Repetitive Strain Injury (RSI): Frequently Asked Questions

A) I have constant numbness and no one to help ...

A sufferer writes from halfway around the world (that's as far as you can go, right?) of constant finger numbness, and suspects computer user. There's doubt about finding a helpful doctor or therapist. What do I do?

I answered the questions and realized I wasn't offering anything new. Everything we know about RSI is in our book except a few items I'll list in a moment.

Despite our book being several years old, almost no new scientific information has arisen to render it obsolete. We'd be the first to applaud such progress. We're not getting wealthy from book sales, far from it, it's really a labor of love that barely pays for itself. We've sold 8,000 and need to print more. I'm not sure it's worth it.

Here's what precious little we've learned since writing this book:

• Breaks are nice, but the big lesson for hardcore users who won't change their evil ways: learn how to keep moving, fidget. Work in motion.
• For do-it yourself massage, if your problem is adhesion and poor blood flow, etc., consider Armaid.com but don't do any self-treatment without a doctor's advice and a good understanding of what your problem is. If you're a compulsive person, you're likely to overdo it with any self-massage device.

Variations in individual's anatomy at the chest (thoratic outlet) impress me as one of the biggest possible reasons why some people suffer and others don't. The nerves and blood vessels go through the muscles in different (called 'anomalous') paths, some of which could make people less suited to hunching over a keyboard all day.

Very Important: New imaging technology can show objective evidence of blood vessel problems.

One of the most difficult aspects of RSI is the psychological component. The parasympathetic nervous system could have a big role in the less mechanical side of diagnosing RSI

I couldn't find good info on biofeedback prior to print time but I recently learned of a Kathy Bender in San Francisco who uses dynamic EMG muscle feedback and temperature feedback to help computer users find their ideal workstation configuration. They have an occupational therapist first do a history and ergonomic review. They evaluate what they call the "functional path" and work on diaphragmatic breathing. The cost is approximately 10 sessions @ $92= $920, generally prescribed by a chiropractor or doctor. Sufferers should use web to find a biofeedback person certified by National Biofeedback Association. Specifically ask if they do their biofeedback in a dynamic setting, and do temperature biofeedback.

B) What do you recommend for trigger finger? [Jan 01, 2004]

(Suparna) I do believe that conservative therapy helps trigger finger, in fact, I have treated several trigger fingers with good results. Have you had a cortisone shot to the area? That sometimes helps to reduce the inflammation, and may assist the therapy. I treat trigger fingers with manual therapy, modalities (ultrasound, iontophoresis, etc.), manual exercises, and tendon gliding. In my experience, treatment has to be quite aggressive to be effective.

C) Do touch pads help? [Dec 12, 2003]

As I've had to be reminded myself, there are no perfect devices, only "perfect" usage, which means - to me at least - staying in motion and knowing your limits. I'm trying out a vertical mouse and really like it, but quickly found that it accentuated a new pinch point. Like a new pair of shoes, it moves the resting place that one uses on the heel of the hand, rotating it slightly.

This virgin skin was uncomfortable being the contact point for the first time in 47 years. And I do graphics work for hours straight sometimes. But I'm still using the VM and really think the new pinch point might be a better one than the old one which could have been right over the ulnar nerve at Guyon's canal.

Anyway, pads in general are a big help to many sufferers because they eliminate the pinching grasp and therefore the incessant tendon abuse and forearm tension. Both of these presumably shut down oxygen flow. But as a graphics person, pads aren't precise enough for the work I do.

D) What is the most important ergonomic device? [Dec 12, 2003]

The trick answer of course is that your body is an ergonomic device, which is the topic above, so let's say "purchases" device. Considering the body to be a chain with some vulnerable links, it would make sense that the link that needs attention would matter most. For folks who just over-grip a mouse, a touch pad or trackball seems most important. If maniacal overuse simply shifts the wear-and-tear to another link in the chain then purchased equipment is not the full answer.

If you in particular are only vulnerable at the elbow as I was, it could still take several corrections, chair height, arm rests, split (wider) keyboards, massage, motion, or vertical (uprotated) mouse. The analogy that is offered most often on sore hand, perhaps by Penny Kome, or Sharon Butler is that your body as a health bank account; one mustn't withdraw faster than you replenish.

