Scott Hanselman

The Programmer's Hands

September 21, '04 Comments [29] Posted in Speaking | Tools
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I've said a few things in the past about The Programmer's Back.  Well, when it rains it pours. We all have pain I'm sure, but since I'm the center of my own universe my pain takes priority. I've had trouble with my hands and wrists over the years of programming. Recently, however, it's become rather ridiculous as I can only type for a few minutes at a time before my fingers and wrists start to ache.

I've got the natural keyboard and I've got the trackball mouse but fundamentally I'm I/O bound when it comes to my hands.

If you've ever seen me present before, you know that I type fast. This is not hyperbole, this is simply fact, my fingers move really fast, and now I'm paying for it. I'm not particularly athletic either and 10 years of not working out has no doubt created a weakness in my hands and forearms that can be covered up no longer. Perhaps I'm just having a flareup, but regardless it's time to deal with it.

I've looked at all sorts of funky keyboards that claim to have the One True Way of typing but I've decided the typing is just not where it's at. It's just one syllable for me to say something like "code" but it's four keystrokes between two hands and that seems ridiculous to me. So lately I've been into voice recognition, first starting with the built-in Microsoft voice recognition software and currently with Dragon's NaturallySpeaking. I've taken a few typing tests online using the voice recognition software and I've achieved up to 100 (160 in one case) words a minute - which is just about what my typing speed was at my peak. The quality is so much greater than it was five years ago when I tried previous versions of voice recognition software that at least I can feel that the future will hold positive things around voice recognition.

In fact this entire post has been dictated entirely with Dragon NaturallySpeaking version 7, and I have to say I'm not completely disappointed. For dictation, it's fantastic. The accuracy is easily 95+%, and the only strange things happen when there are words like "Corillian" that are just too weird for it to possibly understand. However it does mitigate some of these issues by scanning all of your e-mails and all your documents looking for potential vocabulary words.

I don't know if I could use it effectively if I had no hands at all, as most of its commands consist of one or two word chords and it seems to have trouble with very small words. For example the breeze forcibly on the microphone it might say "up" or "pop". It knows about a large number of applications, except it doesn't know about Firefox which makes browsing a bit of a problem. One day I'll have to go Google for additional command sets for the tools and programs that I use.

Seems that a lot of people out there have had carpal tunnel release surgery and continue to have trouble. That seems like an awfully drastic step. The only answer seems to be to "lay off" the keyboard.

Has anyone else had to stoop to this level and use voice recognition software in lieu of a keyboard? Has anyone found a vertical keyboard or some strange alternative keyboard that has changed their life and suddenly opened up new vistas of use for their damaged hands? Am I the only programmer out there with a bad back and a bad pair of hands who's 12 years into his career and wondering what the next 12 will hold? Or do I just type to damn fast?

(P.S. One thing to note, I am using a USB microphone for this dictation, and I can't imagine someone getting this kind of accuracy with an analog microphone.)

(P.P.S. Looking back on this blog post, I shudder at the sheer number of characters and keystrokes that would been required had I'd done this by hand. Perhaps voice recognition will usher in a prolific new era in blogging for me. Or, I'll just ramble a lot into my blog. :) )

About Scott

Scott Hanselman is a former professor, former Chief Architect in finance, now speaker, consultant, father, diabetic, and Microsoft employee. I am a failed stand-up comic, a cornrower, and a book author.

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Tuesday, September 21, 2004 12:56:14 AM UTC
I've done the carpal tunnel thing. I'm only a lowly high school computer science teacher, not a programmer but I put myself through college with my hands and keyboarding skills, and frankly I do all my lessons, etc. and communicating with my students by typing.

My hands when beyond pain to numb. I finally got treatment because my doctor's and I couldn't tell if it was diabetic neropathy (sp), or if it was carpel tunnel. It was over 90% carpel tunnel.

I recommend getting a good hand surgeon and getting orthoscopic surgery. I have no numbness and very little pain. I agree with an article I recently read, that it's the mouse, not the keyboard that's the problem, and I do avoid mouse use now. I also make sure my mice fit my hand.

There is an excellent hand surgeon in Dallas, contact me privately and I'll give you his name. He could probably recommend a good hand surgeon in your area. The good news, is that he will work with diabetics. The first surgeon who saw me wouldn't touch me but he was a general plastic surgeon. My first surgery didn't heal as well as we liked but I was still on shots then, and wasn't as good at fine tuning as I am now, and I am sure you are since you are a pump user.

I've used Dragon Dictate when I was recovering from surgery and while it was faster than one handed typing it was too frustrating to use on a regular basis. If I were forced to stop typing I could use it, and it would probably become second nature. My students could probably adapt too, but I'm not sure I would be as productive.
Tuesday, September 21, 2004 1:25:36 AM UTC
Hi Scott

Best of luck -- i hope your find some relief!

