Care of hands and arms for computer users 8-Mar-2009 Angel Rivera [email_address] www.AngelicalTouch.com Model and Pictures by Victor Rivera

Agenda Objectives My qualifications Caveats Problem Posture and Mechanics Setup of workstation Exercises Devices / products Self-massage

Objectives

My qualifications

Caveats

Problem

Posture and Mechanics

Setup of workstation

Exercises

Devices / products

Self-massage

Objectives To share information on: The causes of fatigue and discomfort of the hands and arms while using computer keyboards and mice. Recommendations on how to provide relief: Adjusting a better posture Taking frequent breaks Considering ergonomic devices Exercise Self-massage

To share information on:

The causes of fatigue and discomfort of the hands and arms while using computer keyboards and mice.

Recommendations on how to provide relief:

Adjusting a better posture

Taking frequent breaks

Considering ergonomic devices

Exercise

Self-massage

My qualifications Why do I think that I can talk about this topic? Several years ago I had a lot of pain and discomfort in the hands and I took a long-term approach that is working for me. I am a licensed massage therapist.

Why do I think that I can talk about this topic?

Several years ago I had a lot of pain and discomfort in the hands and I took a long-term approach that is working for me.

I am a licensed massage therapist.

Caveats I cannot diagnose a condition, nor prescribe treatment. Although, I can offer recommendations. I am providing information on products and I give specific examples for illustration purposes. I do not have any financial interest on them. I am not an ergonomics “expert”. I am providing techniques that are working for me.

I cannot diagnose a condition, nor prescribe treatment.

Although, I can offer recommendations.

I am providing information on products and I give specific examples for illustration purposes.

I do not have any financial interest on them.

I am not an ergonomics “expert”.

I am providing techniques that are working for me.

Problem Many people who use computers for many hours a day are feeling discomfort and pain in different parts of the body due to the continuous and long term use of computers. This presentation concentrates on the upper extremities: arms, forearms, wrists, hands. Note: A commonly used (and sometimes a catch-all) term for pain condition of the wrist is: Carpal Tunnel Syndrome

Many people who use computers for many hours a day are feeling discomfort and pain in different parts of the body due to the continuous and long term use of computers.

This presentation concentrates on the upper extremities: arms, forearms, wrists, hands.

Note: A commonly used (and sometimes a catch-all) term for pain condition of the wrist is:

Carpal Tunnel Syndrome

Causes of fatigue and discomfort The 3 main causes of computer-related fatigue and discomfort are: Repetitive motion , which causes overuse of muscles Improper body positioning , which causes lack of oxygen to the muscles Staying in the same position for long periods of time

The 3 main causes of computer-related fatigue and discomfort are:

Repetitive motion , which causes overuse of muscles

Improper body positioning , which causes lack of oxygen to the muscles

Staying in the same position for long periods of time

Reducing fatigue and discomfort To reduce fatigue and discomfort and possible musculoskeletal disorder it is important do: Understand how to avoid awkward body postures Setup your workstation properly Practice safe work habits to increase circulation Maintain a neutral position while working Alternate tasks - move your body throughout the day Use ergonomic devices and auxiliary products Do stretch exercises Do self – massage on the affected areas

To reduce fatigue and discomfort and possible musculoskeletal disorder it is important do:

Understand how to avoid awkward body postures

Setup your workstation properly

Practice safe work habits to increase circulation

Maintain a neutral position while working

Alternate tasks - move your body throughout the day

Use ergonomic devices and auxiliary products

Do stretch exercises

Do self – massage on the affected areas

Muscle anatomy http://training.seer.cancer.gov/module_anatomy/images/illu_muscle_structure.jpg

Muscle contraction A muscle is a set of bundles of bundles of muscle fibers (each fiber is a long cell – visualize a single thread in a spider web). A muscle fiber is able to contract upon a nerve impulse. Blood vessels are inside the bundles and provide nutrients and remote waste products to muscle fibers. During contraction, the blood vessels are squeezed and their flow capacity is diminished. A muscle that is contracted for too long, it is not receiving enough nourishment and is accumulating waste products. Therefore, to provide proper blood flow, it is necessary to reduce the muscle contraction by avoiding being a long time in a single position, by alternating tasks, doing exercise and self-massage.

A muscle is a set of bundles of bundles of muscle fibers (each fiber is a long cell – visualize a single thread in a spider web).

A muscle fiber is able to contract upon a nerve impulse.

Blood vessels are inside the bundles and provide nutrients and remote waste products to muscle fibers.

During contraction, the blood vessels are squeezed and their flow capacity is diminished.

A muscle that is contracted for too long, it is not receiving enough nourishment and is accumulating waste products.

Therefore, to provide proper blood flow, it is necessary to reduce the muscle contraction by avoiding being a long time in a single position, by alternating tasks, doing exercise and self-massage.

