
How I Cured my RSI Pain - prakash
http://aaroniba.net/articles/tmp/how-i-cured-my-rsi-pain.html
======
simonw
Chiropractor, Hand Surgeons, Acupuncture, Massage... what's missing here is a
physiotherapist. My girlfriend suffered from career threatening RSI (though
RSI is actually a pretty useless term, since it works as an umbrella term for
dozens of completely different possible problems). We found her a physio but
they didn't really help. Then we found her an excellent physio (recommended by
numerous friends) who spent 6 months fixing her. She can now type for 7 hours
a day, provided she has at least one day a week with no typing at all. That's
going from being unable to type for more than 5 minutes without searing pain.

We've referred a bunch of other friends to that same physio, all with
excellent results. If you're anywhere near Brighton, UK drop me a line and
I'll send you her details.

If you need to find your own physio, be aware that just like anything you
should be ready to shop around for one. Personal recommendations from fellow
RSI sufferers are incredibly useful here.

~~~
dasil003
No doubt. I had RSI start to creep up on me when I was 25 and the _first_
thing I did was get a referral from my HMO to a physical therapist. I got some
simple exercises with a band, and I was cured entirely for a couple years.
These past few years it's come back a little bit, but at worst it's mild
discomfort, and I keep it in check with weight lifting and mountain biking. In
my case I'm entirely convinced that building wrist strength is the key.

What this guy experienced definitely sounds different though, but it's
shocking that he never tried one of the most basic solutions.

------
m_eiman
It's not actually about "How the technique works", it's more "This book worked
for me, but I'm not going to give you even a slight hint about how so go buy
the book".

Anyone have a link to the actual "How" part?

~~~
paulbaumgart
<http://podolsky.everybody.org/rsi/> has a summary.

The book is worth reading. It worked for curing similar wrist pain that I
suffered starting about 1.5 years ago. I actually managed to cure it just by
reading about Dr. Sarno's ideas online, as unlikely as that sounds. I bought
the book, after, though, to get more details. I think he takes it too far in
terms of the types of ailments to which he ascribes a purely psychological
origin. But I was definitely impressed with how effective his
explanation/techniques were for wrist pain.

------
sshumaker
I too, encountered crippling RSI pain, and eventually switched to a kinesis
keyboard (<http://www.kinesis-ergo.com>). While the keyboards are crazy
expensive, and a bit flaky, they completely cured my carpal tunnel.

The downside is, I'm now stuck hauling around this weird, non-standard
keyboard. :)

~~~
Luc
Same here. Had nasty pains in both wrists and tried a lot of things until I
finally purchased a Kinesis (the current model is this one:
<http://www.kinesis-ergo.com/advantage_pro.htm> ) and a Kensington Epert Mouse
trackball. I had to learn to type again, but am now faster and completely
pain-free for about 6 years.

~~~
sokoloff
Very similar experience here; bought myself a Kinesis for home and one for
work (I'm sure they'd have paid for it, but I couldn't be bothered). It was
quite possibly the best $600 I've ever spent. I don't mouse enough to have yet
bothered with the trackball, but perhaps I'll get one to try it out.

The _only_ downside I've found (other than cost, which is a non-issue IMO) is
that you get very used to the keyboard and now when I go to a conference room
or someplace else with normal keyboards, I might as well be typing with my
elbows.

~~~
jonstjohn
I keep a kinesis at work and a standard keyboard at home. Now I'm so used to
using both that I can type just as fast on either one.

------
vai
I actually had chronic RSI (CTS) from the age of 16~ due to
studying/practicing music (brass/guitar/piano), and a lesser extent computing.

I'd tried pretty much everything in that list, as well as an operation on my
right wrist. I won't say nothing worked .. because I was able to go from not
being able to hold a pen .. to not being able to hold a plate :)

I'd actually given up (both therapy, and Music/Software Engineering) due to
nothing seemingly working, and by chance started hitting the gym. As a part of
my regular workout I integrated some basic wrist exercises (initially, I think
it was wrist curls / reverse wrist curls).

So fast forward 10+ years and I now have absolutely zero problems. In
hindsight I'm sure it was a combination of all the treatments and building
significant forearm strength .. but not one Doctor, or Physiotherapist
mentioned physical training as part of the path to recovery/prevention.

------
ErrantX
Im still sceptical :)

Less, though, than when I opened the article; I have independently noticed my
RSI worsens when stressed. Im not sure I buy the mumbo jumbo about the
solution as much as I buy the explanation of why stress could affect it.

I use a powerball daily which has really helped. Saw the same issues with
massage that the article writer had (short term fix) but it feels really great
so I stuck with that=. But the powerball seems to really keep it in bay (I
think it is the rotational stuff that helps).

When really stressed I do pull ups and press ups to stretch the relevant
muscles.

