Frequently-Asked Questions

How do I contact Suparna?

Suparna's Office:

Address		1040, South Cedar Crest Blvd, Allentown, PA 18103 USA
Phone		610-821-9135
Public Transportation		There is a bus service (hourly for most of the day) from Phila to Allentown, which tkes about 90 minutes.

I have constant numbness and no one to help

A sufferer writes from halfway around the world (that's as far as you can go, right?) of constant finger numbness, and suspects computer use. There's doubt about finding a helpful doctor or therapist. What to do???

I answered the questions and then realized I wasn't offering anything new. Everything we know about RSI is in our book except a few items I'll list in a moment. Despite our book being 4 years old (probably 6 since it took two years to write), almost no new scientific information has arisen to render it obsolete. We'd be the first to applaud such progress. We're not getting wealthy from book sales, far from it, it's really a labor of love that barely pays for itself. We've sold 8,000 and need to print more. I'm not sure it's worth it.

So read our book. Can't afford a new copy? They're available used from plenty of websites. Can't afford a used copy? For years now we've offered to loan one from our Lending Library (and curiously the offer's only been taken once.).

As for finding help for serious nerve damage, I told the writer to try one doctor after another until finding one that takes a sense of ownership about determining the precise point at which the nerves are pinched or abraded, or some other systemic cause exists. I suspect the neck, chest (thoracic outlet), or armpit (brachial plexus) because both the median and ulnar nerves are showing symptoms.

Here's what precious little we've learned since writing the book:

Breaks are nice, but the big lesson for hard-core users who won't change their evil ways (and I'm one): learn how to keep moving, fidget. Work in motion.
For do-it-yourself massage, if your problem is adhesion and poor blood flow, etc., consider Armaid.com. But don't do any self-treatment without a doctor's advice and a good understanding of what your problem is. If you're a compulsive person, you're likely to overdo it with any self-massage device.
Variations in individual's anatomy at the chest (thoracic outlet) impress me as one of the biggest possible reasons why some people suffer and others don't. The nerves and blood vessels go through the muscles in different (called 'anamolous') paths, some of which could make people less suited to hunching over a keyboard all day. But there's no data and unlikely to be any until extensive cadaver research is done. Diagrams of the variations are in "Rehabilitation of the Hand: Surgery and Therapy," James Hunter, M.D., et al, (Mosby) Part 9, Chapter 49, page 866.
Although in our book we recommend against armrests, I've changed my thinking, and for years have used one from MorencyRest.com.
Very Important: New imaging technology can show objective evidence of blood vessel problems.
I couldn't find good info on biofeedback prior to print time but I recently learned of a Kathy Bender in SanFrancisco who uses dynamic EMG muscle feedback and temperature feedback to help computer users find their ideal workstation configuration. They have an occupational therapist first do a history and ergonomic review. They evaluate what they call the "functional path" and work on diaphragmatic breathing. The cost is approximately 10 sessions @$92= $920, generally prescribed by a chiropractor or doctor. Sufferers should use web to find a biofeedback person certified by National Biofeedback Association. Specifically ask if they do their biofeedback in a dynamic setting, and do temperature biofeedback.
One of the most difficult aspects of RSI is the psychological component. The parasympathetic nervous system could have a big role in the less mechanical side of diagnosing RSI.

Not much of a list for 4 years, huh?

How do I find an RSI Therapist?

This is the most common question we get. Without a doubt, the hardest part of solving difficult RSI problems is finding a knowledgeable pro. We recommend these avenues to check:

Support Groups: Get word-of-mouth referrals from some folks in a support group. You can find the groups at www.tifaq.com 's page, http://www.tifaq.com/information/supportgroups.html
Check Findadoc:
http://eeshop.unl.edu/findadoc.html It's a list maintained on a popular RSI website. I've been told it's hit-or-miss but that's to be expected. Still great starting point.
Join Sorehand http://www.ucsf.edu/sorehand/ if you're not already a
subscriber). Then you can:

Post a request on Sorehand for someone to tell you the login name and password to the archives at http://www.sorehand.org. This enables you to search the archives by entering a text search for your area's name. If the archives don't help...
Post a request on Sorehand for recommendations in your area.
Inquire on Sorehand about searching the archives. A third-party site provides a simple, powerful search but the password is by invitation-only, to those who've joined the list... so as not to compromise the confidentiality of those whose comments are in the archives. Then you can search for words naming your locale, such as "Wyoming."

