Our goal in treatment is to enable you to work free from pain or discomfort. In the most serious RSI cases, a reasonable goal is to achieve a state where you can manage your symptoms. We want to get your body to a point where it is healing more quickly than your work habits are tearing it apart.

In contrast to our approach, you can find several other sources of information that simply recommend eliminating the causes, as in not typing any more. I found particularly amusing the way one book repeatedly referred to "removing the patient from the offending environment," as the best, conservative course of action. That’s easy advice from someone who doesn’t have to follow it himself!

And keep in mind that simply avoiding typing, although it will heal most RSI cases, is not enough to help everyone. For some serious patients, the routine activities of life are enough to sustain symptoms that only full-time typing could initially bring on. So "removing yourself from the offending environment" is certainly a wonderful course of action if you can do it&ldots; we’re simply addressing the vast majority of folks out there who can’t, or don’t want to.

Ultimately, you must manage your RSI recovery yourself. Take an active part in your rehabilitation as you discover what works for you and how your body reacts to different techniques. By the end of the rehabilitation, you should feel confident managing your symptoms as they flare up.

Our treatment recommendations will be rather extensive, so we’d like to synopsize them for you. More details on all of these concepts are presented in the following pages. Believe it or not, we feel that your treatment regimen should include almost all of the following techniques. If you’ve been typing for years and are noticing symptoms, you shouldn’t try to apply just those techniques that seem to apply to the one part of the hand or arm that hurts. That’s our premise&ldots; you must address the whole arm. The one notable exception concerns the first two items, relieving muscle spasms and resolving nerve trigger points. You might have to emphasize only one of these two techniques.

Deep Massage for Muscle Spasms If you have sore, inflexible muscles, you need to break the hidden muscle spasms with intensive, deep massage, preferably by a trained therapist. The muscle spasms will initially pop under the therapist’s touch. As they resolve they will crunch a little, and eventually roll smoothly when pressed. This can take as long as eight weeks to resolve, and more weeks to rebuild healthy tissue. You may find that ice packs relieve the discomfort from the process itself.

Localized Massage to Eliminate Trigger Points Eliminate trigger points that are entrapping nerves with vigorous, localized massage. In normal activity, you won’t even notice these spots, but when pressed, they will feel just like a splinter does—a small but intense irritation. Although a therapist will probably be most effective treating these, you may be able to treat them yourself by pinching the spot, and while holding it, performing the movement that the nearby muscle would ordinarily cause.

Reduce Your Short-Term Workload For the short-term, reduce your workload as much as necessary to facilitate the healing process. Take whatever measures you have to. If you damage your nerves, the healing process will take a lot longer.

Improve Your Seated Posture For the long-term, adjust your workstation, your energy level, and your concentration, to maintain a posture in which your shoulders and head are not collapsing into your chest. The goal is relaxed balance. When your head is balanced over your shoulders, the muscles are less tense. Emphasize diaphragmatic (abdominal) breathing to further reduce the pressure on your chest.

Stretching and Mobilization Have a therapist perform active stretching and mobilization to increase mobility where the nerves are most likely to be pinched or compressed, such as the brachial plexus and the area under the collarbone. Restore flexibility, resilience, and range of motion with self-stretching exercises. Continue stretching exercises for the rest of your keyboarding career.

Strengthening and Endurance Exercises Increase muscle vitality and stamina with strengthening exercises. Especially emphasize muscles that hold your shoulders back, hold your arms up, and extend (open) your fingers. These are all likely to be in a state of constant fatigue.

The book includes dozens of illustrated exercises and stretches:

Perform Exercises Called "Glides" To counteract nerve entrapment, perform motion exercises called glides. In a glide, you move your hand or arm from one position to another, without any force or resistance, to put a nerve or tendon through its maximum range of motion.

Improve Ergonomics Establish workstation ergonomics that enable you to work in the most neutral (least stressful) positions.

Use Large Muscle Movements When Working Adopt keyboarding techniques that emphasize the use of large muscles, such as the shoulders and upper arms instead of small muscles such as those that drive the fingers. In extreme cases, you may have to resort to typing with three fingers, or even one finger on each hand. Use the same principles with the mouse, avoiding finger and wrist movements and pinching actions.

Reduce the Repetitiveness Exploit every possible opportunity to reduce or displace the incessant, repetitive tasks of keyboarding. This includes everything from breaks to voice recognition software.

Reduce Stress and Combat Aging Address lifestyle and work habits to reduce your level of work-obsessed tension, and create a more favorable balance between the destructive and restorative forces acting on your body. Work on improving your sleep patterns. Drink lots of water.

Warm Up Do a serious warm-up routine before each work session. One way is to use a hand cream and rub your hands vigorously until your hands get very warm. Try to warm up several times a day.

Therapy by Degree

In our discussion of diagnosis, we proposed three degrees of RSI, and promised to use this as a basis for categorizing our therapy. Here’s how our treatment breaks down per degree:

As you know by now, we don’t suggest that RSI lends itself to any iron-clad rules about choice of treatment solutions. But we’ve targeted two main points with this chart: first, if your problems are occasional and minor, start strengthening and establishing good ergonomic habits; second, if your pain is constant, get serious help now.