|Welcome to Harvard RSI Action
is a GSAS student group open to all Harvard students (graduate, undergraduate, professional
schools) providing preventative education, advocacy and support for students with RSI (and
those hoping to avoid it).
Disclaimer: This web page is written and maintained by students. We are not doctors, and do not have any medical training. While every attempt is made to keep this page up-to-date with the best medical advice we have received, it is not a substitute for obtaining professional medical advice, diagnosis, or treatment. While it is sometimes difficult to find doctors with knowledge and experience with RSI, this should never prevent you from seeing a doctor. Finding a doctor with the proper experience is well worth the effort.
|About Harvard RSI Action
is a GSAS student group open to all Harvard students (graduate, undergraduate, professional
schools) providing preventative education, advocacy and support for students with RSI (and
those hoping to avoid it).
Harvard staff should see the section on staff. Our purpose is three-fold:
Harvard clerical and technical staff with problems are encouraged to contact the union (HUCTW), at 617-661-8289. The contacts are Donene Williams and Gloria Buffonge. They are willing to talk to non-HUCTW staff members as well, but are unable to work with those staff members in their worksite.
We don't currently have much useful staff specific information. We should note that workers' compensation rules differ significantly from state to state, and so we cannot provide general information about workers' compensation. Also, note that in general, the offices at a company which deal with disabilities work for the company, not for disabled staff members, and are not required to provide information on workers' compensation. It is probably in your best interest to seek information about workers' compensation from a neutral source. It may not be in the company's interest for you to correctly file your claim, and it may be in their interest to emphasize non work-related activities that could have contributed to your injuries.
|Contact Harvard RSI Action
If you have questions about RSI, feel free to contact members of our group. If typing hurts you and you write instead of calling us, we will yell at you.
Please note that we have NO additional written material we can send you, other than what is already reproduced on this page.
|Spreading the word and starting support groups
This page was originally designed for Harvard students, but around
90% of the hits come from outside Harvard. Our group has been fairly
effective at spreading the word about RSI here at Harvard, although
more so in some parts than others. In this section is propaganda
material we've developed which we encourage you to use (for
non-commercial purposes) to spread the word in your own area. Also
included are suggestions for starting a support group.
IF YOUR HANDS HURT
OR TINGLE OR GO NUMB
OR YOU DROP THINGS
SEE A DOCTOR
STRETCH AND TAKE REST BREAKS
CALL HARVARD RSI ACTION ###-####
Here is a set of RSI prevention tips we have developed for publication. We have found that it's hard to stop people from hurting themselves or to pay serious attention to RSI until they have symptoms. Therefore, our goal has been to remind people often about RSI. Hopefully, soon after they get symptoms, they will see a reminder, and will take action. Putting tips like these into a school newspaper, bulletin, or message of the day on a computer system is a good way to remind people about RSI. The tips consist of one longish overview paragraph, followed by small tips meant to stand on their own.
Repetitive Strain Injuries (RSIs) such as tendonitis, carpal tunnel syndrome, and others, are an increasing problem. These injuries are potentially very painful and disabling. They are typically caused by too much typing, writing, or mousing with poor ergonomics and not enough breaks.
The symptoms of RSI include pain, soreness, numbness or tingling in the hands, wrists or forearms, or clumsiness. If you have any of these symptoms, you should take them seriously. See a doctor. The Harvard RSI Action web page, http://www.rsi.deas.harvard.edu, contains information about prevention and treatment of RSIs, and pointers to other resources.
