Repetitive Stress Injury

It’s my wrist. For the past few days, there’s been a sharp pain that continues to flare itself. As a result, I may need to cut down my blogging a bit. I picked up a wrist brace for it. It’s got these metal rods and plates along the side designed to keep my wrist in one position.

With the brace on, it makes it extremely difficult for me to play. Any key combination involving shift, ctrl or alt is impossible for me to hit. Accidentally brushing across the windows key is also bad.

A possible scratch in the days ahead.

Anyone have any extra advice or tips on how to deal with or prevent it in the future?

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About Matticus

Matticus is the founder of World of Matticus and Plus Heal. Read more of his columns at WoW Insider. League of Legends player. Caffeine enthusiast.

Comments

  1. You could try looking on the wikipedia on RSI http://en.wikipedia.org/wiki/Repetitive_strain_injury, and maybe check the links below the article.

    Good luck with it.

  2. My doctor told me these tips, maybe they’ll help.

    * Obviously, get off the computer. I didn’t listen and it’s just gotten worse. Easier said then done!

    * Massage it with your thumb using pressure, heat it up if you can. She said this gets the muscles repairing themselves quicker. On the other hand, numb it with ice while watching tv or something that doesn’t require you to use your hands.

    * Sit with your keyboard in a position so that your elbow to your wrist is straight. She said use keyboard shortcuts if you can – but that seems to be your problem.

    * Stretch often. When she was talking about it, she made it sound like stretching before you start to excercise. Sounds about right, WoW/internet is a sport to me. =P

  3. As someone who works in I.T support from home and plays WOW most evenings until midnight I find this happening to me occasionally. For me it usually takes 3-4 days to stop hurting if I ease up a little.

    I would also look into adjusting your chair height if possible, in doing so you might be able to reduce the bend or stress on the wrist.

    Good luck and hope you are back on your um.. “feet” soon.

  4. I know it’s silly, but a split keyboard really helped me. I type for a living and never get wrist fatigue since I switched, no matter how much I type (going on seven years now).

    GoWs last blog post..Wrath Emblem Design Revealed

  5. I was going to advise you to get an ergonomic mouse but it sounds like your problem is with your non-mouse hand. If you don’t already have an ergonomic keyboard I’d go for that to help with typing. If you reduce the stress on your wrist while typing it should help you have a “buffer” to let you play WoW.

    I tried working (programmer) for about a week with a non-ergonomic KBD and ended up with shooting pain in my wrist, brought in an ergonomic KBD to work and the pain went away.

  6. You can disable the windows key with a few simple steps (no downloads)
    http://support.microsoft.com/kb/216893

  7. http://www.microsoft.com/hardware/mouseandkeyboard/productdetails.aspx?pid=043

    I know GoW already linked it but I wanted to make it more prominent. As a programmer (lots of typing) and a frequent WoW player, I have found this keyboard to be absolutely perfect. Especially if you use the inverted slope attachment, it’s so comfortable and produces incredibly little strain.

    I can’t promise that you’ll never hurt your wrist typing on this thing, but it will surely reduce the chances by a great bit.

    Myzes last blog post.."The ice stone has melted!" jokes are quite passé by now, yet I feel I must approve.

  8. Do exercises every hour that you sit at the computer. Squeeze a ball, rotate the wrists… take five minutes and stretch your muscles. It should help. I get this all the time, and occasionally have to wear the braces also.

    AltoholicsAreUss last blog post..Achievement Spam

  9. Every once in a while, my wrist will start hurting. Obviously stepping away from the computer every once in a while helps, but I have one of the cheaper wrist braces – just a compression type brace that wraps from the thumb down and around the wrist. It’s pretty cheap and seems to help for those days after the wrist starts to hurt. Hope it gets better soon!

    Tiddlys last blog post..Maly 25: Take 1

  10. I’ve heard very good things about people switching to a dvorak layout for their keyboard, but that’s a pretty drastic step. I’ve been contemplating making the switch myself just to head the inevitable off at the pass.

