My recommendations for RSI treatment

I’ve writ­ten this guide be­cause I’ve no­ticed up that a very large num­ber of peo­ple I know (es­pe­cially effec­tive al­tru­ists) have had some trou­ble with repet­i­tive strain in­juries (RSI), which is when overuse or repet­i­tive mo­tions lead to pain in one’s mus­cles, nerves and ten­dons. Some other peo­ple in the effec­tive al­tru­ist com­mu­nity sug­gested that I write it for this rea­son. This guide is mostly about RSI in the hands or arms caused by com­puter use, but peo­ple with other types of RSI or other types of chronic pain may find some parts use­ful.

This guide is meant as an ad­junct to a treat­ment pro­gram in­volv­ing med­i­cal pro­fes­sion­als. I’d recom­mend go­ing with their recom­men­da­tions any­where it con­flicts with the recom­men­da­tions in this guide (which is hope­fully not too of­ten).

There is a pretty long list of pro­fes­sion­als that you can see about RSI. Th­ese in­clude spe­cial­ist doc­tors such as sports medicine doc­tors, rheuma­tol­o­gists, or­tho­pe­dists, physi­a­trists, and pain spe­cial­ists. It also in­cludes phys­iother­a­pists, mas­sage ther­a­pists, oc­cu­pa­tional ther­a­pists, and er­gonomic spe­cial­ists.

I’ve done some re­search into the sci­ence be­hind treat­ing RSI, but I don’t have the kind of back­ground knowl­edge of a med­i­cal pro­fes­sional. The ev­i­dence on this topic is not great, so some of the claims in this ar­ti­cle are based on anec­dotes.

I try to fo­cus on where I think I can be the most helpful. I have lived with RSI for a few years, which I think gives me some in­sight that med­i­cal pro­fes­sion­als may not have. I’ve also no­ticed that at least in my in­ter­ac­tions with them, med­i­cal pro­fes­sion­als do not give many sug­ges­tions on daily liv­ing with RSI. I could not find an­other guide if this kind that overviewed the all rele­vant con­sid­er­a­tions for liv­ing with RSI in an ev­i­dence-based way.

I use the term RSI in this guide as an um­brella term to de­scribe mul­ti­ple con­di­tions in­clud­ing ten­dini­tis and carpal tun­nel syn­drome. I think this vague­ness is a virtue in this case be­cause it seems like gen­er­ally similar con­sid­er­a­tions ap­ply to all of these con­di­tions. I use the more spe­cific terms as ap­pro­pri­ate. There are some tests that you can get done to di­ag­nose carpal tun­nel syn­drome and this is likely worth do­ing for any pro­longed case of RSI.

I recom­mend a num­ber of prod­ucts and web­sites in this guide. I haven’t re­ceived spon­sor­ship from any of the sources in my recom­men­da­tions are only based on the merit of those prod­ucts and web­sites.

Surgery is sel­dom a good op­tion for RSI, so try to get a sec­ond opinion be­fore go­ing ahead with it if an or­tho­pe­dic sur­geon does recom­mend it. Steroid in­jec­tions are also haz­ardous and un­re­li­able, so be care­ful be­fore pro­ceed­ing with them.

My case:

I’ll share my story of RSI here. It may help you know where I’m com­ing from and may give you some in­sight into your case. I have not re­cov­ered from RSI, though my RSI and as­so­ci­ated chronic pain has im­proved a great deal, and there is some hope for a com­plete re­cov­ery in the fu­ture. I’ve also learned to get around the limi­ta­tions my RSI gives me, and it no longer defines me or gives me se­ri­ous prob­lems.

I’ve had RSI for ap­prox­i­mately the last four years. Prior to de­vel­op­ing it I had also be­gan to feel a num­ber of other bod­ily pains such as neck and back pain. I at­tribute this to a stu­dent lifestyle, a ‘no pain, no gain’ at­ti­tude, week­end war­riorism, worka­holism, perfec­tion­ism, anx­iety, and a stark lack of phys­i­cal health prob­lems in the past lead­ing me to tac­itly as­sume that my body was in­vin­cible.

