Gamers With RSI

So lately I've been getting nasty, crippling pain running from my wrist up to my elbow, in the tendons you feel moving when you wiggle your fingers. This sucks, because I sit writing code for eight hours a day at work, and then come home and play games on my PC.

An official "workstation assessment" at work turned up the fact that my chair was too low for the desk. So now I've raised my chair, I need monitor risers and a footrest to get them at the right height too. (I can't help but think that making the desk lower would be easier, but unfortunately it's not adjustable.) So now I have a bunch of plastic stuff scattered over / under my desk (two monitor risers and a footrest), plus a giant old-skool white Microsoft Natural keyboard. Since then, things have been improving and I'm in a lot less pain than I was.

...until it gets to the weekend, when I sit for hours on end on a chair that's too low in an awful posture. I'm pretty sure I do more damage to myself when I'm at home than at work, so I'm taking steps to rectify this. I'm off to town today to get a better office chair that I can actually adjust to a useful height, and I suspect I'll end up needing monitor risers for home as well. What's bugging me is the keyboard. I find with normal keyboards I tend to roll my wrists outwards (especially to hit the Ctrl and Shift keys). Ergonomic keyboards tend to solve that, but at the expense of being utterly huge, so my mouse hand is miles off the other side of the desk. If only I could take a Microsoft Natural and saw off everything right of the Enter key, things would be vastly improved, although I really don't like the incredibly hard and clunky key action.

Now, small laptop-style keyboards are fairly common, as are ergonomic ones. The intersection of those two? Not so much. The best I can find is the Goldtouch, which looks incredibly weird but seems to have a pretty sound design (and also isn't as hideously expensive as the website says if you know where to look). But I don't have any experience of it.

How do you cope with your aches and pains? What have you found useful - and overpriced rubbish?

In my old job as data entry, they had some ergonomics/ocupational therapists in to take a look at what we were doing. One of the things they suggested besides the desk setup (which I think you've got a handle on) was stretches before starting, move your joints around a bit and flex your fingers every once in a while. Staying in the same position for ages doesn't help either, so shift how you're sitting regularly.

Yeah, I've installed Workrave which is basically a set of timers that intermittently block input to your machine and force you to take a break / get up and walk around. For the longer breaks, it also suggests some exercises to do, which may or may not get you filthy looks round the office when you start cartwheeling your arms around the place...

What mouse do you use? I've found that a vertical "handshake grip" mouse works wonders for my forearm and wrist. Doesn't solve any finger problems though as you're still "clicking" and "rolling".

Malor: In my final year of Uni they wheeled out some old students who managed to get severe RSI and pretty much crippled themselves for life. They then told us that 40% of students on our course end up with it due to doing too much work on our final project. I managed to escape unscathed, but I'm still quite careful. It's something that crops up for a couple of months every couple of years for me, and I usually find that taking a few steps to rectify the problem - and sometimes wearing a wrist support - tends to fix things up. Things have already got better since I raised the issue at work, but certainly if things continue or get worse, I'll be hitting up my nearest medical establishment.

I did have a Model M kicking around once upon a time, although I don't know where it's gone (might still be at my parents' house). I've looked at the Kinesis, but it's a pretty hardcore solution, and quite expensive. Plus I don't have enough space on my desk at home for it, so I don't think it's going to work for me. The Goldtouch seems like a good idea since it's adjustable and also a lot smaller, which means I can keep my mouse hand closer.

Mousewise I use an MX510, which I love, although I have been tempted by the vertical style ones. Are they any good for gaming?

Floomi wrote:

Mousewise I use an MX510, which I love, although I have been tempted by the vertical style ones. Are they any good for gaming?

I haven't used one myself, but I've seen one. It's just a mouse with a different shell on it. Pick up your mouse, rotate your wrist 60+ degrees and that's pretty much it.

Scratched wrote:
Floomi wrote:

Mousewise I use an MX510, which I love, although I have been tempted by the vertical style ones. Are they any good for gaming?

I haven't used one myself, but I've seen one. It's just a mouse with a different shell on it. Pick up your mouse, rotate your wrist 60+ degrees and that's pretty much it.

My Evoluent vertical mouse is brilliant for gaming (i use it exclusively) because it's really accurate (switchable DPI) and nice button action going on.

I recently enabled someone else on the GWJ IRC to buy an Evoluent as well... i can't remember who it was though

Duoae wrote:

Evoluent vertical mouse

No thumb buttons, instant no-buy for me. I've got very attached to my forward and back buttons on my MX510!

You should see a doctor right away, because if you nip this in the bud, you can prevent it from turning into a serious problem. Serious tendinitis is absolutely crippling, and will prevent you from doing almost anything in your life. You really, really want to avoid that, and it's usually not that difficult.

