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 so many ways today to fritter away huge amounts of our time in our new virtual worlds. Have you ever played a video game and noticed how 3 hours of your life just disappeared?

Technology has brought us immense benefits as a society, but it has also made us slaves to a great extent, and we spend ever increasing amounts of time interacting with devices whether they be computers, mobile phones, PDAs, games consoles, MP3 players, GPS or TV remotes.

A substantial portion of employment now involves working on computers, whether it be the inputting/analysing of data, or the creation of the latest software that controls our lives. The trouble is that, the more high technology we introduce to our lives, the more time we spend interacting with it, often to the disadvantage of our health. It’s not too hard to imagine that, if current trends continue, there will be a technological gadget to interact with from the moment we wake up until the moment we fall asleep (or more scarily from the moment we are born until the moment we die!).

The Web has expanded the information available at our fingertips by a staggering amount. It has also changed the way we spend large amounts of our leisure time (news surfing, watching videos, e-shopping, chatting, talking, sharing photography, socialising, network gaming, browsing) but this has come about at the expense of our health since we are now sitting in a sedentary posture for hours on end making small repetitive movements with our arms, hands and eyes, often in a slouched, bad posture. Before the Internet was available, we obtained our information from books, magazines, newspapers, talks etc which at least involved a walk to the newsagent, library, pub, town hall etc. Socialising was solely done by interacting with people you physically met, and gaming involved running around the public park kicking a football. Nowadays the exercise involved is often no more than climbing out of bed and turning the computer on, and we wonder why obesity rates are spiralling out of control! Not only do we have all this technology available, but we also feel compelled to use it for longer (often hours at a time) in a way that we never did with other more conventional pastimes.

The one thing that all of this technology has in common is that it has forced us to replace lots of big movements with lots of small, repetitive movements, and spend many hours interacting with virtual worlds on a small screen instead of interacting with the real world. It has disassociated us from reality, and made us feel like this virtual world is hugely important, so much so that we can’t imagine life without it. It has led us to be at a heightened risk of developing many types of problems including the very real threat of Repetitive Strain Injuries (RSIs). It has also just as worryingly made serious addicts out of all of us.

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OK, so you are experiencing a long term RSI condition, ie it has gradually worsened for more than 2 years. You are in continual pain at work and find it difficult to do your job. You have perhaps gone through consultations with ergonomists, doctors, physiotherapists and just about anybody who’ll listen, but still you find no relief. You struggle to remember what it felt like not to associate pain with computer use. You may be wearing an arm brace (and probably have a large collection of them by now), and you probably have a sizeable collection of strange ergonomic mice at your computer that don’t seem to help. Your employer keeps expecting the same work output from you and you stress about how you can get through it. You get by by doing what you can, but generally come home each night from work and feel anxious about the situation and the searing pain down your arms. You wonder what you can do, and how you are supposed to live a normal life – you can’t remember what normal life was like before this injury!

So what are the options then? Well I remember a great bit of advice from my father (that’s what fathers are for after all). It was at the stage where I was still living in the US and wanted to return home. The prospect of a new computer intensive job and a new situation was looming, and I wondered how I’d cope because my injury was getting worse. The stress of the situation wasn’t helping either and changing countries of residence can be a very anxious time. I just wasn’t sure whether I could go on working with computers any more. I phoned my father and told him the situation, fully expecting him to tell me to stay with the job. I was, however, surprised when he said rather straightforwardly, “Well, you’ll need your arms and hands for everything else you decide do in life”. In other words, it wasn’t really an option to keep doing something that could ultimately make me any more disabled. I knew then that I had to consider doing something else.

Before coming to any radical decisions, I really strongly recommend trying to adopt all the suggestions in RSI – What to do? (Part 2 – RSI Dealing With Progressive Symptoms) in the majority of cases you will see improvements.

In addition I’d recommend -

• Eliminating as much computer interaction as possible at work, home and elsewhere
• Eliminate text messaging entirely
• Eliminate use of games consoles if you use them
• Get as physically fit as possible, go swimming
• Use meditative techniques to relax and ease the pain, maybe as part of a Yoga class
• De-stress your life wherever possible
• Get at least 8 hours of sleep a night
• Stick to core work hours – if you are in really bad, continual pain, consider medical leave
• Talk over options with your employer – there may be something else less computer intensive that they can find for you to do
• Find a good physiotherapist who can do deep tissue massage
• Find a RSI support group and share your experience with others. Hear what has worked for others and get free helpful advice
• Consider a career change – it’s tough to do and can be stressful in itself, but there are still jobs out there that don’t require computer use, or at the very least involve less computer use. I am now a self employed picture framer!

