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RSI Symptoms and Treatment
Guy's Battle with Repetitive Strain Injury

RSI Symptoms and Treatment - Guy's Battle with Repetitive Strain Injury

Guy's RSI - Introduction

Recently I was crippled by a severe attack of RSI (Repetitive Strain Injury); fortunately, my story has a happy ending.  Indeed, this article is the proof of my recovery and now I wanted to share with you my solutions to this computing affliction.  What happened was pressure of work forced me to spend more and more time bashing the keyboard and clicking the mouse; the result was ever increased pain in my fingers and wrists.

Other names for my RSI problem include, CTD (Cumulative Trauma Disorder), OOS (Occupational Overuse Syndrome) and WRULD (Work Related Upper Limb Disorder).

Guy's RSI Symptoms

When I tried to match my symptoms to those described in the literature it struck me that there are many variations of RSI symptoms.  It is likely that there are at least three levels of the condition, mildly irritating, painfully debilitating and completely crippling.  What precipitated my search for a solution was when the pain in my hands moved from irritating to painful.  Another piece of the symptom jigsaw is that there are at least 4 places which maybe affected wrist, fingers, elbow and shoulder.  In my case of RSI, the pain was mainly associated with the wrists and fingers, curiously, my thumbs were not affected.  To complete the picture of RSI symptoms, the pain ricochets around, as I cured my wrist and finger pain, so a new pain developed in my elbows.

My research also indicated that RSI symptoms can be classified as localised or diffuse.  I did not fully understand the difference, but it seemed that localised meant specific and identifiable injury, for example Carpal Tunnel Syndrome; whereas in the case diffuse RSI, the pain is more widespread.  My symptoms lean towards the diffuse version RSI.

Specific RSI Related conditions

Carpal Tunnel Syndrome
Carpal Tunnel Syndrome occurs in the wrist, where friction on the nerve passing through the wrist carpals causes inflammation.

Tenosynovitis
Tenosynovitis applies to both the wrist and the fingers.  It is caused by soreness of the tendon and its associated sheath.

Tendonitus
Tendonitus is swelling of the soft tissue around joints.  In the case of RSI, these would be the finger joints or the elbow.  However, the condition can occur in other joints, for example the knee.

What ever combination of the above conditions I was suffering from, the upshot was the pain in my wrists caused me to stop computing.  The sensation I experienced was that my wrists were hot and tender.  Also my fingers were stiff, claw-like and painful to bend.  I also felt a tingling sensation especially in the little fingers. What most difficult to describe was a general numbness over the back of my hands.  Sometimes, this numb pain extended from the wrist to the elbow.  Last, and in my case, least, my back and shoulder blades ached, but that pain was bearable.

Cause of my RSI - Too Much Typing and Mouse Work

The cause of my RSI could not be clearer, 8, 10 maybe 12 hours at the keyboard / mouse.  In 1984 I learnt to touch type, therefore on a standard computer keyboard, I use all my fingers on the recommended keys.  I would say that judged by professional standards my speed is moderate.

I have lived with a certain amount of RSI mouse related discomfort for about ten years, but in August 2006 it gradually got worse.  The final straw was a callus on my wrist caused by 'cleaning' 50 pages of html.  Foolishly, I kept on at the same operation of arranging the meta tags for three days.  Three factors alleviated this immediate problem, rest, switching to other computer tasks and a fancy new mouse mat with a built-in gel wrist support.   This mouse-pad unit is really soft, supportive and very comfy and while it reduced my callus, it did not cure my mouse RSI.

RSI Treatment with Physiotherapy

The secret of treating your RSI symptoms is to speak with a chartered Physiotherapist (or Physio for short).  In my case it was the third time that a Physiotherapist had, over the phone, diagnosed the root cause of the problem and come up with a cure.

It seems to me that the number one skill of a Physio is common sense.  This is not just ordinary common sense, it's a talent.  Let me explain further, in the way that some people have green fingers, Physios have a knack, even a gift, for treating physical problems.  Perhaps it's literally their hands on approach that makes Physios so perceptive and effective at treating all manner of ailments.  Physios have the same knowledge of anatomy and Physiology as doctors, but whereas doctors reach for the prescription or the knife, Physios look for a more thoughtful and a more hands on solution to any physical injury. 

