How I Fixed My Wrists
|31 May 2015
|This is a copy of Steven's own website. He kindly gave me the permission to copy his story to this website. I just have added headings.
I considered calling this article "How I won the war against RSI", because really, it is a war. It's been two and a half years since the first twinges of pain and these days a I live of a life of relative freedom. I plan my day like a normal person, not like the old me who was paranoid of whether I could drive to a friend's house, worried about turning in another late project at work, afraid to make dinner … afraid turn a doorknob. In fact, these days I treat doorknobs with the same lack of fear I show to a whisk, my chubby baby boy, or keyboard and mouse. I am completely unafraid of using my body however I want. Someone who has not had RSI could never understand how powerful and freeing this feels.
Now I'm going to tell you my story, most of which is probably your story too. You already know how it starts.
I was working long hours to make a good impression at my new job. One fateful day I felt some odd tightness in the muscles in the underside of my forearm (I now know they are called wrist flexors). Being athletic, healthy, and 24 years old I did the only sensible thing -- I ignored it. Over the next few days the tightness became pain and the pain became "Oh my god." pain. I began to feel tingling in the tips of some of my fingers at night. Having experienced no chronic illnesses or serious injuries in my life so far, I assumed my invincibility hadn't worn off and this injury would soon heal. Again, you already know how this goes. I ignored the pain and it became a force that controlled my entire life.
Wrist braces, anti-inflammatories, steroid injections
My first doctor was an orthopedic specialist of the hand and wrist. I see specialists first for everything. Why trust a family doctor, who's job it is to know everything, with something so important? Orthopedic specialist. That's bringing out the big guns. At this point Google revealed to me that I had carpal tunnel syndrome. A common wrist overuse issue best treated by a wrist expert. I thought to myself: "Let's have this expert, who has probably treated hundreds or thousands of people like me (since it's so common), knock this carpal tunnel syndrome out of the park. Easy peasy." Unfortunately, you probably know what happened next too.
I went back to work armed with funny looking wrist braces and prescription anti-inflammatories (the big guns). A week or so later I was worse than I'd ever been. Other than a greatly increased level of co-worker sympathy from the wrist braces, there were negative changes across the board. I think that was when I knew something was seriously wrong. I went back to my doctor twice more to swap out for different anti-inflammatories and to get a half-hearted lecture about how stretching has maybe helped some of his patients. More pain and less productivity later I was once again sitting in the examination room. Now my doctor had suggested that we try cortisone shots in both of my wrists (as it had now spread to my other wrist). I was sure that if anti-inflammatories were the big guns then steroid injections were massive ship-mounted anti-aircraft guns. Just the thing I needed. Now here's where our stories might diverge, although I doubt it. My initial response to the steroid injections was a profound improvement in both of my wrists. After just a week I was back to working through the day, and working on side-gigs and playing games at night. I still felt a little pain, but it was just an echo of what I was used to dealing with. I jumped into the deep end of wrist usage like an addict deprived of their choice drug, even despite lingering concerns that I might be moving too quickly. I think I discovered that steroids were a false miracle about a month in. While I had never felt cured, the pain was at a manageable plateau. Each day I began to feel the pain deepen and swelling inflammation was starting to constrict both of my arms. I couldn't use a keyboard for more than 10 minutes before it became impossible to ignore the pain. That was my first breakthrough: my doctor didn't know how to help me and now I'd made the condition even worse than had I left it alone. I theorized that the steroids had stopped the inflammation and the pain, but I was still injuring myself (now at an increased rate) all the while. Once the steroids wore off it was like opening a floodgate. I begged forgiveness for missed deadlines at work and took a sudden one week leave of absence to give myself the rest I needed months ago. If this is your story too, I'm sorry.