~~~
gtani
I think you're talking about the DynaFlex, which helped me quite a bit:

<http://www.thinkgeek.com/gadgets/electronic/6a4b/>

Also the powerWeb and the wrist roller:

[http://www.amazon.com/GoFit-GF-WFB-Wrist-Forearm-
Blaster/dp/...](http://www.amazon.com/GoFit-GF-WFB-Wrist-Forearm-
Blaster/dp/B0007W2FJA/)

<http://www.fitter1.com/Catalog/Category/35/HandWrist.aspx>

Also, computer time means the smallest mouse i can find with decent action
(Logitech, no model number I can find), and switching between Apple and Matias
keyboards (short-travel and long, respectively) and carefully setting the tilt
angle of the keyboard and height under heels of my hands (rolled up towel)

~~~
ErrantX
Yeh that seems to be the one; they are just branded powerball over here.

Really therapeutic.

------
_debug_
If the author of this article is reading this : can you please provide a
timeline of events? Spreadsheet with column A = date, column B = event, column
C = number of hours per day of typing at this point.

Events include {Started Acupuncture, Started using ergonomic product A,
EtherPad acquired}, etc;

I wish to exclude these 2 possible reasons for the cure:

a) a simple reduction in the number of hours on the keyboard b) the
acquisition of your start-up, which may have released a lot of mental stress

~~~
fredoliveira
no wonder your name at HN is _debug_

~~~
_debug_
:-))

------
msb
Assuming that the techniques the author describes really work, is it any
different from taking a pill to relieve the pain? I tend to operate under the
assumption that when our bodies present us with pain, then we are doing
something to deserve it. Instead of attempting to remove the pain we should be
trying to discover what we are doing to cause it.

Vacation, chiropractor, surgeons, acupuncture, massage, micro-breaks...but no
exercise? A light dumbbell routine and a few walks or runs per week can work
wonders on RSI and any other aches and pains we encounter while at the
computer.

 _There is a certain "common knowledge" among computer workers that RSI is the
result of poor ergonomics. This fails to explain why some people can work for
long periods of time under conditions of atrocious ergonomics, but not
experience the same pain that I did._

In my experience, an increase in RSI and back pain correlate directly with my
level of physical activity outside of the work environment. A combination of
fitness and ergonomics have absolutely made the difference.

------
pwk
If I had known about this 14 years ago I would have certainly tried it, I
tried many things... the ones that I think were helpful for me are:

Ice bathes for my arms: I filled a sink with water and ice and submerged my
arms up to the elbows; this was obviously useful for short term pain relief,
and might have helped reduce inflammation over the longer term. It was
important to wait until the arms were warmed up again before going back to
typing.

Keeping fingernails well trimmed; surprising, but it made a big difference.

Massage; I think it was through massage that I started realizing that even
though my symptoms were in the wrists the problem was probably more systemic,
it's amazing how much pain a good massage can discover in surprising places!

Stretching; stretching the wrists felt immediately good, as did standing in a
doorway, arms on the door frame, and leaning forward. Working on the
hamstrings probably helped longer term.

Weight lifting, particularly exercises that strengthened the back; lots of
people have mentioned it here, and I credit this for being the biggest long
term help.

------
slmbrhrt
It may seem small, but adding these lines to my vimrc have entirely broken my
habit of scrolling with the arrow keys.

    
    
        map <up> <nop>
        map <down> <nop>
        map <left> <nop>
        map <right> <nop>
        imap <up> <nop>
        imap <down> <nop>
        imap <left> <nop>
        imap <right> <nop>
    

It may seem irritating at first, but in the end I argue it's worth it.

~~~
spudlyo
That's a good way of training yourself, I weened myself off the left-pinky
control key by doing the same thing. I now press it with my left thumb - which
is easy on my new Kinesis keyboard. Moving your hands off home row to hit
arrow keys also slows you down. It adds about 500ms latency to your workflow
every time you do it.

------
zefhous
Typing in dvorak decreases finger movement significantly. I recommend it.

~~~
tigerthink
Doesn't work with Vim as well though.