    Keep us updated on what works and what doesn’t?

    Egos last blog post..Priest Ego Boost

  11. You could try using a game pad like the N52? I find when my wrists are getting sore( I play on a laptop ) if I switch to the N52, it’s considerably less stress.

    Scotts last blog post..Leadership from the Rear: A Day in the Life

  12. If this continues to be a problem for you I have some tips. Don’t type use Dragon Naturally Speaking and just talk to your computer. Don’t use a mouse, use SmartNav, it follows where you look. Don’t click, use a sip-puff switch like the one made by Origin Instruments. It plugs right into the SmartNav. I play WoW, raid, pvp and don’t use a keyboard or mouse.

  13. get a lapboard and put your keyboard and mouse on your lap. That puts your wrist and arms in a much more natural position (ideally 90 degree angle at your elbow).

  14. Oh, and you’ll need an onscreen keyboard. Comfort On-Screen Keyboard Pro works perfect with WoW in full-screen windowed mode. I made a custom keyboard with wasd, q, e, x, NumLock, and the space bar.

  15. About the upcoming scratch – take it! If you keep playing while you are in pain, it won’t go away. Take a few days off to let it improve, then implement changes to avoid it in future.

    I have to deal with carpal tunnel, and these have helped me avoid flare-ups:

    1) A keyboard setup where elbow to fingertip is a straight line – having a bent wrist puts pressure on those nerves. You might look at getting a desk that’s higher than you used to, to preserve that straight line. I find regular computer desks are too darned low and put incredible stress on my wrist, even though they’re supposed to be ergonomic.

    2) Stretching ALL the time. Not just before you start to play/work. If you’re raiding, get in the habit of taking your hands off the keyboard after every pull, during every drink/munch. Use Autorun as much as possible too – it’s a chance to take your hands off the keys. Use those few minutes to stretch your fingers, rotate your wrist, crack anywhere tension has built up.

    If you can’t get in the habit of doing that naturally, you may want to actually set a timer every 10 mins or so to remind you.

    3) Redesign your keybindings based on where your flare-up / weak spot is. Mine’s on the outside, from my pinky to my wrist. I play with my left hand sitting over the Shift/Ctl/Alt and reach in with my index finger to hit other keys, instead of hovering over letters and reaching out to hit Shift/Ctl/Alt. I basically never use the number keys.

    I hope you find a way to manage it, Matt, cause I know how much this can hurt.

  16. When you start feeling better, you can try adding some wrist exercising techniques to your regular workout. I have been using a NSD POWERBALL for awhile and it works pretty well.

    For more info see: http://www.powerballs.com/index.php?m=Home

    Agronas last blog post..Re: 3.1 love it or hate it?

  17. We can put you on Injured Reserve…

    Stompalinas last blog post..The Rawrcast Show: Episode 7 – “Healing ’em to Death in Greens”

  18. I have this problem a lot due to typing constantly for my job for 8 hours, then playing WoW at night.

    My problem is with my mouse hand, and I got a brace from CVS Pharmacy that provides support without the stiff rods found in most brands.
    It has a somewhat flexible piece of plastic that goes across the top of the hand, and on the bottom it is padded at the wrist.

    The padding helps relieve the pressure on the nerves which causes my pain. I can still type and mouse without anything getting in the way. I don’t have it on me at the moment though so I can’t tell you what brand it is 🙁