Hitting rock bottom
I still shudder when I remember that week. My wife was visiting family in a neighboring state and I was alone with my misery. This is hard to share, but I think it's important. I remember laying my arms down, palm side up, on the table in front of me and just screaming at them. Just screaming at them. I was crying too. Mostly from the helplessness, but from the pain too. I felt pathetic, and still do, for hating my own body. The futility and weakness of that moment was humbling. Hitting rock bottom was important, if only so I didn't have to go any lower. After I'd had my fill of self-pity I turned that self-loathing rage into a righteous one and vowed that I would have my life back -- my real life; the one that felt like it was worth it. From that point on I stopped feeling sorry for myself, stopped expecting other people to feel sorry for me, and realized that I could only rely on myself if I ever wanted to be whole again; my recovery was my responsibility alone. Accepting nothing less than an inevitable and complete cure I started doing what little research my arms could handle. I turned up a way to extinguish the rampant inflammation with a sink full of ice water. By soaking my arms up to the elbow for 20 seconds every 10 minutes or so, over the course of two or three hours, I was able to beat the inflammation. I did this every day when I got home religiously. I came to look forward to it and thought of it as pouring a bucket of water on the fire that burned in my arms. In a few weeks the inflammation part of my symptoms were greatly diminished, even though the pain and numbness persisted. To combat that I bought a highly reviewed book on stretching that convinced me that muscle tightness from knotted muscle tissue was responsible for my continued symptoms. I created a routine of stretches that I did every hour or so during the day. At this point I didn't care how stupid I looked with my arms spread out, fingers wriggling, in the center of my cubicle. I started seeing real improvements in the weeks to come. The numbness was the next symptom to subside. The stretching did seem to improve my wrist flexibility, but the pain was a constant companion. Over the next year or so I oscillated between okay and bad, but never as bad as rock bottom. My productivity and happiness were similarly okay, bordering bad during that time. A lot of people I've read about and talked to seemed to get stuck here, but I was fortunate enough get out of this stage.
Daily stretching, icing and heating routine
My next major breakthrough came when I started seeing another orthopedic specialist in a renowned hand and wrist organization. Despite her apparent expertise, her treatments and diagnosis were from the same ineffective script as my first specialist. Dismayed, but not defeated, I got her approval to take a 3 month unpaid medical leave from work. During that time I started seeing a chiropractor specialized in Active Release Therapy, put simply it's a kind of cooperative stretching. According to my chiropractor's theory significant amounts of weak, sticky scar tissue was the cause of my pain, inflammation, and lack of healing. This theory seemed to align with theories I had been reading about online so I jumped into the treatment plan head first. After the very first session I felt like I had been given a new set of wrists. My therapist warned that I would soon be very sore, and true to her word the relief, and my elation, soon faltered, but for the first time in six months I had made more meaningful progress. Over the next few months I kept up my daily stretching, icing, and heating routine while receiving twice weekly sessions of A.R.T. and another treatment called Graston, which is another scar tissue removal technique that re-creates minor injuries so that your body can, theoretically, get a second chance at healing. The science behind Graston was minimal, and it didn't seem to have the immediate impact A.R.T. was having, but I was seeing some long-term gains that may or may not have been a placebo effect. When my medical leave came to an end I was able to work a full day at work again (with some pain, admittedly), but lacked the pain threshold and endurance to resume my hobbies or projects outside work.
80 % cured
This is the second time that I plateaued and thankfully it was at about 80% cured, but being just healthy enough to make a living isn't really living. I was stuck around 80% (as well as such things can be quantified) for another six months or so. During that time I tried all sorts of different treatments, including more A.R.T. and Graston, which no longer seemed to be improving my condition. I tried new stretching routines, strength exercises, trigger point injections (which is lidocaine, an anesthetic), back and neck adjustment, posture coaching, radical diet changes, and more. Nothing seemed to have a significant impact on my long term health. I became more and more bitter about having just enough strength to finish a minimal day of work before I had to spend the entire evening babying my wrists to get them ready for another punishing day. It beat unemployment and crippling pain, but it wasn't enough. Exhausted of promising treatment options I decided that I was missing something simple. I needed to focus on the things that worked for me in the past, not seek out even more long-shot, fringe medicine treatments (which were getting progressively more expensive). If I still had residual pain and weakness in my wrists it must have meant there was scar tissue still there. The theory wasn't accepted by modern medicine, but given modern medicine's hopeless track record for helping me I had to embrace it because it was the only model for RSI that had worked for me. I put in for approval another three month medical leave, convinced that I needed more time outside the cycle of daily abuse to fix myself. This was to be my last shot at losing RSI while keeping my job, and I had to make it count. I spent the first month and a half trying home equivalents of Graston, as well new exercises with rubber bands, weights, and rubber therapy bars. I modified my diet to the extreme, cutting out basically everything except fresh, organic fruits and vegetables. It felt like important groundwork for a recovery, but not enough on its own to make a difference in the six weeks I had left to solve this riddle. I read voraciously during this time, hoping to glean clues to a recovery from books, forums, and RSI websites, and while that provided improvements to my existing daily routine it did not provide me with a breakthrough.
