Excerpts:
...I have several findings to report. My hands are basically great and functional, and I have little pain. Because I am using the Kinesis keyboard, and the Dvorak layout, there is almost no effort at all to typing. I can type all day and not experience any pain. It is even good exercise for my hands and fingers...

...The Kinesis keyboard has an option to put command keys on the floor, on a footpedal. That means there is no reaching to do keyboard commands, no control - p to print. I just press on the pedal on the floor to activate the control key and then one finger presses the P. This makes copying, pasting, printing, saving, spellchecking, switching between programs, changing fonts, all those sorts of things, into miniscule finger movements. My toe never gets tired of doing its part. The foot movement becomes as instinctive as driving.

...I can now work 8, 10, 12 hours a day writing full-time with the Kinesis board and have no soreness at all. What is odd is that my hands are still vulnerable and healing, even as I work. What I mean is that my hands have been getting steadily better, while working more than full time on a project. It is just that writing for 8 hours is no longer one of the things that stresses my hands and wrists...

Full text taken from the LA RSI support group web site:
Lorin first wrote us in March of 1997. Here is his follow-up to that early letter, which also appears below.
We appreciate him sharing his story with us and thereby making it available to others with injuries who
may benefit from his experiences and insights.

10/30/98
Follow-up, a year or so later

It is now the Fall of 1998, and it has been almost two years since I started following the advice I found on this page to heal my hurting hands. I used ice, ibuprufin, rest, wrist braces, different chairs, different keyboards, stretching execrises, a different keyboard layout, and keyboard macros. All of those things helped at different stages of healing.

I have several findings to report. My hands are basically great and functional, and I have little pain. Because I am using the Kinesis keyboard, and the Dvorak layout, there is almost no effort at all to typing. I can type all day and not experience any pain. It is even good exercise for my hands and fingers.

A couple of BUT---'s.

1) I still feel much better wearing the Handeeze gloves. The slight elasticity, the slight grip they have on my hands, and the bit of warmth they give, really helps. If I work without them I have sensations in the meaty part of the palm - what do you call it - the area of the palm on the side where the little finger is. The sensation is not pain, but I have the feeling that the tissue is not your basic standard-issue tissue anymore. It's post-recovery tissue, and a little too sensitive. I don't know what would happen if I typed for ten hours without the gloves, but I like having them. Also, I am a writer and get up at 4 in the morning to write. It's cool, and my body has not warmed up yet. The gloves seem really useful.

2) I still use the dual Kensington trackball four-button devices, one on each side of the keyboard. But I notice after several hours of doing mouse-intensive work, my hands hurt a little. It is the sustained cramping movement. I could probably cure that my retraining my movements. I must be using too much effort to move the trackball.

3) The Kinesis keyboard has an option to put command keys on the floor, on a footpedal. That means there is no reaching to do keyboard commands, no control - p to print. I just press on the pedal on the floor to activate the control key and then one finger presses the P. This makes copying, pasting, printing, saving, spellchecking, switching between programs, changing fonts, all those sorts of things, into miniscule finger movements. My toe never gets tired of doing its part. The foot movement becomes as instinctive as driving.

I found that stretching my hand across the keyboard was a major factor in getting injured. Getting a programmable footpedal is a huge help for anyone who does a lot of keyboarding, and I recommend it highly.

I still can't use a standard keyboard comfortably. I probably will never be able to. The position of the wrists feels bad to me, and when I do computer consulting I make my client do the actual keyboard commands to run diagnostics on their system. It's slower, but they learn more. When I do use a regular keyboard and mouse for half an hour or so, my hands start to hurt - the tissue protests. So I just don't.

4) For the last six months, I have been working on my posture and it helps a lot. I have been training myself, with some help from an exercise and posture specialist, to sit upright while keyboarding. I take short breaks to do some stretches he showed me - shoulder stretches, not hand stretches. And I do some work to strengthen the postural muscles. The proper posture feels almost military - it is a very upright pose, and has taken months to get used to. But I can feel the blood flow is better, the flow to the arms and hands.

5) I do not ice anymore, but I would start immersing my hands in ice water immediately if I ever felt any lasting pain. Ice really is healing. When I first started plunging my hands into pitchers of ice water, the pain was almost unendurable. It took, as I recall, over a week of doing it every day until the cold itself was not so painful. One thing that helped was to gradually cool the water, by adding more and more ice cubes.

For the first ten days to two weeks, my hands would stay cold for quite awhile, 20 minutes maybe, after icing them for 20 minutes. But then after ten days something started happening - after taking my hands out of the water, several minutes later they would be very warm. Warmer than usual. There is a rebound effect where the body floods the area with blood, flushing it out.