As an example of their pure medical skill, on three separate occasions, over a 25 year period, Physios have diagnosed my medical problem over the phone.  These were three different serious conditions that baffled doctors, in addition, on each occasion the Physio came up with a solution, I say again these diagnosises were all by way of a phone call.

I would like to emphasise that you should only deal with chartered Physios.  Avoid quacks who don't have the requisite medical knowledge, such charlatans may use cheap tricks to impress you by clicking a few bones, but trust me, their medical ignorance will cripple you eventually.  Only deal with a chartered Physiotherapist they have the necessary medical training, which gives them deep understanding of physical problems and their effective treatments.

My problem was obvious; I was working too long at the computer keyboard and mouse without a break.  Both my short term and my long term strategies to overcome RSI were not effective.  Namely, half an hour break when the pain became too much, or a 3 day holiday doing no computing, then back to work did not cure my mouse RSI.

In Worcestershire, England, there is a free Physiotherapy Telephone service, which helped with my RSI symptoms.  My Physio was called Jan Myers.  I applaud this telephone initiative and wish it would extend both to other medical services and to become a worldwide service.

The Solution to my RSI Problem

The Physio diagnosed the need for short breaks from the keyboard, 30 seconds rest every 5 minutes.   However, this Micropause was no good without taking a longer break before the onset of the day's first RSI symptoms.  Thus I now also take a 10 minute breaks every half hour.

Judging by previous successes with Physiotherapy, I was looking for exercises to cure my painful fingers and wrists.  Here was where the Physio's skill coupled with common sense came to the fore; she explained that RSI is not a condition where exercises by themselves cure the problem.  Yes, exercises help.  However, I should realize that perhaps their best effect is distraction.  Stretching my fingers, wrists, neck and back, force me away from the keyboard and thus rest my aching joints and thus prevent the repetitive effect of RSI from kicking in.  As a result of the Physio's diagnosis, intellectually I knew what I must do, it was just a problem of will-power.

WorkPace Software - Your Personal Enforcer

The WorkPace piece of software is like the most demanding sergeant major, or the fiercest hospital matron that you have ever met.   The problem is that left to my own devices, I just keep on working harder and harder, time flies, I will ignore the need to take a break.  WorkPace cuts in and enforces a break by locking the keyboard and mouse.  There are two types of break, what WorkPace calls a Micropause; I set it for 30 seconds every 5 minutes, and a Break of 10 minutes every 30 minutes.  You can also set a daily limit, I chose 6 hrs.  As you would expect from software which is intelligent enough to monitor and lock your keyboard and mouse, the Micropause, Break and daily limits are configurable.

For me, neither Physiotherapy nor WorkPace software would have cured my RSI in isolation.  The synergy of clear direction, explanation and reassurance from the Physio, combined with enforcement from the WorkPace software is what cured the pain in my wrists and the numbness in my fingers.  Above all the program gave me belief that there was a way out of the despair induced by my RSI symptoms.  Thanks to WorkPace, I could see how to manage the physical and mental debilitating effects of RSI.  Get your free download and try WorkPace

Peter Suggests an Alternative Mouse Strategy

I have been using the standard computer mouse for many years.  Then I started to get RSI from long hours of using it.  Although I tried using the mouse with my left hand, after a while the same RSI problem recurred.

I thought about it and the answer was so simple.  I fixed the problem and cured the RSI in about 10 seconds. Now I can use the standard computer mouse with my right hand, 7 days a week for as many hours as I please No RSI.  It does not cost anything and you do not even have to replace the computer mouse with some fancy pointing device or gadget.

How?
Simply reverse the mouse so that the click buttons face you.
Grip the mouse button on the left with your thumb.
Grip the mouse button on the right with your middle finger.

Now that the left mouse button, which in reverse becomes the right-click button, falls conveniently under the first finger. So to move the onscreen cursor, bend your fingers or straighten your fingers. This will move the cursors up or down.

