Usually RSI sneaks up on you and hits you when you are most under pressure and least able to cope with or, indeed, rest from its causes. Often it seems RSI hits conscientious hard workers. In my case, I went from being a top performer to a problem employee in the space of  less than 10 years. This steady decline was not something that I wished for, wanted or felt happy about, but there was very little option, later at least, to change course. I could make management happy by working harder and thus continue to hurt my arms and hands, and I knew that backing off work would mean less throughput, less visibility and fewer financial rewards. It’s a vicious cycle.

I can remember how it ultimately felt when I quit. In one respect, there was the relief of being free from the cause of pain but, on the other hand, there was the bitter feeling of how the injury had made me fall from being a top rated performer to simply a problem employee in the space of 10 years. In truth, the injury had led me from loving my job to becoming almost disillusioned with it when I realised that I just couldn’t perform my role any more due to the pain. It’s a nightmare journey with a lot of frustration along the way.

It was also a sad day to finally say goodbye to my engineering position, in which I was qualified and had spent the best part of 20 years doing, in a career that I really had enjoyed. And, of course, the future lay before me with a very large question mark over it. There were a lot of mixed emotions.

The one thing that still rankles me is how the transition from a star employee to a problem one can happen. An injured worker isn’t very useful to a company and there is a breakdown in relationship between employer and employee when you get injured, which I guess relates to the business ethos. It’s a fact of life that, if you are limited in learning new things because you are injured, then you are becoming less and less useful. The only contribution for a long term employee is knowledge of the job. This can be tapped into in an advisory role for a while, but once that knowledge is imparted or becomes dated, your usefulness rapidly diminishes and you become a problem that needs to be addressed. Should I have done more? Should my employer have done more?  There are many open ended questions that linger with me to this day, ones that I know will never have an answer.

If I could change one thing, I’d have taken the injury more seriously a lot earlier. I can’t over-stress this point to anyone reading this who has just developed an RSI. It is very important to break free from the underlying causes before you too end up going from star employee to company problem.

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Civil liberty infringements aside, this example shows how ignorant some employers are to RSI and how it manifests itself. RSI is pain induced by micro movements of a repetitive nature, which ‘flares up’ and produces painful symptoms when doing many small micro movements over long periods of time eg typing on a keyboard or clicking a mouse. In bad cases, it can cause pain and weakness, for example in wrists, which may affect other activities, or other repetitive everyday tasks. The condition does not, however, generally affect the muscles groups associated with doing many tasks requiring larger motion, including most motions involved in working out at the gym.

The irony is that with RSI, activity that is based on large non-repetitive motions and especially cardio based activity should be encouraged since movement of the larger muscular groups will enhance blood flow to injured areas and promote natural healing. It should not be criticised and brought up as evidence against an RSI claim. To do so just shows the complete ignorance of the individuals and organisations involved.

It is a travesty that the perception is that someone with an RSI condition should be effectively seen to be in a wheelchair and/or doing nothing before they look like they have RSI to an employer. If they were observed continually texting on their phone or playing video games all day that would be a different story! However, being criticised for living a normal macro movement life whilst trying to keep fit and healthy is an outrage.

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One question they asked that has stuck in my mind to this day was, “When was the last time you listened to music?”, to which I replied well, “In the car driving here”. Their response was, “No, when was the last time you listened to music just to enjoy the music, not as part of something else?”. I really had to rack my brain to think that one through. I couldn’t remember. Not for many years and probably when I was a lot younger, had a lot more time on my hands and a lot less to worry about – probably in my teens! I had to be honest and say, “I really don’t remember”.

The lesson she was trying to impart was that we rarely take the time in life any more to just enjoy simple things that once were a source of relaxation. Music should have been there to enjoy and relax to on its own. By then my life was so busy that music had been demoted to something less.

It may be a part of the reason we hanker after music during our childhood to teen years. Back then, we had more time to listen to music with fewer worries and distractions in our lives. Not only that, but we spent time listening to whole albums from start to finish (which back in my day were on vinyl) and playing them to death whilst memorising the lyrics. This changed in my busier twenties, demoting music to be something listened to when I was driving about, at my desk whilst working or when I went for a workout at the gym. It just wasn’t something I had time for any more on it’s own, yet it was still an important part of my life, just not for relaxing to. In other words I always added something else into the mix with music without obtaining any of the mental relaxation that could be found from listening to an entire album and doing nothing else.

