(NB: This was originally posted to the Sorehand mailing list, August 29, 2002)
Regards dealing with RSI/OOS (Repetitive Strain Injury/Occupational Overuse Syndrome) I haven’t found any cure or quick fix, but have found that a combination of things can make it easier and less painful. It’s a matter of pain management rather than cure.
The following is not regurgitated out of books, but my own actual experience of computer-related RSI and RSI management.
These remedies may not work for you, you will have to find out what does.
Treatment
Because I think the first thing you’ll do after getting RSI type pains is seek treatment, I’ll start with that first.
a. Doctor – first port of call
A GP may not really know much about RSI but this won’t necessarily stop them from proclaiming their authority on the matter. The first doctor I saw basically told me there was nothing I could do. I don’t think she knew very much about RSI but she didn’t come out and say this, instead she told me there was nothing I could do.
I saw a second doctor who did know about RSI and had treated others and he put me in touch with some other great health professionals that really helped. To be fair the first doctor did give me a referral to a specialist but it was for a month after I had seen her, and in that month I felt so helpless I decided to give in and actually handed in my resignation. I had a flight booked home from Australia and everything. In my last week of work I had an appointment with a new doctor, which I almost didn’t go to because I was leaving. When I saw the new doctor he presented me with some options and I began to see some light at the end of the tunnel and believed there were things I could do to combat RSI.
b. The specialist and the multi-disciplinary approach (pain clinics etc.)
Don’t give up after an unhelpful GP, go to a specialist (or another GP). A GP may tell you there is nothing you can do, or you will have to quit work but a pain specialist will set about developing a program to help you manage the pain. Their goal is to get you back working.
My experience with pain specialists has been a multi-disciplinary one and involved an occupational therapist (OT), a psychologist, a physiotherapist and the specialist. This team followed the, I believe well known and regarded, practices established by Dr Michael Nicholas and Dr Allon Molloy of the University of Sydney Pain Management and Research Centre and outlined in their book “Manage your pain” – Nicholas, Molloy, Tonkin, Beeston.
The OT came to my workplace to assess my workstation. They had good contacts to produces of ergonomic devices such as the keyboard tray and put me touch with them. I also got a trackball from them. The keyboard tray was extremely helpful.
The psychologist talked about pain management and his job was really about finding ways to deal with the pain physically and mentally. I never really liked going but each time I went I came away with a more practical “I actually can do it” attitude.
The physiotherapist was not a run of the mill physio in a clinic, but operated her own private gym. She had all sorts of people, with bad backs, RSI, bad knees, etc. etc. come to her. Her goal was to get people back into work. She puts her clients on an exercise/strengthening program. It was all light weight stuff like bouncing a weighted ball on a trampoline, lighting light weights from the shoulders, pulling elastic bands, various exercises on a exercise ball, picking up and putting down various objects in various locations, aerobic exercise etc. It was extremely helpful, and strengthened my body such that I was able to work at lot less pain free. No cure, but increased that mark over which if I stepped I would bring on pain.
c. Other providers
I also tried
- Feldenkrais – only once so I can’t really say if it did anything
- Bowen therapy – several times, didn’t notice any benefits
- Chinese herbs – didn’t notice any benefits
- Acupuncture – again like the GP I found you had to shop around. I haven’t found the practising of acupuncture to be very standardised. The first acupuncturist I saw didn’t help at all. The second I found to be really helpful. I think her methods were better. She would massage my muscles looking for tight parts in the muscle (spasms). She would then insert needles in/around that area. It really helped relax the muscle. The first GP and acupuncturist I got out of the yellow pages and like I said they weren’t very good. The second GP and acupuncturist I came across by word of mouth. People I knew had been to them and had good results. I found the same when I went.
- Physios – I found the general physios I saw to provide short term pain relieve but no real long term benefits. They did give me sets of stretches and exercises to do which are probably quite helpful.
Preventative measures I have tried
a. Modify your working environment
The idea is to make your environment as easy on your body as possible.
Your body is in a more fragile state with RSI. Compare this state to a delicately balanced spinning top. Any slight nudge will cause it to fall over. Any slight strain on the body with RSI will bring on pain. So it doesn’t mean you can’t be without pain, just that it is a lot easier to tip your body over that edge into pain.
In order to prevent tipping your body over that delicate edge, you need to modify your working environment or find alternative ways of doing things.
Things I have done/tried:
- the pointing device: for me this I think this is the biggest source of pain/aggravation. Try using alternate pointing devices: trackball, touchpad, 3M renaissance mouse sometimes I use the trackball in the left hand and turn on the Windows MouseKeys feature in the Accessibility control panel so I can use the keypad as the button clicks. I use the devices in either hand depending on how a particular arm feels at any one moment. Using a device in the left hand will bring on pain/aggravation in that hand.
