March 27, 2013
[private user] Background: I am a computer programmer, which requires me to spend between 7-8 hours a day sitting at a desk using a computer. I take a few minutes break between every 1-2 hours, and also an hour for lunch. I have, however, developed "golfer's elbow" in my right arm and am not sure how to best handle the situation.
I have been doing wrist-curls every night with a 10 lb dumbbell; 3 sets of 30, which has helped a lot, but after doing them for a couple months I'm still feeling the affects. I also have a "tennis elbow" brace that I wear with the air pad on the inside (that's what hurts), which I use when my elbow is bothering me more than usual.
On top of this, I constantly stretch my forearm by holding my arm straight out and pulling my hand towards me while my fingers point towards the ground. This stretch feels good and helps for a few minutes, but not for much longer than that.
I also have been taking Vitamin B-Complex. I read somewhere a couple months ago that it helps with these type of issues because it's ability to regenerate/maintain your nerves.
I always sit upright, with a minor (10-20 degree) tilt, with feet flat on the floor and my arms at 90 degrees to my desk. My eye-level is about 75-80% up my screen, which I read is a good height so you don't have to move your head/neck often.
As far as using the mouse, I always try to focus on keeping my wrist straight so that I move the mouse with my arm instead of my wrist. I also have my mouse sensitivity turned up as high as it will go, to limit the movement that i have to make with the mouse.
Questions:
Is there any noticeable ergonomics that I'm not following and is there any equipment I can get to help? I use a simple Logitech M305 mouse, but several people at my company use the same one and never seem to have any issues.
Would a gel wrist pad for my mouse help? I've read mixed reviews on this, some saying they are helpful, others saying to avoid them.
March 28, 2013
[private user] Cardinal,
I may not have the complete answer but a few things jumped out at me:
1. Taking vitamin B complex is good for "nerves" (conduction speed) but I'm doubting that your problem is nerve related; might be a joint problem.
2. You say that your elbows are at 90 degrees, which I believe is too "tight"; I'd open it up to 120 degrees- allows better blood flow to the area.
3. Your monitor is too high- top of display should be at eye level.
4. Question: is the monitor straight in front of you? If not, that could be an issue.
just some thoughts
Jeff
Dr. Jeffrey Anshel, Optometrist
March 28, 2013
[private user] A few thoughts. First, keep in mind that the best way to find the right solution would be to have en expert come to your work and evaluate you. They can look not only at what equipment you have but also how you use it as well as the type of work you do. All of these should be considered for optimum result. In regards to the proper medical/therapeutic treatment I will refrain from offering advice as that is best done by an experienced professional (doctor, certified hand therapist, etc) who can work with you directly. I can offer you some advice on your workstation set up though. (Please keep in mind no one piece of equipment can heal you, but it can reduce strain on damaged tissue so it can heal via other treatments.)
It sounds like you have many of the main points covered (though the screen is a bit high for my liking) but have not explored the forearm/wrist/hand issues as they relate to the equipment fully. Likely the biggest issue is getting your wrist straight all the time when mousing and typing without having to think about doing that (or you will go back to bad habits once the pain resolves). The keyboard and mouse should be at elbow height. This can be done by adjusting your desk height or use of a keyboard tray, but if the equipment is on a standard desk it is likely too high for you. This causes the muscles you are having issue to work inefficiently (and become overused). Once you get them to the right height make sure the wrist is straight. Not using the pop-down feet on the bottom of the keyboard can help with this and if necessary you can angle the edge of the keyboard furthest from you toward the floor. This can be done with the use of a keyboard tray, foam wedges made for this purpose, or simply placing a wrist rest or folded hand towel under the part of the keyboard close to you.
