Programming with chronic pain
thomasvogelaar.me
thomasvogelaar.me
Oh, and since the author of the blog post mentions "tennis elbow": I healed mine doing unilateral triceps extensions with a kettlebell. I naturally felt that it was the most straightforward and efficient exercise, just by messing around with the weights. It took around two weeks to heal completely, and I had it bad on both elbows (judo practice and pull-ups with bad form will do that, yeah).
Indeed, rest alone will most likely result in a chronic issue that one can live with. But these injuries can be remedied even years later with the right physical therapy— it is rarely too late to make a change.
Example: nerve damage requires some unintuitive solutions that are difficult to isolate on YouTube or other resources (due to high volumes of quackery).
That being said, new treatments are being discovered all the time. I suffered from a TBI and I am part of a study. The medication I am on is 4 decades old, but it helps folks with TBIs, long COVID, ME/CFS, etc. with an 85% success rate. It is helping me as well. My working and long term memory have improved along some other stuff as well.
That being said, I feel bad for people with chronic pain. A sibling had chronic pain for decades, got accused of being lazy, etc. After seeing dozens of doctors spanning those decades, they finally found the cause and surgery fixed it. For every success like that, there are hundreds more that never see relief.
I'm not GP but did the same thing (ignoring my therapist's specific plan) because:
1. Every time I see him it costs me hundreds of dollars, and if we made any changes to the routine he will want at least 6 more visits.
2. When I asked about increasing the weight over time, he told not without first coming to another appointment because it would be unsafe. He also would only allow small increases at a time. Surely only for safety purposes, definitely certainly not in any way influenced or incentivized by revenue...
3. I'm not an idiot, and this is not rocket science. I know my body pretty well on account of living in it and with it and having been engaged in intense physical activity off and on my entire life.
4. Some of the exercises he gave me were wrong for me anyway. I have torticollis (something that he missed entirely despite me telling him about it at the time, though I didn't yet know the technical term for it) which necessitates some changes to the routine.
I think it's important as patients not to listen to the people who say, "You're not an expert. Shut up and listen to the experts." or "Are you a doctor? Then stop using your brain immediately and cease all functions of rationality and accept what you're being told." I've known plenty of experts (including myself in my own field) and being an expert and/or credentialed doesn't magically make you omniscient. Some of the most interesting and fierce debates happen between two people who are equally credentialed, and both of them can't be right.
It's your body and your life. You have insights into it that nobody else does. Be humble, know what you know and try to know what you don't know. Treat your doctor like an incredibly wise and experienced friend and give their opinion heavy weight - they are most likely correct. But that doesn't mean they are infallible. Sometimes they don't have enough information on your issue, sometimes it's just not something they have a lot of experience with, and sometimes they are just plain wrong. It turns out that a human with a credential is still a human. Forgetting that and treating them as god-like all-knowing machines won't make them such. You still have to engage your own mind, and sometimes that will lead you to finding a new doctor or in some cases just dealing with stuff yourself[1].
[1] I would hope it goes without saying, but in this current environment I think it bears explicit stating: Just because doctors are fallible and sometimes wrong does not mean whatever quack on the internet is right. There is some great information on the internet and some real quality people producing content. There is also a mountain of bad content that at best will waste your time and money and at worst could hurt you. I am in no way advocating that you shouldn't see a doctor or trained professional. You should do that. Just don't turn off your own ability to think when doing so. I do advocate "do your own research" (a phrase that has unfortunatley come to mean more than its face value, which is unfortunate) but step one or two of that research should (in most cases) be to ask a doctor!
Rest is not for "healing" it is to avoid re-injuring something already weakened by an injury
This is potentially very reckless advice
It’s potentially reckless to rest excessively, it just doesn’t feel that way.
The 'McGill Big 3' is comprised of 3 core-strengthening exercises that rely on muscular contraction (e.g. planking) over muscular extension (e.g. sit ups, twists). More on that here: https://squatuniversity.com/2018/06/21/the-mcgill-big-3-for-...
I weigh over 200 pounds. I would never walk up to a weight bar and military press 200 pounds cold. I regret that I used to walk up to a pull up bar and pull down with 200 pounds of force cold, I think it caused me shoulder trouble that was made worse by long days of intense keyboard/mouse work, and the caffeine in one or two cups of coffee per day.
