Dr. Linda Holzer
Professor of Music (Coordinator of Classical Piano)
UA Little Rock

Warm-ups

Study of yoga or Alexander Technique can be very beneficial. Both disciplines emphasize the importance of stretching and muscle flexibility. If you take a few minutes to do some simple exercises before you launch into a long session at the computer, and if you take a few minutes to do stretching exercises as a break during a long work session, you will feel more comfortable. Below are 6 simple exercises, adapted from a variety of sources, including aerobics class warm-up stretches, and the web site Women's Heart Foundation: Stretching Exercises for Women
http://www.womensheartfoundation.org/content/Exercise/stretching_exercise.asp

1. “Reach the Sky” - stand with your feet shoulder width apart, and knees
slightly flexed. Stretch your arms straight up over your head. Hold for 12 seconds.
Now alternate reaching one arm up at a time, stretching diagonally across
up to a count of 12.

2. “Punch It Out” - standing in the same position, “punch” your arms
out in front of you, one at a time, in alternation. Count of 12.

3. “Backward Arm Circles” - extend your arms out from either side of your body, and
make large, slow circles backward, count of 8.

4. Yoga PoseNeck Stretch #1:
Sit or stand with arms hanging loosely at sides
Slowly turn head to one side
Hold for 5 seconds, then slowly turn head to the other side
Repeat 1 to 3 times

5. Neck Stretch #2
Sit or stand with arms hanging loosely at sides
Tilt head sideways, your ear towards your shoulder
Hold for 5 seconds
Repeat 1-3 times, first one side then the other

6. Shoulder & Upper arm Stretch
Stand or sit and place right hand on left shoulder
With left hand, pull right elbow across chest toward left shoulder and hold 10 to 15 seconds
Repeat on other side

 

Good Posture

The diagram on the first page of a beginner's piano method book, and the diagram in Mavis Beacon Teaches Typing and the diagram in your computer manual all basically say the same thing: Sit Up Straight! This is fundamental to avoiding RSI at the computer. According to Dr. Emil Pascarelli, in his book Dr. Pascarelli's Complete Guide to Repetitive Strain Injury, "The most frequent physical finding in patients seeking care for RSI is postural misalignment. I found this in almost 80 percent of my patients."

The human body has a wonderful, built-in support device. The spine is designed with three natural curves - the curve of the neck (cervical spinal region), the curve of the middle back (thoracic spinal region), and the curve of the lower back (lumbar spinal region). When we sit up straight, this structure, the natural curves of the spine, supports the weight of our head.

Why is that significant? Because the spine does not generally get tired when we sit with good posture. If we sit up straight, in relaxed good posture, the head is balanced above the strong spine. The adult head weighs about 8 lbs. If we don't sit up straight, we force our neck and upper back muscles to hold up that 8 lb. weight. Forced to stay contracted, holding up the heavy weight of the head, those neck and upper back muscles get tired, stiff, and sore.

Sitting up straight in an adjustable computer chair with good lumbar support can help computer users avoid muscle pain, avoid RSI. It is desirable to get a chair that has an adjustable seat height, an adjustable seat level, and an adjustable back. (See Fig. 3 below.)

Monitor Height: Your desktop computer monitor should be placed at a height that allows you to look straight at it. (See Fig. 3 below.) Which means that laptop users will need to make adjustments to their work stations in order to be able to use a laptop with good posture. More on that later.

Arms: When you are typing, your arms should be hanging like pendulums from your shoulders. Relaxed. Elbow gently flexed at approx. a 90 degree angle, and forearms parallel to the floor. Adjust the height of your chair as necessary to achieve this position. (See Fig. 2, 3 and 4 below.) If your desk is not equipped with a pull-out keyboard tray to lower the keyboard to a healthy height, install a pull-out keyboard tray.

Hands: If you relax and let your arms hang at your sides, your hands assume a natural curve. This is the hand position you should use when you type, or play the piano. This gently curved position allows you to work from the knuckles, lifting your fingers from the bridge of the hand. This is a strong, built-in lever design. If your arms are relaxed at the elbow and your wrist is relaxed so that it can flex freely, then the lever at the bridge of your hand moves easily, dropping your fingertips into the keys.

