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A Quest for Comfort

by Andrew Savikas, author of Word Hacks
03/03/2005

I consider myself reasonably adept at finding information online. But when I started looking for good advice on ergonomic products during a bout with Repetitive Strain Injury (RSI), I was surprised at the dearth of reviews and information, apart from the (surprise!) glowing testimonials from the equipment manufacturers. (You may have heard RSI called by a different name, like Cumulative Trauma Disorder, or its most common misnomer, Carpal Tunnel Syndrome; while it is a type of RSI, true Carpal Tunnel Syndrome is relatively rare; more commonly, the wrist is merely the first site of the symptoms of a problem that originates elsewhere.)

This is something that causes 62 percent of all work-related injuries (according to the U.S. Bureau of Labor Statistics), and most estimates of its annual costs to the economy run into the tens of billions of dollars, so clearly there's a market for ergonomic equipment. Desperate for relief, I started trying every different keyboard, mouse, and monitor attachment I could find. In the hopes of saving someone else from the same frustration, this article looks at each of the different products I tried, and offers a few suggestions for finding relief if, like me, the best you get from your doctor is "put on an ice pack and take some Advil."

You're Not Being a Wimp

When RSI symptoms start worsening, it can be demoralizing, especially as you look around and see your co-workers happily banging away at their keyboards. It's easy to feel like a complainer, or even a wimp for having trouble typing or using a mouse. But take a minute to think about your answers to the following questions:

  • Do you hate to walk away from an unsolved problem?
  • Do you always look for the most efficient way to do things?
  • Do you think about work during non-work time?
  • Do you love your work?

How about this profile; sound like anyone you know?

These people are serious, detail-oriented perfectionists. They love their work, hate to walk away from an unsolved problem, look for the most efficient way to work (so they can get more work done), and think about work all the time.

The questions and the profile are taken from an excellent book about RSI, called It's not Carpal Tunnel Syndrome: RSI Theory and Therapy for Computer Professionals (available from Amazon). The authors contend (and I happen to agree) that folks who fit this profile are the ones most at risk for RSI. That book gave me the answers I wasn't getting from my doctor, and gave me hope that things would eventually improve. I highly recommend it for anyone dealing with RSI. The authors make three important points about dealing with RSI:

  1. As the title suggests, you probably don't have Carpal Tunnel Syndrome. RSI is a complex condition involving your entire upper body, caused by years of hunching forward at a keyboard and over-taxing your chest and shoulders.
  2. Aspirin, ice packs, and wrist braces might provide temporary relief, but they won't solve the problem. Instead, you've got to tackle the root cause--poor posture and muscle fatigue--before you can hope to find lasting relief.
  3. Ergonomic equipment is an important part of getting better, and avoiding future flare-ups. But unless you tackle the main problem (see number 2), the best keyboard/mouse/chair in the world won't help.

If you are experiencing symptoms of RSI, you should see your doctor--who will probably tell you it's tendonitis, and that you should take aspirin and wear a brace. The folks who really know how to treat RSI are physical therapists, so ask your doctor for a referral (most insurance plans cover physical therapy with a doctor's prescription). After eight months of pain, three weeks of working with a physical therapist made all the difference in the world for me. Your mileage may vary.

Once you've got a treatment plan in place, it's time to see what improvements you can make to your computer setup to help maintain good posture, and avoid the kind of awkward movements that got you into this mess in the first place.

One Size Does Not Fit All

First of all, chances are that no mouse, keyboard, or other equipment alone will eliminate your RSI, no matter what it says on the box. Things may improve for a few days or weeks, but it won't last. Good equipment is an important part of managing symptoms, but no less so than posture, stretching, exercise, diet, and a bunch of other things I'm not at all qualified to give advice on.

There are dozens of "ergonomic" products on the market. Whether one works for you depends on a lot of different factors, making it very difficult to predict whether a particular device will help you until you've tried it for at least a week or two. Fortunately, most of these products come with at least a 30-day return policy. Use it! Give yourself at least two weeks to adjust, but if it's not helping, send it back.

