My experience with RSI
(and answers to some frequently asked questions)

1. Finding a suitable doctor.  This is hard because there is no medical specialty devoted to RSI. I saw my general physician, who, finding nothing obviously wrong, suggested rest and better ergonomics. After a month of this, he refered me to a hand surgeon. The surgeon checked me for nerve damage, and finding none, diagnosed my problem as "tendonitis" in the hand and refered me to a phsyical therapist. (In restrospect, I should have seen a physiatrist, who takes a more "holistic" view of problems than a typical surgeon does.) After two courses of physical therapy over a few months (accompanied by a few weeks of total rest from typing) my problem was reduced but a persistent core remained.   I understand that this kind of partial "cure" is quite common.  Many people are left with some residual pain, which they "manage" for the rest of their lives. In any case, it was reassuring for me to know that I did not have any "serious" nerve problems. But on a scale of 1-10 I would say my pain still fluctuated between 3 and 6, with an average around 4.5. That is still something you don't want to live with for the rest of your life.
   
   
2. Ergonomic equipment and typing technique. Small investments in equipment can really pay off, as described in Pascarelli and other books. A fair bit of computer work is possible -albeit more slowly---using dictation software such as Dragon, which works surprisingly well (even the $100 version).  Don't overdo dictation though, or you will get RSI in your vocal cords!
   
   Different people swear by different ergonomic equipment so you have to experiment to find the "right" one for you. I tried several expensive keyboards and mice, before settling upon the Goldtouch keyboard, Adesso EasyCat  touchpad and a chair from Neutral Posture. Better equipment can alleviate RSI symptoms, but sometimes the symptoms can return after a while, which happened for me. So it may be a good idea to have several keyboards and mice options and to switch among them every few weeks. Good typing technique ---things like keeping the hand and fingers relaxed, and avoiding repetitive actions---is more important. Frequent rests are even more important. Obviously (even though it took me painfully long to realize it) even if I rest for a minute every four minutes, I am still working at 80% of full capacity, which is not bad at all if it keeps pain away. I think a 1-minute rest (which can be as simple as getting up and walking away from the computer) every 9 minutes is a good routine even for people with no RSI. In restrospect, I  think sane work techniques and proper posture is more important than fancy ergonomic equipment.
   
   Interestingly, Pascarelli recommends against using wrist pads and especially against  "CTS wrist braces" you can find in a drugstore.
   
   
3. Exercises, physical therapy, hot/cold compresses. All of these can help. I have known several young people who were otherwise in good health who were able to get rid of RSI symptoms with change in equipment, rest,  and some mild exercises (e.g., the ones recommended in the Pascarelli book). I am guessing their RSI symptoms were due to local fatigue or wear in the hand muscles, and hence responded well to the obvious treatments.
   
   
4. Good posture. Dr. Pascarelli lays the blame for many RSI problems (especially persistent ones) on faulty posture. Though this may be obvious to people who are into holistic or somatic approaches, I frankly found it a bit far fetched at first. Pascarelli's explanation is as follows: faulty posture fatigues the muscles of the neck and shoulders (which after all support the arms), sending them into a state of permanent spasm. Unfortunately, the nerves controlling the arms and the upper body pass through these  muscles, and these nerves get pinched when the muscle goes into spasm. (One medical condition with this description is thoracic outlet syndrome.) Nerves deprived of blood and proper signals tend to get in trouble and cause all kinds of other trouble (e.g., RSI symptoms) downstream.  Pain may occur far from the source of trouble ---this is the reason why surgery at the site of the pain often fails to cure RSI.
   
   I now realize that my problems were caused by poor posture, and were worsened by my naive efforts to improve posture. My single biggest warning to people who ask me about my experiences is to avoid posture change as a kneejerk reaction to RSI symptoms. Another warning is that "posture problems" are hard to diagnose even for doctors, most of whom suffer from poor posture themselves! Unfortunately, learning good posture is extremely difficult.  For one thing, most of us have no idea of what good posture is; I certainly did not. Looking at a picture of "good posture" in a book and then trying to attain that  posture by conscious effort or "willpower" is not only doomed to failure but also likely to worsen the problem by putting additional strain on key muscles. Furthermore, "posture" is an unfortunate term; what is at fault is the body's overall organization.
   

I think seeing a good Feldenkrais practitioner is the best way to diagnose and address such problems. (Yoga, tai chi, physical therapy etc. can also help but are not as effective in my opinion; see below.) I also  realized that I had a lot of stored muscular tension in my body which also is best addressed by Feldenkrais. (Relaxation tricks like deep breathing don't really suffice as the tension is not mental but muscular, and is caused by faulty body organization.)


5. Acupressure,  acupuncture, massages, trigger points etc.  I tried all of these, and think that they can have a role to play in recuperation. (Though I must admit to being somewhat uncomfortable with acupuncture despite having gone through 6-7 sessions of it. I am not squemish about needles at all, but it does seem more invasive than the other approaches.)
   