To move the cursor left to right first bend your thumb and straighten your middle finger. Then to move it the other ways simply straighten your thumb and bend your first finger.

You will find there is very little movement with the wrist, and practically none with the elbow and shoulder. So No RSI in that area.

Only one small problem all onscreen cursor movements are in reverse. So you have to give yourself time to get used to it. Once learned it is an asset for life. After learning this method I came up with, I suddenly thought maybe the rest of the world had got it wrong. Or the original teachers wanted us to get RSI!

Best regards

Peter

Footnote:
Guy says, I also published this letter to show that there must be all sorts of strategies, many won't suit you, but keep trying until you find the right one for your circumstances.

Guy's Pain Threshold

It is hard to gauge one's own pain threshold, however, from playing sport and seeing fellow players reaction to injury, I would say that my pain threshold is average or maybe slightly lower than average.  But did I show pain?  Of course not, opponents would sense weakness, team mates would just take the Mickey.

The relevance to RSI is that I spent time in denial, refusing to admit that anything was wrong.  I mention my reaction as it may offer insight into the widely held view that RSI sufferers are malingerers.  One benefit of having a low pain threshold is that this is nature's way of preventing the chronic or third level injuries that you read about in connection with RSI.

Anti-inflammatory Drugs
My doctor suggested that I take anti-inflammatory drugs.  I said no.  What I wanted was a solution not a temporary relief.  I expect there are cases when I will need anti-inflammatory drugs, but this was not one of them; as what I sought was a long term cure not a short term fix.  I then asked if the doctor could refer me to a chartered Physiotherapist, where upon they gave me a phone number of the Physiotherapy Telephone service.

Malingering and RSI

Malingering and RSI is a contentious issue.  I want to say that in my experience, what happens is RSI predisposes a person to become a malingerer.  It is not that you start out as a malingerer and then look to RSI as an excuse.  For employers this distinction is important.  What is frustrating, and the final insult, is that the fastest typists and the hardest workers, are the ones most likely to suffer from RSI symptoms.

What I had was the horrible feeling of frustration.  I wanted to work but couldn't because of the pain.  For a while, acting like a malingerer and avoiding work was my only recourse.  I took a complete rest for 3 days, but frustratingly this did not cure the problem.  After about an hour the fingers felt stiff as if they had not warmed up properly.

No wonder others look on people with RSI as work-shy.  Having RSI turns you into work avoidance mode, you really would like to compute but the pain won't let you.  As I mentioned earlier, because of the negative image of RSI I was in denial for a while.  Luckily I found salvation in Physiotherapy and WorkPace, who between them alleviated my RSI symptoms, remarkably, I was 'cured' in two days.

Working Smarter

A great man called Peter Morgan once taught me that you need an infirmity to bring out the best in a person.  He preached that many who had a crippling affliction found away to overcome their problems and only then became great people.  Peter's teaching came to mind when I wondered how to cope with my mouse RSI symptoms

My greatest challenge was adapting mentally to these micro 30 second breaks and to the 10 minutes away from the keyboard every 30 minutes.  At first I was so annoyed when WorkPace enforced a 10 minute break at an inconvenient time, that I considered turning off the machine at the mains and quickly restarting it.  You and I can see that this drastic action to get around the locked keyboard would be foolish on two counts, risking corrupting the operating system and risking abandoning the programme designed to reduce my RSI.  That instant when I accepted WorkPace's insistence that I must take a break, was the definitive moment in controlling my RSI.

Without WorkPace, I would not have broken out of the viscous cycle of Repetitive Strain Injury to my wrists and fingers. By the way, I had already postponed the 'Break' twice; WorkPace gives you this ability to defer a break if you are doing something crucial.  What was remarkable was that the effect on my RSI was so quick, after one day I felt better, after two days I was 'cured'.  Mind you to stay cured, I still have to take the breaks as dictated by WorkPace and my Physio.