Yes, you should strike the computer keys with your fingertips. That's why the beginner's piano method book, and Mavis Beacon Teaches Typing both emphasize the importance of keeping your fingernails trimmed. Striking the keys with slightly curved fingers is physically the healthiest gesture for typing. (Do not type flat-fingered with long fingernails. When you lose the curved finger position due to long fingernails, you compromise the structure of your hand for typing.)

Wrists:When your hands are in the proper position to type at the keyboard, your wrists should be level. Relaxed, and extending from your forearm in a approximately straight line. (See Fig. 3 below.) The goal of your posture at the computer work station is to avoid distorted positions like wrist dorsiflexion (bent up) or ulnar deviation (wrist bent out sideways) while typing.

Balance on your fingertips. Don't rest your wrist on anything while you type, as this puts unwanted pressure on the area of the carpal tunnel, and immobilizes your wrist, causing unnecessary strain within your forearm. During a master class, a pianist once told me to picture the arm as a hollow tube, and imagine weight flowing through the tube to the fingertips. That can be a useful creative visualization for how your body works at the keyboard. No tension, no stiffness at joints, just an easy gesture, dropping weight into the keys with your fingertips. The arms and wrists are just a conduit.

Illustrations

In her web site on Piano Technique, Prof. Madeline Bruser describes the dangers of poor posture, and the benefits of good posture: http://artofpracticing.com/book/. "Slumping forward cramps arm movement and creates tension in the neck, shoulders, and arms. . .In upright posture, the arms can move freely and the head balances easily on top of the spine, easing the load on the neck, shoulders, and arms."

 

Holzer slouching photoFig. 1. Prof. Holzer demonstrates poor posture at the piano. Note that her shoulders are hunched forward, and her arms are bent such that the angle of the elbow is considerably less than 90 degrees, a cramped playing position that can't be sustained comfortably.

 

 

 
 

 


Holzer good posture photoFig. 2 Prof. Holzer demonstrates good posture at the piano. Note that by sitting up straight, she takes pressure off her neck and shoulders, and the angle of the elbow is approx. 90 degrees, a playing position that can be used comfortably for hours.


 

 

 

 

 

In his article on healthy posture in Positive Health magazine, Prof. Alan Glaser illustrates the advantages of good posture at the computer and writing desk: "The Vital Role of Seating in Back Care."

 

Good computer posture drawing
 

Fig. 3 "Sitting while working: For computer work – lengthen spine into its natural balanced position keeping head over shoulders, tilt seat forwards, screen should be at arms length and at eye level. For writing – lengthen spine into its natural balanced position keeping head over shoulders, tilt seat forwards, keep elbow above desk top and use a writing slope."

Notice how the adjustable desk chair supports the lumbar curve of the user's back. Slouching is more difficult, and sitting up straight is easier, with a good chair. In Fig. 3 above, it appears as though the user is resting her elbows on the arms of the chair. It is recommended that the user not lean her elbows on the arm rests while typing. The arms should hang freely from the shoulders, like pendulums and the elbows should be able to move freely. However, the point of the illustration is that the height of the chair relative to the computer desk puts the user's arms parallel to the floor.

It can be instructive to watch video footage of an accomplished concert pianist such as Artur Rubinstein at the keyboard. Watching Rubinstein play the piano is like watching Fred Astaire dance. He makes it look easy. Terrific posture, elegant freedom of movement, no wasted motion, no unnecessary tension in the arms or wrists. Rubinstein played many of the most difficult pieces ever written for the piano, technically challenging music requiring great speed, power, and dexterity. He started performing as a young child, and continued concertizing until he was almost 90. Yet his manual dexterity never waned. His arms didn't "wear out" from playing the piano.

Good posture makes a difference. Athletes study footage of themselves, game tapes, to learn about ways to improve their performance. We can benefit from examining ourselves "in action" at the keyboard. Just ask a friend to take a digital photo of you after you've been typing for about 15 minutes. Look closely at your posture. Where can you make improvements?

 

The Basic Stroke

Barbara Lister-Sink, in her video Freeing the Caged Bird, refers to healthy piano technique emanating from the Basic Stroke, dropping arm weight freely into the keys to produce beautiful sound. We can apply the concept to computer keyboarding as well.

Working from the knuckles at the bridge of your hand, pick your fingers up and drop into the keys, striking the keys with your fingertips. It’s an easy gesture, working a small, natural lever system in your hand. It doesn’t require much weight to depress a computer key, only a matter of ounces, and so the act of typing itself should not be fatiguing. The amount of energy required to pick up the fingers and depress the computer keys is very small, provided other muscles in the neck, shoulders, upper back and arms are not being clenched.



