Oops! RSI

by Sean McGrath

February 29, 2008 —

First up: disclaimer. This is about health hazards of using a computer keyboard all day. I am a computer geek. Not a medical practitioner. If you have symptoms that you believe are related to your use of computers, go see a doctor.

Twenty five years bashing a computer keyboard has finally caught up with me I'm afraid. Movable aches and pains running up and down arms, in and out of my wrists, through my fingers, shooting pains in my shoulder and arm muscles...the works!

There are two common acronyms related to this state of affairs. RSI (Repetitive Strain Injury) and CTS (Carpal Tunnel Syndrome). Both are problematic pieces of terminology for reasons we will get to soon.

If, for want of a better label, you think of yourself as having RSI or CTS, you might find my story interesting for comparative purposes. If you don't have symptoms, please don't conclude this piece will be of no relevance to you. RSI/CTS can be cumulative. You do not have to overtly injure yourself to bring it on. It has most likely incubated in me for decades, silently getting stronger and stronger and then popping out dramatically. I did not have RSI/CTS for twenty five years. And now, all of a sudden, boom, I do! Next week, it could be you.

Next up: the terminology problem. The term RSI covers a wide variety of symptoms and causes. So much so that it is next to useless in pinning down a particular cause or particular effect. Also next to useless is the other regularly encountered acronym CTS - Carpal Tunnel Syndrome. The carpal tunnel is in your wrist. Pains in your wrists could be because of a compressed nerve in your wrist. This is true of CTS as I understand it. However, there appear to be lots of ways in which pain in the wrist can be the effect but not the ultimate cause. Unfortunately, conflating the effect with the cause appears commonplace out there.

Next up: my story so far. It all began in November 2007...

Phase 1: Aches, pains and denial. I have been doing this computer keyboarding thing for twenty five years darn it! This RSI thing cannot happen now. Surely my system is used to whatever stresses and strains keyboarding causes? Besides, how can gently tapping keys cause injury? Now if I was a professional lumberjack or baseball pitcher, perhaps but keyboarding?

Phase 2: Doctor visit. "You have a repetitive strain my friend. Just rest it up and you will be fine."

Phase 3: I Rest up. In my case 12 clear days without so much as touching a
keyboard over the Christmas break period. 12 days!

Phase 4: Uh oh. My first day back and the aches and pains arrive back to exactly as they were 12 days before. The pains are annoying on many levels. Physically, the best analogy I can conjure is that it is like distributed Chinese water torture. No individual ache or pain is severe but they come regularly - but randomly - to different parts of my upper body. I never know where the next "ping" is coming to. Sometimes they wake me up at night.

Phase 5: I am a computer engineer darn it! I know how to debug things. I will debug this myself if medical science fails me! I order a slew of books on Amazon, subscribe to mailing lists[2]. I Google a lot. A picture slowly emerged.

Phase 6: Maybe sports massage therapy can help if my problem is (at least in part) tendonitis? I take some sessions. I feel better but have a mental ache that this is not getting to the root of the problem. I have a second mental ache concerning the placebo effect. The more I read the more interactions between mind and body I come across. Dr. Sarno's book in particular, holds out the bold assertion that there may be nothing wrong with me physically at all! Yikes.

Dr. Sarno talks about tension, stress. Yes. They ring bells for sure. I have some of those. So the stress (in part) causes the pain, which in turn stresses me out which in turn...Uh oh. I don't like where this hermeneutic circle is heading.

I try to talk myself out of it. I tell myself I'm fine. The pain, however begs to differ.

Phase 7: Stretches and breaks. From what I have read, there appears to be a general consensus that getting some stretches in and taking regular breaks from computer keyboarding is a good idea. There also appears to be general consensus that ergonomics plays a role in many types of RSI/CTS. I hit the online stores again and tool up with split keyboards & vertical mice. I re-arrange my desk area so that my keyboard is much lower (leaving my arms more bent) and my monitor is higher (leaving me looking out rather than down). I think it is helping but I cannot be sure. Not only do my symptoms move around but there appears to be a significant delay between any given effect and its original cause. I keyboard heavily on a Friday. No pains. Then I take the weekend off but pains kick in Sunday evening. Go figure.

This is driving me nuts! The first thing they teach you in debugging school is to establish cause and effect. How can I do that when the effects are variable and possibly days removed from some unknown cause?

Phase 8: No major improvement and a dose of fear, uncertainty and doubt kick in. What if I cannot fix it? What would life be like if I cannot type? I go to see a physiotherapist.

Phase 9: "Your posture is real bad my friend", she says. "Forget about your arms, hands and wrists. Your problem starts in your spinal shape and in particular, your neck." Time to hit the exercise mat...

So here I am. Working on the assumption that posture is the root of the problem. I have the hunched shoulders and underutilized abdominal muscles that are something of an occupational hazard in computing.

I feel I am making progress with the posture and exercise work. I feel I can work without doing myself cumulative damage. Hopefully that is not naivety on my part. The aches and pains persist. If it took me twenty five years to get myself into this mess, perhaps it will take me quite a while to get out of it? I live (and thankfully, continue to work) in the hope that I can get to the bottom of this and get it under control.

I am in phase 9. I don't know what phase 10 will look like. When the saga takes its next big turn, I'll write it up.

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