I think that prob­a­bly these fore­shad­ow­ing phys­i­cal health prob­lems set the foun­da­tions for me to de­velop RSI. I’ve tried many differ­ent things but I definitely didn’t find any ‘silver bul­lets.’ I’m now able to use my hands to do al­most any nor­mal task ex­cept com­puter use (which I can only do small amounts of). I’m now good enough at us­ing text-to-speech soft­ware that I’m able to use a com­puter at ap­prox­i­mately the same speed for al­most any task as I could be­fore the in­jury. The chief re­main­ing prob­lem is some chronic mus­cle pain that I’m now fo­cus­ing on and try­ing to make progress on.

What to do when you start to no­tice you have RSI?

When you no­tice pain as­so­ci­ated with RSI for the first time, the best ap­proach is prob­a­bly to stop the trig­ger­ing ac­tivity un­til the pain goes away. This may mean chang­ing the tasks you’re work­ing on for a few days, but if this is an op­tion available to you, this rest pe­riod may pay off richly in the fu­ture.

You may also want to make some changes to your work set up when you go back to work. For ex­am­ple, if you nor­mally work from a lap­top you could buy an er­gonomic key­board and mouse and switch to a desk­top set up for your com­puter. Too much of the same type of move­ments, es­pe­cially if they are awk­ward move­ments, lead to the de­vel­op­ment of RSI and just chang­ing seem­ingly minor things may make a big differ­ence.

There also some se­tups that are in gen­eral more er­gonomic and so should be helpful for the RSI. Th­ese se­tups put your body a more nat­u­ral, less awk­ward, less con­tracted, and eas­ier po­si­tions for your body. But re­mem­ber that your body also just likes vari­a­tion. I per­son­ally fell into the trap of try­ing to at­tain ‘the perfect er­gonomic pos­ture’ at the ex­pense of vari­a­tion and this was a mis­take. You can try pe­ri­od­i­cally switch­ing be­tween your er­gonomic equip­ment in or­der to achieve this.

At this stage of the RSI that is prob­a­bly good to pay close at­ten­tion to the pain and not try to push through it. If the pain is get­ting worse and worse, definitely do not try to push through it. If the pain doesn’t go away af­ter this rest pe­riod or comes back, I’d recom­mend go­ing to a phys­iother­a­pist and pos­si­bly other health­care pro­fes­sion­als. You might also try ex­per­i­ment­ing more with your com­puter setup. For ex­am­ple, you might try stand­ing while work­ing for part of the day.

If you can af­ford to, it can make sense to throw more money and time into treat­ing the RSI then might naïvely seem ap­pro­pri­ate. RSI is some­thing that can se­ri­ously cut into your fu­ture pro­duc­tivity and well-be­ing, so this can eas­ily be worth it.

RSI is coun­ter­in­tu­itive:

One fea­ture of RSI that I found to be coun­ter­in­tu­itive is how it can in­volve much more of the rest of your body than you would ex­pect. I guess this is be­cause “ev­ery­thing in the body is con­nected” and if one thing starts to go wrong it can have a rip­ple effect on the rest of your body. I don’t think this is spe­cific to RSI, but is gen­eral fea­ture of the sorts of in­juries that phys­iother­a­pists and mas­sage ther­a­pists treat.

For this rea­son, don’t be sur­prised if a phys­iother­a­pist recom­mends that you fo­cus on your neck or an­other seem­ingly un­re­lated part of your body, even if pain in that area that is far from the chief com­plaint.

Also for this rea­son, it is also pos­si­ble for the RSI to spread or lead to other con­di­tions. This may hap­pen be­cause what­ever con­tribut­ing fac­tors that con­tributed to you de­vel­op­ing RSI in the first case are still pre­sent and may con­tribute to the sec­ond case. For ex­am­ple, if you de­velop RSI from us­ing a mouse with your right hand and switch to us­ing it with your left to avoid the RSI, you might then de­velop RSI in your left hand! It may also spread or lead to other con­di­tions be­cause sys­tems in the body are con­nected with each other in sur­pris­ingly in­ti­mate ways. For ex­am­ple, if you hurt your foot this could af­fect your walk­ing pos­ture which could af­fect your leg and so on. See the sec­tion on trig­ger points for fur­ther in­for­ma­tion about this.

