
Stopping the RSI pain that almost destroyed my programming career (2016) - jxub
https://codewithoutrules.com/2016/11/18/rsi-solution/
======
jlarsen
I'd like to throw my two cents in here: strength training.

I started having problems with RSI about five years ago, and I tried and
failed to get relief from quite a few different things, including the Mindbody
Prescription, but what ultimately helped me the most was arm and grip
exercises: pull ups, deadlifts, farmer's walks.

If you're going to do _anything_ for 8 hours a day, even sitting, you should
be taking measures to make sure it doesn't impact your health.

~~~
protonimitate
Every time I see someone mention strength training around here I have to jump
in and agree - it is the single greatest improvement I've made to my lifestyle
thus far.

Lifting weights has the best return on time invested I've experienced, period.
You can make progress and eliminate 90% of physical discomfort with 3 hours in
the gym a week. All you really need are the main compounds. Throw in a couple
cardio sessions if you're feeling ambitious and you will gift yourself years
back onto your life and avoid all sorts of aches and pains.

~~~
gnur
Do you have any sort of routine you can recommend?

~~~
roganartu
Starting Strength and Stronglifts 5x5 are probably the two most popular. These
programs are based on what's called beginner gains. You wills start with what
will feel like a very light weight, but you increase it every workout until
you can't lift it anymore. You'll be amazed at what your body can do after 6
months of this.

When the parent said compound lifts they were referring to lifts that (when
you are doing them heavy and correctly) are whole body exercises: Deadlifts,
squats, and bench are the three main lifts. Programs will typically mix in
some other lifts to round out the program a little like power cleans, overhead
press, and bent over rows.

Most beginner strength programs are three days a week, I've found most people
do Monday, Wednesday, Friday, but it's flexible as long as you have at least
one rest day in between workout days. If you don't mess around and just go to
the gym to work you can easily be done in 30-45 mins so under 3 hours a week
is very realistic.

You will absolutely feel uncomfortable when you start. Everyone does. Read a
lot about form and pay attention to yours (gyms have lots of mirrors, lift
near some especially when you're starting out). It's really easy to hurt
yourself once the weight increases if you have bad form. Consider getting a
good personal trainer to teach you the fundamentals of the lifts.

~~~
mclemme
Can strongly recommend Starting Strength, started out reading the book
(written by Mark Rippetoe) back in January - started the program in February
using the android app* as my guide. I feel better than I've done in years (I'm
in my mid thirties)

Remember to eat well and make sure you get enough protein, otherwise it's hard
to follow the program.

* = [https://play.google.com/store/apps/details?id=com.shabu.star...](https://play.google.com/store/apps/details?id=com.shabu.startingstrength)

~~~
cblop
Starting Strength is a great program, but I can't understand how beginners are
doing power cleans without any kind of guidance from a trainer. Power cleans
are really hard to learn - it took me months of going to Olympic weightlifting
classes to get even close to good form on them. How did you manage to learn
this from a book?

Also, you need to be doing them on a lifting platform for the end of the lift,
when you have to drop the weight all the way to the floor. Not too many gyms
(in the UK, at least) seem to have these.

~~~
mclemme
I did crossfit 2-3 times per week for 1.5 years around 7 years ago at a gym
where there was a lot of focus on technique, so it's been a while, but I
didn't start from scratch with regards to technique.

That being said, I'm sure I have bugs in some of the exercises, I try to work
them out via. videos and focusing on technique before I put more weight on the
bar.

All the gyms I've been to here in Denmark have lifting platforms, squat racks,
etc. so that hasn't been a problem for me.

------
moosehawk
There are a lot of "what worked for me in here" and that's great, but I want
to stress that people need to consider seeing a physician, and possibly an
OTR/L several times. The anatomy of your arms are more complicated than you
think and any number of issues can cause pain, weakness, tingling or numbness.
These people work with these issues 40+ hours a week and are more equipped to
target and fix the issue sooner than you are on your own.

Sometimes it's just one lifestyle choice you need to change to improve your
health (e.g. posture), but for some people it's more complicated than that.
Everyone's physiology is just a little bit different and responds differently
to different treatments.

~~~
melling
I’ve read lots of RSI stories and seeing a doctor never seems to solve the
problem.

[https://github.com/melling/ErgonomicNotes](https://github.com/melling/ErgonomicNotes)

One example is John Ousterhout, the creator of Tcl/Tk, has had RSI for
decades:

[https://web.stanford.edu/~ouster/cgi-
bin/wrist.php](https://web.stanford.edu/~ouster/cgi-bin/wrist.php)

~~~
WhompingWindows
Primary care physicians are often switchboard operators - they hook you up
with potential resources or referrals that may lead to a solution. The chances
that any given PCP is going to know a lot about RSI is pretty small, they have
literally the entire spectrum of human health to consider, not to mention the
looming issues of obesity, heart disease, cancer, and other more damaging
syndromes.

Personally, I found wrist pain to be of multifactorial origin: too much
typing, driving, playing piano, not enough cardio, strength training, and
relaxation vs. stress.

~~~
Bartweiss
This is true, and I certainly don't blame PCPs for not being up to date on the
specifics of low-frequency disorders like RSI.

But my frustration is that even the 'switchboard' component of PCPs seems to
be broken on this topic - across several musculoskeletal issues, I've only
ever gotten recommendations to surgeons (who then said "you're not sick enough
yet"). PCPs didn't even know what kind of specialist to suggest for finding
causes and reducing pain, and the internet wasn't much better.

At risk of saying "what worked for me", talking to a physical therapist was a
huge help with each problem - they didn't have cures, but their education was
much more relevant to saying "here are some common risk factors and pain
reducers you could look into".

And yes - 'multifactorial' seems like the usual answer, so I'm not surprised
everyone has a different fix.

------
fnord123
I used to have RSI. Then I stopped using Emacs and it went away. It flared up
one time when I had to do some data entry in Excel; but then I learned the
hotkeys and it went away again.

Just stop using emacs, people. It's literally damaging you!

-vim user

~~~
vemv
I use Emacs but also completely 'hijacked' the way it works with keyboard
shortcuts, making it similar to a GUI editor and ignoring/disabling typically
emacs-y chords.

