Severe Hand RSI Pain and Recovery
It's been over a year since I wrote something on my site. It's not because I got lazy or disinterested. It's because my hands hurt. They hurt like I never knew they could. After months of trying to determine the issue and subsequent rehab, they're manageable, but still not great.
I'm writing this post with the intent of informing two types of people: 1) in-pain people: if someone out there is feeling the sort of pain I describe in this article hopefully it will help expedite successful diagnosis and recovery, 2) pre-pain people: if you're twenty-something and feeling invincible, I'm here to tell you you're not.
The Root Cause: Young/Invincible + Too Much Typing
I'm a home-grown hacker. I've written countless lines of code. I started when I was 8 or so on a TRS-80 Color Computer 2 and was hooked. BASIC then Perl then C then Ada (Ada? I went to a military academy) then the wide world of Internet markup, scripting, and languages. It seemed there were never enough hours in the day.
In 2004 I started a side project called OmniNerd. Though it never really caught on, it was my baby, my first Internet project. I learned more hacking on that site than I did in college. I spent many nights and weekends tweaking it. I think this was probably the point where I really started to over-use my hands. At the time, I was an officer in the US Army, specifically in the Signal Corps, which meant I spent quite a bit of time on the computer at work. At the end of the day I'd get home as quickly as possible, eat, and then the after work hacking would begin. I recall one Saturday morning being greeted by my roommate around 7am, "Uh, dude, have you been writing code all night?" The answer was yes, but who cares, right? I was 25 and didn't feel a thing. I wish I could go back in time and punch myself in the face.
The details don't matter so much, but several projects followed. More activity. More hours. More typing. Fast forward a decade ...
The Pain Starts
In late 2011 I experienced the first real pain. I'd had minor pain in the past but I was always able to stop for a few hours or a day and it'd be fine. In 2011 I took a short expat assignment in Switzerland. Part of the deal was a temporary apartment, which did not include a desk. This meant my already bad habit of typing for hours got really bad as I hunched over a laptop on my couch. I'm 6'4", so for me a laptop is particularly bad. In December, on a flight from San Francisco to Zürich I distinctly recall an unexpected, sharp, shooting pain in my hands and arms as I played a game on an iPad. While bad, I simply put the iPad away and dismissed it. It would go away, right?
It didn't. In the weeks that followed simply putting my hands on my keyboard hurt and typing itself was really bad. I freaked out a little. How would I be able to do anything? My entire life demanded computer time. I wasn't sure what to do, so I reduced hand work where possible and hoped that nature would just fix things over time. After about six weeks things did get better. I changed a few bad habits, moved back to the US and a proper desk, and slowly the pain went away.
Fast forward to early 2013. I was at somewhat of a cross-roads in my career, poking around at opportunities. I was expecting a baby girl in March, and work was busy with me in the middle of a large international project. I was interested in the startup world as a change of pace and by March I had established mutual interest with a fantastic SF-based startup. I was on my way to discuss possibilities with them when the pain came back in full force as I typed a text message while riding the train into San Francisco. I had noticed a little pain here and there in recent weeks/months, but nothing too bad, nothing like this. I don't know if it was the ergo of the phone, the subconscious stress of a potential career shift, or just bad luck, but it hit me like a ton of bricks. I recall trying to put it out of my mind when I met with them, but I kept glancing over to the rows of just-out-of-college hackers. It was around 6pm and they were still hacking away. Could my hands keep up with the startup pace? Would this be a terrible move for me?
The next week or so was stressful as I struggled with the decision. Ultimately, I decided the move was a gamble I didn't want to take. I liked my current job, had tremendous support from my management and colleagues, and I could predict how much I'd use my hands. Despite choosing status quo and stability, the pain got worse. It went from my hands, to my forearms, and into my neck and upper back. I couldn't ignore this any more. I had to go to a doctor.
Before noting treatments, let me describe the pain. I never really understood what it meant to be depressed until this started. 24/7 pain. Not sharp stabbing, but dull, deep pain. The only position that provided any relief was lying on my back on a hard floor. Sitting up, my back felt dead, like every muscle had been overworked for hours. My arms and hands felt tight. Any movement away from my core was uncomfortable. Driving a car hurt, especially turning the wheel. Holding my newborn hurt, all 8 pounds of her. This was probably the most depressing part. When you have pain like this, your mind plays games with you. You can't help but think about horrible scenarios. You add more stress to an already over-stressed body. And worst of all, stress intensifies nerve pain, so it's a bit of a downward spiral.