What to do if you have re­cur­rent or chronic RSI

At some point RSI may de­velop into a sec­ond phase and differ­ent treat­ment con­sid­er­a­tions ap­ply at this stage. At this point the ‘com­pletely ab­stain from all trig­ger­ing ac­tivi­ties’ treat­ment route may no longer make as much sense. If you can eas­ily ab­stain from trig­ger­ing ac­tivi­ties, such as by speech to text soft­ware in­stead of a key­board and mouse, this ap­proach may still make sense, but avoid­ing trig­ger­ing ac­tivi­ties is now less press­ing. This tran­si­tion from acute to chronic in­jury may take place be­cause the origi­nal in­jury heals but is re­placed by trig­ger points or sim­ply a pain con­di­tion.

At this stage it seems like peo­ple may be­gin to rec­og­nize that they can reg­u­larly en­gage in a cer­tain amount of trig­ger­ing ac­tivi­ties, for ex­am­ple us­ing a key­board for three hours a day, with­out their RSI symp­toms be­com­ing pro­gres­sively worse or un­man­age­able.

I don’t have a good sci­en­tific or me­chan­i­cal un­der­stand­ing of why this sec­ond phase of RSI ex­ists. One ex­pla­na­tion that I’ve heard, which may not be en­tirely cor­rect but may at least give you the right gen­eral idea, is that at this point the con­di­tion may be­come pri­mar­ily re­lated to trig­ger points in the mus­cles rather than ten­don de­gen­er­a­tion or nerve dam­age.

When my RSI reach this stage, I found that cer­tain psy­cholog­i­cal tech­niques were es­pe­cially helpful. I de­scribed these more in the psy­chol­ogy sec­tion, but in gen­eral adopt­ing a mind­set of ‘ac­cept­ing your pain’ and see­ing that it is no longer a re­li­able sig­nal that ‘your body is dam­aged’ or that ‘you are bro­ken’ was very helpful.

At this point it’s worth try­ing a lot of differ­ent health­care prac­ti­tion­ers in­clud­ing spe­cial­ist doc­tors. If your RSI is not get­ting bet­ter, I would recom­mend to con­tinue to ex­per­i­ment. A lot of peo­ple just haven’t tried enough treat­ment op­tions. It is good to adopt the mind­set of try­ing any plau­si­ble treat­ment as long as the costs and risks from the treat­ment are low.

Text-to-speech soft­ware:

Us­ing text-to-speech soft­ware to re­place your key­board and po­ten­tially mouse us­age rep­re­sents the most de­ci­sive op­tion in avoid­ing trig­ger­ing ac­tivi­ties, though also the one that that has the largest time cost as a trade-off. Even if you de­cide not to go with this op­tion, it may give you some peace of mind to rec­og­nize that this can be a fal­lback op­tion if your RSI ever gets too bad.

You might say that there are two main lev­els to us­ing voice to con­trol your com­puter. One is us­ing Dragon to re­place longer stints of nat­u­ral lan­guage typ­ing in­clud­ing writ­ing emails and writ­ing in text doc­u­ments. You can do this to re­duce your key­board us­age with­out elimi­nat­ing it en­tirely while still us­ing a mouse. This prob­a­bly won’t slow you down and might even speed you up a lit­tle bit, all things con­sid­ered.

The next level is to use voice to con­trol all (or es­sen­tially all) of tasks on your com­puter. At this point you are no longer only do­ing speech to text but giv­ing many voice com­mands to your com­puter. This is what I do now, and it works ad­e­quately, though Dragon is not well-suited to this and the learn­ing curve is steep. It’s also hard to get Dragon to rec­og­nize long strings of char­ac­ters that are not from a nat­u­ral lan­guage, so pro­gram­ming will be es­pe­cially difficult. I know that some peo­ple are able to do this, how­ever.

There are some peo­ple who even pre­fer us­ing voice to con­trol the com­puter of our other op­tions even if they do not have any prob­lems with RSI. I have a bit of a hard time un­der­stand­ing this, but if you are par­tic­u­larly a com­puter ‘power user’ this could be true for you.

My cur­rent set up for con­trol­ling my com­puter by voice is the lat­est ver­sion of Dragon Nat­u­ral­lyS­peak­ing, an add-on to Dragon Nat­u­ral­lyS­peak­ing called Voice Com­puter, and a $120 micro­phone. The main func­tion­al­ity of Voice Com­puter is that pop­u­lates each win­dow or tab of your com­puter with a se­ries of num­bers at al­most ev­ery click­able lo­ca­tions (in­tags). Now to to click next to one of the num­bers you just need to speak the name of the num­ber and Voice Com­puter will click that lo­ca­tion for you.