Good thing being that Emacs is powerful enough to completely change itself
without much effort.

~~~
DoingIsLearning
I am glad you shared that.

I did exactly this but was always too afraid to admit it publicly, because of
Emacs 'purism' users.

I love Emacs exactly because of how highly customizable everything is (without
other editors bloat) but equally because I can leverage the huge user-base to
not spend an infinity amount of time on customizing.

Although I appreciate other people's experience may be different with
vi/vim/emacs, in my personal case I don't have to remote into other machines
so I can get away with a custom init.el on my machine.

------
melling
No one knows what causes RSI. It might be multiple problems.

Anyway, on Github I’ve collected several dozen articles and created a table of
things people have tried.

[https://github.com/melling/ErgonomicNotes](https://github.com/melling/ErgonomicNotes)

My personal feeling is that if programmers embraced voice input, simply not
having to type when issues arise would help. Of course, most programmers will
rant about how keyboards are so much more efficient, which they might be until
you can’t use one.

Here’s the current state of voice programming:

[https://github.com/melling/ErgonomicNotes/blob/master/progra...](https://github.com/melling/ErgonomicNotes/blob/master/programming_by_voice.org)

~~~
ballenf
Here's one for your list that worked for me within 1 week of starting:
dropping wheat from my diet. Noticed you don't have diet as a category even.

For more detail, I was sleeping in two wrist braces every night and doing
stretches and strength exercises for an hour or more a day before the diet
changes. Now I don't need any exercises or braces.

When I regress for a day or two it comes back, but not as bad.

~~~
melling
I’ve never seen an article on that. If you write one with your experience,
I’ll include it.

Why did you omit wheat? Was it in direct response to RSI?

~~~
curioussavage
Maybe a more general article on an anti inflammatory diet would be better. A
quick search should gives results from some reputable liking sources.

There is also this:
[https://news.ycombinator.com/item?id=17109010](https://news.ycombinator.com/item?id=17109010)

------
nileshk
Reading Dr Sarno’s book “The Mindbody Prescription” was what cured me. There
was no physical cause. I haven’t had issues since 2001, and I don’t do
anything specific to address the physical, the solution is purely
psychological (though the symptoms were physical).

~~~
tom_mellior
Did you really just _read_ the book or did it also tell you to also _do_
something about the "psychological", which you then did?

~~~
corpMaverick
As strange as it sounds. I think people really improve just by reading the
book.

Imagine one day you find an itch on your little pinky on your left foot. You
never notice it before. Now spend all day thinking about it. Every day. It
will be magnified, it will become unbearable. I think the book teaches you to
shift your attention.

~~~
MichaelGG
It's bizarre. I tossed the book away in disgust because it's crazy
pseudoscience....and it still worked.

------
seasoup
Around 2004 I started having a sore right wrist. I saw a specialist who said
it was a repetitive stress injury and not carpal tunnel. He prescribed some
exercises but it didn’t work. I moved to using my left hand to use the mouse,
switched to ergonomic keyboards, tried a trackball, fancy ergonomic nice,
adjusting my seat height, adjusting my desk height, and nothing worked. When I
switched hands, my left wrist became sore too. Finally, finally, I tried using
a pen tablet and the soreness disappeared. Turned out the motion that was
killing my wrists was clicking the mouse with my finger and pushing my whole
hand down to depress the pen instead worked out. I’ve been coding pain free
ever since. The way to make a repetitive stress injury heal is to figure out a
way to stop making that motion over And over again.

~~~
koonsolo
I had this wrist pain 2 times in my life. If I would put pressure on that
wrist (eg to do pushups), it would hurt like hell.

I was always able to fix it by using the keyboard shorcuts more. Navigating to
menus with alt etc.

------
pure-awesome
Hmm, this article makes me think some people's RSI problems may be caused by
Raynaud's Disease.

[https://www.mayoclinic.org/diseases-conditions/raynauds-
dise...](https://www.mayoclinic.org/diseases-conditions/raynauds-
disease/symptoms-causes/syc-20363571)

It's more a description of symptoms than a description of cause, but being
able to put a name on it makes it easier to ask about and Google. Basically,
anything that can help treat this might be able to help with related RSI.

~~~
aidos
Both my wife and youngest daughter have Raynaud's. It's really obvious due to
the external signs - though, as you say, I'd never have known what it was and
that it was a thing before my wife told me about it.

------
ninjakeyboard
I did a few things to stop my RSI pain:

1) Use an alt keyboard layout. Use colemac. It's easier to learn than dvorak
and decreases finger travel at the keyboard

2) Stop using a mouse. I used a trackball for a while but it has its own
issues. I use a cheap wacom bamboo tablet now. It's far and above more
ergonomic than any other device I've used as a pointer.

3) Use a kinesis advantage. Blank keycaps for style points.

4) Use your left hand. I use the wacom bamboo tablet with my left hand (I'm
right handed.) This has had amazing results for me personally with the wacom
because my left wrist does not bent/turn at all - I move entirely from my
elbow primarily because I'm not that dextrous with my left hand.

I did them in that order but I'd recommend swapping the keyboard and mouse
first, as they have the biggest bang for the buck in terms of ergonomics. The
alt keyboard layout is marginal. Left hand was big for me personally.

All of these items take some time and effort, in particular learning another
keyboard layout. And the kinesis also has a relatively steep learning curve
relative to other keyboards. Don't do it all at once - it's a multi year
journey but hey - no more hand pain! I still use a regular tenkeyless
mechanical keyboard and mouse at home in the studio, and obviously carry a
laptop for work, but my use of these is fairly infrequent relative to the 40+
hours a week at my desk at work.

