Why wrist pain occurs as a software engineer (from a physical therapist)
Hey all,
I’m a Physical Therapist! Over the past 8 years I’ve focused on helping desk workers, gamers, musicians, crafters not only resolve but find better ways to resolve their wrist pain (1HP). Over the years we've found that many of the gamers we've worked with are also software engineers (league of legends is the common game of choice for some reason...) who experience wrist & hand pain. Since then we've had many software engineers reach out to get some better guidance about how to address & prevent their wrist & hand issues.
Because of this I wanted to write this longer post to hopefully act as a good starting point for anyone that has wrist & hand problems
Think back to your last work sprint as a software engineer. Whether it be developing new features, debugging, hackathons, refactoring or responding to incidents, these all involve long sessions of typing and using your wrist & hands WITHOUT a break.
Add on suboptimal postures and ergonomics and what do you get?
Cumulative stress that can affect the muscles & tendons of your wrist & hand. This can lead to some pain and issues preventing you from being able to handle longer sessions. If not handled appropriately it can lead to your needing to take time off work and not being able to use your hands for other things like gaming, music, etc.
This thread will help you understand more about the lifestyle and physical demands of being a software engineer. And of course how to better think about approaching your behaviors & lifestyle so you can prevent the common issues we see.
TOO MUCH TOO QUICK TOO SOON.
This phrase describes the most common reason why repetitive strain injuries occur with programming, desk work and even gaming.
Too much typing within a short amount of time without having the endurance of the muscles at the wrist & hand to be able to handle it. The amount that you have to type when having to complete massive updates (for example Angular updates along with its material styling framework) is significantly higher than the actual capacity you can handle (muscular endurance)
Here are some of the situations our patients have described to us
- Updating web dev frameworks
- Debugging and problem solving sprints
- Hackathons
- Refactoring or technical debt management
- Emergency fixes
The underlying theme is: lots of typing and use of the wrist & hand without breaks that exceed the typical amount you perform on a regular basis. Here is a visual of this idea & concept along with some examples.
Individual 1:
Let’s say on average an engineer actively utilizes their hand 4-5 hours during a work-day. During this times the intensity of the typing vary depending on the task at hand. In the image above we’ll say that 4-5 hours is equivalent to around 700 “stress units”. This is a made up unit but represents stress on your tissues.
I’m not a programmer myself but I’m sure during certain tasks of the day you may be typing more (more actions per minute) than when you are responding to a message on slack.
This individual was fortunate in that his schedule only required him to increase the amount of hours he needed to type gradually with some 8-9 hour days but always a lower amount of typing on the second day. This engineer proactively looked for ways to reduce the amount of typing after a longer day to avoid excessive stress building up.
This gradual increase in load avoids irritating this individual’s tissue and reduces risk of developing injuries. But not everyone is so lucky in being able to gradually increase their physical load. This is the case with individual 2
Individual 2:
This individual also has an average of 4-5 hours a week however his projects were poorly managed which required him needing to spend 3 days in a row working between 9-11 hours a day. Due to the schedule and what was required from from his job, he was unable to rest or deload throughout this work sprint.
This significant increase in typing and work volume led to him irritating his wrist & hand and feeling pain. His schedule and the work sprints that are so common in the software engineering profession led to the development of an injury.
Now the schedule to a certain extent is out of your control since certain work sprints may pop up as a result of an emergency or feature that needs to be shipped more quickly. There are of course things you can do while you are working to reduce the amount of cumulative stress on your tissues like taking breaks and stretching after every hour.
But there is one thing you can do that you have direct control of which can allow you to handle these expected work sprints with far less risk of injury:
Endurance exercises.
That’s right. Exercises focused on endurance allow your tissues to handle more repeated stress without being irritated. Based on how you hold your mouse, posture & ergonomics you will be utilizing specific muscles of the wrist, hand and elbow.
Those are the muscles you need to focus on to build endurance. Here is the way we always help gamers understand this concept of capacity. Think of your muscles and tendons as having a healthbar.
Whenever you click or spam WASD with high APMs you are gradually losing HP
There are things you can do to modify how quickly you are losing HP like have better ergonomics (macros / binds), posture, better general wrist health, sleep etc. Poor overall grip can mean more HP lost per unit time of playing.
