Pain in my Hands, Too
Chip Patton
I just now became aware of the typing RSI discussions going on here; and I'd
like to add my two cents worth (although it pains me to do so). Obviously
this is a widespread problem, why then are the doctors so ignorant of it?
Here, very briefly, is my experience:
I'm 30 years old. I've worked as a computer programmer for 7 years, and
typed while in college before that. About a year and a half ago I transferred
to a new project. I had a lousy set up ergonomically (desk was too small
and too high and non-adjustable) and worked 55-60 hours a week, my only
break was a 10-15 minute lunch at my desk. Most of the workload/pace was
self-imposed, but the pressure to "get the job done" was palpable.
It took about 2 months before my arms started to go. I figured it was
just a little pain and I could work through it, when the pace let up my
arms would heal, hell, I'm fairly young I can take this. Oops.
A few weeks later I called our company nurse. She asked about my non-work
activities. I said I've played competitive table tennis for 12 years. She
suggested I quit. I asked how that would cause pain in my left arm. No
answer. I very patiently explained about my switch in work set up, hours,
etc. She finally set me up with an occupational injury specialized physician.
My symptoms have waxed and waned for the past 18 months or so: pain, fatigue,
soreness in the forearms, elbow, biceps, hands, right shoulder, inability to
relax my right shoulder, tingling, specific varying sore points. Always
the right is worse than the left (I'm right handed but operate my mouse with
the left hand), but both are effected. Sometimes its deadness wakes me at
night.
The first doctor referred me to an Orthopedist (hand surgery specialist) and
then a Neurologist. The first 2 doctors suggest I change my career, no other
help they can offer. The third said maybe if I forced it to get real acute he
could pinpoint something.
The things I've found that help have been a wrist rest (I always rest my
wrists now at the keyboard, I can't type more than a minute or two without
it), an elbow support (made myself from stiff foam rubber covered with duct
tape), an ice-pack in the evenings; work 40 hour weeks; take frequent breaks
and stretch arms, wrists, shoulders.
I know two others here with similarly severe and very similar symptoms. My
favorite theory is the restricted blood flow/anaerobic one since Carpal
Tunnel has pretty well been ruled out for all three of us (via nerve conduction
and other tests).
What types of doctors are most knowledgeable about treating this? One of the
victims I mentioned goes to a chiropractor for ultrasound therapy. The other
went as far as getting an MRI, which apparently no one knows how to read.
Neither are recovering, although the ultrasound seems to help some.
Has anyone recovered from this type of RSI (even if it required changing
careers)? I don't know of any. But it effects everything I do. I don't
hold my son, because it hurts and I'm afraid of messing up my job. I don't
do yardwork, because it hurts and I'm afraid of messing up my job. I don't
play competitive table tennis, because it hurts and I'm afraid of messing up
my job....
*****************************************************************************
Chip Patton Phone: (205) 730-7612 Mail Stop: IW1511
Intergraph Corporation
Huntsville, AL 35894-0001 Mailpath: crpa...@chipster.b15.ingr.com
*****************************************************************************
Richard Donkin
This has turned out to be a long reply, but I hope it is useful!
Yes, there are people who have recovered from RSI - I am well on my way to
complete recovery (touch wood!) from quite severe RSI about a year ago, which
took several years to develop. I have had 3 weeks off work, with about 2 half
days per week on RSI treatment ever since. I am typing quite a lot these days
and am about to get my own PC (with a Maltron keyboard) so I can do more work
at home in a better ergonomic environment, rather than on customer sites where
ergonomics are almost never very good.
Assuming you can do Internet ftp's, you might want to get a file from
soda.berkeley.edu called 'amt.advice', in the pub/typing-injury directory.
This summarises much of my experience in recovering from RSI (non-CTS,
non-Tenosynovitis, a bit like yours), and has a lot of background on RSI and
how it develops.
The treatments I have had or done to myself are many and varied more details
in amt.advice except for cranial osteopathy, Chi Kung and Chinese medicine
(mail me for info if interested). Comments as to efficacy are based only on
my experience, though I do know other people who have had similar experiences.
Bodywork for pain relief and longer term recovery:
- adverse mechanical tension physiotherapy - rapid effect, very useful, can
self-treat a lot, strongly recommended. This is the *only* mainstream therapy
I have had, all others are 'alternative', because conventional medicine is not
very able to treat RSI, as you point out.
- trigger point therapy (myotherapy) - ditto on all counts, very effective
indeed, and very easy to self-treat. Good self-help books, and good therapy
available in the US, less expert therapy available elsewhere in my experience.
This therapy has even 'cured' misdiagnosed 'arthritis'.
- Alexander therapy - much slower effect but crucial to get your body use
right and avoid poor postures at all times, not just when typing, very useful
in long term
Relaxation techniques
These are very important, as with Alexander, so you don't resume old stress
habits.
- meditation: hard to get into but useful on pain relief; in some cases I
could just turn off the pain for a while, still use breathing and other
techniques a lot
- flotation tanks: very deep relaxation, very easy to start doing unlike
meditation
Miscellaneous:
- Cranial osteopathy (cranial-sacral therapy): this is a very gentle therapy
that aims to untwist and release the fascia that surround nerves and muscles;
it has a definite effect, and I can feel things untwisting while I am being
treated, which is a very strange experience!
