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December 26, 2002
Greetings from planet RSI
An attempt to explain what it's like to have hands that hurt all the
time
By Kimberly Patch
For the past couple of decades, a large number of office workers,
programmers and writers have lost their jobs, cashed in their retirement
accounts, and even sold their houses in an effort to cope with the lingering
results of finding themselves on the losing end of a battle with the computer
keyboard.
Despite the general awareness of the term carpal tunnel syndrome,
people with repetitive strain injuries often feel like they're on another
planet. Repetitive strain injury (RSI) is a catchall term that includes
the relatively rare carpal tunnel syndrome along with a half-dozen other
syndromes related to muscle and tendon strain.
I've spent a lot of time trying to explain what it is like to have
RSI's in my hands, arms and neck and how the injuries came from something
as seemingly innocuous as typing too much. I still find explaining somewhat
difficult.
Nine years ago my wrists started hurting. Despite seeing several
doctors about the problem, a year later I couldn't tie my shoes, turn a
key in a lock, or lift anything that weighed more than a couple of pounds.
Doing anything with my hands or arms was painful, including turning a faucet,
picking up a phone, using a plastic fork, and signing a check. Driving was
impossible. During one very bad week, my husband Eric brushed my hair for
me.
When I was first hurt, I described to friends the various sharp,
shooting, tingling and vague pains that wandered through my hands and arms
as a result of what I had used them for minutes, hours, or even days before.
My first explanations to editors at the magazine where I worked
were brief and filled with assurances that the problem wouldn't affect my
work. As the injury dragged on for weeks, my explanations included changes
I'd made: taking notes by hand and dictating stories by phone so I didn't
have to travel with a laptop.
And as the injury dragged on for months, there were more changes.
I was sure that using a tape recorder to take notes, wearing braces on my
hands all the time, taking high-dose ibuprofen, and requesting that Human
Resources requisition speech recognition software would make everything
all right.
I found myself telling worried family members that I was getting
better, and I thought I was. That is, after all, what usually happens with
an injury. I expected all the changes I'd made to be enough to allow me
to heal. But what was really happening was a series of ups and downs that
ended in a net loss. And with each cycle my hands seemed more fragile.
It became difficult to watch Eric do all the housework. It became
obvious that Human Resources wasn't getting the software I needed. It felt
like half my brain was taken up dealing with low-level pain that didn't
go away. I couldn't get comfortable sitting in a chair.
I became more philosophical. Being a healthy and active 30-year-old
before I got hurt, I hadn't thought about what it was like not to be able
to wipe off a counter or pick up a cat. I hadn't realized how difficult
it was to be dependent.
When I eventually acquired speech recognition software, people were
curious about how it worked. But more difficult to explain, both to myself
and others, was why I wasn't getting better despite doing very little typing.
The injury was more than simply a matter of overtaxed hands. I had
the typical head forward, rounded-shoulder posture of someone who uses the
computer for hours without breaks. Just sitting at a desk with this posture
was a problem, but it was extremely difficult to change. It took time to
become aware of the problem, and meanwhile, my hands got worse.
One of the most difficult things to convey about this injury is
how it fools even those who have it. It's hard to understand that even if
you can do something once, you may not be able to do it several times in
a row, or even a few times in one day, without suffering. And the pain might
not hit you until you're lying in bed that night trying to sleep. It takes
time to understand that RSI's make your hands so sensitive that your limits
are ridiculously low.
After working hurt for a year, I hit bottom, left work and began
to concentrate on getting better. I thought it would take a couple of months.
It took three years of ups and downs, including a couple of spectacular
failures at trying to use a computer again, to get most of the way better.
The magic formula turned out to be a mix of Trigger Point and Myofascial
massage therapy, stretching, drinking a lot more water, permanently stopping
all typing, and summoning much more patience than I thought I had learning
how to move more efficiently and relax using the Alexander Technique and
Tai Chi.
My injury had a lot to do with very tight muscles, which in turn
made the tendons they attach to more susceptible to injury. The massage
got the knots out of my muscles, but they kept coming back, even when I
wasn't typing. Drinking more water helped some. A body can survive dehydrated
for a lifetime by rationing water, but it is the muscles that first give
up the optimum amount of water they need.
The Alexander Technique and Tai Chi are subtle disciplines rather
than quick fixes. The Alexander technique is a century-old method founded
by an Australian orator whose voice strain kept coming back when he stepped
on stage. It teaches efficiency of motion and awareness of muscle movement,
and is popular with actors and musicians. Tai Chi, the least martial of
the martial arts, is a several-thousand-year-old Chinese practice that teaches
you to be aware of and control the subtle movements deep inside your muscles
and joints.
Over time, Alexander and Tai Chi helped me notice when and where
I was tightening muscles and learn to relax them. It quickly became clear
that one of my main problems was a subtle move into the rounded-shoulder
computer posture whenever I did practically anything -- picked up a fork,
brushed my teeth. It took years, however, to train my muscles not to do
that.
During those years I slowly gained back the ability to write with
a pen for short periods of time.
I started to wash dishes that were light and didn't require much
scrubbing. My hands became a little less sensitive to vibration and jarring.
I found that I could go running again as long as I took dirt paths rather
than sidewalks and walked down the hills.
