Best Practice Ezine #100 RSI – Guy’s Battle with Repetitive Strain InjuryRecently I was crippled by a severe attack of RSI (Repetitive Strain Injury); fortunately, my story has a happy ending. Indeed, this article is the proof of my recovery and now I wanted to share with you my solutions to this computing affliction. What happened was pressure of work forced me to spend more and more time bashing the keyboard and clicking the mouse; the result was ever increased pain in my fingers and wrists. When I tried to match my symptoms to those described in the literature it struck me that there are many variations of RSI symptoms. It is likely that there are at least three levels of the condition, mildly irritating, painfully debilitating and completely crippling. What precipitated my search for a solution was when the pain in my hands moved from irritating to painful. Another piece of the symptom jigsaw is that there are at least 4 places which maybe affected wrist, fingers, elbow and shoulder. In my case of RSI, the pain was mainly associated with the wrists and fingers, curiously, my thumbs were not affected. To complete the picture of RSI symptoms, the pain ricochets around, as I cured my wrist and finger pain, so a new pain developed in my elbows. My research also indicated that RSI symptoms can be classified as localised or diffuse. I did not fully understand the difference, but it seemed that localised meant specific and identifiable injury, for example Carpal Tunnel Syndrome; whereas in the case diffuse RSI, the pain is more widespread. My symptoms lean towards the diffuse version RSI. Specific RSI Related conditions Carpal Tunnel Syndrome
Carpal Tunnel Syndrome occurs in the wrist, where friction on the nerve passing through the wrist carpals causes inflammation. Tenosynovitis
Tenosynovitis applies to both the wrist and the fingers. It is caused by soreness of the tendon and its associated sheath. Tendonitus
Tendonitus is swelling of the soft tissue around joints. In the case of RSI, these would be the finger joints or the elbow. However, the condition can occur in other joints, for example the knee. What ever combination of the above conditions I was suffering from, the upshot was the pain in my wrists caused me to stop computing. The sensation I experienced was that my wrists were hot and tender. Also my fingers were stiff, claw-like and painful to bend. I also felt a tingling sensation especially in the little fingers. What most difficult to describe was a general numbness over the back of my hands. Sometimes, this numb pain extended from the wrist to the elbow. Last, and in my case, least, my back and shoulder blades ached, but that pain was bearable. The cause of my RSI could not be clearer, 8, 10 maybe 12 hours at the keyboard / mouse. In 1984 I learnt to touch type, therefore on a standard computer keyboard, I use all my fingers on the recommended keys. I would say that judged by professional standards my speed is moderate. I have lived with a certain amount of RSI related discomfort for about ten years, but it’s gradually got worse. The final straw was callus on my wrist caused by ‘cleaning’ 50 pages of html. Foolishly, I kept on at the same operation of arranging the meta tags for three days. Three factors alleviated this immediate problem, rest, switching to other computer tasks and a fancy new mouse mat with a built-in gel wrist support. This mouse-pad unit is really soft, supportive and very comfy and while it reduced my callus, it did not cure my RSI. See Windows 8 Touch Keyboards » The secret of treating your RSI symptoms is to speak with a chartered Physiotherapist (or Physio for short). In my case it was the third time that a Physiotherapist had, over the phone, diagnosed the root cause of the problem and come up with a cure. It seems to me that the number one skill of a Physio is common sense. This is not just ordinary common sense, it’s a talent. Let me explain further, in the way that some people have green fingers, Physios have a knack, even a gift, for treating physical problems. Perhaps it’s literally their hands on approach that makes Physios so perceptive and effective at treating all manner of ailments. Physios have the same knowledge of anatomy and Physiology as doctors, but whereas doctors reach for the prescription or the knife, Physios look for a more thoughtful and a more hands on solution to any physical injury. As an example of their pure medical skill, on three separate occasions, over a 25 year period, Physios have diagnosed my medical problem over the phone. These were three different serious conditions that baffled doctors, in addition, on each occasion the Physio came up with a solution, I say again this diagnosis was all by way of a phone call. I would like to emphasise that you should only deal with chartered Physios. Avoid quacks who don’t have the requisite medical knowledge, such charlatans may use cheap tricks to impress you by clicking a few bones, but trust me, their medical ignorance will cripple you eventually. Only deal with a chartered Physiotherapist they have the necessary medical training, which gives them deep understanding of physical problems and their effective treatments. My problem was obvious; I was working too long at the computer keyboard and mouse without a break. Both my short term and my long term strategies to overcome RSI were not effective. Namely, half an hour break when the pain became too much, or a 3 day holiday doing no computing, then back to work did not cure my RSI. In Worcestershire, England, there is a free Physiotherapy Telephone service, which helped with my RSI symptoms. My Physio was called Jan Myers. I applaud this telephone initiative and wish it would extend both to other medical services and to become a worldwide service. The Physio diagnosed the need for short breaks from the keyboard, 30 seconds rest every 5 minutes. However, this Micropause was no good without taking a longer break before the onset of the day’s first RSI symptoms. Thus I now also take a 10 minute breaks every half hour. Judging by previous successes with Physiotherapy, I was looking for exercises to cure my painful fingers and wrists. Here was where the Physio’s skill coupled with common sense came to the fore; she explained that RSI is not a condition where exercises by themselves cure the problem. Yes, exercises help. However, I should realize that perhaps their best effect is distraction. Stretching my fingers, wrists, neck and back, force me away from the keyboard and thus rest my aching joints and thus prevent the repetitive effect of RSI from kicking in. As a result of the Physio’s diagnosis, intellectually I knew what I must do, it was just a problem of will-power. Calculating IP Address ranges is a black art, which many network managers solve by creating custom Excel spreadsheets. IPAT cracks this problem of allocating