~~~
ryan-c
How long did it take you to learn colemac?

> 3) Use a kinesis advantage. Blank keycaps for style points.

These keyboards are quite expensive, but totally worth it. My previous
employer offered them as one of several keyboard options. I went with it due
to some pain, it took maybe 6 weeks to used to the layout. Ended up buying one
a few months later when they went on sale (usually 10% off around black
Friday), as my pain had gotten dramatically better. The company that makes
them is also pretty hacker friendly - they sell spare parts and they've been
willing to help people who want to make custom controllers for their
keyboards.

I actually hacked a trackpoint (harvested from an old IBM desktop keyboard)
into my kinesis and used that for a while, but due to the way the sensor works
it really needs a solid mounting to work well which I just couldn't achieve.

I personally have had decent luck with a vertical mouse (anker makes a
cheapish one that works fine).

~~~
mellinoe
> How long did it take you to learn colemac?

Not the guy you replied to, but I switched to Colemak last year. It took me
about 3 weeks to get to a "usable" state, and maybe 2 months to get within 75%
of my previous speed with qwerty. My progression was roughly:

0-1 weeks: Can't type anything without looking at the key map. I would switch
back to Qwerty if I needed to type something long out (emails mainly).

1-2 weeks: Weird phase. I can't effectively type in either qwerty or Colemak
unless I really "focus" on it. It's hard to describe, but this week was
terrible for productivity :)

3+ weeks: Forced myself to use Colemak exclusively. During this time I started
doing real typing exercises, and turned off autocomplete in my IDE, since I
found that was detrimental to learning. I also wrote a ton of documentation
for a couple of my projects, which involved a lot of typing.

Before I switched, I would get intermittent pain in my wrist (maybe twice a
month), which has since completely disappeared. When I need to type in Qwerty
now, it is very uncomfortable, in a way that Colemak never was.

~~~
arafa
I can confirm all of this learning Dvorak. Having seen this with myself and
others, it really is like a short version of learning a language and seems to
use the same part of my brain. There's that period where you're not good in
either layout and you need to get something done like you're saying (but after
all the fun initial gains) and that's when most folks quit. If you can push
past that week or so, it seems you're good. It's painful though.

And yeah, I can still touch-type in Qwerty too, but it feels like contorting
my hands in knots. I can type it in fine, I just never noticed before how
crazy you have to move your hands to do it.

------
wallflower
This post is for those who believe that they will never get RSI symptoms.
Don't be foolish. I spent my teens and twenties pounding away at a keyboard
with a slouch and bad posture. No pain. Eventually it got to a point where my
forearms experienced soreness after a long binge of typing. Luckily, a night
of rest "solved" the problem. Then, the recovery period became longer - a
weekend, three days, using a heat pack. Finally, and this is the reason why I
am writing this, the soreness never went away. Once you pass a certain point
with active denial, your body gets damaged. Like another poster mentioned, at
that point you need to spend equal time counteracting the effects of what you
did with something like functional fitness or strength training. RSI once it
reaches a certain point, like most problems in life, does not go away. It can
only be managed. All the advice and personal experiences shared here is good
but keep in mind that the best time to manage RSI is before symptoms appear.
Don't fall for the premise that there is a solution for RSI without addressing
the root cause, continually and daily.

------
codingdave
My RSI ended up being due to an anomaly in the structure of the sheath my
tendons pass through. I went through doctors, NSAIDs, cortisone shots,
physical therapy, and all the ergonomic adjustments you can think of. Finally,
a surgeon just 'fixed the glitch'.

All the other advice is still good advice -- but sometimes you have a
mechanical problem, so dropping conversations with doctors just because their
first treatment failed may not be the right move - there are further actions
to explore. And if nothing is working, it is worth finding out whether there
is a deeper underlying problem to resolve.

~~~
cache_miss
Can you elaborate on how the issue was found? I've been through similar
treatments, even had carpal tunnel release just to see if it would help (it
didn't).

How would you describe the pain? All of mine is in the fingers, exclusively.
No wrist pain.

~~~
codingdave
I initially went in because my wrist was hurting when I coded all day,
sometimes shooting up my forearm. At the first appointment, they had me put my
thumb inside my fist, and try to move my hand down (Finkelstein's test) - I
had no motion and lots of pain, so the diagnosis was easy - DeQuervain's
syndrome... totally different than carpal tunnel, but still an RSI coders get.
For most people, it heals easily, but not in all cases:

We went through the standard steps for this problem - rest, ergonomic changes,
a cortisone shot, then physical therapy. Nothing worked, so I consulted a
surgeon, who gave me an additional shot with more expertise in exactly where
to give it. That actually helped for 6 months, but when I called back after
the pain recurred, they said surgery is the last resort, but also the best
option in my specific case, as it is a simple fix and almost always works.
During the surgery, they found that my tendon sheaths were bisected, leaving
less room than normal for movement through the wrist.

