How I Beat Repetitive Stress Injury

I had pain in my right hand, that I fixed with trigger point therapy.

Using a mouse, typing, or using an iPad all made the top of my right hand hurt and feel very tired.

The trigger point therapist pushed on a few points in my forearm. When pressed, I could feel tension in the usual spots on my right hand.

Having found the right spots, the therapist simply pushed on them really, really hard, and maintained the pressure. It hurt, but immediately afterwards my hand was useable for everything except the iPad.

I went in for another session a few months later, he found another small spot that again referred pain to my hand, and after that session I could use my iPad normally.

It's a year later, and I'm totally pain free. If you have an insurance plan that covers trigger point therapy (most likely under "massage"), you should definitely try it.

Note: It can be hard to find a good practitioner. I'm not talking about deep tissue massage. Trigger point therapy is sustained applied pressure more than massage. The technique should hurt if it's being done properly, but the results are worth it.

It's all in your head. This is a must read for any stressed out programmer, founder, new parent -

http://aaroniba.net/articles/tmp/how-i-cured-my-rsi-pain.htm...

I find trackballs where the hand rests on top and the ball is manipulated only with the thumb are much better than mice and trackpads for cursor movement. Our fine motor skills are more refined in the thumbs, not in the fingers or forearm, which is something video game controller vendors have known for years...

Logitech makes these - this is the newest version: http://www.logitech.com/en-roeu/mice-pointers/trackballs/dev...

They've been making variations on the same thing since the early 90's - I have an ancient Mac ADB version in beige somewhere around here, which predated the invention of the scroll wheel...

I tend to get considerable pain in my forearms when I've been typing too much for too long, and I've found the easiest thing that helps is rock climbing. As little as an hour a week is enough to keep the pain and discomfort away, and it only takes two or three times of doing it after a "break" before the pain is gone.

I'm not sure why adding more muscle strain to the equation (when I'm in shape I climb 5.10/low 5.11) helps, but I've read that it's important to balance strength with agility, so maybe that's related somehow. Anyhow, climbing is a ton of fun, and anybody with bad RSI who's already using a trackball and an ergo keyboard should give it a shot.

Has anybody read "pain free" by Pete Egoscue? His aproach is that due to the continuous bad position certain back and shoulder muscles become weak and the other (not properly suited) have to make the force of the original ones. They finally contract or create pain due to the forced possition( take this explanation with a grain of salt as is from memory). He gives some easy exercices to recover the possition and strengthen the muscles. It is very straight forward. BTW he is no MD, but the system seems to work. Just as a note my wife is reumatologist and used to be very sceptic of this kind of "structural" theories, as there is very little of this on the medic literature. Now acter trying some of them herself, she thinks they have their place for some kind of pains. ( caveat this only a n=1 enviroment). I think is worth a shot.

I had (1) RSI too. The solution is in ergonomics, not a new mouse or keyboard or wrist support or whatever.

It's all about the way you sit in front of the computer.

Your wrists should be around elbow-level or a little lower when typing, your feet should be on the floor, and the upper half of your screen should be roughly at eye-level or a little below.

All of this is affected by the height of your desk, your chair, and of course your monitor.

  - Are you using a laptop and looking downwards at the screen? -Expect neck pain. 
  - Are you sitting too low? -Expect pain in your forearms.
  - Are you sitting too high? -Expect wrist pain.

1) I still kind of have RSI. If I'm doing something wrong, my forearms get irritated quite fast.

I posted a similar story here on Hacker News last week: http://news.ycombinator.com/item?id=3592000

Long story short: Using keyboard shortcuts and taking frequent breaks helped reduce the tension and pain I was getting from long hours at the computer.

I highly recommend AntiRSI if you're looking for a Mac OS X utility to remind you to take breaks: http://itunes.apple.com/us/app/antirsi/id442007571?mt=12&...

I've spent thousands of dollars on ergonomic keyboards and chairs. In the end all of them were nothing more than a crutch.

Here is the comment I left on the original blog post, since I think most readers will miss it; I've shared this before here to one degree or another:

I can one up you on this, I cured my RSI.

My story is similar to yours (short of the rolfing and acupuncture.) Around 2005 developed extremely painful RSI. Just using a non-ergonomic keyboard hurt like hell within 10 minutes. The only thing that really helped was limiting my work and typing.

That was, until I started doing body weight exercises back in late 2010. Back in 2005 when it hit me hard I was lifting weights regularly. That led me to believe that the weight lifting was at least half responsible. I backed off all upper body strength training completely. I felt like I was physically damaging myself when I did.

