Ergonomics of Healthy Computing

Ergonomics:

Is an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely. The word ergonomics is derived from the Greek ergon, which means work. Nomics refers to the study of a particular subject; consequently, ergonomics is the study of work. This definition is courtesy of Webster's Collegiate Dictionary, 10th Edition.

Causes and Remedies

Definition:

Carpal Tunnel Syndrome (CTS) is a painful and often debilitating condition. CTS is part of the family of repetitive stress disorders that afflict about 15% of the U.S. workforce. The syndrome occurs when the median nerve, which passes from the wrist through the hand, becomes pinched. Between the arm and hand are nine tendons that travel through a tunnel of wrist bones, or carpals. When hands and fingers are moved, the flexor tendons rub against the sides of the tunnels. At times, too much rubbing causes irritation, and the tendons swell. Upon swelling, the flexor tendons apply direct pressure on the median nerve. The result is numbness, tingling, or a burning sensation in the hand and wrist.

Causes:

Hereditary:

The amount of natural tendon lubrication varies within the population. Sometimes, the anatomy of the wrist contributes to the affliction.

Health:

Those with diabetes, gout, or rheumatoid arthritis are more at risk than others. Also, hormonal changes during pregnancy increase the risk for CTS. It is estimated that over 28% of pregnant women contract CTS during the third trimester.

Repetitive Motion:

This is the most frequent cause of CTS. Activities such as typing and mouse movements cause the flexor tendons to rub against the carpal tunnel walls. According to Mark Smith, an industrial engineer and ergonomics consultant from Austin, Texas, "The issue that is growing the fastest and is potentially the most expensive complication is the placement of the mouse. You can walk into any office today and see the keyboard at one level, and the mouse at higher level further away from the user. The solution is to put both the mouse and keyboard on the desk. Hold the mouse with a light touch, and move it from the elbow rather than the wrist. Moving the hand outward from the wrist, repetitively, is one of the highest risk factors." The author prefers a Logitech Trackman Vista, which is discussed in more detail in the Ergonomic Devices topic.

Trauma:

Injuries to the hands, wrists, or forearms encourage the development of CTS.

Candidates for CTS:

Cases involving women outnumber men by 3:1. The prime range of onset occurs between thirty and fifty years of age.

Symptoms:

1. Numbness and tingling.
2. Associated pain that radiates into the arms and shoulders.
3. Muscle weakness involving the index and middle fingers, along with the thumb.
4. Lack of feeling in either hand.
5. Difficulty performing tasks that require nimble hand motor skills.

Prevention:

It is essential to maintain an overall comfortable seating position, along with specific emphasis on wrist/arm positioning. Keyboards that require the user to bend the wrists is a frequent cause of CTS.

Exercises:

The following exercises have been approved by the American Academy of Orthopaedic Surgeons. These exercises should be performed at the beginning of a work shift, or following a break in activity. The purpose of these exercises is to reduce pressure on the median nerve. According to Dr. Houshang Seradge, clinical assistant professor of orthopaedic surgery at the University of Oklahoma Health Sciences Center, "In the long run, daily exercises, combined with job modification, will save employers money that they would have had to spend on CTS surgery for workers." With regards to saving employers money, ergonomics consultant Mark Smith notes that "A single case of carpal-tunnel syndrome can cost a company over $25,000 in medical and workers' compensation costs."

1. Extend and stretch both wrists and fingers in a hand-stand position. (For each exercise, hold the positions for at least five seconds, and repeat 10 times.)
2. Extend and straighten both wrists and relax the fingers.
3. Extend both arms, and make a tight fist with both hands.
4. Extend both arms, and make a tight fist with both hands. Then bend both wrists down.
5. Extend both arms. Straighten your wrists, and relax your the fingers.
6. Hang arms loosely at their sides, and shake them for a few seconds.

Tips:

Squeeze technique. Take a rubber ball, or specially designed ergonomic egg-shaped device, and perform squeeze repetitions with both hands. This keeps the fingers and wrists limber, and promotes lubrication of the tendons.
Maintain a light key stroke motion while typing.
Don't place your body weight upon the wrists, which occurs during forward-leaning postures.