You should also try to get the arm in a more thumbs up (neutral) position. This can be done when typing by use of an ergonomic keyboard that is higher in the middle. If your hands bend at the wrist to angle toward your small finger an ergonomic keyboard can help straighten this out as well. You have numerous options for mousing to do this and often the right option for you will take some trial and error. Consider a "vertical mouse" such as the DXT mouse or the Evoluent vertical mouse. If that is too extreme for you (all new equipment takes a while to get used to) you could opt for a mouse that is larger than a standard mouse as well as angled so your thumb is higher than your small finger. Being larger will allow you to rest your whole hand on the mouse (straightens wrist and encourages more arm > hand/wrist movement.) There are numerous of these on the market. Some examples are the Orthomouse, Handshoe mouse, Contour mouse, and many others. If you use a wrist rest for the mouse it will likely act to tether your wrist down and force you to move more from the wrist (which you don't want in your condition). I would recommend against it.
While on the topic of the mouse, having the mouse sensitivity at the most sensitive setting may or may not be good. You do not want to have to keep grasping and picking up the mouse but on the other hand if your mouse is very sensitive and you need to have fine cursor control often people will grip the mouse tighter to gain control. Obviously, this increase grip could contribute to your discomfort as the muscles that do this insert into the tendon you are having trouble with.
Again, there are so many variables the best thing to do is have an expert observe you at work. I would suggest you see a doc, hand therapist, PT, etc as well as the way you do eccentric strengthening, the possibility of dry needling, proper diagnosis, etc could all be properly explored. Hopefully this helps some though.
Regards, Chris Sorrells OTR, CHT, CEAS, Occupational Therapist, Certified Hand Therapist, Certified Ergonomics Assessment Specialist
March 29, 2013
[private user] Hello. Medial epicondylitis/epicondylosis, commonly referred to as Golfer's Elbow, is a common overuse MSD affecting the upper limb. There are often other contributing factors however, including neck and neural structures. I agree with the other subscriber that an assessment of your workstation as well as a Hand Therapist/PT clinical assessment should discover causative factors in both your arm and workplace!
One thing i would like to add is that this site at the elbow is where the forearm flexor muscles of the hand and fingers arise. Therefore any action that requires constant low loading (ie force) of this muscle group is likely to exacerbate your problem. (The exercises and stretches you describe sound appropriate, but hard to say exactly; no evidence for Vit B helping this.) The height at which you key and use the mouse should be as low as possible to keep your elbow angle less than 90 degrees adn wrist 'neutral', but I would avoid ANY unilateral mouse, which requires some amount of constant grasp. I have had good success with rollerbar mice (eg the Contour Design Pro2, or similar), particularly for a programmer who is very mouse-dependent.
You need to have much more frequent work breaks too! I agree that you should avoid any form of mouse rest. Poor evidence for TE splints but can do no harm, so sometimes worth a try! (BTW, do you have any other tendon problems in other parts of the body? This may indicate other pathology.)
Hope that helps. Good luck!
Jo, Occ Health Physio/Ergonomist
March 29, 2013
Cardinal,
You have been receiving excellent advice thus far in all the replies. Let me ask a few more questions about what you are experiencing and then will give you some additional direction we have used with our clients with this problem.
1) How much scroll wheel use are you doing when using the mouse and 2) How much overall gripping are you doing both at work and also outside of the office/computer work? Quite often the non-occupational influences are a major contributor to on-going issues, especially when so much emphasis is being done at the office.
As others stated, the issue is with the attachments of your forearm/wrist flexor muscular bundle. Everytime you contract these mucles (in typing, flexing the fingers and wrists downward, or just overall grasping and gripping) the muscles activated and shorten thus pulling on the attachments at and above the elbow joint. The purpose of the band you are using is to provide an initial location for the muscles to pull against when activated, thus reducing the pull effect at the true attachment sites and in theory reducing the local irritation to the musle tendon interface. I have never had tremendous results with the air bladder type bands and the simple forearm bands have never worked well. We have had excellent results using the Band-it brand brace (you can google it). Provides a more firm band with some space to prevent the band from becoming a tourniquet and reducing blood flow. In addition, the harder shell provides better purchase and thus it doen't have to be work as tightly.