The way I learned it, when I was having serious trouble about fifteen years ago, is that first you need to get the inflammation down, which is usually done with anti-inflammatories. Ibuprofen worked really well for me, but there may be better things now. Once you have the inflammation down, you need to work on strengthening the muscles in your arms so that they take more of the load. The fundamental problem is that the muscles get weak after you've been hitting keys all day, and the tendons take too much of the load, and thus get inflamed.

You don't need to worry about 'masking the pain' with ibuprofen, for two reasons. One, the pain IS the problem; it's the damage being done to you. Stopping the pain means stopping the problem, literally. Second, when it's bad, there is NO WAY ibuprofen will mask it; serious tendinitis is agonizingly painful, to the point of involuntary screams if you do the wrong thing. It's REALLY bad, and you REALLY want to avoid it.

Go see a doctor right away. In the US, this would be considered a work-related injury, and that would give you a number of extra legal protections, but in the UK, I have no idea how the legal code works. Here, you definitely want a work-related injury classified as such. It may not matter in Britain. But you do want to go see a doctor and get it taken care of.

Note also that once you have the pain under control, you may want to go to a HARD-strike keyboard, rather than the typical squishy ones that are often prescribed for wrist pain. The problem is that your muscles are underdeveloped, and something like an IBM Model M, one of the old keyboards you really bang on, will gradually strengthen your wrists and help prevent the problem. You probably can't do one right away, and may need to go squishy early on to get the pain under control, but then moving to a hard-strike keyboard may very well help you over the long run.

You will need a lot of years out of your wrists if you're in technology. Don't screw around with this. Hie thee to a doc as quickly as you can. A little attention now, and some habit and keyboard changes, and you'll be in much better shape to keep this kind of work up for a lifetime. I haven't needed to see a doctor about my wrists in ages and ages.

I was starting to have some slight issues a few months ago, a few twinges here and there, and I switched to an actual Model M. This was a little painful at first, and I think it would be a bad idea if you were in active pain, but six weeks later I'm in very good shape again.

(Model Ms aren't made anymore; you have to buy them used. Just get one with a PS/2 connector and you're probably good. They are incredibly durable and last forever. There are many Model Ms in active use that are old enough to vote.)

Another option is a Kinesis Ergo, which I had very good luck with when I first had problems, but you have to partially retrain yourself how to type, because it moves keys into different places. It won't mess up your ability to type on normal keyboards. I stopped using them because they're very expensive, and I didn't find them to be very durable.

Again, I strongly suggest going to see a doctor; it's a pain, but if you see the right guy, he can make sure you know exactly what you should be doing. The occupational therapist people can be clueful, but not always, and doctors are often better.

If you're absolutely opposed to doing that, the medical advice 15 years ago was 'first eliminate pain, and then work on grip strength'. For me, that was 800mg of ibuprofen 4x/day for about a month, lots of squeezing on some grip tongs, and major workstation changes.

I'll Nth that you need to take this seriously and get ahold of a doctor.

I don't have an RSI, but another condition that affects my joints. I have to do the same stuff, though, and making sure to be careful to prevent RSI on top of it is a big part of what I do. Here's a couple ideas:

-- One thing you might want to get away from is the idea of one-size-fits-all tools. For different work, you're going to want to look at tools that are designed for that work. Your body is running on a narrower tolerance band now.
-- You also have to look at working in a variety of ways. The old saying "A change is as good as a rest" is a watchword when it comes to dealing with RSI.
-- Don't just address each problem or situation from one viewpoint. For example, one of the best ways to cut down on mouse problems is to not use it as much. A great way to do that many people don't think about is to incorporate the use of shortcut keys into your work instead of mousing through menus.

Pointed Input
I don't PC FPS, but for "mousing" I use a combination of a Kensington trackball and a Wacom Intuos 3.

The trackball is for "standard mousing" for coding and surfing. The bigger, heavier ball gives a much smoother action and their custom function keys are helpful, but unobtrusive if you don't want to mess with them. I use the grandfather of the one I linked to - an eight year old Kensington Expert Mouse Pro and still haven't managed to wear it out yet even with years of 80+ hour work weeks. In my experience you can't kill their hardware without a baseball bat and small munitions.

The Intuos is for drawing, of course, but that's not all it's good for. I game with it a lot. It's awesome for RTS because of the selection precision and the customizable buttons make it so easy to issue various commands to your units. You can also take a look at their new Bamboo series, which incorporates multi-touch input. A friend of mine got one and while he swore at it for a few days while he was getting used to it, now he swears by it.

Changing it up is easy this way. Since all these things are USB, I can just hook them all up to my machine. They all switch seamlessly between each other. I can pick and choose between them as I need without doing a bunch of setup.