Treatment:

At the sign of any significant pain or discomfort, visit your health care practicioner for a proper diagnosis. According to Dr. Randale Sechrest of the Medical Multimedia Group, Dr. Jack L. Greider, Jr., of the Southeastern Hand Center, and Dr. Ian MacMorran of IMAK Products Corporation, here are a few treatment options:

1. In the early stages of CTS, splints or braces usually help with the numbness and pain. Some doctors recommend complete immobilization of the afflicted wrist for at least one week. Dr. MacMorran has developed the Pil-O-Splint, which is specifically designed for rest and sleep.
2. Anti-inflammatory medications to reduce swelling.
3. Cortisone injections, which assist in the actual diagnosis of CTS. If a patient doesn't respond to cortisone, usually there is an underlying problem.
4. Diuretics to reduce fluid accumulation.
5. Vitamin B tablets.
6. Carpal Tunnel Release: A surgical procedure to reduce the pressure upon the median nerve. The most commonly performed CTS surgeries are the Open Incision Technique, or the newer Endoscopic Release. Both procedures reduce pressure upon the median nerve. In the Open Incision Technique, wrist ligaments are cut carefully, which releases the pressure inside of the carpal tunnel. Due to the two inch palm side scar, recovery time is six to eight weeks. With Endoscopic Release, the surgeon looks through a scope and cuts the ligament with a small knife. This eases the pressure on the median nerve. Recovery time is much shorter with this procedure; consequently, within a week, a patient can resume work duties.

Perfect Posture

Facts:

Sitting at an L shaped 90 degree angle, as we were taught in childhood, does not always translate well at the computer workstation. Proper posture can be defined as whatever feels best for you, does not cause bodily pain, and adds to your productivity.

Remedies:

1. Select the proper chair, have adequate lumbar support, and adopt a relaxed posture. Metamorphis Design & Development is a firm that designs and evaluates workstation furniture. Their considerable research on posture indicates that the most ergonomic position is reclined against the backrest, with the arms rested. This position transfers the weight of the upper body to the backrest of the chair and arm supports, instead of the back and arms themselves. According to the Swiss Federal Institute of Technology, "Body postures measured under practical conditions are characterized by a marked trunk inclination; that is, pronounced backward leaning. Only 10% demonstrated an upright trunk posture."
2. Use wrist or arm supports. The author places his hands over an opened notebook. A colleague uses individual foam cushioned supports for each arm. The key is to remove pressure from the median nerve.
3. Place documents on a level plane with your monitor. Frequent head movement causes neck and back strain. In place of a document holder, many newer tower style computers can be enlisted for this purpose.
4. Take scheduled breaks. Interruptions don't have to be unproductive; however, it is important to spend a few minutes away from the work station every hour or two. Perhaps you could take this time to visit a colleague to discuss an issue, instead of using email? World class athletes don't perform for several hours at a time without scheduled breaks. Why should you?
5. Consider a professional Workstation Evaluation by the Healthy Back Store.

Back Pain: Causes and Remedies

Most of us experience lower back pain or stiffness throughout our adult years. Here are a few common causes low back pain:

Posture And Poor Alignment:

Lumbar Rotation:

From a standing position, raise your knee toward your chest.
Slowly pull the knee across your body.
Repeat with the other knee.

Side Bends:

From a standing position, clasp your hands over your head.
Lean to one side as far as possible.
Hold for 5 seconds.
Repeat 3 times per side.

Back Bends:

From a standing position, place your palms against your lower back area.
Lean your torso backwards without arching your neck.
Hold for 5 seconds.
Repeat 3 times.

Emotional Stress And Muscular Tension:

Due to the rigors of modern day life, most of us could benefit from Stress Management techniques. Stress causes muscles to contract. Chronically contracted muscles stop the circulation of blood and oxygen, which results in pain and atrophy in the muscle.