RSI conditions can be tricky to get rid of. I have been away from my computer intensive career for two years now, and I still have bad RSI symptoms. Interaction with a computer for 5-10 minutes can make it start to hurt badly, so these conditions are not easy to shake off. There is no ‘magic bullet’ to fix them.

Look after your arms and hands, remember you will need to use them in any new career you decide to take. Good luck with finding a solution that works for you.

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“Only one in six workers takes a regular lunch break.”

“One consequence of the credit crunch is that breaks are getting even shorter as job insecurity increases.”

“Employees are struggling to keep on top of to-do lists and think the answer is to work harder, eating a sandwich at their desk as opposed to taking a full lunch break, and also not having sufficient breaks during the rest of the day.”

“The vast majority of people are having lunch at their desk while working. That’s the average person now. Very rarely do they get out of the office.”

“If senior management create a culture that lunch is for wimps, it’s counter productive. We all need breaks.”

The research quoted in this article, if valid, foretells a very bleak scenario for office workers and in turn for the vast majority of those workers who spend their lives working on an office PC. Unfortunately, the article makes no reference to computers or computer related injuries, and I feel this is a major omission by its author(s).

The consequences of the above findings are abundantly clear however, and will directly relate to an increase in the number of reported repetitive strain injuries. If the research is valid, then we could be on the verge of a large RSI epidemic.
Breaks are there for a reason, and never more so than in today’s computer operating office environment. It is imperative for our health and safety that break times are observed religiously, and it is an extremely worrying trend when scenarios develop where we fear for our jobs over our health. The situation is of course exacerbated by the pressures of the office work environment as I described in this previous blog entry.

I myself am a victim of the “not taking a break to get though workload” syndrome, where other workers around me did take breaks regardless of workload. They are still happily employed in the same occupations, whereas I am not. Please learn from my mistake.

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Addressing this idea seems to have worked for some people. Other people see the condition as solely a physical disability and treat it as such. I however prefer to believe that it is more than likely a merging of the two in a pain cycle that contributes to the worsening of such injuries.

The following is a list some of the physical and psychological factors with RSI injuries -

Physical (matter)

• sore/deforming/cramping muscle tissue from bad ergonomic practices, muscles in continual tension.
• tendon over-stretching, friction in tendon sheaths
• numbness, tingling and pain from pinched nerves in shoulders elbow, wrist, hands
• low circulation and burnout from non fluidly moved muscles in arms and hands
• lack of circulation in arms and hands

Psychological (mind)

• tension about condition, pain, symptoms
• stress about impact of condition on life and wellbeing (physical, psychological, social, career prospects, financial etc)
• anxiety over work related stresses eg workload, project deadlines
• depression about facing life with a disability
• addiction to use of computer devices outside of work
• belief that there is an ‘instant fix’ for RSI and being frustrated that there isn’t
• tensions, stresses and anxiety about your own personal life outside of work/computers
• stress at general skepticism encountered towards RSI type conditions and lack of ‘magic bullet’ cure

I personally find that any suggestion that RSI could be 100% mind related to be quite ridiculous. In my experience I’d have to say that it is a mixture of both physical and psychological factors that cause RSI symptoms. The percentage impact of psychological (mind) over physical (matter) can vary from individual to individual, but as an estimate I’d say the figure for me is about 30%(mind)/70%(matter). This ratio could of course change for different people, since we all have different backgrounds and circumstances.

The impact of the psychological (mind) issues however should not be overlooked as they play a key part in a cycle of positive feedback that increases pain-like symptoms. The tensing of your body muscles when you see a computer (in fear and foreknowledge that this computer makes you feel pain) can lead to stressed muscles, tendons and ergonomic problems before you even begin to use the computer. These tensions, coupled with the bad ergonomics that led you to have the symptoms in the first place, can lead to the continuous self feeding RSI pain cycle which makes the symptoms you suffer even worse. It can also be very hard to break free from this continual cycle.

