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Contents
Introduction and Purpose
My Story
What I Think I Had
What Helped Me
As you've probably gathered from the title of this page, I have gone through the problems associated with Repetitive Strain Injuries (RSI.) RSI basically refers to any injury associated with repetitive motions. In my case, my injuries were caused by typing. Not to kill the suspense, but I am doing okay now, approximately 2 years after my first symptoms. I even work as a full-time computer programmer.
There are many sites on the 'net which have plenty of information about RSI. Because of that and because I am not a doctor and have absolutely NO relevant training (besides attending the School of Hard Knocks (tm)) I am not trying to create a comprehensive RSI page. Rather, I simply wanted to present my story, because I find one person's story provides an informative view of a subject usually treated en masse. The facts on this page are of course the epitome of anecdotal evidence, which can be helpful in some ways, but misrepresentative of facts in general in other ways.
Mostly, however, I wanted people to see my story, because my RSI got pretty bad, and then much better. I wanted people to know that they probably will get better, because there were many times when I doubted I would.
Before I start, I think it's important to point out that the information you find from sufferers of RSI on the internet -- including this page -- is probably not fairly representative of RSI sufferers as a whole. If someone gets RSI and is quickly diagnosed and cured within a month, for instance, he or she is not going to spend the time to write a page like this or post to the numerous RSI bulletin boards and mailing lists. People who do make webpages and posts are probably disproportionately long-term sufferers. So don't be upset if you notice that everyone online who has RSI has it for a while -- it might not be true for you.
One day towards the end of summer '98, I was sitting at my summer job, feet propped up on a trash can, slouching as usual, typing my regular 65+ very loud wpm when, for the first time, I felt pain. Two pains really. Twin, matching tiny pains, one on each arm, on the underside, a couple of inches below the inside of the elbow. Curious, I stopped typing, and did other work for the last couple hours of the day.
Over the next few weeks, I noticed the pain wasn't really going away. I asked not to do data-entry work for the last couple weeks, and then my summer job was over. By the time I got back to school, I had stopped writing long emails to my friends, and pretty much stayed away from the computer as much as possible (for a computer science major!)
Although my arms didn't hurt too badly at rest, I developed a pattern: I wouldn't use the computer at all for a week or two, then have a 2 or 3 day marathon programming session to get my work done, after which I would rest for a couple of weeks again. In hindsight, BAD IDEA.
I saw my first doctor, a hand surgeon, Dr. 1, (whom I later went back to) at the beginning of that semester. I had pain, but no tingling or numbness at the time. He said that I didn't have carpal tunnel syndrome, but didn't really say what I did have. (He talked so fast and threw so much information at me that I was out of there before I could formulate coherent questions.) He told me to do some dumbbell exercises, nerve glides, and hot and cold soaks. I did the exercises, glides, and soaks, but I didn't really get much better.
Throughout that entire school year, I was functional, but certainly not comfortable. I accepted a full-time programming job for the summer, being perhaps overly optimistic. It actually started out okay. I had found that lower tables were much better for typing, so I spent a day at work finding one in a closet somewhere and putting it together. Also, straight programming wasn't as bad as regular typing because you typically have to stop and think every few lines (or at least I do.) By the end of the summer though, I was in more pain, and I had given up the dumbell exercises because I felt they were hurting more than they were helping.
I went back to my doctor, and he didn't really have any new ideas for me, except for telling me that lifting the dumbells couldn't be making me worse and that maybe I should consider carpal tunnel surgery. I was confused because I was pretty sure I didn't have carpal tunnel syndrome--I had pain up near the elbows but no tingling in the fingers or pain in the wrists. He even gave me the test for carpal tunnel syndrome, where you hold the backs of your hands together so your wrists are bent and see if it causes tingling. IT DIDN'T. But he said, "Well I bet if you held them like that long enough it would."
