Psyche

As described on the page causes, the psyche may play a role in RSI in three different ways:

  1. As a "concomitant": When you are in constant pain you might become afraid of your future and a pain memory develops.
    Please read the general section of this page from "work attitude" onwards.
  2. As a trigger: Subliminal, severe stress (Tension Myositis Syndrome)
  3. As a trigger: Fear of RSI
All exercises / activities on this page are only suggestions. For your individual complaints some will be more useful than others. Print out this page and discuss all the information with a doctor or physical therapist before trying them out. You do everything at your own risk!

TMS (Tension Myositis Syndrome)

As an introduction to this issue please read the TMS-section on this page. The treatment strategy has similarities to erasing the pain memory, so that the following section should be of interest to all people who are in persistent pain. In return, all TMS sufferers should also look at the information about the pain memory.
Inner tension, repressed problems or life changes can be the cause of your pain. TMS is not always the sole cause, it can also occur in addition to a physical overload. Pain can occur in any body part, but it often does where you expect pain. With the pain your brain tries to distract you from dealing with a (sometimes positive) life change. Due to the pain you might develop fear of using the affected body part because you don't want to aggravate the pain. You are caught in a vicious circle between a relieving posture and brain induced further pain.

To escape this vicious circle, have a look at the following strategy:

  1. For one day engage yourself in the topic of TMS and read the respective success stories. You will automatically gain euphoria that will help you in the early days. A pain-free life is possible!
  2. Accept Dr. Sarno's theory. Yes, initially it is very difficult to believe that a real pain can be controlled by the brain alone and that there must not be any physical injury present. However, you have to really believe in it - be a 100% convinced. Give this theory a chance and try it out for a week, you have nothing to lose! Only if you then feel no improvement at all, your RSI is probably caused by a physical strain.
  3. Dr. Sarno recommends patients with a clear TMS diagnosis to stop all stretching exercises etc., because the pain is not caused by a physical overload which can be counteracted with appropriate exercises. All exercises would only draw unnecessary attention to the existing pain and would be counterproductive. If your diagnosis is very clear (you were not exposed to repeated stress over a longer period of time), then you should stop other exercises in this phase. If you're not sure if the Tension Myositis Syndrome is the sole cause, then I recommend you perform at least a few stretching exercises. With those few stretches you will counteract the following thought you will inevitably develop during the week: "Am I not just wasting my time? Shouldn't I perform conventional exercises instead?" If you do both, you create a win-win situation. If the pain is (at least partly) caused psychologically, then you are on track of becoming pain free after this week (the first step is the most difficult). If you don't feel any improvement, then at least you haven't lost any time.
  4. Create a list of things that affect your feelings (even supposedly positive ones). Possible areas are:
    • Adverse childhood experiences (very strict rules, abuse, problems of your parents [alcohol, drugs, depression], separation of parents ...)
    • Personality traits (you want to make it right for everyone, perfectionism, low self-esteem ...)
    • Current personal challenges/problems (serious illness or death of a family member or friend, divorce, debt, problems with work colleagues or friends, new boss, new job, partner starts/quits an employment, legal dispute, feelings of shame, feelings of guilt, vacation, relocation, marriage, pregnancy, birth of a child ...)
    • Trivial matters that always bothered you, but you have never addressed (attitude towards certain topics or behavior in certain situations from your partner or from friends)
    • Your own age and thoughts about the inevitable death
  5. Each day choose a different theme and write down everything you can think of. Write about your feelings and consider various strategies to address the problems. This regular work requires some time and effort, but it is currently the most effective method of treating TMS.
    According to Dr. Sarno about 20% of his patients need psychotherapeutic help to overcome their traumatic events. When in doubt, take up professional help.
  6. Read your records regularly and work constantly to implement your strategies. Work on yourself and discuss unpleasant topics with your family and friends.
    Something that you or others cannot change, you must try to accept. You will not be able to clear up every little annoyance. It is enough to identify it clearly and to accept your feelings. For example: you think that a family member acts embarrassingly in public. Previous talks couldn't bring any improvement. That you are ashamed of another person is not a bad thing. However it becomes stressful for you if you feel uncomfortable and embarrassed to be ashamed. This is perfectly natural, stand by your feelings and do not try to suppress them.
  7. Your muscles aren't overloaded and the tissue isn't damaged! Start slowly with everyday activities and try to use your hands normally. Also apply the tactics for erasing the pain memory. When you see an initial success, restart light computing tasks and increase the time continuously.

Additional information can be found in the book "The Mind Body Prescription" by Dr. Sarno (who has come up with the term Tension Myositis Syndrome) as well as on numerous other websites.