There are many easy things you can do to prevent RSIs. These include taking breaks: 1 or 2 minutes for every 10 or 15 minutes of typing. Type properly: use one hand to hit control or shift and the other to hit a letter key, rather than using one hand in a contorted position to hit both. Don't rest your wrists on a wrist rest, arm rest or desk while typing; put your wrists in your lap or get up during breaks. Set up your computer properly, including getting your keyboard to the right height: your elbows should be at about a 90 degree angle, or a little more open. The web page has more typing ideas, illustrations for stretches to do during your breaks, diagrams on how to set up your computer, and more; check it out. Repetitive Strain Injuries (RSIs) are a continuing problem. Check out http://www.rsi.deas.harvard.edu for prevention tips.Repetitive Strain Injury (RSI) prevention tip: take 1 or 2 minute typing breaks every 10 or 15 minutes. Stretch and get up from your chair occasionally. Check out http://www.rsi.deas.harvard.edu for more prevention tips. Repetitive Strain Injury (RSI) prevention tip: make sure your computer is set up right: your keyboard should be low enough that your elbows are at about a 90 degree angle, or a little more open. Check out http://www.rsi.deas.harvard.edu for more prevention tips. Repetitive Strain Injury (RSI) prevention tip: don't rest on a wrist rest, arm rests or the table while typing. Your hands and arms should move freely while you type, so that your arms do the main work, and you don't have to bend your wrists in awkward positions. Check out http://www.rsi.deas.harvard.edu for more prevention tips. Repetitive Strain Injury (RSI) prevention tip: if your hands, forearms, or wrists are painful, sore, numb, or tingling, you have thesymptoms of RSI. See your doctor. Check out http://www.rsi.deas.harvard.edu for more information. Repetitive Strain Injury (RSI) prevention tip: keep your hands and forearms warm while typing. Warm up your room, wear a sweater. Check out http://www.rsi.deas.harvard.edu for more prevention tips. Repetitive Strain Injury (RSI) prevention tip: don't pound your keys when you type. Don't keep your pinky or thumb up high while typing. Keep your wrists mostly straight, and move your arms rather than bending your wrists. Check out http://www.rsi.deas.harvard.edu for more prevention tips. Repetitive Strain Injury (RSI) prevention tip: keep your hands and forearms warm while typing. Warm up your room, wear a sweater. Check out http://www.rsi.deas.harvard.edu for more prevention tips. Repetitive Strain Injury (RSI) prevention tip: don't pound your keys when you type. Don't keep your pinky or thumb up high while typing. Keep your wrists mostly straight, and move your arms rather than bending your wrists. Check out http://www.rsi.deas.harvard.edu for more prevention tips.
What is RSI
How bad is RSI
How do you get RSI
How do I prevent RSI
Type properly: don't rest your wrists while typing, but keep them floating above the keyboard. Don't rest your hand on a wrist rest: use it as a reminder to keep your hands up. Don't contort your hands to type key combinations like control, shift, or alt: instead, use the index finger of the opposite hand to type combinations. Don't rest your arms on arm rests while typing.
Set up your workstation properly (see the web page for an illustration). Your arms should be at a 90 degree angle, or slightly more open. Your monitor should be at about eye level.
Stretch and exercise your hands, wrists, arms and upper back. Good stretches include the prayer stretch (illustrated on the web page) and shaking your arms gently. But if you have any signs of RSI, don't exercise: this could make it worse. Go see a doctor.
What if I start to get RSI
If your symptoms are more serious or persist, go back to your doctor. They may tell you to stop typing or writing. Listen to them, even though you probably have something important due (if you didn't, you probably wouldn't be working hard enough to get problems). If you don't listen, you could seriously and permanently injure yourself. Ask your teachers for extensions, or your supervisors for accommodations. Bring a note from your doctor.
Harvard RSI Action
So far, the most effective means we have found for spreading the word about RSI is a mousepad placed in the public computer rooms. This mousepad contains information about what RSI is and basic prevention tips, as well as where to go for more information. The mousepads cost about $4 each to produce. (The mousepads are Harvard specific, so those outside Harvard probably wouldn't want to purchase them. Those inside Harvard can talk to Lenny Solomon, email@example.com, for more information about samples or ordering. The mouse pad increased hits on our web site from within Harvard from about one per day to about 2 per day: they are the single most effective means we have had for getting information out. Theft has not been a problem, especially since people can just go to the website for more information (and it's hard to get people to care enought to read them, never mind steal them...)http://www.engr.unl.edu/eeshop/supprsi.html a list maintained by Paul Marxhausen and ARMS -- The Association for Repetitive Motion Syndromes.
(ARMS) P.O. Box 514
Santa Rosa, CA
95402-0514 707/571-0397 (please call between 10 a.m.-5 p.m. only, Pacific Standard Time)
If there is not already a support group in your area, it's easy to start one. The way our group was founded was with help from the physical therapy department at Harvard University Health Services. Since most people with serious cases of RSI get physical therapy, by putting a poster in physical therapy and by notifying the physical therapist (who then told patients about us), we were able to find most of our original members. Other useful places include disability services, human resources, mental health services (since many RSI sufferers become depressed) and relevant doctors. You will need to pick a contact person to maintain a list of people in the group. Our online mailing list has been incredibly useful for organizing meetings.
