RSI Help!
February 2, 2014 11:40 PM   Subscribe

I have recently developed lateral epicondylitis (tennis elbow) from too much computer usage. What has helped you? What should I do next? YANMD. Snowflakes inside.

YANMD. But I'd love to hear your suggestions/experiences and what has worked for you.

My left forearm near the elbow hurts almost all the time. My right forearm hurts a bit but not as much. My wrists and shoulders are fine. It hurts to straighten my arms. My arm has a dull pain when I wake up in the morning.
I have no strength in my left arm when lifting at certain angles.

Things I have tried:
- I tried a TENS unit once and it seemed to make the problem worse (meaning that my arm hurt much worse for a day after I used it).
- Biofreeze and ibuprofen gel. They alleviate the pain temporarily.
- Stretching and massaging. It seems to get better when I do this regularly.
- Avoiding computer use for a day at a time. This works, but I can't just stop working for a few weeks/months.

Things I haven't tried yet:
- Acupuncture, chiropractic, physical therapy, general painkillers, strengthening exercises...

I've never been able to work comfortably at a regular desk with an external keyboard and monitor (including before this RSI). I don't use an external mouse. I mostly use a laptop on my lap.

- What has worked for you?
- What should I avoid? (other than work!)
- Resources that could be helpful in learning more
posted by 3491again to Health & Fitness (32 answers total) 12 users marked this as a favorite
This is a question close to my heart. Things that helped me include
  • Anti-inflamitory tablets - voltaren, specifically. This is not a permafix, of course.
  • More comfortable keyboard height - I have long(ish) arms, and found that I need my keyboard lower in order to not strain my elbow.
  • Once that was solved, Reducing switching between keyboard and mouse/trackpad - more keyboard shortcuts, less mousing around.
  • Better keyboard/mouse - in my case, this meant a trackball and a model m, but what is comfortable for you may vary - one of my coworkers actually uses a raised keyboard, for example.
You'll notice the general trend of more comfort and less waving your elbows about during your daily use - think the name, tennis elbow. But probably the most salient point, to me:

I've never been able to work comfortably at a regular desk with an external keyboard and monitor (including before this RSI).

Pain and discomfort are your body's way of telling you that shit is not okay - it sounds to me like you need to put some serious thought/work into the ergonomics of your work environment, in order to sustain it. I assure you (from bitter, bitter fail) that this shit can get far worse than just some tennis elbow.
posted by jaymzjulian at 12:20 AM on February 3, 2014 [2 favorites]

Oh, I forgot to link to: Typing Injury FAQ.
posted by jaymzjulian at 12:23 AM on February 3, 2014

FWIW pretty much every ergonomics resource says that there is no way to use a laptop in an ergonomically safe way without external devices.

Are you open to using an external keyboard and mouse?
posted by MonsieurBon at 12:23 AM on February 3, 2014 [1 favorite]

I mostly use a laptop on my lap.

You need to understand that you're basically asking "using a laptop on my lap is causing me significant pain. How can I keep using a laptop on my lap without significant pain?" and you can't. You need to radically improve the ergonomics of your positioning to improve your pain. You are spending huge amounts of your day with your elbows at acute angles and you are injuring your muscles and tendons. Unless you change your setup, those injuries will get worse, no matter how many painkillers you throw at it.
posted by DarlingBri at 1:16 AM on February 3, 2014 [3 favorites]

Does your mouse pad have a wrist rest? Using a wrist rest and switching hands has kept me from arm pain. So far.
posted by Cranberry at 1:20 AM on February 3, 2014

Nthing the general consensus that laptops are evil, ergonomically speaking, and using them on your lap is a particularly quick way to develop all manner of interesting pains.

What worked for me: minimizing mouse use by learning as many keyboard shortcuts as I could; switching to a more compact, narrower keyboard (anything with a number pad is too wide for me and forces me to stretch my arm to reach for the mouse); generally paying attention to the ergonomics of my work station (getting a quality chair, adjusting monitor height, etc) and booking a few sessions with a phyisiotherapist who taught me a bunch of stretching exercises.
posted by doctorpiorno at 1:21 AM on February 3, 2014

OK. Having read DarlingBri's comment, I concur. If you are to ameliorate your pain and damage. you will need to change your computing style.
posted by Cranberry at 1:22 AM on February 3, 2014

Learn to mouse with your other hand and switch off.
posted by nat at 1:26 AM on February 3, 2014

Response by poster: Ok, so I shouldn't use a laptop keyboard? I guess I'll need to plug in my laptop (I don't have a desktop) to a keyboard. Any suggestions on what kind I should get? Will that be enough to help?

