A number of years ago, I developed a very bad case of repetitive stress injury (RSI), likely through extended numbness, and I found I had to wear wrist braces constantly to be able to bear it. I was diagnosed as having carpal tunnel syndrome, tendinitis, compressed nerves, or other syndromes depending on which doctor I talked with. I started wondering how much longer I could continue working as a software engineer, and started considering alternate careers. Things looked bleak.
Gradually, however, I started to figure out what I had done wrong to get into the state I was in, and how to recover. I asked others who were having similar problems about what had and had not helped them. I read what I could find about RSI, learned more about my condition, and figured out and tried quite a few things that helped.
Eventually, I've gotten to the point where I am nearly cured of RSI. (I don't know if it's possible to be completely, 100% cured; at least, I've never heard of anyone totally recovering) My wrists give me occasional twinges and rare flare-ups, but have otherwise been trouble free. I probably do more computer work now than I did when I first developed RSI, but it's not something I worry about much anymore. I still practice the preventive items below, but about the only active items I still do once in a while are getting a massage and giving my wrists a hot/cold bath.
Of the people I've met who have had bouts with RSI, I'm probably the one who had it the worst and still recovered. I consider myself very lucky: I believe I was very close to crossing the threshold of an incurable condition.
Over the years, I've been frustrated by the difficulty of finding practical advice for dealing with RSI. I've mostly only seen either items about good ergonomics, or drastic solutions like surgery. Others who have asked about my experience have expressed similar frustrations. This page is an attempt to detail less commonly described simple and middle-ground solutions that I've found and that have helped me personally (and a few that have not).
A caveat: I'm not a doctor, and can't say that any of the below will help anyone else. All I can offer is a description of what has helped me and what I've observed has helped people I've talked with. I hope it will be of some use to others.
The various items I mention below have different levels of importance. To indicate how important I think each item is, I have added a star level:
| **** | Very helpful. These items were a major factor in helping me recover from RSI. |
| *** | Helpful. These items were a significant factor in helping me recover from RSI. |
| ** |
May or may not help a lot. These items either only helped me a little, or
in my opinion are less likely to be a major help to most RSI sufferers.
Try them if you've run through the 3 and 4 star
items and still are looking for more help. |
| * | Minorly helpful. These items may have helped me a little. Try them if you're desperate. |
| - |
Unhelpful. I didn't find these items to help at all. |
Most people reading this have gotten RSI (or worry about getting it) from using computers, and many RSI articles focus on using computers ergonomically. Because there have so many ergonomics articles written by more knowledgeable people than I, I won't duplicate the usual advice about right angles, getting good chairs, etc. (A good page that goes into some detail about ergonomics is the Microsoft Hardware Healthy Computing Guide.) There are a number of other related items about using computers that seem to get mentioned less often that I've found are important:
Mouse clicking is the most RSI-inducing input method I've encountered. I don't know why, but it seems much more stressful on my wrists than keyboard entry. I've heard a number of other people say the same thing. You can minimize mouse usage in a few ways:
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Besides the normal right-angle ergonomics you always hear about, you should be cautious about a few areas:
In general, if part of your body is getting tight and/or feeling pain, you're probably doing something wrong. Step back, become aware of how you carry yourself, and think about how to change what you're doing to reduce the tension.
Take note of your posture during any activities thoughout your day, including away from the computer. For example, what is your posture like while driving? Do you grip the steering wheel tightly while tensing your shoulders? Are you hunched over? Are you holding the steering wheel far out from your body at a high angle? Simple ergonomics applies here, too. Note for older drivers: due to airbags, you should be holding the steering wheel at 4 & 8 o'clock or 5 & 7 o'clock, rather than 3 & 9 o'clock. The new position should result in a more relaxed driving position.
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Many keyboards require a lot of force to press down, which also seems to induce RSI over time. If you find your keyboard has too much tension, replace it.