As far as the pain, it was very focused on the side of my wrist at the base of
my thumb, in particular when moving the hand to the outside of the wrist.

All that being said, the bigger lesson I got from it all is that not all RSI
pain is the same problem. Hand specialists know how to tell the difference
between all the problems and can give you guidance on which treatment will
help. At the same time, general practitioners do not have the same level of
knowledge, and may waste your time running you through treatments that won't
work. So if you are having problems... ask a hand/wrist specialist for help.

------
tom_mellior
"At some point during this period I read one of Dr. Sarno’s books. His theory
is that long periods of pain are not due to actual injury, but rather an
emotional problem causing e.g. muscles to tense up or reduced blood flow.
There are quite a few people who have had their pain go away by reading one of
his books and doing some mental exercises. [... it works, then it stops
working, author makes tenuous connection to the cold in their office...] I
started wearing a sweatshirt and hand warmers at work, and I avoided caffeine
on the days I went to the office. The pain went away, and so far hasn’t come
back."

Good for them. Sounds like a particular case, but I guess if you feel
uncomfortably cold in your office, you should do something about it.

~~~
Cthulhu_
It might be for them that they didn't feel cold as such, just that it was cold
enough for blood flow to the extremities to be restricted.

------
Twirrim
I used to get RSI, then I switched to a Microsoft Natural Keyboard about a
decade and a half ago (I'll be sad if this line ever goes away), and my issues
went away. At every job I've had, I find the same thing happens. I start, and
have a normal keyboard. Within a few weeks the RSI is back again. I expense a
Natural Keyboard, switch to it and the RSI goes away again.

This last job change was way more dramatic. They gave me a magic keyboard.
Those things are a cramped, ergonomic nightmare. My RSI came back within a
single day of typing on the damn thing. I had to get rid of the magic mouse
for similar reasons too (arching your finger and wrist, like you need to do to
tap it, is similarly bad)

~~~
microcolonel
It really can not be overstated how inhumane Apple's desktop peripherals are.
I honestly can't think of worse mice or keyboards.

------
emtel
I've never had RSI severe enough to have to stop working because of it, but
the minor issues I once had were completely cured by taking up indoor rock
climbing.

Of course I don't know exactly why it worked, but my guess is that a) it
massively increases blood flow into your forearms and hands, and b) it
strengthens all the small muscles and tendons in your forearms and hands _so
much_ that typing and other movements don't even register as "strain" anymore.

If you start climbing, start slow and easy and build very slowly, especially
if you are an athletic person who is used to improving fast and pushing
yourself. The tendons in your fingers get stronger much more slowly than you
expect.

------
clircle
For Emacs users, common wisdom is to swap control and caps. I urge you to try
swapping left control with left alt instead. Thus you can use your left thumb
to hit control and right thumb to hit Meta (alt). Map Esc to capslock if you
use Evil-mode. Linux commands for x windows:

    
    
      setxkbmap -option 'caps:escape'        
      setxkbmap -option 'ctrl:swap_lalt_lctl'
    

This works well for me and would probably work even better if my keyboard had
big alt keys.

Edit, as another user said, everyone should probably be using sticky keys. On
linux I run

    
    
      xkbset sticky -twokey -latchlock
    

on login with Xorg. Sorry, not sure how to do this under Wayland.

~~~
willtim
Excellent advice. I also swap control and alt _on both sides_. This means I
can reduce the amount of chording needed and use alternate hands together.

~~~
clircle
Interesting. How do you hit the Meta key if you swap on both sides? With a
pinky?

~~~
willtim
Normally, I use a Kinesis, so it would be thumbs for both. But on my laptop,
yes I would use pinkies for both shift and alt.

------
mmjaa
The #1 thing that has always worked for me, and I've been addressing this for
years .. since 1983 .. has been to switch things up.. Change my keyboard at
least twice a year.

You know that whole vim vs. emacs debate? Actually, thats really healthy for
you. If you don't wanna have sore knuckles every week, use both.

It really helps to switch it up.

In 1984, I was mostly a user of 8-bit style keyboard systems. Had MSX, had
British-8bit, had a bit of American..

In the 90's I had a lot of American. I mean, who hasn't had a bit of IBM or
Cherry or two, amirightkids?

All through this period, there were periphery effects where I could observe my
hands saying, enough is enough. Please do something else for a while so
pathways can be repaired.

So, I did it. I've pushed all kinds of switches in response. Turns out, this
is good for all kinds of other reasons too (pollygots ftw) and so on.

But every year I think to myself, how well are my hands behaving? And the
answer always comes back to, did I upgrade my main machine this year?

(Disclaimer: ready to ditch Apple and go with someone else, unibody..)

~~~
godshatter
I did something similar back in 1997 or so. Instead of switching keyboards or
input programs, I switched keyboard layouts. I switched to dvorak, and (after
a month or two where I couldn't type well in either layout) the pain went away
and hasn't come back. I use qwerty at work and dvorak at home now.

------
willtim
I wholeheartedly recommend the excellent Kinesis Advantage 2. It's relatively
expensive for a keyboard, but absolutely worth the money for anyone who uses a
keyboard professionally for hours every day. It also has featureful firmware
and the ability to remap keys in hardware. I wish I had purchased one years
ago. My typing is faster and feels like much less effort.

~~~
Cthulhu_
I want to get me one of those, but I tend to use my mouse a lot; it's more
aimed at people that can actually use keyboard-only interfaces I think.

I've got a (tenkeyless) wireless mac keyboard, the low profile really works
for me. Wouldn't mind if it was a split keyboard though.