If you buy Dragon Nat­u­ral­lyS­peak­ing, I would highly recom­mend buy­ing it from the web­site Know­brainer.com. They will give you much bet­ter tech sup­port then you can get from Nuance (the com­pany that makes Dragon). The Know­brainer web­site also has its own soft­ware that is an add-on for Dragon that is ac­tu­ally free to peo­ple with a dis­abil­ity or RSI (you just have to email them with any sort of ev­i­dence of the con­di­tion). I just pre­fer Voice Com­puter be­cause of its num­ber­ing sys­tem, but in other re­spects Know­brainer ap­pears to have bet­ter func­tion­al­ity.

Their web­site and fo­rums also con­tain a lot of use­ful in­for­ma­tion. At least if you are rely­ing en­tirely on speech to text soft­ware to con­trol your com­puter, it can be very frus­trat­ing. I’ve got­ten a fair bit bet­ter at us­ing the soft­ware over time, but Dragon and add-ons to Dragon are of­ten very buggy and you may find your­self hav­ing to in­vest very sig­nifi­cant amounts of time into learn­ing to use them bet­ter and trou­bleshoot­ing.

As an ex­am­ple of some of the prob­lems you may run into, you may run into se­ri­ous prob­lems if you try to use Dragon Nat­u­ral­lyS­peak­ing on a com­puter with less than an I7 pro­ces­sor and 8+ gi­gabytes of RAM.

Un­for­tu­nately, the ver­sion of Dragon that was com­pat­i­ble with the Ap­ple op­er­at­ing sys­tem has now been dis­con­tinued and there don’t seem to be any com­pet­i­tive al­ter­na­tives.

Trig­ger points and self-mas­sage:

Trig­ger points are hy­per ir­ri­ta­ble spots of mus­cle that, if some sources such as painscience.com are to be be­lieved, may be re­spon­si­ble for most cases of RSI and many other mus­cle pain is­sues. They are also more com­monly known as mus­cle knots. There differ­ent the­o­ries of what trig­ger points are, and I be­lieve a pre­cise mechanism has not been pinned down, but my im­pres­sion is that the sci­ence say­ing that that there is some­thing gen­er­ally similar to trig­ger points go­ing on, is quite strong.

Most of the in­for­ma­tion that I get in this sec­tion comes from painscience.com. The guy be­hind that web­site, Paul In­gra­ham, is a schol­arly and scep­ti­cal former mas­sage ther­a­pist and now full-time re­searcher for the web­site. His method­ol­ogy seems to be good, though one thing that gives me pause is if trig­ger points are as big of a deal as he says they are, I would ex­pect more health pro­fes­sion­als to be talk­ing about them and talk­ing about them more promi­nently. I only out­line some of the most rele­vant in­for­ma­tion in this sec­tion, and I would en­courage you to check out the pain sci­ence web­site for bet­ter in­for­ma­tion on this topic.

This ar­ti­cle gives some good tips for how to treat trig­ger points. He also pro­vides a trig­ger point symp­tom checker in that ar­ti­cle to try and di­ag­nose if you have trig­ger points. The best treat­ment is prob­a­bly some com­bi­na­tion of self-mas­sage as well as vis­its to a pro­fes­sional mas­sage ther­a­pist. The bal­ance be­tween these two meth­ods of treat­ment de­pends on how much money you can af­ford to put into the treat­ment, but you prob­a­bly want to have a lit­tle bit of each one.

If you rely only on pro­fes­sional mas­sage, you prob­a­bly won’t be able to af­ford the kind of fre­quency of treat­ment that is best for trig­ger points. If you rely only on self-mas­sage, you will prob­a­bly miss some trig­ger points that may be im­por­tant and ne­glect cer­tain tech­niques that may be use­ful.

