Four RSI Questions Answered

What are the characteristics of RSI?

RSI is characterized by nonspecific upper extremity pain that results from engagement in cumulative hand-intensive tasks.

Am I at risk?

Occupations at greatest risk for RSI are in service and manufacturing industries, including any job with computer and keyboard use.

What about treatment?

Physical activity should be encouraged. Efforts should be made to keep patients at work with accommodations, as indicated. Ergonomic modifications may be considered.

Could technological advancements help avoid RSI?

Advancing technology, including voice recognition software, may enhance the ergonomic environment and help to alleviate symptoms.


Most lap desks are not ergonomic

Most lap desk ergonomics are not fit for long-term use. The problem starts with the fact that, in themselves, most laptops are not ergonomic and require additional equipment for prolonged use.

Most lap desks are, by design, rather small work surfaces. There is little space for an external keyboard and mouse. Adding an external keyboard and mouse is necessary for ensuring proper ergonomic posture using a laptop.

Some of those do not have a laptop elevation mechanism, which means the laptop screen is not at an optimal position.

Need to keep your wrists neutral when typing

While there is no definite evidence that keyboard use can cause or aggravate carpal tunnel syndrome, “The study found that carpal tunnel pressure is influenced by wrist posture during typing and, independently, by the act of typing.” [1]

The mere “activity of touch typing increases carpal tunnel pressure above the pressure associated with just holding hands suspended over the keyboard at the same wrist posture.” [1]

The findings of this study suggest that “the keyboard and workstation be adjusted to avoid wrist extension greater than 30° and radial deviation greater than 15° when using a computer for long hours.”

Wrist extension can be reduced by

  1. decreasing the slope of the keyboard
  2. decreasing the keyboard thickness.
  3. using a split keyboard.
  4. using a forearm support surface, or raising the keyboard height relative to the chair. (questionable)

“Ulnar deviation can be reduced by using a split keyboard, but it should be noted that a large keyboard opening angle may lead to radial deviation, which should be avoided.” [1]

These findings may provide guidelines to keyboard designers and to clinicians for the management of patients with carpal tunnel syndrome who use a keyboard at work or home.” [1]



Using a Laptop as your daily driver

Laptops are not ergonomic. Using a laptop every day, requires extra equipment. If you don’t, keep in mind that you are making a tradeoff between poor neck/head posture and poor hand/wrist posture.

Use a desk. Position the laptop in front of you so that you can see the screen without bending your neck.

Sit on a good chair that is comfortable and provides good back support.

Elevate the laptop off the desk surface using a stable support surface, such as a computer monitor stand, a laptop stand, or a bunch of books.

Use a separate keyboard and pointing device. Connect them directly to the back of the laptop or to a docking station. You can also go wireless.

Of mice and wrist rests

Mousing while resting on a wrist rest is not ideal. Using wrist rests can significantly increase the pressure inside the carpal tunnel. Further, wrist rests compress the finger flexor muscles.

Do not use a wrist rest for the mouse. Also, do not rest your elbow or lean your forearm on a chair arm rest while mousing.

Instead, take breaks from mousing. It is OK to use the arm rests to rest in when not actively mousing or typing.

Laptops are not ergonomic

Laptops are not ergonomic.

The reason? The screen is not separated from the keyboard. This means that when the screen is in an optimal position, the keyboard is not and when the keyboard is in an optimal position, the screen is not.

None of the popular laptops, as of 2021, satisfy the basic ergonomic need that the screen be separated from the keyboard.

Prolonged standing at work may be risky too.

If you spend most of your workday standing, you may be at a greater risk of heart disease compared to spending most of your workday sitting. This might mean that “combinations of sitting and standing are likely to have beneficial cardiovascular health benefits.” [1]

Interestingly, jobs that combine standing, sitting and walking seem to be more risky for women that for men: “While occupations that involved combinations of sitting, standing, and walking were associated with a decreased risk of heart disease among men, they were associated with an increased risk of heart disease among women.” [1]



Sitting a lot? Take frequent breaks, even if you exercise.

Even if you follow standard recommendations for physical activity with the aim of “reducing risk of type 2 diabetes, cardiovascular disease, and some cancers”, it seems that, according to [1], having long periods of inactivity is distinctly “related to risk of chronic disease independent of physical activity”.

Interestingly, taking more frequent breaks from sitting seems to be beneficially associated with metabolic risk variables. Again from [1]: “independent of total sedentary time, moderate-to-vigorous intensity time, and mean intensity of the breaks, more interruptions in sedentary time were beneficially associated with metabolic risk variables, particularly adiposity measures, triglycerides, and 2-h plasma glucose.”

It appears that “it is not only the amount of sedentary time that is important, but also the manner in which it is accumulated.”


  1. Breaks in Sedentary Time: Beneficial associations with metabolic risk (link)

Office worker? Stand up and walk!

Office workers tend to sit. A lot.

Spending too much time sitting can be detrimental to our health. There is “significant evidence on the adverse cardio-metabolic health consequences of sitting” [1]. Additionally, “high levels of TV time were significantly associated with increased all-cause and cardiovascular disease mortality” [1].

Interestingly, daily exercise alone does not seem to offset the adverse effects of prolonged sitting. “Even if daily exercise recommendations are met, metabolic health might be compromised if sitting occurs without regular breaks”. [2].

The one most important thing you can do, is to take breaks from sedentary time. According to [2], “breaks in sedentary time (as distinct from the overall volume of time spent being sedentary) were shown to have beneficial associations with metabolic biomarkers”.

During your work day, you should get up and move briefly regularly. Having a higher number of breaks in sedentary time was “beneficially associated with waist circumference, body mass index, triglycerides, and 2-h plasma glucose” [1].

So what is a good sitting/standing ratio? “Wellness perception varies across sit:stand ratios, typically greatest near 24:6.” [3]. This ratio ties up nicely with the Pomodoro technique [3]:

  • Set a timer for 25 minutes. Start working.
  • Then, take a 5 minute break. Get up and move away from you desk. Try being lightly/moderately active. Walk around, stretch, maybe do a bit of light strength training.
  • Repeat.


  1. Too Much Sitting: The Population-Health Science of Sedentary Behavior (link)
  2. Different sit:stand time ratios within a 30-minute cycle change perceptions related to musculoskeletal disorders (link)
  3. Wikipedia page on Pomodoro Technique