Neck and Upper Back – awkward postures Forward head posture is a common cause of discomfort in the upper back and in the neck muscles. It can compress the nerves that run from the neck into the arms, which may cause pain in the arms and hands.

Forward head posture is a common cause of discomfort in the upper back and in the neck muscles.

It can compress the nerves that run from the neck into the arms, which may cause pain in the arms and hands.

Neck and Upper Back – Solution Maintain a neck posture by keeping aligned the ears with shoulders and hips. This posture reduces the amount of work required of upper back and neck muscles.

Maintain a neck posture by keeping aligned the ears with shoulders and hips.

This posture reduces the amount of work required of upper back and neck muscles.

Shoulder – awkward posture Sustained reaching forward with the shoulders can compress blood vessels and nerves that travel through the shoulder.

Sustained reaching forward with the shoulders can compress blood vessels and nerves that travel through the shoulder.

Shoulder - Solution Maintain a neutral shoulder position (relaxed, elbow at side, not over reaching). This position allows proper circulation to arm and hand.

Maintain a neutral shoulder position (relaxed, elbow at side, not over reaching).

This position allows proper circulation to arm and hand.

Forearm/Wrists awkward posture Wrists bent upward: extension Wrists bent downward: flexion Wrists bent to the side: deviation (illustrated)

Wrists bent upward: extension

Wrists bent downward: flexion

Wrists bent to the side: deviation (illustrated)

Forearm/Wrist - Solution Maintain a neutral position: Elbow rests as your side, bent around 90 degrees. Wrist stays flat, with middle finger aligned with forearm May need to use split keyboard

Maintain a neutral position:

Elbow rests as your side, bent around 90 degrees.

Wrist stays flat, with middle finger aligned with forearm

May need to use split keyboard

Devices and products There are input devices that allow a more ‘neutral’ position for the wrist (diagonal, not parallel) when using these devices: Ergonomic keyboard Ergonomic mouse Wrist braces to stabilize the wrist, such as: “ ACE Wrist brace with rigid splint” Beware! Many companies and products use the “ergonomic” buzzword for products that are not really ergonomic.

There are input devices that allow a more ‘neutral’ position for the wrist (diagonal, not parallel) when using these devices:

Ergonomic keyboard

Ergonomic mouse

Wrist braces to stabilize the wrist, such as:

“ ACE Wrist brace with rigid splint”

Beware! Many companies and products use the “ergonomic” buzzword for products that are not really ergonomic.

Work habits Maintaining a neutral body position is critical. However, long sustained periods in any position, including a neutral position, may also lead to fatigue or pain. You need to take breaks from your neutral position by rotating tasks and moving your body: Stand up while talking on the phone Walk to colleague's offices rather than emailing (when possible) Break up keyboard-intensive tasks by returning calls, hand writing notes. Perform mini-break stretches for a few minutes each hour

Maintaining a neutral body position is critical.

However, long sustained periods in any position, including a neutral position, may also lead to fatigue or pain.

You need to take breaks from your neutral position by rotating tasks and moving your body:

Stand up while talking on the phone

Walk to colleague's offices rather than emailing (when possible)

Break up keyboard-intensive tasks by returning calls, hand writing notes.

Perform mini-break stretches for a few minutes each hour

Workstation setup, general concepts Arrange your workspace so that your body can work in a safe neutral position to enhance vital circulation and limit overuse. Neutral Spine: Ears, Shoulders, & Hips Aligned, with a Small Low Back Arch Neutral Shoulders: Relaxed by Your Sides, Not Reaching Neutral Elbows: At Right Angles (90 Degrees) Neutral Wrists: Flat, In Line with Forearms

Arrange your workspace so that your body can work in a safe neutral position to enhance vital circulation and limit overuse.

Neutral Spine: Ears, Shoulders, & Hips Aligned, with a Small Low Back Arch

Neutral Shoulders: Relaxed by Your Sides, Not Reaching

Neutral Elbows: At Right Angles (90 Degrees)

Neutral Wrists: Flat, In Line with Forearms

Workstation – adjustable chair Use an adjustable chair: Height - up and down Tilt – back and forward Considering the amount of time that you spend sitting using a computer, an adjustable chair is a good investment on your health!

Use an adjustable chair:

Height - up and down

Tilt – back and forward

Considering the amount of time that you spend sitting using a computer, an adjustable chair is a good investment on your health!

Workstation Setup - typing Proper keyboard and mouse positioning will facilitate proper typing: Type with your hands and fingers floating over the keys Use larger arm and shoulder muscles, rather than your forearm and wrist muscles. Do not rest your wrists on any surface, including wrists rests (to avoid pressing on the carpal tunnel)

Proper keyboard and mouse positioning will facilitate proper typing:

Type with your hands and fingers floating over the keys

Use larger arm and shoulder muscles, rather than your forearm and wrist muscles.