As far as first aid for these conditions, here is what I recommend, 1) triple the frequency of your micropauses and stretch breaks (many software programs available for this), 2) prior to stretching warm the tissues up with some simple self-masage and the incorporate flexor stretching (move your fingers in the other direction to stretch the flexor surface), 3) immediately follow up your stretching with ice massage- simpley get an ice cube, hold with a paper towel and then starting at the attachment at the elbow rub the ice in long strokes all the way down to your wrist until the ice cube melts (about 4 minutes). This can be repeated every 1-2 hrs, as needed. 4) whenever you need to graps things, make you grip fatter, whole idea of why fatter pens work. The fatter the grip, the less force the muscles need to generate to achieve the needed level of control. You can use foam arounf things like broom handles, lawn mower handles, etc. Can also be achieved with using padded palm weight lifing gloves. I would hold off the dumbbell curves- why use these muscles more if they are activiely irritated, they need some time to recover.
For the ergonomics side, I agree open up the angle of the forearm, however you can't compromise on the straightness of the wrist while doing this. Avoid scroll wheel work, isolated flexor activation of one tendon. I like the Contour Rollerfree2 device but I teach the mechanics of using this device very specifically. I have also had great results with the Handshoe mouse as it helps reduce the grasping oftern associated with the palm-down versions of mice on the market. Never a big user of the Evoluent mouse, personally have huge hands, but we use them frequently on site. Hope this helps
Gary Podesta, PT
Program Manager, Rapid Response Program, Chevron San Ramon
April 1, 2013
Thanks everyone for the replies, it is very much appreciated. I will take all of these comments into consideration and see what I can do about having an expert examine my workstation. I do use the scroll-wheel pretty often, as it is an "easy out" to keep me from moving the mouse more to drag the scroll bar down the screen (on the right side). I didn't realize that using the scroll wheel may actually be worse than manually scrolling up/down pages. I am not having any other issues throughout my body, but I did have tendonitis in my elbow when I was in high school from playing baseball. I suppose that because of that, my elbow may be weaker and more prone to this type of injury. From the sounds of it, it seems like the majority of you agree that looking into a new mouse and lowering my mouse/keyboard is a good place to start. I will look into trying this out and see if I gain positive results.
Thanks to all again for the helpful replies, I appreciate it very much.
April 2, 2013
[private user] Great discussion and solutions to an aggravating problem. I would like to add a simple suggestion regarding your mouse: move it to the left of your keyboard (if space allows) and make it a left-handed mouse (in control panel, as I am sure you know). This will provide imediate relief of your right arm. Continue with all the other suggestions otherwise you'll end up with the same problem on the left. It takes a little practice, but it works.
May 23, 2013
[private user] Here's another vote for the left-handed mouse recommendation. If you are successful, and depending on the software you are using, and the keyboard style, the 'page up' and' page dow'n buttons are now accessible with the right hand to help reduce mouse scrolling.
May 30, 2013
[private user] Hi!
I was just wondering if perhaps I missed some information in the thread. Apologies if this is a repeat of someone else's input, but do you use a standard keyboard with an attached number pad on the right side? If so, that is a signigicant reach outside of your neutral range which would make mousing in a "good" position very difficult on the right side of the keyboard. In addition to trying to mouse as much on the left as possible (no number pad over there to reach over, and always nice to give your left side something to do while giving your right side a break), I would immediately get a shorter keyboard that does not have the standard attached number pad on the right.
Hope that helps!
Shelby
May 30, 2013
[private user] It sounds to me like you sit quite statically throughout the day. That's a no-no! Start moving!
The posture you describe is a good 'home' position – as amended by other contributors, but you need to lean back, lean forwards, stretch your legs out or put them under your chair for a while, lean on an arm rest for a while, and so on. Do you have arm rests on your chair? Many people will say not to use them, but if they don't prevent you from sitting close to the desk (and keyboard – armrests can be set back) I say use them. I spend most of my day at a computer (and have been doing so for years), and I frequently rest my elbows on my armrests. Relieves muscle stress. Helps to relax.
