Ask HN: How have you cured your RSI?

34 points by whitepoplar ↗ HN
Currently suffering from RSI, more specifically numbness and tinging on the ulnar side of both hands and wrists. After countless doctor's visits and imaging (x-ray, MRI) along with occupational hand therapy, nothing seems to work. It's gotten a bit better over the course of 18 months, but I'm still unable to comfortably type, use a smartphone, or perform many other daily chores. If anyone else has been in the same boat, any help? Thank you!

123 comments

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I had issues with my right hand (which as a professional bassoon player is not great). I struggled with it for years, and it came and went. Then I started swimming. I did a front crawl course, loved it and started swimming 3-4 times every week, and after about 6 months my hand pain went away.

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 never had actual diagnosable RSI, but I was on my way there I think. I really highly recommend split ergonomic keyboards though. They run quite expensive but are worth it IMO. At entry level there's the Kinesis Freestyle (~$100) but the Kinesis Advantage ($350) is probably the best ergonomics you can get without going for a more niche enthusiast focused keyboard.
I had neuropathic pain in my hands and feet on the ulnar side. In my case it was gluten intolerance. It has cleared up after a month of strict gluten free dieting.
Uh i have a little experience with this. I was an intern for a few months as part of my computer science degree, and sitting at a desk very not suites for office work, caused my right hand to start hurtig and having issues with tingeling like you describe. What ultimately worked for me was minimizing mouse usage by stopping pc gaming, switched to console gaming instead and stretching primarily my neck and shoulders, that really worked wonders. I was tested if my arms/hands had any permanent nerve damage, and fortunately I had not. Let me know if you have any questions.
Stop using a mouse, or use a vertical mouse (e.g. Evoluent). Move to a standing desk if you can.

These two things worked for me.

43 y/o now, got first carpal tunnel at 12 y/o. Only thing that fixed it was to

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.

I feel like I've conquered mine. I can primarily thank the Kinesis Advantage2 keyboard, it's basically the only reason I can type now. I have no pain using it, and I honestly get a shooting pain every time I switch over to my laptop's keyboard.

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

I agree with everything, I love my Advantage 2. I've been using it for about half a year and almost all pain my hands has gone away.

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.

Bi-modal input worked for me. That’s a fancy way of saying use a trackball and a mouse at the same time. I would use the trackball to fling the cursor around the screen with my left hand, and the mouse to fine tune the aim with my right hand. I can only speak for myself, but this solved an acute pain in my wrist.
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Kept my keyboard but switched it from QWERTY to Colemak. Two weeks cold turkey to get back up to acceptable typing speed.
I was able to turn it around by cutting back/quitting other activities like weight lifting, bicycling, and piano.
I've started wearing fingerless gloves. That solved the pain in my hands completely!
Interesting--do you attribute it to compression/stability, warmth, or something else?
I'm not sure. I didn't have really cold hands but I do think that the fact that my hands are kept warmer is helping the blood flow go more easily?
My first serious tech startup had me working 18 hour days, 7 days a week. The pain in my wrists became unbearable. I knew people who had surgery for this and it didn’t go so well. I was going to avoid this at all cost.

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.

I started to get some slight wrist pain a while back - switched to a vertical mouse and started releasing my forearms with massage (they were getting tight) and that did the trick. Never had issues since.
I started regularly lifting weights a few years ago. After a few weeks, all the muscle and joint pain in my body disappeared completely.
I keep hearing this! Can you recommend some weight lifting exercises that you think may have helped most?
Upper body and core. At home, pull ups and chin ups and sit ups are the best. At the gym, weight machines isolating key muscles.

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!)

if you're just starting out, you wanna start with the top 5 compound exercises. I'd recommend "starting strength" by mark ripetoe. There's thousands of exercises you can do at the gym but you'll get 80% of the output with just these 5 exercises.

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.

Same. I heard a famous entrepreneur say on a podcast recently that every time he felt a bit of pain he knew it'd been because he hadn't hit the gym for a few days... 100%. I get back in the workout routine and it's all good.

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.

This is somewhat similar to how I tend to exercise when I go hard at it. If I'm feeling down or I'm feeling dull pains I intensely workout and always feel better afterwards. I like to imagine I'm pushing the pain out with a rewarding kind.
Highly recommend yoga too.
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Exercise. Also works for back pain. Try gym + running.

A small improvement without exercise can be had by always wearing warm long sleeve shirts, which improves the blood flow or similar

Have you talked to a hand surgeon?

