Go With the Flow : The unnatural way you move your body may be causing you pain. Think of the hand, fingers and arm as one.

Nina Scolnik’s hands move with grace and precision across the grand piano keyboard in her living room. Then she abandons Chopin and slides off the piano bench to settle onto a chair at her dining table, where a computer keyboard awaits.

There she types as if she were playing an etude, then stops to explain the connection she sees:

Whether you’re a butcher, court stenographer, landscaper, concert pianist or computer operator, if you want to cure aching fingers, hands, arms and back, you needn’t resort to splints, wrist rests, stretching exercises or surgery.

Just learn the basic, natural movements that successful pianists have relied on for centuries, she says.

The problem is not with the computer, the cash register or the meat cleaver, says Scolnik, 41, a piano faculty member at UC Irvine. “The problem is with the way people move. The finger, the hand, the arm must move as a unit.”

And that’s the basic idea emanating from a Brooklyn woman who has taught piano for 50 years. During that time, Dorothy Taubman has spawned thousands of disciples of the Taubman method, known largely within the U.S. piano community.

“Blaming the instrument,” says Taubman, 76, “is like saying that writer’s cramp is caused by the pencil.” Or the computer.

Now, Taubman and her colleagues, including Scolnik, are launching a nationwide business to transfer what they know to the broader realm of non-musicians who suffer from repetitive stress injury, or RSI.

Aimed at teaching people how to use computers with techniques previously reserved for musical instruments, the company offers workshops to retrain injured workers and to train those who want to prevent injuries.

As the RSI problem has mushroomed to afflict everyone from secretaries to executives with hurting muscles, tendons and nerves, Taubman and her associates have been approached on occasion by businesses wanting to see if the technique could help. But only recently has the Taubman Institute decided to focus on it.

“There are so many people out there in trouble (who) can’t get help, and this little lady has figured it all out--what the medical profession has not figured out,” says Taubman Institute Executive Director Enid Stettner, who lives in Upstate New York.

To initially spread the word, Taubman is relying on two dozen faculty members who teach at her institute, held each summer at Amherst College in Massachusetts.

Key among them is Scolnik, the principal West Coast advocate of Taubman’s methods. Since the late 1970s, she has been associated with Taubman and has introduced many of her own students to the technique.

As the Taubman consulting firm starts up, one of Scolnik’s former UC Irvine piano students, Greg Dempster of Laguna Beach, has also begun what he bills as the first company “in the country to adapt this approach to the business community.”

From 1983 to early this year, Dempster studied with Scolnik, who introduced him to Taubman’s ideas. “At first I thought this was really snake oil, that this was from Mars,” says Dempster, 34, who completed his undergraduate and master’s work with Scolnik.

But soon Dempster, who had been injured from his earlier technique, became a believer. For six summers, he studied with Taubman at Amherst and was a teaching assistant at the institute.

As he was teaching one of his own students who worked as a computer operator, Dempster says, “It became obvious that this applied quite directly to computer people.”

Within the past few months, Dempster has put together a staff including other Taubman devotees and has already been offering seminars and making a pitch to intrigued representatives of Southern California companies.

At a recent seminar at the Irvine Hyatt Regency, he spoke to a small gathering, including representatives from Orange County businesses interested in this new tactic to combat RSI.

“Correct movement minimizes effort, fatigue,” he says. “If you are not moving correctly, there is a level of fatigue you are operating under.”

As an example, he cites the problem of hitting the keys too hard. “Anybody have an idea of the weight it takes to displace a computer key? It’s about a gram or gram and a half. Your forearm weighs about 15 pounds. So this is always a winning battle.”

At Dempster’s request, his seminar students stand with hands and arms by their sides. Then he outlines another of Taubman’s main ideas. “Notice how your hands hang. No two are alike. Everybody’s hand will look different on the keyboard.

“The natural profile of the wrist, at rest, at your side--that is more or less the profile it should have when it’s moving or performing work. Any time you distort that, so that any of the joint structure is out of the mid-range arc of motion, you develop problems.”

That means avoid curling your fingers, avoid twisting your hands into positions that would mimic actor Charlie Chaplin’s famous splayed feet antics and avoid stretching your fingers to reach unnaturally.

To trouble-shoot for these tendencies in his students, Dempster asks one of them, Michael F. McCrackin, Fluor Daniel’s safety manager at its Irvine facility, to sit before a computer keyboard. McCrackin begins to type.

Dempster spots a problem and coaches him to keep his hands in line with their natural curve.

Several years ago, McCrackin says, his company saw there was a problem with RSI--that typing on a computer is different from using a typewriter. “We started throwing things at the problem--wrist rests, articulated keyboard platforms. But we didn’t address how people were using the equipment.”

Ergonomic solutions have been insufficient, he says. And it’s not enough to tell someone to align the body properly, to keep the wrists relatively straight or to take frequent breaks. Many people, he says, must be completely retrained.