Here are a few guidelines for Having a Healthy Back:

Balance:

A healthy back is balanced, and is supported by flexible discs and well-toned muscles. The cervical (neck), thoracic (chest) and lumbar (lower back) curves are all properly aligned. When your ears, shoulders and hips are stacked in a straight line, you have correct posture alignment.

Strengthen abdominal muscles:

The majority of adults have strong leg muscles, and weak stomach muscles. Abdominal muscles support the back, and when unconditioned, may worsen back problems. The Nicholas Institute of Sports Medicine and Athletic Trauma suggests a variety of exercises to strengthen abdominals:

Sit ups.
Side Ups.
Bilateral Leg Lifts.
Spiders.
The Coach's Corner suggests the following Beginner's Abdominal Exercises:
Leg raises:
Crunches.
Bicycle crunches.

Stretching:

Tight and inflexible muscles cause spasms.
Have proper fitting shoeware:
Shoes that are too tight, too loose, or with extremely worn heels and soles, cause misalignment of the spine.

Lift objects with your legs:

From the nation's largest spinal care center, The Texas Back Institute, Ten Ways to Prevent Back Pain:

1. Perform back exercises.
a. Press up.
b. Knees to chest.
c. Hip flexor stretch
2. Use your head when lifting objects: Never bend over at the waist. Instead, bend at the knees and pull the object close.
3. Don't lift and twist: Turn the entire body when lifting heavy objects.
4. Don't carry heavy luggage on your shoulders.
5. Watch out for twisting sport activities: Rotational sports place great torque on the spine. Be certain to perform a warm-up routine to increase circulation, and to make muscles more flexible.
6. Push objects, instead of pulling them: Pushing utilizes the legs and body weight to move an object.
7. Don't stand in one position for extended periods.
8. Don't sit for long periods: Sitting places significant pressure on the back.
9. If you must sit for extended periods, have an ergonomic chair.
10. Don't sleep on your stomach: Sleeping on your stomach arches the back. Sleep on your back with a pillow under your knees, or on your side with a pillow between your knees.

Eye Strain: Causes and Remedies

According to Bill Sardi, a computer vision care author, Computer Eye Strain is caused by:

1. Dry eyes.
2. Staring at the computer screen without blinking.
3. Improperly positioned monitors. "The screen should be just below eye level, so that the eyes aren't opened too widely. Overly opened eyes increase evaporation of tears from the eyes, and causes computer users to raise their brows unnaturally, leading to fatigue and headaches."
According to Charles Poynton, the 1994 Society of Motion Picture and Television Engineers Gold Medal recipient for his work to integrate video and computing technology, there are ways of Reducing Eyestrain:

1. Contrast ratio:

Refers to the ratio of intensity between the darkest and lightest areas of a computer screen display. "Anything you can do to make the screen blacker will improve its contrast ratio, and consequently reduce eyestrain."

2. Minimize Reflections:

"To determine whether your screen suffers from reflections, turn off your monitor. Sit in your normal working position and examine the dark screen for reflections. Arrange your environment so that you can see no intense light sources reflected from your screen."

3. Control Ambient Light:

"In order to minimize reflections of things in front of your screen other than lights, it helps to reduce the general light level (ambient illumination)."

4. Establish a Surround:

Surround is the area perceived by our peripheral vision. "Try to establish a visual surround that is quite a bit darker than the brightest white of your screen. It is beneficial to have a visual reference to the outside world. If you have a window, sit so that the window is far enough to your side that it does not impinge your peripheral vision."

5. Can You See The Pixels?

If you can see pixels on your screen, you are sitting too close to your monitor. "Our visual recognition skills, particularly reading, develop on the basis of recognizing shapes, not dots. I work at arm's length from my 19 inch screen; in addition to its benefits for shape recognition, this viewing distance minimizes stress due to focusing at short distances for an extended period of time."

