How do I deal with my tendonitis without failing my classes?

October 9, 2007 5:13 PM

I have tendonitis in both my forearms from computer over-use. It is bad enough that I'm having trouble taking lecture notes in my university classes--a serious problem. Aside from not using the computer, what can I do?

I am pretty sure it's not carpal tunnel as I have none of the nerve pinching, just pain down the underside of my forearms. I know getting an ergonomic keyboard and mouse are a good idea, but which ones? How do I learn to use keyboard shortcuts (I'm on Ubuntu)? Is there a specific way to write that will reduce the pain? Should I be doing grip exercises or using a forearm roller, or would that worsen the problem?

Also, while I can cut down my computer usage since I'm not in any computer-heavy classes, I have to take notes. Recording doesn't work at all for me. Will this be OK? It's usually 3-5 hours of note-taking a day.

posted by Braeog to health & fitness (26 comments total)

Have you tried taking notes by hand? (Is there a reason that you can't, other than that you don't prefer it?)

(And I honestly don't mean that to sound snappish.)
posted by Prospero at 5:16 PM on October 9, 2007

This guy's web site was helpful to me for similar problems. Basically, building up your upper body reserves. A nice stretch I developed that relieves a lot of pain is lie on your side and slowly and gently rotate your arm in an extended circle.

I didn't find the ergonomic msoft natural keyboard helped at all. I needed to get the hell away from the rigid position and get moving.
posted by Listener at 5:19 PM on October 9, 2007

Stretch. Get a therabee.
posted by gnutron at 5:24 PM on October 9, 2007

Rest your arm as much as possible, take some ibufrofen, and see your doctor.
posted by hot soup girl at 5:27 PM on October 9, 2007

Might be a good idea to get in touch with a physical therapist and see if they do (or can recommend someone who does) an on-site ergonomic assessment. Often such problems come about from a combination of factors--chair height compared to desk height, angle of your arms; or use/non-use of wrist rests; if you're typing in a classroom on a laptop keyboard, you might do best to get an external keyboard to attach (and if it's like my classes, the desk you're using might not allow you the best position for typing; you might get some further help from the disabled student services or a similar office you can go to in addressing ergonomics issues--it's their job!).

And maybe even do a session or two with the therapist to learn some exercises and strategies.
posted by troybob at 5:28 PM on October 9, 2007

...in any case, don't ignore it without some expert help...letting it go too long can turn into a chronic painful problem that will bring a whole lot of problems compared to the initial learning curve to correct it...
posted by troybob at 5:30 PM on October 9, 2007

Strategies for avoiding chronic pain and eventual cortisone shots, (which, by the way, really suck):

-NSAIDs: my orthopedist recommended Aleve over Advil
-ice: I usually run one ice cube over each forearm until it melts
-wrist braces: if you think you may be sleeping with your wrists curled, get braces and sleep in them; it's not the most fun, but neither is chronic pain
-ergonomics: make sure your elbows are not at an acute angle that forces your wrists to bend
-rest, rest, rest.
-physical therapy, if the rest of it doesn't help adequately; they can teach you exercises to do at home
posted by moonlet at 5:40 PM on October 9, 2007

Actually, I do handwrite my notes. Even handwriting is painful.
posted by Braeog at 5:50 PM on October 9, 2007

You NEED to see a doctor. The pain is damage being done to your nerves and tendons. Don't screw around with this, get to the doctor NOW.

I had a pretty severe DeQuervain's inflammation when I worked as a word processor. At the time, which was nearly twenty years ago, this was the basic thinking: first, get the inflammation down. You do that with anti-inflammatories. I was on 800mg of ibuprofen 4x/day. Then, strengthen the muscles involved so that they take more of the load; stronger muscles mean that tendons don't work as hard. The idea was to wait until the pain receded, and then start doing grip exercises. But to know what exercises you specifically need, you will definitely need to see a doctor.

You don't need to worry about masking the pain with tendinitis. The pain IS the problem, and if you reduce the pain, you reduce the damage. No OTC medicine will be strong enough to cover a real problem; tendinitis is excruciatingly painful if it's serious. You will find yourself very badly impaired at nearly everything if you have a bad case. With my DeQuervain's (the thumb tendon), I had a lot of trouble driving; gripping the wheel was very painful.

If you can't see a doctor at all, heavy ibuprofen and no computer use will help, but this is NOT something to screw around with on your own. And what I am telling you is no substitute for Real Medical Advice, because my knowledge is twenty years old.
posted by Malor at 5:58 PM on October 9, 2007 [1 favorite has favorites]

What Malor said. Plus, accupuncture - it may be new to Americans, but it's time tested, and it will accelerate your healing time.
posted by beezy at 6:06 PM on October 9, 2007

Malor has it down pat. I had tendonitis in both arms and was referred to a physical therapist. I could only afford 3 sessions, but the uv therapy I had really helped. Most important, a therapist can recommend great techniques and exercises to help prevent the situation in the first place. And ditto beezy's suggestion - when it does flares up, I go to an acupuncturist as it reduces the swelling. You definitely don't want to let it go on until you can't pick things up and worse, feel anything at all.