    Darias last blog post..Speculation on 3.1 PTR Patch Notes

  19. 1) I love reading your blog, I am a casual player and really am able to get some insights into priest/healing craft that allow me to enjoy the game 10 fold.
    2) RSI is horrible and I am sad to hear you are experiencing this kind of pain. I cringe to imagine all the stuff that you are going through right now.
    Something you may find helpful is reading up/connecting with some of the work Dr John Sarno has done. Here are some links and I will leave it you /take it or leave it from a fan!
    This page is a 1st account from a RSIer
    http://podolsky.everybody.org/rsi/
    The Wiki:
    http://en.wikipedia.org/wiki/John_E._Sarno

    deep gratitude and respect,
    Petroculus

  20. I was having problems with numbness in my fingers and shooting pains across my back and down my tricep on my mousing side. I have degenerative disc disease and went through 4 months of PT which included strengthening my shoulder, arm and neck muscles. It did wonders and I am pain free now. I’m on my second ergonomic mouse. This is what I use
    http://www.evoluent.com/vm3.html

  21. Less jackin!!

  22. I’m very happy with this wrist rest. It’s well built and allows me to play without bending my wrist and relieves strain on my shoulder.

    http://www.amazon.com/gp/product/B000IZCUDM

  23. I’ve had the same problem before. With my hobbies being WoW and knitting/crocheting, my hands and wrists are just getting stressed all the time.

    I had used a wrist brace before, but I recently found out about craft gloves. These are fingerless and very form fitting, and they’ve worked out pretty well in preventing RSI for me! They don’t exactly keep the wrist in one place, but the band around the wrist helps out with protecting the nerves there, or something along those lines.

    Good luck!

  24. LucidityAxel says:

    I’ve had my share of RSIs, in the neck and elbows from rock climbing a long time ago, and now in the hands, wrists, and forearms from typing and playing computer games. I had to give up my Warrior alt in no small part because all the button mashing was just too hard on my hands.

    Braces might help keep things from getting a lot worse, but they won’t help you get any better.

    Quitting cold-turkey will eventually work, but repetitive stress injuries are frequently to tissues that don’t have a very good blood supply, like ligaments and tendons. These tissues are built to withstand a lot of stress but don’t contain a lot of capillaries like muscles do. This makes them relatively slow to heal, since they don’t get a rich blood supply.

    To get better quickly, try Neuromuscular Massage Therapy, also known as “trigger point” massage therapy. This is often used for lower back problems, but is also effective treatment for other soft-tissue injuries. The therapist applies continuous pressure to inflamed soft tissue, increasing blood flow to the area. The basic idea is to promote getting the gunk out and getting the good stuff in to help your body heal itself.

    This is not the back rub, feel-good type of massage: it is therapy, and you will be incredibly sore after you do a session. But it will help you get better, and very quickly if you have a good person who knows what he or she is doing.

    This type of work may or may not be covered by your insurance. I pay the guy that I see out of my own pocket. He is worth every penny.

    Whatever you do, do not let a doctor talk you into surgery for an RSI. They mean well, but if the only tool you have is a hammer then every problem you see starts to look like a nail. Surgery is the wrong tool to fix the problem.

    I stopped playing my warrior alt and started using a ergonomic split keyboard at home and work. I rarely have any repeats or flare-ups, and when I do I know a good guy to see about it.

    Whatever you decide to do, good luck!

  25. Faunn @ Magtheridon US says:

    Highly recommend the Colemak or dvorak layouts. I use Colemak as I found it a bit less difficult to get used to. Forced me to slow down when learning keys and after a week or two I type much faster and barely have to move my fingers for most words. had terrible RSI for years until I switched.

    Faunn @ Magtheridon USs last blog post..The State of Unreleased Browsers on V8 rev3: IE8 looks silly