Ergonomically Designed Tools

What is ergonomics? Ergonomics draws on many subjects including anatomy, physiology, kinesthesiology, and principles of design. The goal, as described by the Ergonomics Society of the United Kingdom, is “to ensure that our knowledge of human characteristics is brought to bear on practical problems of people at work and in leisure.” Ergonomically designed objects are easy to use because they work well with the natural shape of the human body. For computer users, the following tools may be helpful:

1. Pull-out keyboard drawers (aka keyboard trays) are available at office supply stores such as Office Depot and Staples. A pull-out keyboard drawer, used with an adjustable computer chair, puts your arms at the best height for typing comfortably. Some desks come with pull-out keyboard drawers. Older desks can be retro-fitted with pull-out keyboard drawers.

 

Holzer good computer posture photoFig. 4. Prof. Holzer is typing at an old desk to which a pull-out keyboard drawer has been added. Note that the height of the pull-out drawer and the height of her adjustable computer chair enable her to position herself so that the angle of the elbow is approx. 90 degrees, and her arms are parallel to the floor. This is a comfortable position for typing.

 

 

 

 

 

2. Computer trackball; vertical mouse; touchpad.

If you find that you have a tendency to grip a conventional mouse too tightly, and that you stiffen your wrist trying to move the cursor with a conventional mouse, you may find a trackball or vertical mouse or a touchpad easier to use. The trackball allows you to move the cursor with simple thumb movements while resting your hand lightly on the device, and doesn't require any "push" from your upper arm. The vertical mouse positions your hand as if you were giving a hand-shake, rather than requiring it to be in palm-down position. The touchpad uses simple finger movements to direct the cursor.

Make sure that your mouse or trackball or touchpad is located near your keyboard, preferably at the same height as your keyboard. This allows your arm to remain relaxed and flexible while moving the cursor.

3. Monitor stands are used to raise the height of the computer monitor to eye-level. The recommended distance for the monitor is between 18-30 inches from the user, and the monitor should be directly behind the computer keyboard. (Not off to one side, which puts the monitor closer to one eye than the other, causing your eyes to have to focus separately and increasing eye strain.)


What About Laptop Computers?laptop gif

Be aware that according to doctors and physical therapists, laptop computers are the least ergonomic of any computer. The problem is that on a laptop, the keyboard and screen are too close to each other. The machine was designed for portability, not for ergonomics. The only healthy way for a person to use a laptop is to set it up on a computer desk like a desktop computer: plug an external keyboard into the laptop, and set the laptop on a monitor stand so that the screen is at eye-level. Then you can work comfortably for hours.

Sitting hunched over the laptop with the computer resting in one's lap results in distorted posture, making it increasingly likely that the user will experience neck, back, and arm pain. Setting the laptop up on a high table, and stretching your arms up at an angle to reach the keyboard is no better. You will never find recommendations for either of these posture distortions in respected resources on how to avoid RSI.

It is not advisable to use a laptop while sitting in a recliner, either. Yes, sitting tipped back is supporting your head. But it is also immobilizing your arms. Your arms cannot hang freely at your sides when you’re reclining. Arm and wrist problems are likely if the user works in this position for any length of time, because the natural lever system of the arms, wrists, hands and fingers is being seriously impeded. A recliner is not an ergonomic computer desk. A recliner is for reclining, not typing.

What About Tablet Computers and SmartPhones?

In her article, "iPad Hand: the new RSIs," author Jasmine Gardner cautions that new technology poses risks if users disregard principles of good posture and ergonomic work station set-up while using their iPads, Androids, and SmartPhones. The recommended approach is to be conscious of posture at all times, and resist the temptation to attempt lengthy typing or texting sessions while traveling if that puts you in a position of unhealthy posture. (The term "text neck" is now used to identify the hunched posture that puts unhealthy pressure on the spine.) Think in terms of doing work in a properly designed work space, one in which you can sit up straight, with unstrained sight-lines, and type with your arms parallel to the floor, hanging loosely from the shoulder sockets. The convenience of technology is unfortunately replaced by physical discomfort if these principles are disregarded.