As for Ubuntu keyboard shortcuts, try the Ubuntu forum here. And as for writing notes, try shorthand and perhaps a new handwriting grip? I find that when I write, I grip the pen too firmly, which leads to severe cramps when it goes on for 2 hours a lecture. Now I write with the pen snugly against my fore and middle fingers; it's awkward but prevents me from gripping too hard.
posted by sweetlyvicious at 6:20 PM on October 9, 2007 [1 favorite has favorites]

Talk to a doctor or physical therapist/physio at your university. Should be cheap. They will give you exercises to do to strengthen the right muscles.

From my own experience, if you handwrite a lot you should get a pen with a fat grip. Gripping a skinny pen puts -- oddly -- a lot of strain on the hand and related systems. You can buy those foam grip-fatteners if you have a certain skinny pen you like to use. This made a surprising amount of difference for me.
posted by LobsterMitten at 6:50 PM on October 9, 2007 [1 favorite has favorites]

It may not be carpal tunnel, but the same stretches will help you. Your Googlefu will help you find the right ones, basically stretching your wrists (I know the pain is elsewhere, trust me, the pain can extend all the way to your shoulders and still be sourced in how you touch the computer) forward and backward. Keep your wrists straight during computer use and consider ergonomic keyboards and pointing devices. Don't ignore the pain because you can do permanent damage quickly if you do. Also, ice and NSAIDs of course.
posted by caddis at 6:53 PM on October 9, 2007

Braeog, I have bilateral tendonitis in the inner elbows (golfers elbow they call it). I've had the injury for many years, and I've learned a coping strategies along the way:

Write only the notes you have to - don't be writing stuff down you already know. Borrow notes from classmates when you can.

Directly ice the affected area whenever the affected area starts getting inflamed and weak. Do it for 20 minutes.

Pick and choose your activities carefully. Like me, you probably have good days and bad - the bad days happen after you overuse your arms. You can use the computer, but be judicious about it.

Tell your professors about your injury, as well as the schools guidance councellor. They can help.

I know this sounds weird, but eat lots of carbohydrates. Carbohydrates convert to muscle glycogen, and the glycogen will act as a "buffer". Low carb diets are not recommended, unless you want to further aggrevate your injury.

Watch your posture, when you're on the computer, when you write and even when you walk. Bad posture can stress nerves in the neck and back, and negatively affect the tendonitis.

Make sleep a priority. Take naps when you can. You will feel stronger and more able to take on pain.

I use Dragon Naturally Speaking for the computer, so I don't have to type (although I am right now because I don't want to hear my own voice right now), Skype (so I don't have to hold the phone) and I've learned to use my left arm/hand to navigate the mouse because my right arm is far worse. What I'm trying to say is try new things out.

Most of all - stick with it. Finish school. People have done it with greater challenges than you and I.

Disclosure: I'm also going to college and in my third semester, and I found the first semester was the worst. I too was wondering if I could make it.
posted by JaySunSee at 7:00 PM on October 9, 2007 [1 favorite has favorites]

Some universities have notes available for disabled students - if you can get a doctor to say you shouldn't be taking notes, they (the student union? disability service? not sure who runs these) will pay a student in your classes to take notes that you can use.
posted by jacalata at 7:04 PM on October 9, 2007

My tendinitis was greatly improved by visiting an acupuncturist (I only needed a single session), wearing a simple wrist support such as this one, and using a Wacom tablet for all of my mousing needs.
posted by mezzanayne at 7:05 PM on October 9, 2007

Get a digital recorder and tape all of your lectures. Then go back and take your time transcribing them. If the classes are chalkboard-intensive, you might even bring your laptop to class and shoot it all with a webcam, although you'd probably want to ask the prof's permission for that.
posted by backseatpilot at 7:18 PM on October 9, 2007

I got horrible RSI my freshman year of college from too much video games in the worst desk setup imaginable. I have seen doctors, taken ibuprofen, iced, rested, etc. Those all help. But you really REALLY need to fix your desktop ergonomics NOW. That is the only thing that will actually fix this problem. To this day, if I am working at a desk properly fitted to me, I have no problems being at the computer 8+ hours a day. With a bad desk I hurt within the first 20 minutes. Frankly, long-term ibuprofen use can have negative side-effects, and icing gets tiresome. Fix the desk.
posted by ch1x0r at 7:18 PM on October 9, 2007 [1 favorite has favorites]

I've had long term problems with tendonitis and a few other OOS related issues stemming from my first stint at University. You really do want to see a doctor and possibly a physio because this will only get worse if untreated (including the possibility of permanent nerve damage like I have), but could improve surprisingly fast if you get it sorted out correctly.

