services (DSS) office that can make your life easier if you have an RSI. DSS can possibly arrange for you to have extensions on assignments that are to be written or typed, and they can also arrange for a scribe to assist with writing or typing. Other accommodations may also be available.

Please note that typically DSS can not offer you any assistanceunless you have written documentation from a licensed physicianthat details the nature and severity of your problem, the medicaltreatments currently prescribed, the expected time of recovery,the accommodations you would benefit from during your recovery,and the credentials of the diagnosing physician.

Two must read books

Repetitive Strain Injury: a Computer User's Guide, by Pascarelli and Quilter (John Wiley and Sons, 1994), is a comprehensive source of information on how to prevent, live with, and recover from RSI. Much of the information from this webpage comes from this book, and the book contains far more detail than I was able to include here. Deborah Quilter maintains an RSI website (see below).

Another excellent book is It's Not Carpal Tunnel Syndrome! RSI Theory & Therapy for Computer Professionalsby Suparna Damany and Jack Bellis (Simax, 2001). This gives a very down to earth, plain-spoken account of what RSI is, how it should and should not be treated, and plenty of good practical advice on coping, home-remedies, and getting professional help. The authors also maintain a website devoted to the RSI cause (see below).

Online resources

  • Harvard RSI Action, where I got the idea (and some of the content) for this web page. A variety of perspectives on RSI, and lots of advice for those dealing with serious RSI problems.
  • RSI Program: Collection of RSI resources maintained by the authors of It's Not Carpal Tunnel Syndrome! (see above)
  • RSIHelp: Deborah Quilter's site.
  • Eric Shannon's RSI page.
  • Paul Marxhausen's RSI page.
  • The Typing Injury FAQ.
  • IBM's Healthy Computing website.
  • The OSHA web page, for scientific or statistical documentation on RSI.
  • Sandra Day O'Connor's opinion from Toyota v. Williams.

Please direct comments and questions to Clay Scott

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