I recommend reading "healing back pain" by Sarno which talks about this phenomena. The book is mainly about back pain but it applies to all kinds of psychosomatic pain. There's also a free forum with free guides and support from others who have dealt with the same: https://www.tmswiki.org/forum/
In particular the success subforum is very inspirational as it contains posts from peoole who have resolved all kinds of pain syndroms that they originally thought were caused by structural injuries (including rsi).
I feel like a shill writing this and I remember I thought people talking about this theory back in the day were paid shills. But I promised myself after I got rid of this huge burden due to the psychosomatic approach I would let people know about it no matter how many downvotes I get.
But ergonomically speaking I use a Kinesis Advantage 2 keyboard and a Logitech MX Vertical mouse.
You may also need a long break to heal, which might not be an option if you're American. An engineer from Germany I know had something like 4 or 6 weeks off work when diagnosed with RSI and nobody batted an eye.
I’ve trained and raced bikes for years and I’m currently on a break from cycling and now I’m running 5-6 days a week instead.
I’m eventually going to build a gym in my garage because I felt so dang good overall during the period I was lifting that I’m now convinced it’s part of the key to keeping my body from falling apart as I age.
Granted, all this can be alleviated by working out and sunlight. Get those bands and just work out. Nothing beats it.
My best advice. Try everything and see what helps. I’ve tried every keyboard under the sun. I even bought a datahand keyboard. The Kinesys Advantage is amazing. I have one. It made the biggest difference for me. I cannot use a mouse anymore not even for 10 mins. I use a touchpad now but in the beginning a Wacom touch pen (you can configure it to work in mouse mode) was the only thing I could use. Try these things and see what works.
A physio also gave me some writs stretching exercises to do each day which helped a little.
Biggest things that helped me when coding?...
Kinesys advantage keyboard
Wacom Bamboo tablet and pen (with mouse mode). It’s odd a first but seriously try this if you can’t use a mouse.
Highly recommend trying this.
Ps. Take it seriously and don’t just plough through it. It might never go away fully but you can avoid it getting so bad it affects your career.
The most intense symptoms (I even had partially numb fingers) went away after visiting the orthopedic who realigned my back. (You know, where they pull up your shoulders and then click, click, ...) I tried to move around more while realizing sitting still is the worst thing one can do for the back even if it might be less painful for the back/arms in some moments. Also I switched to an ergonomic setup and switched from vi to a more boring editor.
Then I started meditating regularly, slowed down on my job and quit it a few weeks after. Also I did a pause of around 2 months and at the same time I started doing swimming and parkour (1-2x a week). My new job was far less stressful and as it turned out it was okay to ditch the ergonomic setup. Now, years later, my back/arms/hands are better than ever.
Also take care to exercise important muscle groups for your job. Core strength helps a ton in sitting, and in my experience forearm adds a lot of stability to wrist and typing motions.
I would sometimes get tennis elbow (not sure why..) from desk work, and a specific type of releasing exercise was almost a light switch for the pain. So not just building muscle, but touching the right muscles in the right way i imagine is important as well.
If you're curious, specifically i use a type of rubber-ish solid tube that is designed for you to twist it. You can twist to build muscle in one direction, but you can also reverse your grip and "untwist" it under pressure. This tension-ed untwisting motion is what massively helped my elbow RSI, like a light switch, it was sort of insane.
That experience really solidified the idea to me that exercise is the foundation to damn near everything. Ie Physical Rehabilitation over reactive fixes like bone alignment / etc. Yea, posture is important, but i don't think posture can fix a body that isn't capable of supporting itself.
That's not RSI! That's from posture! This happened to me when I worked on the couch with my laptop on my lap. And to my friend. And to my mom. And to my other friend. It's always the same source, the ulnar nerve root coming out of C8-T1, always the same problem, the angle of the neck (looking down) and the set of the shoulders (typically because the elbows aren't supported in a neutral position), and the fix is always the same, use a proper height desk with a proper height monitor and proper height arm rests.
Did you have to do anything apart from changing your desk setup in order to recover? What type of medical imagery was needed (if any) to be diagnosed with your C8-T1 problem? Thanks for your help!
> What type of medical imagery was needed (if any) to be diagnosed with your C8-T1 problem? Thanks for your help!
Most likely imagery won't show anything because usually it's just strain and not something broken, overgrown, or torn. But if there's a more persistent physical cause like abnormal bone growth or a herniated disc, then an MRI of the base of your neck should be able to show it (though often herniated discs don't bulge abnormally in typical imaging postures so that's iffy too).