Go to a store that has a lot of different keyboards, and try them out until you find one that you like. I found the Microsoft keyboard had a good soft feel, but the fixed angle that they chose to split the keyboard was not correct for me. I like the MaxiTouch keyboard made by MaxiSwitch, Inc. It has a good feel, and the keyboard is also programmable. (Since I use the ctrl key a lot, I switch the positions for the caps-lock and ctrl keys to reduce how much I need to reach when I type.) Unfortunately, the keyboard isn't being made anymore, and I haven't found one I like as much that is being currently manufactured. Dave Reynolds wrote me in email to recommend the Kinesis keyboard.
You can also try calling up the manufacturer for your computer and ask if they have a soft-touch keyboard. Some of the bigger manufacturers do, but don't advertise it much.
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It's very important to keep yourself and especially your wrists warm when you're doing computer work. If you work in an area that is cool, turn up the heat and/or wear long sleeves. Some people have found it helpful to wear finger-less gloves.
Above all, don't work when there is a draft! Working in drafty conditions is a quick way to give yourself neck, shoulder, back, and wrist problems. Usually, vents being nearby cause drafts, and you can get facilities to move or redirect the vent. If not, block it yourself.
Because office heating systems seem to decide on random occasions that just above freezing is the proper temperature for that day, it's also worthwhile to keep a sweater in your desk. If you have your own office, you could even bring in a space heater.
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I've seen a few people who developed bad cases of RSI by continuing to work no matter how much it hurt. Usually, these people go on permanent disability within a year. If your wrists start to be painful, your body is sending you a message. If you just pull back and stop working then, you can probably continue working without pain the next day. If you ignore the message, the longer you work, the more likely you'll have pain for an increasing number of days following and the more likely you'll have a permanent problem. Ask yourself how important it really is to meet yet another deadline everyone will forget all about in a few weeks.
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Of course, it's better to not be in the situation above where you need to decide between your wrists and deadline in the first place. Often, you don't have to be if you plan ahead. Try to balance your workload so that you work at a more even pace instead of working like crazy when a deadline approaches.
Also, if you know in advance that you're about to be doing something you know is especially destructive to your wrists, do whatever you can to minimize the damage. For example, I wear wrist braces from the start in these situations.
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Every hour or so, take a few minutes off from using the computer. Get up and stretch.
My wife says she uses tricks such as sending her printing jobs to a printer a bit further from her office than the nearest one to force herself to move around more.
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I've found that placing my hand on a trackball and moving the ball is considerably less stressful than moving a mouse around. It also has the advantage of requiring less desk space. If you consider buying a trackball, make sure to try it out in the store first: many trackball manufacturers have very hard-to-press buttons, and seem to have designed the trackballs without ever considering how a human hand looks and moves. I like the Logitech TrackMan Wheel, but you can only use it if you're right-handed. (Logitech says there's "not enough demand" for a left-handed version, which ticks off my left-handed wife.)
Alternatively, you might try a vertical mouse. I've heard that this style of mouse can be a lot less stressful on your wrists, though I haven't tried it myself. One that's available and that I've seen reviewed favorably is the Active Release ZTM Mouse.
For a more radical solution, you can try Mouser, a free program which allows you to move and click the mouse from the keyboard. The page describing Mouser also contains links to a number of pages with mouseless tips.
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Try to avoid using the armrests on your chair. The problem with them is that when people use them, they tend to bunch up their shoulder or put pressure on them. This adds to the stress on your shoulders, which can contribute to RSI.
There are a couple of ways to get your armrests out of the way. The simplest is to lower the armrests so that you can't lean on them. If you can't do that, remove them. Most armrests are set up so that they can be removed with a wrench.
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I've found that wearing wrist braces while typing can help prevent or reduce wrist pain, but I like to minimize it. They're a crutch and tend to cover up the underlining problems that cause you to need them in the first place. Besides, they're bulky and ugly.
I realize, though, that using wrist braces is not an option for some people. If you decide you need to use wrist braces, don't get the kind that are sold in drugstores. Instead, ask your doctor or chiropractor to order a pair for you. They have access to catalogs that contain much sturdier and better-designed wrist braces. Look through their catalogs and pick out one you like.