Tactics from other Sports

What tactics can we learn from other activities and apply them to RSI?  When running marathons, it's too fast a pace that cripples you not the absolute distance.  So let us learn from marathon running, take the long view, set the correct pace for your typing and take breaks.

In cycling's Tour de France they have a rest-day half way through the race.  Do the cyclists rest up?  No.  Incredibly on this supposed rest-day they cycle a short 100km just to keep the legs supple and stop them seizing up.  On race days they cover 200-300km a day.  The message for RSI sufferers is that prolonged rest from typing then straight back in the saddle, sorry keyboard, is not the answer.  I can vouch for learning this RSI lesson the hard way.  It seemed so unfair that after 3 days of complete rest, within two hours of returning to the keyboard my hands hurt as much as ever.  Now, I take 30 second breaks every 5 minutes and 10 minute breaks every 30 minutes, the result is I am keep the RSI at bay.

Hidden Agenda

If I have a hidden agenda, then it's to do my bit and add to the power of the internet for mutual support.  Individuals can never compete with doctors for professional expertise, but people who have suffered injuries and recovered have insights that doctors may lack.  Also, we can come out and say how it was for us, what worked and what did not.  In this particular instance, I would like to give hope for those with RSI symptoms who want to recover without drugs or surgery.

RSI Update 10 days later - 27th August 2006

My hands feel good.  Each day they feel 'used', but not abused.  I do feel that I have the RSI under control. What I have done with the WorkPace settings is increase the Micropause to 6 minutes and to take 10 minute breaks after each 40 minute session.  It is these 10 minute breaks that are the secret to curing my RSI.  A hidden benefit is that as I work from home, I get other jobs done in these 10 minute breaks - jobs that needed doing, but I had been putting off or avoiding.

RSI Update 20 days later - 7th September 2006

Following a complete break for four days, I my fingers felt stiff when I returned to work.  Thank goodness for WorkPace, without it's enforced breaks I do believe that my old RSI symptoms would have returned.  More good news, my wife Pauline has decided to try WorkPace.  Her initial reaction of frustration at the enforced breaks reminded my of my early battles.  But as I said to Pauline, you soon get into the rhythm of taking both 30 second micro breaks and 10 minute breaks every 40 minutes.  In addition to treating the RSI symptoms, the breaks mean that we can do some of those jobs that otherwise get neglected.

RSI Update 50 days later - 5th October 2006

Research indicates that the average computer user spends 2hrs 30 minutes a day actually using the keyboard. My WorkPace tells me that I frequently spend over 6 hrs, yet with the enforced regular breaks, I now manage to stay pain free and productive. This is not to say that I don't suffer the occasional RSI twinge, but the difference is that I am confident that pacing myself rather than 'Ignoring' WorkPace's nagging messages, will alleviate the niggling pains.

RSI Update 100 days later December 2006

Something's never change, I still get annoyed every time WorkPace tells me to take a break.  One 'trick' that I have learnt is that if I ever have to leave the computer BEFORE a scheduled break, I find tasks to keep me away for the full 10 minutes, and this triggers a fresh ration of time when I get back to the keyboard.  On the downside, I often wake up with a pain in my fingers, with a little flexing it soon wears off.  Sometimes I experience a stiff thumb.  These two very minor complaints are likely idiosyncrasies caused by the way that I work.

RSI Update 2 years later - July 2008

I still use WorkPace.  Although my fingers still feel stiff some mornings, I am convinced that regular 10 minute breaks from the keyboard prevent the crippling effects that I experienced before I installed WorkPace.  I still configure WorkPace to enforce a 10 minute break every 40 minutes (sometimes I extend the interval to 50 minutes).

RSI Winter 2008/9

As the colder days of winter intensified I noticed that my RSI reappeared and seemed to be getting worse.  This was particularly noticeable in the mornings when my computer room was at its coolest.  Once I realized that it was cold hands that were the cause of my pain, then it was relatively simple to warm them by wearing fingerless gloves.

With the onset of spring the days became longer, my hands were no longer cold, and I have put away my gloves for another year.

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See what Guy is doing now - Funny Medical Jokes

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