I wanted to build up some basic strength so I got this book “You Are Your Own Gym.” I hadn’t done a pushup in years so I started out doing them against a wall. By the end of the month I was doing normal pushups no problem. Then one day I got really sick and sat in bed on my laptop. Hours in I realized I had no pain whatsoever. It was mind blowing. Just months earlier things had progressed so my hands were partially numb all of the time.

Its been over a year and a half now. I had a few tiny incidents were I developed minor pain. I can do pull ups all day long. I can do clapping pushups. I can do handstand pushups. No wrist pain using a laptop 12 hours straight. I was really cautious saying this at first but I’m pretty sure now that I’m cured — assuming I get up with my workouts.

Here's what worked for me to cure my RSI:

(1) Kinesis Contour Keyboard.

(2) BodyBilt ergonomic chair with linear tracking arms.

(3) Stretch Break, a program which stops you periodically to do some stretches, which are illustrated by computer animated figures.

(4) Physical therapy to identify muscles that had completely atrophied in my back and to do (hard!) exercises to build them back up.

I'm sure I would have had to go on disability without these things, but I've been fine now for the last 18 years.

I started wearing one of these while I'm working

http://www.amazon.com/Mueller-Reversible-Splint-Wrist-Brace/...

Mueller wrist brace with splint

It only worked with a full-size keyboard and mouse. I can't wear it while typing on my laptop. I'll occasionally pop an Aleve in the morning if my forearm is bothering me.

Previously I was having occasional numbness and tingling in my right wrist. That has gone away.

Doc also suggested wearing a soft wrap on my wrist at night. Keep the area warm to promote healing, and keeps it in a relatively neutral position to prevent further inflammation.

http://www.amazon.com/Mueller-Wrist-Support-Wrap-Black/dp/B0...

I also have started lifting weights, though my doc said that could actually be putting further strain on the area. I think that was the case at first, but now I feel like my arms are strong, but more importantly my core and upper body and back are stronger. Helps with posture, and a lot of times the root of the wrist pain originates with other parts of you body being in a poor position all day. (skip the isolation exercises and just do compound exercises, especially deadlifts, probably the most underrated and unsexy, but its one of the best exercises)

Make sure your desk is low enough. It was subtle, but lowering it an inch put a lot less pressure on my forearms and less reaching.

And I drink a ton of water all day, which ensures I get up at least once an hour to pee or fill my water bottle. As others have said, taking breaks could be the most important.

Near the beginning of my career, I started getting really bad pain in my wrist, arms and back, and numbness down my right arm. I went through all the requisite things like the OP, even going to a rheumatologist, and nothing worked, and I was worried that my career was going to be cut short from this problem.

But the question that really bothered me was why I could spend most of my life writing for hours at a time with a pen, and not have similar problems.

I figured out, at least for me, was that the problem was my mouse. The way the current mouse is designed is to have your hand flat with the tabletop. When you use a regular pen, your hands are almost perpendicular to the tabletop . Your hands normal position relative to your body is essentially at a 90 degree angle to your body.

When you use your mouse with your hands flat to the table, it cause you to twist your hand out in a completely unnatural way and your elbows tend to flare out from your body, for hours at a time, and it pinches and eventually hurts some of the nerves in your arm and write.

My solution was to hold my mouse in different manner, with my thumb almost near the top of the mouse, and about half of my hand on the right side of the mouse, so that my hands were at an angle to the table. It also allows me to keep my elbows flush against my body instead of flared out. It's a similar hand position to how the trackball mice are, but I get away with using my $10 wired mouse.

I also switched to the original Microsoft Natural Keyboard (and I still use the same one today despite several drink spills).

This was roughly 15 years ago, and I haven't had any problems since. I work at my desk for hours at a time, without any breaks, and I'm generally okay, except for the weight gain from my sedentary lifestyle.

I've switched to using a laptop style, short-travel keyboard. As a matter of fact, I just stocked up on some spares, anticipating the product's inevitable demise.

I also have a comfortable but firm 3M gel palm rest (I don't actually rest my wrists on it). No longer sold -- of course.

I was finding the normal keyboard stroke length -- combined with the increasing binding during travel that inevitably occurs with today's budget keyboards -- to be increasingly tiring. To the point where I think I was subconsciously adjusting my workflow to avoid typing.

I'd just use the laptop keyboard, but they insist these days on manufacturing laptops with a "ginormous" shelf in front of the keyboard. As a result, the edge of that shelf ends up pressing into my wrists.