Fear of RSI

  1. If you work less than 2 hours a day on a PC (and are not exposed to comparable repetitive motions):
    Your risk is very limited. Follow the instructions in the summary, but continue to work as usual. You can also have a look at the treatment plans (section "prevention").
  2. If you work more than 2 hours a day on a PC (or are exposed to comparable repetitive motions):
    Even if you are at risk, you really don't need to be afraid! As long as you follow the tips of this website (equipment, breaks, stretching ...) your risk of developing RSI is reduced dramatically. You can find an overview with all tips on the page treatment plans.
    Particularly in stressful work phases you should take regular, short breaks and shake out your arms. Whenever you think that you just don't have the time to pause for a few seconds and only want to quickly complete a task, it is time for a short break! There is software available you can install on your computer which reminds you to take regular breaks. Millions of people work in extremely non-ergonomic positions and don't develop any pain. If you follow the basic advice you are quite save.

Work attitude

Very diligent people who take on voluntary extra work and skip breaks are especially prone to Repetitive Strain Injuries. If you belong to this group and develop pain, you will probably want to continue to work as usual.

Right here you have to step in, because the sooner you address the pain, the faster you will be able to work normally again. Discuss the problem with your partner, your boss and your colleagues. They all need to know that you need to take your time temporarily and must adhere to regular short breaks. You should be as transparent as possible in order to counteract any additional outside pressure ("What funny exercises is he/she doing?" "Is that a mouse for disabled people?" "Sick of PC work? You only want to work less!").

You also have to work on your work attitude:

  1. Accept your disease! You don't benefit from continuing to work for another two months in pain, if that results in being unable to work properly for the rest of your life.
  2. Draw the right conclusions and change your behavior. This is also in the interest of your employer. He will not want to trade a single completed project with the subsequent loss of your work force.
  3. You cannot please everyone 100% of the time; this is a fact and cannot be changed! Don't be frustrated, you have done your best.

Work organization

With a sophisticated self-organization you can work more efficiently. A reduced workload does not necessarily mean that you also achieve significantly less. The first pain often occurs in a very stressful situation. For example when a project must be completed by the end of the month and you have to do a lot of overtime in the last week. A realistic time schedule and a list of priorities would have made more sense.
The Pareto principle states that 80% of the result is achieved in only 20% of the time. The remaining 80% of the time is consumed for only 20% of the result. For perfectionists (a 100% result) it does not matter if they start with the unimportant tasks and then finally work on the most important parts. However, this approach is very inefficient. A good result (95%) could be achieved in significantly less time. In practice this means that at the beginning of each project you should create a sort list of all sub-goals in order of importance. After about 20% of the estimated time all indispensable tasks will already be done and now you can devote the rest of your available time on the less important tasks. If the original schedule turns out to be too tight, you have two options:

  1. Nocturnal overtime for a 100% result (if you are a perfectionist you want it that way - people without a priority list have to work overtime, as they have not even started an important sub-task)
  2. Achieve a 95% result within normal working hours and without stress due to your priority list.

Here is an example of a small task (creating a presentation):

Priority Description Scheduled time Time in %
Elementary Work out the content of the presentation 2,0  
Elementary Create slides 0,5 22
Very important Define slide transitions 0,5  
Very important Create charts 1,0  
Very important Practice lecture 2,0 30
Important Revise texts 1,0  
Important Check spelling 0,5  
Important Refine layout 1,0 22
Optional Create animations 1,0  
Optional Create handout 1,0  
Optional Create opening and closing slides 0,5  
Optional Print out slides, in case the projector is defective 0,5 26
    11,5 100

With this example you can see that you have already achieved a good result in half the scheduled time (priority elementary and very important). A presentation would be possible now. The rest of the time you can spend on improvements that are desirable, but which could also be omitted if time is tight.

If you hadn't worked according to a priority list (and started with the layout, animations, opening and closing slides etc.), you would probably be stressed towards the end. Any unforeseen "emergency" would have also jeopardized the timely finishing.

The following additional points can also result in a significant workload reduction:

  1. Delegate tasks
  2. Practice saying "No!" (don't undertake all tasks which could also be done by someone else)
  3. Don't postpone unpleasant tasks
  4. Perform routine tasks such as responding to e-mails during mid-afternoon energy slumps
  5. Only budget 60% of your working time for fixed tasks
  6. Set concrete and realistic goals
    An example:
    What: Reduce strains in the workplace
    How: Take 10-seconds short breaks
    Extend: Every 10 minutes
    Period: 4 weeks
    "To reduce strains in the workplace, I'll take short 10-second breaks every 10 minutes. After four weeks, I will check if I have achieved my goal with this measure."