Set your mouse on single click. I don't know how much this will help in programming, but in general use, it reduces clicking by more than 50%.
Reduce your mouse sensitivity. All that fine motor movement will be causing static, or near static, muscle contractions. Movement is good. It just needs to be kept in moderation.
If you stay with a separate mouse, left hand mousing would be good (as suggested elsewhere). It takes a couple of weeks to get proficient, I'm told. When your elbow issues resolve, alternate between left and right. Note: That might affect the type of mouse you get, if you get a new one. Some of them are "handist".
Do you use page viewing shortcuts? I do a bit of VBA programming. VBA has shortcuts that step you back and forth between lines of code you have recently visited. This saves a lot of scrolling, and it's quicker. Perhaps your programming language has the same.
How big is your code on the screen? There's a compromise here. You can use small font and reduce cursor movement and scrolling (you don't have so far to go between lines of code), but this requires more precision to place the cursor and to select text. A large font will require more mouse movement and scrolling, but precision requirements are reduced. Look for a happy medium (not referring to a successful fortune teller!) You will need to choose a size that can be easily read from a good distance, too, especially if you want to lean back occasionally.
Do you have time constraints: "I need this NOW!"? That could be causing stress, including in your arm. If it's continuous, problems can arise. Find solutions to that. It may be your employer's problem.
May 30, 2013
[private user] Oh, a couple more programming tips:
There is a lot of bracket, quote, and other enclosing-symbol use in VBA programming. I have found it helpful to put both ends of the enclosure in at the start, then fill in the middle. For example: (to type this in brackets, i first typed both the brackets, then moved one space to the left (the cursor is now inside the brackets), then typed this text), then moved one space to the right to get back out of the brackets. I find it easier to use the left and right arrows, than to go up to the brackets a second time, also requiring the Shift key.
Have a look at customising your keyboard. I have replaced the Right Windows key with Escape (better than in the top left corner of the keyboard), and I have changed Caps Lock to End (you often want to get back to the end of a line in programming, after altering something in the line).
June 2, 2013
[private user] Hi ,
After reading all the respones, I am going to keep this short. After 32 years of practise,the most effective treatement for medail or lateral epicondylitis is Active release technique (ART), it is extraordinary how this well this technique works for soft tissue adhesions even severely chronic ones . Three visits and you will be 90% better.
The only reason more people dont know this simple but effective technique, is because Chiropractors do it, and lots of people wont go to chiros.
But if you really want it gone, go for an ART practitioner.
Once the adhesions are gone then you ICE it as per previous advice, and follow workstation setup as stated above.
No use doing it the other way round, just not effective. By the way Vit B has nothing to do with medial epiconylitis.
Chris Webster, Registered Chiropractor Australia
June 3, 2013
I just wanted to post a reply as I have had some positive gain.
After a few months now I hardly ever feel pain in my elbow, and my wrist only gets a little tight towards the end of each week (usually late Thursday or sometime during Friday) then feels great again after the weekend. The only things I have really changed to get some positive effects are:
1. I replaced my small Logitech M305 with a bigger, wired (lighter) mouse and moved the sensitivity back to normal.
2. I started using the arm rests on my desk chair. I currently have them at the exact same height as my desk with my arms at about a 95-100 degree angle.
3. I have continued doing wrist and bicep curls with a 10 pound weight. I do 3 sets of 15, each, every other day.
4. I still stretch my forearms and wrists every 10-15 minutes while working on the computer.
5. When I do get a litle discomfort towards the end of the week, I ice the inside of my elbow and lower forearm (near the wrist) for about 20 minutes each.
Also, I would like to again thank everyone for the helpful feedback. I'm still trying out different feedback from here to see if I can completely get rid of the soreness, even at the end of the week.
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