Unfortunately I also have a very bad knee (osteoarthritis) and on some days I cannot walk from one room to the next without clutching every solid piece of furniture around me. Just recently, after years, I learned that it was movement that helped me most in such states. Of course I can barely walk and walking makes it noticably worse, but biking actually helps me quite a bit and rapidly improves my mobility and general well-being. But you kind of have to have the insight that moving is what you need, when you can barely move at all - and only certain kinds of movements too!
These issues are as complicated as anything else. Sometimes rest is necessary and sometimes certain movements are most beneficial. It's difficult to know. And rest is not a bad default, because while it might not help you, it rarely hurts you much worse. Training the wrong muscle when it shouldn't be trained can do some damage you might regret dearly for a long time.
Well that's not exactly what was written above but I read it in the same way.
Dear reader, if you want my advice instead; the internet advice of random posters is great for finding new ideas but little else.
I happen to have a glut of experience with injury, recovery and pain too. Whether or not a particular injury needs rest or exercise depends on very many factors and expert physicians will differ.
I slept maybe 3-4 hours per night for ~7 years.
Then one day I saw someone on Hacker News mention Dr. Sarno's book, and it changed my life.
I convinced myself that the pain was all in my mind. I'm still not 100% symptom free, but I now have far more good days than I do bad days.
I read all of his books and I try to re-read the first one at least once per year.
It become convenient for me to blame my problems on my chronic pain. I fixed all of that by simply changing the way I thought about the pain.
Now, whenever I feel the pain flaring up, I just make myself focus on my breathing rather than focusing on the pain. And then I simply forget about the pain.
I guess it's impossible to prove whether someone's anecdote is genuine or not. I'd at least suggest people try visiting a YouTube financial advice video, read the comments, and you'll see this pattern like every ten comments.
Edit: I'm pretty sure this is the post that first taught me about Sarno. Just based on my comment like history.
He does encourage patients to stop any and all forms of physical therapy. I had already stopped PT by the time I read his first book. But I do remember thinking that the PT was making it worse.
All of the stretching and specific exercises were only causing me to focus on the pain even more which lead to even more pain.
But I would add that one should be careful when exercising and stop as soon as the pain is more than a nuisance. I have pain in my ankle and after trying to sprint through the pain I couldn't walk for a couple weeks. Then when I started going on really easy runs and slowly ramping up the time/pace, it finally started to improve.
I learned of Dr Sarno from HN several years ago. I bought 2 books of his, and did my best to implement what he wrote.
It made no improvement to my pain (very similar pain as the author).
I definitely don't mean to turn people away from Sarno's treatments. I have definitely met folks who have never heard of Sarno, but whose pain evolution and eventual management aligns with what Sarno has in his book, so if you do have that type of pain definitely check it out.
But don't blame yourself if it doesn't.
I "upgraded" to a Casper mattress in 2019 and it took 5 years of debilitating referred pain and headaches, and attempted resolutions including a 12-level spinal fusion, to realize that the mattress was the cause.
Switched back to a more traditional spring mattress and the pain faded within about 3 weeks.
Easily the worst and most trying experience of my life which will have lasting effects on the remainder of my life - never in a million years would I have expected that the mattress was the cause.
I’ve never seen any evidence to suggest this was good for spinal alignment. If you’re a side sleeper, it can also be bad for your shoulders if it doesn’t sink in enough.
If you don't sink evenly, your spine is aligned though not level. Whereas in a traditional mattress a poor fit to your body will feel like a hammock, or a hard floor with pressure points
I think that since I am a side sleeper (and have desperately tried other positions with no luck), that my body was sinking in to the bed but my head was not and so my neck muscles were compensating to try to "hold" my head/neck all night long, causing them to become overworked and fatigued.
I suspect people who sleep on their back or stomach have different experiences; my wife sleeps on her back and found the Casper to be comfortable but ultimately she got tired of the 'soft' edge of the bed which was not easy to sit on without sliding off, so she shopped for a spring mattress - and once my pain subsided we were able to put the timeline together.
Been on memory foam since 2011. "Upgraded" to a $3k traditional mattress in 2021. My pain became unbearable after 6 mo. Since my old mattress was disposed of, I bought a $300 memory foam mattress from Wayfair and it resolved my issues.
