Date:         Wed, 1 Jun 1994 18:30:53 -0800
From:         "Gary L. Karp" <Gary_L._Karp@faludi.com>
Subject:      Wrist Support
To:           Multiple recipients of list SOREHAND <SOREHAND%UCSFVM.BITNET@CMSA
	      .BERKELEY.EDU>
Organization: Faludi Computing, San Francisco
X-To: SOREHAND@UCSFVM.UCSF.EDU


Since there has been a recent thread about wrist splints, I thought this would
be a good time to share my current sense of the topic.

First a dire warning not to become dependent on them.  Although they provide
relief for many people, it is a severe mistake to wear them all the time.
Muscles atrophy and tighten when not used, as do tendons.  In the process of
trying to heal and rest, one can exacerbate the situation by weakening the
very tissues that need to recover.  These tissues NEED some degree of use and
movement, and normal, unloaded movements on occasion are highly unlikely to
aggravate your injury.

Others would suggest that the very nerve pathways become silent and the brain
loses its connection to some degree.

Next, NEVER, NEVER, NEVER, choose a splint yourself off the shelf or out of a
catalog.  There are a million of them out there, and the differences in
design are for a reason.  Some restrict the thumb more than others.  The
angle of the wrist is critical, depending on whether your injury involves
flexion or extension.  Some are more breathable than others, so may be
intended only for very short periods of wearing.  Some extend farther into
the forearm than the others, rigidly fixing the wrist, while others allow a
limited range of movement.  All of these issues must be taken into account on
advice of a trusted treatment provider.

It is also a concern that in the process of restricting the wrist, pressure
points and undue musculotendonous strain can be caused at the inevitable
moments when the wrist tries to move and is stopped by the brace.  It is also
possible, of course, that a brace may be put on too tight, restricting
circulation.

They are generally considered of value at the most acute stage of injury.
They also are helpful for people who tend to bend the wrists while they
sleep.

I subscribe to the idea that the forces which bear on the hand during
computing are played out through the movement of all of our joints - the
fingers, wrist, elbow and shoulder.  When any one of them is held fast, the
actual physical forces redistribute to the other areas, giving them more than
their share.  This is why I hesitate to recommend articulating elbow support
for everyone, and why you should spend part of your time with your wrist on a
support when typing to relieve static load on the extensors, and part of the
time with the wrists elevated so the whole arm can move.  (All of this
assuming, of course, that the keyboard is at the right height and in front of
you.)  The conclusion that follows is, restricting the wrist adds strain to
the elbow and shoulder.

Braces have taken on the status of the iconic symbol of repetitive strain.
This is very unfortunate.  They are not a catch all, and the dangers of
misuse are very real.

Gary Karp
Onsight Technology Education Services
San Francisco
gary_karp@faludi.com