Recovering from RSI Richard Donkin 4th October 1994 This note started off as an email message. It includes information about a number of treatments I have had for Repetitive Strain Injury of the adverse mechanical tension variety. I have updated it to reflect the fact that I am now almost completely recovered. Other people's results will vary - adverse mechanical tension (AMT) type RSI is unusual in that there seems to be no permanent damage, unlike tendinitis, carpal tunnel syndrome and other RSI disorders. However, these non-AMT RSI disorders may occur with, or be mis-diagnosed as, AMT RSI. .................. Yes, there are people who have recovered from RSI - I am now almost completely recovered, with only a slight stiffness and mild ache in my right hand from time to time, from quite severe RSI about one and a half years ago, which took several years to develop. I had 3 weeks off work, with about 2 half days per week on RSI treatment for one and a half years after that, and now no treatment at all except for self treatment a few minutes per day. I am still working full time and have started a business as a freelance computer consultant, involving a fair amount of typing on some days and nothing on other days, using both a desktop PC (with a Maltron keyboard) and a notebook PC (which is, of course, not too good ergonomically). The treatments I have had or done to myself are many and varied - more details in amt.advice except for cranial osteopathy, Chi Kung and Chinese medicine (mail me for info if interested). Comments as to efficacy are based only on my experience, though I do know other people who have had similar experiences. The amt.advice file can be found on ftp.csua.berkeley.edu, directory pub/typing-injury. Bodywork for pain relief and longer term recovery: - adverse mechanical tension physiotherapy - rapid effect, very useful, can self-treat a lot, strongly recommended. This is the *only* mainstream therapy I have had, all others are 'alternative', because conventional medicine is not very able to treat RSI, as you point out. - trigger point therapy (myotherapy) - ditto on all counts, very effective indeed, and very easy to self-treat. Good self-help books, and good therapy available in the US, less expert therapy available elsewhere in my experience. This therapy has even 'cured' misdiagnosed 'arthritis'. - Alexander technique - much slower effect but crucial to get your body use right and avoid poor postures at all times, not just when typing, very useful in long term Relaxation techniques These are very important, as with Alexander, so you don't resume old stress habits. - meditation: hard to get into but useful on pain relief; in some cases I could just turn off the pain for a while, still use breathing and other techniques a lot - flotation tanks: very deep relaxation, very easy to start doing unlike meditation Miscellaneous: - Cranial osteopathy (cranial-sacral therapy): this is a very gentle therapy that aims to untwist and release the fascia that surround nerves and muscles; it has a definite effect, and I can feel things untwisting while I am being treated, which is a very strange experience! I eventually dropped this due to time and cost but I think it had some effect. - Chi Kung (pron: chee gung): a Chinese discipline involving standing in special positions for 10 minutes or longer at a time, still getting into this but it has a good effect. I kept this up for a long time and still do it occasionally for relaxation and to stimulate blood flow. - Traditional Chinese Medicine: my doctor (also Chi Kung teacher) has massaged some oils into my arm and prepared a poultice of Chinese herbs which I wore continuously for some time, changing for a new one every two days. This did not have a great effect and was very expensive, but it may have helped overall. - Shiatsu (acupressure): was quite helpful in short term but not as good as trigger point therapy - Bao Ding balls: you roll these around in your hand, which are a little helpful in short term for immediate pain relief, as long as you do this in the right way (which I think is to stay very relaxed). Some people find these aggravate their problems since they are just another type of hand use. - Swimming: backstroke only, breast stroke not good for RSI. This had some effect but I'm not convinced it was all positive. I am feeling better now that I don't swim every few days. Maybe if it is done slowly, with relaxation and with help from a physiotherapist? After all, it is repetitive motion! Every one of these therapies has helped, but especially AMT and trigger points; one of the major benefits has been increased awareness of tension and other problems in my body, which means I can counteract it whereas before I was not even aware of this (like most people). I am no longer doing AMT physiotherapy, it seems best in the early stages, and flotation tanks are a bit expensive for the benefit they bring, so I don't use them much any more. I have also raised my monitor a lot, used a wrist rest, though I don't need this now, and am just trying out the Maltron alternative keyboard, which seems a lot better for my shoulder and arm tension. I also use a foot rest, though I need a still higher one it turns out. I also try to force myself to take rest breaks religiously, 10 minutes work then 1 minute break, 1 hour work then 10 minutes break, 3 hours work then 40 minutes break. I try to type as little as possible, which is possible in my job, so I end up doing between 1 and 4 hours per day, much of which is lightweight mouse work rather than typing. Currently, some of this is on a laptop, which is ergonomically horrible! The main technique I use for taking breaks is software that tells me to stop typing, which is annoying but very useful - also countdown watches. (See the FAQ files from Dan Wallach for details on this and other topics). I now try to get up and walk around, rather than exercising at the terminal - gets the blood flowing a bit better. Not everyone will be able to recover from RSI completely, but I strongly believe that many people can improve, often to a point where they can resume normal life, with some adaptations. Some miscellaneous points follow: I found that stress was a huge component in getting RSI - working literally around the clock under deadline pressure was a major factor. My ergonomics were not too good, very low monitor and no foot rest. It is very common for symptoms to move around and get better or worse. As you get treated, this will continue to happen, and is in fact part of the healing process - the pain runs away from the treatment until it is finally nailed down. I believe that some cases of Carpal Tunnel Syndrome can be affected by treatments given above, though I have no evidence for this other than the trigger point therapy book. Some non-CTS RSI is misdiagnosed as CTS, according to a quote from a researcher into the subject. Self treatment was the key to fast recovery for me - it allowed me to spend a large amount of time on treatment, far more than would have been possible through treatment by others. It also helped that I had enough financial resources to pay for many alternative treatments not funded by the UK National Health Service or my private health insurance. Above all, don't give up hope - try to keep a diary (on tape if writing hurts too much) so that you can see what the effect of each therapy is. Try one or two therapies at a time, more than that makes it hard to see what the effect is, reducing the effectiveness of self treatment. Richard Donkin Internet: richardd@cix.compulink.co.uk