Energy

According to the acclaimed self-help expert Anthony Robbins, "Energy is the fuel of excellence." In his best-selling book "Unlimited Power," Mr. Robbins outlines several keys for fueling our bodies for peak performance:

Power of Breathing:

Breathing controls the lymph fluid in our bodies. Lymph fluid surrounds each cell, and is four times as prevelant as blood in the body. The lymph system removes toxic wastes from our systems. But unlike the bloodstream, the lymph system is not activated by the heart. Deep breathing and muscle movement propels the lymph system. The most effective way to stimulate the lymph system is to breathe in the following manner:

Inhale for four seconds.

Hold for sixteen seconds: To fully oxygenate the blood, and to activate the lymph system.

Exhale for eight seconds: To eliminate toxins from the lymphatic system.
This should be performed three times a day, for at least ten repetitions.

Water-Rich Foods:

Approximately 80% of our bodies are water. For this reason, water-content foods help to cleanse us of toxins. Fruits, vegetables, and sprouts are ideal choices.

Combining Foods Properly:

All food groups are not digested in a similar fashion. Starchy foods, such as bread, potatoes, and rice use an alkaline digestive enzyme (ptyalin.) Protein-rich foods, such as meat and dairy products, use acidic substances (hydrochloric acid and pepsin.) Whenever a starch is combined with a protein, digestion is impaired. Improperly combined foods rob us of energy, for the digestive process requires more nerve energy than other bodily functions.

Controlled Consumption:

If you want to live a longer, more vibrant life, eat less. Our bodies don't demand the vast quantities of food typical in an American diet. Due to our increasingly sedentary lifestyles, we just don't have the same caloric needs of our agrarian predecessors.

Effective Fruit Consumption:

Fruit takes the least amount of digestive energy. The only food that the brain uses is glucose. Fruit, which is comprised mostly of fructose, is over 90% water, and converts easily into glucose. Fruit should be consumed on an empty stomach; not as a dessert. Fruits are digested quickly, and release their sugars in the small intestine. The best choice is fresh fruit or juice. A personal favorite of the author is bananas, which are a great source of potassium and fiber.

The Protein Myth:

Most of us believe that protein is the key to energy. Actually, our bodies derive energy in the following food group order:

Glucose.
Carbohydrates.
Fat.
Proteins.

Too much protein robs us of endurance, and weakens our bones. "The strongest bones on the planet belong to vegetarians." Green vegetables, sesame butters, and nuts are laden with protein.

Ergonomic Devices

There are several ergonomic tools that can make your everyday tasks more comfortable:

Ergonomic Keyboards:

Microsoft Natural Keyboard: $90.
Ergonomically designed to provide an overall relaxed input posture.

Key features:

Conforms to the natural position of the hands.
Built-in palm rest.
Split sloped keyboard positions the hands in a more comfortable typing posture.
Wrist leveler maximizes straight wrist posture.
Cirque Input Center Keyboard: $100.
A four-in-one device that controls the entire PC.

Key features:

User can type, point, sign faxes, and perform periodic exercises.
The screen cursor is controlled by gliding a finger inside of a small box.
A special writing instrument to record signatures.
Built-in palm rest.
Stretch-ercise digital video software.

Speech Recognition:

According to PC Magazine, "Speech recognition, along with handwriting technology, could make the keyboard at least optional within a few years, and eventually maybe even obsolete."

Dragon Systems Naturally Speaking: 30K personal edition $695. 60K pro edition $995.

Key features:

True continuous speech recognition; no need to pause between words.
Spoken words appear on the screen, and can be edited easily.
30,000 word active vocabulary, along with the ability to add new words.
Software developer claims an accuracy rate of 95% up to 100 words per minute.
Eighteen minutes are needed to train the system to a specific user's voice.
Supports English, French, German, Italian, Spanish, and Swedish.

Philips SpeechMagic:

Key features:

Specifically designed for dictation.
Natural speech recognition.
64,000 word vocabulary.
Uses a vocabulary and language model specific to a user's application; for example, radiology or law.
Supports English or German.

Trackballs:

Logitech TrackMan Vista: $99.
Is a device that replaces the traditional mouse, and reduces the risk of repetitive stress.

Key features:

One side thumb activated button replaces the traditional left mouse click.
One button performs double clicking.
One finger trackball operation.
Ergonomically shaped palm design, which allows precise cursor movement.

