My experience with RSI
by Sanjeev Arora, August
(and answers to some frequently asked
Repetitive stress injury (RSI)
is a broad term for pain that arises from repetitive motions, and
arises in many occupations. Pain in hands and arms
(occasionally, accompanied by pain in shoulders and back) that occurs
from deskwork and computerwork is often called Carpal Tunnel Syndrome (CTS) in lay
terminology, but medically speaking, CTS is a
specific injury to nerves in the wrist that is found in less than
such cases. I suffered from typing-related RSI, specifically, pain in
arms and back
since March 2005, and have slowly recovered for the past two years.
As of summer 2007, I consider myself fully recovered (I have been
safely typing many hours a day). This page summarizes a few things I
discovered in this time.
DISCLAIMER: I HAVE NO MEDICAL TRAINING AND THIS PAGE IS NOT A
SUBSTITUTE FOR MEDICAL TREATMENT IN ANY WAY. PLEASE USE THIS
INFORMATION AT YOUR OWN RISK.
I have read several books on RSI and the most authoritative one appears
to be Dr.
Pascarelli's Complete Guide to RSI. It details different types
of RSI and their causes, symptoms, and treatment. It is a bit
scary because it details how ugly things can get if you ignore
RSI. But a bit of fear is perhaps good
to help you resist the temptation to "work through the pain."
Here are some important points I have learnt, listed
approximately in the order in which they should be tried.
webpage on Feldenkrais.
- Finding a suitable doctor.
This is hard because there is no medical specialty devoted to RSI. I
saw my general physician, who, finding nothing obviously wrong,
suggested rest and better ergonomics. After a month of this, he refered
me to a hand surgeon. The surgeon checked me for nerve damage,
and finding none, diagnosed my problem as "tendonitis" in the hand and
refered me to a phsyical therapist. (In restrospect, I should have seen
a physiatrist, who takes a
more "holistic" view of problems than a
typical surgeon does.) After two courses of physical therapy over a few
months (accompanied by a few weeks of total rest from typing) my
problem was reduced but a persistent core remained. I
understand that this kind of partial "cure" is quite common. Many
people are left with some residual pain, which
they "manage" for the rest of their lives. In any case, it was
reassuring for me to know
that I did not have any "serious" nerve problems. But on a scale of
would say my pain still fluctuated between 3 and 6, with an average
around 4.5. That is still something you don't want to live with for the
rest of your life.
- Ergonomic equipment and typing
technique. Small investments in equipment can really pay off,
as described in Pascarelli and other books. A fair bit of computer work
possible -albeit more slowly---using dictation software such as Dragon,
which works surprisingly well (even the $100 version). Don't
overdo dictation though, or you will get RSI in your vocal cords!
Different people swear by different ergonomic equipment so you
have to experiment to find the "right" one for you. I tried several
expensive keyboards and mice, before settling upon the Goldtouch
keyboard, Adesso EasyCat touchpad and a chair from Neutral
Posture. Better equipment can alleviate
RSI symptoms, but sometimes the symptoms can return after a while,
which happened for me. So it may be a good idea to have several
keyboards and mice options and to switch among them every few weeks.
Good typing technique ---things like keeping the hand and fingers
avoiding repetitive actions---is more important. Frequent rests are
even more important. Obviously (even though it took me painfully long
to realize it) even if I rest for a minute every four minutes, I am
still working at 80% of full capacity, which is not bad at all if it
keeps pain away. I think a 1-minute rest (which can be as simple as
getting up and walking away from the computer) every 9 minutes is a
good routine even for people with no RSI. In restrospect, I think
sane work techniques and proper posture is more important than fancy
Interestingly, Pascarelli recommends against using wrist pads and
especially against "CTS wrist braces" you can find in a drugstore.
- Exercises, physical therapy,
hot/cold compresses. All of these can help. I have known
several young people who were otherwise in good health who were able to
get rid of RSI symptoms with change in equipment, rest, and some
exercises (e.g., the ones recommended in the Pascarelli book). I am
guessing their RSI symptoms were due to local fatigue or wear in the
hand muscles, and hence responded well to the obvious treatments.
- Good posture. Dr.
Pascarelli lays the blame for many RSI problems (especially persistent
ones) on faulty posture.
Though this may be obvious to people who are into holistic or somatic
approaches, I frankly found it a bit far fetched at first. Pascarelli's
explanation is as follows: faulty posture fatigues the muscles of the
neck and shoulders (which after all
support the arms), sending them
into a state of permanent spasm. Unfortunately, the
nerves controlling the arms and the upper body pass through these
muscles, and these nerves get
when the muscle goes into spasm. (One medical condition with this
description is thoracic outlet
syndrome.) Nerves deprived of blood and proper
signals tend to get in trouble and cause all kinds of other trouble
symptoms) downstream. Pain may occur far from the source of
trouble ---this is the reason why surgery at the site of the pain often
fails to cure RSI.
I now realize that my problems were caused by poor posture, and were
worsened by my naive efforts to improve posture. My single biggest
warning to people who ask me about my experiences is to avoid posture change as a kneejerk reaction to RSI
Another warning is that "posture problems" are hard to diagnose even
for doctors, most of whom suffer from poor posture themselves!
Unfortunately, learning good posture is
extremely difficult. For one thing, most of us have no idea of
what good posture is; I certainly did not. Looking at a picture of
"good posture" in a book and then trying to attain that posture
by conscious effort or "willpower" is not only doomed to failure but
also likely to
worsen the problem by putting additional strain on key muscles.