The next semester, my final semester, things became much worse. One week, I played 2 hours of basketball, three days in a row and carried a heavy bag around a career fair for a few hours, two days in a row. After that, my arms hurt much more, even at rest, and I started waking up a couple of times a week with tingling in my hands (for the first time!) I stopped typing all together, which made doing my classwork extremely difficult. I had to have friends type for me a little, I took all the graphics work on one team project since the mouse didn't hurt me as much, and somehow convinced one professor to let me do my final programming project by hand (which, if you're curious is NOT a reasonable way to do a computer project.)
At that point, I decided to go to a different doctor, an orthopedist, Dr. 2 whom I had (successfully) seen for running-related knee problems a few years earlier. He told me not to lift the weights, prescribed an anti-inflammatory, and sent me for a nerve-conduction test. He also gave me wrist braces to wear at night and a different exercise to do, twisting a paper towel tube. (I'd give directions but I don't think it did much good.) The nerve-conduction test came back slightly worse than it should be, so he said that I might want to consider surgery.
I tried everything he prescribed, but a few weeks later, I hadn't had any improvement. By this point, I was starting to believe that surgery might solve my problems, but there was still a part of my brain nagging me: "You don't HAVE carpal tunnel, your pain started higher, is still mostly higher, and the wrist braces don't help." So I went back to Dr. 2 and asked if I could try physical therapy. He said if it made me feel (psychologically) better to try it before surgery, then I could.
So Dr. 2 sent me off to physical therapy with kind of a general instruction to them. The therapists at this place were nice and they listened (which is nice after my 15 minute blitz sessions with Dr. 1) but they didn't seem to really know that much. However, they started me on some heating pads, serious stretching (See Stretching, the table stretch and preacher's stretch) and gave me ultrasound and "normal" massage (basically they just rubbed up and down my forearms, which felt good). Well, after my first day of therapy, I didn't wake up with any tingling for weeks, so that was a huge improvement. During the few weeks I went there, my pain levels also dramatically reduced. I still wasn't doing any typing and trying to avoid any strains, but for the first time, my arms were actually getting less painful.
Things only improved up to a point, though. I still couldn't USE my arms without the pain returning, which was clearly an unacceptable situation. I didn't know what else to do, though. I felt that at this point, I had an idea of what I had, but I wasn't sure that my doctors really knew a whole lot or even believed when I told them what specifically was bothering me, so I looked for a different one. I went to one of the big RSI websites (FindADoc: Health Care Providers for RSI Patients) I had found and looked for a recommendation to a doctor in my area. I found that a couple of people were raving about this doctor who worked about an hour and a half away, so I decided to go to him, Dr. 3.
Well, Dr. 3 took a look at my nerve-conduction velocity test results and did the same backs-of-the-hands-together test on me (with the same negative result) and said that he wouldn't recommend surgery at that point. He also told me that I had some tendinitis in my elbows (true) and also cubital tunnel syndrome (not true as far as I can tell.) He gave me some elbow pads to wear night and day (they're still in the box to this day) for the cubital and wanted to take me down the hall to inject both wrists with cortisone. That was a little sudden for me, so I decided not to have the shots.
Sometime around this point, I started interviewing for jobs as a programmer, which was tricky, because I didn't know when (or if!) I would be able to type for sure. I didn't mention my RSI at the interviews and was only mildly evasive in response to one question from one potential employer: "What kind of programming have you been doing for fun lately?" Um, none? I got a couple of offers, and called the company who gave the offer I liked best, and told them my predicament, and that the doctor thought I'd be able to work in a couple of months (which was true.) Luckily, they weren't too put off, and told me to call them when I was ready. They didn't guarantee anything, but it sounded promising.
A little while later, I was having a meal with my family and a friend of my parents who is a doctor. My RSI came up, and the doctor said that people should go to rheumatologists for carpal tunnel syndrome. That's how I went to Dr. 4. Dr. 4 was really impressive in terms of thoroughness. He spent a long time (nearly an hour and a half, I think) examining me and listening to me. He also ordered blood tests to make sure I didn't have some systemic problem (thyroid problem, etc) that was causing the RSI symptoms (I didn't.) He prescribed VIOXX, an anti-inflammatory, and said that if that didn't help, he'd put me on oral steroids in a few weeks. The VIOXX did make me feel a little bit better, but it certainly wasn't a cure. Since I didn't want to go on steroids (I didn't like the sound of the side-effects and I didn't think it was a good course of action) I didn't go back to that doctor.