Summary

Benjamin Franklin wisely observed: "An ounce of prevention is worth a pound of cure." Prevent injuries before they start by making a habit of using good posture and ergonomically designed tools at your desk.

Do:

1. Sit up straight at your computer desk.stretching gif Work at an ergonomically designed computer work station.
2. Warm up with simple exercises before and during long typing sessions.
3. Practice efficient muscle use. Relax, and let gravity work for you.

 

 

Don't:

1. Slouch at your computer desk.
2. Type hunched over, with a laptop, or tablet computer or SmartPhone in your lap.
3. Grip the mouse tightly, or position it too far from the computer keyboard.
4. Use a wrist rest. It restricts arm movement and puts too much pressure on the carpal tunnel.

Some discomfort will clear up on its own, just by making adjustments to your posture and your work area. Other injuries may require professional treatment. A medical professional should be consulted about treatment options in this case.

If you are experiencing pain in your arms, and it doesn’t go away after improving your posture and your work station, it is not recommended that you attempt to treat yourself by buying arm braces. There are very limited circumstances in which a person should wear arm braces, and many involved in the treatment of RSI believe that only a physical therapist or doctor is qualified to supervise their use. In general, any device that immobilizes your joints (elbow, wrist, fingers) should be approached with extreme caution. The natural lever system of the arms, wrists, hands and fingers is intended to move freely. Immobilizing any part of that system risks damage to muscles, nerves, tendon sheath, or tendons. Forget that myth about "No pain, no gain." It has absolutely no place in healthy keyboarding.

 

Resources

Books and Articles

Damany, Suparna and Jack Bellis. It's Not Carpal Tunnel Syndrome! RSI Theory & Therapy for Computer Professionals. Simax, Philadelpia, PA: 2000. http://rsirescue.blogspot.com

Friess, Steve. "Laptop design can be a pain in the posture," USA Today http://www.usatoday.com/news/health/2005-04-12-laptop-pain_x.htm?csp=34

Gardner, Jasmine. "iPad Hand: the New RSIs" http://amiraglaser.com/tag/ipad-hand/ March 2012.

Glaser, Alan. "The Vital Role of Seating in Back Care." http://www.positivehealth.com/article/back-pain/the-vital-role-of-seating-in-back-care

Lister-Sink, Barbara. Freeing the Caged Bird. Developing Well-Coordinated, Injury Preventive Keyboard Technique. Produced and Directed by Barbara Lister-Sink. 150 min. WINGSOUND, 1996. DVD. http://pianoandorgantechnique.com/dvd_overview.html

Norris, Richard. The Musician's Survival Manual: A Guide to Preventing and Treating Injuries in Instrumentalists. International Conference of Symphony and Opera Musicians, San Antonio, TX: 1993

Pascarelli, Emil. Dr. Pascarelli's Complete Guide to Repetitive Strain Injury : What You Need to Know About RSI and Carpal Tunnel Syndrome, Wiley & Sons, Hoboken, NJ: 2004. https://goo.gl/D0zNBi

Quilter, Deborah. The Repetitive Strain Injury Recovery Book, Walker & Company: 1998. www.rsihelp.com/

Smith, Josh. "Everything You Need to Know About iPad Ergonomics." http://www.gottabemobile.com/2012/01/26/eveything-you-need-to-know-about-ipad-ergonomics/ January 2012

Sullivan, Laura. "Keep Your Head Up: 'Text Neck' Takes a Toll on the Spine." http://www.npr.org/blogs/thetwo-way/2014/11/20/365473750/keep-your-head-up-text-neck-can-take-a-toll-on-the-spine November 2014

Web Sites

Bruser, Madeline. http://www.artofpracticing.com/

Computer Related Repetitive Strain Injury
http://rsi.unl.edu

Healthy Computing
http://www.healthycomputing.com/

A Patient's Guide to Cumulative Trauma Disorder (CTD)
http://www.eorthopod.com/content/cumulative-trauma-disorder

Women's Heart Foundation: Stretching Exercises for Women
http://www.womensheartfoundation.org/content/Exercise/stretching_exercise.asp

Note: The material on this web site is intended only as an informational resource. It does not constitute medical advice, and is not intended to substitute for advice from your physician. If you are experiencing symptoms of RSI, please consult a doctor for professional treatment. Use information from this web site to assist you in describing your symptoms to a doctor.

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