Sending out propaganda, like that in the previous subsection, to your local newspaper (especially if you are starting a group in a corporate or educational institution, where there is some regular newsletter) will also help: you will spread prevention information while gainingmembers.
You should also contact the nearest support group if it is anywhere close to you. They may have members who have been commuting from your area. Just getting a few people from your area who can form the core of a support group is helpful. Then, you can work together to grow (Some Harvard RSI Action members were also members of a Boston area group)
|What is RSI?
RSI stands for Repetitive Strain Injury. It includes a whole spectrum of conditions, from tendonitis of the hand or wrist to carpal tunnel syndrome to cubital tunnel syndrome. Basically, if your hands or wrists hurt or go numb or tingle, that may be RSI. If these symptoms are associated with repetitive tasks, such as typing at a computer, it is almost certainly RSI. (Note that such symptoms do sometimes go away within a few minutes, hours, days, or weeks.) Other symptoms include losing strength or coordination in your hands, or perhaps dropping things.
Not everyone experiences all symptoms, and sometimes your symptoms may not occur until several hours or even days after the activity which causes them. (Have you ever hiked a long way and not been really sore until the next day or even two days later?) Some people, especially at UHS, call RSIs Cumulative Trauma Disorders (CTDs); it's the same thing.
We cannot overemphasize the importance of prevention. A few simple changes in your office setup and work habits could save you months or years of pain and disability. Once you have an RSI, the healing process is usually long and frustrating. Don't make the same mistakes we did. Take the advice below seriously.
Twisting your hands puts strain on them. Resting on a wrist rest, the table, or arm rests while typing forces you to twist your hand to reach some keys. Instead, it is better to keep your hands moving freely above the keyboard, letting the strong muscles of your arms move your hands.
It is also a bad idea to contort your hands in other ways. For instance, some people lift their pinky or thumb while typing. Your hand should be flat, and parallel to the keyboard, without twisting. There should not be any pressure on your wrists or forearms while you type. You should NOT rest your wrists on a wrist rest except while taking a very short break from typing. A wrist rest of the proper height (level with the space bar) can also serve as a reminder to keep your wrists straight. If you feel your wrist touching the rest, you know that your wrists are starting to dip.
Take frequent breaks
The prayer stretch is a good stretch for several kinds of RSI, but it is particularly helpful if you are trying to avoid getting RSI. If you already have the symptoms of RSI, our advice is to get the advice of a physical therapist regarding what sorts of exercises you should do. In fact, some people think that the prayer stretch can actually be harmful if you already have certain kinds of RSI.
The prayer stretch has many positions. The main position is as if you were praying, hands together. Gently push to one side, hold for 15-30 seconds, and then gently to the other side for 15-30 seconds. As with all stretches, if you go too hard or too long, this could cause soreness or burning sensations -- go only until you feel a gentle stretch. Keep fingers straight, and fingertips together.
There are several other positions, including hands rotated 180 degrees, pointing downward, or rotated 90 degrees, pointed inward. A final variation is hands pointed downwards, with backs together instead of palms.
Practice good ergonomics
|Minor RSI Problems
If you have very occasional symptoms, once a week or less, you should still worry. You may be slowly building up damage to your tissues, and the problems may get much worse over time. See a doctor. Try to fix your ergonomics or work habits, so that you never have problems. "Repetitive Strain Injuries, a Computer User's Guide", by Dr. Emil Pascarelli and Deborah Quilter, recommend finding out how long you can type with absolutely no symptoms, subtracting 10 minutes from this, and never typing longer than that without a break.
In addition to following the suggestions for Preventing RSI above, the most important advice we can give you at this stage, is not to overdo it. Listen to your body. RSI is not something which will go away if you ignore it or try to work through it. If you don't correct what is causing the problem, you can cause permanent nerve damage. Don't fall into the trap of saying "I just need to finish this assignment". Too many of us have tried that, only to reach the point where we physically cannot continue.
If your symptoms are more severe than this, perhaps read the more severe RSI problems section.
