RSI-UK Digest for 23 Aug 1997

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. 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’. As well as treatment you will have to make drastic changes to your work environment, even changing the type of work you do. 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’.

Answer 1: The knowledge of RSI doesn’t seem to be that firm to allow any assessment like ‘chronic’ or not. In general I would question the benefits of learning in an early stage whether your RSI is chronic or not. Does this change the way you could handle your condition, given the current knowledge about treatments? Changing your life dramatically is not something most people just do overnight. I feel a ‘chronic’ assessment is something that comes along with acceptance of your condition after a very long period. And some people don’t feel like that at any point.  I found dramatic messages shortly after the RSI-diagnosis very depressing. I don’t think the added frustration is very helpful at that point. If one is unfortunate enough to recover slowly/slightly there is enough time to learn and accept the consequences.

Answer 2: I see what you mean about a firm assessment being inappropriate, but I feel that this has been phrased in such a way as to leave my complaint unaddressed. I asked the people treating me if there was a *risk* of becoming permanently sensitized to certain activities. The *only* reason I asked the question was to help decide how urgently I should change my job, so it’s annoying that they all said “no” or “you’ll be fine”. I want things to run reasonably smoothly career-wise, but my health is far more important, so I would prefer it if they said “I don’t know” or “yes there is a risk” in appropriate cases because it’s more realistic and allows you to make more honestly informed decisions. I suppose most specialists don’t want to be responsible for someone changing their life dramatically overnight, which might incline them to take a “don’t worry” approach. They are in a difficult position because it is important for sufferers to have a positive attitude and not to make rash decisions. But a dramatic decision would help the RSI more than any treatment! No seriously, the knowledge that something may become chronic helps you make the right decision; it doesn’t matter whether it’s dramatic if it’s the right one!

Answer 3: My answer is ‘don’t know’. It is quite likely that if you continue ‘working through the pain’ you will do more and more damage, so it is well worth taking serious adaptive measures – e.g. shell out immediately for voice input if it is suitable for your job, to give your hands a rest and give you some breathing space. This is a big step but not as big as changing your job and it does have the huge advantage of letting you continue at near-full productivity. Finding a new job and adapting to it is stressful in itself, and stress definitely worsens RSI IMO (at least temporarily) so if you can make some simpler adaptations than changing job it is worth a try. Given this sort of breathing space, you would at least not be doing any more damage, and hopefully unwinding some of it – this would then let you concentrate your efforts on recovery, treatment and other important adaptations such as posture, keyboard, relaxation, stress management, and so on. Unfortunately I don’t think anyone can tell – there were people in my company who had RSI symptoms shortly after me who recovered in weeks; equally, I know people with RSI who have had it for years and whose condition is not improving. The best thing seems to be to assume you can recover at least until you have tried a lot of treatments – don’t just rely on conventional medicine, I would not be typing today if I had!

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