Exercise Software:

Cirque Stretch-ercise:

An abbreviated version, which stresses hand exercises, is included with the Cirque Input Center Keyboard. This is a video software application that targets various body groups.

Key features:

Digital video display of an actual person at work.
Ability to test and practice 35 exercises.
Ability to set up an automatic prompting schedule based upon time worked, keystrokes, or pointing device clicks.
On-screen instructions.
Tips on ergonomic office workstation planning.

ErgoMinder: $25. (Free demo is available for download.)

ErgoMinder is an entertaining exercise reminder software program for all computer users. ErgoMinder helps prevent repetitive stress injuries (RSI), and helps accelerate the recovery process.

Key features:

Created by a physiotherapist.
Reminders to move and stretch at timed intervals.
Entertaining cartoon-like graphics.
Ability to customize 16 different exercises.

Bibliography

American Academy of Orthopaedic Surgeons. "Exercises may prevent carpal tunnel syndrome."
Anthony Robbins Companies. "Resources for Creating an Extraordinary Quality of Life."
Arnot Ogden Medical Center. "All About Backs."
Batmanghelidj, M.D., Fereydoon. "How to Deal With Back Pain & Rheumatoid Joint Pain."
Batmanghelidj, M.D., Fereydoon. "Your Body's Many Cries For Water."
Biomet. "Minimum Open Carpal Tunnel Release Surgical Technique."
Capital Office Systems. "Eye Exercises."
Center for Spine. "Exercise."
Chiu, M.D., John. "Carpal Tunnel Procedure."
Cirque User's Guide. "Cirque Input Center Keyboard."
Cirque User's Guide. "Cirque Stretch-ercise Software."
Coach's Corner. "Beginner's Abdominal Exercises."
Dragon Systems. "PC Products: NaturallySpeaking."
Dunn, Connie and Si. "The Risk Less Taken."
Healthy Back Store. "Workstation Evaluation."
Logitech User's Guide. "Logitech TrackMan Vista."
MacMorran, M.D., Ian. "Early Intervention for Carpal Tunnel Syndrome and Repetitive Stress."
MacMorran, M.D., Ian. "New Product Eases Wrist Pain Caused By Pregnancy."
Metamorphis Design and Development, Inc. "Office Working Postures."
Microsoft User's Guide. "Microsoft Natural Keyboard."
Nicholas Institute of Sports Medicine and Athletic Trauma. "Abdominal Strengthening Exercises."
OrthoDoc. "An Illustrated Guide to Muscles & Medical Massage Therapy."
PC Magazine Online. "Software Trends: Talk to Me."
Philips Speech Processing. "SpeechMagic."
Poynton, Charles A. "Reducing Eyestrain from Video and Computer Monitors."
Reader's Digest UK. "Bananas."
Robbins, Anthony. "Unlimited Power."
Rose, Phd., Amy. "Preventing Carpal Tunnel Syndrome."
Rose, Phd., Amy. "Working Safely At The Computer."
Sapiens Software Pty Ltd . "ErgoMinder."
Sardi, Bill. "How to Relieve Computer Eye Strain."
Sechrest, M.D., Randale. "A Patient's Guide to Carpal Tunnel Syndrome."
Sheehan, Mark. "Avoiding Carpal Tunnel Syndrome: A guide for keyboard users."
Southeastern Hand Center. "Carpal Tunnel Syndrome."
Southern California Orthopedic Institute. "Carpal Tunnel Syndrome."
Smith, Mark. "A Self-Defense Strategy."
Swiss Federal Institute of Technology. "VDT Workstation Design."
Taxel, M.A., Pamela. "Backache Prevention Guide."
Texas Back Institute. "Back Exercises."
Texas Back Institute. "Ten Ways to Prevent Back Pain."
University of Wisconsin-La Crosse. "Stress Management."
Washington ComputerUser, May 1997. "The Risk Less Taken."
Washington ComputerUser, May 1997. "A Self-Defense Strategy."
Webster's Collegiate Dictionary, 10th Edition.