And isn't a laptop keyboard fairly narrow?

Also, just to be clear: I am NOT using an external mouse. At all. Ever. So no need to switch off or change it or anything like that.
posted by 3491again at 1:28 AM on February 3, 2014

I found glucosamine chondroitin supplements very helpful
posted by 5_13_23_42_69_666 at 1:40 AM on February 3, 2014

Well, a laptop keyboard may actually be *too* narrow for you. Personally, I can't deal with wide keyboards, but I have wee tiny shoulders. It really depends on your body shape. Your mileage (and wingspan) may vary. :)

It might be a good idea to drop into your local Best Buy or something and take a look at their range of keyboards, trying to get a feel for which models work well with your size and keep your arms relatively straight while typing. Personally, I like the Goldtouch models: they are pretty adjustable and not too crazy expensive.

Also, although I get that you're not using an external mouse, do bear in mind that switching to an external keyboard means the laptop trackpad will no longer be in an easily reachable position. Even if you're anti-mouse, consider getting an external trackpad or trackball as well, just so you can place it somewhere comfortable.
posted by doctorpiorno at 1:41 AM on February 3, 2014

Are you working on a couch or at a desk?
posted by DarlingBri at 2:32 AM on February 3, 2014

Response by poster: I do both (couch and desk). Now that I think of it, this all started when I switched to a smaller laptop. So that might be part of it.
posted by 3491again at 2:46 AM on February 3, 2014

And an ergonomic keyboard that's wireless might help, too. I'm in more pain, too, though I switched to a wider laptop (in my lap) but have other issues that contribute.

A good external mouse and keyboard system (wireless) will let you use one or the other or both and or the built in systems as well.

As for strengthening exercises, my old favorite is eccentric contractions but that's because it works for me.
posted by tilde at 3:50 AM on February 3, 2014 [1 favorite]

If it's pain you're interested in ban hammering...I had steroid injections in my elbow and they were gold. The first one was the bestest of all.

But then I had to change what I was doing and eventually it almost entirely went away. Almost. But stopping the activity is the only cure. Everything else is a treatment.
posted by taff at 4:10 AM on February 3, 2014 [1 favorite]

Best answer: I would start here (while you are figuring out your new permanent setup):
- Do your stretches/exercises every morning.
- Place your keyboard/laptop slightly further away from your body.
- Move your body around as much as possible. Make a stretch your thinking position.
- Get an elbow brace that will keep your elbow in neutral position. Wear it only at night to keep your elbows from going into extreme positions while you sleep.
posted by zennie at 4:46 AM on February 3, 2014 [1 favorite]

What worked for me was:

- Stretching multiple times a day: extend elbow, pull palm towards elbow, pull fingers backwards towards elbow, sets of thirty seconds. Lots of frequency (twice each arm, more than three times a day) is good.
- Careful strength work, particularly low-volume (~3 sets of 5) pull-ups with sssllllooowww negatives. Slow eccentrics in general seem to be disproportionately helpful for tendon strength.
- Vertical mouse and standing desk configured so that my elbows were at 90 degrees and wrists straight when typing/mousing
- Switching between hands to use the touchpad on the laptop.

Various anti-inflammatory approaches "work" but don't solve the problem, as you note. However, I found them useful when beginning my strength-and-stretching regimen.

I've heard that twisting a bendy stick works wonders but have never had the opportunity to try it.
posted by daveliepmann at 5:00 AM on February 3, 2014 [1 favorite]

I have this issue right now, too. I've been to the chiropractor, and he recommended massage, biofreeze/advil as needed, but primarily the stretching exercises.