~~~
ZeroGravitas
I learned Dvorak and Vim at the same time and never noticed an issue. Maybe if
you've already learned Qwerty Vim there's a transition?

~~~
dylanz
Yeah, it's a brain@#$%. I did it though, and wouldn't look back.

------
kqr2
Amazon link to book:

[http://www.amazon.com/Mindbody-Prescription-Healing-Body-
Pai...](http://www.amazon.com/Mindbody-Prescription-Healing-Body-
Pain/dp/0446675156)

------
usaar333
I have tendinitis in my wrists to the point that I need to wear braces
whenever I use a computer.

I'm pretty skeptical of his claims, though I too agree with what he notes as
useless.

The only thing that has worked for me has been strengthening my wrists. I do
about 600 reps a day (variety of axes and loads) and it has stabilized my RSI.

Oh - and I make sure that my keyboard is rather low.

~~~
paulbaumgart
Have you tried it? I'm interested to hear from people who tried following Dr.
Sarno's advice but didn't have any success with it. It gives me a better idea
for how much certainty I should claim when I advise others to try it. :-)

------
jonstjohn
I had an interesting experience with pinky finger RSI. After well over a year
of pain and experimenting with different keyboards (such as the Kinesis, which
I highly recommend), I discovered that part of the problem was resting my
elbows on my arm rests. By restricting some of the blood flow to my fingers by
pressing on the elbow nerve, I was developing cubital tunnel syndrome. Within
a week or so after lowering my arm rests, I felt a ton better. Several months
later, pain returns only rarely.

I also love my Kinesis keyboard, too. It is well worth the price if you want
to continue programming for decades. After discovering what was causing the
pain, it helped me recover quickly and prevent it from occurring again.

I haven't read many posts on this solution, but want to remind people to
examine all aspects of their ergonomic setup, not just the source of the pain
(e.g., hand/fingers).

------
mattchew
I'm another guy who had RSI and eventually got better by using Sarno's
methods.

Sarno's ideas are a little flakey and a little offputting. But if you have RSI
and nothing else seems to help, I recommend swallowing your embarrassment and
giving Sarno's approach a real try.

------
pytxab
This article basically describes my experience exactly. If you have been told
you have RSI, do NOT ignore this possibility.

------
mumrah
I had very similar symptoms to this guy (pain starting in the wrists and then
forearms/elbows). I have adjusted my typing habits and daily routine as
follows:

* Exercise arms with light weights (~10lbs)

* Adjusted chair height

* Started using a real keyboard (I think typing on a MBP for extended periods was a big contributor to my RSI)

* Drink more water, get better sleep, get some kind of exercise

These days, I don't notice any kind of RSI pains. I think generally, RSI (for
a typist) is due to combinations of stress, poor posture, lack of general
wellness, etc.

~~~
wizard_2
The touch pad on the MBP causes me a lot of pain as well. I started carrying
around a Microsoft IntelliMouse Explorer and had the touchpad turn off when a
mouse is plugged in. I'm now able to type for long periods of time without
killing my wrist or thumb. (It's still hard to break the habit of tapping the
pad with my thumb to click.)

~~~
technomancy
Avoiding mouse use entirely is even better ergonomically. Bonus: it makes you
a lot faster.

------
AndrewDucker
It doesn't surprise me. I know that I'm more likely to put my back out or pull
a muscle when I'm stressed. I hold myself differently, and my movements are
also less smooth.

------
mikeklaas
His experience matches mind as well. Horrible RSI persisting for years, with
non of the conventional treatments effective beyond a short amount of time.

After doing a _lot_ of research into this, I experienced an almost complete
short-term recovery. It wasn't just lack of pain... muscles that felt
perpetually taut and ropey were suddenly softened, and I became
extraordinarily thirsty for a couple of days as healing started again.

Unfortunately, I only have speculation about what's going on here medically.
As a seasoned skeptic, Dr. Sarno's explanation of psychological causes is
unsatisfying to me. My hypothesis is that RSI is caused by a problem in the
autonomic nervous system (i.e. the part that regulates your body). Sympathetic
nervous system activity is provoked when your body is in "danger" mode:
muscles are tensed, ready to act, etc. Now, what happens in RSI is that your
muscles are being stressed through use (typing). This isn't normally a
problem: when you stop typing, your muscles heal the tiny amount of damage
that was inflicted. But if you are stressed out, then your sympathetic nervous
system activity is heightened and your muscles don't get a chance to heal.