Related Web Sites

Carpal Tunnel Syndrome:

Definition/Occurrence:
http://www.handsurgery.com/carpal.html
New Product Eases Wrist Pain Caused By Pregnancy:
http://www.tpcorp.com/macmorran/resources.html
Exercises may prevent carpal tunnel syndrome:
http://www.aaos.org/wordhtml/press/exerci.htm
A Patient's Guide to Carpal Tunnel Syndrome:
http://www.sechrest.com/mmg/cts/ctsintro.html
Early Intervention for Carpal Tunnel Syndrome:
http://www.tpcorp.com/macmorran/self.html
Pil-O-Splint:
http://www.tpcorp.com/macmorran/product.html
Typing Injury Frequently Asked Questions (FAQ):
http://www.CS.Princeton.EDU/~dwallach/tifaq/wwwlinks.html
Open Incision Technique:
http://biomet.com/product/strickland/step2.html
Endoscopic Release:
http://www.west.net/~chiu/endoscopic.html

Workstation Posture:

VDT Workstation Design:
http://www.mindspring.com:80/~metaguy/6studies.html
Office Working Postures:
http://www.mindspring.com:80/~metaguy/
Workstation Evaluation:
http://www2.healthybak.com/hbs/ergosurvey.qry

Healthy Back:

All About Backs:
http://www.aomc.org/occmed.dir/aboutyrback.html
Back Stretches:
http://www.centerforspine.com/exerwork.html#anchor663373
Stress Management:
http://www.uwlax.edu/HPER/Courses/HPER-105/StressManagement/index.html
Abdominal Strengthening Exercises:
http://www.nismat.org/orthocor/programs/abstr/abex.html
Beginner's Abdominal Exercises:
http://www.jockz.com/abs.html
Water - The Fountain of Health and Well-Being:
http://www.watercure.com/index.html
Ten Ways to Prevent Back Pain:
http://www.texasback.com/html/how_to_prevent_back_pain.html

Eyes:

How to Relieve Computer Eye Strain:
http://www.primenet.com/~dsilva/eyeinfo.html
Reducing Eyestrain:
http://www.inforamp.net/~poynton/notes/reducing_eyestrain/

Energy:

The Anthony Robbins Companies:
http://www.tonyrobbins.com/
Bananas:
http://foods.readersdigest.co.uk/extracts/pages/bananas.html

Tools:

Microsoft Natural Keyboards:
http://www.microsoft.com/products/prodref/310_ov.htm
Cirque Input Center Keyboards:
http://www.glidepoint.com/cic360.htm
Dragon Systems NaturallySpeaking:
http://www.dragonsys.com/marketing/pcproducts.html
Philips SpeechMagic:
http://muck2.piro.net:100/Pages/WW40.htm
Logitech TrackMan:
http://www.logitech.com/products/trackballs/tmvista/index.htm
Cirque Stretch-ercise Software:
http://www.glidepoint.com/fcic360.htm
ErgoMinder:
http://saturn.vision.net.au/~macsol/shots.htm

Credits

This project was researched, written, and presented by Steve Amoia, Technical Writer, AZTECH Corporation. AZTECH is a leader in the association management software development industry. The project was proofread by Mrs. BJ Stanger, Director of Client Services.

The carpal tunnel exercises were demonstrated by Yvonne Marr, and the back exercises were performed by Thomas Ashley. Ms. Marr is the Customer Support Administrator at AZTECH, and Mr. Ashley heads our Business Development department.

The print version of this documentation was produced  with HelpBreeze 2.0a by Solutionsoft, Website: http://www.solutionsoft.com.

While carefully reviewed for accuracy, AZTECH Corporation and the author do not assume liability for any errors. Before commencing any exercise program, please consult with a physician. This documentation is for informational purposes only, and is copyrighted by the individually referenced sources. The following Internet search engines contributed greatly to this project:

AltaVista:
http://www.altavista.digital.com/
HotBot:
http://www.hotbot.com/
Lycos:
http://www.lycos.com/
Yahoo:
http://www.yahoo.com/