IP addresses in networks in two ways: For Mr Organized there is a nifty subnet calculator, you enter the network address and the subnet mask, then IPAT works out the usable addresses and their ranges. For Mr Lazy IPAT discovers and then displays the IP addresses of existing computers. Download the Free IP Address Tracker The WorkPace piece of software is like the most demanding sergeant major, or the fiercest hospital matron that you have ever met. The problem is that left to my own devices, I just keep on working harder and harder, time flies, I will ignore the need to take a break. WorkPace cuts in and enforces a break by locking the keyboard and mouse. There are two types of break, what WorkPace calls a Micropause; I set it for 30 seconds every 5 minutes, and a Break of 10 minutes every 30 minutes. You can also set a daily limit, I chose 6 hrs. As you would expect from software which is intelligent enough to monitor and lock your keyboard and mouse, the Micropause, Break and daily limits are configurable. For me, neither Physiotherapy nor WorkPace software would have cured my RSI in isolation. The synergy of clear direction, explanation and reassurance from the Physio, combined with enforcement from the WorkPace software is what cured the pain in my wrists and the numbness in my fingers. Above all the program gave me belief that there was a way out of the despair induced by my RSI symptoms. Thanks to WorkPace, I could see how to manage the physical and mental debilitating effects of RSI. See About Windows 8 Virtual Keyboards » It is hard to gauge ones own pain threshold, however, from playing sport and seeing fellow players reaction to injury, I would say that my pain threshold is average or maybe slightly lower than average. But did I show pain? Of course not opponents would sense weakness, team mates would just take the Mickey. The relevance to RSI is that I spent time in denial, refusing to admit that anything was wrong. I mention my reaction as it may offer insight into the widely held view that RSI sufferers are malingerers. One benefit of having a low pain threshold is that this is nature’s way of preventing the chronic or third level injuries that you read about in connection with RSI. Anti-inflammatory Drugs
My doctor suggested that I take anti-inflammatory drugs. I said no. What I wanted was a solution not a temporary relief. I expect there are cases when I will need anti-inflammatory drugs, but this was not one of them; as what I sought was a long term cure not a short term fix. I then asked if the doctor could refer me to a chartered Physiotherapist, where upon they gave me a phone number of the Physiotherapy Telephone service. Malingering and RSI is a contentious issue. I want to say that in my experience, what happens is RSI predisposes a person to become a malingerer. It is not that you start out as a malingerer and then look to RSI as an excuse. For employers this distinction is important. What is frustrating, and the final insult, is that the fastest typists and the hardest workers, are the ones most likely to suffer from RSI symptoms. What I had was the horrible feeling of frustration. I wanted to work but couldn’t because of the pain. For a while, acting like a malingerer and avoiding work was my only recourse. I took a complete rest for 3 days, but frustratingly this did not cure the problem. After about an hour the fingers felt stiff as if they had not warmed up properly. No wonder others look on people with RSI as work-shy. Having RSI turns you into work avoidance mode, you really would like to compute but the pain won’t let you. As I mentioned earlier, because of the negative image of RSI I was in denial for a while. Luckily I found salvation in Physiotherapy and WorkPace, who between them alleviated my RSI symptoms, remarkably, I was ‘cured’ in two days. A great man called Peter Morgan once taught me that you need an infirmity to bring out the best in a person. He preached that many who had a crippling affliction found away to overcome their problems and only then became great people. Peter’s teaching came to mind when I wondered how to cope with my RSI symptoms My greatest challenge was adapting mentally to these micro 30 second breaks and to the 10 minutes away from the keyboard every 30 minutes. At first I was so annoyed when WorkPace enforced a 10 minute break at an inconvenient time, that I considered turning off the machine at the mains and quickly restarting it. You and I can see that this drastic action to get around the locked keyboard would be foolish on two counts, risking corrupting the operating system and risking abandoning the programme designed to reduce my RSI. That instant when I accepted WorkPace’s insistence that I must take a break, was the definitive moment in controlling my RSI. Without WorkPace, I would not have broken out of the viscous cycle of Repetitive Strain Injury to my wrists and fingers. By the way, I had already postponed the ‘Break’ twice; WorkPace gives you this ability to defer a break if you are doing something crucial. What was remarkable was that the effect on my RSI was so quick, after one day I felt better, after two days I was ‘cured’. Mind you to stay cured, I still have to take the breaks as dictated by WorkPace and my Physio. Tactics from other SportsWhat tactics can we learn from other activities and apply them to RSI? When running marathons, it’s too fast a pace that cripples you not the absolute distance. So let us learn from marathon running, take the long view, set the correct pace for your typing and take breaks. In cycling’s Tour de France they have a rest-day half way through the race. Do the cyclists rest up? No. Incredibly on this supposed rest-day they cycle a short 100km just to keep the legs supple and stop them seizing up. On race days they cover 200-300km a day. The message for RSI sufferers is that prolonged rest from typing then straight back in the saddle, sorry keyboard, is not the answer. I can vouch for learning this RSI lesson the hard way. It seemed so unfair that after 3 days of complete rest, within two hours of returning to the keyboard my hands hurt as much as ever. Now, I take 30 second breaks every 5 minutes and 10 minute breaks every 30 minutes, the result is I am keep the RSI at bay. Hidden AgendaIf I have a hidden agenda, then it’s to do my bit and add to the power of the internet for mutual support. Individuals can never compete with doctors for professional expertise, but people who have suffered injuries and recovered have insights that doctors may lack. Also, we can come out and say how it was for us, what worked and what did not. In this particular instance, I would like to give hope for those with RSI symptoms who want to recover without drugs or surgery. Will and Guy HumourWe have a topical computer item – Press any key…
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