December 26, 2002 (first posted at Share

Greetings from planet RSI

An attempt to explain what it's like to have hands that hurt all the time

By Kimberly Patch

For the past couple of decades, a large number of office workers, programmers and writers have lost their jobs, cashed in their retirement accounts, and even sold their houses in an effort to cope with the lingering results of finding themselves on the losing end of a battle with the computer keyboard.

Despite the general awareness of the term carpal tunnel syndrome, people with repetitive strain injuries often feel like they're on another planet. Repetitive strain injury (RSI) is a catchall term that includes the relatively rare carpal tunnel syndrome along with a half-dozen other syndromes related to muscle and tendon strain.

I've spent a lot of time trying to explain what it is like to have RSI's in my hands, arms and neck and how the injuries came from something as seemingly innocuous as typing too much. I still find explaining somewhat difficult.

Nine years ago my wrists started hurting. Despite seeing several doctors about the problem, a year later I couldn't tie my shoes, turn a key in a lock, or lift anything that weighed more than a couple of pounds. Doing anything with my hands or arms was painful, including turning a faucet, picking up a phone, using a plastic fork, and signing a check. Driving was impossible. During one very bad week, my husband Eric brushed my hair for me.

When I was first hurt, I described to friends the various sharp, shooting, tingling and vague pains that wandered through my hands and arms as a result of what I had used them for minutes, hours, or even days before.

My first explanations to editors at the magazine where I worked were brief and filled with assurances that the problem wouldn't affect my work. As the injury dragged on for weeks, my explanations included changes I'd made: taking notes by hand and dictating stories by phone so I didn't have to travel with a laptop.

And as the injury dragged on for months, there were more changes. I was sure that using a tape recorder to take notes, wearing braces on my hands all the time, taking high-dose ibuprofen, and requesting that Human Resources requisition speech recognition software would make everything all right.

I found myself telling worried family members that I was getting better, and I thought I was. That is, after all, what usually happens with an injury. I expected all the changes I'd made to be enough to allow me to heal. But what was really happening was a series of ups and downs that ended in a net loss. And with each cycle my hands seemed more fragile.

It became difficult to watch Eric do all the housework. It became obvious that Human Resources wasn't getting the software I needed. It felt like half my brain was taken up dealing with low-level pain that didn't go away. I couldn't get comfortable sitting in a chair.

I became more philosophical. Being a healthy and active 30-year-old before I got hurt, I hadn't thought about what it was like not to be able to wipe off a counter or pick up a cat. I hadn't realized how difficult it was to be dependent.

When I eventually acquired speech recognition software, people were curious about how it worked. But more difficult to explain, both to myself and others, was why I wasn't getting better despite doing very little typing.

The injury was more than simply a matter of overtaxed hands. I had the typical head forward, rounded-shoulder posture of someone who uses the computer for hours without breaks. Just sitting at a desk with this posture was a problem, but it was extremely difficult to change. It took time to become aware of the problem, and meanwhile, my hands got worse.

One of the most difficult things to convey about this injury is how it fools even those who have it. It's hard to understand that even if you can do something once, you may not be able to do it several times in a row, or even a few times in one day, without suffering. And the pain might not hit you until you're lying in bed that night trying to sleep. It takes time to understand that RSI's make your hands so sensitive that your limits are ridiculously low.

After working hurt for a year, I hit bottom, left work and began to concentrate on getting better. I thought it would take a couple of months. It took three years of ups and downs, including a couple of spectacular failures at trying to use a computer again, to get most of the way better.

The magic formula turned out to be a mix of Trigger Point and Myofascial massage therapy, stretching, drinking a lot more water, permanently stopping all typing, and summoning much more patience than I thought I had learning how to move more efficiently and relax using the Alexander Technique and Tai Chi.

My injury had a lot to do with very tight muscles, which in turn made the tendons they attach to more susceptible to injury. The massage got the knots out of my muscles, but they kept coming back, even when I wasn't typing. Drinking more water helped some. A body can survive dehydrated for a lifetime by rationing water, but it is the muscles that first give up the optimum amount of water they need.

The Alexander Technique and Tai Chi are subtle disciplines rather than quick fixes. The Alexander technique is a century-old method founded by an Australian orator whose voice strain kept coming back when he stepped on stage. It teaches efficiency of motion and awareness of muscle movement, and is popular with actors and musicians. Tai Chi, the least martial of the martial arts, is a several-thousand-year-old Chinese practice that teaches you to be aware of and control the subtle movements deep inside your muscles and joints.

Over time, Alexander and Tai Chi helped me notice when and where I was tightening muscles and learn to relax them. It quickly became clear that one of my main problems was a subtle move into the rounded-shoulder computer posture whenever I did practically anything -- picked up a fork, brushed my teeth. It took years, however, to train my muscles not to do that.

During those years I slowly gained back the ability to write with a pen for short periods of time.

I started to wash dishes that were light and didn't require much scrubbing. My hands became a little less sensitive to vibration and jarring. I found that I could go running again as long as I took dirt paths rather than sidewalks and walked down the hills.

