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.
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.
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".
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.
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.
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. :)
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.
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.
I have to put my vote in for the Kinesis Advantage as well. For anyone reading this that might be on the fence about the cost, you will not be disappointed. I was suffering from excruciating pain in my forearms, wrists and fingers. That pain disappeared almost as soon as I started using the Kinesis. For me, the big difference is having a wide split between home rows. This keeps my arms almost completely parallel and alleviates the forearm pain. The key layout is a little funky at first, but what I have realized is that each individual key is positioned exactly where your fingers naturally curl and extend. The other change I made was to add a trackball. I keep the trackball on the left and my regular mouse on the right and switch up usage as often as I can.
I've actually never had any serious problems with my wrists, and sometimes I think that starting playing piano as a young kid, along with my guitar today, and with regular trips to the swimming pool and daily bike commute, helps keeping my wrists strong and pain free.
I've been using a kinesis freestyle keyboard for about a year, and before that a series of regular chepo 102 keys, but the possibility of having my hands apart a longer distance keeps my wrists more relaxed and overall I get a better body posture.
I think most of the problems other people have come from the latter: my elbows are on top of the table, which means my keyboard is farther away than what I see other people using and so I'm in a very relaxed position. The ubiquity of laptop's small keyboards certainly doesn't help either.
Because they're close enough to the regular keyboards, while offering both the split (match natural forearm angle) and the tilt (match natural forearm rotation) to better align natural wrist position.
I also like that they ditch the numeric keyboad, so I can put the Kensington ExpertMouse just to the right of the return key and not have to move my hand as far.
I did the exact opposite--one time I came across a very cheap keyboard with the keys wobbly and floppy. Was a relief to my hands.
Since then, as long as I used standalone keyboards I bought cheap keyboards where the situation of my fingertips hitting the key caps was that the caps evaded my fingers a little and required some kind-of adjusting of my finger movements to the individual key once my fingertips hit the key in question.
I guess the added movement helped to relax my fingers.
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.
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)
I have no problem in believing that things like this can help with the pain (a lot). But still, author says that now he is able to type in any uncomfortable position for as long as he wants, and it sounds little scary. "See? I don't feel any pain, it's great." Well, wasn't there some reason for that pain in the first place? Maybe you feel great, but still, are you sure that you aren't permanently hurting your own body? RSI isn't just a state of mind…
Yeh, I dug around a bit more and, quite scarily, the advice appears to come down to "ignore the pain and it will go away"
Now I appreciate that if the cause is purely neurological then it is a beneficial thing to do. But if it is physical in some way; well that just feels problematic.
If you can tune out pain (and I know this is possible) then what damage are you potentially then doing....
upvoted for powerball... it should be standard working equipment along with a Microsoft ergonomic keyboard (quit typing on that laptop RIGHT NOW) and a good mouse.
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
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.
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.
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.
I actually trained myself to use the arrow keys because of my RSI. Moving my hands away from the home row slowed my typing down a touch and alleviates some of the constant pressure on the fingertips.
But now that my RSI is manageable as well (two words: wrist breaks) perhaps I should try going back to hjkl.
I also switched to Dvorak due to RSI issues on a QWERTY layout. It's not a substitute for taking typing breaks and improving the circulation in your hands but it helps a lot.
I recommend trying for a day or so. Even after a few hours of use it's obvious that you're doing less work to type the same things. In 3 weeks your typing speed should be tolerable (capable of conversing on IRC) and in 3 months you should be up to full speed.
I don't type any faster on Dvorak than I used to. It's just more comfortable for my hands.
Decreasing finger movement reduces the number of distinct motions you make without reducing the overall number of distinct motions (though it does reduce overall motion.) I'm not convinced this is as good a proof against RSI as it's often considered, since it only ensures that you will type faster (keeping overall motion more or less static) or type less (which will weaken your muscles due to less use.)
Vim works great in Dvorak. I switched to Dvorak, and jumped right in to relearning my Vim keystrokes with it. After a few weeks, I was back to normal in Dvorak, in both typing and Vim.
For a while I used Qwerty for insert mode and Dvorak for command mode, but eventually I ended up using Dvorak for everything. My particular hand pain didn't show up until years after I took up Dvorak. My problem is mainly with my pinky fingers, and Dvorak actually seemed to be worse than Qwerty for me, so I've switched back to Qwerty.
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.
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. :-)
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).
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.
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.
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.)
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.
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.
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.
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.
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).
This is exactly what I was getting at in paragraph 5 of "The Cure" section ("If you find the idea...").
The problem with stress as the root cause is that after I resolved my RSI pain, I have been through tremendously stressful situations during which I was typing a lot, but these have not triggered any RSI pain. So I think there's something more going on unconsciously, and yes I agree with you it sounds pretty far out.
As for exercise, I should have mentioned in the article that I have always exercised regularly and exercise is a big part of my life, even while I was typing a lot, so in my experience exercise (while having may other benefits) did not help my RSI pain.
I got partway into the book. At the first mention of Freud, I wanted to put it down, but I'm so desperate for pain relief, I convinced myself to keep going. Shit, if it cures my pain, I'll believe in pyramid-building aliens.
Then I hit the next chapter where he lists Deepak Chopra as a supporting figure for the TMP idea. At that point, it's an instant Home, Left Arrow, Remove From Device.
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.
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.
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.
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
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.
[…]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.
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.
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.
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
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.
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.
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.
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.