> Did you have to do anything apart from changing your desk setup in order to recover?
The first time it happened to me I managed to make it go away after two weeks of refusing to use my laptop on my lap.
There are certain exercises that may help like reverse fly where you squeeze your shoulderblades together hard and other things, but go slowly because DOMS pain will make nerve inflammation worse instead of better.
If someone recommends epidural cortisone injections, ignore them and go somewhere else. Those are expensive, dangerous, and painful placebos.
It's not rocket science - if your back is stuff and hurts, generally working out your back would have been a good preventative measure (but obv be careful with injuries etc!)
squat
Hits everything from the legs to the core to the upper back.
deadlift
alos hits everything as well as the pulling muscles so it really builds your back
pullup
works your upper back muscles and arms
pushups/dips
works your arms and chest
plank
the ultimate ab excercise.
Honestly, the best advice I can give is to hire a personal trainer for the first few sessions. Get one that knows strength training specifically to watch yoru form and make sure you have that mastered BEFORE you start lifting any serious weight
BACKSTORY:
so a few years ago I sheared my knee. I could not walk more than a few yards before my knee started grinding. I had resigned myself to eventually need a knee replacement. a few months of working with a personal trainer on the squat fixed that. Its like the injure never happened at this point.
On a positive note it's just insanely effective at getting me to exercise. I just have _no choice_ so I know I'll be regularly exercising so long as I'm still using computers.
I also recently switched from GNOME to the keyboard-centric awesome window manager [2].
[1]: https://www.kickstarter.com/projects/keyboardio/the-model-01... [2]: https://awesomewm.org/index.html
He agreed that it seemed my ulnar neve was getting pinched by my elbow, most likely (i had Google around, and while I don't think googling equals an experienced doctor, I told him my symptoms, what I read up on, and asked if he thought it was something like that. To my surprise he agreed after some tests and asking me questions).
He told me to start sleeping in a manner where I couldn't curl or fold my arms. He even advised taking a small pillow, wrapping it around my arm, and ducttapping it, so I couldn't bend my elbow at night even if I wanted to!
I didn't do that, but I did pay more attention to how I sleep, and kept my arms naturally straight (relaxed) when I slept. I did have an extra pillow, and I'd lay that across my arm, which was enough. Anytime I woke up and my arm was folded, I reextended it.
After a few weeks of that, and the pain and tingling not growing, it started greatly reducing and went away. I still try to sleep with my arms as straight as possible.
Plus I lost weight and had to buy new pants because they started filling off. And my shirts became too tight because I suddenly got some shoulders. Best problem I have ever had.
"I had 10 years of 24 hour a day, 7 days a week chronic pain in my fingers, wrists, forearms, arms, elbows from typing, mousing, and using a computer up until 12/12/2008 as a computer science student and as a software engineer."
source: http://www.tmshelp.com/forum/topic.asp?TOPIC_ID=5301 (interview is at bottom, soundcloud)
================================
Also see the "Seattle Repetitive Injury Support Team" site > http://www.satori.org/rist/, who claim:
"After many years of meeting to discuss treatment and coping approaches, share stories and ideas, listen to invited speakers and discuss good ergonomics, we are excited to announce that we think we have finally found a cure for most RSI cases! We know that sounds too good to be true, but please read on."
================================
Lastly, read these RSI success stories on the same technique: https://www.tmswiki.org/ppd/Repetitive_Strain_Injuries_-_RSI
This is a crazy journey, and it is worth knowing about.
Lastly, if you end up going this route, a podcast called "Tell Me About Your Pain" by pain psychologist Alan Gordon and neuroscientist Alon Ziv is a solid entry point on what to do next. It is an educational mini-series that explain what is going on in a build-up kinda way.
It might be worth it to do a consult with Dr. Schubinar who does video consults now (because of COVID) or the Pain Psychology Center (Alan Gordon's center) does sessions too. I am working through the Curable video workshops and found them key too (I am confident they will get me to the last 5%, they really clearly present what is going on).
Wish you the best!
I feel like I have "found it" finally, and it has been at least 3 years since I read my first Sarno book.
Over the previous months of September-December I binged-ate donuts multiple times a week, partly due to lockdown depression. I developed numbness and tingling in my arms & wrists. [I'm young in mid 20s].
Cut sugar since the new year and no more tingling/numbness.
One more thing is getting up and walking around for 5 minutes every 30min. We basically sit ourselves into these problems, and getting up is a helpful solution. I even knock out a bunch of 5-minute chores in a day thanks to this.