Although I made progress keeping my shoulder muscles relaxed while writing, eating or running, however, I still found myself snapping into the rounded shoulder posture when I was sitting or standing in front of a computer, even when I was dictating rather than typing.

What ultimately helped was doing something entirely different that I enjoyed. I wasn't playing violin regularly at the time I was injured. After college I had pretty much stopped playing at all, but when I realized I couldn't play because of my hands, I started really missing it.

And so at a certain point I stopped testing my hands by trying to type, and started trying to play the violin instead, a minute or two at a time. It was frustrating at first because I had to focus on how I was using my hands and arms and shoulders, and so couldn't think about what I was trying to play. But if I was careful I got fewer residual effects -- the various and lingering pains, tingling and tightness -- that I got when I tried to type. With violin it was a little easier to avoid the rounded shoulder posture. This made it easier to be patient about playing just a little more every day, and making sure to back off when it felt like I was taxing my hands. I made progress without having to repeat the exact motions that led to my injury.

Ultimately, I think it would be possible to learn to type again using the same sort of method, along with an excruciating amount of patience, but as it turned out this wasn't necessary.

Before the injury, I was a quick writer. Using speech software, writing was fairly slow and definitely tedious, because the command interface for speech recognition, while impressive at first glance, was substantially slower than typing when you actually started using it for real work.

In the first four years of my injury I'd used speech recognition on and off, but I'd cheated fairly often -- typing or using the mouse some as I went along because equivalent speech commands were slow or nonexistent. But the cheating always got me in trouble. I only really started getting better when I completely swore off typing.

To do this I banished my computer keyboard to the top of the monitor and put the mouse under my desk. This left a large amount of useful desk space, which I quickly got used to and took to covering with papers.

And so I was forced to use speech to do absolutely everything on a computer. It's amazing how many menu commands and mouse clicks are needed to do relatively simple things like change fonts or copy paragraphs from one window to another. And it's amazing how tedious it can be simply repeating these menu commands and watching the computer take one tiny step after another before arriving at a simple goal.

Four years after my initial injury, bolstered by the better movement and posture habits I'd learned through Tai Chi, Alexander and careful violin, and working under a strict rule not to touch the keyboard, I was able to spend a few hours a day dictating to a computer without hurting myself.

During the next two years, I spent a lot of time writing speech macro commands to speed up the poky speech interface, and I gained ideas and additional commands from people who posted their macros on the Web.

I slowly built up to a 40-hour workweek. It was difficult to get myself to take regular breaks, and to notice when it was time to stop for the day. I was often on the edge of getting in trouble again, and I used a succession of tricks to take my attention from the screen: a clock with bird chimes, a pair of bird clocks that chimed five minutes apart, and finally an impossible-to-ignore kitchen timer. I kept taking weekly Tai Chi lessons, doing stretches and drinking a lot of water.

And after writing thousands of macros without hitting a key, I realized I was controlling the computer faster than if I'd been using a mouse and keyboard. I don't think I would have stuck with speech recognition long enough to figure this out if I'd had a choice.

At the same time I was recovering more abilities -- washing heavy dishes, picking up heavy grocery bags. I even started juggling again. I still had to think about how much I could do each day with my hands. I started to drive again, but only for short distances.

For the past two years I've worked full-time and continued to slowly get better, and I think I've finally made it. There's almost nothing I can't do with my hands that I did before the injury. I played my first post-injury round of golf last fall, and this spring I had my first taste of ocean kayaking, complete with a full cartwheel spill in the surf. I can hold up my nieces so they can touch the ceiling. I play violin for an hour every day.

But I still find it difficult to explain exactly how it is that I can play violin and haul heavy bags of groceries around without problems, but can't type without getting in trouble again.

And another thing that's difficult to explain, especially to people who are in the throes of their own RSI's, is that I'm happy despite a long and taxing odyssey. I've learned a lot from the injury. The abilities that are important to me are back, and I'm taking much better care of both my body and mind now. Before the injury I didn't appreciate or make time for things like playing music and running.

What's really difficult to comprehend, however, is that many of the several hundred thousand people a year in the U.S. who are diagnosed with RSI's don't get better. The U.S. Bureau of Labor Statistics puts the number of workers that miss time on the job due to this type of injury at more than half one million a year, and cites RSI's as the fastest-growing occupational illness.

Acquiring the health care that helps and gaining the time to heal is not easy. I had to seek out and often pay for the neuromuscular massage, Alexander, and Tai Chi I needed despite being covered by both regular and workers compensation medical insurance. I exacerbated my injury twice doing repetitive exercises prescribed by physical therapists who were more accustomed to treating traumatic injuries than the subtleties of RSI's.

Getting better was an excruciatingly slow process that included first figuring out how to get better, then not doing things I wanted to do and doing things I didn't want to do, for years. The timing of treatments also turned out to be both important and tricky -- the first time I took Tai Chi it was too much for my hands. Workers compensation insurance ran out long before I got better, but I was lucky enough to receive an inheritance that, along with my 401k, bought me the time and treatment I needed.

If I had known in the first months of my injury what I do now, I could have cut years off my recovery time. But here's the rub -- I'm not sure if my workaholic self of then would have understood even a very good explanation well enough to take it seriously.