JoshWComeau

My Personal Experience with RSI

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December 17th, 2024.
Dec 2024.
Introduction

In 2020, I developed Cubital Tunnel Syndrome, a repetitive strain injury. For about 7 months, I couldn’t use a keyboard or mouse.

I’ve previously shared how I worked around this condition, using a microphone and eye-tracker to code. In this blog post, I want to share a bit more information about how I overcame it.

If you’ve been dealing with an RSI like Cubital Tunnel Syndrome or Carpal Tunnel Syndrome, I hope this can help. ❤️

Link to this headingMy personal circumstances

In March 2020, when the world was shutting down due to the COVID19 pandemic, I injured myself.

Annoyingly, I pulled a nerve during a physiotherapy exercise. I felt an electric jolt through my left arm. Later that day when I tried to type, I felt a burning in my elbow that quickly became painful. I had irritated the nerve.

My physiotherapist assured me that this would clear up in a couple of weeks, but it didn’t. It actually got worse and worse. A couple of months passed, and I started getting the same burning pain in my right arm, despite not having injured it.

I tried a whole bunch of stuff that didn’t help at all, including:

  • Ergonomics. I got a standing desk, made sure my monitor was correctly positioned, and tested no fewer than 6 ergonomic mice/keyboards.
  • Seeing 3 different physiotherapists and 2 occupational therapists, including the #1 hand specialist in my area.
  • 2 consultations with surgeons (more on this soon).
  • High-dose anti-inflammatory regimens.
  • Lots and lots of different herbal remedies and vitamins.
  • Complete computer abstinence, for weeks at a time.
  • Wearing custom-made splints that immobilized my arms at night and throughout the day.
  • Electro-acupuncture.
  • Several tests, including an MRI, an ECG, and an ultrasound.

The tests came back clear, with everything looking good. The only little thing was that my nerve shifts out of place when I bend my elbow. This is what most of the medical professionals focused on, but it was a red herring. This is a totally normal abnormality which occurs in ~10% of people and doesn’t typically cause any problems.

The weird thing was that the pain mostly only happened while I was typing. It wasn’t the only trigger, but it was by far the most consistent. Other activities, like writing with a pen, were usually fine. I painted my office during this time without issue.

Even weirder, sometimes my arms would hurt while I was dictating. My arms would be immobile, by my side, but my elbows and fingers would start to tingle while I was speaking. 🤔

After months of trying all sorts of stuff, I had exhausted all of the conservative options. The only thing left to try was surgery.

The suggested surgery was terrifying to me. It would involve being conscious and coherent while they moved things around in my arm 😬. It would also come with lifelong tradeoffs. I’d need to be careful about how I held things, or where I put pressure on my arms. Each arm would require 3-4 months to heal, and I’d have to do them one after another.

During this time, Quebec’s public medical system was overwhelmed with COVID, and so the government understandably suspended all elective surgeries. There are private surgeons in Montreal, which would have cost ~$30,000 CAD. I was fortunate enough to have enough in savings to cover this cost, but I wasn’t working at the time and had no clue if I’d ever be able to work again.

All surgeries carry risk, and while the surgeons I met with seemed confident, there was a danger that this operation could make my situation worse, or lead to permanent loss of sensation or movement. It was an awful option, but the only option left to try, so I scheduled an appointment.

Being in that sort of situation made me pretty desperate to find an alternative solution. I decided to try suspending my skepticism for things that seemed too farfetched to work.

Thankfully, I did find something that worked for me. I was able to cancel that scheduled surgery. In the 4+ years since, I’ve had zero issues. I can type as much as I want, and I don’t worry about RSIs at all anymore. I was even able to improve some other chronic health issues I’ve had. 😄

Let’s talk about the thing I found that finally worked for me.

Link to this headingThe MindBody Prescription

As I shared details about my RSI online, I got tons of suggestions from the developer community. One of the most common suggestions was to read The MindBody Prescription(opens in new tab), a book by Dr. John Sarno.

