whaack

Although I've been dealing with chronic pain for two years and the situation looks pretty bleak, I am determined to fix my hands.

Here are the key steps I'm taking.

Resting. I try to avoid doing anything forceful or bearing weight on my hands. For example, when carrying small grocery bags I slip the handles up my shoulder instead of holding them in the palm of my hand. There're tons of little tricks like that to reduce the load.

Doing physical therapy for surrounding muscles. I'm strengthening the neck, shoulders, and back muscles. My forearms and hands are too delicate right now, working them out just puts me at risk for reinjury. Strengthening the supporting muscles helps me maintain better posture. It also gives the body an easier time when doing compensation movements.

Staying constantly hydrated. The problem may be due to cellular health and the fix may come from providing the right environment for tissues to regenerate. So I am drinking coconuts all the fucking time! I also may look into examining my blood work more closely and keeping an even stricter diet.

Wearing wrist splints at night. From what I've learned it seems that restricting movement can be quite dangerous when it comes to these type of injuries. However, at night time I know that I can put my wrists in horrible positions and then fall asleep on them.

Stretching Lengthening.¹ The idea is that being more flexible means there is less tension in muscles. This may help alleviate any nerves that are constantly being squeezed.

Learning. Unfortunately this one has been neglected recently, but it's imperative to learn as much as I can about the human body and the anatomy of the hands. My problem is too complicated for doctors to figure out in their routine 20 minute check, so I'm kind of on my own here.

Technique retraining. I'm working on changing the way I type and fixing my workstation to accommodate for my crippled nature. At the moment this mostly means using speech to text.

The future sometimes looks grim but I'm not going down without a fight.

1. The word choice emphasizes the gentle nature. [↩]

Control of the hand is provided to the brain via the radial, median, and ulnar nerve. The default keying position compresses the ulnar nerve.

The ulnar nerve runs through an area called the cubital tunnel in the elbow. This area is colloquially referred to as the funny bone.

A nerve can be modeled as an electrical cable with rubber insulation. Whenever you pinch the rubber tube its internal conductivity reduces. The tube usually quickly expands back to its normal circumference. But if you squeeze that tube over and over and over and over and over for years eventually it will deform permanently.

When you are keying you are almost certainly compressing the ulnar nerve. Stop now before it's too late.

There are two primary reasons why the ulnar nerve is being compressed while keying. The first is that your elbows often need to bend at an acute angle so your hands can reach the keyboard. This is especially true if your keyboard is placed on a high table. You need your elbows to be at an angle closer to 135 degrees. The second reason the ulnar nerve is compressed is that in order to use a normal keyboard one needs to pronate their forearms.¹

Let's address how to reduce this bad posture in an ideal manner. The best thing you can do is to cut your keyboard in half and place each half on the outside of your knee. Each half of the keyboard would be rotated 90 degrees from a normal position so that the keys are facing away from one’s body. With the keyboard in this position, your hands can naturally fall into the home row without you having to pronate or bend your elbows.²

You can approximate this by getting a split keyboard with tenting (the ability to tilt them) and getting a keyboard tray - ideally one that also can tilt away from you. For the keyboard I currently use a Kinesis Freestyle Pro 2. I have yet to install a keyboard tray for myself.

If you don't have a keyboard tray nor a split keyboard one tip is to place the keyboard on your lap. It is a decent way to prevent your elbows from bending too much, especially if your desk/table Is too high. If you don't have a split keyboard, there is nothing you can do to prevent the pronation while you type other than hunting and pecking with the outside of your pinkies. (yes I type like that now when I have to.) What you can do is remove your hands from the keyboard and supinate back to resting position constantly to prevent prolonged pronation.

There you have it, some keys to healthy pinkies.

1. I can reliably reproduce paresthesia simply by putting myself in the naive keying position of bent elbow, pronated forearm. [↩]
2. Another way to think of this is where would you put the keyboard so that your fingers would be in a good position to strike if your hands were relaxed and in the position they are in during a normal gait. [↩]

I've been thinking about what topic I should break the silence with. I ask myself what would be most useful for me and my readers?

The obvious answer is writing about my condition. There are not so many first-hand (pun intended) accounts written about RSI for obvious reasons. It is frustrating for someone with the condition to have to watch videos or listen to audio recordings in order to hear about the experience of other people who have suffered the same ailment.

Although mostly via subpar mediums, there exists lots of information about RSI. So I plan to focus on my specific experience so that I can be a unique data point rather than an echo. I will still mention what I consider the most important information I've learned from other sources.

I urge the reader to deeply consider everything I write in this series if they make a living with the use of their hands.¹ I have reason to believe more people are affected by this condition than is reported. It is possible that people have nerve damage in their hands without having pain and paresthesia. It is also possible that people who have symptoms for RSI don't speak about it publicly for fear of losing their job or because they assume it's normal pain.

Take the warning seriously. I never thought “this could never happen to me” however I did erroneously believe my ergonomic chair and my ergonomic Microsoft keyboard were actually ergonomic. There are easy steps to take to reduce the load on your hands, and not doing so may come at a huge cost.

1. i.e.everyone who doesn't play football. FOOTball. [↩]