Do not rest your wrists on any surface, including wrists rests (to avoid pressing on the carpal tunnel)

Workstation Setup - mouse If you are right handed, notice the long distance that your hand has to travel from keyboard to mouse. Consider using the mouse on the left. It takes a couple of hours to adjust to use it with the left hand.

If you are right handed, notice the long distance that your hand has to travel from keyboard to mouse.

Consider using the mouse on the left.

It takes a couple of hours to adjust to use it with the left hand.

Exercises Performing brief stretches for 1-2 minutes every hour throughout the day is one of the most effective ways to increase circulation and reduce fatigue and discomfort. Hold each stretch 5-10 seconds To increase strength, weight lifting is recommended The following web page has a good set of stretches for computer users: http://login.remedyint.com/ergoanswers/micro_stretch.html

Performing brief stretches for 1-2 minutes every hour throughout the day is one of the most effective ways to increase circulation and reduce fatigue and discomfort.

Hold each stretch 5-10 seconds

To increase strength, weight lifting is recommended

The following web page has a good set of stretches for computer users: http://login.remedyint.com/ergoanswers/micro_stretch.html

Stretching – Shoulder shrugs Stand or sit straight up, arms relaxed by your side Slow roll shoulders straight up towards your ears Squeeze your shoulders together, and let them roll down and back. Repeat 5 times

Stand or sit straight up, arms relaxed by your side

Slow roll shoulders straight up towards your ears

Squeeze your shoulders together, and let them roll down and back.

Repeat 5 times

Stretching – Wrist Extensors Helps reduce forearm and wrist fatigue 1: Straighten your right arm out in front of you 2: Point your fingers towards floor 3: Use your left hand to mildly stretch the right wrist further; slowly rotate right fingers to point away from your body 4: Hold 10 seconds 5: Switch sides

Helps reduce forearm and wrist fatigue

1: Straighten your right arm out in front of you

2: Point your fingers towards floor

3: Use your left hand to mildly stretch the right wrist further; slowly rotate right fingers to point away from your body

4: Hold 10 seconds

5: Switch sides

Stretching – Wrist Flexors Helps to reduce forearm and wrist fatigue 1: Straighten your left arm out in front of you. 2: Bend your wrist backwards, and point your fingers upwards. 3: Use your right hand to mildly stretch the bending wrist further. 4: Hold for 5 to 10 seconds. 5: Switch sides.

Helps to reduce forearm and wrist fatigue

1: Straighten your left arm out in front of you.

2: Bend your wrist backwards, and point your fingers upwards.

3: Use your right hand to mildly stretch the bending wrist further.

4: Hold for 5 to 10 seconds.

5: Switch sides.

Stretching - Fingers Place finger tips together in a prayer position at chin level. Slowly move your hands from chin level to chest level. Slowly rotate fingers to point towards your chest. Hold stretch for 5 to 10 seconds, release slowly.

Place finger tips together in a prayer position at chin level.

Slowly move your hands from chin level to chest level.

Slowly rotate fingers to point towards your chest.

Hold stretch for 5 to 10 seconds, release slowly.

Self-massage You can do some self-massage techniques on your arms: Do general stroking with thumb or fingers Avoid grasping with your thumb and fingers: uses all the muscles of the hand and forearm, causing more expense of energy and possibly more discomfort Use a tennis ball or a racquet ball to provide release on tensed muscles

You can do some self-massage techniques on your arms:

Do general stroking with thumb or fingers

Avoid grasping with your thumb and fingers:

uses all the muscles of the hand and forearm, causing more expense of energy and possibly more discomfort

Use a tennis ball or a racquet ball to provide release on tensed muscles

Self-massage objectives It breaks the feedback loop that maintains muscle contraction. It increases circulation that has been restricted by the contracted tissue. It directly stretches the knotted muscle fibers.

It breaks the feedback loop that maintains muscle contraction.

It increases circulation that has been restricted by the contracted tissue.

It directly stretches the knotted muscle fibers.

Massage with a tennis ball Apply your weight against a wall Slowly press the ball against the muscle

References http://ehs.concordia.ca/pdf/ih/ergonomics.manual.pdf Concordia Univ. Office Ergonomics Manual http://www.pc.ibm.com/ww/healthycomputing/vdt4.html Healthy Computing (Lenovo) http://login.remedyint.com/ergoanswers/index.html ErgoAnswers - guide to comfortable computing http://www.triggerpointbook.com/index.html The Trigger Point Therapy Workbook

http://ehs.concordia.ca/pdf/ih/ergonomics.manual.pdf Concordia Univ. Office Ergonomics Manual

http://www.pc.ibm.com/ww/healthycomputing/vdt4.html Healthy Computing (Lenovo)

http://login.remedyint.com/ergoanswers/index.html ErgoAnswers - guide to comfortable computing

http://www.triggerpointbook.com/index.html The Trigger Point Therapy Workbook

Questions and Answers Any questions?

Any questions?