The final, and perhaps most important strategy for overcoming RSI is a physical therapy exercise program coupled with mentally overcoming the fear of perceived injury. Such a program should be tailor made to suit your personal needs by a qualified physiotherapist. This will allow for healing of the tendons and strengthening of the muscles as well as general improved well being. Previously, Part I and Part II covered hardware and software based changes for reducing strain especially for wrist tendonitis. These interventions, although helpful for reducing pain, are not permanent solutions. This article focuses on physical and mental exercise interventions for treating the underlying cause of pain resulting in complete recovery from chronic pain.
The first step to complete recovery is to reduce inflammation to the point where no or very minimal pain is felt throughout the day. One strategy for this is to get a professional massage from a physiotherapist followed by shock wave therapy treatment. Shock wave therapy works to improve circulation and thus reduce pain and inflammation. After this treatment it is important to wear wrist splits for the next five days or so to allow for complete rest. During this time, keep phone use to a bare minimum and do not indulge in whatever activity is causing the pain.
Wearing a hand splint for too long can lead to muscle atrophy so it is important to stop wearing the brace during the day (wearing it at night during sleep for a few weeks is fine). Once the pain is well managed (no pain doing daily activities apart from the one that caused injury) it’s time to move on to the next step: stretching.
Stretching exercises and self massaging
Once the inflammation is gone, the body is ready for some stretching exercises. A physiotherapist can provide appropriate exercises for your level of strength, and gradually increase these accordingly. The goal of stretching is to return any contracted muscles back to their normal length. Stretching is also generally recommended everyday when taking regular breaks from computer work. Dr. Harrison has a great YouTube channel showing some good stretches for gamers. A few are shown in the videos below:
Self massaging can also be very effective for releasing muscle tension in the lower arms which in turn reduces wrist pain. This is of course an alternative to more costly professional massages. Some people have also found foam rolling to be just as effective.
The key to recovering from tendonitis or RSI is to strengthen the muscles and tendons. This requires working very closely with a physiotherapist to do exercises that progressively but slowly increase in intensity in order to promote full recovery. Slow and steady is the motto. Generally speaking, these exercises are either weight training on the wrist or upper body strength training. The Bob & Brad YouTube channel has some examples of wrist and forearm strengthening exercises to begin with.
Once the wrists are stronger, it’s time to move on to progressively complex full body exercises which strengthen the core and upper body. Progressing from wall pushups, walking on your hands to the modified renegade row and ultimately pull-ups can take several weeks (or months) and should always be done under the supervision of a physiotherapist. Some example strengthening exercises are shown in the videos below:
It is important to realise that after a few weeks of doing strengthening exercises, you will begin to notice a remarkable difference when doing the activity that causes you pain such as typing or using a computer mouse. To avoid having a flare up, do not be tempted to start doing this activity for prolonged periods once again. One way to look at this is that typing or using a mouse is an exercise in and of itself. Setting appropriate time limits for computer use using the Workrave program, discussed in Part II, is very important. In the beginning 15 minutes per day in total will be difficult to achieve. When this becomes easy, very slowly increase the time making sure that you do not over strain yourself. Allow your body the time and space it needs to heal by taking regular breaks and rest days. Overtime, these new habits will become a lifestyle allowing for pain free computer use
Emotional and mental well being
One of the side effects of having chronic RSI or wrist tendonitis is the fear of pain. This can lead to having conditioned pain, where you dread having to use a computer mouse or keyboard due to the pain you anticipate and then get anxious within minutes of using the computer which then further reinforces this pain. Overcoming these mental barriers can lead to significant breakthrough since it requires re-programming the neural pathways in your own brain.
Another challenge could be the psychosomatic nature of RSI and tendonitis in some people. Simply put, this means that there is nothing pathologically or structurally wrong with their wrists or hands, but rather the pain is simply a subconscious level distraction from suppressed emotions. Simply acknowledging this had led to rapid recovery as documented on DDRKirby’s blog, this Github post, the TMS Wiki pages and the lecture below.
Whether or not you believe in these explanations, it is worth exploring whether the onset of RSI pain or tendonitis was triggered by deep suppressed emotions (resentment, stress, anger etc.) and whether improved emotional awareness could be the solution for you. It is however always important to get an assessment from a qualified specialist or medical doctor to rule out any pathological explanation first, as Schubiner’s Talks at Google lecture below warns:
It is possible to make a full recovery from RSI or wrist tendonitis. In the absence of actual structural damage, the best approach is to consider the emotional and psychological roots of pain. A breakthrough in this area will mean complete freedom from the hardware and software interventions discussed in Part I and II, and most importantly the freedom to live life without fear of pain.
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