Move forward a couple of decades, and we find ourselves in a completely different situation. The invention of home computers, MP3 files and players have completely revolutionised music and the way we listen to it. We now have thousands of files on our players that are very easily mixed and are frequently listened to in random order, which can be great, and really allows you to find stuff in  your collection that you’d forgotten about. However it has led to being spoiled for choice, and we tend to flick through music tracks at the push of a button, not listening to albums in the way they were intended to be appreciated. Many artists spend a lot of time sequencing an album into a specific order which ‘flows’ or tells a story, and is really part of the overall experience of that music. This sequencing is more often than not completely wasted with shuffle plays of MP3 players, and really adds to the sense that music is just a cheap commodity in our already over commoditised life.

If we spent a dedicated hour a day to do nothing but listen to a favourite album the way it was intended to be listened to and for no other reason but to enjoy that album, we’d find that the music does a wonderful thing and takes us to a different place, where we can lose our worries and stresses for an hour and start to relax again, just as we did when we were younger. It may also help us to de-stress and unwind from tension induced conditions such as RSI.

So when was the last time that you really listened to music?

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“Tweeting by thought alone is a somewhat slow process using this prototype technology –- we speak at approximately 120 words per minute. But, as with texting, users can improve as they practice using the interface. “I’ve seen people do up to eight characters per minute,” Wilson says.”

Ouch.. that would be a significant downturn in workload!  I can see this form of input being a considerable benefit to people with severe disabilities, however I do wonder what the long term health impacts are of having an electrode implanted in your brain. My guess is that it must surely at this stage be a large unknown. It is, however, an interesting area of research.

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Trigger finger is where a finger in a gripping position appears to lock in place. When you pull the finger open, it unlocks with a click (or in my case a loud ‘clunk’ which made anyone around me squirm!), hence the name trigger finger. The condition is caused by a nodule growth on the tendon which gets stuck on the pulley (sheath) system that is there to guide/hold the tendon in place. Doctors have minimal knowledge about why this nodule forms. Nodules on tendons can come and go on their own, but this one has been bad and persistent.

The build up to the operation had certainly been playing on my mind for several months. Unsurprisingly the mental prospect of the surgery was the worst part since the operation itself was only 15min in duration and was carried out under local anaesthetic (although I avoided the temptation to watch it!).

The procedure itself involved cutting open the sheath(pulley) that was causing the tendon restriction to occur, which freed the movement of the tendon (and nodule). The surgical entry point was  on the palm of the hand just below the finger, and the incision itself was only about 1 inch long.

Recovery time has been fast. I am now nearly 3 weeks post op, the stitches are out , and the skin on the scar has fully healed over. I still have joint stiffness, and a bit of swelling which causes my finger to stiffen up in the bent position, but I expect this to gradually subside over time, especially after I keep stretching it like I have been instructed to do by the physiotherapists.

It is too early to do a complete assessment of the experience, but I can say that it’s great not having an annoying triggering finger condition any longer!

I wish there was a simple solution like this to my RSI condition!

UPDATE : 1 month post op

It’s now been about 1 month post operation, and I thought I’d update this post. Although the scar on the plam of the hand is healed over, however I still have a lot of  sensitivity about the entrance wound, as well as a lump under the wound. Not sure at this point if the lump is scar tissue or the nodule. The triggering has gone, but I still have a lot of stiffness in the joint, and the finger still likes to stick in the bent position (I have to physically bend it straight with my other hand). Hopefully this is just a result of the swelling and that this will go away on time. I am using the finger, but it can be sore depending on the task at hand.

Update: 2 1/2 months post op

The finger is getting  better all the time. It doesn’t stiffen up as frequently as before, but it still can stiffen quite badly and there is no cause I can determine for this. I recently had a follow up with the surgeon, and was advised that post op stiffness is common, and recovery can be as much as 18 months for some individuals – they don’t tell you that before the op! He suggested massaging the joint to reduce the swelling. The scar has totally healed up now, and is a whole lot less sensitive than it was a few weeks ago.

Update: 6 months post op

It’s certainly taken it’s time, but the finger is showing very little stiffness now. I can extend it fully contract it fully, grip things tightly, and have no sign of that horrible triggering any more. I can officially say the op was a success. It does go to show that there is a 3-6 month recovery term for this operation. Good luck with the operation if you are someone who is considering having it done and just factor in a few months for the recovery.

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There are a lot of braces out there, and what works for one person may not work for everyone. Braces are usually made out of neoprene or elasticated material coupled with a metal or hard plastic support to immobilise the wrist.

The primary use of the wrist brace should not be forgotten ie to rest wrist joints and forearm muscles that drive the wrist motion (forearm extensors, flexors), and reduce the pain associated from overuse injuries. While this may sound like a good thing, quite often if you wear a brace while using a computer, you will end up using other muscles in a strenuous way to do the same work, and can cause other injuries because of this.