In order, here are the things I tried:
I heard Aaron Iba had similar issues and read his blog on the topic. I even managed to give him a call and discuss the issue. He mentioned The Mindbody Prescription. It sounded too good to be true. Unfortunately for me, it was. I read the book, tried the techniques, and no results. I even went to meditation classes to build on some of the techniques noted. Nothing. One piece of advice from Aaron that worked well for me: get a Kinesis Freestyle 2 keyboard. I did. It helped, but not to the point of being a cure.
Given that both hands hurt, I thought maybe it was a neck/spine issue. I saw a few D.O. and M.D. specialists in San Francisco. One told me it was probably just in my head and to try not to worry too much (seriously). One agreed to do an MRI, just to see if there was any damage. Luckily everything was negative. They eventually ran out of guesses and left me with no options (because it seems if you don't need surgery, they don't know what to do with you).
I went to an acupuncturist. I noticed no benefit.
I went to a hand physical therapy specialist. For about 20 sessions, I had someone work my hands, massage them, electrocute them, force me to do painful stretches, etc. I noticed a minor reduction in pain, but not substantial. This got me thinking though, maybe a more manual approach would be best.
I went to chiropractor. I'd always been skeptical of these guys, but a girl I know at work had other pain issues and she recommended it. This was the start of real relief. The chiropractor made a guess that I had a build up of a chemical that is the rough equivalent of scar tissue in my forearms. Since the nerves that make your hands hurt pass through your forearms his thought was that the scar tissue was restricting normal nerve movement and causing pain. He applied what's called Graston Technique, which was him painfully crushing my muscles with a metal bar to break up tissue. This helped a lot. Probably a 50% pain reduction, but after 4 weeks or so of therapy we hit a plateau.
I decided to go to a massage therapist next. This was totally a guess on my part, but I thought if the chiropractor applied 10-15 minutes of intense targeted treatment, what if someone applied 1.5 hours of less intense treatment with more variety. For several months I went to a massage therapist every other week for 1.5 hours. We focused on nothing but my arms, neck, and upper back (mostly arms though). The pain dropped another 25%. Finally, I was back down to a livable level.
For the first 6 weeks of massage, I also went to a physical therapist at the same time. We focused on full body stretches and they did a variant of the Graston Technique a few times. I think the stretching was good for many of the symptoms that had become their own issues, e.g., back muscles feeling dead, etc.
Today I have good days and bad days. Mostly good. A good day isn't like before the pain started. A good day is when I wake up and don't notice my hands or arms from a pain standpoint. On a good day I can make light use of a computer before I feel my arms flaring up. A few emails. Browse the Internet. Etc. On a bad day, I stop these activities totally. No keyboard. No phone. It seemed impossible at first, but I actually find my working habits are much more efficient now as I really make good use of any computer time. A few things I find that help me to sustain my progress:
- Standup desk. This is huge. If I sit and type, the pain comes back much faster than when I'm standing. For me, it's a better ergo position. I stand almost 100% of the time I'm at a desk, only sitting to write on paper.
- Stretching. I do this all the time. I don't think an hour goes by that I don't stretch. And I don't have to be on a computer to cue the activity. It's become a good habit. If there's one thing I learned from PT, there are hundreds of easy stretches. I'd actually recommend going to PT once just to learn some arm/hand stretches.
- Dictation. OS X / iOS are really good at this out of the box. Dragon dictate works well too, especially if you want to write more than a few sentences at a time. If you go this route, get a earphone/mic. Recognition is better with them (plus you can talk quieter and not annoy colleagues).
- Not being an idiot. Literally: "Idiot: someone who acts in a self-defeating way." I was an idiot to ignore so much advice in the past. You can be an idiot too, but I don't recommend it.
I'm hoping things continue to improve. If you've read this far, maybe you're curious or maybe this story is more familiar than you'd like to admit. If you're the latter and have any questions you think I could answer, please send me an email. If you want to chat on the phone, that's fine too. It took me the better part of the year to get things sorted. There's no sense in starting from scratch.
And if you're still healthy, start some good habits. Now. This stuff is no joke. You wouldn't believe how many people are in the waiting rooms of the places I mentioned who can't hold a pen to sign in. You don't want to go there.
I've improved even futher with bi-weekly accupuncture massage therapy. No needles. It's just massage that focuses on many of the same points where an accupuncture needle would go. I'd say I'm roughly 90% recovered. I still ensure I don't type too much and without proper ergo, but in general I've been able to resume my previous activities. Prolonged muscle tension seems to have been the main problem.