I'd also look for Bonnie Prudden myotherapists
http://www.bonnieprudden.com/. They're a little marketing oriented but are
probably closest to addressing our theory of RSI.
Check your library for "The Alternative Medicine Yellow Pages."
(Amazon: http://www.amazon.com/exec/obidos/ASIN/0963633422/002-0119295-834322
It's old but anyone listed who's still in practice must be pretty good.

The key to finding a practitioner is that it has almost no connection to the practitioner's "school" or philosophy... some folks understand the muscles, spasms, chronic tension, nerves, adhesions, and pinch points, and others do not. It might be an MD, chiropractor, physical therapist, occupational therapist, surgeon, whatever. Put another way, "it's hands, not words" that will cure you."

Is Thoracic Outlet Syndrome a Cause, an Effect, or a Hoax

Is TOS a cause or an effect? After having not-very-successful surgery, a sufferer inquires about Thoracic Outlet Syndrome... is TOS a result of overuse or a physical condtion that causes strain symptoms? Is it a meaningful diagnosis for repetitive strain sufferers? Is is some sort of ploy by insurance companies to avoid helping patients? Isn't TOS actually very rare? Our answer...

What do you recommend for trigger finger?

(Suparna) I do believe that conservative therapy helps trigger finger, in fact, I have treated several trigger fingers with good results. Have you had a cortisone shot to the area? That sometimes helps to reduce the inflammation, and may assist the therapy. I treat trigger fingers with manual therapy, modalities (ultrasound, iontophoresis, etc.), manual exercises, and tendon gliding. In my experience, treatment has to be quite aggressive to be effective.

Do Touchpads Help?

As I've had to be reminded myself, there are no perfect devices, only "perfect" usage, which means ---to me at least---staying in motion and knowing your limits. I'm trying out a vertical mouse and really like it, but quickly found that it accentuated a new pinch point. Like a new pair of shoes it move the resting place that one uses on the heel of the hand, rotating it slightly. This virgin skin was uncomfortable being the contact point for the first time in 47 years. And I do graphics work for hours straight some time. But I'm still using the vm and really think the new pinch point might be a better one than the old one which could have been right over the ulnar nerve at Guyon's canal.

Anyway, pads in general are a big help for many sufferers because they eliminate the pinching grasp and therefore the incessant tendon abuse and forearm tension. Both of these presumably shut down oxygen flow. But as a graphics person, pads aren't precise enough for the work I do.

What is the most important ergonomic device?

The trick answer of course is that your body is an ergonomic device, which is the topic above, so let's say "purchased" device. Considering the body to be a chain with some vulnerable links, it would make sense that the link that needs attention would matter most. For folks who just over-grip a mouse, a touchpad or trackball seems most important. If maniacal overuse simply shifts the wear-and-tear to another link in the chain then purchased equipment is not the full answer.

If you in particular are only vulnerable at the elbow as I was, it could still take several corrections, chair height, arm rests, split (wider) keyboard, massage, motion, vertical (up-rotated) mouse. The analogy that is offered most often on Sorehand, perhaps by Penny Kome or Sharon Butler is that your body has a health bank account; one mustn't withdraw faster than you replenish.

Where can I find the Elbow Pads for Nighttime Use mentioned in your book on page 49?

It's called a Rolyan Elbow/Heel Protector with Shock-Absorbing (Acton) Gel Padding.
The manufacturer is believed to be Smith & Nephew.
The original site I found it on seems to have gone out of business.
Searching the web on "rolyan elbow pad" starts finding some hits, but not great.
On the following site, the part number is "A730-002". Often, this could be just that site's item number, but notice it's a .smith-nephew domain!
http://rehab.smith-nephew.com/Australiarehab/rehabProducts/consumer/SoftBracingSupport/RolyElbowHeelProtector.htm
Sure enough, searching the web on "A730-002" (the 002 indicates medium size) turns up lots of vendors from whom you should be able to buy it. Here's one in Georgia, USA:
http://www.rehabmart.com/skintears.asp
My advice is to only buy stuff from an online vendor if they show a brick-and-mortar address and only after talking to them on the phone, as a test that you'd actually be able to resolve a problem.