There is no such thing as an ideal wrist brace, it really depends on what they are trying to do.

In the course of your RSI journey you way well encounter many different styles of wrist braces.

My general rules concerning wrist braces are -

1. You shouldn’t jump in and buy a wrist brace without first seeking advice from a physiotherapist or doctor.
2. Ideally, it should be used to rest (heal) the wrist and the overused (painful) muscles that drive the wrist extension and flexion, and not worn when using a keyboard or mouse.
3. Exceptions to the rule are perhaps specific braces intended to stop excessive flexion of the wrist if you are prone to this. It’s a far better idea to be able to spot this flexion yourself and change it, but if you have difficulty doing this then a brace may be required. Alternatively have someone stand and watch over you with a big stick, you will learn faster then!
4. Braces used to rest the wrist should not be too tight, just a snug fit. Over tightening can lead to restricted blood flow to the hand and wrists.
5. Consider wearing a wrist brace at night in bed to avoid sleeping with your arms/wrists/hands in bent positions. It is critical that you don’t have a tight brace when doing this so as not to restrict blood flow.
6. Don’t use them unless you have to. Its better to know your pain, when it happens and try to make adjustments to your  work practice etc to reduce the causes than it is to just ‘bandage up’ your injured wrists into a brace.
7. Neoprene braces can be hot, sweaty, smelly and itchy to wear even for short periods of time. Better to look for ventilated elastic material ones.
8. Wrist braces are not a good  universal fit for everyone, so you may have to make some adjustments to it to make it comfortable, including cutting bits out of it or adding some customised padding.
9. Wear them at work and they do flag to your employer and colleagues that you have a RSI problem!

Remember though, wrist braces are not a solution to RSI, they are really only there to rest an injury and ease pain. To address your injury it is far better to try to make adjustments to your work to stop the motion that is causing you to have the pain. In other words, you should monitor your wrist, hand motions at a keyboard etc, and make adjustments to your bad working practices, including posture changes. You should also introduce more regular breaks away from your computer along with a good stretching routine and some physical activity.

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“There is a growing awareness of how much of an impact there is on students. A lot of the ergonomists I work with at different companies have been noticing that students are graduating from college and coming into the workforce already with chronic repetitive strain-injury problems. It seems at least from the anecdotal stuff that it’s important to start focusing more on the student population.”

This could unfortunately be the start of the RSI epidemic wave that I have long been expecting. The younger generation coming through universities and colleges of further education are the ones that have been exposed to ‘technology’ since they were born and have grown up accustomed to a hi-tech life full of computers, mobile phones, gaming systems and other ‘daily use’ gadgets in complete ignorance of the danger that they pose. They are the generation that have grown up with an ever expanding level of text messaging.

What this generation does not appreciate are the dangers associated with RSI type conditions and their implications for future employment (and earnings) prospects. I also wonder whether employers realise the risks of employing people with these conditions, especially into computer intensive jobs. It may not be too far in the future before employers start to check for these conditions during a pre hiring medical examination, although it may be hard to diagnose without honesty from the potential employee.

What is obvious to me is that ergonomic and RSI health awareness training currently aimed solely at employed adults has to be brought into schools, colleges and universities also to educate the future employees before they succumb to a debilitating RSI condition when they start their employed adult life.

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The RSI pain cycle once ‘locked’ into is a hard one to break free from. The common mistake is to address only one or two factors. If the sufferer is at an early stage of RSI, and is fortunate then one change eg ergonomic setup may be enough to break free, but any medium/long term sufferer who is trapped in this cycle should consider addressing most/all of the underlying trigger causes to allow the transition to an RSI free life. The second diagram (click image to enlarge) shows the key areas to address to break the cycle.

You can also download the 2 diagrams in Breaking The RSI Pain Cycle (pdf)

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• Computer operator professional or otherwise
• Deep in concentration about your work, intolerant of interruptions
• You slouch at your desk, peering at the computer screen, unaware of your posture
• Working on a key project with tight deadline
• Stressing about achieving that deadline
• Working in a competitive environment in uncertain times
• Spending your work time at a computer for 5-10 hours a day
• Taking minimal breaks, and most of these are spent checking email /surfing the web
• Lunch is frequently a sandwich eaten at your desk whilst working
• You are a heavy coffee drinker
• You spend a cumulative 30 min/day sending text messages on your mobile phone
• You go home after a 10 hour day and relax by ripping some CDs to mp3, updating your iPod, catching up on personal email and unwinding by playing a ’shoot ‘em up’ on your computer/games system for 2-3 hours
• You spends 6-8 hours sleeping before starting the cycle again