If you men­tion you do self-mas­sage to them and are in­ter­ested in hear­ing tips, a good mas­sage ther­a­pist should give you some ad­vice on where to fo­cus on and give you feed­back on your meth­ods. A good mas­sage ther­a­pist should also listen when you tell them that you feel a trig­ger point in an area that they are mas­sag­ing, and fo­cus on that spot. It’s prob­a­bly best to try to find a mas­sage ther­a­pist who spe­cial­izes in trig­ger points or RSI. Nor­mal mas­sage tech­niques will also help with trig­ger points, but it’s bet­ter if they know what they are do­ing in treat­ing trig­ger points.

There are ways of ad­e­quately mas­sag­ing your whole body your­self with­out over stress­ing your arms in the pro­cess. Do­ing so takes a few tools and takes a while to learn how to do well, but is not difficult to learn how to do ad­e­quately.

The ba­sics of trig­ger point self-mas­sage is to put pres­sure on your mus­cles and try to find spots of mus­cle that are par­tic­u­larly painful to the touch. The spots will prob­a­bly give you give you a ‘plea­surable feel­ing of pain’ rather than an aver­sive one. The pain may be in­tense, but should feel some­how ‘right’ or re­liev­ing. You may also no­tice that when you touch the spot it refers pain to an­other place on your body. This pain may also some­what du­pli­cate your symp­toms, which is a very promis­ing sign.

Another promis­ing sign is if you no­tice your mus­cles in­vol­un­tar­ily twitch dur­ing the mas­sage. You may no­tice that the trig­ger point feels like a small ball in your mus­cle, per­haps the size of a pea. The mus­cle that has the trig­ger point and it is likely to feel very tight, it may feel more hard than you would think a mus­cle could be. Though trig­ger points are not nec­es­sar­ily as­so­ci­ated with tight­ness. The ba­sic tech­nique is to ap­ply pres­sure to the trig­ger point to keep it at a cer­tain level of pain, and as you ex­pe­rience less and less pain from the same amount of pres­sure, in­crease the pres­sure to main­tain the same level of pain.

Hope­fully you will achieve a re­lease of the trig­ger point which may be ac­com­panied by more in­vol­un­tary mus­cle twitches. After this the trig­ger point may still hurt, but it may be more like a sore­ness in the area then an exquisite ten­der­ness. At this point some sources recom­mend stretch­ing the area or perform­ing mo­bi­liza­tions in­volv­ing the area. Even if you do not suc­ceed in re­leas­ing the trig­ger point in one ses­sion, the mas­sage will likely be helpful in re­duc­ing your pain and re­leas­ing the trig­ger point in the fu­ture.

This is the ba­sic tech­nique, though you may want to add some vari­a­tion to this. I find us­ing my in­tu­ition and do­ing what­ever mas­sage tech­niques feel good to be helpful here. The idea with trig­ger point mas­sage is to use the mas­sage to re­lax parts of mus­cle that will not re­lax on their own. It is there­fore very helpful to try and re­lax the mus­cles you are mas­sag­ing and any nearby mus­cles while do­ing the mas­sage. Try to pri­ori­tize self mas­sage tech­niques and pos­ses­sions that al­low you to do this. Breath­ing deeply is also helpful with this and is highly recom­mended. One of the main rea­sons you want to avoid ex­ces­sive pain dur­ing the mas­sage is that ex­ces­sive pain will lead you to tighten your mus­cles, which is the op­po­site of what you want. You can also ex­per­i­ment with do­ing self mas­sage dur­ing or af­ter a hot bath or shower. Or com­bine it with con­trast ther­apy.

After a trig­ger point is re­leased it will likely come back at some point. For this rea­son it is im­por­tant to be dili­gent and con­tin­u­ing to mas­sage the spot. Do this per­haps 1 to 6 times per day. Reg­u­lar­ity is more im­por­tant than du­ra­tion when it comes to this.

One thing you may no­tice is that when you re­lease cer­tain trig­ger points, it may af­ter­wards be more easy to re­lease other trig­ger points. Trig­ger points may cause each other to come back. In­deed, you may not be able to get rid of cer­tain trig­ger points with­out re­leas­ing other trig­ger points first. You may sud­denly find that you are able to make a lot of progress with treat­ing trig­ger points af­ter find­ing some but you didn’t know about that were caus­ing other trig­ger points.

In gen­eral, trig­ger points in your neck and other core ar­eas of your body are more likely to cause other trig­ger points then trig­ger point in your ex­trem­ities. So if you have trig­ger points in core ar­eas of your body that seem im­por­tant, then it can be good to fo­cus on these.

