My battle with RSI (Repetitive Strain Injury)

INTRODUCTION
As can doubtless be inferred from the title of this piece, I suffer from the pains and aches associated with the condition known as repetitive strain injury. These pains are mainly in my hands and forearms, but have at times extended up into my shoulders and neck. While the symptoms have lessened considerably over the past year and a half, I am by no means symptom-free.

During my battles with RSI, I often found help and hope by reading other people's experiences. As such, I decided to put to (virtual) paper my personal experience with RSI with the aim and that others may benefit. I also include some strategies for dealing with repetitive strain symptoms --- some I have tried, some I have not.

What caused RSI in my case? The main culprit was heavy computer use --- I was involved in the software industry for over a decade, and additionally spent lot of personal time during that period surfing the web and writing and publishing the humor website acidlogic.com. For many years, spending 12 to 14 hours a day in front of a computer was not at all unusual. Also, I'm an avid guitar player.

A SOBER WARNING
I presume many people reading this are experiencing some repetitive strain symptoms and wondering, "how seriously should I take this?" With no desire to cause alarm, my answer is, "very seriously." There's no getting around the fact that RSI completely upended my life, altering it in ways I never expected nor desired. However, I also think emotional stress and anxiety play a role in causing or exacerbating symptoms of RSI, so spending all your time worrying about it probably won't help, and may even hurt. The best advice I can offer is, "take it seriously, but try to keep living life." There are techniques and strategies that can significantly alleviate the symptoms, and, if computer use is the main concern, there are continuing advancements in the world of hands-free computer use that make RSI much easier to bear. (I've written an article on this topic here: How to Operate a Computer without Using Your Hands.)

MY STORY
I recall visiting a doctor around 2000 about pains in my right wrist. The pains were serious enough that the doctor checked to see if I had a marker for rheumatoid arthritis (I did not.) Around that time, I left my then current job as a web designer and had a couple months off. That brief respite seemed to be enough to cause the pains to go into remission. For the next five or six years I had few complaints.

In late 2006, I was noticing some aggravating pains in my right hand and forearm, clearly caused by using a mouse. I took a three-week vacation in January 2007, and was curious as to whether taking a break would cause the problem to go away. I had few pains during the vacation, but they basically came right back once I got back to work. They slowly progressed from there; in May of that year, I started using voice dictation for some of my work. At some point during that year I also did a bout of physical therapy, which was entirely ineffective.

In January 2008, there was a massive month-long work effort involving 15 hour days at the computer. I shifted mousing over to my left hand and rather quickly began noticing pains there. Even after the intense workload diminished, the aches and pains in both my hands continued to get worse. I recall May 2008 as the point where I had to cease any regular guitar playing (quitting all of the the music groups I was involved in.) Around that time I began a second bout of physical therapy. It was also largely ineffective, though I had some sense of gaining respite from the pain by lying on a big foam tube in such a way that it caused my neck muscles to relax. In hindsight, it's hard to say whether this respite was caused by the exercise or was just a valley in the peaks and valleys of aches and pains that are part of RSI. Regardless, it was not a long-term fix.

Within three or four months of starting my second round of physical therapy, I realized it wasn't helping and that the long drive to the therapist's office was aggravating my condition. I stopped going to physical therapy and, for the most part, stopped driving anywhere. I was still working, mainly using voice dictation to perform various tasks related to software documentation. Around this time, my chiropractor took an x-ray of my neck and noted that the curve of my neck was causing two of my neck vertebrae to be slightly compressed. I began to consider that the problem was not the arms themselves, but the nerves coming out of the brain going to the hands (the brachial nerve.) This "nerves as the culprit" hypothesis took on added weight when I started to get a sense of mild numbness and denervation in my hands. For several days, I tried an experiment of keeping my chin tucked in and basically walking around like a robot, theoretically opening up that space in the vertebrae. (Warning: I'm not advocating doing this, though I suffered no ill effects.) It actually seemed to help, but it was an impossible position to stay in.

In the final months of 2008, I started seeing a new physical therapist, one that I could bus to. While none of her techniques helped much, she was, I feel, the first physical therapist to be honest with me, and admit that this was a difficult problem with no definite answers. Oddly, that was actually encouraging.

In January of 2009, my story took a very bizarre turn. The day after I'd gone in for a blood test, I woke up feeling extremely dizzy and lethargic. The symptoms lasted for months (over a year and a half really.) I saw many doctors and neurologists, some who --- observing the combined symptoms of pain, denervation, unbalance and mental fatigue --- became concerned that I was experiencing the onset of multiple sclerosis, a disease often associated with those symptoms. Ultimately, the dizziness/fatigue symptoms were diagnosed as a viral attack on the vestibular system in my inner ear (similar to a condition often called labyrinthitis.) I'll probably write another article about that nightmare, but suffice to say those symptoms were unrelated to my RSI.