~~~
dwringer
The Advantage layout is definitely one that sort of insists on two hands if
you want to reach anything that the right hand types regularly and/or you want
to use the arrow keys. The keywells are open on the outside edge, so it is
pretty easy to slide one's hand over onto a mouse or trackball, but I agree
that a conventional layout has at least some advantage there (I think a split
keyboard would fall somewhere in the middle).

I don't find it to be much of an issue in practice, because I use the
Advantage 2 along with a CST L-Trac trackball, which sits right beside the
keyboard and can be operated with just a couple of fingers. They have a model
which can accept external buttons, which is the one I got, so I also have
duplicated the LMB and RMB next to the other side of the keyboard. In this way
I could theoretically use the cursor with my left pinky and click with the
right pinky without taking my hands off the keyboard, although it's not
particularly effective (or necessary).

FWIW I am someone who uses mouse-driven interfaces all the time, although I
guess emacs more than makes up for it with the amount of keyboard activity it
demands.

------
disease
I may just be imagining things, but it seems a disproportionate number of RSI-
suffering programmers use emacs. From my own experience, I suffered the worst
RSI of my life while using vim. It subsided a bit when I moved to Sublime and
almost completely went away from I switched to VS Code. Obviously correlation
does not imply causation and I have taken a number of other steps to fight RSI
(ergo keyboard, heavy keyboard remapping) throughout the years.

~~~
smaddox
Did these editor changes correlate with any other life changes, e.g. job
change?

------
nickjj
I've been using a keyboard for over 20 years and I'm fortunate enough to not
have any pain or RSI related issue. I've always used regular stock keyboards
and whatever mouse felt comfortable to me (Logitech's G400 fits my hand like a
glove).

This is even with many years of hardcore clicking and "worst case scenario"
things when playing massive gaming sessions back in the day.

But, one thing I've always done from the beginning is to make sure my forearms
are parallel to the floor. I always make sure my hands are well supported on
the keyboard[0], and my elbows are well supported (on a chair's arm rest).

One thing that sucks about a standing desk (something I've been using for 2.5
years) is you lose that elbow support since your forearms tend to dangle.

[0] This doesn't necessarily mean resting them on the home keys. I don't know
how to type properly and over the years developed my own crazy system. I'm
pretty sure if anyone saw my typing, ergonomic is the last thing they would
describe it as.

~~~
Cthulhu_
My main issue with standing desks (and most regular desks actually) is that I
like to have the keyboard relatively low (forearms parallel or slightly
downward) and the display at eye height (well, top row at eye height, maybe a
bit higher); most screens don't go this high. Luckily most of my workplaces
have had printers, and where there's printers there's the best monitor stands
you can get: packs of A4 paper ;). Anyway I need a few more of those for a
standing desk.

I'm not a fan of actually supporting elbows, that (for me) would lead me to
leaning on them, which leads to 'hanging' and shoulder / neck issues.

~~~
nickjj
When I had a sit down desk, I always tried to get desks with the keyboard pull
out draw.

I also much prefer having the keyboard / mouse low, but then I just adjust my
chair to also match that height so my forearms rest naturally.

Funny enough that's exactly what I used to prop up my monitors too. It's so
good because you can fine tune the height by just removing a chunk of sheets.

If you sit up straight, the weight should be pretty evenly distributed. It
felt like floating on air.

In the end I guess that's what matters. Try to find a set up that puts
absolutely no strain on your forearms, wrists and hands.

------
dmortin
Even healthy people should turn on sticky keys:
[https://en.wikipedia.org/wiki/Sticky_keys](https://en.wikipedia.org/wiki/Sticky_keys)

Pressing, Ctrl, Shift, etc. combos strains your hand. With sticky keys you can
press key combinations by hitting the keys one after the other, instead of
simultaneously.

~~~
ivanche
A couple of years ago I heard that one should press Shift/Ctrl/Alt using one
hand and other key(s) of the combination using the other hand. At first, it
was awkward. I had felt that I was soooo slow. But after a week or two I got
used to it. Now I can't even imagine going back to using just one hand for the
combos and for sure the stress on my wrists is lower.

~~~
dmortin
Pressing, for example, Ctrl+C is simpler with the left hand only and if one
uses sticky keys then it's two separate keypresses, no stressing of the wrists
needed.

------
graeme
I had bad RSI in 2010/2011 that I cured. Then it came back in a mild but
tolerable form for several years. Last summer it exploded again, and I took
steps to solve it more permanently. Here's what has worked for me:

* Highly skilled physio who did MAT. Most physios did nothing for the problem. But, I found one who had been the physio for the local pro football team. Unlike the others, he didn't use ultrasound.

* Trigger point therapy massage. Far more effective than regular massage. Hard to find a good practitioner

* Handshoe mouse. A lot of my troubles were causes by mousing or trackpads. This mouse has been astonishingly comfortable. I think it forces you to use the shoulder and have good wrist flexion

* Using the keyboard I used while recovering. I tried any number of mechanical and ergo keyboards, but then remembered that in 2011 I had comfortably types a million words while recovering. I checked and found I had used the logitech MK320. I bought it again and have been able to type more. No idea why this cheap rubber dome keyboard has been so good for me

* External monitor raised up. After recovering, I switched to a mac and used laptops. Using it as a laptop was dumb; while recovering I had an external raised up. I did this again and I think the improved neck posture helps.

I was already doing weight lifting, so the "get strong" advice you commonly
see in these threads didn't apply. Though I think the problem would have been
worse without it.

Also, I find mobile phone use can contribute. I hold mine with my pinky, and
this leads to strain. I haven't figured out how to hold them well, because
they should be up near eye level to prevent neck strain.

Can anyone tell me how to make lists that doesn't format as a code block?
Double spacing seems to be the only way not to have list items all on the same
line.