You can find web­pages and books that give you more in­for­ma­tion about where trig­ger points for most com­monly, their com­mon refer­ral pat­terns, and spe­cific prob­lems that trig­ger points in spe­cific ar­eas tend to cause. The best of these may be the Trig­ger Point Ther­apy Work­book by Clair Davies. How­ever, at least ini­tially you’re prob­a­bly bet­ter off just know­ing the ba­sic prin­ci­ples of trig­ger point treat­ment and ‘chas­ing the pain’ by do­ing trig­ger point mas­sage in the way that feels best to you.

The tools that I would most recom­mend for this are a spiked foam rol­ler, a lacrosse ball, and some sort of hand tool that lets you ex­ert more pres­sure with less force. A body back stick is also helpful. You should be able to hit ev­ery spot on your body with the right an­gle and a lacrosse ball or spiked foam rol­ler be­tween you and a wall. Us­ing a tool to mas­sage your neck is not recom­mended, at least be­fore you be­come skil­led at self-mas­sage. This is be­cause there are im­por­tant blood ves­sels and frag­ile struc­tures there. The back of the head is an­other re­gion to be care­ful in. Books like The Trig­ger Point Ther­apy Work­book have in­struc­tions on how to mas­sage these re­gions safely.

If the pain does re­ally seem to be lo­cal­ized in your hands and arms, you can get quite far with just rub­bing your arms against ob­jects such as chair arm­rests and ex­ert­ing pres­sure. Mas­sage oil can also be helpful here. There’s a de­vice called an Ar­maid that speci­fi­cally made for mas­sag­ing arms and hands that is pretty good. It’s rel­a­tively pricey, but like many of these de­vices, they can eas­ily be worth it for the right per­son.

Phys­iother­apy and ex­er­cise:

Phys­iother­a­pists are some of the health­care pro­fes­sion­als with the most rele­vant area of prac­tice to RSI. Un­for­tu­nately, like mas­sage ther­a­pists they are not as well ed­u­cated as doc­tors and also of­ten be­lieve in some ‘woo.’ The recom­men­da­tion I’ve heard is to try and avoid hav­ing them us­ing ma­chines such as ul­tra­sound on you, be­cause these of­ten have weaker ev­i­dence ba­sis. My un­der­stand­ing is that ex­er­cis­ing the in­jured part is ba­si­cally always recom­mended for in­juries such as RSI. The phys­iother­a­pist should give you a pro­gres­sive ex­er­cise rou­tine that works with your cur­rent level of strength and in­jury.

There are a va­ri­ety of differ­ent ex­er­cises that you can do to in­crease strength in the re­gion and some of them hurt in a prob­le­matic way you can switch to oth­ers that do not. Ex­er­cis­ing the hurt area helps to re­pair it, pre­vent at­ro­phy, and cor­rect mus­cle im­bal­ances.

Mo­bi­liza­tions and stretch­ing:

Mo­bi­liza­tions, defined as tak­ing a joint through its range of mo­tion, may be very helpful for im­prov­ing RSI. I’m un­sure of the mechanism, but the mus­cu­loskele­tal sys­tem seems to op­er­ate on a ‘use it or lose it’ ba­sis and mo­bi­liza­tions may in­crease mo­bil­ity, stop the for­ma­tion of new trig­ger points, and speed re­cov­ery.

Mo­bi­liza­tions may could be par­tic­u­larly helpful if done reg­u­larly as part of a break from a trig­ger­ing ac­tivity. For ex­am­ple, you might set a timer to take a break from us­ing the key­board and do cir­cles with your wrist and fingers.

The ev­i­dence be­hind use­ful­ness of static stretch­ing (as dis­tinct from mo­bi­liza­tions) is less clear. Pain­science.com and other sources I rely on sug­gests that the ev­i­dence ad­justs that static stretch­ing does not have a use­ful effect be­sides in­creas­ing flex­i­bil­ity and that in­creas­ing flex­i­bil­ity is of­ten not use­ful.