Mine wasn't caused by computer setup issues, but I definitely notice a difference between working on my laptop on my kitchen table vs. working at my desk at work.
posted by needlegrrl at 5:13 AM on February 3, 2014

For pain relief, fill a sink with ice water. Plunge the affected forearm all the way up to the elbow (and past). Keep it in for three minutes. Run it under a warm tap for two minutes (this should be a different sink if possible). Repeat two or three times. Do this at the end of the workday.
posted by computech_apolloniajames at 5:38 AM on February 3, 2014

Feldenkrais, Alexander Technique, core strength training such that you have ridiculously good posture even when you're relaxed (being tense in order to maintain good posture won't help), massage therapy, physical therapy that included massage/ultrasound/ and occasionally tens - but done by a professional, arm circles, alternating warm (hot packs) and cold (soaking my arms in ice water) -- ending with cold, laying on tennis balls on the floor such that they loosened the meat between my spine and shoulder blades, sleeping on a mat on the floor, gentle yoga, ergonomic computer set up(not an ergonomic keyboard -- actually paying attention to the angles (elbows & knees), distance (from screen and keyboard), and height (of desk)-- google "ergonomic office posture", buying a seriously adjustable office chair, high doses of anti-inflammatories under a doctor'a orders.DO NOT do this on your own. It's now clear how easily people OD on these and I'm pretty sure a doctor would never recommend it these days. Oh! And having a strap wrapped around my forearm.

What didn't work for me: wrist rests, wrist braces (I had tendonitis and bursitis everywhere)
posted by vitabellosi at 5:53 AM on February 3, 2014

The thing that worked best for me was an Occupational Therapist. They deal with it all the time and know the correct things to do.
posted by maxg94 at 6:12 AM on February 3, 2014 [2 favorites]

their website is flash-tastic thought :(

I had tennis elbow and was looking at flushing my career down the toilet... this pen mouse saved my bacon.

10+ years later I am still 'sensitive' (can't lift weights or use a regular mouse for more than 15min) but I can mouse all day with this tablet.
posted by St. Peepsburg at 7:21 AM on February 3, 2014

If you're not willing to use an external mouse, might you be willing to use an external trackball? All my wrist and elbow pain went away when I started using a trackball. Plus, a trackball doesn't require the same real estate that a mouse would because the base is stationary. Trackballs keep your hand open instead of gripped, which lets tendons avoid overuse. This is one of my favorites.

Good luck and best of recovery.
posted by whimsicalnymph at 8:30 AM on February 3, 2014

I work with my wireless keyboard on my lap and my laptop is elevated so that the screen top is just slightly below eye level. The keyboard goes everywhere the laptop goes, i.e., I never use the built-in keyboard or, by default, the track pad. I'm still too mouse-dependent for my own good.

I deal with the occasional painful flair-ups with double doses (and more) of ibuprofen and ice. I always have 2-3 filled metal water bottles in the freezer for this purpose. N.B.: this is not trivial pain. This is wakes-me-up/prohibits-sleep-and-work pain. On really bad nights, I pace—there is no comfortable still position—in front of the TV (the TV is for distraction). My other option is expensive and not necessarily successful surgery.

Make all the necessary changes asap. Things will only get worse.
posted by she's not there at 9:26 AM on February 3, 2014

Physical therapy. I put off PT for my epicondylitis until I had lost so much grip strength that I couldn't hold a coffee cup in my dominant hand. Six weeks of PT got me back on track. You need to change your working environment too, but this can be a devastating injury if you don't manage it.
posted by KathrynT at 9:49 AM on February 3, 2014

I've had RSI on both wrists for several years. At the worst times, my tendons even started making noise. It was quite horrible. I also had lower back pain. Here's what helped:

1) Group therapy. I've learned that there are people who spend far more time with a mouse behind a computer than me, but they never develop RSI. So those of us who do develop RSI may have unresolved issues that need to be worked out first. Once that happens, your grip loosens and the RSI might go away. It did for me. Half a year into group therapy with all kinds of people who got stuck in their work at some point, my pains vanished.

2) I switched to a Wacom tablet, both at work and at home. I never turned back. In the beginning it seems hopeless, but after a while you can become much faster with the pen and it naturally invites a more relaxed way of using your hands.

Good luck!
posted by hz37 at 11:32 AM on February 3, 2014

I'm dealing with a rotary cuff injury so have implemented some specific changes for pain management with that sort of injury.

However I've found that implementing a two minutes of movement an hour break has done just as much to help with overall pain management. I'm not sure if I read it here or elsewhere about the general health issues that can occur from sitting and working at a computer all day can be and that just two minutes an hour of getting up and moving can mitigate them as well as greatly increase overall productivity.

