Dr. Cady has coined the phrase, ''Silicon Valley Syndrome" as it relates to computer engineers sitting at computers for extensive periods.  This puts a lot of strain on the neck from looking at the monitor, the wrist and shoulder from using a mouse and keyboard, and the lower back which is in the most stressful position of sitting.  This is also called a Repetitive Strain Injury (RSI).

As more and more work, education and recreation involves computers, everyone needs to be aware of the hazard of Repetitive Strain Injury to the hands and arms resulting from the use of computer keyboards and mice. This can be a serious and very painful condition that is far easier to prevent than to cure once contracted, and can occur even in young physically fit individuals. It is not uncommon for people to have to leave computer-dependent careers as a result, or even to be disabled and unable to perform tasks such as driving or dressing themselves.

What is RSI?

Repetitive Strain Injuries occur from repeated physical movements damaging tendons, nerves, muscles, and other soft body tissues. Occupations ranging from meatpackers to musicians have characteristic RSI's that can result from the typical tasks they perform. The rise of computer use and flat, light-touch keyboards that permit high speed typing have resulted in an epidemic of injuries of the hands, arms, and shoulders. Use of pointing devices like mice and trackballs are as much a cause, if not more so. The thousands of repeated keystrokes and long periods of clutching and dragging with mice slowly causes damage to the body. Another name for the condition is Cumulative Trauma Disorder. This can happen even more quickly as a result of typing technique and body positions that place unnecessary stress on the tendons and nerves in the hand, wrist, arms, and even the shoulders and neck. Lack of adequate rest and breaks and using excessive force almost guarantee trouble.

You may have heard the term Carpal Tunnel Syndrome in connection with these injuries, but in fact CTS is only a small and dangerous percentage of typing injuries. Tendonitis, Bursitis , Tenosynovitis , Tendinosis , DeQuervain's Syndrome , Thoracic Outlet Syndrome, Trigger Finger/Thumb , Myofascial Pain Syndrome, Cubital Tunnel Syndrome, and several other related conditions may also be involved. All of these are serious and in advanced cases can cause great pain and permanent disability. In addition, patients injured by repetitive strain sometimes develop Reflex Sympathetic Dystrophy.

What are the Symptoms? 

• Tightness, discomfort, stiffness, soreness or burning in the hands, wrists, fingers, forearms, or elbows 
• Tingling, coldness, or numbness in the hands  
• Clumsiness or loss of strength and coordination in the hands  
• Pain that wakes you up at night  
• Feeling a need to massage your hands, wrists, and arms  
• Pain in the upper back, shoulders, or neck associated with using the computer

How Do I Prevent It?

Correct typing technique and posture, the right equipment setup, and good work habits are much more important for prevention than ergonomic gadgets like split keyboards or palm rests. The picture to the right shows proper posture at the computer. Research suggests that a monitor position lower and farther away may be better. Note that the chair and keyboard are set so that the thighs and forearms are level (or sloping slightly down away from the body), and that the wrists are straight and level - not bent far down or way back. Also note that the typist is sitting straight, not slouching, and does not have to stretch forward to reach the keys or read the screen. Anything that creates awkward reaches or angles in the body will create problems. Please note that even a "perfect" posture may result in problems if it is held rigidly for long periods of time: relax, move and shift positions frequently. This isn't just about your hands and arms either: the use or misuse of your shoulders, back and neck may be even more important than what's happening down at your wrists.

More specifics:  