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I don't know how general purpose this is, but I've found that how I sleep places a critical role in how my wrists are doing. Here are a couple of hints that have helped me.
Correcting my wrist posture while sleeping is by far the number one change I made to recover from RSI. It used to be that when I woke up in the morning, my wrists felt worse than when I went to sleep the previous night, even if I wore wrist braces. I couldn't figure out what was going on, until one morning I realized that my wrists had become permanently rotated to the way I held them when typing. I.e., instead of having my palms against my sides, I had my thumbs against my sides. By forcing my wrists to rotate so that I slept with my palms against my side, I noticed an immediate, drastic, and permanent improvement. I suspect this RSI aggravator is not that common, but I've described my experience here in case anyone else has similar symptoms.
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When you sleep, your body temperature is likely to drop. It's always important to keep your wrists warm, and putting your hands under the blankets rather than over the blankets can make a significant difference.
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If you wake up with your wrists feeling just as bad or worse than when you went to sleep, you may have sleep apnea, a serious but all too common condition in which you briefly stop breathing while sleeping. There are doctors that specialize in testing and curing sleep apnea who can test to see if you have the condition, either by having you come in to a lab to sleep for a night, or giving you a portable machine you hook yourself up to when you sleep at home one evening. The latter test is much more convenient and gives just as good results, so I recommend going to a doctor that uses it. If you have sleep apnea, there are a number of solutions the doctor can tell you about.
However, one caution: doctors have trouble listening and considering anything that goes against their preconceived ideas, and your symptoms may not match what they "know" to be true. In my case, my symptoms were that I had a massage therapist notice that I tensed up when I dozed off, and I noticed I would sometimes wake up with my muscles feeling tight. The usual symptoms of sleep apnea are snoring (especially loud snoring), and feeling tired after waking up. Since my symptoms didn't match the textbook symptoms, I had a lot of trouble getting doctors to do anything to help me at every step of the way even after I had definitive test results showing I did in fact have sleep apnea! Also, my sleep apnea was mild, and thus further dismissed by a number of doctors, even though research shows the severity of your sleep apnea has little to no correlation with the severity of your symptoms! The doctors' conclusions were that my problems were unrelated to my sleep apnea, which, after I insisted on getting help anyway, turned out to be wrong just as I expected. My own theory is that my symptoms are a lot more common in sleep apnea cases than the doctors realize and the actual problem is that people like me don't report the problem or get diagnosed correctly because the cause is hard to connect. It's fairly easy for a doctor or patient to conclude that someone who is snoring loudly and/or very tired despite getting a lot of sleep quite likely has a serious sleep problem and should get tests done to figure it out. It's a lot harder for a doctor or patient to connect sleep apnea with tensing up while asleep, or even for someone with this problem to realize it may indicate a serious condition they should mention to their doctor. If I had to do it again, I would have made up symptoms that matched what the doctors wanted to hear, and that's what I recommend you do. The test will show whether or not you have sleep apnea, and the treatments are the same regardless of symptoms, so what you tell doctors your symptoms are doesn't really matter.
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You may find that sleeping with wrist braces helps. However, I would only recommend you do so while you're in recovery or during a stressful crunch period, rather than as a long-term solution. Your body should naturally be healing while sleeping, and if you need wrist braces at night, your body is sending you a strong signal that you need to make other changes!
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All of the below items are important for general good health, but I've been surprised to find they also seem to be related to RSI.
When you're using a computer or just moving around take a moment to pay attention to your posture and the tension in your body. I've noticed several bad habits that I've tried to break myself of: bunching up my shoulders, locking my elbows when walking, and keeping my wrists rotated in typing position (thumbs against my side) when walking and sleeping. Besides breaking bad body habits (and determining why you developed them in the first place), it also helps to pause for a couple of minutes every once in a while, relax, and mentally try to lower some of the tense spots.
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I've noticed that people who tend to be more sedentary are also more likely to develop RSI. I've also found that exercising can help me prevent or minimize RSI as long as I don't try to exercise the wrists. Obviously, tennis and bowling are out, but so, surprisingly, are sports like bicycling. Generally, if you try a sport and your wrists feel worse afterwards, drop it.