Furthermore, "posture" is an unfortunate term; what is at fault is the
body's overall organization.
seeing a good Feldenkrais practitioner is the best way to diagnose and
address such problems. (Yoga, tai chi, physical therapy etc. can also
but are not as effective in my opinion; see below.) I also
realized that I had a lot of stored muscular tension in my body which
best addressed by Feldenkrais. (Relaxation tricks like deep breathing
don't really suffice as the tension is not mental but
muscular, and is caused by faulty body organization.)
- Acupressure, acupuncture,
massages, trigger points etc.
I tried all of these, and think that they can have a role to play in
recuperation. (Though I must admit to being somewhat uncomfortable with
acupuncture despite having gone through 6-7 sessions of it. I am not
squemish about needles at all, but it does seem more
invasive than the other approaches.)
Dr. Pascarelli also recommends "soft tissue manipulation" or medical
massage. Massages and
acupressure can speed up healing by relaxing specific muscles and
relieving pain. I am especially intrigued by acupressure. It is based
upon vague notions involving "meridians" of "energy flow." For
example, an acupressure massage for back pain might involve
systematically "clearing" (i.e., massaging) energy blockages in the
"back meridian," which goes up from the foot to the head. Though this
may seem to the modern mind like black magic, a closer look suggests
that these meridians are correlated with what we today call biomechanics. To give an example,
how the foot strikes the ground is related to how tense the muscles in
the legs are, and this mechanical interaction can cause problems all
the way up the body and even headaches. So treating back problems by
looking at the entire back meridian makes a
lot of sense.
Acupressure seems related to another intriguing phenomenon identified
by modern medicine, namely, "Trigger
Points,"which are tiny tender points in the muscles that we are
unaware of until they are pressed. Trigger
points can refer pain to places far away from them. You can read about
them in several books, of which the best one seems to be the one
by Clair Davies,
who describes how to "get rid of them" by self-massage. There are
other, medically approved treatments for trigger points such as
release and steroid
injections, which I did not try. I found
Davies's techniques quite effective at temporary pain relief and for a
convinced I had found a cure for my RSI. Unfortunately, I soon
realized that if the problem comes from faulty posture and faulty
biomechanics, any relief from massage or trigger point treatments may
only be temporary. (However,
I would still recommend trigger point self-massage, at least for
pain relief and maybe a cure. It costs nothing and it teaches you a lot
about your body and can totally change your concept of "pain" and its
I did not visit a Chiropractor. Whatever I have heard about them
seem to make much sense, and they favor vigorous manipulation of the
spine, which seems potentially dangerous. However, I do know
people whose RSI has improved with chiropractic treatments.
- Feldenkrais. This
is what cured me, and which I recommend the most for chronic RSI
Feldenkrais method, invention
of Israeli physicist
Moshe Feldenkrais, is a way of retraining the body so that all
movements become smooth and efficient. (See my webpage on Feldenkrais.) There are two
of this retraining. The cheaper one is group classes called
Awareness Through Movement or ATMs. These are somewhat similar
classes in yoga, tai chi,
pilates etc., though Feldenkrais is very different from any of these.
(For one thing, the instructor doesn't show you how to make the
movement; he or she just sits around and talks while you do the
movements!) But more effective and dramatic improvements occur in
sessions (called Functional
Integration or FI) with a trained practitioner, which can cost
about $100 per hour in the US. In such a session you lie fully clothed
on a low
table and the practitioner gently moves or presses your body in
different directions to make you aware of (a) subconscious tension and
holding patterns in muscles that make your movement less efficient (b)
efficient ways of coordinating your muscles that your body had somehow
not figured out thus far.
I think FI is the trump card of the Feldenkrais method, which makes it
superior to yoga, tai-chi, pilates etc. Good practitioners of
Feldenkrais have tremendous intuition and insight and can sense
the source of your problems within minutes after watching your movement
patterns. Of course, the harder part is to get the fix across to your
subconscious brain (after all, did it ever help anybody to be told
"Don't slouch! Sit up straighter!"), and that is where Moshe
Feldenkrais's true genius lay. I think the lack of one-on-one training
why Tai Chi---which I also tried for more than a month--- or Yoga
are not as effective. If your brain has resisted seeing the
"obvious" all its life, it is not going to pick it up from watching the
In my case the end result of 16-17 Feldenkrais lessons (over a period
of 7-8 months) was that my shoulders and neck, which were too far
forward, eased to a more natural alignment, floating right to top of
the ribs. The agility and strength of the entire body greatly improved
(with no exercises or strength training). During this process, I
realized that Dr. Pascarelli's explanation of RSI was completely
correct in my case. As my shoulders and neck eased into a natural
alignment, I could clearly sense the muscles of my arms and hands
relaxing, since they were now being supported and helped by the more
powerful muscles of the trunk. After a while, my RSI symptoms were
gone. (The process of finding a better alignment was slower in my case
than usual because of an underlying complication of mild scoliosis,
which I had not known about. This scoliosis also improved a lot.)
However, I must emphasize the importance of working with a good
and experienced practitioner; see my
If you are
lucky enough to have a good practitioner close by, I recommend spending
your money on
rather than on massages, acupressure, physical therapy etc.
Note: most health insurances will not pay for Feldenkrais. If money is
issue for you, you may be able to find physical therapists or other
medically trained personnel who incorporate Feldenkrais
principles in their work, and are covered by your insurance. Of course,
the ideal situation is to get lessons
from somebody who specializes in Feldenkrais. (Warning: the first few
sesions may not address your RSI symptoms at all; your teacher
might choose to address other, bigger problems in body organization
before going to the arms and hand.)
- RSI Faq page.
- Another RSI page.
- Typing injury page.
- Ergoblog (ergonomic
equipment, software etc.)
- Feldenkrais Guild (find
practitioners in your region; links to many other resources).