I had other issues sleeping at that time, but comfort was never one of them. And later on, when it became her guest bedroom, visiting home would often relieve my pain in a couple nights of sleep.
Her elderly aunt came to visit, and my mother had the mattress "upgraded" with a 6 inch foam \ pillow topper. I cant sleep on it. It causes me physical pain and distress. Eventually she replaced the mattress too, and now its just a ridiculously thick piece of foam and pillow. My spine relaxes to some kind of crazy bend when I am on it. I wake up feeling like I spent all night in a boxing match.
The only Orthopaedic doctor with impactful advice happened to have a daughter with the same issue. Loose ligaments required stabilizer muscles to work overtime. Her solution: supported strength training exercises to build up the larger muscles so they can compensate. For the next 6 months, I worked out 5 times a week, and the symptoms practically disappeared. I was able to work 8 hours at my computer with very little strain - compared to just 30 minutes at the start. The symptoms returned about a month after falling out of the routine.
Other treatments that helped:
Ergonomics - I use the Logitech ergonomic keyboard and vertical mouse. These have been great. I avoid using the mouse as much as possible, and use keyboard shortcuts + vimium browser extension to navigate.
Compression Gloves - Just like the author, I also found that long sleeves help somewhat. But not nearly as much as the cheap, fingerless compression gloves I get off Amazon. Between these and the ergonomic peripherals, my symptoms are generally under control, so I struggle to find motivation to continue my workouts.
Relaxing Muscles - When using a phone or game remote, support your wrist (and perhaps elbow) on a pillow. Avoid tightening your muscles - this is tricky when playing intense games. Stop doom scrolling.
YMMV, I am not a doctor, these subjects are complicated and actively researched
You also want a desk with a lot of depth; many smaller home desks don't have that. You're often better off with a table than a desk.
Eventually I came to the conclusion that chronic pain isn't curable. It's our nerves rewiring themselves to constantly send pain, even when no problem exists.
This also gave me peace though. Until I tried everything, I thought my body was breaking down. I'm a very physically active person, who has tried to be proactively healthy their whole life.
Knowing the pain isn't organ or muscle related, but is just fucked up nerves, is consolation. It's not preventing me from doing anything. I still have full range of motion and mobility, it just hurts, but it can't stop me from doing the things I want to do.
So I continue to be active. I have a very high pain tolerance as a result, but I can cope with the pain better than years ago. Last year I hiked the whole 2,600+ miles Pacific Crest Trail despite the pain. Strangely enough, my pain actually mostly disappeared on the trail, but returned after I got home. I think the sudden change of daily habits and sleep conditions may have thrown my nervous system in for a loop.
I have MS. I have brain lesions. It is just nerves, but they affect mobility for me, because it messes with the communication between the brain and some muscles (and my bladder, leading to incontinence).
So in my case, it is not a relief, to be honest. Unfortunately.
Also, lift weights. Squats/deadlifts/bench press. Hasn't helped my arms much but been a game changer for back and neck pain.
I had some upper forearm pain (likely from pullups, but perhaps coding as well) for around 6 months last year, and after a long break from pullups and trying the rice bucket it seems that the pain has subsided.
Could be worth a try anyway!
https://www.reddit.com/r/kettlebell/comments/1759tyo/elbow_t...
He's a small engine mechanic so full motion and sensation is ideal.
Just to add a little bit of my own experience. I had debilitating nerve pain as a result of surgery complications to the point where I could walk for a bit over a year.
It’s easy to fall into the trap of running from discomfort and making yourself more and more brittle in the process. At the same time it’s really easy to want to skip a few steps and try to jump back into the intensity level you are accustomed to. I think this even applies to coding. Before my surgeries, I could work for several hours straight and feel physically fine. Nowadays if I am physically static for such a long time, my nerve pain will come roaring back.
My main takeaways through all this are two relatively standard words of advice: “Movement is medicine” and that balance is key. Swimming, Pilates, yoga and build up towards more movement heavy lifestyle slowly got me to the point of walking and now being able to do 80% of what I once was able to again, but this time in a more sustainable way.
This NIH document has finally allowed me to (nearly) fix the problem:
https://pmc.ncbi.nlm.nih.gov/articles/PMC1119282/
I'm not going to tell you what, specifically, helped me, because every time I mention this the person then tells me that they did what I did, even if it doesn't apply to their body at all. If you read closely, the author details how various parts of the body are stretched in different sleeping positions. If any of these apply to your situation, give it a try.
