Repetitive strain injury: recovery formula

clasped-handsI‘m a tendinitis expert, but not by choice. In 1997, I started an online business and by 2002 my hands were so sore from typing I knew my company and career were in danger. Then, I got bad advice from a doctor and the sh*t really hit the fan. After wearing a brace for three weeks, my muscles atrophied and my condition worsened so much I was unable to serve my food, drive a car or even dress myself.

Repetitive strain injury (RSI) and tendinitis happen when you repeat a motion frequently on tight tissues and when the rate of damage exceeds your body’s natural rate of repair. I’m going to show you how I’ve learned to treat my RSI by loosening tissue and accelerating my body’s repair efforts. My primary injury was to my hands so this guide will focus on the hands, but  I’ve also used the same principles on my feet and you can use them anywhere you have tendinitis or RSI.

The Formula

Faith

your-miracleThe first thing you need on your journey of healing is to know that you will heal. Your miracle will happen once you learn what your body needs because it has a remarkable will and capacity to heal itself. Know too that you aren’t alone – there is a large community of people who have suffered similar injuries and therapists who can help you heal.

Fifteen years ago when my injury reached crisis stage, I was very frightened when I read that some people never recovered from RSI if it was allowed to progress too far. With research and experimentation, however, I discovered an effective therapy. Now, 15 years later, I still have the same underlying disease which makes me ultrasensitive to repetitive stress, but I’ve refined my therapy protocol and I can get a lot done with my hands as a result (those are mine in the picture).

Here’s how I’ve learned to treat repetitive stress injury (with the help of many books, therapists and much trial and error):

Rest

Stop or slow down whatever you’re doing that’s causing you pain. I know as well as anyone how difficult that is — I didn’t drive a car for three months and bought new pants that were easier to get on and off. I didn’t pick up my newborn daughter for months. I relearned typing on the Data Hand keyboard and eventually I switched to speech recognition software Dragon Naturally Speaking (a tremendous nuisance but it works). Whether you like this advice or not doesn’t really matter because your body will eventually force you to do what’s necessary – still, sooner is better than later. Take my word for it.

upside-down-mouseOne of the ways I rest my hands is by using my knees to click the mouse. Notice in the photo at the right, I used hot melt glue to position an optical mouse upside down under my desk on each side of the keyboard. I use the right knee for right clicking and the left knee for left clicking.

“A recovery for every effort.” When you’re healthy, you can do whatever you like. But, with a chronic illness, the metaphor of the bank account should guide you. Imagine your injury as an overdrawn bank account – when you rest or do therapy, it’s like making a small deposit. When you do physical activity that stresses your injury, you’re making a withdrawal. Healing happens when you make more deposits than withdrawals.

Stretching

conquering-carpal-tunnel-syndromeErase everything from your mind you know about stretching so we can start from scratch. Injured tissue is very delicate and therapeutic stretching is a science. I learned how to do it from Sharon Butler’s superlative book Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program. There’s also a very helpful collection of emails she wrote to patients. I broke down in tears reading those emails when it gave me hope I could recover the use of my hands. Thank you Sharon!

I still do about 45 minutes of stretching every evening to improve flexibility in my hands. At the end of my session, my hands feel worn out and crappy, but the next morning, this extra layer of distress is gone and from experience I know this is a good protocol for me. About a third to one half of my stretching targets the upper body and the remainder is focused on my fingers and hands themselves.

Understanding the Stretch Point is the first key to healing your injuries. The Stretch Point is just a very small stretch, but we’ll need to measure how small it is to make sure we’re doing it right and doing it the same way each time. The stretch point is the amount of stretch that subsides when held for 15 seconds.

Let’s try it – put both hands together in front of your face as if you were going to pray. But, these are very subtle sensations, so do this in a quiet place, when your mind is quiet and where you will have no interruptions. Next, raise your elbows slowly out and upwards keeping your hands in the same position. When you feel a very small stretch, stop and hold that position. Start counting – you should start to feel the stretch fade. If it fades substantially within 15 seconds, you just found the Stretch Point, congratulations. If it takes 45 seconds, your stretch was too strong, try again.

Why is this important?