Julia Lerman ("http://www.thedatafarm.com/blog") wrote recently that her marble trackball mouse was isolated as the cause of her own hand troubles. are you sure the trackball is doing you good?

another possible solution is to hire a bunch of people you can dictate to. They will transcribe all your thoughts, fix up grammatical errors, etc. Sort of like the posse of yes-men that Elvis liked to keep around him.

again, best of luck
leon



Tuesday, September 21, 2004 1:38:14 AM UTC
Do you find people being bothered by your talking at the computer. I've often thought of getting a voice recognition system running, but I just figured that I'd have to stop using it, since there always seems to be other people in the room. Having me stand up yelling, "Turn left, shoot! shoot! AGH! Stupid zombies! Shoot!" probably would not be too appreciated.
Tuesday, September 21, 2004 3:26:25 AM UTC
Sorry you're having trouble. I don't have any answers for you. I am interested in your comment about the USB mic vs. an "analog" one, though. What do you mean by that? Do you mean you're using a headset rather than a desktop mic? All mics are analog. :)
Tuesday, September 21, 2004 3:54:23 AM UTC
Mark, what I'm saying is that the microphone on using goes into the USB connector, rather than the sloppy analog connector on my sound card. In my opinion, this eliminates my sound card's signal-to-noise ratio as potential place to lose quality.it's automatically detected by Windows, requires no third-party drivers and is largely considered to eliminate one potential point of problems around speech recognition.

Is my logic flawed?
Scott Hanselman
Tuesday, September 21, 2004 6:12:57 AM UTC

That depends on your definition of logic :)

Simpler, yes, but it's still very analog, just like plugging into your sound card would be.

I am sorry to hear about your hand problems. Can you estimate how many years, and how many hours, you spent typing? Is there anything unusual about your typing position, your posture, your hand positions, etc?

In other news, it looks like all those years of one-handed web browsing may finally be paying off for me!
Tuesday, September 21, 2004 7:04:52 AM UTC
Hi,
I'd had a similar problem back in 1999 while typing out my 4th year CS research project... It was caused by really bad posture. At that time I ended up using Dragon Dictate as well, and found it an amazing help. I found that my talking to the computer would seriously confuse my housemates, but after a few days the "oddness" value wore off and it was fine. (One consistant problem was having them come in and reprogram the dictionary so that the word "Windows" would make it write out "Stupid OS" or other similar things)

Whenever I've started having similar pains I've found that going to a Physiotherapist helps - the lady I go to usually gives me exercises to do and treats the inflamation. My symptoms sound far less severe than yours so while this info might not help you out, it might be of use to someone else who reads your blog.

Hope you find a good solution, and I hope to hear about it in your blog. :-)

From
Paul
Tuesday, September 21, 2004 8:08:25 AM UTC
I have an alternative solution for your problem. check out www[dot]magnabloc[dot]com. it is therapeutic magnets that can manage and relieve pain signal from going into your brain (so that you will not feel the chronic pain).

I am using it now and I can do wonders with it. I can relieve wrist pain, back pain, knee pain and head pain.

cheers,
TK
tkteh
Tuesday, September 21, 2004 8:14:37 AM UTC
Jeff - would I get better quality with a traditional Mic+1/8" connector, and an external USB Sound Card?
Scott Hanselman
Tuesday, September 21, 2004 8:16:30 AM UTC
Hmmm, its cold today (uk) and my knuckles are burning. I too know what it is like to be finger dependant, the ability to type quickly has given to keyboard entry as the primary source of input.

Cant see the dictation thing taking off for me though I mostly spend my time coding C# in an open plan office.

What does the future hold in the next 15 years. Certainly not magnets or magic crystals. ;-)



SimonT
Tuesday, September 21, 2004 12:35:08 PM UTC
Try accupuncture. It works.
Tuesday, September 21, 2004 1:43:37 PM UTC
Although I'm a very slow typist and had never had any serious pain or discomfort in my hands (yet), I thought about voice recognition in the past but I was concerned that it could damage my vocal cords and throat instead of my hands.
I wonder what telemarketing folks would have to say, since they use hands and voice all day long.
Sergio Pereira
Tuesday, September 21, 2004 4:38:44 PM UTC
Hi Scott. I've written a bit about my own experience here: http://haacked.com/archive/2004/06/10/590.aspx

"At the end of an average eight-hour workday, the fingers have walked 16 miles over the keys and have expended energy equal to the lifting of 1 1/4 tons."

I recommend getting Occupational Therapy and Physical Therapy. You know that marathon runners can increase their efficiency with very minor adjustments to their technique. The same is true for computer programmers. I found a great PT and I'm starting to show improvements. Take a lot of breaks and check out the resources in my article.