Finally, find some 10min yoga sessions to do in the morning. Do 'em a few times a week. They'll stretch your hands out in ways you wouldn't expect.
Oh, and smartphones suck to hold, find the tiniest one possible. iPhone SE is killer for this
Additionally I use Dvorak which I find to put less strain on my hands.
And paired with your advice to walk is this: wear a hoodie or any long-sleeved garment. I think increasing blood flow to my hands has helped a lot.
Rowing is, in my opinion, the perfect anti-programming exercise.
- you unfurl your body instead of hunching over, stretching it in a way counter to the usual strains programming creates
- you exercise your back, especially lower back, giving you support muscles for good posture
- you also exercise your forearms, building strength to support your wrists
P.S. If I've misunderstood your question and you're asking what machine specifically, I use a Concept 2 I bought 8 years ago but only because that was what my gym was using and I figured might as well match it at home. Nowadays there is a huge variety of machines to choose from, and the basic physiological benefits are going to be the same for all of them.
The muscles in your neck become tight due to keyboard work, and the pain radiates to your wrists. It’s often misdiagnosed as carpel tunnel or similar.
As I searched for info I came across a litany of temporary solutions that scared me: ice, anti-inflammatories (some people popping many ibuprofen or similar per day), wrist braces, expensive surgery.
When I started stretching, I could barely move my head to touch my ear to my shoulder. My neck was incredibly stiff. Do this test yourself.
Stretch your neck out, multiple times per day. 30 seconds or more per stretch, and there are 4 really core stretches. There is a set of stretches I can share via PDF in a PM. I should put them on a website or similar.
In addition, take many micro breaks throughout the day - relax your arms to your side, let your shoulders come back. Just let the blood flow. These micro breaks can be only 15 or more seconds.
Other things people suggest here can help - ergonomics (chairs or desks, mice, speech-to-text programs), working out, etc.) but in my opinion the source is tight muscles in your neck.
I learned all this from Rick Mahaffey of Peninsula RSI in the Bay Area. His practice is not there anymore, but he changed my life and I’m sure the life of many other keyboard workers with his simple and cheap method of stretches. For a while he was a go-to for local FAANG insurance companies when workers had RSIs.
How should we PM you, HN doesn't offer a messaging functionality
- Exercises and stretches from the pdfs here: https://orthoinfo.aaos.org/. Finding some that feel kinda good and then doing them a few weeks worked better than suggestions from doctors. I do the exercises as part of my warmup for my normal 3x a week workout and do the stretches at the end.
- Use a stylus for my phone at all times. Just the type that is a ballpoint pen with a rubber tip on the cap. Also a pop-socket to hold it with.
- Cut down on bike riding for the sake of my wrists.
- Play mostly console games, less phone and PC b/c consoles have more ergonomic controllers.
- Fasting. I do at least a 24hr fast every week and that always works at least temporarily. I have several problems related to inflammation and for some people this helps a lot.
Geekiest bonus suggestion: use XFCE as a desktop and configure all the hotkeys so you can do things like move windows around with the keyboard.
EDIT: The thing I will add here is that my thirty-plus years with RSI have taught me, is that it seems to be a deeply personal issue, and what works for me may not work for you, and vice-versa.
You’ve got to do what works for you, and good medical assistance will involve going through the list of various different things that might help in the order of how likely they are to help and how much they are likely to help — and if one thing doesn’t work for you, then move on to the next. And if one person or school of treatment isn’t working for you, then you should seek out alternatives that will.
Good luck, and good health!
Make sure your chair seat is in proper height (whole area of both feet are touching the ground).
Make sure your table is in proper height (your elbow should for a right angle when bent and resting on the table)
Learn to sit up straight (both elbows on the desk, belly touching the edge of the desk)
Make sure your screen is at proper height (top of screen at eye level)
If your hands are hurting from leaning on the desk, try to use a gaming mat - you can buy an XXXL sized one for your whole desk, I personally use two large mousemats, one for mouse and one rotated 90 degrees under the keyboard.
Wearing warmer clothes on your arms and hands can also help, try handwarmer gloves or long sleeves.
I did, after going through the months of therapy and various treatments. He told me that he sees this all the time - that some people (~10%) just have variations in how their tendon sheaths form in their wrists. For most people, it never matters. For people who use their hands a lot, it does. If you hit that Venn diagram of being in the 10% of the population with this problem and also heavily use your hands... therapy isn't going to help. You need surgery.