The reduction of stress per unit time with your previous ergonomic changes may have helped but because you haven't focused specifically on building endurance your muscles are beginning to fatigue.
When you get to 0 the muscles and tendons (most often tendons) get irritated.
On the flip side you can do things to "RESTORE" your hp like rest, ice, massage kinesiotape etc.
But the MOST important of all is the size of our health bar. This is our muscular endurance or how much our tissues can handle of repeated stresses over sessions.
Building endurance time however which means it is important if you are software engineer to recognize your PROFESSION requires you to have a less physically active lifestyle. If you maintain that lifestyle over many years without a focus on maintaining the conditioning of your wrist & hands (and generally your body), they can weaken over time.
This means if you don’t adopt some basic habits:
- Regular wrist & hand endurance training
- Taking breaks on a consistent basis for both your mental and physical health. You can go on a walk or perform stretches for the wrist & hand
- Optimizing your ergonomics to minimize stress during your actual work sessions
Your risk for injury can gradually increase. In most cases the physical demand of most software engineering jobs will stay constant.
It is really easy for us to understand this concept when we think about being a professional athlete or runner. These individuals have to train and prepare their bodies to tolerate the physical demands of their sport.
Sitting and typing at the computer does not seem like much physically. But when you zoom out you can see how it can potentially impact your body
- Sedentary Lifestyle: 8-10 hours of sitting or being sedentary. At least half of our waking time is spent in front of a computer and in many situations we spent even more hours on the PC or couch afterwards. So maybe 70-80% of our day is spent not moving. This can have alot of detrimental effects on our body.
- High Wrist & Hand Activity: Although the movements aren’t strenuous in nature, software engineers often spend a large amount of time performing small repetitive movements of the wrist & hand with typing and mouse clicking. How many APMs do some of you guys get to? (if you guys track that). This can lead to tissue irritation if our muscles & tissues aren’t ready to handle this type of repeated stress over time
This doesn’t take into account the other potential factors that can affect our health like sleep, nutrition & lack of light exposure.
I’m hoping the message is becoming more clear. It doesn’t matter what activity you perform. Whether it be gaming, playing music, typing on the keyboard, drawing… you have to have the physiology to be able to handle the physical demands over the years you are participating in that activity.
Now that this is clear, let’s actually highlight four steps you can take to adopt these habits into your lifestyle.
1. Schedule Management (Load Management)
Improving your schedule management can directly affect how much stress you are applying to the muscles of the wrist & hand. This means looking to integrate more breaks after deep working blocks (ultradian rhythm).
You can use this time to either take a short walk (helpful for both mood and.. find references) or perform stretches to help with stiffness that can often occur from repeated use.
2. Exercise
Endurance. Endurance. Endurance
Not Strength, but endurance. Those are different physical abilities our tissues have. Regularly perform wrist & hand exercises (dumbbell, rice bucket, etc.) to target the muscles you are using when typing and clicking to build up your endurance. Focus on higher overall repetitions with less weight. 3x20-30
Start slow and work up. Less during work sprints and more during lower work periods.
3. Build Better Work Habits
Incorporate breaks into your schedule. Set an alarm or rules or use apps to create reminders to get up and perform the stretches or go on a walk.
Focus on the other important aspects of better work health like cognitive deloads, appropriate nutrition and consistent sleep
4. Posture & Ergonomics
I’ve written about this in a bit more depth here but posture & ergonomics don’t play as large of a role as we think when it comes to preventing injuries. It may reduce the stress per unit time on the muscles and tendons but our tissue capacity is the most important thing that will help provide a buffer for injury
There are of course situations in which posture is a larger contributor but in our experience these are mainly associated with the shoulder.
I hope this was helpful for the community and please feel free to ask any questions! Here is a list of some helpful resources & common questions we’ve answered
Important Resources & Q&A:
- Why Rest, Medication & Injections aren’t the solution
- Do MRI, Ultrasound and other imaging results matter?
- How do posture & ergonomics contribute to hand issues? (will a vertical mouse help?)
- Tingling & Pain in your hands can come from the shoulder
- Why understanding more about pain can help you recover
- What’s the role of bracing with wrist pain (it doesn’t really help)
- It’s normal to feel more pain initially with exercises
P.S. It’s almost never carpal tunnel syndrome. I wrote about this in a megathread here