I've tried the Dragon thing and gave up for two reasons. A lot of people don't recognize the fact that using voice rec 8hrs a day creates its own forms of repetitive stress injuries including burning your throat. But also the stress of not speaking naturally. No ahs, umms, hems and haws. No thinking out loud.

I'm looking into a tablet pc largely because it's a different type of motion when writing. I'm hoping to do emails and blog posts using a tablet.
Tuesday, September 21, 2004 4:46:28 PM UTC


I recommend taking the preventative measures that I use:

I use something called a mousemitt. Basically its kinda like a glove but it doesn't cover your fingers and mostly covers the wrist area. If you're a typist where you rest your wrist anywhere, you're causing problems to your wrist leading to carpal tunnel syndrome. The mousemitt has a pad underneath which absorbs the pressure from your wrist. You ideally should type while your arms are floating in the air. If you can't or are too lazy, get these from
http://www.mousemitt.com. I use them ALL the time at home and at work for years now. I got so used to them that if I start typing without it (I use one only for the right wrist), I feel my wrist is naked.


Taking breaks. It's very important to take a short break once every 1-2 hours. It's easy to sit at your desk for hours without stretching or moving a muscle. My quick break could be going up to the lunch room floor, reading a section of the paper and coming back. You can also do some basic stretching routines while sitting.


I was never able to get used to one of those split ergonomic keyboards. Old habits are hard to die. To compensate, you can type at a more extened angle than your regular one.

Abdu

jentel@hotmail.com (Abdu)
Tuesday, September 21, 2004 8:11:03 PM UTC
John Ousterhout (creator of TCL) has had similar problems for many years. He discusses them at http://home.pacbell.net/ouster/wrist.html. He has used Dragon Naturally Speaking since 1999, and also recommends biofeedback training.

Peter
Peter Hornby
Tuesday, September 21, 2004 8:29:52 PM UTC
A friend of mine has used voice rec almost exclusively for years after doing way too much damage to his hands by playing console games too much(!). He finds the voice rec stuff to be very effective.

I sometimes get wrist / finger pain if I spend too much time typing on my laptop but I don't find it as bad on my current laptop (PowerBook) as I did on my previous three laptops (Toshiba, Dell, Fujitsu). Keyboard (and mouse!) ergonomics are very important, clearly.
Tuesday, September 21, 2004 8:41:39 PM UTC
Scott,

Sorry to hear about the pain your body is currently experiencing.

I had pain in my hands and back and made a few small changes that have really helped.

1. Began using mini optical mouse. (Bought in 2003 at MS conference in Dallas, where I attended your Web Services session...any miniature mouse should do ;)

2. Began taking Chondroitin and Glucosamine supplement. (Over the counter from Target - It's meant for arthritis (which I don't have) but my doctor recommended it to me and it has helped...like a joint/cartiledge vitamin)

3. Changed my posture when sitting.

4. Exercise. Not sure what it does for the hands, but my back and hands feel better and so does the rest of me!

Hope this helps



James
Tuesday, September 21, 2004 8:45:00 PM UTC
My wrists never got as bad as yours but all those hours playing Doom started the deterioration that continued when I started working as a programmer. Microsoft's split keyboard seems to work fine for me - it was the mouse that was causing most of the problem.

I solved my mouse problem by switching to the Anir Ergonomic Pro. It's a mouse that looks more like a joystick. It keeps my wrist mostly vertical while I use it. They were bought out by 3M a while back and it's now packaged as the 3M Renaissance Mouse (http://cms.3m.com/cms/GB/en/0-170/ckceiFQ/view.jhtml). They're really great - I own 3 of them. The biggest disadvantage is that they don't have a scroll wheel.

My wrists don't suffer pain anymore - now my ego suffers from scroll wheel envy. I'll take ego pain over wrist pain any day.
Steve Hiner
Tuesday, September 21, 2004 8:50:59 PM UTC
Funny. Don't listen to James. I'm sitting right across from him and he is full of it. Totally. He is sitting at a 45 degree angle, all slouched over the table and keyboard. He keeps telling me the same line that I need to work out. Uh huh, James.
Clint
Tuesday, September 21, 2004 9:08:20 PM UTC
Clint DOES need to exercise. His body is atrophying at a quick rate and his doctor keeps prescribing blood pressure medicine. We went for lunch the other day and he ordered a cheeseburger and said, "The blood pressure pills the doctor gave me cancels this out."

Anyway, Clint, this is not a forum to post such things. Go back to rathergate.com

Scott, my back was starting to get whack...exercise and posture has helped me out. (yes, when seated i kinda hit a 45 degree but it takes all the pressure off of my lower back)

James
Wednesday, September 22, 2004 1:08:38 AM UTC
"Jeff - would I get better quality with a traditional Mic+1/8" connector, and an external USB Sound Card?"

Not really; the quality of the microphone itself is the overwhelming factor here. Be sure to get a nice voice-specific one.