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 saw three hand surgeons, all extremely well-regarded, but who ultimately didn't know what was going on with my hands. It's been super frustrating for me because they're loathe to even acknowledge the problem. It's either "all looks to be okay structurally" or "I'm stumped". That being said, even though these were extremely well-regarded surgeons, I didn't feel much confidence during the visits. I didn't get the sense that they really wanted to get to the bottom of it and help me, and the visits felt rushed. I have an appointment scheduled with a physiatrist in a few weeks--a hand therapist recommended that I get my upper spine/neck checked out in case the pain I'm feeling is referred nerve pain that originates in the spine/neck somehow. Crossing my fingers that I can come to some resolution with this--I just want my life back.
I had a similar experience. Surgeons can be excellent at performing surgeries but very poor at diagnosing our understanding the myriad issues with ergonomics.
That's maybe a good thing. Surgery is a fairly drastic solution. I get the impression that a fair amount is psychosomatic - a lot of people mention Sarno's book. Personally a 10 day Vispassana meditation retreat has given me the best relief from chronically tense muscles from my wrist, under my arm and should blade and side. I guess it depends on the person.
Yes. I was in the same boat. Tried many things. Eventually,

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.

I interviewed someone with crazy RSI and debilitating hand issues (they had to use voice control software). They cured their RSI and you can listen to the interview here and also read their success story.

"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.

I've looked into TMS and read all of Sarno's books. I believe in it. I believe it's real. I believe all the stories and 5-star reviews. I want this to be the answer, but sadly it hasn't worked for me. :(
For what it is worth, I didn't get that far with Sarno's books either, and I read three of them. It turns out I needed much more specific direction and the work that Alan Gordon (TMS Wiki courses), Dr. Schubiner (Unlearn your pain) and Curable have been gold for me in the specificity that I needed. It took years for me (neck, upper back & lower back) and finally with significant therapy, journaling, and Curable I have had very good success and am 95% pain free but still not 100%, and most of us here are perfectionists, so I want 100% pain free.

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!

Wow, this gives me hope! I'm willing to try anything at this point, and will probably give TMS theory another shot as I fit the prototypical TMS patient description to a T. Thanks!
Nice, I was in the boat of trying almost anything too!! I had been to over 8 different physical therapists, massage therapists, chiropractors etc over the past 10 years spending well over 10-20K, hundreds of hours in travel and treatment (lost time) and nothing really stuck. The days of any _new_ pain are 100% over now, including turning my neck the wrong way and having a week long "can't turn my head" situation.

I feel like I have "found it" finally, and it has been at least 3 years since I read my first Sarno book.

How many times a day are you icing your arms, elbows, and wrists?
I tried icing my hands/wrists and elbows every 3-4 hours for about 2 weeks, but it didn't help, so I stopped.
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I've got nearly identical symptoms, and while it does come back now and then, I feel like I'm finally on top of it. I spent about a year trying various things, including exercise ( which actually only seemed to aggravate the symptoms rather than helping), various targeted stretches, physiotherapy, rest, ice, compression, wrist support braces, various ergonomic keyboards

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

Thank you so much for this thorough response! I have the Armaid and use it regularly, though I haven't done any focused massage therapy. Can I ask how you found your massage therapist?
Just through a quick google search and chose one that happened to be near the route I drove between work and my sons daycare. Her website was pretty generic and minimal, so I didn't have high hopes going in, but feel I lucked out as she had an undergrad degree in Kinesiology (or similar), and was a semi-professional cyclist, and had a lot of applied knowledge on anatomy, health, wellness, performance.

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.

I really appreciate this! How often did you visit the massage therapist? After looking at prices, I know many can be quite expensive, but if it works I'm fairly price insensitive.
Good point about the wrist posture during sleeping. One doctor recommended wearing a wrist brace to sleep and that made a noticeable improvement.
Mine was never as severe as OP's. At a time when I started to feel some numbness, I took to doing wrist exercises with some 10lb(?) dumbells. That eliminated the numbness.
One thing that definitely helped was using dumbbells. Basically, any strength training should help.

Same thing with slight shoulder pains. I started using resistance bands and they went away.

Switching to a Split keyboard and Vertical mouse did it for me.
Found out it was psychosomatic. My belief that my pain was caused by structutal damage reinforced the pain. The cause of the pain seemed to rather be a combination of stress, fear, and supressed emotions. When I started working on these areas the pain resolved. It comes back now and then but now I know it's my mind messing with me so I just resolve what's stressing me at the moment and just keep using my hands and then it goes away. I dealt with this shit for years and it severely restricted my life so it's kind of a miracle to be rid of it.

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.

I mentioned this in another comment, but I tried reading all of Sarno's books and it didn't really work for me. I 100% believe the stories though, and based on another comment, I may give it another shot, this time going beyond just the books. Do you have any TMS-specific recommendations that helped you cure your pain? Thanks!