Your body will heal when you perform the right stretches – always using the stretch point as a guide to avoiding further injury. Anyone who has experienced the recovery process knows that it’s not easy to avoid taking two steps forward and one back. With a little forward progress, everyone gets excited and pushes a little too far, too fast and inevitably falls backwards. The Stretch Point is a critical yardstick that will protect you from overstretching. It will help you to have a deeper understanding of how stretching works too.

First, let’s talk about fascia, a form of connective tissue that supports and gives form to muscles. Inside a muscle, the smallest muscle fiber is wrapped with fascia. Then, bundles of those fibers are wrapped together with fascia. Then, bundles of bundles are wrapped with fascia, then the whole muscle is wrapped with it. If you follow that muscle along, at some point, the muscle fibers end. But, the fascia doesn’t – it continues until it joins other strands of fascia to become a tendon. Finally, if you follow the tendons along, they attach attache to and blend into the bone.

You can feel this too — how fascia that was spread in many layers, running lengthwise through the muscle, joins together becoming tendon — in your lower calf where the belly of your calf muscle is very thick up near your knee, but narrows and becomes the Achilles tendon down at your ankle.

The same structure is present in every muscle in your body. That means that fascia connects everything in your body to everything else. So what, you ask?

Well, fascia is unique in its ability to chemically change in order to protect the body. When stressed, the collagen fibers that make up the fascia bunch together, forming a thickened and denser bunch of fascia. This can happen instantly as in the unfortunate case where you get rear-ended at a traffic light. At the moment of impact, your fascia instantaneously thicken to create a natural neck brace that protects your spinal cord. Or, if you fall backward on the ice as I did last year and stick your hand out to break your fall, you find that your wrist sustains an enormous impact and bends backward much farther than you like, but doesn’t snap.

Fascia also thickens to protect your body in nonemergency situations, for example when you are typing. The body’s ability to adapt slowly or instantaneously to our activities and accidents is miraculous – what’s not so hot is that the fascia lacks the ability to reverse the thickening and tightening on its own. So, the consequences of stress and trauma in your body are cumulative – your fascia thickens and causes some muscles to work harder than others which causes more thickening in another muscle and the restrictions accumulate. Eventually, it becomes painful especially when tight fascia tugs and pulls on a nerve.

What bodyworkers like Dr. Ida discovered, is that stretching restricted fascia is the most effective way to restore its normal, loose fluidity. By applying pressure, we can manually stretch our fascia back into its natural shape.

Understanding how it all works is helpful, because now you can start to understand what you are doing and feeling as you stretch and massage. You’ll understand what’s happening when you feel a stretch point resolve. You should see too that massage pressure creates a stretch of your fascia the same way that performing a split or bending your wrist back does.

Now, you can understand how using the Massage Track or a foam roller releases restrictions in your fascia that are inaccessible any other way. Finally, you’ll understand how restrictions causing pain at one point, can result from restrictions in your fascia located in different parts of your body and sometimes in different layers of the same muscle.

Massage

Massage has been used for thousands of years to heal injuries, but your doctor won’t mention it, because until recently, scientific evidence has been lacking. Last year, however, researchers from Ontario and California found clear molecular evidence that overworked muscle cells respond to massage with decreases in inflammatory compounds and increases in cell metabolism and healing factors.

Twelve years ago, my first experience with massage was a disaster. I received a strong massage on my hands and they swelled up right afterwards. It was 7 days before the swelling went down and they returned to ‘normal’. So, go slow if you’ve never had a massage before.

If you have sore hands, for example, get an upper body massage that excludes your hands and do your own very gentle massage on your hands before letting someone else touch them. I do my own 30 minute massage on my hands and forearms nearly every evening and it’s transforming. Here’s how I do it:

When my injury was acute, I also used a tool called the Armaid which was very helpful. It has a significant drawback, though, which prevents me from using it today. It requires too much physical strength in the hands to operate, so while I’m doing therapy I’m also stressing the same tissues I’m trying to heal. For this reason, I had family members assist me to do massage on my forearms using Armaid. Now, I prefer my own invention, the Massage Track, because I can use it on my own using bodyweight without further stressing my injury.