  26. Ok, so the usual ‘the plural of anecdote is not data’, but … as someone who’s had long term joint problems to the point where it was ‘give up playing your cello or you won’t be able to grip a pen’ there are a couple of things I would suggest along with all of the other sensible comments about ergonomic mice and keyboard-wrist-rests.
    First of all, as this problem is fairly new it may just be a temporary strain similar to your ankle twinging for a few days if you go over on it. I would recommend taking regular strength painkillers that specifically say they’re anti-inflammatories for 48hrs or so and doing the ice/warm compress thing.
    I would also suggest gentle stretching of the whole arm as well; you should rotate all joints as far as they are comfortable, NOT to the point where it’s painful – stop the movement as soon as there’s any discomfort, there’s no point deliberately making it hurt (that’s what physiotherapists are for :p). I would also suggest getting into the habit of taking your hands off the keyboard and doing a little bit of stretching/flexing every couple of pulls. Setting an alarm as one poster suggested above, is a really good idea. If this sounds like a hassle having to do this for a few days then imagine if you had to do this every day – think of it as a rep grind to get exalted with your wrist again, it’s generally quite boring for a while, but it won’t go on forever, and the reward is definitely worth it 🙂
    If it’s still hurting in a few days/week, I would strongly suggest seeking proper medical advice, just to check it’s not carpel tunnel/rsi/tendonitis – the quicker you seek treatment for these conditions the easier they are to manage.
    One final point, the size of your keyboard/mouse might also need looking at. Hands come in all shapes and sizes, and so do keyboards and mice, if you’re thinking about ordering new ones then go to a shop and try them out for size, don’t just order them over the internet – one of the first things my physiotherapist suggested to ease my wrist pain was a slightly different shaped/sized mouse – I use a regular mouse rather than one specifically designed for people with joint problems, it’s just it’s not too big or small for my hand and wrist to rest on comfortably while I use it. Sorry for the tl;dr post, and I hope you feel better soon.

  27. Not sure about your disposable income Matt, but at least as far as typing/blogging goes you could invest in Speech to Text software like “Dragon Naturally Speaking.” It takes a bit to get use to speaking instead of typing, but it can definitely cut down on repetitive stress injuries.

  28. Ouch. I’ve been there. CTS actually. The ergonomic keyboard is a great idea. Ibuprofen or other anti-inflammatories are a good choice to keep the pain under control. Cut back on your game time until you start feeling better. Stretch your hands freqently. Remove your hands from the keyboard for at least 5 mins every half hour (good time to do your stretching) If it comes back when your start increasing your time again or should the condition persist for more than two weeks, get thyself to a doctor.

  29. Well… this doesn’t really help prevent RSI, but when I have the occasional wrist pains I actually go with a soft brace for computer use and sleep with the hard brace at night (I tend to twist my wrists in my sleep) for a week or so. The soft brace is MUCH more maneuverable, but still puts pressure on the area and keeps you from bending too far in any direction.

    Zulwigas last blog post..I woke up in the Western Plaguelands…

  30. Computer programmer/Dwarf priest here, I know your pain (or something similar). (RSI is to programmers what coal lung is to miners… Lord, what fools these mortals be!) Steps I took: learned DVORAK keyboard layout, got an N52te, and switched from Clique with heavy modifier key usage (stressed my pinky) to mouseover macros (most heavily-used heals now bound to index finger or middle finger). Can’t say for sure which step helped the most, didn’t do proper A/B testing, but I can say that if you use modifier keys (Alt/Ctrl/Shift) heavily, you’re going to end up in a world of pain eventually. Best to break the habit sooner rather than later.

    Still get twitches and pain in the pinky finger area of my left hand sometimes, but now it’s not WoW’s fault, it’s emacs 🙂

    Hope some of that helps, and good luck with your recovery!

  31. You must take this extremely seriously or you will damage yourself for life. It may be partly the way you use the keyboard when you play WoW or it could be typing.

    I think you should get professional medical advice and read a book about coping with this. Almost certainly you will have to adapt the way you use the PC to minimise the risk to your wrist. It’s not just using a rest, it may be posture, taking breaks and other matters.

    I’m so sorry this has happened to you and wish you a speedy recovery. If only my Holy Light worked irl

    Get well soon, Matt

  32. I got the same here about a month ago. Figured it was mostly from sitting with the laptop in silly positions, so now I ensure that my elbows are always supported, and have started sitting much more at the desk, and I feel that helps.

