May 09, 2008, 2:38 PM — First up: disclaimer. I am a computer geek. Not a medical practitioner. If you have symptoms, go see a doctor, ok?
So, here I am typing - yes typing with my fingers! Back in February I wrote about the onset of my RSI. This article is by way of a follow-up.
Well, the good news is that I'm still typing and I have managed to get the general level of pain and discomfort down pretty significantly by making a variety of changes. The bad news is I'm not sure which change or indeed combination of changes has made the difference. In fact, I cannot be sure that any of the changes are involved in my apparent presence on the road to recovery at all!
Debugging, as any software engineer knows, is a tough problem owing to the difficulty of establishing repeatable causal connections between events. Debugging RSI is about the most complex problem I have ever tried to debug I think. All I can truthfully do is list the changes I have made, in the hope that some of them are actually involved in my improvement, and in the hope that they may be of use to other RSI sufferers.
Research: I have done a ton of this. I have read widely, even venturing into the dense thickets of medical papers, in an effort to get a handle on my problem. All the information gained has been useful but the overall result has been open ended so far.
In summary:
- this is complicated stuff because RSI is really just an umbrella term for many different ailments
- the medical world is very scientific and physical (and rightly so). Diagnosis starts with the measurement of effects and works back to causes. If your effects are troublesome to measure scientifically, it is tough to find medical practitioners who will even listen to you. I know from my reading about RSI, that this drives many sufferers nuts but, being a software engineer, I can see it from the medical professional's perspective.
If a user of one of my applications comes to me and says "sometimes it is hard to do X and sometimes Y seems to pop up out of nowhere and sometimes I feel as if all I can do is Z but the feeling goes away after a while..." I will likely tell them there is nothing I can do until they have a repeatable scenario for me to measure and diagnose.
The relatively benign possible outcome here is that your medical practitioner just tells you to "rest up". The significantly less benign outcome that seems common is a rush to diagnosis on the basis of some symptom or other. For example, pain in the carpal tunnel of the wrist. Tales abound on the Web of people who have had surgery or drug interventions that have addressed a symptom of RSI but not addressed the underlying cause. Oftentimes leaving the sufferer no better off physically and worse off financially.
A related problem here is that the diagnostic weapons of choice in medical science seem to be much more advanced at measuring bone and bodily fluids than the more invisible world of nerves and electrical signals. If it cannot be measured, it cannot be diagnosed and cannot be fixed. That is the scientific way and I wouldn't want it to be any different. Let's hope that some measurement technique comes along that makes chronic pain pathways visible in the same way that X-rays make bones visible.
Posture and muscle weaknesses: I took physiotherapy and now have a daily (thankfully short) exercise regime I follow. In summary:
- From my physio's perspective, treating my RSI is really a matter of addressing posture and musculature problems. Like many a geek, I have spent years, slouched in a dodgy chair with hunched shoulders and tensed arms squinting at a monitor and twisting my wrists into crazy positions to minimize keystrokes. The cumulative effects include unconscious slouching and hunching; stressing of shoulder/neck muscle groups; weak torso muscles; shallow breathing and finally, wear and tear on arm/wrist/finger muscles/tendons/ligaments/fascia.
- I now do basic Pilates/Yoga exercises pretty much every day for a few minutes, focusing on torso muscles and stretching.
- I use an ergonomic desk setup with a high monitor; low keyboard table, split keyboard keys; and a vertical mouse.
Rest breaks: I have installed an application that reminds me to take a short break after 5 minutes of continuous typing (30 seconds) and a longer break after 30 minutes (5 minutes). I'm getting pretty good at not hitting the "cancel" button and obeying its command.
