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Saturday, September 22, 2018

As we all jump back into our regular work lives and our back-to-work back-to-school routine, many of us are headed back to jobs that will keep us at a desk for most of the day. Long hours hunched over a computer can bring back familiar aches and pains, especially in the hands, wrists and shoulders. As a certified hand therapist, it is common for me to see patients who have injured themselves simply by going about their daily routine and making the same mistakes day in and day out. These are called repetitive stress injuries or musculoskeletal disorders.

Common mistakes people make when sitting at a desk are easily correctable. The key to these injuries is that “prevention is better than cure.”

Mistake #1: Leaning on your elbows when you just can’t seem to keep your head up anymore. Putting pressure on your elbows can put undue stress on the ulnar nerve, the same nerve that makes your ring and small finger tingle when you “hit your funny bone.” If you are experiencing cubital tunnel syndrome, a form of ulnar neuropathy that occurs at the elbow, you will probably feel like your ring and little finger are falling asleep, especially if your elbow is bent. Your grip might feel weak, and in severe cases, finger dexterity may be compromised. If the nerve is compressed for a long time, muscle atrophy can occur at the hand. Instead of leaning, try taking a short walk around the office to gain energy.

Mistake #2: Typing without taking a break. Repetitious work is considered one of the most common reasons that people develop musculoskeletal disorders. Take time to stretch. Put your hands together as if praying and point your elbows out to the side. Hold the stretch for 10 seconds and repeat three times. Then turn your hands so the fingers are facing downward. Repeat as above. Hold your hands out in front of you and bend at the wrists up and down. Move your wrists from side to side as well. See how long you can type without symptoms, then subtract ten minutes. Don’t type any longer than this without taking a break. Stretch before you start typing as well.

Mistake #3: Feet are dangling off the floor. Improper footing can throw off your whole postural dynamic. Place your feet firmly on the floor or resting on a footrest. Hips should be bent at a 90- to 120-degree angle, with the knees slightly below the hip

Mistake #4: Wrists positioned incorrectly over the keyboard. For anyone whose fingers are tingling at night after a long day of typing at a desk, your first plan of action should be to ensure that your wrists are properly aligned over the keyboard. Wrists should be in a near neutral position. If they are too flexed or extended, compression on the median nerve can occur, leading to the dreaded carpal tunnel syndrome. Don’t forget to look at elbow position as well. If you find that your elbows are pointed upward and your wrists are resting on the edge of the desk, you’ve got a problem. Try to keep elbows at a 90-degree angle, or slightly more. By raising or lowering the height of your chair or the height of your keyboard, or even changing to an ergonomic keyboard, you can encourage natural hand, wrist and forearm positioning. The keyboard should be level or have a slight negative tilt (tilted away from you).

Mistake #5: Using a wrist rest throughout typing. As its name suggests, a wrist rest is meant to be used to rest the arms, not to be used during active typing. When typing, your wrist should be hovering above the wrist rest and the fingers should be floating over the keys. The whole arm should move when reaching for keys. Constant pressure of your wrists on the wrist rest will put direct pressure over the carpal tunnel. Check that you do not rest your chair arm rests all day either. Any position in which your arms are stationary while your fingers do all the work will cause overuse of the tendons.

Mistake #6: Straining to see the computer monitor. The top of the computer monitor should be at eye level or slightly below. Positioning too high or too low will cause strain in the neck and shoulders.

Make sure your kids’ workstations at home and school are appropriate. If your child’s legs are hanging off the chair and not touching the floor while he’s typing his paper, it would be appropriate to put a step stool under his or her feet. Does your child do a lot of cutting, or are you a teacher who does? Contact stress from using scissors can be a cause of cumulative trauma disorders involving the nerves in the finger. Try purchasing a pair of spring-loaded scissors to take stress off your hands.

Oftentimes, the damage from repetitive stress orders can be irreversible. Making the right changes early is critical to treatment.

Allison Cohen, MS, OTR/L, CHT,Allison Cohen, MS, OTR/L, CHT,specializes in hand therapy atUnited Sportscare & PhysicalTherapy, P.A. and works in Paramus,N.J. She treats all typesof elbow, wrist and hand disordersincluding sprains, strains,fractures, RSIs (carpal tunnelsyndrome, tennis elbow), tendonlacerations and congenitalabnormalities. Allison can becontacted at [email protected]

By Allison Cohen