I read about this once, it is called "the hunter's reflex" and it's a reflex in the body to protect body parts from frostbite. Anyway, it really kicked in. The first time I noticed it my wife was standing nearby and I told her, "feel my hand" and she flinched, as if I were going to shock her with an ice-cold hand. But she took my hands and they were totally warm, as if they had been soaking in warm water. This effect occurred every time I iced after that, as long as I had been icing twice a day for twenty minutes for several weeks. I don't think it would happen right away now, if I started to ice again.

Lorin Roche, Ph.D.


Date: Sat, 01 Mar 1997
Subject: sore hands are better now

My hands started hurting a year and a half ago, in the Fall of 95. I was amazed when they started hurting at night, at first I didn't even know what that numb, tingling feeling was about when it would wake me up. I was using an ergonomic-looking keyboard, and a trackball. The soreness increased in intensity for all of 96, until even taking two weeks off did not heal my hands. It probably took a year for the desperate thought to reach my so-called conscious mind and realize, "Oh, I have a repetitive stress injury." I did not go to a doctor and get diagnosed, but my wrists hurt, the middle of my palm hurt, the top of my hands hurt, day and night.

I have been in one of the most creative periods of my life. So I kept on working, and doing that thing everyone on this list knows of trying to get along.

This last two months I have been pain free. For now, I baby my hands a bit, because they will hurt for awhile if I do a lot of lifting, turning tools, and wrist-intensive work at the gym. But the chronic soreness is gone.

Almost everything I did that worked I got off this list.I changed my movements, got new equipment, and iced my hands a lot. 1) I installed dual trackballs, one for left and right hands.(the kensington turbo mouse, with four programmable buttons). That worked really well, so I also put a trackball on the floor, the Stingray, which has big flat wings on each side ideal for toe activation. The programmable buttons and the foot pedal let my hands change their habits.

2) I started to ice my hands for 20 minutes at night before bed. Oh, that hurt at first! I found it better to use an icepack through a towel at first, to let some cold do its work. Then after five minutes I would go ahead and plunge my hands into a couple of pitchers with ice and water in them.

3) I began wearing my rollerblade wrist guards to sleep in. That worked well, so I went to the sporting good store and looked at all the different kinds and found an ideal pair.

4) I got the Handeze gloves and wear them all the time when I am working and even when driving.

5) I got a keyboard macro program, OneClick, and programmed the function keys on my Mac. That helps hugely.

6) Following ergonomic links from this RSI page, one thing led to another and eventually to a web page of dozens of keyboard alternatives, I found the Kinesis keyboard page and ordered one. It is very, very good and worth the money. Get the top of the line one, with the onboard RAM chip for programming macros.

7) I switched to the DVORAK keyboard layout. I ordered the Kinesis board with it built in (it toggles back and forth at the press of a button, DVORAK / QWERTY). This was hard. I found it infuriating to go from 80 or 90 words a minute to 12 wpm. But I hung in there. There are wonderful Dvorak pages on the web, full of useful info.

All of these things were indispensable. I refuse to type on anything but the Kinesis now. It is mac/pc changeable at the flick of a switch, so I just carry it with me.

I pulled out the old keyboard awhile ago and was playing with it to see what I was doing that injured me. It seemed like this: I type so fast, and do so much editing, that the sheer velocity at which I was doing Select, Copy, Paste, and so on, was injuring my hands. Also, I was using too much force -- I don't know why. The placement of the keys on a regular board seems all wrong to me now. I think they are hideous devices.

I can now work 8, 10, 12 hours a day writing full-time with the Kinesis board and have no soreness at all. What is odd is that my hands are still vulnerable and healing, even as I work. What I mean is that my hands have been getting steadily better, while working more than full time on a project. It is just that writing for 8 hours is no longer one of the things that stresses my hands and wrists.

Now I have to go easy on things like turning the key in the lock and carrying groceries and driving. I have to do those kinds of things a bit more slowly, so as not to aggravate the old injury. After all, my hands, probably my tendons, were inflamed for more than a year. I find that occasional icing during the day will prevent flare-ups (meaning that the hands will hurt for days) if I have overdone some household chore or have overworked my wrists at the gym.

Hey, I have to get back to work but I felt I owed you something for the great information you so freely share here. I haven't mentioned the dozens of things I tried that did not work -- ibuprufin, various keyboards, and so on.

Lorin Roche, Ph.D.