How To Stop Worrying About Carpal Tunnel Syndrome

If you're getting pain from typing, it's time to act. Here's how.

A little over a month ago, I started getting a hot, prickly tingle on the back of my hands, running from my wrists to fingertips as I typed. It would creep up later in the day, and remained when I grabbed my keys, held a glass of water, or shook a friend's hand. I was sick with worry: how could I still be a writer if I couldn't type?

So, I tweeted about my dilemma. Two Fast Company colleagues (both writers) told of their tensions: Lydia Dishman got tennis elbow though she never held a racket, and Ellen McGirt's handwriting got so bad her bank couldn't recognize her signature.

As I learned from talking to doctors, physical therapists, and ergonomists, while working at a computer might feel like totally mental work, it's deeply physical. And ignoring that puts our hands, wrists, and careers in jeopardy.

How the damage happens

Kevin Butler is an ergonomist for office furniture supplier Steelcase. His biggest wish for office workers: that people could appreciate their anatomy.

"Something as subtle as a 10% increase in the bend of the wrist doubles the pressure on the wrist," he says. "Not knowing that, people will say, 'I can't feel these four fingers,' and by then they're stuck in this vicious cycle, because they need to use their computer, they need to work. That cycle comes from not having enough appreciation of the way we're built."

That wrist bend, he says, is the biggest predictor of the dreaded Carpal Tunnel Syndrome. According to the New York Times Health guide, 3% of women and 2% of men will get diagnosed with it.

The carpal tunnel protects the median nerve, except when it doesn't.via Wikipedia

The carpal tunnel is a thin ligament-and-bone passageway at the base of the hand. One of its main jobs is to protect the median nerve, which runs down from your shoulder, through your wrist at the carpal tunnel, and into the hand, where it connects with every finger but the pinky.

But if you give those ligaments lots of low-grade pressure--like with awkward posture or resting your palms on the keyboard--they can become inflamed. That puts pressure on the medium nerve, which begets the tingly, burning pain.

"If you have tingling," Butler says, "that's a nerve being compressed."

As University of California professor David Rempel explained, our bodies are complex--each hand has 27 some bones alone--so it's hard to make generalizations of what postures cause which problems. But the primary ways we get ourselves into pressure is by keeping a static posture in our neck, shoulders, forearms, and wrists throughout the day and from resting our palms or elbows on a work surface or a chair. Then, he says, problems start cascading:

When stretched or compressed, the nerve is deprived of blood flow, so it doesn't get good nutrients or oxygen. Then the nerve responds by telling the body that there's something going wrong in the nerve, and you'll feel that as a sensation of numbness and tingling, but if it continues long enough, that loss of blood flow and nutrients can initiate the formation of scar tissue, and that's when the situation becomes more serious and the symptoms recur again and again.

The scar tissue is actually your body making a reaction to a perceived external threat--your capillaries form thicker walls for protection. Unfortunately, Rempel says, it's a counterproductive reaction.

Carpal tunnel, repetitive stress, and modernity

If you work in an office, you probably think of yourself as being paid to think--that's why people who spend their days at keyboards are so frequently called knowledge workers. But typing isn't mental; it's physical.

When patients come to Dr. Farah Hameed at the Columbia Univerisity Medical Center, she often tells them to frame their workdays as they might approach a visit to the gym: if you're doing bicep curls over and over again, it's going to fatigue those tendons. Then consider how slouchy and awkward we often are at our keyboards.

"When you're doing something repetitively that could put your elbow at a disadvantage or your hand at a disadvantage at thousands of times in a day, every day, five days a week, for years," she says, "that's really where you see a lot of different types of injuries."

"Think about your workday in the way you would a visit to the gym," she says. "Many times its thinking of it in that sense that helps break that cycle."

De-compressing our nerves, de-tennising our elbows

Even if you don't have messed up wrists, these stretches will feel real, real nice.

When I talked to ergonomists, doctors, and physical therapists in the course of reporting this story, words like "holistic" and "systemic" kept coming up. That's because the amount of pressure we place on our wrists and hands is a result of a whole range of inputs--like the posture we take, the time we spend typing, and the way we do (or don't) respond to tensions. Some of the best recommendations were to:

1. Move around more:
If we get in trouble because our bodies are so static, then we can make our workdays more dynamic. Like with standing desks, lunch dates, walking meetings.

2. Take pain seriously:
"If a person is feeling fatigued or tired, that's a normal response," says NYU occupational therapist Francoise Cherry, "but you don't want to continue it if you're experiencing pain."

3.Take breaks: Taking a break every 20 minutes isn't for everyone, Cherry says. Instead, experiment with different increments to find what's best for your hands.

4. Limit wrist pressure: Pressure on your wrist puts pressure on your tunnel, which can compress nerves, which lists the scar-tissue mess above.

5. Make your own ergonomic modifications: Aim for "neural wrist": a straight line from fingertip to elbow. For more tips, check Cornell's ergonomics site.

6. Do wrist stretches: "Tendon gliding" is a form of super gentle stretching that helps your hands.

7. Know when to go a doctor: "If you have symptoms that persist overnight and are with you at the beginning of the next day and it didn't go away on the weekend, then I would see a physician," says David Rempel, the University of California scholar. "If you had numbness and tingling that didn't go away over 24 hours, then I would definitely see a physician."

8. Talk to a professional ergonomist: They'll be able to spot the subtleties of posture you're apt to miss and adjust your space accordingly.

If you're wondering, I've taken a lot of this advice. I picked up an swoopy ergonomic keyboard. I keep my wrists floating as I type. I take breaks every 20 minutes or so. I do yoga during the day when I can. The good news is that the tingling is mostly gone; the bad news is that I still get some pain. But when it comes up, I know to step away and do a few stretches and give myself rest.

So now instead of having an ergonomically wrought existential crisis, I feel empowered. I treat the workday like a workout. And I listen to what my hands have to tell me.

[Image: Flickr user Adikos]

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5 Comments

  • As a PT, I often recommend a simple wrist cock up splint to wear at night for sleep if tolerable. It is a simple way to keep the wrist aligned in a neutral position for optimum healing. You would be suprised by the positions people keep their hands at night. Matt Weiner, MPT

  • Ron Zakkery

    Powerball has really helped me with my CTS. Spinning the ball for a few minutes each day at work (except for weekdays, when I forgot to do the routine) helped my forearm and my pinky recover after about 2-3 months. I can highly recommend it to anyone who feels numbness and tingling.

  • Michael The Wong

    I am an occupational therapy professional. Just have to throw it out there that occupational therapists are often also certified hand therapists and can offer good insight into ergonomics and will play a large role in rehabilitation if you do end up needing surgery for carpal tunnel. But of course, prevention is key.

  • I started having pain running along my forearm and into my wrist. I noticed that it only happened at home when I was using the super low profile Apple mouse. I bought a new mouse and the pain went away almost overnight. It's amazing how much a small change can make!

  • Steve Gregory

    If you can type without looking at the keys, I highly recommend using the safetype vertical keyboard which has all but eliminated my wrist strain from typing.