Now this is the insidious bit: the pain and injury eventually becomes a danger
signal to your body. The injury thus provokes further sympathetic nerve
activity. This negative feedback loop can thus perpetuate without the person
feeling actively stressed any more, but is obviously exacerbated by feelings
of worry about the RSI. Every time you try to be careful, you make the problem
worse.

For a more medical take, some pieces are conveyed in this article:
<http://www.aapb.org/tl_files/AAPB/files/biof_34_2_pain.pdf> . Some people
speculate that similar issues underlie more serious problems, like RSDS and
fibromyalgia

So that's all well and good, but what about the "cure"? Well, it seems that
many people have virtually instantly solved their problems by adopting
positive beliefs about the nature of the problem, that it is a problem caused
by problematic nervous system signals and NOT an insoluble muscular injury.
How does that work, exactly? I have no idea. Obviously, some stress is
reduced, but that can't explain the magnitude and suddenness of the change. If
anyone has ideas, I'd be very interested in hearing them.

If you suffer from RSI, the advice I would have is to think about this
explanation while researching the ideas thoroughly to see if you're convinced.
In the meantime, the best thing to do is daily exercise that isn't too
intense, but gets your blood flowing for 20-30 minutes. Biking, running, yoga
all have good benefits. You can do things like lift weights as well, but it is
easy to overdo it, so I don't recommend it if your symptoms are severe. It's
worth reading Dr. Sarno's book, but keep in mind that he uses words like
"freudian unconscious rage", which made it hard to take anything he said
seriously. In my mind, he is inaccurately explaining something which isn't
true but corresponds to _some_ true phenomenon.

I've wanted to write this up for a while, but while I'm relatively convinced
that I have a better explanation for RSI than most doctors, I don't really
understand how "the solution" works (nor for how many people it does). I also
realize that it sounds exceptionally hokey, which fuels my reticence. We'll
see how it goes over here... ask me anything.

~~~
carbocation
Being a medical person, I am skeptical by nature, so I looked into Sarno's
academic publication record. According to NYU, at least, he hasn't published
in a journal for 7 years. That doesn't mean anything necessarily; it just
calibrates my expectations.

His explanation for what is going on is not credible - but that does not mean
that I don't find his solution credible. Biofeedback techniques are
noninvasive and always merit a try.

In the absence of actual evidence, I cannot conclude that the technique works
any better than placebo - but I am certainly glad that your pain is gone. The
placebo effect (if that's what this is, which it may not be) is quite real.

~~~
m_eiman
In one of the articles I read while following links from here (
<http://www.tarpityoga.com/how.html> ) they say:

    
    
      You also have to completely believe in the TMS diagnosis.
      That means that you have to completely accept the fact
      that your symptoms are emotionally induced. If you still
      believe that there may be something physically or 
      structurally "wrong" with you, you're not yet "cured."
      You're not paying attention to the underlying emotions,
      which means that the symptoms can still work as a 
      distraction, and it's likely that they will return. 
    

Sounds like a self-imposed placebo to me. If it works it's still good, of
course; it'd be very useful for "standard" medicine to learn how to use the
placebo efficiently and ethically.

It also sounds like a good excuse to explain the people who aren't helped by
the therapy - if they don't get better they don't believe in it enough and
have themselves to blame (or they have the wrong diagnosis).

------
matt1
This was a great article and it sounds very familiar.

On and off for the past two years I've experienced similar pain. (see
<http://news.ycombinator.com/item?id=889067>). The last three weeks have been
particularly bad: I've taken time off, I continue to wear wrist braces at work
and at night when I program, I've started doing rigorous hand and wrist
exercises daily, and while it has helped a little bit, I still experience a
lot of pain. It scares the hell out of me because a lot of my future plans
depend on me being able to spend a lot of time programming; without my wrists,
I'd be lost.

What occurred to me reading this article is that about three weeks ago I found
out about an incredible opportunity that may drastically change my life. (Stay
at my day job or leave and work on a startup full time). I've spent a lot of
time dwelling on it, trying to decide what to do. It can't be just a
coincidence that my debilitating wrist pain started at about the same time.

I'm going to buy the book. I have high hopes. We'll see what happens.

------
grrrr
I have suffered from RSI repeatedly over the years. I use an ergonomic
microsoft keyboard, and this really helps. However what made the biggest
difference was when I started using a Logitech Mouseman Marble mouse. The pain
in my right arm/wrist vanished. I will never use a normal mouse again.