(On older models, years back, the shelf would end somewhere under my palms and so was not a problem. I may try a small form factor laptop (e.g. Lenovo X220) the next time I change machines, if I have a choice.)

Over the past 15 years, my RSI symptoms have been extremely well correlated to how much I read and hear about RSI.

Now my wrist hurts.

I'm surprised that none of the doctors suggested taking a break. That's the first thing the doctor I saw recommended: get up and walk around for a minute or two every hour. That was in my first year of professional programming, over ten years ago, and the problems never came back.

I think there are some doctors who make a blanket assumption that patients never successfully maintain lifestyle changes, so you might as well jump straight to drugs or surgery. That is probably 95% accurate, but I believe the 5% who are able to improve their lifestyles deserve consideration even if that means treatment is delayed for the 95% who won't, and there are plenty of doctors who agree. It was just the author's bad luck that all the doctors he saw ruled out lifestyle changes because of ignorance or cynicism.

On another note, an important thing for people working at computers to know is that typing may not be the culprit. Simply sitting at your computer can damage your body if you're tense, have bad posture, or maintain the same posture for long periods of time. The problems I had originated in my neck, not my hands or arms.

Also, for years I only had good posture when I was paying consistent attention. When my attention to my posture lapsed for too long (at the keyboard or anywhere else) I would sag back into my bad posture. I made a breakthrough when I discovered that a session lifting weights or kettlebells makes it easy for me to maintain good posture for the next couple of days. My "good" posture now is better than my old "good" posture, and if I've been in the gym recently, it comes naturally instead of requiring constant effort. I invested a significant amount of thought and effort into developing decent weightlifting form, but the effect on my posture is a physical aftereffect of the lifting itself -- knowing isn't enough, and apparently simply being in shape isn't enough, either, because my posture starts to slip after just a few days. My slack posture now is a little better than the sagging posture that used to come naturally, but it's still pretty bad.

I'd say I'm pretty heavy keyboard user - a touch-typing programmer, about 15 years in the profession. So what do I have to say about this? When your RSI begins, ergonomic keyboard may help you, may not help you, and often can make the problem even worse.

The way I see it, there are 2 main causes of RSI:

1) you work under stress, and you are hitting the keys much stronger and you are flexing your muscles much more than when you are more relaxed - this is a tremendous strain on your hands,

2) you are using a certain keyboard shortcut or successive combination thereof, or you are repeating certain specific movement which is causing you the RSI, while the RSI feels as if it's coming from the general usage of the keyboard, from generally using it too much.

3) (bonus point) It's something unrelated, like a missing vitamin or mineral in your body, or a heightened presence of a free radical or some other negative element. (I'm not a doctor so I won't elaborate here.)

I don't know how many ergonomic keyboards from Microsoft I destroyed while I was still on PC, but now I'm on a MBP 17" and at one point I had to work with a bandage on my left hand, in pain. Turned out the cause were the shortcuts for application and window switching on OS X. This was CMD+Tab and CMD+` (on an US keyboard layout, so the both Tab and ` are kind of higher). So what I did, I searched for an app[1] to remap the keys to a much more sane[2] combinations, and that fixed my hand.

[1] KeyRemap4Macbook, my config here: https://github.com/ypocat/misc/blob/master/keyremap4macbook/...

[2] this just made me realize the default shortcut combinations for app and window switch are in fact insane. And I don't think Lion solves this with the 2 finger swipe, which is one hell of a long movement, if you have to do it hundreds(?) times a day. At least the swipe gives you a switching direction, as otherwise, generally, app and window switching is one of the weakest design points of OS X, IMHO.

RSI began. I switched to Dvorak. It never came back.

(Yes, I've read the critiques of Dvorak's research on alleged speed and accuracy. But your fingers definitely don't travel as far - it could hardly be otherwise - and my fingers were a lot less sweaty afterward.)

What worked for me:

- 1.5 hour of weekly yoga (or more)

- changing hand for mouse at the end of each pomodoro

- learning more keyboard shortcuts instead of using mouse when possible

I applied this after nerves pinched me in the back, which stopped me from working during almost two weeks and was really, really painful.

This guy's experiences are very similar to my own except that mine started in 2004 when I moved my own stuff from location A to location B, injuring my wrist in the process.

And that started a two-year saga during which several doctors told me to quit my job. Obviously, I beat RSI (mostly), and still code to this day. Observations:

1) Avoid long-term use of NSAIDs: initially they work but ultimately they make you feel crappy, possibly because they do something to your liver causing your liver enzymes to rise.