"In this position the Achilles tendon of the leading foot can be inserted in the gap between the big toe and the first lesser toe to help correct a bunion."
That description is meant for the bottom of fig2 but applies to the top. Same with the penis lying on the thigh.
Similar story for fig1. "Left" actually describes top and "right" describes bottom.
Programming gave me "I forgot I have a body" levels of engagement with a problem. It was a way to actually find relief from pain. My addiction to programming was very useful in my development.
I was lucky in so many ways. My pain wasn't caused by the kinematics of my body, instead it was a heart condition, cancer, Celiac and Crohn's and I have managed to cure a nontrivial part of it over the years (heart surgery, diet change, immunosuppressants).
Ultimately i do not recommend the "cause yourself so much pain you seek refuge in flow state and become an expert" method. It results in a lot of maladaptive behaviors, damaged relationships and needing a lot of therapy (but also the money to pay for the therapy).
Counterintuitively, and for me, being more active helps. If I take a few days off because I'm lazy or tired I invariably get stiff and my pain ratchets up. Stretching twice a day is a huge help; I won't say how long as you have to come up with a routine that works for you. A massage every couple of months can help as well, as I often have spots getting bunched up that are pulling other things out of alignment.
As for treating it, I use non-THC CBD oil, Ibuprofen, and gabapentin when it gets really bad. My doc is currently discussing TNFi's with me for my AI stuff; we shall see if I pursue that.
Hiding in a flow state and such can be a little useful, for a while. I know what kinds of tasks I can best do when I am only at a five at the scale, which has apparently grown somewhat distorted due to becoming inured to such things.
They say suffering builds character, but they were not specific as to which type of character it builds, because it largely seems to have constructed only bad character for me. Part of me believes that many people -- and therefore society as whole -- could be not only more productive, but possibly better human beings overall. Our civilization, I think, would benefit from trying for solutions, treatments, and the like when it comes to chronic pain.
The scientist Lorimer Moseley has some excellent videos on Youtube about pain, recommended for anyone interested.
https://www.nature.com/articles/d41586-025-00456-x
Did this happen after a known infection of some sort? Does it run in your family? These questions may be important to know the answers to until science gets more tests over the counter as they are fairly close already.
A few years ago after motorcycle accident i broke without knowing a few bone in my leg. The urgency didn't see it despite making scan.
I went out of the hospital a few hours after and back to school, walking on the broken leg for days. Obviously it got worse to the point where my leg was red black from the foot toe to the very top.
After that, the pain came and it was constant, just like the author, but to the point where I couldn't sleep for 2 weeks. I spent days on the sofa in pain, falling asleep every 30 minutes but waking up literally just a few seconds after because of the pain.
A man can take a lot of pain but the kind that is constant and makes you sleep deprived is absolute torture.
I surprised myself of thinking what is the best way to end it all.
Finally, I went to the urgency because it was either that or I was going to end myself.
They gave me morphines over and over, felt good for a few seconds but then it would stop and the pain come back.
At some point I received enough morphine so that I went unconscious, slept for a long time and at wake up it was all gone.
The leg was still completely red, they say I went very close from having a Blood clot kill me but the pain was just completely gone.
My 2 cents, pain is a lot in the head. The more you think about it, the more it consumes you. It's easy to say don't think about it, but it's actually what you got to do.
Also I write this to everybody suffering from this kind of pain. It's the raging epidemic of our time.
This all sounds too familiar for fascia as the source of pain. Fascia pain is often described as "nasty". MRT doesn't show problems is also indicative of fascia.
I may say that I saw your profile pic on LI and immediately noticed your hanging shoulders. Slight head-forward-posture also doesn't surprise if I may say so and if I'm not mistaken.
My advice would be, leave the stretching behind. Theraband is an insult for every young healthy individual. I sorted out my problems by training upper limbs with weights (start with 1.5kg dumbbells), resistance band and also the occasional fascia roll aka foam roller.
Let me suggest some reading to get into the matter.