At this point, I was totally at a loss as to how to proceed. Basically, because I couldn't think of anything better to do, I decided to try a cortisone shot in ONE wrist to see if it helped. Since I thought highly of Dr. 1's technical ability (although he didn't seem to listen enough, he did have a great reputation - and an aura - of extreme competence as a surgeon) I went to him for the shot. I also decided to just stay with him so that I could have at least one doctor really get to know my arms.
He gave me the shot (poking me in the nerve in the process, which gave me shooting pains for a few weeks) and I went to see him for the follow-up a couple of weeks later. The shot hadn't helped at all. On one level, this further confirmed my suspicions that my problem wasn't really carpal tunnel, but on another, I just wanted to do SOMETHING that would make a difference. So I agreed to have the surgery on my left wrist two weeks after I graduated college in December '99.
The surgery itself wasn't such a big deal. There was a huge snowstorm that morning, so getting there at eight in the morning was a little difficult, but I don't remember the actual procedure. They told me I wouldn't be unconscious, but I wouldn't remember it. I'm told that it only took 20 minutes but that the doctor didn't rush.
I was under strict order not to use the hand for ANYTHING (brushing teeth, tying shoes, etc) for four weeks. It seemed a little extreme, but I did as I was told, and thankfully, I healed very well. I now have a slightly visible scar on my palm, but no other adverse effects. After a few weeks, I realized that my left hand still felt no better than my right, so I knew the surgery had not cured me. I am still really grateful to Dr. 1 though, because I have met others who say their hands were never the same as the result of surgery. So please, if you do get surgery, find the best surgeon around.
Anyway, after the surgery didn't help, I felt even more sure that carpal tunnel wasn't my problem. Dr. 1 sent me to a different physical therapist for "residual pain even after surgery." This therapist was amazing. She read his recommendation, then proceeded to figure out what was hurting me herself. Her theory was that the tendons at my elbow were inflamed and that was causing the muscles they attached to to hurt. She began treating me three times a week with friction massage and with trigger point therapy, exploring each session for new or different sore spots, always trying to get more information. Finally, I felt that someone was figuring out what was going on with me.
After a week or so of therapy, I saw Dr. 1 again as a four week's follow-up to the surgery. He advised me to start building up my typing (from nothing!) and to do strengthening exercises, which I was very reluctant to do, having stayed out of pain for the previous several months by avoiding doing anything strenuous with my arms. He and my therapist were able to talk me into it though, and I realized that if I was careful I could do the weights and putty exercises, and that if I used good ergonomics I could even type for a few minutes.
After several more weeks, I really felt like I was getting stronger. The friction massage was really helping with my pain, and my therapist had found a new spot, at the top of my pronator muscle (the muscle at the opposite side of the elbow that twists your wrist counter-clockwise) which seemed to be the cause of the tingling which they had thought was due to compression in the carpal tunnel.
In another month, I had finished therapy, and was typing several hours a day fairly comfortably. I had a couple of flare-ups, after playing basketball two days in a row, and after carrying a bunch of chairs, but I felt that I was ready to jump into the workforce. I called the employer who had made the offer several months earlier and told them I was ready. They looked around for a spot, and a few weeks later, I went to work.
I am now pretty comfortable typing much of the work day. My job is not 100% typing, but I have found that as long as I take five-minute typing breaks every half-hour or so, use good ergonomics, stretch a couple times during the day and at home, and continue my strengthening routine, I can keep going. I have not had a major flare-up since before I started work more than two months ago.
