Motion Based Ergonomics
Keyboard Retraining II - "Mousing"

  Reprinted from The RSI Network - Issue 41 - September'99

Norman J. Kahan, MD
(408) 725-7277, Fax: (408) 725-2625

Vivienne Griffin

In recent years, the mouse has become an integral tool for most computer programs as well as for working “on line”. Unfortunately, as computer users have become more dependent on mouse input devices, the number of repetitive strain injuries (RSI) related to the mouse has been on the rise. Most of these injuries can be traced back to both faulty movements and awkward postures when using the mouse. Typical trouble spots include the wrist, forearm, elbow, shoulder, and neck, resulting in pain, impairment, and even disability.

To complicate matters, the number of  “mice” now include many options, including traditional a two or three button mouse, (mechanical or optical) trackball, mouse pen, joy stick, touch pad and glide point. There are even foot and head mice. The following pitfalls and guidelines apply to whichever mouse you choose to use. Remember, gadgets alone won’t prevent the development of RSI, but learning how to use them properly can.

Most Common Risk Factors Associated with the Mouse

1.   Poor placement of the mouse—i.e., too high, low, or far from easy reach:
The placement of your mouse is the most important aspect of mouse use! Bringing the mouse as close as possible to the body minimizes strain to the shoulder, elbow and wrist.


  Use a keyboard tray with sufficient space for both your keyboard and mouse. Never place your keyboard on your mouse tray while your mouse sits on a desk surface that is higher than the keyboard and far from reach.

  Try using a keyboard tray which wraps around, allowing the mouse to sit closer to the body.

  Try using a mouse bridge, a platform that sits over the number pad of your keyboard. This dramatically minimizes the need to reach for the mouse.

  Investigate a split keyboard or mini touch keyboard which does not have the numerical pad attached. This will shorten your keyboard by approximately three inches, therefore reducing your reach.

2.   Grip force (aka "choking"):
How tightly do you grip your mouse? Do your hands or forearms tire after using the mouse for a prolonged period of time?


  Bring the mouse as close to your body as possible.

  Lightly rest your hand and fingers on the mouse. The weight of your hand is more than enough to maneuver a mechanical mouse. If you are using a joystick or mouse pen, soften your muscles and keep your wrists loose.

  Check to see if your pinky, thumb, or middle finger is tense. If so, relax them.

3.   Initiating motions at the wrist—ulnar and radial deviation:


  Bring the mouse as close to your body as possible.

  Rather than move the mouse only from the wrist, allow your forearm, wrist, and hand to move together. Your fingers, wrist and hand should feel loose and fluid.

  Make sure you have enough cord to allow for full range of motion.

4.   High "clicking" finger:


  Look down at your hand when you mouse. Do you see either the index or middle finger raised up?  If so, settle them on the mouse. The mouse buttons are more resistant than you think.

  There is no reason to ever leave the surface of the click button. The travel is small and requires minimum effort.

5.   "Clicking and dragging":
Several mouse functions require you to click and drag, which can put undue strain on your body.


  Try using a mouse input device that has a click-lock feature. This will eliminate the need to click and drag.

  When highlighting text, pulling down menu bars, or scrolling, use key commands instead.

Commonly Used Mousing Key Commands

Many tasks that you currently do with the mouse can easily be done using key commands instead. You may elect to alternate between key commands and mouse use, or over the next few weeks learn and use key commands on a consistent basis. Key commands are easy to learn and are a lot easier on the body.

1.   Cursors—to move the cursor around the screen, the following keys are available:

  Arrow Keys (up, down, up & down)

  Page Up / Down (moves cursor half a screen up or down)

  Home / End (moves cursor to beginning or end of a line)

  Ctrl + Right or Left Arrow Keys (allows the cursor to skip words)

2.   Selecting Text—to select or highlight text:

  Hold down the shift key and use the Arrow, Page Up/Down, or Home/End keys.

3.   Editing—to cut, copy, and paste, select your text and use the following key combinations:

  Ctrl + X = Cut

  Ctrl + C = Copy

  Ctrl + V = Paste

  Ctrl + B = Bold

  Ctrl + I = Italics

  Ctrl + U = Underline

4.   Open Menus—to go into a menu and select a task:

  Under each menu option you will find a letter in each word that is underscored, i.e., File or Edit.

  ALT + Underscored letter opens file.

  ALT + F = File,  ALT + E = Edit etc.

  Once you are in the menu, you will see more letters underscored. Simply strike the desired letter. There is no need to hit the ALT key once you are in the menu.

  If you are in a dialogue box, then ALT + Letter has to be used. The TAB key gets you from field to field. Enter will activate the OK or Cancel Button.

5.   Printing Documents

  Ctrl + P = Print

6.   Minimize Programs

  ALT + Space Bar + N = Minimize

7.   Toggling—to go between different programs that are already open:

  ALT + TAB (holding down the ALT button)

8.   Navigating on the Web

  Use Arrows or Page Up / Down to scroll

  ALT + Right Arrow = Page Forward

  ALT + Left Arrow = Page Back

About the Authors:
Norman J. Kahan, MD, a physiatrist (specialist in physical medicine and rehabilitation), and Vivienne Griffin, a concert pianist, have developed the Motion Based Ergonomics™ (MBE™) Keyboard Retraining Program, an innovative and effective program designed to address RSI problems associated with improper use of the computer keyboard and mouse. To date, this retraining program has helped over 1,000 patients throughout Silicon Valley [Santa Clara County, California, U.S.—Ed.].

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Last Updated: 08/30/01