Beginner level: Fascial Fitness, Schleip Expert level: Anatomy Trains, Myers
Also: Built From Broken, Hogan
With kind permission, from that book:
Because posture is what you do most of the time, it is often at the root of joint pain, muscle imbalances, and injuries. On top of that, it tends to worsen with age. If you don’t address posture, you’ll be continually slapping Band-Aids on the problems caused by it. It’s a game you simply can’t win. But you can’t just fix posture by consciously holding yourself differently. It takes structural changes to musculature [...]. It requires a combination of training your body to maintain better posture and consciously working to hold yourself in better positions. [...]. While exercising, you train muscles and movements that improve dynamic posture, and you see a little progress from week to week. It’s a painstakingly slow process, but it works. And it’s worth it.
Same source: It isn’t the mountain ahead that wears you out - it’s the grain of sand in your shoe.
Good news is that you will get better soon if you start exercising regularly. Bit of a downer is, that it will take about the same amount of time to revert to "pristine" posture as it "took" you to imprint your current posture into your fascia.
Pain from the 50th repetition of a weight lift has far better quality to it than chronic pain.
I am taking more standing breaks now, and I use the gym at my office during lunch time to get some steps in on the treadmill, I also stretch everyday and I feel like it has been helping me heal but it is frustrating that I am not 100% recovered yet.
As for actual strategies to manage emotions, I would strongly recommend reading books about REBT (the precursor to CBT) such as "How To Stubbornly Refuse To Make Yourself Miserable About Anything-yes, Anything!" It's honestly been life-changing, and I think a lot of folks here would appreciate the rational approach to adjusting one's beliefs, feelings, and actions. Being able to avoid unnecessary negative emotions, and irrational beliefs that upset you, can be a superpower.
The good news is that with better posture, some equipment adjustments, and a new, slightly less comfortable chair, I've seen significant improvement and am feeling much better. So, I'm optimistic that you'll be on the road to recovery as well. Wishing you the best of luck!
I've had back pain forever, but the thing that has been really bad the last few years is "migraine" or tension headache that feels like it's coming from my neck.
The more I concentrate on my work, the worst I have it in the afternoon. This means I can rarely work a full 8 hour day without a nasty, nauseating neck migraine episode.
The only thing I have found that has helped a lot is quitting caffeine. I switched to decaf, which does not taste as good and only gives me a mild placebo boost each morning. I really miss my coffee, but it's not worth the headaches.
- Compression clothing.
Not only does it help you stay warm but it keeps enough pressure on your joints to really help
- CBD Topical
I'm not a user of cannabis but when my pain first started a neighbor recommended it. I was in enough pain that I said screw it, and it's been absolutely amazing at helping. Only way I can describe it is, imagine rub a535 on absolute steroids
Anyway, after he migrated to this new system, his productivity plummeted remarkably. He spent more time futzing with this system then he did actually doing work. I don't think he ever really got over that phase.
RSI is related but more general stress injuries, that can happen anywhere.
Whilst my tennis elbow is probably caused by poor ergononics and not warming up properly before exercising, I'm finding tiger milk mushroom, a known anti-inflammatory [1] is helping a great deal.
The aircon is a fun one. Outside of 16-18C (60-65F), the pain flares, and continues to flare. Mostly the referred pain and tendonitis. That reduces when under a fan or aircon - except the tendonitis. So I often end up wearing a jumper, and working under aircon. The two together confuses a lot of passerby.
And just to add - I sometimes use STT when my hands are worse, or TTS when the nerves in my eyes malfunction. And I gotta say... The accessibility controls on most IDEs is utterly crap.
If you have a hambuger menu? I might get read "triple bar" or "trigram for heaven". That ain't useful. If the UI absolutely has to use unicode symbols instead of text... Please give an alt text. Please.
Can you send me a screenshot or something?
Edit: Damn looks like it is Disqus, I'm going to remove that. I've got no interest in running ads.
With the latest 2.0 release, Chronic Pain is completely numb mindingly hard to develop in, offering unprecedented programmer suffering.
It now has git integration which builds a much more complex version control system on top of git, with three times as many commands. A repo now has three indices/staging areas. Commit hashes are no longer unique: the parent object where a hash reference pointer emanates specifies a salt which is used to hash the object being pointed to. Multiple hard links are then put into the object store to resolve these multiple references the same object. The documentation for this is like a root canal treatment, and never manages to explain the rationale.
AI is struggling with Chronic Pain too; 9 out of 10 responses are useless.
Anyway, try programming with Chronic Pain!