Keyboards

Here's a list of the different keyboards I tried. Your employer may have one of these available in the office. If not, ask if they'll purchase one for you. Most will--despite what seems like a steep price, these keyboards are much less costly than a worker's comp or disability claim.

Microsoft Natural Keyboard
$34.99 retail

This was the first ergonomic keyboard I tried. My employer had one in the office, and it was an easy switch to replace my standard keyboard. I used this one before my symptoms were very severe, but overall it was comfortable, and less fatiguing than a standard flat keyboard.

But I quickly discovered a deal-breaking flaw--the arrow keys are comically undersized, and very difficult to use. I've heard this has been corrected in newer models, but check carefully if, like me, you depend on those arrow keys.

Belkin ErgoBoard
$49.99 retail

This was another keyboard my employer already had around the office, and it's very similar to the Microsoft model, but this one has standard-size arrow keys. I used this keyboard for about a year, and was generally quite happy with it. However, it's awfully tempting to rest your wrists on that large, flat surface in front of the bottom row of keys. This is a big source of problems, and if, like me, you just can't keep yourself from resting your palms (a big sign that your chest and arms are overworked), this might not be the best choice.

Also, this one's quite wide, which forces you to put your mouse pretty far away, if you're right-handed. Having your mouse too far to the side can cause as many problems as the keyboard itself solves.

Goldtouch Split Keyboard
$121.98 retail

The Goldtouch is a bit pricier, but is more flexible. You can fully adjust its height and split angle; a big advantage over the Belkin and the Microsoft keyboards. Another huge advantage (or disadvantage, depending on the work you do) to the Goldtouch is that it doesn't have a side number pad. That means you can get the mouse a lot closer to the center of your workspace, which can help cut down on awkward stretches and movements. Most of the keys you'd usually find on the number pad, like the Page Down and Home keys, are relocated to the left side. And with the Goldtouch, there's nowhere to rest your palms, which is actually a good thing.

A downside to this keyboard is that the keys are all standard-sized, and aren't angled at all. It was not easy adjusting to a smaller Space bar and Shift and Alt keys, as compared with the Belkin.

Kinesis Advantage Keyboard
$299 retail

The Kinesis is by far the strangest-looking keyboard I've seen. It's also the most expensive, but again, with a 30-day return policy, you've got plenty of time to decide if it's worth the price.

This keyboard is the only one that you won't quickly adjust to within a few hours. You really need at least a week of dedicated practice (of at least an hour a day) to acclimate to what seems at first to be a truly bizarre layout. Fortunately, the folks at Kinesis include some very handy typing exercises to help you adjust. The two most difficult adjustments to make are to the odd concave shape of the main keying areas--the keys are all at different heights and angles, and aren't lined up in straight rows like on most keyboards-- and to the unusual placement of the "utility" keys (Space, Enter, Ctrl, Alt, etc.), which are all located in the center of the keyboard. The idea is that you use your thumbs for those commonly used keys, rather than your small and relatively weak little finger.

I'll admit, it was very frustrating at first to use this keyboard. But after about a week, things started feeling much more natural, and I was back up to regular speed (70+ words per minute). This is the only keyboard I've tried that is not fatiguing. I can type for extended periods of time with minimal discomfort (I do, of course, take frequent breaks and stretch a lot). Comparing that with my laptop keyboard, which I can use for only a few minutes before discomfort sets in, I knew I'd found a winner.

Mice and Other Pointing Devices

For me, using a mouse was the most problematic part of my work. I spend a lot of time in GUI-heavy publishing software, so just learning keyboard shortcuts wasn't enough--I can't avoid using a mouse, so I was forced to find a comfortable way to do it.