Sometimes when I worked intensively at a computer and was very focused on the job at hand, I would not notice the symptoms quite as much as usual (my mind was obviously more focused on work than the condition I had). I would, however, ultimately pay for this later when, after leaving work for the day, the muscles would all hurt (physically), and I’d tense up because of the pain (psychologically) which would lead to a worsening of the symptoms. Breaking this cycle is key to being able to relax (psychologically) and rest the injured tendons and muscles (physically). Quite often I’d be able to break the pain cycle through my own physiotherapy, by using contrast baths to relax the muscles (physical), decrease the pain (physical) and make me more relaxed about my condition (psychological). A good night’s restful sleep is another way to help break the cycle too.

Breaking the psychological/physical RSI pain cycle may be one of the hardest things in life that you will have to face especially if you are immersed in a full time occupation that involves intensive computer use with deadlines, workload expectations and pressures to perform at your peak capability.

Whilst RSI cannot in my opinion be attributed to being ‘just in the mind’, there are psychological factors that can contribute to the overall RSI pain cycle. It is important to recognise that these factors need to be addressed too, and should be targeted in any attempt to address your RSI condition as a whole.

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The following is relevant if you have been experiencing RSI symptoms for a few months and they are now persistent in nature.

The rate of success in dealing with RSI symptoms is proportional to the speed that a sufferer can diagnose the causes of those symptoms, and their understanding of the corrective actions required to avoid further injury.

The onset time for RSI injuries can be fairly rapid (in my own case I went from having initial symptoms to intermediate symptoms within 3 to 4 months. It is therefore vital that sufferers glean RSI knowledge as fast as possible, try to understand the causes of their symptoms, and make the necessary adjustments to their working practices.

So the scenario for this article is of a worker who has had RSI symptoms for a few months, and is experiencing any of the following -

• wrist, arm, hand, finger, wrists, shoulders, neck pain
• numbness of fingers, back of hands, wrists, thumbs
• swelling of arm, hand tissues

on a regular basis and predominantly after working with computers. Typically, you may be regularly coming home after a day at work, with one or more of the above symptoms. You may or may not have reported the injury to your employer, and you may or may not have consulted a your doctor about your symptoms. You may also have decided to keep the injury to yourself in the hope that it would go away, and that you would not have to disclose it to your employer.

The danger to you at this stage is that by letting the condition(s) go unchecked for a few months you have made the RSI injury more difficult to get rid of. However there is still hope that your condition can be diagnosed, addressed, relieved, and ultimately cured. It may however involve making several radical adjustments in your life.

You have to continue to believe that there is still a lot you can do to help yourself.

Progressive Symptoms of a computer (over)use RSI condition

Progressive RSI symptoms can be varied, this is because RSI is a collective term for a number of different musculoskeletal conditions.

Progressive symptoms will be similar to those described in the Initial Symptoms Article but will be more persistent in nature ie. you may be coming home every night after work and experiencing some of the following -

• tingling/numbness in back of fingers, thumb, hands
• sore (fatigued) arm muscles including upper forearm
• sharp pains in joints or wrists
• sore shoulder /neck
• coldness of hands
• loss of strength in hands/arms
• abnormal swelling on parts of the arms and hands

What to do?

Since you have been experiencing RSI symptoms for a while, you need to try to urgently diagnose the mechanisms causing your pain to occur before they get more permanent, and try to make the adjustments to your working practice to reduce or eliminate the factors that are causing you pain. You still have a great chance to get rid of these symptoms with a little research and modifications to lifestyle, but it will take a more dedicated effort on your part to make those changes happen.

The following are some general recommendations to counteract progressing RSI symptoms -