Now, does this apply to you? Maybe not - it is not the typical problem. But if you have tried everything else, ask a wrist/hand surgeon.
I dont use a mouse.
For me the arms where just in total relaxed position this way, but its probably the opposite what people advice :|
Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program (https://www.amazon.com/dp/1572240393/ref=cm_sw_r_cp_api_glt_...)
Oh.. I also got a trackball (Logitech MX Ergo Wireless Trackball Mouse).
[0] https://smile.amazon.com/gp/product/B00066D6K4 "TheraBand FlexBar Resistance Bar For Improving Grip Strength, Tennis Elbow, Golfers Elbow, Tendonitis "
It may not help with your issue because that sounds more nerve related. I'm not a doctor.
I should also mention some other things I have tried or still use: Kinesis Advantage2, Vimium, i3/sway, better chair, better posture, neck/scalene stretches, less laptop keyboard use. It all probably helps in some small way.
I was massively over using my pinkies with laptop modifier/arrow keys, and it's now all thumbs and home row. Took a while to come up with and learn my mappings in a Vim friendly way, but super worth it.
I had significant ulnar nerve pain. Tried PT, weightlifting, sleep braces, a (rather painful) nerve conduction study, stretches...nothing helped much, until the Keyboard.io.
Note: nothing expensive. Also, what works for you will vary.
1. Bad posture in back/neck could noticeably make my hands numb. Got a strap on thing that helps remind me to sit straight.
2. I think my hands/arm muscles were very weak, and somehow that made things worse. This kind of thing helped A LOT: https://www.amazon.com/TOCO-FREIDO-Strengthener-Adjustable-R...
It hurt a little at first, but after the first couple days things felt noticeably better with a tool like this. Note - I'm not a doctor, don't injur yourself...
3. To help posture, a little stand to put my feet on. This does wonders.
4. Sustainable schedule. I don't touch a keyboard on Saturdays, or Thursday nights.
5. Eight hours of sleep to let the body heal. Disciplined sleep schedule.
6. Games like CSGO are really bad contributors to RSI, so I cut down time on this (only couple games a week).
7. For some reason, stressful or work I hate doing makes RSI MUCH worse. So, try put yourself in a position to do things you enjoy.
8. Split keyboard. Stationary ball mouse. The mouse is a big one.
9. Monitor AT EYE LEVEL and close to you. I had my monitor far away with like 13px font like everyone else. This meant I was leaning, ruining my neck, and pinching/straining nerves.
10. Look at piano players. They float their arms. Everyone suggests resting your arms flat on your arm wrests. This seemed to cause a pain to go up my arms and into my wrists. Typing with floating arms feels much better, but I have to switch it up to prevent strain.
All in all, it's a bunch of little stuff I was doing wrong for a long time, and I caught up with me. I hope someone finds this helpful. I did get a nice chair, but this didn't seem to help much, so I didn't list it.
If I go back to a laptop, the pain comes back in a day, so I try to avoid that.
Then I bought a Microsoft Natural Keyboard Pro and an ergonomic mouse and it went away so quickly (like, nearly instant), that I now believe, that what I once read may be true: That the reason for RSI may be psychosomatic.
The interesting thing to note is, that I did not use an ergonomic keyboard/mouse in the last ten years and the RSI did not come back.
I took a couple of weeks off to design and build a custom ergonomic desk.
Within a week or two all pain was gone. I could work almost as long as I wanted to and be comfortable.
I also stopped using mice and moved to a thumb-operated trackball.
Look for ergonomic desks and chairs.
Hold your arms out 90 degrees and hold it for a minute. Fingers outstretched, hairy knuckles up. Stretch those finger tips like its Thomas Covenant.
Turn your hairy knuckles downside (apols if female, turn your non hairy knuckles down). Hold for a minute.
Rotate them so it's the reverse of whatever I said. Hold for 90 seconds.
Clench palms.
Get into gardening and another hobby, this one is bad.
It still comes back in a mild form when I read about it or discuss it, and your thread literally triggered pain on my left hand and forearm.
1) stop using mice and track pads (wacom pen and tablet for the win), It was the incessant clicking that did me in I think
2) focused physio, then followed up with regular (3x week minimum) yoga-ish stretching, and weight training.
Additionally it crept into my shoulders as tendinitis, solved the same way.
My issues are due to ligament laxity though which is not common unless you lose the genetic lottery.