For most of 2009, because of the combined problems, I was unable to work full-time. In late 2009, I had to leave Los Angeles, where I had been living for seven years, and move in with my dad in San Diego. At this point, the RSI symptoms had begun to recede, mainly because I just wasn't doing much with my arms. I was able to do some driving and guitar playing, and was continually working to improve the hands-free system I used to operate the computer.

I was, however, out of ideas. Physical therapy had been a complete failure. Various techniques like hot and cold arm baths, traditional massage and stretching offered some relief, but nothing long-term. However, soon after my move to San Diego, my mom sent me an e-mail that pointed me towards two possibilities. One was a particular kind of massage called trigger point therapy, the other was a kinesthetic discipline called Feldenkrais. I started getting trigger point massages and attending Feldenkrais classes. The trigger point definitely helped; I would say it was really the key to turning things around. I'm less confident about the Feldenkrais, but I find it interesting, and a number of people suffering from RSI give it credit for changing their lives. (The dilemma hinted at here --- not knowing what is working and what isn't --- is one of the more frustrating aspects of dealing with repetitive strain injury.)

That leads up to my situation today. There's been a steady decrease in the RSI aches and pains though I still have flareups (I'm in one now due to increased guitar playing.) However, I have some techniques in my arsenal for combating the pain. In my good periods, I can drive and play guitar almost without restriction. However, even in the best of times, the use of my hands for manipulating a computer is very limited.

RSI TREATMENTS
Throughout the duration of my experience with RSI, I've read up on a number of treatments for the symptoms. Sometimes I feel like the more I research, the less I know. Soft muscle tissue damage is difficult to see with diagnostic tools such as MRIs or x-rays, so much of the theorizing about the causes of RSI is difficult to confirm. Some people put the blame on tiny balls of inflamed muscle (e.g. trigger points) some people put the blame on emotional stress, some people put the blame on micro tears of muscle fiber. My suspicion is that each explanation has some truth to it.

Below, I list some treatments available for RSI, first noting treatments I have tried (ordered from most helpful to least) followed by treatments I have heard about but not tried. (Note, several of the authors in the Resources section below have their own lists of treatments, and I recommend browsing through them as well.)

Treatments I have tried

Trigger Point Therapy
Trigger point therapy is a particular type of massage which targets tiny concentrations of dense muscle fiber called, you guessed it, "trigger points." Part of the premise is that these trigger points can cause referred pain. For example, a trigger point in your back can cause pain in your shoulder. Thus, by massaging the trigger point in the back and releasing its tension, the shoulder pain disappears. I, frankly, make no claims for the validity of this, I only know that it has helped me quite a bit in regards to RSI.

Obviously the ideal solution is to find a trigger point therapist in your area. However, I also find self massage using the concepts behind trigger point therapy to also be useful. Most of the self massage I do is based upon reading the book "The Trigger Point Therapy Workbook" by Clair Davies. I've also read some materials by Bonnie Pruden.

Various conversations have led me to believe that trigger point massage is similar to acupressure and deep tissue massage, so you may get some benefits from them as well.

Stretching
On one hand, the benefits of stretching our hard to ignore. When you're suffering from RSI symptoms, after you stretch you definitely feel better. But stretching doesn't seem to be much of a long-term solution e.g. I haven't eradicated RSI merely by stretching. Knowing which stretches to use can also be a challenge. I find my stretching regimen is always evolving --- some stretches work great for a while, then seemed to lose their effectiveness, so I discard them and try new stretches. Bookstores are loaded with books on stretches targeted for particular parts of the body, and the web has tons of material as well. If you're seeing a physical therapist, they can doubtless provide you some guidance.

Ergonomics/Voice Dictation
Quite a number of people put the lion's share of the blame for RSI on bad ergonomics e.g. a poorly designed work environment, computer monitor set too high or low, keyboard and mouse placed in a position that's stressful to reach. While I'm sure there's something to this, I followed some of the basic rules of ergonomics for years before getting RSI. I once videotaped myself working and showed it to my physical therapist at the time, and she thought it looked pretty healthy. Personally, I think you can have the most ergonomically correct setup in the world, but if you're working excessively (for your body), it's going to take its toll. That said, anyone with RSI brought on through computer use would be well served to do some research on correct workspace design, chairs, ergonomic keyboards, mice etc. I recall reading about one person who greatly alleviated their RSI by switching to using a Wacom tablet instead of a mouse.

I'm a great proponent of using voice dictation to operate a computer. However, like everything, it's got its pluses and minuses. I discuss voice dictation and various workplace ergonomic tools over at my article How to Use a Computer without Using Your Hands.

Hot/Cold Baths
The idea here is to submerge your RSI afflicted body parts in the icy cold water, then switch to very hot water, then back to icy cold, and back to hot etc. I've seen different recommendations for the length of time you should keep your limbs underwater (usually the recommended time is somewhere between 1 to 10 minutes.) I usually do about three minutes each, starting with cold and ending with cold, going back and forth about four times. It's a little hit or miss --- sometimes it doesn't do anything, on rare occasions it seems to make the symptoms worse --- but I feel like the technique has a pretty good track record. I also find that just running my hands under hot water can provide some temporary relief. (I'm not sure anything really therapeutic is happening in that case; I suspect you're just overloading your brain's sensory "circuits.") If your pain is in a body part that's hard to submerge --- your shoulder for example --- hot and cold compresses may be the answer.

