Ten Simple OOS Prevention Tips
Occupational Overuse Syndrome (OOS), which is also known as Repetitive Strain Injury (RSI), is a potentially disabling illness caused by prolonged repetitive hand movements, such as those involved in computer use. Symptoms include intermittent shooting pains in the hands, wrists, forearms, and back.
Here are ten simple tips which may help you prevent computer-related OOS.
1. Type using a Neutral Wrist Position
When you type, your wrists should be in a neutral position. That means like this:
The Neutral Position
not bending your wrist towards your little finger:
nor bending it toward your thumb:
This is known as dorsiflexion. It's particularly easy to do this if your keyboard is badly adjusted, or at the wrong height.
Typing with your wrists in any position other than the neutral position puts additional strain on the tendons and sheaths, and increases your risk of repetitive strain injury.
2. Adjust (or replace) the Keyboard
Many people believe that, because cheap keyboards have a height adjustment at the rear of the keyboard, the back of the keyboard should be raised when typing.
This is not true.
The correct keyboard adjustment is one where the keyboard is flat and at or below elbow level. This position makes it easiest to type with your wrists in the neutral position. If you can't have the keyboard at the correct height, you should choose the adjustment which keeps your wrists as near to the neutral position as possible.
Watch out for what you do when you are not typing! It's all too easy to rest your wrists on the hard edge of the desk or table. A gel wrist rest placed along the edge of the desk may help you to you to stop doing this, as well as encourage you to avoid dorsiflexion.
More modern "ergonomic" keyboards, such as the Microsoft Natural Keyboard make it easier to type with your wrists in a neutral position. As well as splitting the keyboard in the middle to reduce ulnar and radial deviation, they allow the front of the keyboard to be raised to avoid dorsiflexion. In addition an integral wrist rest prevents you from resting your wrists on the hard edge of the desk when you aren't typing.
But watch out! Tempting as a wrist rest is, never rest your wrists on the wrist rest while typing. The wrist rest is for use when you aren't typing, not when you are.
3. Watch Out For That Mouse!
Many people develop OOS in their mouse hand. Dorsiflexion is often to blame. A gel wrist pad (such as those made by Fellowes, Belkin or Innovera) may help you to keep your wrist in a better position while using the mouse. You should try to keep your wrist in a neutral position, just as when using the keyboard.
You may be able to cut down on your mouse usage by using keyboard shortcuts instead. Our free booklet The Reluctant Mouser: A Guide to Windows Keyboard Shortcuts may help you eliminate a lot of mouse usage.
If you switch mouse hands, it takes about a week to become ambidextrous as far as the mouse is concerned. However, watch out! If you haven't identified yet what the cause of the problem is, you will probably just get OOS in the other hand and have two sore wrists instead of one.
4. Take Regular Breaks
One of the most frequent pieces of advice you will hear if you have OOS is to take regular breaks. It's also one of the most difficult pieces of advice to follow.
It has been suggested that, for OOS prevention purposes, you should take a five minute break after every 20 or 30 minutes of continuous activity. If you are suffering from OOS you should clearly take more frequent and longer breaks.
It's difficult to remember to take a break while you are working. By definition, you are doing something else at the time. A suitable and discreet break reminder program, such as our own Albion StopNow! can help you here.
When you take a break, get up and walk around. Get a glass of water. (Useful, if sneaky tip: if you carry a bunch of papers and walk around the office looking purposeful, everybody will think you are exceedingly busy and not just getting a little exercise while taking a break).
5. Sit Up Straight!
Don't slouch. Your mother probably told you this. It was good advice, and she probably didn't know how many hours you would be spending in front of a keyboard.
Bad posture is a primary risk factor in OOS. Choose and adjust your seat so that you sit up straight, rather than leaning forward over the keyboard.
Adjust your display so that the monitor is directly in front of you, with the top of the screen at eye level except if you wear bifocal glasses. If you wear bifocals, you may need the screen slightly lower down so that you can focus on the screen through the correct part of your glasses without straining your neck.
6. Take It Easy After the Holiday
Holidays are a great idea. They give your body time to recover from the rigors of the workday. But watch out when you return!
Think of yourself like a marathon runner. You've trained yourself over a number of years to execute thousands of precise movements with your fingers for a number of hours each day.
Then you take some time off.
If a marathon runner spent a month or two without running would he or she expect to be able to run a full marathon the next day? Don't expect too much of yourself when you return to work after an extended break. Take a little time to get back into the routine and work yourself up to your previous peak performance. Otherwise you, like the marathon runner, will risk injury.
7. Eat Your Veggies and Get Some Exercise!
I know, you've heard that advice before. But it is still good advice.
Not only is lack of cardiovascular exercise (that's exercise for your heart like walking, running and swimming) going to make you die sooner, it's also going to make you more likely to have OOS (and a host of other problems). So you'll end up with not just a short life, but a miserable one.
Obesity is another risk factor. If you're overweight, your muscles are having to support that extra weight. If you are very overweight, you may also find it difficult to find a typing position which avoids ulnar deviation.
Your chair is important. You spend a lot of time sitting on it, and if it doesn't give you the support you need or causes you to sit in an awkward posture, it can cause you a lot of problems.