McCrackin expects 300 to 400 of the 2,500 employees of the Irvine-based international engineering firm to fall into the “high-risk” category--those needing retraining to cure and existing RSI problem or to prevent one.

“I’m pretty excited by this whole concept. I’m impressed by the level of detail,” he says. Even basic training, he says, would be beneficial. “You don’t need to know how a car works to learn to drive it, to get the proper instruction.”

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In some cases, Garry S. Brody, medical director of the Hand Rehabilitation Center at USC University Hospital, says: “Nothing else works. And you have to do surgery.”

However, he says much is still unknown about RSI. “We’re all struggling to know, No. 1, what’s really behind all this and, No. 2, how to prevent it and how to live with it.”

As far as the Taubman approach goes, he says until scientific studies are done to verify the anecdotal claims, skepticism is in order.

“I would say a couple of months of trial won’t do any harm. But if after a month or two you still have the problem, you’d better look for a more conventional treatment.”

Regardless, he adds: “Nobody ever died from a carpal tunnel problem. It’s not a crippling disease. The problem is the pain.”

To find what common ground might exist with medicine, music and the Taubman technique, an Oakland occupational health physician is starting a research project on injured pianists.

William A. Pereira, 45, is undertaking the work as part of degree studies at UC Berkeley’s School of Public Health. A pianist since age 7, he has studied with Scolnik and Taubman. While living in Orange County and working as a physician in the 1980s, he completed a bachelor’s in music with Scolnik at UC Irvine.

“I want to do something to get this information more available to the mainstream in the medical community,” he says.

“From what I know of physiology, the ideas (Taubman) is saying make complete sense. The motions involved in piano playing are often invisible. Dorothy’s genius was figuring them out and how they connect with muscles and movement. It was like analyzing a wave form, and she broke it all down.”

Preventing Repetitive Stress

The study of ergonomics--how people work--shows hand-arm alignment is at the center of keyboard repetitive stress injuries (RSI). Misalignment causes muscles to become overworked, causing stress and fatigue in the hands and arms. In retraining, piano and computer keyboard users learn how to move without causing the injuries.

Signs of RSI

Repetitive stress injuries can have a variety of symptoms including muscle fatigue and pain.

* Puffy skin surface: General sign of stressed or overworked muscle group that flexes fingers.

* Ganglions: Small cysts beneath skin form as result of stressed muscles that flex fingers and hand.

* Finger numbness: May be caused by inflammation of nerves in wrist when muscle that extends wrist rests on hard surfaces.

* Elbow swelling: Could indicate twisting and resulting stress of muscle that rotates wrist when arm is palm down.

* Wrist pain: Often caused by inflamed muscles constricting nerves.

* Forearm ache: Usually indicates inflamed biceps which contracts arm and moves hand side to side.

Top Causes of Injury

The most common poor keyboard postures cause the wrist joint to move beyond its range of motion, which leads to physical problems. The three most common incorrect keyboarding practices and their symptoms:

* Twisting: Long muscles in arms forced to stretch around the elbow, which stresses muscles in hands and arms.

* Symptoms: Elbow inflammation, throbbing in forearm, loss of dexterity of little and ring fingers.

* Over-curled fingers: Continuously flexed muscles that contract and extend wrist cause nerve compression in wrist.

* Symptoms: Pain in wrist or forearm; tingling or numbness in fingers.

* Dropped wrists: Tendons press against nerves in wrist area, weakening the thumb, index and ring fingers.

* Symptoms: Numbness, tingling in fingers at night; swelling of wrist and/or thumb joint.

Posture Perfect

Computer desks and keyboards can be equipped to ensure good posture and proper alignment.

* Arm at 90-degree angle

* Keyboard at elbow height

* Back straight

* Thighs, forearms parallel with floor

* Wrist straight

Ergonomic Equipment

* Padded wrist rests

* Cushioned keys

* Elbow rests

* Adjustable computer table

* Sliding keyboard holder

* Foot rest

Futuristic Typing

New keyboards are designed to encourage good typing posture. This one, for example, splits in half and has built-in padded wrist rests, encouraging a naturally relaxed position of fingers, hands and wrists.

Typing Test

Score your knowledge of good keyboard technique with these true-or-false questions:

1. Only the fingers should move.

2. Shoulders should be relaxed and dropped.

3. Keys must be pushed to bottom of stroke.

4. Wrists should rest on edge of table or on wrist pad.

* Answers

1. False: Entire arm should move and get involved in the process. The elbow should act as a stable hinge supporting the forearm.

2. False: Shoulders should be relaxed, but dropped shoulders cause the long tendons to hold the arm in place, stressing the elbows.

3. False: Keystroke is complete through the top two-thirds of the motion. Finger muscles should be at rest at the bottom.

4. False: Resting the wrist on table edge can cause nerve damage. Use pads as guides for proper alignment, not as pillows.