   Dr. Pascarelli also recommends "soft tissue manipulation" or medical massage. Massages and acupressure can speed up healing by relaxing specific muscles and relieving pain. I am especially intrigued by acupressure. It is based upon vague notions involving  "meridians" of "energy flow." For example, an acupressure massage for back pain might involve  systematically "clearing" (i.e., massaging) energy blockages in the "back meridian," which goes up from the foot to the head. Though this may seem to the modern mind like black magic, a closer look suggests that these meridians are correlated with what  we today call biomechanics. To give an example, how the foot strikes the ground is related to how tense the muscles in the legs are, and this mechanical interaction can cause problems all the way up the body and even headaches. So treating back problems by looking at the entire back meridian makes a lot of sense.
   
   Acupressure seems related to another intriguing phenomenon identified by modern medicine, namely, "Trigger Points,"which are tiny tender points in the muscles that we are unaware of until they are pressed. Trigger points can refer pain to places far away from them. You can read about them in several books, of which the best one seems to be the one by  Clair Davies, who describes how to "get rid of them" by self-massage. There are other,  medically approved treatments for trigger points such as myofascial release and steroid injections, which I did not try. I found Davies's techniques quite effective at temporary pain relief and for a while was convinced I had found a cure for my RSI. Unfortunately,  I soon realized that if the problem comes from faulty posture and faulty biomechanics, any relief from massage or trigger point treatments may only be temporary. (However, I would still recommend trigger point self-massage, at least for pain relief and maybe a cure. It costs nothing and it teaches you a lot about your body and can totally change your concept of "pain" and its mysterious ways.)
   
   I did not visit a Chiropractor. Whatever I have heard about them doesn't seem to make much sense, and they favor vigorous manipulation of the spine, which seems potentially dangerous.  However, I do know people whose RSI has improved with chiropractic treatments.
   
   
6. Feldenkrais.  This is what cured me, and which I recommend the most for chronic RSI problems. The Feldenkrais method, invention of  Israeli  physicist Moshe Feldenkrais, is a way of retraining the body so that all movements become smooth and efficient. (See my webpage on Feldenkrais.) There are two modes of this retraining. The cheaper one is group classes called Awareness Through Movement or ATMs. These are somewhat similar to classes in yoga, tai chi, pilates etc., though Feldenkrais is very different from any of these. (For one thing, the instructor doesn't show you how to make the movement; he or she just sits around and talks while you do the movements!) But more effective and dramatic improvements occur in one-on-one sessions (called Functional Integration or FI) with a trained practitioner, which can cost about $100 per hour in the US. In such a session you lie fully clothed on a low table and the practitioner gently moves or presses your body in different directions to make you aware of (a) subconscious tension and holding patterns in muscles that make your movement less efficient (b) efficient ways of coordinating your muscles that your body had somehow not figured out thus far.
   

I think FI is the trump card of the Feldenkrais method, which makes it superior to yoga, tai-chi, pilates etc. Good practitioners of Feldenkrais have tremendous intuition and insight  and can sense the source of your problems within minutes after watching your movement patterns. Of course, the harder part is to get the fix across to your subconscious brain (after all, did it ever help anybody to be told "Don't slouch! Sit up straighter!"), and that is where Moshe Feldenkrais's true genius lay. I think the lack of one-on-one training is why Tai Chi---which I also tried for more than  a month--- or Yoga classes are  not as effective. If your brain has resisted seeing the "obvious" all its life, it is not going to pick it up from watching the instructor.

In my case the end result of 16-17 Feldenkrais lessons (over a period of 7-8 months)  was that my shoulders and neck, which were too far forward, eased to a more natural alignment, floating right to top of the ribs. The agility and strength of the entire body greatly improved (with no exercises or strength training). During this process, I realized that Dr. Pascarelli's explanation of RSI was completely correct in my case. As my shoulders and neck eased into a natural alignment, I could clearly sense the muscles of my arms and hands relaxing, since they were now being supported and helped by the more powerful muscles of the trunk. After a while, my RSI symptoms were gone. (The process of finding a better alignment was slower in my case than usual because of an underlying complication of mild scoliosis, which I had not known about. This scoliosis also improved a lot.)

However, I must emphasize the importance of working with a good and experienced practitioner; see my

  If you are lucky enough to have a good practitioner close by, I recommend spending your money on Feldenkrais sessions rather than on massages, acupressure, physical therapy etc.

Note: most health insurances will not pay for Feldenkrais. If money is an issue for you, you may be able to find physical therapists or other medically trained personnel who incorporate Feldenkrais principles in their work, and are covered by your insurance. Of course, the ideal situation is to get lessons from somebody who specializes in Feldenkrais. (Warning: the first few sesions may not address your RSI symptoms at all; your teacher might choose to address other, bigger problems in body organization before going to the arms and hand.)

Additional resources

1. RSI Faq page.
2. Another RSI page.
   
3. Typing injury page.
4. Ergoblog (ergonomic equipment, software etc.)
5. Feldenkrais Guild (find practitioners in your region; links to many other resources).