What I’ve learned about massage from my experiences over 15 years:

  • Pressure heals
  • Strong, slow deep tissue massage makes a difference, anything else is just relaxing
  • Deep tissue massage is a type of internal stretching for tissues that are inaccessible through yoga or standard stretching
  • Rolfing/bodywork can create long-lasting changes in your body
  • Cross friction massage (CFM) on the hands and feet can be painful but helpful all the same
  • Pain is just tightness leaving your body
  • A great massage therapist is worth higher rates

Rolling

foam-rollerrollerBefore I developed Massage Track the tools that I used most were rollers – the black foam roller and the calf and thigh rollers are good tools for healing tendinitis in the lower half of the body. The black foam roller is also good for working the lats which connect to the arms and hands but not as good as 4″ PVC pipe! Now, I rarely use a roller.

Strengthening

I initially started strengthening exercises because my muscles atrophied after using a brace. However, I continue to exercise my fingers using rubber bands. Here’s why – look at your arm, for a moment. When you bend your elbow, your biceps (flexors) shorten while the triceps (extensors) on the other side of the arm must lengthen an equal amount.

thera-band-hand-xtrainerDigi-Extend-Hand-ExerciserThat makes them protagonist and antagonist and there must be an easy balance between them. If there is imbalance due to scarring or thickening of the fascia, one muscle will have to work harder, making it feel fatigued.

When my hands are at rest, my fingers are curled from tightness in my flexor muscles. So, I do rubber band exercises to strengthen the extensor muscles hoping to restore balance between the two. I just use rubber bands but there are special gloves and devices like the Thera-Band Hand Xtrainer or Digi-Extend shown on the right.

Wherever your pain is, consider strengthening your extensors because that’s frequently a source of imbalance and pain. You can find devices to help you strengthen the toe extensors and shin muscles, for example, which may help you beat foot pain if you’ve got it.

Ice

I have used a lot of ice and always find it helpful. Grab a large kitchen bowl and fill it with 4 or 5 cups of ice and about the same amount of water so that you can submerge both hands in ice cold water. I leave them in as long as I can tolerate the pain, usually for bursts of 10 to 20 seconds.

After 4 or 5 minutes of this, when my hands are so cold that they start numbing, I’m finished. It temporarily decreases inflammation and greatly improves circulation. A pain in the a** to be sure, but when you need to make an immediate deposit in your therapy account, this works!

Warming Up

hand-warmersTendinitis is always more painful when your body is cold (because your tissues are tighter) and I find it helpful to keep my hands warm. So, in the winter, I use the hand warmers you see in the picture on the right. There are tighter fitting fingerless gloves available which I wear occasionally. Mostly though I find these loose-fitting ones in the picture most comfortable.

Background Issues

If you’ve got repetitive strain injury, it means your body is not healing fast enough to keep up with the strain it’s under.  If you’ve got a garden-variety case of RSI,  you probably need to fix your posture or technique and maybe your diet. After some rest and therapy, you’ll be back in business in no time.  However, if you have a case of RSI that won’t go away after you’ve done all the right things,  you’ll want to take a deeper look at your health picture.

  • Watch  Forks Over Knives
  • Consider a home sleep study using an oximeter to determine whether you are suffering from sleep apnea. If you’re not sleeping deeply, you’re not healing. I did a formal sleep study and threw away $1500.  My  $100 oximeter works much better.
  • Do you have Mercury in your mouth?  Amalgam fillings can be highly toxic to some sensitive individuals disrupting their natural healing capabilities. It takes time, but you can fix this.

What Not to Do

Repetitive Stress Injury is a chronic disease putting it into a category where the traditional medical establishment in the US fails tragically. My personal experience leads me to believe that you put yourself at great risk of physical harm if you take your RSI to a traditional MD.

If you want to let my experience guide you, you’ll avoid:

Resources

Books

Info & discussion

Mouse alternatives

Therapists

Tools

Email This Page
Print Friendly
If you have questions or just found this helpful, please comment below and consider sharing with your friends using the buttons on the left. Want more? Subscribe to our newsletter over on the right to get our monthly email. Thanks for stopping by!

16 comments…

  • Philippe January 7, 2014, 11:36 pm

    Great blog. It is a bigger issue than people think ! I solved my problem with the Enterpad which is a programmable keyboard that helps for repetitive tasks and macros.