2) Ice, ice, baby: A key aspect of the cure for me was submerging my forearms in icewater for 10 minutes daily until they became mostly numb. They were inflamed, and cold (though above freezing) is about the only anti-inflammatory with no really negative side-effects

3) Lose the mouse, lose the laptop: I use a logitech trac-ball now (though that penclic pen looks tempting) and a really big screen. If I want to revisit my pain, all I need to do is use a mouse for a couple days or try to use a laptop to be productive. Strangely, touchscreen tablets are fine. This tends to run head-on into the insane focus on laptops at tech companies these days.

4) Yes, it does seem like part of the problem is in your head: I hate hate hated my job in 2004 but I needed the money. I changed that in 2006 and started knocking everything out of the park. That's right about the time the symptoms gradually went away. Also, I started hitting the gym again and lifting weights despite the pain (losing the 15 lbs I had gained during the experience). It seems like once there's been a long-term physical trauma, one's awareness gets rewired to focus on it despite it being mostly healed and then the only way out is to deny its existence to the best of one's abilities.

5) I've become acutely aware of how many extraneous mouse motions and button presses exist right now and that's a real sore point with me.

Stuff that didn't work: yoga, rolfing (felt nice though), acupuncture (except for one time I needed to get something out by a deadline and one needle blocked the pain long enough to get there), various alternative mice and keyboards (Dvorak touchstreams and Kinesis were awful for me), and supplements (though I suspect more Omega-3s might have helped had I known about them)

Keep in mind that a split-keyboard like the Goldtouch might mitigate wrist deviation and pronation, but it does not eliminate them completely. If you want a completely neutral wrist position, I recommend the SafeType keyboard ( http://safetype.com/ ).

There is a video here of someone just pointing at the screen to control the mouse. This site hasn't been updated since 2009. There must be something even better out there by now, right?

http://www.mgestyk.com/

Switching from a mouse to using a Wacom tablet full time made a massive difference for me. Learning curve is a bit steep, but I think I'm actually faster now with most tasks. And using photoshop is definitely more fun.

Anyone know if there is a pen mouse like the one he shows, where you tilt it up/down/left/right instead of using a wheel motion? That wheel motion can't be good for your finger over long periods of time.

Is it bad that I thought this was going to be a joke about quitting emacs?

A standing desk eliminated my arm and wrist pain, for whatever reason. I think I move around more when standing and maybe tend to rest some body weight on my arms when sitting.

It also helps to remap mouse buttons to some keys on the keyboard (moving left/right click to the left hand, if your right has rsi pain).

I developed bilateral De Quervain syndrome (tendinitis in the wrists, starting near the thumb, spreading across the wrist) in college. I went out into the work field and suffered so much pain that I could barely shift my car on the way home from work. I was absolutely panicked.

I got physical therapy (where they told me the exact type of tendinitis I had), learned stretches, did strengthening exercises, and started tracking down better keyboards.

In the end, the Kinesis Classic contoured keyboard proved to be the one that saved my wrists. You'd be amazed at how much of a difference consistent, light keystrokes make. The other major element was stretching and light friction massage. By working on several wrist stretching exercises throughout the day, and making them part of my unconscious routine, my pain was alleviated within about six months. I also wore high quality wrist braces for the first couple of months, which provides an important rest for your joints.

Several years later, I discovered rock climbing. As pointed out by another commenter, this is fantastic for wrist health. The stretching and strengthening of the wrist (while having fun) is hard to match anywhere. Within about two months of beginning rock climbing, I ceased to have any wrist pain at any time. Not even a twinge.

Another few years later, I developed a bulged disc in my neck (ironically, it may have been initiated by a couple of preventable climbing accidents!). The entire left side of my neck and left shoulder became a bundle of tensed muscle, in a vicious cycle of self-defeating automatic body response to injury. The solution was ultimately to do more things that improved my posture. I've done weight training, focusing on my back and rear shoulders, and perhaps most importantly I've started walking more. Walking has an almost magical ability to reset your posture, provided you break out of your old habits of slouching. The other huge key for me was a Steelcase Criterium chair. The amount of relief provided to my neck and shoulders by having proper back and elbow support is simply indescribably.

If I point out that someone is slouching, or using devices that are an ergonomic catastrophe, many people respond with things like, "but I've been sitting like this for years without any problem." Well, I used to think that, too. Certainly, there are people who go their entire career slouching, leaning, and mousing on their outstretched arms. But here's the catch: you don't really know if you're prone to these issues until you've already developed them. So, for the sake of your future, I encourage all of you to 1) exercise 2) stretch and 3) get an ergonomic setup and use it properly.