If you start complaining of wrist or hand problems, friends or co-workers may suggest switching hands to relieve the problem. For some people, this does work. But for many, it just prolongs the inevitable, and eventually the same problems surface on their non- dominant side. But switching sides isn't bad advice--in fact, it's a great idea to take the time to adjust to using a mouse with your other hand. Once you do that, you've given yourself another option, allowing you to switch hit, helping to avoid too much strain on either side. I now work with a mouse on each side, often switching several times during the same task; using my left (weaker) hand for simple movements like opening a program or moving a file helps keep my right hand rested for when I need more precision.

The following is a list of the different pointing devices I've tried. As with the keyboards, give yourself some time to adjust before making a final decision. What can seem great (or awful) at first can turn out quite the opposite after a few days or a week.

NaturalPoint SmartNav
$299 retail

This is a device that sits on top of your monitor, and tracks the movement of your head (using reflected infrared light). This was the most impressive technology I found in my search for ergonomic equipment. I had no idea such a product existed, and was very excited to try it out. Since your head doesn't reflect infrared very well, you have to attach some sort of reflective surface to it. The SmartNav comes with several sizes of adhesive dots that you can stick on your forehead. I opted instead for the optional hat, which can be worn forward or backward.

Seeing the cursor follow my head movements was pretty cool, and I found the movement tracking to be much more accurate than I had expected. However, after a week of trying, I decided the SmartNav wasn't going to work as a mouse replacement. For one thing, whenever you look away from the screen, the tracker "loses" you, forcing you to re-orient the cursor when you return to your work. Additionally, I just found it too hard to manage the kind of fine movements needed when working in a program like FrameMaker or InDesign, programs that rely heavily not only on mouse movements, but clicking, right- clicking, and dragging, as well.

MagicTouch touchscreen
$179 retail

After trying out a relative's tablet PC, I hoped this would be a low-cost way to turn my vanilla laptop into something more tablet-like. The MagicTouch touchscreen attaches with Velcro to your monitor, and lets you use either your finger or a supplied stylus as the input device.

At first I was quite pleased with the device, but soon found it unsuitable as a mouse replacement. One of the reasons a Tablet PC is so well-suited to use with a pen is that you can rotate the screen and lay it flat--with a regular notebook, you're forced to reach over the keyboard, which can be as straining as using a mouse. And since the screen is touch-sensitive, you can't rest your hand on it while using the stylus.

Although it wouldn't meet my needs, the MagicTouch is an impressive product, and is an affordable way to make most any monitor touch-sensitive. I could see this as a very useful addition to a trade-show display or kiosk.

E-Quill AirO2bic Mouse
$99.95 retail

After trying this optical mouse, I was surprised I hadn't seen more like it before. The design forces your hand to rest sideways, so your palm faces inward toward the keyboard. This dramatically reduces twisting in the wrist, and though a bit awkward at first, I've come to really like this one.

On their "What to expect" page, E-Quill says you can expect a warm sensation in your hand the first few times using this mouse, a product of increased blood flow to your hand. Sure enough, within a few minutes of using the mouse, my hand was noticeably warmer, almost uncomfortably so. But that soon subsided, and hasn't returned since.

Overall, this is a very comfortable mouse to use. Much like with the Kinesis keyboard, I can use this mouse for extended periods of time without discomfort. The only complaints I have about this one are that it takes a lot of force to click, especially if you're using your non-dominant hand, and the scroll wheel feels like it's too far back--it would be better moved up farther toward the tips of the fingers. Also, this is one mouse you can't switch sides on; it's available in either left- or right-handed versions, but they are definitely not interchangeable.

Give Yourself Options

Almost any device, however well designed, can cause you pain or discomfort if used too much. I've found that one of the best ways to avoid RSI pain is to have a lot of different options available when using the computer, and to make an effort to switch positions, devices, and tasks as often as possible.

None of these devices will be a miracle cure for RSI pain or discomfort. But they can be an important part of keeping symptoms under control while still getting your work done. And if you're like me, that's the biggest relief of all.

Andrew Savikas is the VP of Digital Initiatives at O'Reilly Media, and is the Program Chair for the Tools of Change for Publishing Conference.

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