The breakthrough came from experimentation when I decided that I was going to try to approximate Active Release Therapy on the parts of my wrists that hurt the most, without the help of a therapist. When A.R.T. was at its most effective for me I could feel gritty scar tissue beneath the skin getting pulled apart in a very distinctive sensation. Even though the grips were awkward, and it would take weeks to perfect the form, I soon felt that very sensation right where my symptoms were the worst and knew at once that I had found the lynchpin to my next stage of recovery. I don't blame my therapist for missing the critical spots that I hammered out over the next month and a half, after all it must be a daunting task to pinpoint a problem area when you are numb to the patient's senses. I learned a lot about how to treat myself during this time and more than once I overdid the treatment, setting my recovery back a few days and causing a flare up of symptoms. Each time my wrists healed enough to allow further treatment I would begin the search for weak, sore spots with all the glee of a treasure hunt. When these spots started to become more and more elusive my frustration grew. I was healed enough to work through most days at work without pain and had just started to resume hobbies and after work programming in small amounts, but as I had promised myself, it wasn't enough. RSI knowledge and recovery had become my obsession and it would remain so until it was just a bad memory.
At this point I had plateaued again at the very unscientific measurement of 90% cured. After work I could now play games for a few hours, or work on programming projects for about an hour before some symptoms arose and required short rest. Looking back this paradox should have been more obvious, given that playing games is much more physically stressful activity than programming. My constant, casual research into RSI revealed a new theoretical diagnosis (as all things RSI seem to be, given the widespread lack of understanding) called TMS, or The Mind-body Syndrome. TMS is a psychosomatic illness that can manifest pain and inflammation in almost any part of the body. The underlying cause of this pain is supposedly repressed emotions in the subconscious, according the pioneer researcher Dr. Sarno. I read Sarno's flagship book on the subject in a single sitting and came away convinced that the remainder of my symptoms had to be mostly, if not entirely, psychosomatic. I've long felt that mental health illnesses were underappreciated in the U.S. and never believed myself immune to such problems. I believe that this background helped me accept that my own brain might have been perpetuating my chronic pain long after the original physical trauma was healed (if there ever was one), sort of like the ghostly sensations of a phantom limb. I can't say that I'm completely on board for every piece of the Sarno theory, but I do believe that my brain and not my wrist is the final piece of the RSI puzzle. Since I started focusing on my mind, and completely stopped all of my physical treatments, I've hovered around 95% cured with continual improvement. I can do almost any activity now without even a hint pain for quite some time. I do seem to have some sensitive holdouts, like using a computer mouse while programming, that more quickly activate my old RSI symptoms. I am emboldened by this rather than frustrated because I take it as a sign that my brain recoils the most from the activities I fear the most. This unconditioning of pain and fear is slow, sometimes grueling work, but the progress is apparent each day, so much so that I would recommend any RSI sufferer focus on the treatment of their mind at least as much as their body.
Now that we've reached the point in time where I am writing this article, it should be clear that there is no magic, simple cure for RSI if you're still looking for one. It's a complicated, insidious disease that is as resilient and it is elusive. The causes could be physical, mental, or both. The only real way to win is to be more resilient than it -- to have enough self-discipline to never stop learning, and never stop fighting. I hope that my own blueprint for success will help you find treatments to get you to the next stage of recovery. Email me with any questions you have and I'll get back to you as soon as possible. If you'd like to receive an email when I figure out something new, or elaborate on the treatments that helped me most, enter your email below. I want this site to become a place of hope when you run out of answers.