Most of us, when we first had minor symptoms, didn't stop. We really wish we had, now that we have long term problems. The longer it takes you to stop typing (or writing or whatever causes you problems) the more severe your problems become, and the longer recovery takes. Probably, when you first start having problems, it's because there's some deadline. Here is a list of the top reasons why people keep typing and don't go to the doctor, even though they know they shouldn't:
|Severe RSI Problems
If your problems persist, you should see a doctor. The advice below may be helpful, but is not a substitute for professional medical advice. While it is geared towards students going to University Health Services, it also contains information of more general interest.
One extremely important piece of advice is to FIGURE OUT WHAT KIND OF RSI YOU HAVE! There are several different kinds, including tendinitis, carpal tunnel syndrome, tennis elbow, and so forth. These require DIFFERENT treatments. It is therefore essential to get a knowledgable doctor's diagnosis; otherwise, you will be in the dark about how to treat your problem.
(Chances are that if you have problems at this severity level, you will want to read the section on tips.)
You probably want to know how long it will take to recover from your problems. The answer depends on a lot of things, but probably won't make you happy no matter what. Typically, it takes a long time to recover from RSI, from perhaps 2 weeks if you are very lucky, stop quickly, and make all the necessary ergonomic changes. On the other hand, it is often much much longer, a year or more. Even then, this will depend on how well you do what your doctor tells you to do, how quickly you stopped, how good your doctor is, how often you cheat (a few bad hours or less can set you back weeks or more). Be prepared for the long haul. Have patience.
You may get pretty depressed at some point. Not being able to eat without pain can do that to a person. Most of us have suffered through this, and almost all have eventually gotten better. But it is still really depressing. Feel free to give us a call.
This section contains some tips about every day living.
While some specific products are mentioned in this section, it is not intended as a comprehensive guide to ergonomic products. We are sorry, but we are unable to evaluate or mention most of the products about which people email us. The Typing Injury FAQ provides a much more complete list.
Here are tips for long term sufferers. Some of these tips are also appropriate for those with shorter term injuries. These tips are not meant to be comprehensive. Also, check out the book "Repetitive Strain Injuries, a Computer User's Guide" by Pascarelli and Quilter. These tips are aimed partially at the Harvard student population, and meant to supplement other sources of tips. And don't forget to come to Harvard RSI Action meetings, where we exchange useful ideas!
Pascarelli and Quilter is usually available at Wordsworth 354-5201. You can call first to see if they have any in stock. If they do, it might be in either the health section or the computers section, so check both.
RSI at Harvard
The handbook for teaching fellows is pretty vague on what accomodations need to be made for students; it is generally up to you, your T.F., and the professor. However, if you shouldn't type or write (ideally, as written in a note from UHS), don't type or write, even for exams. Students with other kinds of disabilities, such as blindness or deafness, are given reasonable accomodations for their needs, such as sign language interpreters, or someone to read for them. Ask for reasonable accomodation, which could include someone to take dictation for you in an exam, perhaps a T.F. For taking notes in class, ask the T.F. if you can have their notes, or ask another student in the class. If you can get a note from a doctor saying that reading is hard (flipping pages hurts), you can get books on tape, including text books.
UHS/Health Care Providers
This section assumes that your doctor is at Harvard University Health Services. If you go to a different doctor, this will apply to varying degrees. If you wish to find a doctor outside of UHS, there are two excellent resources. On the web, check out FindADoc at http://www.engr.unl.edu/ee/eeshop/findadoc.html. In Massachusetts, call CNOT, who maintain a referall guide.
For general medical advice on RSI, see the book "Repetitive Strain Injuries, a Computer User's Guide" by Pascarelli and Quilter, which is more accurate and more comprehensive than this section. In general, trust your doctor far beyond any advice you get on the web, including this page.
When you first go to UHS , you will see your primary care physician. UHS primary care physicians have received some training in RSIs, but certainly aren't specialists. (Elsewhere, most clinicians have likely received no training.) Try to get referrals to more knowledgeable people, depending on your symptoms. Several people in our group received incomplete or faulty diagnoses from their primary care physicians (though this may not be representative of people's experience at UHS in general). Since getting the proper diagnosis and treatment is very important, we strongly recommend getting a referral. If your symptoms are not very severe (e.g. minor pain only while typing -- goes away quickly), then you may not be able to get referrals. Instead, your physician will (or should) probably suggest rest, ergonomic changes, stretching, and exercise, as well as possibly splints, anti-inflammatories, ice, or heat.