I also feel that my arms are getting stronger every day and I really believe I will be nearly good as new within a half-year or so. So, I have to call this a success story. :)
In the end, I believe I had a couple of problems. The original, primary problem was that a couple of the muscles in my forearms became overstressed and needed help recovering. The stressed muscles threw off the balance in my arms and other parts began hurting too--mostly tendons in my elbow (I briefly had both "tennis elbow" and "golfer's elbow." Ask me if I play either.) The pronator muscle at the elbow would get swollen or displaced and put pressure on the median nerve, which caused tingling. A nerve-conduction velocity test across the carpal tunnel showed a reduced velocity, so there was some compression there too. I don't think that was a big problem, since a carpal tunnel release left my left arm still feeling the same as my right arm.
Stretching and strengthening helped get the muscles back into shape. Friction massage helped the tendons. Nerve glides help the nerves some, but releasing the muscles helps more.
What Helped Me (Might help you, might not): (In approximate order of my perceived importance)
This is crucial.
Update: I have since found Active Isolated Stretching to be a very quick and effective method of stretching. It's the only method I've used where I still feel more flexible the day after stretching. It's best to find a professional to teach you as they can help you make a lot of progress in one visit. Aaron Mattes, the creator of AIS, has a list of resources on his webpage. If you're near Rockville, MD, I can recommend James Graffenberg, who helped me significantly. If you want a book, I recommend The Wharton's Stretch Book or Specific Stretching For Everyone, by Aaron Mattes himself.
The following four stretches for at least 30 seconds each, several times a day. Start gently, gradually increasing the stretch. (Update: unless you're doing AIS, above.) If you stretch too hard, you'll end up tightening your tissues instead of loosening and lengthening them, and you might even injure them more. If you can't tell what part of your muscle you are stretching, you probably aren't stretching. (I've seen people doing leg stretches who couldn't point out which muscle they were stretching -- you should be able to feel it if you pay attention.) Stretching works best after heat (either walking to warm up, moist heating pads, or hot shower) but who has time to heat first every time?
Every now and then I do the corner stretch to stretch my pecs (the big muscles of your chest.) Stand facing a corner of a room, with one foot close to the corner and one foot further back. Spread your arms, bend them 90 degrees at the elbows, so that your hands are pointing upwards. Then put your forearms in this position against the walls, and thrust your upper body towards the corner, feeling the stretch in your pecs.
One other stretch is for the side of the torso, the armpit, and the triceps. Simply stand (or sit up straight), let one hand hang relaxed at your side, and bring your other hand up and over your head, palm up, leaning your body towards the relaxed arm's side.
Additionally, go buy Sharon Butler's book Conquering Carpal Tunnel Syndrome : And Other Repetitive Strain Injuries. Check Best Book Buys for the cheapest online rates or look for it at your library or area bookstores. She writes about fascia, the tissues that surround and form your muscles, tendons, and ligaments, and provides a bunch of good stretches. Be sure to read the introduction, because using her unique method is as important as following the stretches in the diagrams. One of the stretches I do once a week or so. It takes me at least ten minutes, but it totally releases the tension in my arms. I think that if I were patient enough to do it every day, I'd be in even better shape.
There are several kinds of rest. The first kind of rest I did was pretty much total rest. I didn't type at all for a few months, tried not to lift anything heavy, carry anything, or lean on my arms. I'm not positive that this was the best course of action because my arms got a lot weaker during this time, but they hurt so much I couldn't imagine doing much else. I do feel that the time off gave my muscles some (much needed) time to recuperate.
This total rest is hard and terribly inconvenient. Although thankfully (thanks Mom and Dad) I was still in college, being supported by my parents, at the time, I still had to find a way to finish a computer science major. This involved doing the graphical design for one team project (the mouse never really bothered me too much), writing one assignment by hand (NOT a good way to program,) and even getting friends to type for me a little. Buy your friends dinner -- you both get a good deal that way. One other tip -- it's possible (but slow and frustrating) to "type" by holding a pen in your fist (or mouth!) and picking out the keys.
Know when to end your period of rest. I needed to be persuaded by my physical therapist that I could begin with strengthening. This is why I'm not positive the period of rest is good.
The second kind of rest is a daily/weekly kind of rest. If you have RSI, don't be a for-fun programmer or carpenter in your free time, or at least not until you're stronger. Don't work crazy hours at the computer. Take weekends.