- Switched from Emacs to Vim editing
- Started pair programming nearly full time
- Went from obese to normal BMI
- Got a Microsoft Natural 4000 split keyboard (after trying all the expensive mechanical ones that didn't help due to various bad angles)
- Standing desk almost every day with right height keyboard and mouse
Been pain free for almost a decade
These two things worked for me.
Also exercising helps for neck and shoulder areas.
And while I'm cycling I make sure I shift the position of my hands on the handlebars at least once every 10 - 15 mins or so.
I have a road bike, so I try and also 'ride on the drops' if that makes sense?
I tried western studio yoga too, and while I enjoyed it, it did aggravate some of my pre-existing back injuries.
I started exercising (very very infrequently) and trained myself to use the Mouse with the left hand.
It has been 15 years since then. I suck at a counterstrike now but avoided giving up on a career with computers.
30 years later you can still see odd bumps on my forearms, on the inside, but functionally I never has problems again.
She saved my career. Thank you.
Same thing with slight shoulder pains. I started using resistance bands and they went away.
A small improvement without exercise can be had by always wearing warm long sleeve shirts, which improves the blood flow or similar
I had wrist pain earlier in my career (pre-trackpad) that I fixed by switching to Dvorak and using a left-handed mouse or trackball.
But that pain comes back within ~10 minutes of using a trackpad. Those things should be banned, IMO.
What ultimately worked for me was a combination of massage therapy and self-massage.
I found that I had a large number of muscle knots/myofascial trigger points in my hands, forearms, tricep/biceps, shoulder, and back. Working with the massage therapist we slowly worked them out. In particular I found targeting the teres minor, which is a small muscle below the shoulder almost in the armpit, to be one of the breakthrough moments. Normally I have no back or shoulder pain, but when you find these knots and you start poking at them it can be incredibly painful.
I now have a home self-massage routine that I do regularly, especially if the tingling or any pain comes back, and it really helps. I use a combination of tools, including a lacrosse ball which I use against a wall on my forearms, back, and shoulders, and teres minor area, a Theracane massage stick, and a forearm massage tool from Armaid.com. The combination of the Armaid and Lacrosse ball really helped work the knots out of my forearms, and I highly recommend both of them.
A book I found useful was "The Trigger Point Therapy Workbook" by Claire Davies. I coupled this with a muscle anatomy book to help name/identify muscles to search in the Trigger Point book. The location of trigger points and symptoms as described in the Trigger Point book were uncannily accurate, it was literally spot on.
There are some good youtube videos, blogs, and websites of course. A few I found particularly helpful were the "Doug and Brad physiotherapy channel" (https://www.youtube.com/watch?v=HzVO9DU-bog), and the Painotopia youtube channel and corresponding website: https://www.youtube.com/channel/UCCwTpwn8lWZQ_lXfUPL1JZg/fea... https://www.muscle-joint-pain.com/ the Painotopia website is full of info, but I did find that I had to search around to find a bit.
Anyway, that's what worked and is working for me. I believe that stress, posture, and computer use, all contributed to developing these muscle knots, many of them near the ulnar nerve.
Everyone's pain, symptoms, and causes are different. Good luck! If you have any questions or want more info send a comment and you can drop me an email: my HN username @ gmail.com
The keywords I would recommend looking for when looking for a masseuse would be myofascial release, trigger-point therapy, and active release therapy, though, your mileage may vary of course. I found the 30-45 minute appointments too short, and the 1.5 hour too long, but an hour was just right.
At first we just focused on the shoulders and back, but as I learned and researched more, as well as trying to find problem spots myself, we did a couple sessions on calves, buttocks (mainly piriformis), hands, neck/scalenes, forearms/elbow.
A few other things I didn't add in my first comment:
- I now always use a heating pad under my keyboard. The office spaces I've been working in the last decade are cold, industrial spaces, and the desk surface and hence my keyboard are always frigidly cold. I was developing arthritis-like symptoms (joint stiffness, I could feel the tendon 'clicking' in my pinky finger). I now use a generic heating pad under my keyboard and couldn't go back to not using it.
- Really paying attention to my wrist/arm posture when I sleep. I was a side sleeper and would flex my wrist under my chin when I slept which was putting additional stress on my wrist/forearm, I now really try to focus on relaxing my hands/arms when I sleep. This took some time, but I think it's one of those little things that paid off in the long run.
- I also have a Dr. Ho's Tens electro stimulation unit which I will use on my elbow, forearm, shoulders and back as needed. I find it helps. For the cost of ~1 massage appointment it seems worth while, even though reception/reviews/clinical proof of it's effectiveness is mixed.