On the other hand, even if the ev­i­dence might be lack­ing, there still seems to me to be a con­sen­sus among health­care pro­fes­sion­als that stretch­ing is use­ful, and so I still do it. Also, it is pos­si­bly the case that even if flex­i­bil­ity isn’t always use­ful, RSI may be as­so­ci­ated with patholog­i­cal de­creases in flex­i­bil­ity and self-stretch­ing may be use­ful in this spe­cific case. The gen­eral rule be­hind stretch­ing is that it shouldn’t cause you any pain.

The psy­chol­ogy of RSI

Your psy­cholog­i­cal re­sponse to RSI may be quite rele­vant. Get­ting RSI may be quite a blow to you, es­pe­cially if you have a more worka­holic bent. When I got RSI I strug­gled with thoughts like ‘my body is fal­ling apart’ and ‘my work­ing life is over.’ It’s im­por­tant to be able to be okay with tak­ing some time off to re­cover.

It’s im­por­tant to try and stay pos­i­tive and not catas­tro­phize. If you form strong nega­tive as­so­ci­a­tions with the pain, this may make the pain sub­stan­tially more aver­sive than it would oth­er­wise be. There are on­line sup­port groups available if you need them. Stress may also worsen the pain that you feel and lead to a nega­tive spiral. It is im­por­tant to re­mem­ber that pain is not always a re­li­able sig­nal of body dam­age, es­pe­cially in cases of chronic RSI. Your in­ter­pre­ta­tion of some­thing as be­ing threat­en­ing may in­crease the amount of pain that thing causes you.

You may want to try some guided med­i­ta­tions for deal­ing with chronic pain. See­ing coun­sel­lors is also an op­tion if the psy­cholog­i­cal as­pect of RSI seems to be par­tic­u­larly im­por­tant for you. Nor­mal mind­ful­ness med­i­ta­tion may also be helpful for cop­ing with the RSI as well as po­ten­tially re­duc­ing the pain it­self. If you feel dis­tract­ing pain dur­ing the med­i­ta­tion you can fo­cus your non­judg­men­tal aware­ness on the pain and this should make it feel less aver­sive, at least at the time.

Avoid­ing trig­ger­ing ac­tivi­ties:

One key way of re­cov­er­ing from RSI is by avoid­ing do­ing move­ments or ac­tivi­ties that ag­gra­vate the RSI. It may be sur­pris­ing how sim­ple or spe­cific trig­ger­ing move­ments for RSI may be. For ex­am­ple, through­out most of the time that I have had RSI, I have been able to do most nor­mal ex­er­cises at the gym. So I was able to main­tain my grip on sub­stan­tial weight with my fore­arms with­out much trou­ble while us­ing a nor­mal mouse could bring on pain within a few min­utes.

I haven’t been to many ap­point­ments with oc­cu­pa­tional ther­a­pists, but it’s my un­der­stand­ing that they are the ex­perts with the most rele­vant ex­per­tise to deal with this ques­tion.

One thing to keep in mind when avoid­ing trig­ger­ing ac­tivi­ties is to only avoid the spe­cific move­ments that ex­ac­er­bate the RSI and not avoid ac­tivity al­to­gether. Avoid­ing ac­tivity al­to­gether may lead to at­ro­phy, in­flex­i­bil­ity, and im­mo­bil­ity which can ex­ac­er­bate the RSI.

For this rea­son, it is not a good idea to wear arm braces for very long stretches of time. Th­ese braces also keep your arms rel­a­tively im­mo­bile which can cause trig­ger points. Prob­a­bly the best time to wear arm braces (if at all) is is dur­ing the trig­ger­ing ac­tivity it­self.

Do­ing ac­tivi­ties with your arms that en­gage them in light ex­er­cise and does not ex­ac­er­bate your RSI will prob­a­bly be helpful for the RSI. If you do need to start avoid­ing many ac­tivi­ties it might be good to sub­sti­tute oth­ers such as us­ing a row­ing ma­chine at the gym. I haven’t tried much of it my­self, but if you pre­fer to get your ex­er­cise through a hobby, climb­ing or boulder­ing seem like a great way to ex­er­cise your arms and hands (if done in mod­er­a­tion).

Another key thing to re­mem­ber while avoid­ing trig­ger­ing ac­tivi­ties is to avoid sub­sti­tut­ing for ac­tivi­ties that can be­come new trig­ger­ing ac­tivi­ties. Once you already have RSI, it can be more easy to de­velop RSI as­so­ci­ated with new move­ments. For ex­am­ple, I started to use a foot mouse af­ter I de­vel­oped RSI, but I fairly quickly de­vel­oped knee pain as­so­ci­ated with us­ing the foot mouse.

