Repetitive Stress Injuries: A Cautionary Tale

As I mentioned in yesterday’s post, during the summer of 2003 and due to massive overwork, I developed a series of repetitive stress injuries (RSIs) in my arms, wrists, and hands. Not bad enough to require surgery (although I was heading in that direction); severe enough such that I was in pain all the time and couldn’t sleep.

When finally diagnosed in late August, the list included:

• Carpal tunnel syndrome (inflammation of the channels in the wrist through which nerve bundles pass) in both wrists but worse on the right
• Lateral epicondylitis (also known as “tennis elbow”) in my right arm, but also showing some on the left
• Ulnar neuritis (inflammation of the nerves that go along the underside of the forearm) in my left arm
• De Quervain’s disease (inflammation of the thumb joint where it meets the wrist and palm) both sides, but worse on the right.

More after the flip…

————————————–

The causes? Lousy ergonomics, poor work habits, and just plain too much work. In my personal opinion, I also blame FrameMaker’s terrible user interface, in combination with Logitech’s Trackman thumb-ball mouse. To be fair, I generally like Logitech products, and still occasionally use the thumb-ball trackball — but only occasionally. The thumb motion though, in combination with the buttons just isn’t meant for heavy use, especially lots of hold-click dragging of the cursor.

In addition, one of the issues with Frame is that I didn’t know enough of the keyboard shortcuts. That led to lots of clicking and dragging — hence the De Quervains. The lateral epicondylitis was due both to the mousing and excessive typing.

My desk was also too high, which in the resting state, had me leaning on my forearms, particularly the left — thus the ulnar neuritis.

Carpal tunnel? Bad wrist angle while typing (despite the Microsoft Natural split keyboard… probably would’ve been far worse without it), as well as simply too much typing.

The breaking point for me came when one of my clients said they not only needed a complete rewrite on a manual I’d submitted for review six weeks before, but that the whole product schedule had slipped from October to December. Maybe. Could go longer. At that point, I didn’t even care if I’d been able to negotiate more money. The pain was already so bad, the stress so high, only the thought that it would be over in eight weeks kept me going. When that was taken away, I had a minor breakdown.

In summary, I was working three jobs at once:

• Client #1: Tech writing gig for Cisco (networking company), documenting installation procedures for their new CRS-1 terabit routing system. Using FrameMaker 5.5.6. Job also required a lot of web browser use. Primary delivery was a 175 page manual, but with other documentation as well.
• Client #2: A moderately funded start-up with a new wireless networking technology, including a fairly advanced network management software system. Using Frame 7.0. The product I was documenting had a web-based interface, and in its alpha release state did not have any keyboard shortcuts built in at all. First delivery was a 170+ page Administrators manual, with more books to follow.
• Client #3: A technical writing contract house, basically serving in a human resources capacity as a candidate screener. Lots and lots and lots of mousing, clicking and dragging, because their primary contact tracking system was web-based, with no keyboard shortcuts at all.

When I visited my doctor, I was simply going to ask for some anti-inflammatories and perhaps we should consider a steroidal injection. After seeing how awful and stressed-out I looked and testing my rather meager arm/hand mobility and strength, she said, “I know you’re working for yourself, but I need to give you a disability form.” While writing out some presciptions for heavy pain relievers and anti-inflammatory meds (which I hadn’t even gotten around to asking for yet), she also ordered me to take two weeks off and come back then for a re-evaluation.

I thanked her, feeling both a little shaken and a little better. Got the ‘scrips filled and went home. Using the disability news, I simply told Client #2 that I would not be able to continue on that contract, and worked with the main contract holder to find a temporary replacement for me. Client #3, I told them I’d need to work less. Client #1, for them I said I’d need a little downtime, but intended to continue work.

Two weeks later, I went back to my doctor. She said, “I have good news and bad news. The good news is you’re not getting any worse. The bad news is you’re not getting any better. You didn’t take the two weeks completely off like I said, did you?” My answer: No, I cut my workload in about half. (She’d also shrewdly had me bring in my partner, so that she also heard all this.) Doctor Solomon repeated her order to take two weeks off, giving me another disability slip (underlining the words for emphasis), and further wrote a presciption for physical therapy. She warned me that if I didn’t fix things right away, I could lose the ability to write.

That got my attention. Even though it cost me in terms of client relations, I stopped all the contract work. I did get the Cisco folks to agree to take me back at the end of it…although other issues eventually prompted me to change to another organization. I spent the two weeks doing a lot of walking, a lot of thinking.

After the down-time, I started physical therapy at the hand unit in the Dominican Hospital rehabilitation group. I know a lot of folks make a big deal about hating their physical therapists, but I loved mine. Tracy was friendly, patient, and encouraging. She used electro-muscular therapy, contrast baths, gave me strengthening and flexibility exercises — and yes, for a time I had to wear custom hand/wrist braces. In the meantime, I also had accupuncture weekly. I followed the regimen religiously for the next twelve weeks, doing exactly what I was told.

I also addressed the ergonomic problems of my home office. I replaced the trackball with a 3M Ergomouse. I ditched the foam wrist-rest in front of the keyboard, using a simple hand-towel to pad the edge of my desk. The desk itself I lowered by 1-1/2 inches by cutting down the legs. Originally, I’d gotten it as office surplus, so it’s actually a decent desk — but they make those standardized for people 68-70 inches tall (5-8 to 5-10). I’m only 5-4, so of course it was too high for me. And lastly, in preparation for going back to work at Cisco, using the outdated 5.5.6 version of FrameMaker, I dug into the online help system. Found those keyboard shortcuts and made myself learn them. No more click-and-drag to select text styles; from henceforth it would be F9. Oh, and I’d previously gotten a Herman Miller Aeron chair; it was expensive, but worth every penny. Still, I needed expert advice on how to adjust it properly, just the right height and angle, and to be told not to use the arm rests.

It’s two years later now. Despite a lot of work, a lot of typing, a really killer delivery schedule last year for the other Cisco product I worked on, their new Integrated Services Routers product line (I was Documentation Lead for the last three months of that project), AND the creation of a 362k word epic fantasy book manuscript, my arms and hands are just fine. Thanks to a timely intervention.

Folks, I cannot overstate the importance of good ergonomic practices for those of us who spend a lot of time at the computer keyboard. If you don’t pay attention to these things, you can literally end up crippled. Please let mine be a cautionary tale, and don’t go down the road I followed. Consider how you’re sitting, how you’re typing. Check the height and positioning of your chair, desk, keyboard, mouse, and monitors. Learn the keyboard shortcuts for the programs you use regularly. Don’t stretch your fingers to reach the control-alt-shift keys (my little fingers are permanently splayed a little from the rest of my fingers as a result of poor touch-typing habits). Consider using a split keyboard, such as the Microsoft Natural.

And most of all TAKE BREAKS! Good luck.

-Becca