treating RSI

First of all, I do not advise that you treat RSI as a physical disorder. I believe that all RSI is TMS, and should be treated accordingly.

That being said, you may not agree with me, and I do think that there are better and worse treatments for RSI, if you insist on going that route.

Do not have surgery.

Surgery for RSI has no proven track record. See for example this page #23-25: it has a 57% failure rate. Many people go through it and either experience no benefit or later relapse, and it causes permanent tissue change. In the case of surgery for "carpal tunnel syndrome", a severed carpal ligament (flexor retinaculum) can also lead to reduced grip strength. If you have any other kind of RSI besides CTS, this surgery will certainly not help, and if you are offered it, walk out of that office and don't go back. Other surgeries are generally equally abysmal.

Do not get cortisone shots.

These cause temporary pain relief and may cause permanent tissue damage, and have unpredictable effects.

Educate yourself and adjust your environment.

Read It's Not Carpal Tunnel Syndrome by Suparna Damany and Jack Bellis, and Repetitive Strain Injury by Deborah Quilter and Emil Pascarelli. Do research about RSI.

Follow the instructions given by those books for improved ergonomics and an environment that's easy on you. Get voice dictation software: the current state of the art is Dragon NaturallySpeaking, distributed by Nuance. If you're in severe pain, you should have the Preferred version, which will allow you to do most of the things you need, and can be used in conjunction with NatPython/Vocola to create custom commands that approximate the functionality of the Professional version. Regarding equipment, that's a personal decision, but I love and contiue to use my Kinesis Advantage MPC/USB. Kinesis makes a good product and supports it well, even if they do keep it a bit pricey.

Get physical therapy, massage, or trigger-point therapy.

Of these options, I strongly advise trigger-point therapy. You can administer it to yourself, and it helps many people who suffer RSI symptoms in a substantial way. Trigger points are hard knots in the muscles that allegedly form and cause pain due to either sudden or chronic trauma. (I say allegedly because I still have all the trigger points I always have, but they don't hurt anymore. Nevertheless I do believe that they exist and function in exactly the way described, whether their origin is psychological or physical.) They usually hurt when pressed firmly. They can cause pain nearby or at locations far away. The non-local pain is called "referred pain" and is the key piece of the puzzle. Sometimes, pressing on the trigger point will duplicate or intensify the pain. For example, I experienced referred pain from my neck that was exacerbating many of my arm symptoms, and explained why the pain occurred where it did. The best trigger point book on the market is Clair Davies' The Trigger Point Therapy Workbook. No other book on the subject is needed at least until you have plumbed the depths of that book. Even then, most of them are far inferior.

I started trigger point self-treatment in June 2005, and by November 2005, I was doing about ten times better. I self-treated from June to September, and received professional trigger point therapy from September 2005 to April 2006 (with breaks during the time of my move to the Bay Area). During that time I continued approximately daily self-treatment. I can highly recommend all the practitioners I worked with:

They are all highly trained and genuinely great people. It is to their credit that they were able to help me as much as they did, given that I now understand my problem was in another realm.

By November, when I moved, I could function almost normally in an adapted daily life. I still didn't type much, carry things, or generally do a lot of hand-intensive activity, but I figured I could probably survive in a job. My experience at Borders, starting in February, proceeded to prove me wrong. Lifting milk cartons and blenders and running a cash register were hard on me, and though I'd been hired as full-time, I went down to three days a week. I went back to intensive trigger-point therapy, rather than occasional. I was still looking for a "real" job, but now I really wasn't sure I could hack it.

When I was hired at my current job, I asked for, and got, all the stuff I figured I would need to manage. But by the fourth day, both my hands and voice were worn out. My trigger points kept coming back, no matter what I did to keep them away. That's the story I've heard from many other RSI sufferers. That's when I turned to The Mindbody Prescription, got serious about treating my RSI as TMS, and two months later was pain-free. The $600 I paid Dr. Mehaffy is the last $600 I intend to ever spend on ultimately pointless treatment for my RSI symptoms.

If professional TrP therapy is not available to you, self-treatment can be supplemented with PT or massage. Try to talk to your therapist about TrP therapy and get them to work with you in the problem areas you identify. Try to find a therapist who is knowledgeable about RSI and chronic injuries, but more importantly find one who listens to you and works well with you. If trigger point therapy does not seem to work for you, then you might consider the stretching regime outlined in Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries. I found this also pleasant and helpful when I was in pain.

Acupuncture and Chiropractic

I deeply respect both acupuncturists (whether L.Ac. or D.O.M.) and chiropractors, but I don't think that in general they are the best practitioners for RSI. But that may differ, especially if the person has expertise in massage or trigger point therapy (Dr. Mehaffy, mentioned above, is a DC and trigger-point expert). If you are working with a competent and responsible practitioner, they will not hurt you and may help you. My only advice on this score is to make sure that the practitioner is competent and responsible.

Splints and Painkillers

This is treatment #1 for a lot of people. It does nothing but encourage your arm muscles to depend on the splint, and mask the symptoms. It's not bad for you in the short term, but it won't cure you. Look for something else that will. In the long term you may have painkiller side-effects or more pain due to actual muscle weakness, so it's to be avoided.

Feldenkrais & Alexander Technique

These can help anybody; they're good for improving your use of your body, and improving tension levels. Go for it if you think they'll help you. The lessons are enjoyable.

Working Out: Cardio and Weights, Yoga and Pilates

Cardio exercise is excellent for overall health and can temporarily reduce symptoms (if it does, this is a sign you may have TMS). Don't do something that hurts. Light weightlifting, yoga, Pilates, and pretty much anything else should only be undertaken with approval of your treating professional, unless you are going to go the TMS route and really believe you have no physical problem.

Finally, take good care of yourself. If you smoke, stop smoking. Eat well, sleep well, and exercise. You'll feel better all around. Oh, and buy a copy of The Mindbody Prescription.