March 30, 2004 (first posted at www.scriven.com/RSI/rsiadvice.html)

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Advice from planet RSI: how to get better

By Kimberly Patch

I struggled with repetitive strain injuries in my hands for several years before finding treatment that got me on track to get better. It took several more years to get better. (See Greetings from planet RSI: what it's like to have hands that hurt all the time for the gory details.) During this time I explored many treatments. Here's my advice to anyone who's struggling with this problem now.

Disclaimer: I'm not a doctor. I'm not a therapist. I have read a lot about this injury and many related fields, and I know what it feels like to struggle with RSIs for years and to get better. Please take my advice, along with all advice you get about this injury, with a grain of salt. RSIs are sometimes very difficult to get over. Your mileage may vary. What is most important is that you figure out how your body works, and explore the treatments that work best for you.

Here's my advice:

Try trigger point or myofascial deeptissue massage

Stretch

Stretch a lot, and as long as you're acutely injured do very gentle stretching ridiculously gentle stretching in order to avoid hurting yourself.

Try stretches that your doctors, therapists and books say will help, then choose the ones that do help. Build your own set of stretches that work for you.

Stretching is often fairly tedious. What worked for me was building stretching into my day in a way that it became habit when I was very hurt there was a doorway I didn't go through without stopping to do a twominute series of stretches that required a doorway, and when I was on the phone using a headset I went through a series of hand stretches. I still do some basic stretching as maintenance I do the doorway stretches once a day now, and still find myself doing the hand stretches when I'm on the phone. It makes it much easier that these are habits.

Do some kind of therapy that allows you to be more aware of tension in your body

The Alexander Technique and Tai Chi are what worked for me.

The massage therapy showed me where my muscles were tight and got the knots out of tight muscles, but my muscles kept tightening up. The hard part is becoming aware enough to keep the knots from returning, but you can do this by being aware of tightness when it first starts and releasing muscles before things get acute. I found learning to do this through the Alexander technique and Tai Chi both tedious and difficult, but very rewarding in the end.

I took Alexander from Cécile Raynor in Brookline (www.alexandertec.com, 617-325-0881) and Tai Chi from Brookline Tai Chi (www.brooklinetaichi.com, 617-277-2975).

Keep in mind that you may have to wait until your hands are not so acutely injured before you do these therapies always make sure not to do anything that exacerbates the injuries.

It also helps to have Alexander and Tai Chi instructors who have experience with RSIs. No matter what type of releasing/awareness therapy you choose, the Alexander technique book "Body Learning" by Michael Gelb is a very good read it's less about the therapy itself than about the concepts behind releasing, how you use your body, and how to move more efficiently. It makes things easy to picture.

Make sure you are hydrated

Muscles that are dehydrated are more vulnerable to injury and take longer to heal. A good rule of thumb is to drink half your weight in ounces of water per day, and also match any caffeine or alcohol with the same amount of water.

So if you weigh 150 pounds, drink 75 ounces of water per day plus an extra glass for every alcoholic or caffeinated drink you have. Keep in mind that it takes a couple of months for your body to adjust to the optimum amount of water. You can live your whole life dehydrated, and your body will adjust, but it will strain to do so. Also keep in mind that water with minerals, like filtered tap water, is better than distilled water that doesn't contain minerals.

Exercise to get your blood moving, but don't do anything that hurts your hands

Doctors and therapists tend to recommend swimming. If you like swimming and you have easy access to a pool, this is an excellent way to go. If you have to hurt yourself to drive to a pool, or swimming makes you cold, try something else. Walking works well, too.

I did a lot of walking what I was very hurt. Then, when my hands could tolerate it, I started a type of exercise I was used to, knew well, and felt comfortable doing running. I was careful to wear good running shoes, and run on dirt paths. At first I walked down the hills to avoid jarring my arms. I ran every other day to give my body chance to recover, and did a lot of stretching before and after running.

As long as you're in pain, stay away from repetitive strengthening exercises

The key to getting over this injury for me anyway was to get tight muscles to calm down. (Tight muscles also make tendons more vulnerable to injury, and injured tendons also put strain on muscles, setting up a nasty tendonitis loop that's difficult to get out of and can exacerbate other types of repetitive strain injuries like carpal tunnel.) Strengthening opposite muscles just gave me two sets of tight muscles. Strengthening opposite muscles is commonly prescribed by doctors and occupational therapists because it works for traumatic injuries. RSIs are different, however.

Support your body in any way you can

Eat organic food if you can in order to cut down on the chemical load your liver has to deal with, eat whole foods when you can, because they are easier to digest and extract nutrients from, get enough sleep, and try to stay out of stressful situations I know, having RSI is a stressful situation, but any way you can cut down on stress helps.

Toxins accumulate up the food chain and in fat, so if you can only afford to buy some organic food, dairy is the most important, followed by meat. Certain vegetables are more likely to have heavy loads of pesticides. The book Diet for Poisoned Planet provides good details along these lines.

Some practical tips

Use a phone headset. Use a device like the Able Table to hold books while you're reading. Stop all typing.

If you have to use a computer, use speech recognition software, and be prepared to spend some time learning the software. Here's the difficult part. Wait until you're not acutely injured to learn the speech recognition software, and learn it in conjunction with therapies like Alexander and Tai Chi, which will allow you to learn to release rather than tighten your muscles when you're doing things like sitting at a computer. Seek out and try things that have helped other people who have had this injury, and find your own way

Pay careful attention to what helps, and use what helps, and don't use what doesn't. This of course goes for my advice is well. This is a very tricky injury to get rid of. Different therapies can help or harm depending on the state of your injury, and some commonly used therapies, like exercise programs and ibuprofen, often cause harm.

This bears repeating it is very important not to let anyone tell you to do something that hurts you. You are really the only one who can tell when you're ready to do something.

A useful book for exploring available therapies is "Repetitive Strain Injuries: alternative treatments and prevention" by Timothy Jameson.

Good luck. This is a difficult injury to explain, deal with, and get over, but when you start getting back abilities like picking up children and heavy grocery bags, and playing musical instruments you'll find its very nice to be able to appreciate abilities you might have once taken for granted.

One favor don't forget what it's like to be in pain all the time and have trouble doing things. The world needs more empathy.