Is there an early warning system for RSI?

My RSI (repetitive strain injury) struggles began 25 years ago, after an intensive push to build and ship the BYTE magazine website. The tendons in both wrists became badly inflamed, and I spent a couple of months in rehab: anti-inflammatory meds, alternating heat and ice, stretching. It mostly resolved, but my left thumb joint remained painful. One day, as I wondered what could possibly be the cause, I looked down at my hands as I was typing. I use the world’s best (and rarest) split keyboard so there’s a left spacebar and a right spacebar. Suddenly it was obvious. I was always hitting the left spacebar with my left thumb, an unconscious habit that was repeated hundreds or thousands of times a day. And I was really slamming it too, another habit that I still have to monitor. Thus began one of a series of interventions to remap the relationship between fingers and keys. In that case, I assigned my right thumb to the spacebar, intending to switch to an alternating pattern once things settled down. All these years later, I look down at my hands now and see that never happened. I’m still using the right spacebar exclusively. I should probably try to change that, but there’s a more pressing problem.

Over the years, I got bitten a few more times by the effects of asymmetry. When my left hand became painful again, I realized I was mousing exclusively with that hand, and switched the mouse to my right side. I think I’ve gone back and forth a few times, currently it’s again on the right.

Another time, when I was doing a lot of lap swimming, my right shoulder became painful. Once again, it was something that should have been obvious, but wasn’t to the medical people I consulted, and wasn’t to me either until, once again, I recognized another asymmetry: I was always breathing on the left side, which put extra strain on the right shoulder. When I switched to an alternating pattern, breathing every third stroke instead of every second, that problem resolved.

You’d think I’d have learned my lesson by now. But when the knuckle of my left pinky suddenly became inflamed two months ago, it was the same story all over again. I attributed it to playing more guitar than usual, but when laying off didn’t help I thought I might have triggered arthritis. An x-ray was negative, though. What could it possibly be?

Then last night, while typing, I felt a twinge and looked down at my hands. It was blindingly obvious: I use emacs key mappings; the CTRL key is part of many of the basic chords; my poor left pinky is overloaded. Amping up the guitar playing probably pushed me over the edge, but it seems clear that is the root cause.

So I’m typing this post in order to adjust to yet another remapping. On this keyboard, there’s also a right CTRL key but it’s not convenient to my right pinky, so I’ve recruited the right SHIFT key (which I apparently never use) to be my new CTRL key. It’s not going to be an easy adjustment, but I won’t complain, I’m just glad to know I’ve found the way forward.

Given these experiences, I’ve thought a lot about how we can unconsciously injure ourselves with repetitive and asymmetric patterns of movement. In my case, I don’t seem to receive any signals until damage is already done. I wish I could notice sooner, do the necessary remapping, and continue with less disruption. But it just doesn’t seem to work that way.

I really can’t complain, though. Recently I met a guy in a guitar shop whose left wrist and hand became so painful that he had to switch sides and learn to fret with his right hand. It’s hard for me to conceive of doing that kind of remapping, but you do what you have to do. And as a bonus, he’s now a switch-hitter: as he recovers some use of his left hand, he finds that he can achieve different effects as a right-handed and left-handed player.

I’m pretty sure I’ll get through this episode. The question will then become: how to avoid the next one? When we use computer keyboards or musical instruments, we need our hands to work unconsciously and automatically. It’s only when injuries happen that we have to surface what’s been unconscious, enter manual mode, and retrain until we can form new unconscious habits. I wish there were an early warning system.

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8 thoughts on “Is there an early warning system for RSI?

  1. I’ve been there too. I finally switched to using a pen table instead of a mouse – maybe 30 years ago by now. I wouldn’t be able to function if I hadn’t. I don’t use those tabs that tilt the keyboard up – tilting the wrists up seems to be especially bad.

    That doesn’t answer your question, of course. The only thing I have to offer is to slow down – type slower, mouse slower (or preferably, don’t mouse but use the pen table, but not too fast).

  2. I developed the early signs of RSI around the same period as you: I was working at a non-profit on an early Internet-based database project and was assigned an IBM PCjr, set on a small desk, with a small secretarial chair. Followed by millions of characters of typing. A recipe of for RSI if there ever was one.

    I went to a doctor, who simply advised lots of Aspirin. I went to another doctor, who referred me to the local hospital to have a brace custom-constructed for my right wrist. I wore that brace, increasingly patched together with masking tape and baling wire, for more than 20 years.

    As my workplace evolved into my own control, I gathered all manner of ergonomic keyboards and mice around me, got a stand-up desk (at which I never ever stood), had many visits from an ergonomics consultant, and secured the best, most adjustable chair that I could find.

    And yet, through all this, I endured regular bouts of wrist pain, shoulder pain, facial tingling, generally associated with periods of more intense work.

    Although I still flirt with symptoms from time to time, the “magic fix” for me has been to leave the office and its “ergonomic” setup aside, and to work from a stock MacBook Air with trackpad, at a variety of decidedly non-ergonomic workstations (couches, coffeeshops, kitchen tables). I’ve also adjusted my work schedule so that I don’t have the relentless hours-long coding drives (without breaks) that I had in my younger days.

    All of this has made a huge positive change in my RSI, and I feel like it’s now under control and not in control.

  3. Jon – time to try speech to text now that AI has improved that interface. Then you are just doing keyboard editing and formatting. In other words reduce the load. Just a thought?

    1. Yeah I periodically try to transition to speech-to-text but normal typing isn’t the problem here, it’s all the editing operations that push the words around, and that stuff is really hard to do with voice!

  4. Here’s what I love about this article: The body tries to do whatever we want it to do, even when it’s ‘not working’ for the body. It goes without complaint until it’s all too much, and then that body part (pinkie finger!) lets us know IT’S NOT WORKING WELL. Then all the docs look at that body part, make guesses about what’s going on, and lead us down one path or another, without great results. I’m so glad you figured out what was going on, the deeper story, and once again, found a way back to the do the work (and play!) you love so much.

  5. I tend to think no. My first RSI experience had, retrospect, only one hint. I stopped wearing a watch. A few months later, one day, I came into work and I couldn’t type – not all all. So I switched things up to more management, and and months later I began some degree of recovery.

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