I think the key thing to keep in mind when sub­sti­tut­ing ac­tivi­ties is to keep ev­ery­thing in mod­er­a­tion and don’t con­tinue the ac­tivity if it starts to cause you much pain. If you live with other peo­ple and cer­tain house­hold chores such as clean­ing up af­ter your­self hurt your arms, con­sider ask­ing if you can do more of the tasks that do not ag­gra­vate your RSI in­stead of the tasks that do ag­gra­vate your RSI. Your house­mates or part­ner should be un­der­stand­ing about this. If many differ­ent house­hold chores ag­gra­vate your RSI you could con­sider pay­ing for a cleaner or other per­son to do these tasks.

Er­gonomic de­vices:

Er­gonomic de­vices are very use­ful for re­cov­er­ing from RSI while still be­ing pro­duc­tive. There is a wide range of er­gonomic de­vices and which ones work best for you will de­pend on which spe­cific move­ments are trig­ger­ing your RSI.

Un­for­tu­nately, it of­ten seems to be the case that once the la­bel “er­gonomic” is placed on a de­vice the price of that de­vice mag­i­cally dou­bles or triples. One way to get around this prob­lem is to see if your em­ployer or health­care sys­tem is will­ing to buy you these de­vices for you. There may also be pri­vate char­i­ties in your area that may be will­ing to buy these de­vices for you.

Hav­ing said that, even with a hefty price tag these de­vices can eas­ily be worth it even if you have to buy them your­self.

Tips and tricks for avoid­ing trig­ger­ing ac­tivi­ties:

  • If touch­screens start to ag­gra­vate your RSI, it is pos­si­ble to use your phone in some new ways. I am only fa­mil­iar with an­droid phones so this part will only con­cern an­droid phones, but I imag­ine that there are similar solu­tions for other phones.

    • There is an op­tion to type us­ing your voice on a stan­dard an­droid key­board. You may be able to re­place a rea­son­able amount of typ­ing who on your phone through this op­tion.

    • It is pos­si­ble to use a touch­screen with your nose. I was very re­luc­tant to do this at first be­cause it just looks re­ally weird, but hey, it works. This method is more awk­ward than us­ing your fingers, and you can’t eas­ily re­place all of your touch­screen us­age with this method. Be care­ful that you don’t overuse this method, since you may stress some mus­cles in your neck. De­spite how weird you might think this method as, I’ve never had a sin­gle per­son com­ment when I’ve done this in pub­lic.

    • Us­ing a voice as­sis­tant on your phone can al­low you to re­duce touch­screen us­age. For ex­am­ple, you can say “okay Google, search for XYZ.”

    • There is a voice ac­cess set­ting on an­droid that places num­bers in click­able ar­eas on your an­droid screen and al­lows you to to is­sue ad­di­tional com­mands such as “scroll up.”

  • You can eas­ily buy elec­tric ver­sions of many house­hold items if the as­so­ci­ated ac­tion be­gins to trig­ger your RSI. For ex­am­ple, I found elec­tric tooth­brushes and elec­tric can open­ers helpful.

Re­sources:

Most use­ful re­sources I’ve tried:

· A ver­ti­cal mouse

· A pen mouse

· Dragon NaturallySpeaking

· Voice Computer

· A ‘joy­stick mouse

· Ki­ne­sis Ad­van­tage Keyboard

· Ki­ne­sis Freestyle Split Keyboard

· A track­pad mouse

· Topi­cal pain re­lief creams such as those con­tain­ing men­thol and methyl sal­li­cy­late

Other re­sources that seem like they might be good but I haven’t tried:

· Smart­nav

· Eye move­ment track­ing software

· Mouse foot pedal

· Fold­able lap­top stand

Bibliog­ra­phy:

Un­less oth­er­wise noted, all sources are from painscience.com or from ex­pe­rience.

Many thanks to John Maxwell and Louisa Ro­driguez for feed­back and sug­ges­tions on this post. Many thanks also to (again) John Maxwell and William Saun­ders for giv­ing me ad­vice about man­ag­ing my RSI, some of which has been in­cor­po­rated into this guide.