RSI – chronic, non-curable stage?

Question: How do you know when you’ve got to the chronic, non-curable stage? I know it’s not an exact point, but what are the signs? I have asked most of the specialists I have seen, including my Rolfer, if they think there is any risk of permanently sensitizing my arms to certain activities, e.g. involving gripping such as writing with a pen or playing a musical instrument. And I think to myself, because if the answers yes I’m leaving my job right away! I’m trying to change my job anyway but it’s otherwise a gradual process. But they always say no. The trouble is I don’t always trust them, particularly in relation to permanent problems. I mean, they do their treatment and it helps my posture and everything but my arms still hurt. But is it the right treatment, especially when each treatment is justified with its own language which you usually can’t reconcile with the language of other treatments? I feel very lost without there being one person I can trust.

Answer 1: You are *not* alone, so please don’t feel lost. Hey, your message nearly made me cry at my desk… I feel the same as you about all the stuff you said. It was only last night that my Mum said to me. ‘Oh you’ll be ok, your arms will get better, so don’t be so negative because it makes me miserable’. I told her that I wasn’t being negative, just realistic because no-one knows if I’ll ‘get better’ – I got annoyed that she interpreted my practical attitude as one of someone who’d given up. We keep trying all these different treatments, they usually sound feasible at the time, then as you say, our arms *still* hurt. It’s a shame that there’s no magic potion around, huh? I haven’t really answered your questions but I hope someone gives you a more practical answer.

Answer 2: Hard to say. The pain clinic I attended said that acute RSI will clear up in 6 months providing you discontinue whatever you were doing that caused it and get it treated. Any pain problems left after that are chronic pain rather than RSI per se and can only be managed rather than cured. I suppose it’s a matter of acceptance and common sense – I’ve had RSI or whatever for nearly seven years now and had treatment for it for five and a half years. Nothing stays acute that long so I would assume that I now have a chronic pain problem. I could probably get acute RSI again if I was stupid and went back to doing whatever caused it but any increase in pain that lasts for a few days is just a pain flare up which will die down again with appropriate management techniques (see the info on Input from this or last year’s RSI Assoc AGM)

Answer 3: Once you get to the stage of your arms/shoulders etc. hurting when you type, even before they continue hurting afterwards you are probably beyond the ‘curable’ stage. This does not mean you cannot improve the condition! RSI is treatable but not curable even in its very early stages. Even if you get rid of all the pain and other problems you will find that re-injury is very easy. People who have got rid of all or most of their RSI problems have to be very careful and keep on doing their exercises and treatments just to make sure the RSI does not re-occur.

As well as treatment you will have to make drastic changes to your work  environment, even changing the type of work you do. Some people give up work entirely as this is the only way they can stop their RSI getting worse again. They could try different work or using voice recognition, but they choose not to. You will also have to make drastic changes to your life style, give up anything that involves static posture – including playing a musical instrument – if it makes your pain worse. I know all this seems very negative, but going down with RSI is equivalent to losing an arm, you have to make changes to your life, but you WILL get better, it just takes time.

Answer 4: I think the word ‘curable’ is a bit undefined – what is a cure? Is it being able to resume all your old activities pain-free (in which case I am 99% cured) or is it being able to take up new activities pain-free (in my case, I find windsurfing is too much, but then I only started this post-RSI). It is dangerous to generalise – I was definitely at the stage of arms/shoulders hurting when I typed, and am now basically cured after some time getting treatment. Also, some people I know have had some pain in the arms that lasted a few weeks or so and, when they changed their work practices, went away. I would hate people to be complacent or think that a 100% cure is always feasible, but it is really not justifiable to make statements about who can or cannot be cured, until there is much better medical knowledge about RSI  (particularly the diffuse/AMT variant). I tend to just say ‘you can almost always improve your condition’, which for some people may amount to a ‘cure’.

Again, it is dangerous to generalise – I have not changed the work I do, and in some ways am working almost as many hours as when I first got RSI. Not advisable, but with a good keyboard and attention to posture/stretching/trigger points, it is OK for me anyway. Some people will have to do what you say, but please don’t say ‘you will’ – nobody can tell until they have tried a wide variety of treatments for a significant time (months to years not weeks). One reason I am writing this message is that in my first week post diagnosis I got a book about workplace ergonomics that had 3 ‘levels’ of RSI – my condition clearly fit into the incurable level, and this was very depressing. Happily, the ergonomist who wrote this, competent though he was, did not know the entire story of RSI treatment – in fact no one does. All I can say is that different people can recover different amounts, and there is no simple test for whether someone is ‘incurable’.

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