"I'm looking into a tablet pc largely because it's a different type of motion when writing. I'm hoping to do emails and blog posts using a tablet."

I think there's some great advice presented above. Vary your working position and get regular exercise. Now if only I could follow my own advice..
Wednesday, September 22, 2004 4:32:36 AM UTC
Hi Scott. I have experienced pain in both my left and right arms to hands. Numbness and pain comes and goes and at times it gets so bad I can't even work. This stared 3 years ago and recently I spent 6 weeks at home. I have seen many PT's and my neighbor is a Chiropractor/Message therapists. I have had 3 MRIs and one CT Scan on my neck. I have bone spurs that cause the pain. Although you may or may not have issues in your neck causing the problems, I wouldn't rule it out. Recently I have been seeing a new PT that a cooworker swore by. At first I dismissed it because I was set on the surgery and getting better. But then I started to have doubts about the surgery. So I went ahead and scheduled a visit. It was very enlightinging. He taught me things about muscle relaxation, balance and movement that allowed me to reduce my pain. I continue to see him every week to every other week. This is not because he encourages it but rather I seem to learn something new each time. I am essentially modifing my behavior when it comes to movement and posture. Because you also live in Portland you can visit him. If you want a phone number contact me via email.
Although I have improved enough to work again, after interviewing many surgeons, I will have the bone spurs removed this Novemeber. I just can't stand only being in front of my lap top 8 hours a day. But by all means I will continue to see the PT specialist because It helps my whole body.
Oh ya, walk about 4 miles a day. It helps a lot.
Monday, September 27, 2004 12:13:56 AM UTC
Deluxe Wrist Stabilizer, from Futuro. Strongly recommended. They cost about $20 each and last about 3 months before it's time to get a new pair. I would also watch out for writing huge amounts of text. I would stay with the voice rec for natural language text and IM, and use the keyboard for code (using loads of templates/code snips to ensure that you're pressing fewer keystrokes during the day). About six years ago I did extensive research into Voice Recognition to write code, and had excellent results with context-aware voice recognition. The key to making it work is having good context (understanding what commands make sense and dynamically altering the command list as context changes, which reduces the number of commands the voice rec software has to find a match from). You also need good navigation and code selection commands unless you permit use of the mouse.
Mark Miller
Monday, September 27, 2004 3:33:19 PM UTC
I agree with the post that narrows (most) pain down to using the mouse. I do everything I can to avoid the mouse. For running commands / opening applications I use a utility I can always call up with the keyboard (http://www.bayden.com/SlickRun).

More importantly, do those hand/wrist exercises that help prevent carpal tunnel. This invloves changing (potentially) your work habits. If you're like me you don't waste any time, so when some computer operation takes some time (like a download), my inclination is to immediately switch to some other task. Start using those times to take a brief time out for some hand exercises (and work a squeezy ball - absolutely necessary).
Brad
Monday, September 27, 2004 3:50:28 PM UTC
I had carpel tunnel before. It heals, albeit slowly. But you have to allow it to heal. If you don't it can cause permanent damage.

1st - do not pound on the keyboard. You only need touch it enough to echo the characters to the screen. Buying different keyboards won't do squat.
2nd - I've had pain from the mouse before. Do not use a trackball -- they make matters worse. Rest your hand comfortably on the mouse and don't stay tensed up. Try the MX 510 Logitech mouse.
3rd - exercise with weights.
Steve
Wednesday, September 29, 2004 9:42:43 AM UTC
A good friend of mine that was a C++ programmer started complaining that this hands hurt while typing on the keyboard.

He was diagnosed with having RSI (Repetitive Strain Injury) (I'm not sure exactly sure what the details were) which has something to do with your muscles overworking.

He's left the IT industry and is now an english teacher.
Sunday, October 03, 2004 9:55:33 PM UTC
Have you looked into whether there are small improvements that you can make to your typing technique? Although you may be very fast, you may be able to make small changes that minimize finger travel and reduce the strain on your hands. For example, although I'm a good typist, technique wise (7th grade typing class - best class I ever took) I still have a few bad habits - e.g. using the same hand for chorded combinations (left hand keying both shift and 1 for !), which can put the fingers in tweaky positions.

Also, if you're not using keyword expansion tools such as QuickCode, they're worth a look (at least until VS2005 comes out).
Tuesday, December 28, 2004 11:59:27 PM UTC
I've put up a Speech Recognition resource wiki at
http://speech.squidnet.com

Friday, January 07, 2005 8:13:55 PM UTC
"Real" ergonomic keyboards (follow the links for pictures, and don't confuse with so-called ergonomic keyboards from Microsoft etc) may help. See http://www.maltron.com/ and http://c2.com/cgi/wiki?KinesisKeyboard
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Disclaimer: The opinions expressed herein are my own personal opinions and do not represent my employer's view in any way.