~~~
ballenf
I was spending an hour a day doing stretches and exercises and sleeping with
two wrist braces.

Then I dropped wheat from my diet and it went away within a week. I was the
true skeptic going in, so I returned to wheat a few times and the pain comes
back every time within a day or two.

~~~
graeme
Interesting. I don't have that, but goes to show why trying a variety of
things is smart.

I tried a bunch of stuff that didn't work. The stuff that did work always made
a differece very quickly. Often within a day or two. Becomes startling when a
problem is otherwise intractable.

------
jdietrich
There might be something to the cold hands thing. Handwarmers are a ubiquitous
accessory in the esports community.

[http://businessinsider.com/esports-hand-
warmers-2015-8](http://businessinsider.com/esports-hand-warmers-2015-8)

~~~
Uberphallus
Having been a gamer (long ago), and a developer now, cold hands directly
impacted reaction time and precision, which in turn made one "get pwn'd". But
I didn't feel like it hurt more (or at all, no RSI problems here, cross
fingers).

------
randomsearch
My experience:

1\. Get ibuprofen for the pain.

2\. Cut down on time at the machine. Use the minimum you need.

3\. Stop using your phone/tablet so much.

4\. Start walking as much as possible. You will not believe how much this
helps.

5\. Change your mouse. [https://www.amazon.co.uk/Wireless-Vertical-Ergonomic-
Optical...](https://www.amazon.co.uk/Wireless-Vertical-Ergonomic-
Optical-1600DPI/dp/B00BIFNTMC/)

6\. Go see a physio for advice on exercises.

7\. Swimming for long-term strength and prevention.

It's worth adding that stress can be a significant factor, so if you're
stressed you should address that too.

------
teknico
Good keyboards and pointer devices are not as expensive anymore, both in money
and learning time terms. My picks:

Kinesis Freestyle Edge (never mind the "Gaming" slant):
[https://gaming.kinesis-ergo.com/edge/](https://gaming.kinesis-ergo.com/edge/)

A big-ball trackball (not the thumb-operated ones):
[https://www.kensington.com/us/us/4493/trackballs](https://www.kensington.com/us/us/4493/trackballs)

------
partycoder
A prioritized list:

0\. If you are in pain, stop immediately.

1\. Posture: get an ergonomic assessment at work, follow it. A proper posture
should not injure you. While typing your wrist should not be at an angle.

2\. Stretching: physical therapy will train you to do it correctly. poor
stretching will harm you even more.

3\. Wrist braces help preventing injury. Ice and ibuprofen can help managing
pain. But pain is useful to understand what is harming you.

4\. Get ergonomic hardware. A mechanical keyboard can be softer than a regular
one.

~~~
swah
Mechanical ergonomical (angled) keyboards are currently very expensive / rare.
I read that many coders are enjoying the Microsoft Sculpt as an alternative.

~~~
willtim
Expensive relative to what? Certainly not expensive relative to the rest of
your computer and your office chair. It's a great shame that so many of us are
willing to put up with the ten dollar keyboards that come complimentary with
desktop machines. The keyboard is the primary input device used for many hours
every working day. We deserve better.

~~~
swah
> Expensive relative to what?

It would cost me half my monthly salary, if I didn't get taxed. For something
that I might not even get used to and have no one to sell it to in the local
market.

------
eggie
I had the same kind of problem. For me resolving the issue was as simple as
learning and using the dvorak layout. Having a different and entirely more
efficient way to type completely resolved the problems I was having. This in
combination with a typematrix keyboard has ensured that I never once
experienced hand pain in more than ten years working with code.

Before, when using QWERTY on a regular keyboard, I reached a point where I
could no longer type at all without pain. Although I code I mostly write prose
and messages. After switching I can type on QWERTY without pain as the
original injuries healed, but I can feel after several hours how difficult and
uncomfortable it is to type on that layout.

If you're at a point where you can no longer type why wouldn't you consider
changing the layout of your keyboard? Even if it's to something substandard in
many ways it at least ensures you use your hands and arms in different
patterns. It's also a nice exercise for the mind.

------
attaboyjon
I solved my problem by getting serious massage therapy. For a long time I
thought I had carpal tunnel, but the real problem was super tight muscles in
my back and shoulder. After one painful massage the burning, tingling and pain
in my hand and wrist was gone. Outside of getting an occasional massage, the
answer was a regular routing of weightlifting.

------
desireco42
Pretty much as a rule, you will find Emacs users with wrapped wrists. When you
point out that editor of choice might be the cause, you will hear all kinds of
explanations and excuses. They are also biggest market for Kinesis and other
ergonomic products.

I had few times wrist pain and it is usually due to mismatch of height of the
desk and the chair.

------
jwr
As a data point, I had "RSI" wrist pain for many years, and finally determined
that it was psychosomatic. Sarno is spot on — I've been pain-free for the last
10 years after understanding the real cause.

If you have symptoms which are not easily explainable, and especially if they
vary, it is worth taking the effort to read his books.

------
kylnew
Failed Solution #1 has mostly worked for me. I regularly wear a wrist guard
and bought an Evoluent vertical mouse and have seen great improvements. The
wrist guards actually caught on a bit at my last workplace. I think maybe
people were afraid it looked dumb then once it started people realized they
should just go for it.

------
thomastjeffery
> a Kinesis Advantage keyboard

There are a lot of nice alternatives to this, too.

If you are happy spending >$300 on a keyboard,
[https://shop.keyboard.io/](https://shop.keyboard.io/) is definitely worth
looking into.

If you are feeling more frugal, there are all kinds of options. Anything
"ortholinear" is an improvement. We don't need typewriter-staggered layouts.
Anything that puts modifier keys near the thumbs instead of palms is also
helpful.

Here are some great open-source designs:

[https://olkb.com/planck](https://olkb.com/planck)

[https://www.ergodox.io/](https://www.ergodox.io/)

[https://github.com/adereth/dactyl-
keyboard](https://github.com/adereth/dactyl-keyboard)

------
yedava
The cause of my RSI was using arm rests on the chair and resting the wrists on
the desk. It led to scrunching up my shoulders which ended up causing severe
neck and shoulder soreness. This setup also caused pain in the underside of my
forearm when using the mouse for extended periods of time.

So I got rid off arm rests on my chair and put the keyboard and mouse on a
tray and put the tray on my lap. That was the neutral resting position for my
arms. And it got rid of my RSI for the most part.

If you've tried other options for your RSI and still can't find respite, check
if typing from your lap alleviates pain. You can test this using a laptop. If
using your laptop on your lap for long periods feels less stressful as opposed
to typing and mousing from your desk, it means the least stressful position
for your arms is at the level of your lap.

------
pasta
The cause of RSI is bad blood flow in your arm (starting at your neck).

So you have to figure out why blood flow is bad. And this might be different
from person to person.

Some personal experiences:

    
    
      * Bad posture.
      * Stress causing neck muscles to block blood flow.
      * Working too long.

------
watmough
My experience of eliminating RSI:

1) Consider getting a big trackball and learning to use it with your wrong
hand,

2) Get a better keyboard,

3) Work slower,

4) Walk as much as you can,

5) Lose weight,

6) Manage stress.

In common with many others, I believe there's an emotional and/or stress
context to pain, and you need to fight conditions such as RSI on multiple
fronts.

------
mnort
other useful books along these lines are Becoming a Supple Leopard, The Body
Keeps The Score, anything by Joe Despina

In my estimation, especially on the east coast, most people are more tense
than they consciously realize

I enjoyed that you pointed out avoiding caffeine as a way to detense