Lets break down each point and try to inject some solutions -

• Computer operator professional or otherwise
  Can’t change a lot here (short of changing careers!)
• Deep in concentration about your work, intolerant of interruptions
  I’m not suggesting that you should not be concentrating on your work, but you need to recognise that interruptions, including going for breaks, are very important to your wellbeing!
• You slouch at your desk, peering at the computer screen, unaware of your posture
  Posture is not always an easy thing to correct since you often feel comfortable slouching, however slouching is often  having an adverse impact on your muscles, tendons and nerves. Good ergonomics is key and you need to pay attention to them. If you are working for a company with an Ergonomist, listen to what they have to say and make those changes.
• Working on a key project with tight deadline
  Again not a whole lot you can do to change this, but try to understand that your current project, future projects, and your entire workload could be put at risk if you develop a RSI condition. It is in the interests of both you and your employer to keep you healthy both now and in the future. This fact is often lost in the everyday hectic business environment.
• Stresses about achieving that deadline
  Stressing about a variety of things in life is part of human nature. However, you are not likely to improve either your work output or your health by stressing over a work related task or deadline. Your muscles will tighten up, and cause tension in much of your body which can exacerbate RSI conditions. As a result, it is important to reduce this tension. Short ’sanity’ breaks as well as taking lunch and tea breaks can help act as stress busters. For more mental relaxation try taking up yoga and/or meditation, or perhaps some other physical pastime.
• You are working in a competitive environment in uncertain times
  Once more not much you can do here unless you want a career change. Just remember that you are far more valuable to your employer as healthy worker. Pacing yourself, but being a dependable, reliable worker is key here. Blasting through your work at break-neck speed may make you look like a superstar, but is not sustainable, and may lead to even more work/pressure/expectation, at detriment to your health.
• You are spending your work time at a computer for 5-10 hours a day
  This is something you can reduce, and need to do so dramatically if you are hitting these types of hours per day at a computer. You can do this by introducing break timers to your computer, and making sure you take ‘micro’ breaks throughout the day. At least one 5 minute ‘micro’ break every hour is ideal. You also need to adhere to official break times even if you don’t feel like taking them.
• You are taking minimal breaks, and most of these are spent checking email/surfing the web
  If you are spending break time checking email and surfing the internet, then this isn’t a physical break. Your body won’t thank you for this type of rest.
• Lunch is frequently a sandwich eaten at your desk whilst working
  Many people skip lunch breaks. This may be due to workload, social reasons or perhaps just to free up time to do email. However, by making the choice to stay at your desk, you are not letting your body get the physical break that it requires when using a computer all day. Even if you set out with the best of intentions, eg reading a book or newspaper, you are likely to get interrupted by fellow workers or the telephone, and end up jumping back on to the computer as a result. It is always best to ensure that all breaks are taken away from your desk.
• You are a heavy coffee drinker
  Caffeine is a diuretic, and as such will cause you to lack hydration which is what sore, tight muscles need to heal. Better off switching to water.
• You spend a cumulative 30min per day sending text messages on your mobile phone
  This is an activity that has to be reduced by everyone. Texting is repetitive in nature and can increase the small repetitive motions in your thumbs and fingers. All these small clicks will add to an already heavy arm/hand workload, and should be avoided as much as possible.
• You go home after a 10 hour day and relax by ripping some CDs to mp3, updating your iPod, catching up on personal email and unwinding by playing a ’shoot ‘em up’ on your computer/games system for 2-3 hours
  If you have a career using a computer then you seriously do not want to be using them after work for relaxation purposes. If you do, you will just be adding more risk to your already high RSI risk lifestyle. Computers at home are seldom set up ergonomically and are often located in decidedly tight, unergonomic spaces. All computer/gaming/gadget use at home should be severely restricted or eliminated if you work with computers during the day.
• You spend 6-8 hours sleeping before starting the cycle again
  If sleeping is the only time that you are not interacting with a computer, mobile phone, handheld or other gadget, then I’m surprised if you don’t have an RSI condition already! Resting your body is not something that needs to happen only when you sleep. Resting from computers isn’t necessarily all about sitting, sleeping etc,  it can take the form of some other physical activity eg swimming, cycling etc, where you start to get blood flowing around your body which will promote healing of tight, damaged and stressed muscles.

You don’t need to meet all of my listed risk criteria to be at risk of developing RSI. The key is to recognise where in your life you can see similarities with the criteria, accept that you may be putting yourself at risk, and make some lifestyle adjustments accordingly to minimise those risks.

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