E) Where can I find the Elbow Pads for Nighttime use mentioned in your book on page 49?

It's called a Rolyan Elbow/Heel Protector with Shock-Absorbing (Acton) Gel Padding. The manufacturer is believed to Smith & Nephew. The original site I found it on seems to have gone out of business. Searching the web on "rolyan elbow pad" starts finding some hits, but not great.

On the following site, the part number is "A730-002". Often, this could be just that site's item number, but notice it's a .smith-nephew domain! Rolyan Elbow/Heel Protector. Sure enough, searching the web on "A730-002" (the 002 indicates medium size) turns up lots of vendors from whom you should be able to buy. Here's one in Georgia, USA: www.rehabsmart.com. My advice is to only buy stuff from an online vendor if they show a brick-and-mortar address and only after talking to them on the phone, as a test that you'd actually be able to resolve a problem.

F) What's the more common complaint 1) pain 2) cramping or spasm, or 3) functional complaints - can't do an important set of activities?

Well, If you want genuine statistical facts, only a scientifically controlled survey will suffice, right? The first thing to keep in mind is that RSI is many things and has almost as many attitudes as sufferers.

But I'd like to answer for myself and the many people I know who suffer from RSI as a result of intensive computer use. The answer is emphatically #3, not being able to do our jobs, not being able to sleep, and not being able to perform some of the other activities of daily life (ADL's). I don't want to diminish the suffering that many experience from unremitting pain, but most of the people that I encounter are accustomed to many forms of pain and would gladly accept a known amount of pain in exchange for a promise that their livelihood would be unaffected. That is the real pain of RSI for most computer workers. Who are generally self-motivated, obsessive about work and doing a good job, and often unable to tear themselves away from the keyboard.

On the flip side there are also many people who are compelled to work at the keyboard by a harsh work environment or simply having no alternative to pay the rent or put food in their families mouths. Even among this group I suspect you'll find the same personality profile: driven people, working their fingers to the bone.

Certainly, there are RSI sufferers with excruciating pain, some with extreme conditions (perhaps reflex sympathetic dystrophy). But statistically, most have erratic, on-and-off pain that occurs when working. Aside from fear for our livelihoods and the many forms of pain, there is the misery of lost sleep, guilt, scary numbness, erratic motor control, and peculiar shock sensations - and yes, cramping and spasms. But relative to the concern that you could be unable to support yourself, these are all just ADL's: annoyances of daily living.

G) What are the "best of breed" office equipment choices?

A recent sore hander asked a quite sensible question that essentially boils down to "What are the best of breed office equipment choices with respect to RSI?" The question goes right to the core of how difficult the RSI problem, is because no single answer seems right for all RSI sufferers. And for the most part, those who don't yet suffer from serious RSI generally don't care. (And who can blame them?)

Based on my experience, and with the disclaimer that I'm not an ergonomist or a licensed medical practitioner, let me offer my answer. If you've got a health problem, see your doctor.

While there certainly are some lousy products and some favorites of many RSI sufferers and opinion makers, there are two problems answering the question: 1) Even as ragards the favorite products, there's not enough agreement on the best products to establish a consensus. RSI sufferers, even if they spend all the money in the world on the popular equipment, will have questionable benefits from the changes. In other words there's much doubt over whether the relative contribution of the equipment itself, as opposed to the habits with which it is used. Which brings us to the second factor ... 2) Someone who has no RSI symptoms at all can wreak absolute havoc on their body using only the most widely favored equipment.

Our advice the is this: get the most adjustable equipment you can, get good advice on using it with low strain/pressure/tension, and don't work like a zombie. Maybe we sore handers can help you and ourselves best by answering the question "What is the most adjustable product in each class?" For mice (pointing devices) this would probably mean using a different style every "fatigue period."

By "fatigue periods", I simply mean the amount of time it takes you to get tired or otherwise start overwhelming your body's ability to fend off damage

The collective but best guess sore hand wisdom is that after some period of time any number of things might be happening whether you feel it or not. The body can't sufficiently flush away the waste products of metabolism, tissues are starved of oxygen, tendons are insufficiently lubricated, nerves and blood vessels are not just pinched but kinked, and residue accumulates on moving parts (becoming adhesions).