ROTATION – every time I got a new pointing device it would work wonderfully for about 3 weeks without pain. Then the pain returned. I find it useful to rotate the point devices, using different ones at different times in different hands. Different pointing devices (and different workstation setups) engage different sets of muscles and so I think by rotating you are spreading the physical work over parts of the body and not just repeatedly using the same muscles all the time.
- chair: get a good _adjustable_ chair. Adjustable is the key here. A fully adjustable chair will have the ability to angle the base, raise the base up and down, raise the back rest up and down, and angle the back rest. I have also found adjustable arm rests to be helpful although I’ve read in books they are supposed to be bad for you ergonomically.
- adjust the height of your monitor: this may seem insignificant but for me it has made a huge difference by having the monitor high. The idea is to have it a such a position that the head is in a neutral as possible state. At the moment while typing this I have the bottom of the viewable part of the monitor on a beer crate 40cm above the desk.
- get a keyboard on which you can rearrange the keys. I got a flash Kinesis contoured keyboard, but for all its bells and whistles I have found its most useful feature to be the ability to rearrange the keys. This was great for reducing the pain I was experiencing in my pinkie finger. The ability to move the shift key (which I would normally stretch to reach with my pinkie finger) to a key right under my thumb has meant I don’t get a sore pinkie like I used to. You can get software that does this, I tried a few but they didn’t really work.
You might find this or similar keyboards helpful for different reasons. It has major keys (enter, ctrl, alt, space) under your thumb which may be helpful. It took me several weeks of full time usage till I got used to the keyboard and could type at my usual speed.
- adjusting the keyboard location: I got a keyboard tray that attaches to the underside of the desk and has an adjustable arm. This made a _huge_ difference at the start. I would have the tray/keyboard as low as possible, literally sitting on my lap. These days I haven’t found it as useful, it’s funny how one thing works great for a while then might not. I still have it and use it from time to time but find I don’t really need to. Maybe in the future I will have to go back to it.
Overall I think the key here is to be aware of pain and stiffness in parts of your body, and then make environment changes to reduce the physical load on these body parts. I have found the pain and stiffness moves around my body and each time this happens I need to change my environment again to suit.
b. Rest breaks
This is quite important and I feel deserves a section on its own.
I think the theory behind it goes like this: You are doing your body damage with all this repetitive action. But your body is able to heal itself. So you only want to do some much physical work vs. rest in any one time frame so the damage can be adequately healed.
You will need to find a schedule for you. My current schedule of actual on the keyboard work is a 12 second break every 3.5 minutes, and a 10min break every 30mins. The software I has enforces this (it measures when you are actually typing/mousing vs. not typing/mousing). At first it is frustrating to follow but eventually becomes second nature. At the moment I work a total of 5.5 hrs actual keyboard/mouse work a day. I like to give myself at least 12 hrs between each 5.5 hr day. So if I finish at 11pm I won’t start till 11am the next day. I also like to give myself two complete days (i.e.: the weekend) off the keyboard a week. At the moment it is not a problem to adhere to this as I am self-employed. I’ll mention being employed later.
c. Stretches
Develop a stretching program that works the muscles in and around the areas of pain. I do this from time to time. I must admit I don’t notice any direct benefits but I believe the books and professionals when they say it’s good for you.
Other issues
a. Employer
You are going to have to discuss your situation with your employer. How your employer responds is going to be a big factor in your attempts to manage the pain. Recognise an unhelpful employer for exactly what they are – an unhelpful employer, and not a reason to think that management of the pain is not possible. They are just one piece of a whole combination of factors you have to deal with. This really highlights the fact that is no quick fix but instead an array of factors that need to be addressed, and the employer is just one of these factors.
I think an employer will be satisfied if you can convince them that you can still provide them value (not that you should or will have to convince them). If you have to spend less time on the computer, find other non-keyboard tasks you can do for your employer that provide them value. The fact that you have to take lots of rest breaks is not a problem if you can do other tasks in that time. Your role might have to change to provide you with opportunities to do other tasks.
b. Cost
I suspect my total costs including lost work hours, treatment, aids etc. cost about $10 000AUD, I don’t know for sure. If you are very unfortunate and have to pay that cost yourself it might be helpful to try and justify in your mind the cost as a “business cost”, i.e.: how much am I prepared to spend in order to stay in business (i.e.: employed/working)? If I complain that treatment costs me say $500/month, but it means that I can stay working earning $30 000/year, even though the costs are high I can satisfy myself that it is a financially sound decision.
c. Emotions
The experience with the different doctors (see above) also showed me that emotions can play a part. I got quite down and felt helpless during that month and made that big decision to quit. In hindsight I believe that that situation pushed me to an extreme, and in such a situation I began to lose a balanced view. I believed the only option available to me was to quit, but that wasn’t true. If someone had told me before that your emotions about RSI can start to take a hold of you I would have rubbished it. But when you are down you can become very narrowly focused and begin to contemplate drastic measures. Be aware of what your emotions are doing in regards to the situation and the pain.
Best of luck to all in pain, do not give up!