In a classic case of tendonitis, with these changes, your symptoms should go away in about two weeks. In any event, schedule a follow up appointment so that if your symptoms do not go away, you can get more referrals.
Ask your physician for a note saying that you should not type, and diagnosing your condition. Have the note list other activities which cause you pain so you shouldn't do them such as writing or reading (yes, flipping pages and holding books open can hurt.) You will be able to give this note to teachers, teaching assistants, and the disabilities office. You may have to call UHS a few times to get the note. As always, be persistent.
If your initial problems are more than just minor, or your symptoms have not sufficiently improved by your followup visit, you will want to start getting referrals. The first referral you probably need to get is to physical therapy. The physical therapist is probably the most important person you can deal with. He will be able to teach you alternative typing techniques, stretches, and exercises. While some stretches and exercises are given on this web page, your physical therapist should be able to do a much better job, including a more extensive list of exercises and stretches, better tailored to your individual needs. For instance, some people need more work with their upper back muscles, while others need more work with their posture, while others need work with the hand. The physical therapist can also give you deep tissue massage and ultra sound, if appropriate.
Some people eventually get frustrated with the slow pace of physical therapy, and stop making appointments. Until you are either cured, or your doctor and physical therapist agree there is nothing else for them to do for you, it's probably a good idea to keep going back. First, if you are getting better, the physical therapist can give you more aggressive exercises. Also, your problems will probably move around a bit over time, and you can get new stretches appropriate to the new areas. Finally, if you're not getting better, the physical therapist can try more aggressive treatments, such as new stretches, harder deep tissue massage, etc. In summary, until you're cured, don't stop P.T.
Physical Therapy tends to get overbooked very quickly, with waits of four weeks possible. You should try to schedule appointments in advance if possible. Remember the four week lag, and keep enough appointments in the pipe line that the delay doesn't cause you to not get appointments you need. When you schedule your initial appointment for physical therapy, see if you can schedule one or two followup appointments. Otherwise, it could be eight weeks from the time of your referral to the time of your second appointment: a long time.
You should also try getting referrals to other more specialized doctors than your primary care physician if your problems persist or if you have serious problems, such as pain or numbness at rest. You will probably want to try getting referrals to an orthopedist, who will know a bit more than your primary care physician. You may also want to try to get a referral to a hand surgeon, who may know even more. If you have nerve problems, e.g. numbness or tingling, consider getting referrals to a neurologist. If your nerve problems are in areas other than just your hands and forearms, you should definitely try to see a neurologist. If your symptoms don't go away in a reasonable amount of time, you and your doctor should consider the possibility of other causes. These could include thyroid diseases, diabetes, thoracic outlet syndrome, arthritis, etc. So, getting a referral to a knowledgeable doctor who will have you tested for these diseases can be important.
Getting outside referrals at UHS can be very difficult. While your student health insurance will reimburse (up to a standard amount) for up to three outside referrals per year, (check with the insurance office: don't trust us!), you will need to get a UHS clinician to give you this outside referral. Some of them may be very resistant. Keep trying. Get internal referrals instead, and then ask the internal referrals for outside referrals. We may know physicians who are less reluctant, so contact us. You might try getting a referral to the head of orthopedics, who has more leeway regarding referrals. Change primary care physicians. Be persistent.
Kathleen Dias is the Patient Advocate. Consider asking her for help. On the other hand, you may also want to hold off talking to her, until you have tried other avenues within UHS. In one case, I asked the patient advocate for something, and my case was sent to Dr. Rosenthal, the head of UHS. When Dr. Rosenthal didn't give me what I wanted, it was more difficult to get it, since I had already gone all the way to the top.
A few of the treatments for RSI need some explanation. First, if you are told to use ice, be careful. Ice can tighten your tendons and muscles, so you shouldn't work after icing until you are warmed back up. Heat may be a better treatment, if it relieves your symptoms. (Ice and heat both cause blood to flow into the treated area. Ice can have more of an anti-inflammatory response, but has the tightening effect. Also, if you ice too long/too cold, eventually the blood flow is cut off, rather than increasing.)