Exercise that stresses your legs tend to be very good for your wrists. For example, hiking and snow skiing are both great. In general, more strenuous exercise that gets the heart beating faster is better, as long as you're up to it and don't overdo it. So, for example, if you're in shape for it, hiking up steep hills is much better than hiking on level ground, but even hiking on level ground may help.
The one exception I've found to the don't-exercise-the-wrists rule is martial arts. I've heard other people say martial arts have helped them. I've tried Aikido and found that even though a lot of the moves stress the wrists, it seems to help rather than hurt. However, when I started Aikido, I was already well on the road to recovery; I probably would have been ill advised to start it when I was at my worst.
A page that gives some good stretching exercises is this page on How to Create a Comfortable Working Environment.
Also, here's some advice from email I got from Ken Sweda:
My doc recommended tennis-elbow type rehab exercises. You might check out the exercises I did for tennis elbow. Wrist curls (regular and reverse) with very little weight (start 1-2 lbs, 10 reps), working up to 5 lbs and 30 reps over 3-4 months, then maintain a couple times a week. Add in pronation work with a hammer held at the handle. The key was doing only the "negative" movement (the eccentric), i.e. let the weight drop slowly and controlled, then lift it back up (to the clenched position) with the other hand, then repeat. Since my "research" suggests tendinosis precedes the nerve entrapment syndromes (it's what causes the swelling in the nerve passageways), eccentric exercises builds up new, properly aligned tissues that can bear the burden of the tasks we do, and actually reduce the width of the malformed tendon tissues. There are several studies that confirm this, specifically with achilles tendinosis. When the problematic tissue gets stronger and more streamlined, and more good (narrow and strong) tissue is added, the situation improves.
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My weight fluctuates. I've found that when I gain a few pounds, I'm much more likely to have an RSI flare-up. As with lack of exercise, I've also noticed that people who are overweight are more likely to develop RSI. For help with RSI and general health, try to get down to a healthy weight if you're not already there.
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Times when I'm stressed seem to correlate with RSI troubles. It's obviously best to minimize tension, and, nowadays, there are many resources available that suggest things to do to reduce tension.
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I'm not really big on pills, but there are a few I've heard about that I've tried over the years.
I've read of a study that showed taking vitamin B6 could help people who had RSI. When I tried taking it, I noticed a possible slight improvement, but I wasn't sure. It certainly didn't hurt at least.
On the other hand, I received the following email from John Googe, a clinical nutritionist at Nutrition Advice in UK:
Vitamin B6 at an adequate dosage DOES work for RSI/CTS. I have 3 clients who have all responded quickly {2-3 weeks} and positively to B6. The initial dosage needs to be high. I suggest 3 x 50mg of B6 as P-5-P [The more active form of B6 piridoxyl 5 phosphate] for 3 months then cut down to maintenance dose of 50mg once daily. A quality b-complex or multivitamin should be taken alongside it.
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Vitamin E is supposed to help, but, as with B6, I didn't notice much of a benefit when I tried it.
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Doctors like to prescribe these, but they're useless for treating RSI. I have yet to hear of anyone benefiting from taking these.
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Here are a bunch of other hints that have helped me.
There are times when my wrists feel very tight and nothing seems to help, save one. A great technique for seriously loosening up your wrists and eliminating pain is to run the wrists under alternating hot and cold running water for 10 minutes. Make the hot water as hot as you can stand and the cold water as cold as you can stand. Every minute switch from one temperature extreme to another. This technique can provide good intermediate term relief.
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When you have some free time or you take a break, stretch your wrists. Try pushing one hand against another in various directions; you'll soon feel which angles need stretching in particular. Also try forming your hand loosely into a fist, and rotating it around one way, and then another for a minute or two.
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A wristwatch is extra weight and adds tension on your wrist, especially when you're typing and clicking. Try taking it off and see if that helps.