Keyboard
Another thing you might want to look at is a "gaming" keyboard. Finding something that does both fun and work can be a challenge, though. I would have suggested the Wolf Claw (and if you can find one somewhere I still do) but the company appears to be gone. Here's some ideas to look at:

Wolf King - has the Timber Wolf, which does pretty much what you ask in that it takes all the crap to the right off and replaces them with an ergo pad on the left focused for games while still leaving the regular keyboard functionality in place. Or you can look at the Warrior Xtreme, which pulls the two in together somehow. Or you can get the Warrior gamepad to add to your setup for while you game and use your standard ergo keyboard for regular tasks.

There's several other configurations out there by different companies, including one that you can just place the keys wherever you want inside a tray, but those tend to be out of stock all the time and pricey as all heck. Take a look up on ThinkGeek for some ideas.

I was having problems with my right hand/forearm and I eventually traced it to the mouse I was using, or more specifically, the way I tend to hold most mice. After trying a few that just made things worse I just switched to mousing with my left hand. Between that and some new exercises, the problems went away. I still mouse with my left hand for everything but gaming though. I try to avoid marathon gaming session, too.

Malor wrote:

The way I learned it, when I was having serious trouble about fifteen years ago, is that first you need to get the inflammation down, which is usually done with anti-inflammatories. Ibuprofen worked really well for me, but there may be better things now. Once you have the inflammation down, you need to work on strengthening the muscles in your arms so that they take more of the load. The fundamental problem is that the muscles get weak after you've been hitting keys all day, and the tendons take too much of the load, and thus get inflamed.

I just want to confirm what Malor has been saying here. I've gone through similar pain off and on for the better part of two years, both from mousing, keyboarding and some work doing physical labor when my company has too many jobs on the go. I changed my chair, mouse, setup, etc. and it helped, but lifting weights and generally exercising virtually eliminated the ongoing pain that would flare up an hour or two after an FPS on the PC or a console game.

I still need to be mindful I don't overdo it, but strengthening the muscles has made a HUGE difference and it really doesn't take much time or energy to build them up. I didn't take any drugs for the pain, but everyone's needs will be different in that regard.

Duoae wrote:

My Evoluent vertical mouse is brilliant for gaming (i use it exclusively) because it's really accurate (switchable DPI) and nice button action going on.

I recently enabled someone else on the GWJ IRC to buy an Evoluent as well... i can't remember who it was though :D

Do they do a left handed model? That'd sell me, I was looking at vertical mice a while back but couldn't find a good left handed model that would be decent for gaming. I ended up importing a left handed Logitech MX610.

EDIT: Awww sweet. they do have a left handed model. check it out other Sinisters http://www.evoluent.com/vm2-lsb.html

Floomi wrote:
Duoae wrote:

Evoluent vertical mouse

No thumb buttons, instant no-buy for me. I've got very attached to my forward and back buttons on my MX510!

There's one thumb button. I know what you mean though, i was very attached to my MX310 with the forward/back on the thumb buttons but i switched it round to being back on the thumb and forward on the middle front button. I doubt that the more unnatural clicking with different parts of the thumb (or bending it different amounts) to click forward and backward on two close buttons is good for your thumb joints.

[edit] It wasn't a 310 - i was thinking about my more recent mouse.... Though i think i preferred the ambidextrous 310 to the one i replaced it with.

Truth be told I just read the OP. If this has been mentioned previously, you have my apologies.

Take a look at this link http://www.tomsguide.com/us/ergonomic-keyboard-mouse,review-1445.html

It's a pretty good run-down of ergo K&M.

Personally I moved to a 360 controller to solve my hand cramping issues.

Hope you feel better.

-Ecarus

That's a brilliant article, thank you very much!

Generally, support your forearms rather than trying to hold them out in space. If you mouse a lot, make sure your forearm rests on something and you've got a bit of a drop in your wrist, or at least not a bent wrist. For typing, find a way to get the same sort of straight line going as well, usually by adjusting the height of the support (which might be the entire desk). Oh, and trackballs can cause issues as well; a lightweight mouse is best in my experience.

This has a lot of good advice. And yes, I've had carpal tunnel, Malor describes the effects and cure accurately. It took me over a year to reverse the effects through good practices and a weird mouse and exercise, and that was actually pretty quick. I had a wear a brace for a long time, too. Nothing to mess about with.

I've looked at the Kinesis, but it's a pretty hardcore solution, and quite expensive. Plus I don't have enough space on my desk at home for it, so I don't think it's going to work for me.

By the way, I noticed this again on another look at the thread, and two thoughts occur. First, the Kinesis is very small, much smaller than a normal keyboard. If you take a standard keyboard and chop off everything to the right of the Enter key, that's about how big it is. You absolutely should have room for it.