• Follow through on the recommendations in my Initial Symptoms Article
• If you havn’t done so already , alert your own doctor, employer and company doctor about your symptoms,
  take on board any recommendations and if they advise you to take time off work to rest, do so.
• If you havn’t done so already, get an ergonomic consultation (it’s never too late for one of these), and listen to everything that the Ergonomist recommends and try to adjust your practices accordingly. This may mean changes to your desk, chair, keyboard, mouse/input device, or adjustments of your posture or other working practices.
• read up on some common causes of RSI conditions such as my articles on typing with clawed hands, and lateral wrist deviation, and work had to eliminate these bad habits from your working practice.
• consider using different input devices. At this stage, you need to be trying out a variety of them to find out which ones are less uncomfortable for you to use.
• Try click generating software (if your injury is mouse use related)
• Cut down on mouse usage by learning keyboard shortcuts for your O/S or software package
• Try voice recognition software if you type a lot of text documents.
• You need to eliminate all non-essential interaction with computers and computer like devices including organisers and mobile phone messaging.
• Eliminate or severely restrict use of home computers.
• Eliminate all video game use including games consoles.
• If you have a hobby that aggrivates an RSI eg Piano playing, reduce practice for a while to help your RSI heal.
• You must take up a physical pastime that exercises your musculoskeletal structure in a fluid, healthy way. I would recommend anything that gets you away from a desk/chair and doing non-stress movements. Swimming is an ideal low impact fluid motion activity. Try looking into Yoga, it has a very good fluid movements/methods for stretching muscles and tendons in a healthy way, whilst promoting relaxation (it also actually can get you fit, and no, it’s not just for girls!). Physical pastimes are also very good for getting your mind ‘into the moment’ of what you are doing (the physical exercise) and away from stressful every day factors (work, injury symptoms, other problems in life etc), and can help break the negative thought cycle that can accompany persistent injuries. Other sporting activities can be good, but they should be avoided if they worsen your symptoms. Physical pastimes are also good for getting blood circulating around your body, and blood circulation helps heal fatigued muscle tissue.
• If you are still working on a computer you should be taking a minimum of 5 minutes rest and stretch breaks every 30 minutes, even if your symptoms start to feel better. Install a take a break reminder to remind yourself to take breaks. Get up and walk around for a break, don’t take a break surfing the web!
• Take all company allowed breaks including tea and lunch breaks. If you work in an office, leave your desk. If you have hour long lunch breaks, get away from the office environment completely.
• Research and obtain a good stretching routine, to stretch out muscles of the forearms, upper arms, shoulder and neck, as well as the wrist and hand tendons. Consult a Physiotherapist for the best stretches for your condition.
• Use pain reduction techniques, like hot/cold contrast baths, physical therapy (ultrasound, massage etc), TENS machine, or a hand held heat massager.
• Keep hydrated.
• Adopt a healthy diet.
• Take measures to de-stress your life
• Consider getting your back structure analysed by a Chiropractor or Osteopath for potential problems.
• Research your problem extensively, learn as much as you can, and consult as many doctors, physiotherapists and specialists as you can. Knowledge about these conditions can vary widely in the medical community.
• Find out fellow sufferers though internet forums, or even your own workplace to share learnings. It is often very beneficial to learn from what other sufferers have gone through.
• Don’t take painkillers and continue to work as before. Painkillers will just mask the symptoms (pain) whilst allowing you to continue to worsen the problem and can lead to further worsening of your injury!

Keep in mind that very rarely is there a ‘magic bullet’ fix for RSI type conditions. Usually, a combination of factors have lead you to experience RSI pain, and it is up to you use every resource that you can to identify as many of these as possible, make changes to your lifestyle and work practices that can reduce and ultimately eliminate your RSI symptoms.

By this time you should need no further motivation to address your RSI symptoms. The main driving factor now being to avoid your injury worsening and potentially becoming a permanent disability (like mine has), which can ultimately have disastrous consequences to your career!

In Part 3 I discuss dealing with a long term (2 years or more) RSI condition.

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Coming from an office environment with a large employer, I have witnessed first hand how difficult it is to educate a workforce in the dangers of using a computer. Employers can spend vast sums of money on employee ergonomic education and can still make little impact on workers’ perceptions on computer use.

I have seen several instances of Ergonomists visiting an employee, giving them an ergonomic assessment and once they have gone, that employee saying to the effect, “They say that I’m not sitting properly, but what do they know, I’m sitting comfortably like I always do!”. (The said employee was slouching in the office chair like a sofa!).

My point is that it is easy to run ergonomic education courses, and give people assessments, but will the workers actually constructively listen to any advice and try to change anything or will they (as frequently happens) instantly be dismissive and return to their old habitual ways? Very often employees will only start to listen to ergonomic advice after they are injured, the pain being the motivation to find out why.

It’s probably indicative of this blog really, ie how many of you have found this site because you are experiencing an injury and you want to find out more, and how many are finding it as pre-emptive research? I’d wager that the majority of you fall into the first category.

It is for this reason that I run my own ‘Living with RSI‘ awareness lectures, so that employees can see and hear first hand how serious and debilitating these injuries can be. The hope is that I may alert attendees into proactively adopting the necessary changes to their ergonomic practices, and change their attitudes towards the advice of ergonomic/occupational health professionals.

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