I’ll tell you right now: you will be skeptical about the ideas in this book. I was extremely skeptical, to the point that I stopped reading the book after a few chapters, dismissing it as pseudo-scientific nonsense. I decided to give it another shot when my surgery got scheduled, as a Catholic-inspired sports term that refers to a desperate late-game play that has a very low likelihood of success.

The core thesis of the book is that many chronic pain conditions are caused by the brain, in order to distract us from repressed emotions. It’s a defense mechanism gone awry. Our nervous system is trying to protect us, and doing a terrible job of it. 😅

According to the book, our brain triggers the pain by selectively depriving nerves and muscles of oxygen. So the pain is real, it’s not imagined or hallucinatory, but it’s also not due to a structural problem. It’s self-inflicted.

The analogy used in the book is that repressed emotions are like prisoners who are trying to escape from the unconscious part of our mind. To prevent them from exploding into consciousness, the brain conjures up minor nuisances so that we’ll focus on them instead.

Sometimes, this is a good thing. For example, I am a conference speaker who is also quite scared of public speaking. Before a talk, I often develop a stomach ache. The stomach ache doesn’t make my nervousness go away, but it does keep me distracted. It stops me from fully exploring all of the bad things that could happen. As a result, the terror is kept in its cell, and I’m able to deliver my talk without (much) panic.

In other cases, though, the repressed emotions are fairly trivial, and the “minor nuisance” is incredibly disruptive. It’s a bad trade, but the nervous system doesn’t realize it. No matter the cost, our nervous system will make sure those emotions stay repressed.

Link to this headingEvidence

So, like I said, this stuff all sounds very farfetched. When I mentioned it to the medical professionals I had been seeing, none of them had heard of Dr. Sarno (the book’s author) or his work. Honestly it was a bit embarrassing even bringing it up to them; it all sorta sounds like the sort of crackpot theory that some guy made up, like how fiction authors create worlds in their head.

But I kept hearing from developers who told me that they had been through the exact same thing I had, and that this stuff had really helped them. I found a blog post by Etherpad creator Aaron Iba, who shared an uncannily-similar experience(opens in new tab). In the years since, many other developers have shared similar stories, including:

This is all anecdotal, of course. When The Mindbody Prescription was published in 1999, there hadn’t been any formal studies conducted. In the decades since, there isn’t as much research as I’d like, but there have been several studies that have shown positive results. For example:

It’s also worth considering Dr. Sarno’s track record. He worked in a clinical setting for almost 50 years, from 1965 until his retirement in 2012. His work was focused primarily on back pain, but he helped treat all kinds of chronic pain syndromes. He became a bit like House M.D., receiving problem cases that nobody else had been able to treat, people with multiple failed surgeries and decades of chronic pain, barely able to walk. He was somehow able to help these people, by the thousands.

I recently heard from Max Shen, a pain researcher at MIT. He’s been working on an awesome resource that covers all this stuff specifically for software developers. It collects a bunch of evidence(opens in new tab), and ends with the following super-important note:

Link to this headingTreatment

The main goal with treatment is to convince your nervous system that it doesn’t need to keep emotions repressed, that you won’t be harmed if they escape.

There are lots of roads to this path, but I’ll share the things that were most effective for me, as well as some things that others have told me worked for them.

Link to this headingJournaling

This was the most important thing. Every day, I’d spend ~30 minutes and write about everything that was bothering me.

This was tricky at first, since the main thing bothering me was the RSI itself, but I tried to look around that. I thought about my relationships, past experiences, things I felt guilty or resentful about.

When I let my mind wander, it occasionally veers into some pretty unpleasant memories, and my inclination is to jump back from them, to redirect my attention elsewhere. During my journaling, however, I try to let my mind go wherever it wants to go, and to commit all the bad stuff to paper. The point is to convince yourself that these unpleasant thoughts aren’t harmful, that your nervous system doesn’t need to protect you from them. They might be uncomfortable, but they aren’t dangerous.

Some days, I’d only write a short paragraph or two. Other days, I’d fill one or two lined sheets. The most important thing was consistency, that I did it every single day.