The third kind of rest is while you are using the computer. I try to take a 5 minute break after every 20 minutes of typing, during which I can stretch or do non-typing work. It's best to get up and walk around. There are computer programs which will remind you every 20 minutes and even guide you through some stretches. Two are StretchWare and StretchBreak. I like StretchWare much better. Both have a free trial period after which you should buy them. I'm sure there are free ones out there, and I can't imagine one would be hard to write if you're a programmer. For an alternative, use a real-life timer on your desk. If you don't use any of these, you won't remember to take breaks.
After resting and stretching enough for my muscles and tendons to calm down a little (a few months) and at my doctor's and therapist's instructions, I began strengthening. I was very reluctant/scared at first because I had been resting my arms so much and specifically challenging them seemed the opposite of what I should do, but thankfully my physical therapist was able to convince me I could withstand it. Within a couple weeks it became clear that it was the right course of action. Here's what I did to strengthen my arms (as instructed by doctor and therapist):
This is a special kind of massage that my last therapist did for me and taught me how to do for myself. It is to treat tendonitis. Basically you take a finger or thumb, put it to the most tender part of the affected tendon, and rub across it back and forth. My therapy basically consisted of ten minutes of friction massage each on two spots for each elbow.
These are kind of hard to describe. Basically, you are trying to get your nerve to glide smoothly through the areas of compression, so you move your hands so that your nerves move back and forth. For the median nerve -- the nerve affected by carpal tunnel syndrome -- extend your arm to your side so that it is parallel with your chest, your hand in a fist. Next, open your fist so that your fingers are extended straight out, palm perpindicular to the floor. Then bend your wrist back (on its own, not with the other hand.) Then, your hand stays the same, but raise your thumb so it points up. Then, rotate your hand down 90 degrees so that your fingers point downward. Then with your other hand, pull gently backwards on your thumb (you will have to move your arm a little bit forward for this.) Hold each position for 1 second. There is a diagram at this site. This site says, "DO NOT DO THIS STRETCH IF IT IS PAINFUL OR CAUSES SEVERE TINGLING!!!"
Okay, I know, it sounds corny. And certainly easier said than done. But I noticed early on that if I sat around being upset about my arms they bothered me more than if I was out with friends having fun. Maybe it's because when I sit and worry I fidget and overstretch my arms and when I go out, I'm up and moving, but whatever the reason, it works. Also a positive attitude is more conducive to taking necessary action.
Besides, you're happier that way.
Besides being good for you in general, these activities really made my arms feel better, at least temporarily. I think that this is primarily because swinging my arms helped loosen the tight muscles and fascia, but also because exercise gets the blood flowing, releases endorphins (natural painkillers,) and raises body temperature. It was possibly partly psychological as well.
This is a great way to help tight muscles. You find (takes some exploration and practice - I asked my therapist to draw an X on the spot at the beginning) the part which is tight and press it firmly with a thumb or fingers as you move the muscle back and forth. (E.g. Press a trigger point on the left forearm with your right thumb while moving your left wrist up and down on its own power.) I did this several times a day when I was just starting to type again. It also works elsewhere on the body (tight neck? leg muscles? whatever.) There are books/websites which list various trigger points. Some of them may be unreliable, I think. Do what feels right. Another way I've read about is just to press the point and hold it, making sure to let go gradually when you do.
My first physical therapist used to massage my arms up from the wrists towards the elbow on the undersides. I can't tell you the technique, because I never learned it. I'm not sure if it helped, but I feel like it helped loosen things up, and it sure felt good while she was doing it.
There are tons of websites out there that discuss computer ergonomics. I'll just tell you what I do. You are supposed to have everything at about 90 degrees -- your thighs and forearms should be parallel to the floor and you should be sitting up very straight. I've found that sitting up straight is much easier after doing abdominal crunches and, um, back crunches (I have no idea what they're actually called.) To do ab crunches, lie on your back, knees bent, feet a foot or so from your butt. Put your hands behind your head to hold it so your neck doesn't get sore, flex your abs, and roll your head forward so that your shoulders lift a few inches off the floor. You should be lifting with your abs, not your hands, neck, or back muscles! Do as many of these as you can, keeping your abs tight the whole time. Don't forget to breathe. Back crunches are the same, but on your stomach. Do these carefully, and don't do as many repetitions as ab crunches. You also probably shouldn't do these every day.