For me a special keyboard (I've found chunky, clicky keys that work my hands and arms work way better than the fancy ergonomic ones and don't cost very much), decent mouse and really good desk and chair setup have prevented any new problems and generally control the old ones (albeit with a certain level of continual pain). Try not to grip the pen too hard when you write and be relaxed, better to have slightly messy notes and a working arm.

A lot of the things listed here will help you, but as to which ones exactly you need more specific advice from a medical professional. For example, I don't tolerate anti-inflammatories at all so the standard ibuprofen advice would make me really sick, even though it works for most other people. Problems like you're having are pretty standard for students, your med centre should be used to dealing with it and hopefully there will be resources available to help you out. So give them a call.
posted by shelleycat at 8:09 PM on October 9, 2007

I lost the usage of both of my wrists to the pain you are feeling now. I am dictating this message with Dragon NaturallySpeaking, because it would be too painful type it directly.

Go read this post I made about a year ago to another fellow with wrist pain.

Stop typing. Go see a doctor. Begin physiotherapy. Do not type one-handed with the remaining good hand. Switch to a touchpad or to a tablet. Buy the cheap-ish version of Dragon NaturallySpeaking. Apply ice all the time, until your flesh turns pinkish-red, but not so much that it freeze burns. Read, read, and read a lot.

Once the pain is gone, get a Kinesis keyboard.
posted by gmarceau at 8:23 PM on October 9, 2007 [2 favorites has favorites]

Along with the SEEING THE DOCTOR and getting enough sleep, I like the IBM Model M keyboards:
http://www.dansdata.com/ibmkeyboard.htm
http://www.dansdata.com/clickykeyboards.htm

I'm fond of the utility for KDE:
rsibreak
There's some recommendation for gnome deviants in the comments there.

Note that regarding RSI breaks, short and often is better than long and rarely. (A general trueism, that.) I've got mine set up for a 30s break every 5m of activity, but that's for very mild wrist pain.
posted by sebastienbailard at 9:00 PM on October 9, 2007 [1 favorite has favorites]

If you go through the right channels (doctors and such), most universities will get you a note taker if you need to stop writing for a while. They may even be required to do so under ADA, but I'm not sure about that. You should certainly check this out; a friend of mine had trouble with her wrists in college and I was paid by the university to take notes in a couple classes for her. It was excellent money for something I was basically doing anyway, so it's a good deal all around.
posted by matematichica at 9:52 PM on October 9, 2007

In addition to all the other advice, I want to mention wearing elbow braces when you sleep. I recently found out that in addition to constant keyboarding, part of my tendonitis was caused by sleeping with my elbows bent (hands tucke prayer-fashion under my pillow). This was irritiating my ulnar nerve, or some such. Anyway, you can buy a brace, or make one using a man's tube sock with the toe cut off - pull it up over your elbow, then stuff the inner elbow with additional socks so that it's impossible to bend the elbow more than a few degrees.
posted by Oriole Adams at 10:52 PM on October 9, 2007

I do handstands daily up against the wall (Not kidding) and this helped alleviate some pain I had in my wrists. Though I'm not a Doctor and didn't get this advice from one. YMMV
posted by debu at 2:07 AM on October 10, 2007

As Oriole Adams says, make sure you're not aggravating the problem overnight. I had persistent wrist and forearm pain on one side that I couldn't shake off no matter what I tried, which was starting to get scary, until I realised I needed to change my sleeping position to minimise bending & twisting of my wrist and reduce the elbow bend a little.
posted by malevolent at 4:05 AM on October 10, 2007

IMAK Smart Gloves are awesome - much better than stiff braces in my experience, but your mileage may vary. They are sort of like lycra mittens with no fingers, but they have a flexible brace along the back of your hand, and a beanbag sort of thing underneath at the base of your palm. Sounds crazy but they are great, and I have clued numerous coworkers onto them. (It's well worth the $ to try stiff braces as well as the IMAK softer style.) You can figure out your size using the chart on the IMAK site, then buy them most cheaply (new) on ebay. They are reversible and washable.

Here's what helped my tendonitis:

1) Physical Therapy - helped me get better when things were bad, taught me stretches, scared me into not letting my lazy habits harm my body. (Back stretches are really important for arm problems.)

2) Smart Gloves - see above.

3) Taught myself to mouse with either hand - sounds crazy, but every 2-3 weeks I change my mouse from left to right or vice versa. This helps a lot. Took about 4 days to get back up to speed at first, and I do have to go back to right hand for detailed photoshop work.

4) Heavy ibuprofen use early on, to reduce the inflammation. BUT WATCH OUT - I eventually got an ulcer due to my ibuprofen habit - it took about 6-7 years though. But I don't really need it anymore, the stretching and other good ergo habits seem to take care of things.

5) Heating pads when things start to hurt again definitely help out.

Manual labor like digging a new garden, or lots of hammering can send me totally back into tendonitis hell - so watch out for that sort of thing.
posted by chr1sb0y at 7:59 AM on October 10, 2007