- Chi Kung (pron: chee gung): a Chinese discipline involving standing in
special positions for 10 minutes or longer at a time, still getting into this
but it has a good effect
- Traditional Chinese Medicine: my doctor (also Chi Kung teacher) has massaged
some oils into my arm and prepared a poultice of Chinese herbs which I now
wear continuously, changing for a new one every two days. This is
surprisingly effective, combined with minor dietary restrictions.
- Shiatsu (acupressure): was quite helpful in short term but not as good as
trigger point therapy
- Bao Ding balls: you roll these around in your hand, which are a little
helpful in short term for immediate pain relief, as long as you do this in the
right way (which I think is to stay very relaxed).
- Swimming: backstroke only, breast stroke not good for RSI. This had some
effect but I'm not convinced it was all positive. I am feeling better now
that I don't swim every few days. Maybe if it is done slowly, with relaxation
and with help from a physiotherapist? After all, it is repetitive motion!
Every one of these therapies has helped, but especially AMT and trigger
points; one of the major benefits has been increased awareness of tension and
other problems in my body, which means I can counteract it whereas before I
was not even aware of this (like most people). I am no longer doing AMT
physiotherapy, it seems best in the early stages, and flotation tanks are a
bit expensive for the benefit they bring, so I don't use them much any more.
I have also raised my monitor a lot, used a wrist rest, though I don't need
this now, and am just trying out the Maltron alternative keyboard, which seems
a lot better for my shoulder and arm tension. I also use a foot rest, though
I need a still higher one it turns out.
I also try to force myself to take rest breaks religiously, 10 minutes work
then 1 minute break, 1 hour work then 10 minutes break, 3 hours work then 40
minutes break. I try to type as little as possible, which is possible in my
job, so I end up doing between 1 and 4 hours per day, much of which is
lightweight mouse work rather than typing. Currently, some of this is on a
laptop, which is ergonomically horrible!
The main technique I use for taking breaks is software that tells me to stop
typing, which is annoying but very useful - also countdown watches. (See the
FAQ files from Dan Wallach for details on this and other topics). I now try
to get up and walk around, rather than exercising at the terminal - gets the
blood flowing a bit better.
I have a dull ache in the arms if I do too much, plus some hand and front
shoulder pain, but this is gradually improving from the agony I was in almost
exactly a year ago.
Not everyone will be able to recover from RSI completely, but I strongly
believe that everyone can improve, often to a point where they can resume
normal life, with some adaptations.
I have a few comments on your experiences:
> I'm 30 years old. I've worked as a computer programmer for 7 years, and
> typed while in college before that. About a year and a half ago I transferred
> to a new project. I had a lousy set up ergonomically (desk was too small
> and too high and non-adjustable) and worked 55-60 hours a week, my only
> break was a 10-15 minute lunch at my desk. Most of the workload/pace was
> self-imposed, but the pressure to "get the job done" was palpable.
>
I too found that stress was a huge component in getting RSI - working
literally around the clock under deadline pressure was a major factor. My
ergonomics were not too good, very low monitor and no foot rest.
> It took about 2 months before my arms started to go. I figured it was
> just a little pain and I could work through it, when the pace let up my
> arms would heal, hell, I'm fairly young I can take this. Oops.
At least you did not work on through the RSI for years, like many people!
>
> A few weeks later I called our company nurse. She asked about my non-work
> activities. I said I've played competitive table tennis for 12 years. She
> suggested I quit. I asked how that would cause pain in my left arm. No
> answer. I very patiently explained about my switch in work set up, hours,
> etc. She finally set me up with an occupational injury specialized physician.
I was very lucky in having a GP who understood RSI, physios who specialised in
RSI, a sympathetic rheumatologist, and an understanding boss. This helped a
bit, but was not a determining factor in recovery.
>
> My symptoms have waxed and waned for the past 18 months or so: pain, fatigue,
> soreness in the forearms, elbow, biceps, hands, right shoulder, inability to
> relax my right shoulder, tingling, specific varying sore points. Always
> the right is worse than the left (I'm right handed but operate my mouse with
> the left hand), but both are effected. Sometimes its deadness wakes me at
> night.
It is very common for symptoms to move around and get better or worse. As you
get treated, this will continue to happen, and is in fact part of the healing
process - the pain runs away from the treatment until it is finally nailed
down.
I believe that some CTS can be affected by treatments given above, though I
have no evidence for this other than the trigger point therapy book. Some
non-CTS RSI is misdiagnosed as CTS, according to a quote from a researcher
into the subject.
>
> The first doctor referred me to an Orthopedist (hand surgery specialist) and
> then a Neurologist. The first 2 doctors suggest I change my career, no other
> help they can offer. The third said maybe if I forced it to get real acute he
> could pinpoint something.
I have had no treatment from doctors, largely because they are no use at
treating RSI in my experience. Try AMT therapy and trigger point therapy
first.