• While you are actually typing your wrists should not rest on anything, and should not be bent up, down, or to the side. (Figure 2) Your arms should move your hands around instead of resting your wrists and stretching to hit keys with the fingers. (wrist rests give you a place to rest your hands only when pausing from typing, NOT while you are typing.) When you stop typing for a while, rest your hands in your lap and/or on their sides instead of leaving them on the keyboard.  
• Wrists also should not be bent to the side . . . but instead your fingers should be in a straight line with your forearm as viewed from above.  
• This is easier to do if you tilt the back edge of your keyboard down, away from you. Put a prop an inch or two thick under the edge of the keyboard closest to you, but make sure the whole thing is still low enough so you aren't reaching up. This is a good argument for getting an adjustable keyboard tray that permits optimal positioning.
• INCREASE YOUR FONT SIZES. Even with ever-larger monitors, many people favor tiny little fonts in their desktops and applications. This encourages one to hunch forward into the monitor to read things, putting pressure on nerves and blood vessels in the neck and shoulders. Microsoft Windows and Macintosh desktops and applications can easily be configured to use larger, easier-to-read fonts. Also consider using color schemes that are easier on the eyes, particularly shades of gray for text documents.
• Don't POUND on the keys: use a light touch.
• Use two hands to perform double-key operations like Ctrl-C or Alt-F, instead of twisting one hand to do it. Move your whole hand to hit function keys with your strong fingers instead of stretching to reach them.
• TAKE LOTS OF BREAKS TO STRETCH and RELAX. This means both momentary breaks every few minutes and longer breaks every hour or so. Pace and plan your computer work. Fidget a lot! Here are some GIF animations of some stretches you can do, courtesy of David Brown & the New Zealand Occupational Safety and Health Service. ->  (Don't do these at the speed displayed. Easy does it.) Notice that several stretches involve the neck & shoulders, which have more involvement with typing injuries than you might imagine. From the same source, here are some still pictures of exercises/stretches to do. Another good source of stretches is the innovative E-Stretch Web site.
• Hold the mouse lightly, don't grip it hard or squeeze it. Place the pointing device where you don't have to reach up or over very far to use it; close to the keyboard is best. Better yet: learn and use keyboard equivalent commands whenever possible, as no pointing device is risk-free. Even trackballs have injured users.
• Keep your arms & hands warm. Cold muscles & tendons are at much greater risk for overuse injuries, and many offices are over-air-conditioned.
• Eliminate unnecessary computer usage. No amount of ergonomic changes, fancy keyboards, or exercises are going to help if you are simply typing more than your body can handle. Don't try to be the fastest, most powerful hacker around - the cost is too high. Also: is there recreational computer use you can reduce? Can some of your electronic mail messages be replaced by telephone calls or conversations in person? And lose the computer/video games . . . which often involve long, unbroken sessions of very tense keyboard or controller use. If nothing else, PAUSE the game every 3 - 4 minutes. Don't sacrifice your hands to a game!
• Consider voice recognition. Software that allows computer control or full voice dictation is becoming more powerful and less expensive.
• Evaluate other activities. Problems may be caused or aggravated by other things you do frequently. Sports, carrying children, hobbies requiring intense small work (like knitting), and excess effort/tension in other daily things may have enormous impact too.
• DON'T TUCK THE TELEPHONE BETWEEN YOUR SHOULDER AND EAR so that you can type and talk on the phone at the same time. This common procedure is very aggravating for your neck, shoulders, and arms.
• TAKE CARE OF YOUR EYES. Eyestrain is also a related, widespread problem that should be addressed at the same time you are setting up your computer for healthier use. See this article from Doctor Ergo.
• PAY ATTENTION TO YOUR BODY. Pain is your body yelling that it's in big trouble, but learning what is comfortable or awkward for your body before you're in pain may prevent injury.
• KIDS ARE AT RISK TOO .. . with increasing hours in front of the computer at home and school, using equipment that rarely is set up correctly for people their size. This news article also examines the problem. Also, read this Workstation Ergonomics Guidelines for Computer Use by Children  published by Cornell University. The program Stretch Break for Kids can be downloaded for free.

What If I Have Symptoms of RSI?

We all have occasional aches and pains that go away in a day or two, especially when we overdo anything. But if you have the symptoms listed above regularly when you are using the computer, run, do not walk, to your chiropractor or other health care provider right away. Dealing with this early is critical to limiting the damage, and to spare you a world of hurt, trouble, and frustration. You are not overreacting: by the time you have symptoms there has already been some damage done, and if you try to ignore the pain you may sustain a serious injury. If your doctor doesn't seem to know much about RSI, find one who does. When you find one, listen to them and check with them about any changes you intend to make or therapy you want to try.  In order to be an educated patient, read the other resources on this page. 

THERE ARE NO QUICK FIXES.

No wrist splint, arm rest, split keyboard, spinal adjustment, etc. is going to let you go right back to work at full speed if you've been injured, and even carpal tunnel sufferers who undergo the release surgery on their wrists can be back in pain and trouble if they don't make the long term changes in technique and work habits that hurt them in the first place. Healing can happen but it may take months, even years. That's why it's important that you . . .  

DON'T GIVE UP!!!

Many RSI patients do regain the ability to work and substantial freedom from pain, although they may find that they remain vulnerable to re-injury and flare-ups. DON'T GIVE UP. Recovery may take much longer than you think you can bear. DON'T GIVE UP. Almost everything in your life may turn upside down in the course of dealing with long-term recovery. DON'T GIVE UP.

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