If you find that it's better for you not to wear a wristwatch, and you must have a watch, consider buying a ringwatch. Timex doesn't sell ringwatches directly, but they sometimes make them for other companies. Timex doesn't advertise who they make ringwatches for: you need to call and ask. Their customer service number is 1-800-448-4639. In the past, I've found some at Target or large department stores. They're also available on EBay.
Unfortunately, since ringwatches are considered a novelty item, your selection will be very limited. Often, the watches have cartoon character designs clearly designed for kids (Tigger, Powerpuff Girls, etc.), or they be gaudy with, say, many fake diamonds. There's typically only one size; if you have big fingers, you may only be able to wear the watch on your pinky if at all. Also, I've never found a ring watch that was even remotely water resistant. Never get them wet, and make sure to take them off when you wash your hands
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Avoiding cold drinks is helpful as part of the effort to stay warm. It's pretty simple to do: just microwave refrigerated drinks for 30 seconds or so when at home or in the office, and ask for drinks without ice when you're eating out. I've found that after quickly getting used to the slightly warmer drink temperatures, I no longer even like drinks as cold as I used to drink them.
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If the problem has gotten bad enough that you feel you need professional help, there are a number of options available to you. Overall, dealing with RSI has taught me to be a lot more open to alternative medicine than I was before. Here's my experience.
For RSI problems, chiropractors seem the most knowledgeable and helpful of any medical people I've run into. They seem able to treat a wide variety of RSI cases, and they have helped a lot of people I've met. One caution, though: if you have RSI, you likely have shoulder problems, too, that contribute to the RSI. Make sure the chiropractor treats the shoulders as well as the wrists.
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Again, if you have RSI, you probably have very tight shoulders and wrists. Massage from a professional or a friend is excellent for reducing the built-up tension in these areas and giving your body a chance to heal.
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I have to admit I was highly skeptical that acupuncture could do anything for me. How could sticking in a few needles possibly help? However, after various other treatments, I found that although I was fine when I was awake, I still needed to wear wrist braces when I slept or I would wake up in a lot of pain. (As long as I wore them when I slept, my wrists were fine.) Nothing I tried helped me over this last hump.
Someone I knew recommended an acupuncturist who had helped others with RSI, and I decided to give it a chance. After 5 sessions, the acupuncturist fixed the problem permanently. I have no idea how it can possibly work, but it did.
Though acupuncture was very helpful for me when nothing else worked, I'm only listing it as a two-star item for a couple of reasons. First, it appears that though most chiropractors and massage therapists can help with RSI, only a few acupuncturists seem to be able to help. If you decide to try acupuncture, choose carefully and ask around for recommendations. Second, even if you find one who helped others, it might not work for you: someone else I know with RSI went to the same acupuncturist I did, and didn't notice any improvement.
By the way, some insurance plans will cover accupuncture, and other will pay for it if you have note from a doctor or chiropractor. So do check with your insurance company about their policies before making an appointment.
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Past an annual check-up, I've never dealt much with doctors before developing RSI; my experience since has left me very unimpressed. If I ever have problems in the future with a disease or something well studied that can show up easily on tests, I'd still go to a doctor. Otherwise, forget it.
Although I've recently found a doctor I like, my general experience with them has been very negative. My typical experience with doctors has been (1) they tend to be rushed and want to try to spend the minimum possible time dealing with you, (2) they like to delay any treatment in the hope that your problems will disappear on their own (fine in many cases but absolutely the worst thing you can do with RSI), (3) they like quick, pat answers, and (4) if quick, pat answers can't be found, they tend to disbelieve you really have a problem. For example, after one doctor found out I had RSI problems in both wrists, he immediately declared that one of the wrists had "sympathy pains", thereby eliminating half the problem. After a very cursory examination, he advised me to seek no treatment, and check back with him in a month if I still had problems. I've gotten the distinct impression from a number of doctors that they suspect RSI has been overblown by the media, and that anyone who complains of having it is likely just another psychosomatic patient who has the trendy problem of the week. All I've ever gotten from a doctor is a prescription for anti-inflammatories, which were useless.
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