Coping Successfully with RSI
By Maggie Black & Penny Gray - a Sheldon Press book

RSI ( Repetitive Strain Injury) is becoming a more and more common problem among computer users. The critical symptom is debilitating pain, both acute and chronic, which may well also cause stress, fear and anxiety. For the vast majority of sufferers, there has been no reliable method of medical diagnosis or of cure.

This book offers essential, practical advice to anyone who has RSI, who is concerned about it, or who wants to guard against it. It includes a concise account of current medical information, with advice about treatments, including complementary approaches, and practical guidance about coping with the symptoms. There is also advice about how to make work stations safer - whether you have RSI already or are fearful that symptoms may be developing.

Crucially the book provides a method of coping with the pain of RSI, and thus bringing this disabling condition under control.

With a foreword by Dr Charles Pither, St Thomas Hospital London.

'This is an excellent book, which will be of help to many.'
Wendy Lawrence, Chair of the RSI Association

Contents 

• Acknowledgements
• Foreword by Dr Charles Pither
• Authors' note
• What on earth is my computer doing to me?
• There must be some medical solution
• OK then, I'll try the alternatives
• What can I do about my work station?
• Making your computer work for you
• Beginning to get on top of the problem
• Fitness and flexibility
• Pain management techniques: pacing
• Pain management techniques: thoughts and feelings
• Pain management: you can do it!
• Appendix 1: RSI, your employer and the law
• Appendix 2: Useful resources
• Index

Foreword

In 1864 Samuel Sally published an article in the Lancet, based on a lecture he delivered at St Thomas' Hospital on 'Scrivener's Palsy'. In his lecture he described the sad fate of individuals afflicted with this troublesome condition. His account includes a number of case histories with many of the sufferers giving first-hand reports of their difficulties. Readers of this book would find these depressingly familiar.

Patients describe how their problems start with pain in the hand which they initially think must be a sprain, although they cannot recall an injury. They take a break from their writing tasks and - sure enough - the pain settles down. Unfortunately the pain returns on recommencing work, and seems to spread. They do not feel that they are suffering from a serious complaint and are relaxed about the likely cause, not thinking it to be of any great consequence.

When the symptoms persist a little longer they consult a doctor who suggests various diagnoses, including rheumatism. The doctor makes some recommendations but these seem to be of little benefit. The sufferer returns to work only to find that the pain becomes worse and spreads up the arm. The symptoms persist and it becomes increasingly difficult to carry on. Then they start becoming anxious and worried.

• What if the condition does not get better?
• Could it possibly be something serious?
• What treatment do they need?
• Do they need to see another doctor?

Perhaps they take a further break from work and find, once again, that the symptoms settle down. However, on returning to work the intensity of the pain is magnified and extends into the whole arm, and maybe into the neck. Alas, very often they reach the situation where they have to stop work again. However, on this occasion they find, alarmingly, that the pain does not go when they cease work. They return to their doctor, who is becoming increasingly exasperated. The doctor's simple suggestions and treatments have failed, so they come up with stranger explanations as to the cause of the pain, and offer more outrageous remedies. All too often the unhappy scenario ends in the individual losing their job and being unable to work, now with a seemingly permanent disability.

To those familiar with the modem-day affliction best known as RSI, the question could well be asked: So what has changed in the last 135 years? Medical science, with its glittering array of technological and pharmacological treatments and cures, appears to have made little progress with the problem of upper limb pain.

If anything, the situation is worse. Sedentary lifestyles and occupations have increased the number of sufferers, and the condition is now closely associated with use of the computer, a piece of equipment found in every office and many people's homes. This has led to media interest and public curiosity over this mysterious condition. All the stakeholders, upon whom the consequences of upper limb pain impinge, have an opinion about its aetiology, treatment, and the reality of the pain experience.

The traditional medical scientific view is that nothing abnormal can be detected, and therefore the condition is not based in tissue pathology. The legal system opines that the illness is related to seeking compensation or medical retirement. Employers think that it is about failure to cope and work-shyness. Psychiatrists, often called in to give a view of the individual's mental status, usually find no evidence of mental illness but have little constructive information to offer. As a result of the diversity of opinions, sensible advice and effective treatment are elusive. The sufferer is either left on their own, or reduced to seeking out support and advice from other sufferers, which can be emotionally charged. The view that all is hopeless and nothing can be done remains prominent and unchallenged. Is this really the case?

No! All is not quite as it seems. Looking a little further, seeing between the entrenched attitudes and the dogma, there is a group of sufferers who have got better from RSI. They have had effective treatment, developed strategies both physical and psychological to cope with their problems, and returned to fulfilling and enjoyable lives. They have often returned to work in a remunerative and fulfilling occupation.

How have they done it?
They have done it for themselves. Instead of seeing themselves as hapless victims of a devastating disease process, they have come to terms with the various factors that led to their difficulties, adopted a positive approach, and using a number of different techniques have learnt to take control of their symptoms and manage their pain. Inevitably, this is a more difficult option than the magic cure. The problem is that the magic cure is no more available in 1999 than it was for Samuel Solly all those years ago.

The reason is that there is no single lesion to account for the disparate and complex difficulties experienced with this condition. RSI, like a number of other poorly understood medical conditions, is truly a 'whole person' problem. To understand it even partially, one needs to understand links between mind, body and environment that we know to be relevant in other settings, but often choose to ignore when it comes to our own illness.

Treatment in the form of pain management can be effective for the person who wants to make it work. All too often, this approach is delayed by years of fruitless searching and ineffective therapy. How different things could be if this integrated, 'whole person' approach was utilized at the outset, rather than as the last resort when all else has failed.

In this book, Maggie Black and Penny Gray document the experiences of upper limb pain sufferers based on first-hand evidence. They then set out a rational series of steps involving a number of techniques, which if pursued assiduously will undoubtedly result in improvements in function and well-being. This approach to pain management, and the techniques they describe, are in many cases based upon the techniques we have been imparting here at INPUT to RSI and other chronic pain sufferers in our residential pain management courses.

This approach and the techniques it deploys may seem like a tough option. But the unpalatable reality is that they are the only option. The most difficult step is the first: deciding that this is what I must do in order to get better. Those who wait for the miraculous saviour to deliver them back to perfect health are, unfortunately, destined to wait an awfully long time.

Charles Pither
Medical Director
INPUT Pain Management Programme
St Thomas' Hospital, London

About the authors
Maggie Black is a writer and journalist, specializing in international social issues. She has written on many health-related topics, including HIV/AIDS, maternal and child health, and water and environmental sanitation. Her books include Children First: the story of UNICEF (OUP,1996). She has survived computer-induced RSI since 1992, and attended the pain management inpatient clinic, INPUT, at St Thomas' Hospital. In this book she draws on these experiences, advocating the kind of approaches she has found successful.