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Ask HN: Remedies for RSI?

9 points by curej ↗ HN
Anyone know of anything that works well for RSI pain?

I've tried acupuncture, massage, ice, heat, electric stimulation, ultrasound, laser therapy, break timers, ergonomic devices galore, martial arts, weight lifting, running, swimming, speech recognition software, anti-inflammatories, turmeric, fish oil, vitamins.

The only thing I won't do is surgery.

It's been five years since my RSI started and it's starting to look like I'm just going to have to suck it up and deal.

Is there a miracle cure I don't know about?

34 comments

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aj
While not a cure, you should try using a RSI recovery help software which essentially forces you to take breaks and also tells you of exercises you should do.

Check out Workrave ( www.workrave.com ) which I personally use and have found quite useful.

Disclaimer: I am not affiliated to workrave in any form except as a user

gruseom
...laser therapy, break timers, ergonomic devices...
curej
Thanks, yes, I use Workrave and it has helped. But it's not a cure. I also use MouseTool (also free) so I don't have to click - just dwelling over an area causes the mouse to click. That's probably the biggest lifesaver I've encountered. I also use AutoHotKey to eliminate the alt-tab, ctrl-w and alt-f4 combinations which kill my left forearm. Another big help. As is Dragon NaturallySpeaking whenever I have to compose a long Word document or email. But, again, not a cure.

Not to be too demanding, but I'm wondering if anyone has found a way to overcome the problem entirely or if I should only hope for incremental improvements.

andrewf
If clicking the mouse is painful, try switching hands. Using your mouse other handed will feel very clumsy for a few days, and you probably won't ever want to play a game that way. But it does give your other arm a break.

I switch between left and right once every week or so.

curej
Because of the auto-clicking software I use - and the fact that I only use trackpads - typing is more of an issue than clicking.
gruseom
Two things I don't see on your list:

1. I do finger, wrist, and forearm stretches regularly. For me, they prevent RSI and even get rid of it when it's starting. I don't know if this would help for chronic pain.

2. Chronic conditions can sometimes be alleviated by hypnosis. Here the challenge is finding a skilled practitioner. I know one. I can put you in touch if you like (email me).

I suppose these are long shots. Good luck.

curej
I do appreciate the offer but I have some psychological resistance to hypnosis - my mother has tried to get me to do it also but to no avail :)

The hand/arm stretches help but only up to a point. A lot of the tension I get seems to arise in the neck and upper back areas. I feel great when I get out of the gym or after a hot bath but I work in a pretty high pressure environment where I sometimes can't take breaks for hours at a time. Maybe that's the real problem. But I was hoping for a workaround.

silentbicycle
You will probably have to change your work environment (in either sense).
curej
Yes. I'm constantly making adjustments but still have not hit on a comfortable setup. I think I need someone to monitor me while I'm working some day - or maybe videotape myself typing for a few hours.
silentbicycle
No, I meant, "If you cannot take breaks periodically (at least once every few hours), you will have to change your work environment (to be able to take breaks) or change your work environment (by changing jobs)."

Not being able to take a break for hours at a time means that if your RSI continues getting worse, you will not be able to work there anymore. The RSI stuff I have read has suggested breaks every 20-45 minutes in order to not make things rapidly worse and end one's career.

I'm most definitely not a doctor, of course, but your body is already overly stressed and breaking down. It needs more time to recover, at the very least.

curej
Ah. Sorry. I misread you. Yes, you are probably right.
gruseom
A lot of the tension I get seems to arise in the neck and upper back areas.

This reminds me of a third option that I'm surprised I didn't think of earlier: the Alexander Technique. Tension arising in the neck and upper back areas is practically their specialty. I got some amazing results working with a good Alexander teacher.

Incidentally, if your situation is anything like mine (and of course I don't know), you may need to make some changes in your life in order for the pain to go away. I'm not talking about techniques, I mean fundamental personal change. I had a headache for 9 years. No one ever explained it. But it eventually went away as I addressed some important issues in my life.

curej
I got kind of a chill when I read this. It hits close to home.
SwellJoe
When I started having problems about 7 year ago, I did a handful of things, but the two that made the most difference were:

Better chair (Aeron). Sounds odd, I guess, but being the right height and having good posture makes a difference. I also dropped the arms way down, so I simply cannot lean on them no matter how lazy I'm feeling (among many other pains, my left elbow had a permanent twinge of pain, which still pops up now and then, but was always-on back then).

Tiling window manager. This assumes UNIX/Linux, but it made a difference when I almost completely killed the mouse from my life. If typing is more painful than mousing for you, this might not be the right choice. It helped for me, though...I immediately was able to work full days again due to this change, though I don't know if it was therapeutic...it may have just avoided the most serious pains.

Other things that may or may not have helped, but I did them while recovery was clearly happening:

Changing positions frequently. Keyboard slanted/flat. Raising and lowering the chair. Occasionally sitting in a different chair or on a ball or standing. Getting up and walking about a lot.

Exercises that encouraged blood flow to the affected areas. Cardiovascular exercise in general, but tennis and such were my focus. You've already tried swimming...so that's probably in the same league for circulation. I wouldn't quit doing those things, even though they haven't resolved your problem...I doubt they're hurting.