    Reply
  • Marianne Carpenter January 17, 2014, 5:09 pm

    Hi, my name is Marianne and I think your website is brilliant! For the first time in a year something finally makes sence to me so thank you!

    I hope you don’t mind me telling you my story but I feel I might need your help?!

    I had my first baby in 2012 and unfortunately he wasn’t well so we had to stay in hospital for a week, we finally were able to take him home after this time which was amazing. He wasn’t able to breast feed as he was so poorly so I expressed for 2.5 months. The best decision for Rafe but not for me! What I didn’t realise was the damage I was doing to my body. My posture was really bad and the pump I was using was a manual, the warning signs were screaming at me but I just didn’t realise what I was doing as having a tiny baby to look after through out any common sense!!

    I believe that I have a chronic rsi that is in my back and due to this it has effected my whole body, pulling in all my muscles from my feet and from my hands into my back. The pain is so bad every day is a challenge! I was stretching & exercising for four months last year and made some great improvement but then I stopped for seven weeks as the pain became so bad. Its awful as like you explained I have now atrophied my body and my muscles are all in the wrong places. Talk about savere! I have seen specialists, doctors & physio’s and this journey is a true nightmare as no one can tell me the right path to take in recovering.

    Your website has given me more information than I have had from anyone in the last year and makes so much sence to everything I feel, even though my situation is so bad.

    I am now starting again with my stretch programme but I have alot of muscle weekness so im trying to get alot of help from a physical trainer who is qualified in medical problems such as this.

    Do you think there is anything more I can do or is this plan the best way forward? I know it will be a very slow journey but as long as I can get there that’s all that matters.

    Thank you for reading my essay and sorry it’s such a long story! I am however very greatful for any help.

    Kind regards
    Marianne Carpenter

    Reply
    • Eric January 17, 2014, 5:36 pm

      hi Marianne, thanks for writing and for your compliments, I’m glad this material is making sense for you. It sounds like you are pretty much on the right track, I would just encourage you to experiment with rolling your back on tennis balls, or any other type of ball that feels right to you. You might try putting them in a sock to keep them in place… you want to hold each position for a minimum of 12 seconds and up to 60 seconds or longer. You want to wait until you feel a release of tension before moving to a new spot. This is sure to help you!

      Reply
      • Marianne Carpenter January 17, 2014, 9:17 pm

        Thank you so much for your reply, I will certainly give it a good go. I hope in time things will progress, its just the waiting game that’s always the hardest.

        Thank you again
        Kind regards
        Marianne

        Reply
  • steve May 3, 2014, 11:20 pm

    I had rsi for about 10 years from working 12 hours a day in high stress investment trading programming job.

    The best thing for me was about 50% massage, 20% ergonomic aids and 30% changing to stand up desk.

    Reply
    • Eric May 4, 2014, 2:33 pm

      Thanks for mentioning that Steve! when I first got serious about treating my RSI, I also started using a stand desk and am sure that it helped too, although couldn’t say what percentage. I quit using it long ago but have just become interested in the idea again and very tempted to put in a preorder on this sharp looking desk on Kickstarter: https://www.kickstarter.com/projects/2036834894/the-most-affordable-automatic-sit-to-stand-desk

      Reply
      • stevek May 6, 2014, 8:11 pm

        Hi Eric,
        Yup you for sure want the auto adjust desk because it gets tiring standing for too long. I think much of my problems came from just “fighting” through the pain. Now with any pain I make sure to change hands using the mouse or change trackballs or positions.
        Also massage even if hands and wrists feel good. Daily massage ! I am interested in your massage track !

        Reply
        • Eric May 8, 2014, 5:13 pm

          Yeah Steve, I really want that desk, but $500 with shipping is still a chunk of change.

          You are so right about the massage even if hands and wrists feel good. I generally wait until the problems crop up but you are inspiring me. I’m going to try to do the preventative sort. Been working too much under pressure and got into trouble over the past few days and had to do some serious therapy to get back on track. Fortunately I discovered some new ways of using my tools which I’m very happy with. I will include you in my Kickstarter project preview circle when it is ready – would love to have your feedback. Hoping that will be around June 1.