Although I made progress keeping my shoulder muscles relaxed while
writing, eating or running, however, I still found myself snapping into
the rounded shoulder posture when I was sitting or standing in front of
a computer, even when I was dictating rather than typing.
What ultimately helped was doing something entirely different that
I enjoyed. I wasn't playing violin regularly at the time I was injured.
After college I had pretty much stopped playing at all, but when I realized
I couldn't play because of my hands, I started really missing it.
And so at a certain point I stopped testing my hands by trying to
type, and started trying to play the violin instead, a minute or two at
a time. It was frustrating at first because I had to focus on how I was
using my hands and arms and shoulders, and so couldn't think about what
I was trying to play. But if I was careful I got fewer residual effects
-- the various and lingering pains, tingling and tightness -- that I got
when I tried to type. With violin it was a little easier to avoid the rounded
shoulder posture. This made it easier to be patient about playing just a
little more every day, and making sure to back off when it felt like I was
taxing my hands. I made progress without having to repeat the exact motions
that led to my injury.
Ultimately, I think it would be possible to learn to type again
using the same sort of method, along with an excruciating amount of patience,
but as it turned out this wasn't necessary.
Before the injury, I was a quick writer. Using speech software,
writing was fairly slow and definitely tedious, because the command interface
for speech recognition, while impressive at first glance, was substantially
slower than typing when you actually started using it for real work.
In the first four years of my injury I'd used speech recognition
on and off, but I'd cheated fairly often -- typing or using the mouse some
as I went along because equivalent speech commands were slow or nonexistent.
But the cheating always got me in trouble. I only really started getting
better when I completely swore off typing.
To do this I banished my computer keyboard to the top of the monitor
and put the mouse under my desk. This left a large amount of useful desk
space, which I quickly got used to and took to covering with papers.
And so I was forced to use speech to do absolutely everything on
a computer. It's amazing how many menu commands and mouse clicks are needed
to do relatively simple things like change fonts or copy paragraphs from
one window to another. And it's amazing how tedious it can be simply repeating
these menu commands and watching the computer take one tiny step after another
before arriving at a simple goal.
Four years after my initial injury, bolstered by the better movement
and posture habits I'd learned through Tai Chi, Alexander and careful violin,
and working under a strict rule not to touch the keyboard, I was able to
spend a few hours a day dictating to a computer without hurting myself.
During the next two years, I spent a lot of time writing speech
macro commands to speed up the poky speech interface, and I gained ideas
and additional commands from people who posted their macros on the Web.
I slowly built up to a 40-hour workweek. It was difficult to get
myself to take regular breaks, and to notice when it was time to stop for
the day. I was often on the edge of getting in trouble again, and I used
a succession of tricks to take my attention from the screen: a clock with
bird chimes, a pair of bird clocks that chimed five minutes apart, and finally
an impossible-to-ignore kitchen timer. I kept taking weekly Tai Chi lessons,
doing stretches and drinking a lot of water.
And after writing thousands of macros without hitting a key, I realized
I was controlling the computer faster than if I'd been using a mouse and
keyboard. I don't think I would have stuck with speech recognition long
enough to figure this out if I'd had a choice.
At the same time I was recovering more abilities -- washing heavy
dishes, picking up heavy grocery bags. I even started juggling again. I
still had to think about how much I could do each day with my hands. I started
to drive again, but only for short distances.
For the past two years I've worked full-time and continued to slowly
get better, and I think I've finally made it. There's almost nothing I can't
do with my hands that I did before the injury. I played my first post-injury
round of golf last fall, and this spring I had my first taste of ocean kayaking,
complete with a full cartwheel spill in the surf. I can hold up my nieces
so they can touch the ceiling. I play violin for an hour every day.
But I still find it difficult to explain exactly how it is that
I can play violin and haul heavy bags of groceries around without problems,
but can't type without getting in trouble again.
And another thing that's difficult to explain, especially to people
who are in the throes of their own RSI's, is that I'm happy despite a long
and taxing odyssey. I've learned a lot from the injury. The abilities that
are important to me are back, and I'm taking much better care of both my
body and mind now. Before the injury I didn't appreciate or make time for
things like playing music and running.
What's really difficult to comprehend, however, is that many of
the several hundred thousand people a year in the U.S. who are diagnosed
with RSI's don't get better. The U.S. Bureau of Labor Statistics puts the
number of workers that miss time on the job due to this type of injury at
more than half one million a year, and cites RSI's as the fastest-growing
occupational illness.
Acquiring the health care that helps and gaining the time to heal
is not easy. I had to seek out and often pay for the neuromuscular massage,
Alexander, and Tai Chi I needed despite being covered by both regular and
workers compensation medical insurance. I exacerbated my injury twice doing
repetitive exercises prescribed by physical therapists who were more accustomed
to treating traumatic injuries than the subtleties of RSI's.
Getting better was an excruciatingly slow process that included
first figuring out how to get better, then not doing things I wanted to
do and doing things I didn't want to do, for years. The timing of treatments
also turned out to be both important and tricky -- the first time I took
Tai Chi it was too much for my hands. Workers compensation insurance ran
out long before I got better, but I was lucky enough to receive an inheritance
that, along with my 401k, bought me the time and treatment I needed.
If I had known in the first months of my injury what I do now, I
could have cut years off my recovery time. But here's the rub -- I'm not
sure if my workaholic self of then would have understood even a very good
explanation well enough to take it seriously.
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