My experience preventing and managing RSI (n=1)


Yet another story of typing-related repetitive strain injury (RSI) and what did/didn’t work for me in my journey out of it. I am not a doctor. This is not medical advice. YMMV.

RSI is one of those things that turned out to be more serious than I thought at first and warrants significant intervention if it shows up. At the lower end of the spectrum, you deal with frequent pain while working. At the higher end, the chronic pain leads some people to depression, and a smaller subset of people actually end up having to go on disability because they can no longer type. My experience was definitely not that extreme, but reading some of these accounts shocked me into doing something about my RSI while it was still manageable.

I started developing excruciating pain in my wrists in the later years of my PhD when I was more of less programming or writing my thesis around the clock. I was using a Microsoft ergonomic keyboard at the time, but that wasn’t enough to prevent wrist pain. The pain was always there, but most of the time at a manageable—albeit distracting—level. I tried to ignore it as best I could and figured it would go away after I finished grad school and healthier work/life balance prevailed.

(Narrator: It didn’t.)

I then joined a consulting company where I worked long hours. My wrists were okay except for periods of heavy report writing, like where I was typing for almost 10-12 hours straight for days on end. But then it started getting worse and was an issue more often than not. I had to use NSAIDs to get to sleep at night. It was around this time that I accepted I had a serious problem with my wrists that wasn’t getting better and sought medical attention.

I then found out that most doctors and physical therapists aren’t very helpful when it comes to RSI. I was in Boston–a medical paradise–and couldn’t find someone who had specific experience treating RSI. It’s commonly misdiagnosed as carpal tunnel, often quickly referred to surgery, and I couldn’t find anyone who could help me. I was prescribed wrist braces and stretches, nothing more. Things did not improve and I was in a lot of pain.

So it was up to me to figure it out for myself.

This was several years ago, so what follows is basically everything I remember about my return to normalcy.

First, I read a bunch of blog posts about RSI. The most impactful ones that I can still find (RIP dead links) are:

A lot of websites I found pointed to two books by Emil Pascarelli (MD/professor at Columbia University) as the canonical references for RSI. I read both of these books cover to cover and gleaned most of what I would eventually need. He covers the physiology of RSI vs. carpal tunnel, approaches for treatments, exercises, how to set up your workstation, and advice for finding a medical professional who can actually help with RSI. Many people online have reported being able to effectively self-treat their RSI using just these books, which was my experience. Here they are:

These two books informed the steps I took, which I outline below:

  • Kinesis Advantage keyboard: If you Google “RSI” long enough, you will find almost all roads lead to the Kinesis Advantage keyboard. Like many before me, I graduated through several levels of increasingly expensive “ergo” keyboards (none of which made a difference) before I finally spent the money on the Kinesis. I wish I had bought it immediately. Impact: Eliminated 80% of my RSI problem within days. A few comments on this keyboard. First, it is quite unaesthetic, but I viewed it as a necessary medical intervention, not a design statement. Next, it only took a few days to learn how to type on it. Finally, it’s very easy to switch between this layout and a regular keyboard (like when using my laptop undocked); the brain has a wild ability to context switch between both modes and did not mess me up at all. I was concerned about being unable to type on my laptop keyboard whenever necessary after acclimating to the Kinesis; this turned out to be a non-issue. If you are concerned about the noise of a mechanical keyboard, Kinesis offers a low-force, quiet version.

  • No wrist braces: I tried them for awhile to no avail. Then I read Pascarelli argue strongly against the use of wrist braces for RSI because they restrict blood flow and people become over-reliant on them leading to muscle atrophy. So I stopped using them completely. Instead, he said, his patients should wear “air braces” which he explained as training yourself to keep your wrists in a perfectly neutral position at all times. I had to change my sleep position. This mindset helped me a lot when sitting at my computer.

  • Dialing in an ergonomic work setup: Your body is a complex system and your entire body positioning/posture influences your wrists. At the time I started treating my RSI, I was using a makeshift standing desk at work and had to tweak it extensively and iteratively until every piece was dialed in perfectly so that my wrists were in a neutral position for typing and mousing (this photo was pre-Kinesis keyboard, note the furniture risers beneath the desk contraption to dial in height, and also the keyboard shelf which I redrilled/remounted multiple times). This included keyboard height, mouse height, wrist rest heights, etc. It’s important to dial in all of these pieces, not just the keyboard. For example, if your monitor is at the wrong height, you will tend to slouch and your body will compensate by throwing off your wrist alignment. My current work setup (Aeron chair, adjustable sit/stand desk, articulating monitor arm) was designed to make every single element completely adjustable. Note that although I no longer have regular RSI symptoms, if I make any adjustment to my work setup, I will have a slight RSI flare-up like clockwork for several days until my body adapts.

  • r/bodyweightfitness Recommended Routine: It’s very counterintuitive given the strain it places on the wrists, but I started this strength training routine and it drastically helped my wrists. The four components specifically involving the wrists are the wrist prep routine from GMB (I think this especially helped), pushups, L-sits, and rows (using gymnastics rings). I would have thought pushups would have killed my wrists, but strangely my wrists handled them fine with time. This led me to hypothesize that a fundamental cause of my problem was actually related to lack of strength and mobility?

  • Started taking frequent stretch breaks when working, focusing especially on neck, shoulders, arms, wrists, and fingers. I used an app on my computer that prompted me for a micro-break every 15 minutes and a longer break once an hour. It was interruptive but helpful.

  • Working fewer hours. I had horrible work/life balance coming out of grad school, which persisted into consulting and then startup life at times. My RSI was always correlated with number of hours worked. I will get an RSI flare-up now if I start working longer hours or typing a lot in the evening for several days in a row.

  • NSD Power Essential Spinner Gyro Hand/Wrist/Forearm Strengthener: Interesting device that exercises and stimulates all the small musculature in the hands and forearms. This thing is actually pretty wild. If the hypothesis was that strength was needed to help fix my hands, I think this was probably helpful. Definitely made my hands/forearms very tired after a few minutes of use. I used it at my desk twice per day for a few minutes.

  • Donut grip strengthener: I kept one of these on my desk at work and used it throughout the day to try to exercise my hands and mostly just get them moving. I had the black version (80 lb, whatever that means).

After making these changes, my RSI symptoms effectively went to zero and have almost completely stabilized ever since (more than five years as of now). In fact, I eventually changed jobs and started working directly on my laptop more often without the Kinesis Advantage due to travel and working from home. I realized one day that I had exclusively used the laptop keyboard for awhile with no wrist issues, meaning that the changes I listed above eventually brought a level of stability that warranted few special accommodations aside from a generally ergonomic desk setup. I kept the Kinesis for awhile just in case, but eventually moved to a regular keyboard with wrist rest with no problems.

I still have the occassional RSI flare-up, usually if I change something about my work setup, if I have to type after 6pm for more than a few days in a row, or if I am spending a lot of time doing wrist-intensive exercise such as cycling. But for the most part, my RSI is under control and have zero worries about it spiraling into a serious issue again.

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