I started doing this a couple of weeks ago. I even use a timer. I have noticed a difference. Plus is your work has the right people it can be fun. A few us now do a 'two minute office dance party' and just move to the music in our heads.
posted by Jalliah at 12:08 PM on February 3, 2014

Brain dump:

Don't use any painkiller before/during time when you're using your hands. You may mask symproms, overdo it, and move backwards.

Consider it at night to bring swelling down for healing, but don't use it regularly and "chronically" or you will be in danger of worse issues with your stomach.

Key, though: if it hurts or tingles or anything at the end of the day, *at all*, then you've gone backwards. You've done new damage and you're further in the hole than when you woke up that morning, so you need to do whatever it is your body needs you to do the *next* day so that you're not feeling any tingles at the end of the day (which is probably a lot less than you're hoping.)

I don't believe that splints are a good idea, and for the same reason I don't think you should avoid using your hands when they hurt. Both lead to muscle atrophy. (I got to my worst point when I thought I should avoid turning doorknobs because that hurt too much. I made some big improvements then when my doctor said it was good to do anything that wasn't one of the repetitive motions that bother me. PS. I liked giving strong backrubs as a handbreak/exercise.)

I discovered "microbreaks" late in my problem (using the software, "AntiRSI" to remind) These are surprisingly helpful, much better than just having the long break every hour or what-have-you (which you also need.) i.e., i take 13 seconds every 5 minutes. really helps reset how I'm holding myself if there's some odd tension.

("Long break every hour" is probably too long between breaks until some healing. You'll start with a shorter time in between long breaks because "Key, though", above.)

I liked the book by Pascarelli and Quilter a lot.

I've actually found powerbook and macbook keyboards to be very good, though I imagine it's very personal what you need.

Vigorous exercise. You can exercise (in addition) when you take hand-breaks, too: yoga or pushups or jumping around or all sorts of stuff. Sleep is probably always a good idea.

You've got to go to a doctor, of course, and should be referred to a specialist. (I'm not a fan of surgery or splints, though.)

I have my own RSI very well under control right now (and I program professionally.) There's hope. It took years.
posted by spbmp at 7:53 PM on February 3, 2014 [2 favorites]

I'd certainly start by varying your working arrangements and see if this makes any difference. I'd avoid taking up a permanent regimen of painkillers, certainly.

I had pretty awful RSI arm pain a few years ago, and I still have episodes every now and then. I went to several doctors and none of them helped. This isn't uncommon with RSI.

What lifted the cloud and made me feel like I could get better was going to a massage therapist who went to work on my back. Your brachial plexus is quite capable of pushing pain down into your arms. I had been turning myself into a giant knot of tension without even knowing it, and fiddling with my arms (which is mostly what the docs did) wasn't even targeting the right place.

Later, I found out about John Sarno and mostly use his techniques now to manage my arm pain. Sarno has the idea that a lot of chronic pain syndromes are psychosomatic. This is substantially true in my case. See Rachel's RSI page for a typical story. If your stress levels have spiked recently, I'd at least check this out.

I am less of a purist about Sarno's methods than a lot of his fans. My attitude is more "whatever works". But it's a good thing to check out, especially if your pain is intractable otherwise.
posted by mattu at 7:55 PM on February 3, 2014 [1 favorite]

Best answer: Seconding what other folk say about core strength and posture. An acquaintance found that yoga was what he needed.

Pick up an ergonomic keyboard, footswitch, trackball, etc.

flax is an anti-inflammatory, and you need omega-3s to build up your cell membranes. Grind it, keep in the freezer, put 3 tablespoons on your breakfast porridge.

If your desk isn't working for you, redo it with a lap desk, standing desk, perfect height keyboard tray, etc. You want your elbows to be bent at 90 degrees as per this diagram:

I've actually found powerbook and macbook keyboards to be very good, though I imagine it's very personal what you need.
And the lenovo thinkpad ones.

Make a bunch of fixes, not just one.
posted by sebastienbailard at 7:57 PM on February 3, 2014

I also found the very gentle stretches in this book (which are geared toward fascia rather than muscle, hence the odd technique) to be very helpful.
posted by spbmp at 8:08 PM on February 3, 2014

The solution that worked for my mother's tennis elbow: Eccentric exercises.

Plus side: only costs $20.
posted by BusyBusyBusy at 3:01 AM on February 4, 2014 [2 favorites]

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