Battling RSI

A few months ago I wrote a post about my struggles with repetitive strain injury and how it had got to a point so bad that I was in almost constant pain and I could foresee a potential future in which I would not be able to write at all. After I wrote this post I got some really encouraging feedback from other people who had been, or were going, through similar experiences. From this I got some great advice some of which I tried out. So here I thought I would do an update on how things have improved and what I’ve implemented as perhaps this can help someone else.

A few years ago, and long before this recent and most severe bout of RSI first started, I got a Microsoft Ergonomic 4000 keyboard.

This has helped a lot. It puts my hands into a more natural position with the split keyboard and also supports my wrists. Although I had previously assumed the typing was the biggest problem I discovered mouse usage was as much of an issue.

I had been using a standard wireless Microsoft.

On recommendation from someone else I got a Penguin Ambidextrous Vertical Mouse. This is really easy-to-use with either hand and can be held in a very natural position which for me causes minimal discomfort.

However, even this mouse has started to cause me problems, particularly by creating new pain in my middle finger. The biggest positive impact has come from technologies which mean I don’t have to interact physically with the computer at all. Initially, the biggest help was from a tiny button on my iPhone and iPad (which I think a lot of people don’t realise is there).

The dictation on iOS is pretty good and it also means it easier to get away from the desk, stand up and walk around while writing. But Dragon Speech Recognition Software is far superior.

It is highly accurate and can do more than merely take dictation, it also enables you to select files, navigate webpages, etc. This is really transformative as it enabled me to do a lot more work without touching a mouse or keyboard very much at all. I’m increasingly finding that this method of writing easier and much less of a chore than typing, anyway.

Since I wrote my previous blog post I went back to my GP and was referred for physiotherapy which was a lot more helpful this time. The gave me some massage treatment and provided me with a splint which helped to keep my arm in a position which made it difficult for me to aggravate it further.

My physio also gave me a rubber band with which to do some exercises.

Getting a diagnosis from my physio also enabled me to get help through my university who have given me some excellent support through occupational health. They bought me the Penguin mouse and Dragon software and have arranged for me to have a course of acupuncture.

I’ve only had three sessions of this so far so don’t know if it will be successful but it has been found to be effective for carpal tunnel syndrome.

These treatments and adjustments have not cured my condition and I don’t think that is possible. However they have on the whole made it more manageable. Generally my symptoms are less severe than when I wrote my previous post and when I am using all of these techniques consistently there are times when I have almost no pain at all. However, there are many times when it is impossible for me to do this. My work environment and commuting mean that I am often not able to use the dictation software and at times like this the pain can be quite significant. Also, my general level of discomfort is higher than it was before the RSI flared up last year.

All of this does cause me some concern as I still worry that it may become even more debilitating in the future. However, the information and support I got from people who read my previous post was really encouraging.

When investigating RSI I was surprised to discover that there have been questions over its physical existence as to me it’s this seems to be pretty clear. But studies have shown that it is not necessarily related to the amount of physical movements undertaken but with low job satisfaction and high stress levels. While I am generally very positive about my job and don’t feel I have high levels of stress I do perhaps work through a sort of nervous energy. Perhaps this creates the kind of increased muscular stress which it has been suggested has some connection with RSI.

It was also interesting to learn that in Australia RSI as a diagnosis came to be stigmatised due to this questioning of its physical existence. This controversy led to the terminology being abandoned and replaced with the notion of Occupational Overuse Syndrome (OOS). The diagnosis of OOS places a much bigger emphasis on the design and demands of the workplace than the NHS diagnosis for RSI which largely presents it as an issue to be managed by the individual.

For instance, the NHS guidance on the causes of RSI seem to focus narrowly on the activities:

What causes RSI?

RSI is related to the overuse of muscles and tendons in the upper body.

Certain things are thought to increase the risk of RSI, including:

• repetitive activities

• doing a high-intensity activity for a long time without rest

• poor posture or activities that require you to work in an awkward position

Whereas the Victoria State Government Health guidance focuses on the workplace context:

Risk factors in developing overuse injuries

Workplace design and work practices can contribute to OOS. Risk factors can include:

• furniture, tools or equipment that don’t conform comfortably to the body

• benches or workstations that are too high, too low or too far from the body

• machinery that operates too quickly for user comfort, such as speedy conveyor belts that force the worker to move fast

• workspace design that requires repeated bending, stretching or twisting

• tight deadlines that prevent workers from taking sufficient breaks

• repetitive manual tasks.

The NHS guidance on how to tackle RSI seems to focus on what the inidividual should do to manage the symptoms:

There are also things you can do to help reduce your risk of RSI, such as:

• maintaining good posture at work – see how to sit at a desk correctly

• taking regular breaks from long or repetitive tasks – it’s better to take smaller, more frequent breaks than one long lunch break

• trying relaxation techniques if you’re stressed

While the Australian guidance suggests changes to work environment and practices:

Changes to workplace design

Suggestions include:

• Use ergonomically designed furniture and equipment.
• Rearrange the workspace to keep everything needed within easy reach.
• Keep benches at waist height, so that shoulders can relax and arms can bend gently at the elbows.

Changes to work practices

Suggestions include:

• Schedule work to include frequent breaks.

• Vary tasks so that repetitive hand movements are alternated with other work.

• Set realistic deadlines.

Whether RSI is caused by repeated use of particular technologies, inappropriate workstations, poor posture or stress for my situation to improve (as well as others like me) and to avoid others developing these symptoms I feel that structural changes and pressures will need to be addressed.