Will I recover?

RSI is a vicious circle: the greater the pain, the less you want to use your hands. In extreme cases, they are put in casts. When the complaints are finally gone after weeks, months or even years, the muscles have degenerated to the extent that you can't properly perform even the simplest activities. Even everyday work on the computer is no longer possible. The person affected will probably question the ability to be able to ever use their hands again (at least I thought that way). Although apparently one has done everything possible, even light work will be painful. At this point, it is very important not to give up. You can be healthy again! Of course, in the early days your arms are not nearly as strong as they used to be, but the muscles can be rebuilt with light strengthening exercises.

The road to recovery is like a roller coaster ride. There will be days with no pain and others where your hands will feel as bad as in the beginning. At first you will only have a few painless hours a week, but over time those painless hours will return on a daily basis. After a few weeks you will have more good than bad phases and you will be symptom-free in the end.

In addition to this development, the intensity of my pain remained the same at first, which was very frustrating. Only over time, as the good phases outweighed the bad, the pain intensity slowly decreased.

Psychological consequences of long-term RSI

The longer you have problems with a repetitive strain injury, inevitably the more your mind plays a role. You probably will not be able to pursue your recreational activities (volleyball, tennis, hockey, windsurfing, violin, piano ...) and therefore you will also meet less with friends. If you stay home alone, then you will probably often think of all the negative consequences of RSI. "How nice it would be if I could do ... now." From my own experience I know that over time one loses the desire to do anything at all. "Maybe it will hurt my arms. I'd rather do nothing, than do something wrong ..."

Especially in temporary bad phases, please consider the following:

  1. Accept your illness. Do not take it as an "excuse" that you have to sit at home and cannot do what you enjoy. Continue doing your usual activities that you can perform without putting excessive strain on your hands (cinema, theater, swim, jog ...).
  2. See your situation as an opportunity for something new. You've probably wanted to start something but then discarded it due to time constraints. Or you cultivate an existing talent. Now is the time! (jog, swim, sing, read books, magazines and specialist journals, learn a foreign language ...).
  3. You will be healthy again! Read other personal stories of former RSI sufferers. Particularly in the very bad phases it will help you overcome bad moods.
  4. If you, your family or friends think that you cannot cope alone with your negative thoughts, then do not be afraid to get professional help. A visit to a psychologist is absolutely no shame! Many people do not dare to seek professional help because they are afraid of being considered insane or mentally confused. That's absolutely not true, most patients are ordinary people like you and me. Almost every one of us will go through a very difficult period at least once in his/her life and many will also consult a psychologist (it is usually just not talked about). You can only benefit!

Pain memory

When your muscles and tendons have completely regenerated and you can already do all normal household activities without problems, it might happen that the pain reoccurs immediately when doing computer work. This phenomenon is called pain memory. After a long time in pain (approx. 3 months) your brain automatically connects the computer work with pain, even if physical injuries are all healed. In order to "reprogram" your brain as quickly as possible, here are a few tips:

  • Work for a few minutes on the computer every day, just quit shortly before the point at which the pain or discomfort usually occurs. It is very important that the pain threshold is not exceeded and you stop consequently. Every day you extend the time by a few minutes. After two weeks you will notice that you will be able to work longer without pain compared to the first day. On days you have permanent pain even without working, don't switch on the PC that day. You can extend the pain-free phase by increasing blood flow to your arms.
  • Combine the computer activity with something pleasant, for example listening to your favorite CD.
  • Give your hands a comprehensive sensory input, i.e. you regularly palpate small objects with your fingers (without looking at the object).
  • Regularly work at the computer wearing thin gloves (price: ). The feeling when typing on the keyboard is a completely different one and helps the brain to erase the pain memory. You can also temporarily apply adhesive tape to your fingertips.
  • From time to time type on various surfaces, e.g. on a wooden or glass table, on your lap, on a piece of paper. It is important that you move your fingers as if you were writing a correct sentence on your "virtual keyboard".
  • Think of friends/colleagues who have never had RSI pain. Or think of LAN party attendees, who play PC games three days in a row. Without breaks. Without stretching exercises. In a non-ergonomic posture. The human body is capable of compensating extreme strain, you will be able to use the PC again without pain.
  • Consider your pain as an object, with which you can talk. If pain shows up, talk to it (inside or out loud). Say that you understand that your brain tricks you. You know that the pain has no reason to exist and should therefore disappear.
    What might sound ridiculous really works in many cases! Try it out. You have to believe in it a 100%. You have nothing to lose! I promise you an incredible feeling when you experience it for the first time.
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