~~~
mnort
that should say Joe Dispenza

------
molteanu
I still don't understand why palm-pressing[1] the Ctrl key in Emacs is not a
thing. No pain, no stretching, and you can make use of both left and right
Ctrl. Lately I'm even using a Ctrl+Shift combination, both pressed with the
palm at the same time. Xah Lee was not wrong about it. It was actually the
most important thing I've learned from his website. Take it, use it, learn it
and I promise you, after a month or two, it's muscle memory, it's natural and
pain free.

[1]
[http://ergoemacs.org/emacs/emacs_pinky.html](http://ergoemacs.org/emacs/emacs_pinky.html)

------
tejaswiy
I'm not sure how much I agree with this post but what personally worked for me
was simply using the mouse with my left hand instead of my right. I play a lot
of video games and 15 years of intense clicking has taken its toll on my right
hand so I just limit the mileage I put on it now.

That's not to say never use your right hand at all - If I was playing some FPS
I'd happily switch to using my right hand again but giving it extended periods
of rest (by not using the mouse) and hitting tough key combos with my left
hand (Cmd + Shift + 4 + Space for a screenshot anyone?) were what made things
better for me.

------
fermigier
I've had RSI 20 years ago for about 1 year. At the time, my life basically
revolved around two activities, both known to have an impact on RSI (and more
specifically, CTS): programming / surfing the Web, and playing the bass.

Cold temp, as in the OP, was probably one of the issues. It went away, and
didn't reappear since, by using open glove when typing / playing the bass, and
doing some hands / wrist stretches before / during work and practice.

------
joelthelion
I've used Workrave ([http://www.workrave.org/](http://www.workrave.org/)) with
success for light RSI symptoms. It's a small piece of software that prompts
you to take regular breaks from the computer. It's a bit cumbersome, but being
forced to move away from the computer every now and then also has its
advantages.

------
sandGorgon
The Sarno thing worked for me and for another friend of mine. I can personally
vouch for it.

It was seriously bad and now I don't even have it.

------
hobie
I couldn't use a computer for 9 years. Then I followed "The Trigger Point
Therapy Workbook: Your Self-Treatment Guide for Pain Relief" by Clair Davies.
Within 3 days I could type for 1 minute, within 9 months I could work again,
but with occasional relapses. It is still the best $30 I ever spent.

------
mherrmann
What helps me:

1\. Ergonomical keyboard and vertical mouse

2\. QFMLWY instead of QWERTY [1]

3\. Massaging forearms with a Lacrosse ball

4\. Strength training: climbing or "rolling" a long barbell held behind back.

5\. Theraband exercises

[1]:
[http://mkweb.bcgsc.ca/carpalx/?full_optimization](http://mkweb.bcgsc.ca/carpalx/?full_optimization)

------
raverbashing
Ergonomics help, using the mouse less help but what really helped me was
[https://en.wikipedia.org/wiki/Gyroscopic_exercise_tool](https://en.wikipedia.org/wiki/Gyroscopic_exercise_tool)

(It takes a bit to get the hang of it though)

~~~
partycoder
Mousing should not injure you if done properly. Try using your shoulder rather
than elbow. A short keyboard (no keypad) can help too.

~~~
PakG1
Can you explain the biomechanics of what you mean? Not sure how elbows and
shoulders relate to proper and improper mousing.

~~~
partycoder
This is advice given to me during an ergonomic assessment.