Keeping your arms and upper legs parallel to the ground is not really possible at most workstations because the desks are all too high. I use an adjustable-height table from Office Depot here for $80 or here for a bigger, $100 model. I have a plain old adjustable-height chair without arms (they get in my way.) I also use a Microsoft Natural keyboard (about $30 at buy.com,) because it keeps my hands tented up (less pronated) a little, which helps because I think my problem involves the pronator muscle (see What I Think I Had, above.) I keep the table really low, so that my thighs barely fit between it and the chair (which is annoying, but I haven't found a solution yet.) All of these things I have at work as well as at home.
One other tool you might like is a program called MouseTool, which clicks the mouse for you whenever you let it rest over something. It takes some getting used to. It helped in some ways (no clicking) and hurt in others (have to move the mouse very precisely). Give it a free try. I don't need it any more. Additionally, I've heard that some people like trackballs.
I also tried a DataHand keyboard. This is a really expensive (around $900) alternative to a keyboard. It's an interesting idea -- Basically there are two units, one for each hand, with five "wells" each. You put each finger in a well and instead of pressing every key down as on a regular keyboard, you simply move your finger forward, backword, right, left, or down, so it limits downward keystrokes by 80%. It's a little hard to learn, but not too hard if you are a touch-typer. Anyway, at the time I tried it I wasn't typing at all, so maybe I was just too injured even for it, but whatever it was, it didn't help. Thankfully they have a 30-day return period.
There are plenty of other (mostly cheaper) keyboard alternatives that I didn't try, which are listed at The Typing Injury Alternative Keyboard Frequently Asked Questions page. My view is that if you treat your arms well enough, you don't need anything too fancy, but maybe there are exceptions.
Also, I've read that some people like the Dvorak keyboard layout (free for most systems) as an alternative to QWERTY, both for RSI and simple efficiency.
What Didn't Help (Again, might help you, might not)
I think this mostly didn't help because Carpal Tunnel Syndrome wasn't really my problem. (See above, What I Think I Had.) In fact, I suspect that the reason the surgery's success rates aren't higher is that CTS is overdiagnosed. On the other hand, I am still very grateful to my surgeon, because I don't seem to have any negative after-effects either. I have met some people who have. You should definitely try everything else first. It seems to me (a non-doctor) that if the problem is that swollen tendons are squeezing the nerve in the carpal tunnel, it makes more sense to treat the swelling than to make the tunnel bigger. After all, for your whole life until you got injured, there was enough room in there. Of course, if it has gotten so bad that you are actually in danger of permanent nerve damage, you might not be able to wait.
Cortisone Shot into Carpal Tunnel
This did not help. Again, since I don't think CTS was really my problem (see above, What I Think I Had,) it's possible that it might help people for whom CTS is their main problem. However, I have also had one in my foot for plantar fasciitis (don't ask) which also did nothing. I have also heard that effects are temporary (days to months) and there are definitely some risks involved. I was personally poked (not injected) in the nerve and it bothered me for a few weeks. I would still try cortisone before surgery of course. (Which I did.)
Again, I don't think CTS was my problem (see above, What I Think I Had,) so these didn't noticeably help. From what I've read, though, splints almost always help people who do have CTS.
Things Which May Have Helped Me
Ultrasound
I could never feel ultrasound doing anything, but I was doing it at the same time I was doing the serious stretching when my arms first started to get better, so maybe it did help.
The Typing Injury Frequently Asked Questions
Conquering Carpal Tunnel Syndrome : And Other Repetitive Strain Injuries.
Best Book Buys
StretchWare
MouseTool
StretchBreak
DataHand
Dvorak keyboard layout