Link to this headingEducation

I read The Mindbody Prescription(opens in new tab) cover-to-cover twice. When I finished that, I looked for other books on the subject.

None of the other books I found were as impactful, but they were still helpful in their own way. Here are the ones I remember:

Towards the end of my treatment, when I was already mostly better, I discovered Curable(opens in new tab), an Android/iOS app that provides a curriculum and various exercises. I didn’t get too far with it, since I wasn’t experiencing much pain by then, but it seemed solid.

That said, it’s pretty expensive; as I write this in December 2024, it’s a subscription that costs $22/month and is currently on sale for $11/month. There is a free trial, so it might be worth starting with that.

Link to this headingGentle practice

Pain is a very powerful signal. It feels like your nervous system is telling you to stop doing something immediately, that you’re risking grave injury or permanent damage if you continue. “Get your finger off the hot stove right now, you idiot!”

With mindbody conditions, though, the pain is not a sign of danger. There isn’t anything to be afraid of. And so a big part of my treatment was trying to reassure myself, to quell the fear that typing is risky or would exacerbate my condition. I’d remind myself that there is no reason for the pain. And then I would try to type.

Immediately, the pain would return, and I would say to myself “Hi brain, yes, I see that you want me to focus on this pain, but it is not necessary right now. If you could please stop causing this burning sensation, I would really appreciate it.”

At first, it didn’t work at all 😅. The pain would build from mild to moderate to severe, and I’d have to stop typing. Some days, my self-talk was much less patient and included much more profanity.

But over the course of a few weeks, the pain started dissipating. I could type for 10 minutes, then 15, then 30. I was able to prove to myself that there was nothing dangerous about what I was doing, and eventually, the pain stopped entirely.

Now I want to be very clear here: I am not suggesting that you should ignore all pain signals and push through no matter what. Before I started this process, I confirmed with both my doctor and my physiotherapist that it was safe to continue for brief intervals even with moderate pain, that I wasn’t risking any permanent damage. But every situation is different, and what was safe for me might not be safe for you.

Link to this heading Recovery

I wish I remembered the timeline more clearly, but from what I can recall, I believe it was about 3 months between when I started giving the mindbody stuff a chance and full recovery, where I could type as long as I wanted without any pain at all.

For some people, it’s much quicker. For others, it can take longer, and there can be relapses where the pain returns. And of course, there are plenty of chronic pain conditions that are not psychosomatic, in which case this blog post isn’t as applicable.I’ve come to believe that all chronic pain has some emotional component, and so the things in this blog post may still provide some relief, though it may only be a small piece of the puzzle. But I could be totally wrong about this.

I am incredibly relieved that I was able to find a solution for my RSI, but it’s also kind of infuriating that none of the medical professionals I saw seemed to be aware that this was a possibility.

We’ve built a medical system that is cleanly divided into two halves: we have psychologists and other therapists for the mind, and then we have physicians and other medical doctors for the body. This seems like a nonsensical distinction to me; the mind is part of the body, and what happens in one will affect the other. And yet, there is no established medical field that specializes in physical issues with psychological causes.Psychiatrists are the closest thing we’ve got, but they tend to combine the two individual fields of study rather than viewing them as one cohesive thing.

In fact, when physicians suspect that a patient’s issues may be psychosomatic, they tend to be dismissive, as though it’s no longer their job to treat the patient. They’ll be tossed over the fence to the “psychology” world, but this isn’t a good fit either, since the issue is distinctly physical, and psychologists have no idea how to treat RSIs. This is a stunning gap in modern medicine which, as Dr. Sarno puts it, “borders on the criminal”.

Fortunately, science does seem to be catching up to Dr. Sarno’s work, and hopefully the medical system will follow the science. In the meantime, we should still rely on healthcare providers to rule out serious issues like tumors, and we can seek out the small but growing pool of specialists who treat mindbody issues.

Also: MIT pain researcher Max Shen is trying to reach more people who have RSIs or other chronic pain conditions. Feel free to shoot him an email at maxkshen@gmail.com.

Last updated on

December 17th, 2024

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