------
ZeroGravitas
I find it interesting that he got great relief from acupuncture, which has
been fairly well studied and found to have no benefit beyond a totally
untrained person _pretending_ to stick needles into you. Certainly points
towards it being psychosomatic.

------
rabidgnat
If you have RSI typing pain and haven't treated it, spend a whole day typing
with wrist braces. It convinced me to switch CTRL and CAPS LOCK on my
keyboard. I love keyboard shortcuts, and bending my wrist to hit CTRL was
causing my left pinkie to go numb.

I also have 'evasive action' that works well. When I feel pain typing, I
immediately stop and give the offending hand a workout with a stress ball for
5 minutes. Then I massage the tendons in my forearm and then stretch my wrist
on all axes. I haven't had significant RSI pain in a few years, and at this
point I'm not brave enough to test which part of the routine helps most :D

~~~
viggity
I've had really good luck with switching most of the shortcuts I use to use
ALT instead of CTRL. ALT is much easier to reach with your left hand than
CTRL.

------
kadavy
Unlike him, I find the Mac program AntiRSI to be really helpful - not only for
resting my hands, but also my mind: <http://tech.inhelsinki.nl/antirsi/>

------
shin_lao
Well it's nothing new that the mind can cause injuries and even diseases:
<http://en.wikipedia.org/wiki/Psychosomatic_medicine>

------
godDLL
_[…]You can eliminate the pain by addressing the unconscious stress and
becoming consciously aware that the pain is merely a distraction[…]_

This sounds a whole lot like Dzogchen meditation practices, their way of
cleansing the mental palette, achieving "mindfulness". I remember faintly
reading a book my one Norbu Chogyal, or a russian translation of said book. I
remember it being the only coherent piece of material on meditation that I
have ever come across.

------
stretchwithme
massage usually only provides a temporary benefit because it releases the
tension in the muscles, but does nothing to keep it from returning.

The stiffness in muscles is ultimately caused by poor circulation through the
muscle. The sarcomeres pump their own blood supply and if the demand is
greater than the supply, the sarcomere can run out of energy in its contracted
position.

This contraction shortens the entire muscles when many sarcomeres are
affected. New blood cannot enter the sarcomeres until something pushes out the
depleted blood.

Massage can do this, but massage will not correct the poor circulation that
caused the stiffness to begin with.

And that circulation problem is usually caused muscle sheaths that have not
been stretched frequently enough. The body's natural collagen deposition
essentially gluing it to itself so that it cannot expand or stretch normally.

This creates a tight situation when you use the muscle inside of this sheath.
The muscle is thicker when contracted and pushes out against this sheath. That
creates pressure and blood takes the path of least resistance away from your
tight muscle.

The tightness inside the muscle must be massaged and then the sheath must be
manipulated and stretched. Otherwise, the sheath is too stiff due to the
stiff, thick muscle inside it.

Further compounding the situation is the way tense muscles effect other
muscles and spread the problem. Muscles work together and communicate that a
load needs to be moved. A great system when things are healthy, but a
permanent source of stress that will thwart efforts just limited to a muscle
and its sheath.

------
RyanMcGreal
The link to "The MindBody Prescription" is broken:

<http://aaroniba.net/articles/tmp/..>.

------
pxlpshr
I believe it. My dad had chronic lower back pain most of his later life and by
no surprise, he also had high anxiety and stress. He read something similar
about TMP about 15 years ago after tiring of pain killers, this was around the
time he began studying Buddhism to help with stress. Ever since he's been in a
lot better shape.

------
jason114
Comment to SimonW I have been having wrist problems for about 6 months now, i
live in Worthing and would really appreciate the details on the physio you
recommend in brighton

Thanks .

------
bensummers
Here's my list of things which helped me: Logitech Mouseman Marble, the flat
Apple keyboards, regular Pilates, and a conscious effort to sit up straight
while typing.

------
Tichy
What has helped me is Yoga.

~~~
mattchew
I used Sarno's methods to get over my RSI. But I could see yoga addressing
some of the same underlying issues (anxiety and chronic tension) and solving
the problem from a different angle.

------
mwerty
link to book is broken

------
lispm
sacrifice of a few chickens will also help

~~~
paulbaumgart
Since it seems to be psychosomatic in origin, this sort of RSI is related to
the placebo effect. It makes sense to me that it would be possible to overcome
it with some sort of placebo. But I think tackling the underlying emotional
issues is a better long-term solution.

------
Raphael
A gripping tale of medical mystery.