>
> The things I've found that help have been a wrist rest (I always rest my
> wrists now at the keyboard, I can't type more than a minute or two without
> it), an elbow support (made myself from stiff foam rubber covered with duct
> tape), an ice-pack in the evenings; work 40 hour weeks; take frequent breaks
> and stretch arms, wrists, shoulders.
All good stuff - I've never used ice packs or pain killers (except for first
week) on the theory that they mask the pain, letting you push yourself harder
and do more damage. It's a personal decision, really.
>
> I know two others here with similarly severe and very similar symptoms. My
> favorite theory is the restricted blood flow/anaerobic one since Carpal
> Tunnel has pretty well been ruled out for all three of us (via nerve conduction
> and other tests).
The restricted blood flow/toxin buildup theory is quite commonly believed, and
seems plausible - Chi Kung helps a lot in this area, you can feel sensations
in your hands as things start flowing again. The poultice may help in
lymphatic flow, a castor oil poultice certainly does.
>
> What types of doctors are most knowledgeable about treating this? One of the
> victims I mentioned goes to a chiropractor for ultrasound therapy. The other
> went as far as getting an MRI, which apparently no one knows how to read.
> Neither are recovering, although the ultrasound seems to help some.
I heard that US chiropractors are good at this area, though ultrasound sounds
like a waste of time to me - never heard of any lasting effect, though it may
be a good palliative.
Try setting up an RSI support group, or joining one - see the RSI Network
newsletter, also on soda.berkeley.edu, for details of US groups.
>
> Has anyone recovered from this type of RSI (even if it required changing
> careers)?
As stated, I have, almost. I am still doing the same job, though with less
typing for now. A relative of mine got severe RSI from cataloguing books and
has also recovered a great deal through patient AMT physiotherapy (starting on
legs because hands/arms were too painful to be worked on!). She is now back
at work though with very little typing required in her new job.
> I don't know of any.
Can anyone else who has had some success post to this group? I'd like to hear
more stories of recovery.
> But it effects everything I do. I don't
> hold my son, because it hurts and I'm afraid of messing up my job. I don't
> do yardwork, because it hurts and I'm afraid of messing up my job. I don't
> play competitive table tennis, because it hurts and I'm afraid of messing up
> my job....
I've been there, even during the more recent months it has restricted my
activities.
Above all, don't give up hope - try to keep a diary (on tape if writing hurts
too much) so that you can see what the effect of each therapy is. Try one or
two therapies at a time, more than that makes it hard to see what the effect
is, reducing the effectiveness of self treatment.
Newsgroups are rather an unfortunate medium for RSI discussions - has anyone
thought of alternative technologies such as voicemail or fax distribution?
Failing that, mail me and we can talk by phone.
Richard
--
rich...@cix.compulink.co.uk
Timothy Freeman
I also try to force myself to take rest breaks religiously, 10 minutes work
then 1 minute break, 1 hour work then 10 minutes break, 3 hours work then 40
minutes break. I try to type as little as possible, which is possible in my
job, so I end up doing between 1 and 4 hours per day, much of which is
lightweight mouse work rather than typing. Currently, some of this is on a
laptop, which is ergonomically horrible!
The main technique I use for taking breaks is software that tells me to stop
typing, which is annoying but very useful - also countdown watches.
The only treatment I've been using is rest breaks and improving my
ergonomic setup. I have found that short work/rest cycles are better
than long ones; for example, typing 4 minutes then resting 1 is better
than typing 10 minutes then resting 5. Ideally I would like to rest
30 or 15 seconds out of every 3 minutes, but the keyboard watching
software doesn't support that yet.
My workstation has two keyboards now: a Kinesis connected via a PC and
the serial port, and the original Sun-4 keyboard. I recently
persuaded xidle (part of the keyboard watching software) to ignore
typing on the natural Sun-4 keyboard, and I type on it with pencil
erasers during my rest breaks. I haven't been doing this long enough
to figure out whether the extra typing with pencil erasers is harmful,
but I can certainly concentrate better now that I never have to stop
work completely.
--
Tim Freeman <t...@cs.cmu.edu>
When they took the fourth amendment, I was silent because I don't deal drugs.
When they took the sixth amendment, I kept quiet because I know I'm innocent.
When they took the second amendment, I said nothing because I don't own a gun.
Now they've come for the first amendment, and I can't say anything at all.
Clark
Have you seens a sports medicine doctor?
I've just started treatment for rsi, after having symptoms for over 2
years. The first dr. I went to just said 'use ice'. The second one was
a gp/sports med dr. She put me on motrin, gave me a splint for one hand
and an elbow brace for the other (rather lopsided ;) and sent me to
physical therapy. I won't say I'm cured, I've been undergoing this
treatment for less than a month. Still, on the days when I go to
therapy are the only times that I don't feel pain or tingling, at least
not for a few hours. Anyway, given what I've seen and heard from
people, this so far seeming to be doing some good and more good than
I've heard from others who've just had anti-inflamatories and splinting
or surgery.
Sue
--
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Sue Clark | "Chuck Heston - who I feel I've known in the
cl...@netcom.com | biblical sense" -- Dame Edna
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