What's the more common complaint 1) pain 2) cramping or spasm, or 3) functional complaints--can't do an important set of activities?

Well, if you want genuine statistical facts, only a scientifically controlled survey will suffice, right? The first thing to keep in mind is that RSI is many things and has almost as many attitudes as sufferers.

But I'd like to answer for myself and the many people I know who suffer from RSI as a result of intensive computer use. The answer is emphatically #3, not being able to do our jobs, not being able to sleep, and not being able to perform some of the other activities of daily life (ADLs). I don't want to diminish the suffering that many experience from unremitting pain, but most of the people that I encounter are accustomed to many forms of pain and would gladly accept a known amount of pain in exchange for a promise that their livelihood would be unaffected. That is the real pain of RSI for most computer workers... workers who are generally self-motivated, obsessive about work and doing a good job, and often unable to tear themselves away from the keyboard. On the flip side there are also many people who are compelled to work at the keyboard by a harsh work environment or simply having no alternative to pay the rent or put food in their families' mouths. Even among this group I suspect you'll find the same personality profile: driven people, working their fingers to the bone.

Certainly, there are RSI sufferers with excruciating pain, some with extreme conditions (perhaps reflex sympathetic dystrophy). But statistically, most are have erratic, on-and-off pain that occurs when working. Aside from fear for our livelihoods and the many forms of pain, there is the misery of lost sleep, guilt, scary numbness, erratic motor control, and peculiar shock sensations... and yes, cramping and spasms. But relative to the concern that you could be unable to support yourself, these are all just ADLs: annoyances of daily living.

What are the "best of breed" office equipment choices?

A recent Sorehander asked a quite sensible question that essentially boils down to "What are the best of breed office equipment choices with respect to RSI?" The question goes right to the core of how difficult the RSI problem is, because no single answer seems right for all RSI sufferers. And for the most part, those who don't yet suffer from serious RSI generally don't care. (And who can blame them?)

Based on my experience, and with the disclaimer that I'm not an ergonomist or a licensed medical practitioner, let me offer my answser. If you've got a health problem, see your doctor. While there certainly are some lousy products and some favorites of many RSI sufferers and opinion makers, there are two problems answering the question: 1) Even as regards the favorite products, there's not enough agreement on the best products to establish a consensus. RSI sufferers, even if the spend all the money in the world on the popular equipment, will have questionable benefit from the changes. In other words there's much doubt over whether the relative contribution of the equipment itself, as opposed to the habits with which it is used. Which brings us to the second factor... 2) Someone who has no RSI symptoms at all can wreak absolute havoc on their body using only the most widely favored equipment.

Our advice then is this: get the most adjustable equipment you can, get good advice on using it with low strain/pressure/tension, and don't work like a zombie. Maybe we Sorehanders can help you and ourselves best by answering the question "What is the most adjustable product in each class?" For mice (pointing devices) this would probably mean using a different style every "fatigue period."

By 'fatigue period,' I simply the amount of time it takes you to get tired or otherwise start overwhelming your body's ability to fend off damage. The collective but best-guess Sorehand wisdom is that after some period of time any number of things might be happening whether you feel it or not. The body can't sufficiently flush away the waste products of metabolism, tissues are starved of oxygen, tendons are insufficiently lubricated, nerves and blood vessels are not just pinched but kinked, and residue accumulates on moving parts (becoming adhesions).

Many Sorehanders refer to various "body awareness" disciplines such as Feldenkrais, Alexander Technique, yoga, Tai Chi, and so on. These are all great techniques for recognizing your "fatigue period. " In other words, getting your intellect to recognize when you are approaching that threshold even if your senses of feeling, pain, and touch won't.

Send me your votes for the most adjustable computer equipment at jackbellis@hotmail.com.