Your ideal chair is made of breathable fabric (prevents sliding) and has a five-point base. It is fully adjustable. You can adjust the height, tilt, backrest and armrest heights.
But one you have your chair, how should you adjust it?
- The seat pan should be adjusted to tilt slightly forward, to encourage a good posture when seated.
- The backrest should tilt backwards about 10°.
- Your forearms should be approximately horizontal when working, with your shoulders and upper arms relaxed. The seat height should be adjusted accordingly.
- Your feet should be flat on the floor and your knees bent at approximately 90 degrees. You may need a footrest (or some old phone directories) beneath your feet if the desk is not at the right height. The correct height of the footrest is the height your feet are off the floor when the seat height is correctly adjusted.
- If the chair fits you correctly, there should be about 2 inches (5 cm) between the front seat of the chair and the backs of your knees.
- Armrests should be low enough that you don't rest your arms on them while you are typing. Remove the armrests if they prevent you putting your chair at a comfortable distance from the keyboard, they interfere with your use of the keyboard or mouse, or if they prevent you from turning your chair easily.
9. If You Think You Have OOS Visit Your Doctor
Don't rely only on the Internet for all your medical advice. It may be out of date, or just plain wrong. A physician's physical examination may notice factors that you weren't looking for or aware of.
Also remember the story in Jerome K. Jerome's classic comic story Three Men in a Boat where the narrator reads a medical dictionary and concludes that he has every disease in it except Housemaid's Knee. A doctor may be able to point out alternative causes of your symptoms and calm you fears.
10. Do Something!
OOS symptoms may sometimes go away if you do nothing. Or they may get considerably worse. Don't take that risk.
Change your work environment. Change your work habits. Start taking regular rest breaks.
Don't wait until the pain becomes so bad that you need to take time off work. Don't wait until the pain is so bad that you can't sleep at night. Don't wait until you develop carpal tunnel syndrome. Don't wait until you need surgery to relieve the pain. Don't wait until your condition is so bad that you will never fully recover.
Do Something... And DO IT NOW!
Taking regular breaks is one of the most important changes you can make. If you've tried to take breaks, you'll know that it's not that easy to do. Take a free trial of our break reminder program Albion StopNow! on your PC and find out in a week how much difference taking short breaks can make.
The following books may be helpful:
Repetitive Strain Injury: A Computer Users's Guide
Emil Pascarelli & Deborah Quilter, ISBN 0471595330, Wiley, 1994.
It's Not Carpal Tunnel Syndrome, RSI Theory & Therapy for Computer Professionals
by Suparna Damany, Jack Bellis. Simax, Philadelphia, 2000.
How to Make Your Computer Worksation Fit You (PDF)
Worker's Compensation Board of British Columbia, Canada.
This additional advice was suggested by readers of this page. We've edited these for length:
- "Don't pound the keys!"
"Cod liver oil works to ease RSI and Arthritis."
Presumably taken internally. Vitamin E and Vitamin C supplements are reputed to be helpful too, but note that recent research suggests that Vitamin E in higher doses may shorten your life, so cod liver oil may be a safer bet.
"Sit up straight when you type."
My wife, who had formal training in typing skills, remembers her instructors being particularly hot on this one. She has never had any problems with RSI.
"The natural position for the hand is as if shaking hands.
Therefore it makes sense to reduce twist in the hands by using a vertical mouse
and something like a Goldtouch keyboard (expensive but worth it if it reduces/prevents pain).
It is also helpful to have a keyboard without an integrated numeric keypad as
it reduces travel between the keyboard and the mouse (and therefore reduces strain).
A separate numeric keypad can be purchased if it's needed."
I don't have any experience with this keyboard myself, but I've seen some people using it. Amazon reviews seem a bit mixed , but a keyboard like this might be worth a try, and the point about the separate keypad is interesting. (I use an old Microsoft Natural Keyboard similar to this one myself). I find when the arms are bent inwards a little, their natural position isn't quite as vertical as that suggested by the Goldtouch pictures, but I think there is a lot of personal preference involved here.
- "I'm now using a trackball device that allows my hand to be more vertical and it is stationary thus keeping my wrist and hand in the position I choose. I do have a wrist support pad too."
- "Roll your arms around to stretch them out." Stretching is definitely something I find helpful too. I find stretches that involve unrolling a clenched fist particularly helpful.
- "The pictures you show of the neutral keying position, there is not enough space between the keyboard and desk edge. [Agreed — we didn't set up for that picture perfectly. The distance also varies between shots.]
- "… a correct workstation should have a keyboard that is adjustable and the back of it can be raised, as this helps to stop bending the wrists whereas a totally flat keyboard can make you bend wrists." The objective is a neutral position (wrists not bent) with forearms approximately horizontal when working. In this case a keyboard should not be tilted. Unfortunately some people tilt their keyboard just because it has fold-out legs, without realizing it makes their typing position worse. That's the point we are trying to make here.
- "Where the wrist positions are mentioned, showing incorrect positions, there is no mention of having raised wrists tilting down towards the keyboard which is also a risk factor for people typing with wrists too high."
"It should clearly state that if anyone is having any of the RSI problems on here then
their employer needs to complete a DSE/VDU Assessment on them and their workstation."
Sadly this doesn't apply to the self-employed or those in the wrong country…