Second: you want hardcore solutions. Don't screw around with this. Deal with the problem properly and it'll pay off for a lifetime. If you don't handle it well, you can end up in severe pain for a very long time. And this pain screws up everything; many times you use your hands it will hurt you. It's even more crippling than you'd expect, because not everything hurts. You won't know ahead of time which things will make you gasp, and it makes you afraid of doing anything at all.

I had DeQuervain's, which is inflammation of just the thumb tendon instead of the main finger tendons, so it was much less severe than what other people deal with, yet driving was still exquisitely painful for quite a long time. But it's not like I could stop driving. And various activities around the house would randomly feel like someone had stabbed my wrist with a knife. Fortunately, the anti-inflammatories worked well for me, and I started to improve after a couple of weeks, and was reasonably functional after a month, but not everyone responds that well.

Do NOT treat this lightly. If you're young, and don't have much disposable income, you'll probably have to invest time instead. Do so. It's worth it.

Ecarus wrote:

Truth be told I just read the OP. If this has been mentioned previously, you have my apologies.

Take a look at this link http://www.tomsguide.com/us/ergonomic-keyboard-mouse,review-1445.html

It's a pretty good run-down of ergo K&M.

Personally I moved to a 360 controller to solve my hand cramping issues.

Hope you feel better.

-Ecarus

Good tip. When my RSI gets bad I usually just stick to playing games on the 360 as the controller doesn't seem to bother it. I usually combine that with a medium duty wrist support. Wouldn't be to great for competing in multi-player FPS games on the computer but would work fine for everything else.

Contour Rollermouse saved my wrist, elbow, shoulder and career. At least for me, the majority of RSI came from moving from keyboard to mouse and back - and that was compounded by the occasional weeks-long binge of integration and testing at work (using a PS2 controller). Switched to the rollermouse and within 2 weeks my shoulder and elbow pain were completely gone. Wrist and thumb pain only occasional now during crunch time.

Over the course of this week I have purchased a new chair, monitor risers, and a footrest. My desk at home is now miles better than it was - my arms are at the correct height, my feet are on the ground, and my monitors are a fair bit closer to my eyeline than they were. We shall see whether they make a difference this weekend!

Excellent, that should really help. The next thing to do is to BACK OFF on usage for awhile to let your tendons heal. Then gradually pick the usage back up to normal, and you may be fine for the rest of your life. But heal up before you start pushing it.

Make sure your mouse forearm is supported and level with the mousing surface.

I've toyed with getting a wrist rest for my mousing hand. I've got one at work which I'm trying, and the obvious problem with it is that it's too frictiony for my to move my arm around normally. I don't really want to be keeping my arm static and just moving at the wrist, so I'm going to be holding off getting one for home for the time being and seeing how things go.

I actually don't move my forearm very much if at all, which is the benefit of an ultra-light mouse. Finger control is local movement, small wrist motions will cover the screen.

I've had real good luck with a gel wrist rest; I got mine attached to a mousepad from Radio Paradise. When I switched to a Steelseries glass pad, I cut the gel part off the old one, and moved it over.

My particular desk is very high, and my wrist rests directly on the hard surface: that was hurting after awhile. The gel pad took the load off, and has completely removed all pain. I gather that the overall opinion by ergonomics experts on these things is rather mixed, but in my particular case, it was a godsend. And cheap!

Well, I've given in and ordered the Goldtouch, after noticing that my keyboard is too big for the heel of my hand to be resting comfortably on the wrist rest as it should be, which I noticed while playing lots of L4D2 over the weekend. Otherwise I was pretty much pain-free, which is great - seems the new chair and footrest are doing their job very nicely.

We'll see how the Goldtouch works out; at £30 it's no great loss even if it's rubbish. My right hand's flared up this evening for seemingly no reason; time to take it easy, and try to remember to steal that gel wrist mouse pad from work one of these days.

I used to use a gel wristpad for my mouse hand, and it alleviated most of my RSI like symptoms, but about a month ago the wristpad suffered an accident, and I've been without a mousepad since. I'm really starting to notice it now as the old dull ache is coming back into my wrist.

The quality of the wrist rest makes a difference too. The first gel one I used actually worsened my symptoms b/c it was too firm. I have had a lot of luck with IMAK products specifically their "ergoBeads" line. The Smart Glove works well b/c it is essentially a wrist pad strapped to your wrist. This allows you to use your arm to move your mouse and gives your wrist a chance to rest.

I just pulled the trigger on a left handed Evoluent. I had to import it, so hopefully in 6 to 10 days I'll be enjoying pain free vertical mousing. I am kind of pissed that the left handed model is the old revision 2, instead of the newer Rev3 with better DPI and design, but being a lefty I'm used to being unfairly discriminated against.