I cut back dramatically on playing guitar and piano, since they incurred very similar sorts of repetitive stress. This one was not pleasant, but now I can play again without any problems.

curej
You've obviously struggled with this a lot. A lot of ideas here to think about - some stuff I knew about but had forgotten - I have to keep churning this stuff over in my head and making different variations so it's good to think about what has worked for others. Thanks.
sutro
I used to have very bad RSI, and two things saved me: 1) this book: http://www.amazon.com/Repetitive-Strain-Injury-Computer-User..., and 2) this doctor: http://www.yelp.com/biz/mehaffy-rick-dc-redwood-city (only helpful if you live in the Bay Area). Good luck.
curej
Interesting to hear that a chiropractor was successful for you. I've heard a lot of skeptical feedback on using them. The Pascarelli book is good - my physical therapist recommended it to me and the exercises were helpful (unfortunately I overdid some of the stretches and had to stop as a result - but I should probably re-incorporate some of them). Thanks.
trapper
Off the top of my head things you could try:

1. Go to a paul chek, nasm or shirley sharman practitioner. They will check out your posture. Ignore anything they say about the one true way [edit - I mean the research is inconclusive - either may work, but all will claim their way is correct].

2. If you already have bad posture you need to correct it. Some good [alternative] ways:

- overhead lifting and overhead shrugs

- heavy front squat holds (just the hold, not the squat)

- go look at at mike robertson or gray cook for corrective exercises

3. If you haven't already tried, go to an ART practitioner. It's very sore but effective for a lot of people.

curej
I do have very bad posture. Good suggestions - especially the workout suggestions - my trainer recommended those to me a year ago and I stopped doing them but it was probably a mistake. Those are changes I can easily make to my workout. The rest I didn't know about at all. Thanks.
trapper
Remember the key you are going for in your postural work is time. You spend 50+ hours on the keyboard a week. You need to be able to have a [postural] buffer large enough so there are no overflows into poor posture, which means a large work capacity.

Do try ART - (activerelease.com has practitioners probably) - it can work wonders. The basic algorithm is to identify the parts of the muscle that are tenser than the rest, bring the muscle into full flexion, then compress the tense area against the bone while simultaneously moving the muscle into full extension. This causes a mechanical stress that helps lengthen the tissue. You can try it on yourself pretty easily which can be useful.

curej
I've had cross-fiber deep tissue massage (painful). ART sounds similar but I'll give it a try, thanks.
trapper
ART is very different - it couples movement with massage to mechanically stretch out the muscle. It's usually far more effective.
curej
I did some reading on this. Some practitioners claim they can bring about recovery of severe RSI in 3-5 visits. Does this sound realistic based on your experience?
trapper
Ahh claims of magic :)

It does happen though, but strangely only with certain therapists. There is one where I live that is renowned for fixing almost any musculoskeletal issue in one session.

My recommendation would be to find out which one is used by pro sports teams and go to them.

chris_l
Alexander Technique worked for me. But it is not miracle cure, you have to work on yourself to make it work. A one line takeaway is that you're probably doing something too hard as a matter of habit when typing.
curej
I like it in theory but I find it hard to put into practice. I have very poor awareness of my body so when others recommend changes I usually feel like I'm already doing it the way they suggest. It's the same reason I sucked when I tried to learn swing dancing.
chris_l
That's why it's necessary to have an AT teacher for a while, to help you develop awareness of your posture, etc.
AlanEdge
Surprisingly, lot of RSI problems originate from poor back posture, which distends the discs through which nerves run down to your wrists.

Wrist exercises may provide short-term relief without actually solving the root of the problem.

>>Try tweaking how you sit and sleep (90% of your waking hours).

1) Get a used Aeron chair off of Craigslist with lumbar and wrist support (a $300 chair will lave thousands of dollars in Chiropractor bills).

2) Sleep lying straight with your head resting in the curve of a single foam pillow (http://tinyurl.com/87exg3).

3) Learn and properly practice the McKenzie Tecnique (http://tinyurl.com/a8hr2g), a 30 second means of straightening your entire spine using just your pointer finger on your chin.

#1-3 are life-changers.

curej
At my initial evaluation for my RSI problem, the physical therapist said she thought my typing/mousing was relatively inconsequential in light of my head-forward position, forward-sloping shoulders and asymmetrical back muscle development. She believed this had developed from poor posture and slouching while seated at the computer. I tried to pay attention to it but couldn't seem to translate my posture-in-my-head to my posture-in-reality. I considered using some kind of brace to try to hold my posture in check until I get used to a more upright posture but couldn't find anything that would be inconspicuous at work. The McKenzie book sounds very promising for my problem because it seems to address some of these undesirable physical developments that I have grown into from my computer lifestyle. I have already tried #2 although a lifetime habit of sleeping on my side is hard to kick - even on a low pillow I manage to turn onto my side. As for #3, I doubt I could manage to get permission to have one at work which is a pity because I have no problem paying for one and would like to try it out because so many people have recommended it. Thank you for pointing me to this book which I assume has helped you. I look forward to reading it.
AlanEdge
Interesting. A few thoughts come to mind:

1) You should be covered by worker's comp (by law), in which case a brief to-the-point conversation with a key decision maker in your company over the trade-off between them covering thousands of dollars of WC coverage vs. allowing you to bring your own chair to work is in order.

2) Habits are formed and habits are broken. If you believe you can't change your sleeping posture, than you're absolutely right. The opposite is also true.

johngunderman
There are three things that really helped me when I began developing RSI

1. Learn and use keyboard shortcuts. The mouse was a major issue for me, so I started to use the keyboard as much as possible. I installed gnome-do so I would be able to access all my apps through the keyboard.

2. When you aren't typing, DO NOT rest your hands on the keyboard. This one killed me until I finally broke the habit. Resting your hands on the keyboard causes them undue stress.

3. Make sure you are elevated above your keyboard at the correct angle. Find what works for you, but having your arms extend DOWN to the keyboard with a shallow grade is very important.

Just my $0.02