          Reply
  • LucyL August 1, 2014, 1:59 pm

    Thank you so much for this article. I’ve suffered from RSI on my right wrist for 5 months now and I’m coming to my wits end not knowing when it will recover fully. I tried to off load more onto my left hand and ended up with tennis elbow symptoms, so I now have 2 weak arms and hands.

    Thank you for sharing all your tips & research, I will follow closely & hopefully that means my RSI will not turn into a chronic problem.

    Reply
    • Eric August 1, 2014, 3:29 pm

      Do you use the mouse with your right hand? I have recently found a good solution for that… Started using a wacom tablet instead of mouse, fantastic improvement!!

      Reply
  • Ben August 4, 2014, 8:59 pm

    Hi Eric

    First of all thanks for the article – especially the section on stress; I think that’s something that a lot of people don’t really take into account when it comes to using computers and suchlike healthily. What are your views on foam rollers as compared to tennis balls for self –massage? Are they typically better for getting deeper into the fascia than a foam roller would be?

    I also agree with you regarding Sharon Butler’s book; I do some of the exercises in there and they do seem to have some positive benefits for myself as well.

    Best regards,

    Ben

    Reply
    • Eric August 5, 2014, 4:21 pm

      Ben, I used to use a foam roller frequently before inventing the Massage Track. Now I use the roller maybe a couple times a year and when I do I usually don’t use a foam roller – just a cheap PVC pipe!

      -Eric

      Reply
      • Ben August 9, 2014, 5:21 pm

        Good stuff Eric, sounds good. I think I might look a bit more into it!

        Best regards

        Reply
  • Pablo August 6, 2014, 2:43 pm

    Hello Eric,

    I stumbled upon your website today and I must say that it looks very good and some of the tips and things you posted are real solutions, I’m definitely going to try all of these. I’ve suffered of what I think is RSI for the past 2 years and I’m just 27 years old… so I’m pretty damn scare. I’ve seen all kind of specialists and no one can really say to me whats wrong, and no one seems to understand what is RSI… so based on my own judgment and considering I have all the symptoms on both arms, from the neck down to tips of fingers, I must say it is RSI.

    I spend 10 hours a day on the computer, I have ergonomic trackball, ergonomic keyboard, 2 flat big screens and recently just bough Mouse Pedals so Im using less my right hand. I have not lost strength on my arms, but sometimes the pain is so much specially on my shoulder, thumb and wrist that even holding a beer is painful.

    I wanted to ask you a couple for things… have you ever tried Yoga? And if you do, what kind of yoga? What about swimming? In your knowledge or experience… since this is a chronic condition and I decide to rest it and put all the effort to recover, can you really recover to a 100%? or is it a permanent condition and I should just learn to deal with it…

    The only thing so far that relieves my pain everyday is applying Cold & Hot at nights after work.

    I guess the most difficult part for me its the stress of realizing that I could reach a point where I need to quit my job…

    Thanks again for your website.

    Pablo

    Reply
    • Eric August 6, 2014, 8:55 pm

      Pablo, I feel for you because your situation sounds similar to mine. Are you using Dragon NaturallySpeaking yet? It was a lifesaver for me. Recently I started using a wacom tablet in place of the mouse and that has been a tremendous improvement too. You might try a stand desk also.

      Yoga has never helped me enough that I ever think about it as a treatment for RSI. In my case, I have underlying health problems. The RSI was an early sign of them. You may want to go to a nutritionist or naturopath to get an evaluation… I can’t recommend seeing an M.D. because they hurt me badly. Chronic health issues are not there thing.

      warm regards,
      Eric

      Reply
      • Pablo August 7, 2014, 3:03 am

        Hey Eric!

        Thanks for the quick response. I’ve think about the Dragon software but I am a structural engineer and my main task on the computer is not typing words, rather a lot of numbers, formulas, spreadsheets and millions of clicks on specific sofwares.

        Something that I widely accept is that my diet sucks. I eat only 1 or 2 timesa day and nothing really healthy. Have you found that diet has a direct impact on RSI? At least right now at the office I switched from coffee to tea hoping it’ll relax me.

        best regards,
        Pablo

        Reply

Leave a Comment

Top Web Statistics