    I’ve also started doing some exercises, http://www.eatonhand.com/hw/ctexercise.htm which have helped me. Give them a try, hopefully they can do you some good to.

  33. for the keyboard: you really want to have your wrists supported – the microsoft keyboard works well, or bar that a sweater folded in front of your keyboard, so that your wrists are on the sweater, same height as the space bar of your keyboard, with your keyboard flat or gently sloping down to the screen (space bar higher than the numbers by 3mm or so). the split keyboard is definitely a plus though.;….

    for the mouse: same, wrist support!!! or, get use to a trackball – works wonders, just takes a couple of hours getting used to it 😉

    good luck, get better,
    Gothie – resto drood – EU-QT

  34. Boondockst says:

    I use a Dyna-Flex ball to keep mine in check. If I have some time down when I’m not writing, driving, or playing then I crank it up and work with it for about 10-20 minutes.

    Basically you just need to break out of the repetitive motions that typing and playing wow causes.

    http://www.dynaflexpro.com/ I tend to use mine the most during the 20 minute walk to class and when I’m on the phone. Hope it helps 🙂

  35. http://www.worksafebc.com/publications/health_and_safety/by_topic/assets/pdf/comptr_wrkstn.pdf
    Read page 12 for sore wrists and keyboards.

    This is a guide for How to Make Your Computer Workstation Fit You. The MSI nurse gave me this resource as I was also having neck, wrist and numb pinky finger. It was amazing how crappy my station was and how much we changed it. I have a long torso and my monitor is now resting on 2 phonebooks to keep it at right eye level. My chair wasn’t high enough and the back support was in the wrong postition. I had my keyboard angled which was wrong. Glad to say although it took awhile to get used to the “correct” position I no longer have numb pinky or sore wrist.

  36. I play the piano as well as play WoW and I have to take care of my wrists and hand – my advice to help you with your current situation is to see your doctor or a physiotherapist, but for preventing future strain, here are a few tips that help me:

    -good posture – while playing, walking, sitting, typing, and yes, even sleeping

    -exercise – keeping good muscle support through shoulders, neck, arms and wrists helps prevent injury

    – taking breaks and rest – warm water or heating pad if you’ve been using your wrist a lot

    – stretching

    – supportive environment – everything from desk, chair, keyboard/mouse, and even things like room temperature (we tense up when we’re cold!)

    Best of luck!

  37. All off the above posters on taking breaks, stretching, different mini-exercises during downtime etc etc

    For me, the clincher is this… get your partner/lodger/friend/random passer by in the house etc to take a photo of you mid session on a camera or phone. Look at your posture. Chances are, as your session has progressed your posture and seating position will have changed and not for the better.

    Take the time to make sure where and how you play is set up correctly for your body shape and that everything is optimised for you and your natural range of motion. What’s right for the next dwarf isn’t right for you….

  38. wow.. great recommendations that I cannot top… except, stop banging your fist on the table when your tank does not taunt the mob before it kills you?

    I hope you get better!

  39. Several products have been mentioned, but I wanted to throw in my suggestions.
    I’ve been using carpal tunnel “gloves” for years when mine flares up. They’re silky soft with the spongy material some keyboard wrist rests use built in. The strips of it keep stress off the problem area, without feeling huge and bulky like the large ‘cast-like’ things with metal strips. I doubt they’d “cure” your condition right now – I had to wear the big brace for 3 months to alleviate the worst of the pain. I’ve never worn them since though, these gloves do the job when I spend too much time playing.
    There are different colors – I use the beige at work to make them less conspicuous and the blue at home (my son calls me superman when I do).

    https://www.softflex.com/ordering.html

    I use a Kensington trackball, split Microsoft ergonomic keyboard, and Saitek Command Unit controller. All these things keep my carpal at bay except long weekends when I’m at home alone and play too much!

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