~~~
PakG1
Yes, but what was the advice?

~~~
partycoder
0\. Sit straight, arms to the side. Adjust desk and chair so elbows are in a
110 degrees angle.

1\. Use a short keyboard (no keypad) so mouse and keyboard can be closer.

2\. Move mouse using shoulder rather than elbow.

------
VectorLock
I started getting RSI in the early 2000s and switching to a Kinesis Advantage
fixed it all. Occasionally I get sore when I use my laptop without the Kinesis
for extended periods of time, but the Kinesis is all I need. I think also
using a trackball helps a lot as well.

------
jstewartmobile
When I saw RSI in the title, first thing I thought was "emacs!" Sure enough,
emacs.

------
YCode
As a software solution there's a free program called Workrave that will help
time micro breaks, stretches, etc.

I find it's helpful to have actual timers and reminders and it sort of helps
me keep pace on how fast the day is going and how much time I have left.

------
chaoticmass
I used to get bad pain in my right shoulder from using a mouse. I switched to
a keyboard that doesn't have a num pad so that I don't have to reach so far to
use the mouse and haven't had pain since.

------
cptskippy
I was starting to have RSI related issues. My pinky and ring finger were going
numb, tingles up my wrist, and sore wrists. A lower desk and an ergonomic
chair did wonders and I no longer have issues.

------
gaius
I felt the first twinges of carpal tunnel years ago and switching from the
crappy “free” keyboards you get with any PC to a quality Cherry keyboard
cleared it up immediately. G80-11900 is my favourite.

~~~
clircle
Which switch did you use? I find that mechanical keyboards often cause more
pain since many keys require a lot of force to activate.

~~~
gaius
Using black at the moment, I have also used red.

~~~
clircle
Thanks, I may try one of those. Which did you like better and why?

I'm used to using Browns, which I find to be okay, but I really dislike Blue
switches.

~~~
gaius
I think on balance I like the Black better, but the switch isn’t the only
factor - the layout of the Touchboard on which I have black is different from
the MX Board in which I have red.

------
guruz
Related content from a former colleague: [http://www.amlie.name/how-i-beat-
rsi/](http://www.amlie.name/how-i-beat-rsi/)

------
danieltillett
My advice is get a soft silicone wrist rest and a silicone mouse rest. I used
to get RSI until I got some of these rests and since then I haven't had any
issues.

------
ulisesrmzroche
For me it was riding a motorcycle again: pressing the clutch over and over
again healed it, although I don’t recommend it because I almost fell a couple
times.

------
ben7799
Everyone has a different anecdotal experience.

I hurt the ulnar nerve in my left hand in 2013 bicycling. The doctor put me
into a brace and put me on some strong muscle relaxants for 2 weeks. I went to
work and typed with the brace on under the influence of the drugs. I already
had a long history (20+ years of regular weight training) and was really fit.
I had previous moments of discomfort over the years from bad keyboards or
overly cold office environments and such but nothing serious. This was at a
point where I'd been on the computer a lot for 20 years or so.

When I got out of the brace and off the drugs I immediately had full blown RSI
in _both_ arms. According to the doctor it looked like I had tendonitis in the
flexor muscles.

I went through everything they asked and nothing worked. I could "manage" but
was annoyed every day at work. All kinds of keyboards and pointing devices
didn't help much. The most helpful thing was using a foam roller to massage
the muscles of my forearms. This was not something suggested by the doctors or
PT, which was really annoying. The foam roller works better than having a
person massage your arms or use the ultrasound treatment on your arms. Most of
the physical exercises they prescribed & stretching made things worse!

At some point I discovered drinking black/green tea was causing the muscles in
my arms to tighten up. It was causing it throughout my whole body but for some
reason that didn't really cause any symptoms in other parts of my body.

When I eliminated the tea the symptoms started going away within a day or two
and then my forearms slowly got stronger and stronger over time. I was able to
get back to all the exercise/weight training/cycling, etc.. pretty quickly. I
had never really stopped the exercise anyway but it always caused inflammation
until I got off the tea. Maybe the tea had a circulatory effect on me, who
knows.

It was not caffeine. I can drink all the coffee/soda/energy drinks I want
without the symptoms returning. I don't drink that much of them but whatever
it was, it's not caffeine, it's one of the other compounds in tea, of which
there are a lot and of which most are not that well understood.

------
eli
Eliminating the use of a mouse and replacing it with a Wacom tablet
dramatically improved my symptoms. So much for my backup career as a eSports
gamer.

------
enothereska
Best advice that worked for me: make sure the daily repair is more than the
damage. For me that meant more exercise and regular breaks every hour.

------
m3kw9
What worked for me was to do more stretches on the forearms there was one that
was particularly useful in helping to release the ulnar nerve.

------
m3kw9
I’ve heard of docs that prescribed serotonin and anti depressant medications
to attempt to fix pain issues

------
robk
Kinesis keyboard was a lifesaver for me.

------
donquichotte
TL/DR: "I started wearing a sweatshirt and hand warmers at work, and I avoided
caffeine on the days I went to the office. The pain went away, and so far
hasn’t come back."

I understand that keeping back this information is a rethorical tool to force
the reader to read the article to the very end, but I believe it is a
dishonest strategy of keeping people reading.

~~~
_carl_jung
Do you feel the same way about books?

~~~
donquichotte
The books I read have non-trivial content and are written in an engaging
fashion, so, no, I don't.

------
xtf
Roberts Space Industries was more known to me then Repetitive-Strain-Injury
and fits too.