Wrist braces
There's a certain amount of controversy surrounding the practice of wearing wrist braces that keep your hand in a low stress position. I gather that the main concern is that keeping your hand in one position limits the use of hand and arm muscles to such a degree that they start to atrophy. When I was in my most severe period of RSI I often woke up at night to find that my hands were asleep (in the "pins and needles" sense.) Wearing wrist braces at night (for more than a year) was the one thing that fixed that, and I still wear them during flareups. I know two people who seemed to significantly mitigate carpal tunnel type symptoms by wearing wrist braces all the time.

Acupuncture
Early on in my RSI travails I had a single acupuncture session. I wasn't impressed by it. Later, when I was struggling with both the RSI and the vestibular issues mentioned above, I did a series of about 10 sessions to see if it would help with any of those symptoms. Again, it didn't do much for me. That said, I have known several people who enthusiastically endorse acupuncture for dealing with recurring pain, so it's probably worth exploring.

Physical therapy
During the onset of my most severe battle with RSI (a period lasting around nine months) I was regularly seeing physical therapists. They would perform gentle (too gentle in my opinion) hand and arm massages, strengthening exercises and various therapies involving electricity or heat. To my mind, none of them were very helpful. (I can always wonder whether things would have been worse without these techniques, but they certainly didn't cure me.)

Chiropractic
Occasionally, I've seen chiropractic listed as a treatment for repetitive strain injuries of the hands, arms and shoulders. I've actually been seeing chiropractors for over 15 years to treat back pain. While it's been quite successful in treating back pain, it hasn't done much to mitigate the symptoms of RSI. I have found chiropractors to be much better at explaining the complexities of the human nervous system than doctors --- if only because they take the time to do it whereas doctors always seem to be rushing you out of their office. And I would imagine there are certain causes of repetitive strain like symptoms --- thoracic outlook syndrome comes to mind --- that chiropractors might be able to treat, or at least identify.

Doctors
I share the opinion of Micah (listed below in the Resources section) that doctors are basically worthless when it comes to treating RSI. They might tell you to wear a wrist brace, they might prescribe some largely ineffective physical therapy, and they might throw some drugs (probably anti-inflammatories) at you, but they seem unwilling to explore the various causes and treatments of what is an admittedly complex problem. (A Dr. Oz quote in a recent issue of TIME[1] may explain this: "All doctors learn rudimentary pain management in medical school, but few are trained fully or well at it.") My views on doctors might seem harsh, but I frame them this way only to make clear that if you're seeking treatment for RSI and find yourself getting no help from your general practitioner, don't give up and start exploring some other treatments.

1 "The End of Ouch?" TIME March 7, 2011

Treatments I haven't tried:

Yoga

I've known a number of personal acquaintances who've suffered from RSI or similar issues and recommended a specific type of yoga called Vinyasi yoga. This is on my to do list.

John Sarno/Tension Myositis Syndrome
Tension Myositis Syndrome is one of the more interesting (and controversial) theories about repetitive strain injuries (and other kinds of persistent pain.) Proposed by Dr. John Sarno, it posits that RSI pain is the brain's attempt to distract an individual from an overflow of emotional pain. (Sarno freely admits to being greatly influenced by Freud.) I've read two of his books and find that they resonate and are quite fascinating. And I've certainly noticed periods in my life where my RSI pain seems to dissipate even though I'm doing "everything wrong" (e.g. not getting enough sleep, overworking my hands, not stretching etc.) which could indicate a non-physiological component to my pain. I've mentally filed this under "For Continued Investigation."

Meditation/mindfulness etc.
I'm something of a cynic and many who know me would expect me to be skeptical of the various "mind over matter" style treatments for repetitive strain. Actually, I'm open to them. Based on what I've read about the neuroscience of pain, they seem sensible enough. I think there's clearly a connection between emotions and sensation (I base this primarily on reading Antonio Damasio's neuroscience tome "Descartes's Error" which fundamentally argues that emotion is sensation) and it seems reasonable to me that mental techniques that calm the human nervous system could help mitigate pain. I tend to be more dubious of some of the spiritual aspects of such disciplines, but overall I think they have plenty to offer. The only reason I haven't more thoroughly investigated them is laziness, and I hope to take a closer look in the coming year. If you want to explore these pursuits, try googling words such as "meditation," "mindfulness," "Mindsight," "Open Focus," and "EFT (emotional freedom technique.)" Also follow the related discussions at sorehand.org (listed below in the Resources section.)

Active release therapy
This is a technique I discovered while trolling around YouTube looking at videos related RSI. I know nothing about it, but list it here as a possible resource.

RESOURCES