not your typical rsi question
February 6, 2011 9:01 AM   Subscribe

I clean houses for a living. I'm getting RSI. A lot of the usual advice doesn't seem to apply to me, and I don't know what to do.

I've been an independent house cleaner for about a year, and that had been going quite well until I took on a bunch of new clients at once. Now my hands and wrists are screaming in pain, especially at the base of my thumbs, in my wrists, and up my forearms. Looking around the interweb, I'm pretty sure I have de Quervain's syndrome (which used to be called washer woman's syndrome!) in my thumbs, and there might be more going on in my wrists too. It has to do with squeezing out sponges, squeezing spray bottles, gripping brooms, etc...for hours, almost every day. At this point, it hurts when I'm not working, it's interfering with everything I have to do with my hands, and it's affecting my sleep. It's not good.

So. What to do? A lot of the advice I've seen for RSI is for computer professionals, and while I do spend a fair amount of time on the computer (which hurts), I don't think that's the main problem and a lot of the advice doesn't seem to apply to me. I tried taking a few weeks off and the pain mostly went away after a while, but it came back right away when I went back to work. Probably, I ultimately need to quit my job, which is scary for a bunch of reasons; even on top of figuring out my financial situation, I'm afraid that I've screwed up my body for life.

I don't have health insurance and have little to no money, especially if I can't work, so seeing doctors/getting surgery/etc. is out unless they're at the free clinic. I can probably afford cheapish wrist/thumb braces, and am totally up for doing exercises or whatever, but am not sure which ones would work best for me. I'd welcome whatever advice you can give me.
posted by streetdreams to Health & Fitness (8 answers total) 2 users marked this as a favorite
Clearly, recurring pain in your hands is such a life complicating problem, that you need competent medical diagnosis and treatment to alleviate it, and assure that you don't get lifelong impairment. So, I want to challenge you to change your thinking from "I don't have health insurance and have little to no money, especially if I can't work, so seeing doctors/getting surgery/etc. is out unless they're at the free clinic." to something like "I have to find competent care for this problem immediately, to protect my future." You may or may not have actual RSI*, but putting off getting diagnosis is no way to go.

*In my experience, diagnosis of RSI isn't usually all that expensive, anyway, but follow up treatment can take time and money. Furthermore, if it's discovered that you don't have actual RSI, but are, say for example, aggravating an underlying arthritic condition, knowing that instead of presuming that you have RSI, would put you on a different management strategy, entirely.

I'd also point out that not every person is capable of doing the physical work that heavy house cleaning often requires. You simply may not be strong enough for the job, and may not easily ever get strong enough to do it as a regular job. But you may excel at finding new clients, and keeping them happy, and you may be good at training and managing other housecleaners. If you are in the happy position of have an influx of new clients, perhaps it is time you promoted yourself to manager, and hired a couple of workers to do the actual scrubbing...
posted by paulsc at 9:25 AM on February 6, 2011 [2 favorites]

I did have light RSI from too much photoshop work at one point and I got rid of it by doing this exercise: I'd grasp my fingers, one at a time, by the opposite hand, and curl and pull it inwardly with quite a bit of force. I did about 10 hours total of exercises, about half an hour a day and the rsi went away completely. That was about 9 years ago, since then it recurred a couple of times, I did some more exercises and it went away again. I also do yoga asanas pretty regularly and even though they're not specifically focused on hands, I'm sure they help a bit, too.

OTOH my rsi was much lighter than what you seem to have.
posted by rainy at 11:13 AM on February 6, 2011

(I mean, OTOH it was much lighter, not rsi OTOH!)
posted by rainy at 11:16 AM on February 6, 2011

What paulsc said. I have interviewed tens of people who manage on irregular income streams dependent on their health to earn a living. Preventive care is your investment in your future income stream. Can you find some understanding clients who may either be medical professionals or willing to advance you money against working it off for them? Those are some of the ways that others doing your type of work manage in different parts of the world.
posted by infini at 11:43 AM on February 6, 2011

IANAD but I have had rsi, including de Quervains.

I can't speak to what was a actually going on, but the way I look at it is this: doing detail work with your fingers and hands requires increased oxygen via increased circulation. But your hand muscles are small and far from your heart. It is your shoulder and back muscles that are effective at telling your heart to increase oxygen and circulation. So I need to take frequent breaks and move my shoulders and arms. I also tend to get muscle knots on my back/shoulders/neck...and this blocks good circulations to my elbows ands hands too.

Wrist braces increased my problems. I was warned to only use them when NOT using my hands..but they increased my pain even then. Laying on a heating pad on my "wings" - btwn my shoulder blades and spine and getting a massage in that spot (by a friend or student at a massage school) helped.

Now when I have a flareup I see a DO rather than an MD---who does some soft tissue work.

Try not to yank on things like wet laundry or doors---intentional movements that are slower and have mire leverage are better.

I alternated heat and ice---ending with ice, to help control pain in my forearms and hands---but the cold was best delivered by laying my hands in ice water. I cut my hair short and stopped eating spaghetti -- couldn't rinse shampoo out of long hair or twirl spaghetti on a fork.

I'm so sorry this is happening to you. For me, it was devastating. I stopped working for a long time (workers comp) but now I feel like I nip it in the bud when it rears up again.
posted by vitabellosi at 12:52 PM on February 6, 2011

I have de Quervains in my left wrist. A cortisone shot (I'm not going to lie, hurts like hell) fixed me up for about six months. The doctor said if the pain comes back, a minor surgery will release the tendon sheath that is causing the inflammation and pain. I also had trigger thumb on my right hand. Same shot and advice about surgery in the future. Both surgeries would be an out-patient surgery. He also advised seeing a hand rehap therapist. Go see an orthopedic doctor.
posted by tamitang at 7:40 PM on February 6, 2011

Sorry, I didn't read the part about no doctors. Maybe the free clinic can do the shots. Also, the braces only made it worse for me.
posted by tamitang at 7:41 PM on February 6, 2011

I had very severe de Quervain's a few years ago. It was incredibly painful -- going to the ER at 3:00 AM-painful -- and I was disabled for months.

Exercises were worthless. Wrist braces just made it worse. Cortisone shots were extremely painful -- literally screaming at the doctor's office as it was done -- and they didn't help for more than a few weeks.

Ultimately, only surgery helped. My wrist still bothers me from time to time, and I know that there are yoga poses that I'll never be able to do, but I'm able to live my life now, mostly pain-free. I'm very glad that I had the surgery when I did.

I don't know what to tell you. I know that my surgery was outpatient and was relatively inexpensive with health insurance, but I still took a lot of time off work, and I spent months in physical therapy. I feel for you, especially if yours is as painful as mine was.
posted by liet at 9:46 PM on February 6, 2011

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