Another treatment which requires care is wrist splints. If you use them all the time, your hands and wrists can atrophy quickly. If you use them while typing/working, they can put stress on other muscles/tendons. So, use them in moderation. (I like to use them while I'm running. Some people like to use them while sleeping if they have trouble sleeping in a good position or wake up with problems.) If your doctor gives you splints, ask him what activities you should do with them.
Finally, you should use anti-inflammatories (aspirin, ibuprofen, aleve, etc.) with caution. You should never do any activity while using anti-inflammatories that might cause you pain while not using anti-inflammatories: the anti-inflammatory may simply mask the pain, as you cause further damage. I've heard of people who work during the day, and then use anti-inflammatories at night to mask the pain: probably a bad idea.) If your doctor gives you a prescription strength anti-inflammatory or advises you to take an over the counter anti-inflammatory at a higher than usual dosage, watch out for stomach ulcers which are a possibility, especially with long term use. Take your doctor's instructions (often, to take the anti-inflammatories with food or milk) seriously. Most anti-inflammatories can cause stomach bleeding, which can actually be fatal. The signs include dark stools, and stomach pains. Ask your doctor/pharmacist about side effects. I'm told that Tylenol is not an anti-inflammatory, but only a pain reliever (and it typically doesn't relieve pain as well as anti-inflammatories).
UHS has a nutritionist who you can see for free. Poor nutrition could be associated with some problems, especially neurological problems, including low intake of certain vitamins, so this may be worthwhile. You might consider being tested for your levels of B-vitamins, or taking a B-vitamin supplement. But watch out: vitamins, being "natural", are less regulated than drugs; some over the counter supplements are actually not too far from the dangerous levels, so consult a doctor or nutritionist. Levels of vitamin B-6 over 100mg per day could be harmful for some kinds of nerve problems, such as carpal tunnel syndrome.
Don't buy a speech recognition product until you have tried out the ones that are available in the Adaptive Technology Lab. Speech Recognition is not right for every one. Some people get voice problems from it, or don't have the commitment to really get it working well. So, try it for free first. (Harvard used to get a discount on DragonDictate when it cost $700, but I don't know if this is still true.)
Try to get somebody else to buy the speech recognition equipment for you -- your advisor, your employer, etc. Don't think of this as a one time investment that you can afford: every year the technology gets better, and you'll want newer faster computers with better software, so if you can get somebody else to pay, you'll be happier.
Some people get voice problems while using speech recognition. A speech therapist recommended drinking hot decaf tea with honey (caffeine makes you urinate and dries you out). It is possible to develop vocal nodules (calluses on your vocal cords) which take a long time to heal; if you have problems while using speech recogntion, rest your voice! You might even want to consider seeing a voice trainer or speech therapist. Here is other advice you can try, from Eydie DeVincenzi:
Dragon Systems http://www.dragonsys.com/ (Dragon NaturallySpeaking and DragonDictate)
IBM http://www.software.ibm.com/speech/index.html (ViaVoice)
Most people find that Dragon products work best. They tend to work faster and faster as they get to know your voice well. Don't be discouraged if they are slow at first; eventually, they can type your words at 20 or 30 words per minute. While this may not seem fantastic, it is better than not using a computer at all.
The voice users mailing list is a high volume (about 30 messages/day) list which may be helpful. Their archive is http://www.voicerecognition.com/voice-users/archive/. To subscribe, see http://voicerecognition.com/voice-users/.
Joel Gould's Unofficial NaturallySpeaking Page http://www.synapseadaptive.com/joel/default.htm is indispensable for anyone using NaturallySpeaking.
Writing is a problem. Writing and typing share a lot of muscles, so if typing is a problem, writing probably is, too. Or, if you suddenly take up writing, you could easily overuse muscles that haven't been getting much exercise (was your hand ever sore after taking a three hour exam?) So, be careful. Be especially careful if you're in constant pain: it will be very hard to tell whether writing aggravates that pain, or not. It probably does.
In any event, try to find a pen that is especially easy to use. We have found that the best pens to use are pens that are very "fat" (i.e. have a large diameter) and that are also very light. Others like liquid ink roller ball pens. Finally, fountain pens can be especially easy to use. Experiment to find what works best for you.
One trick for making pens easier to hold is to build them up. Find foam curlers at your local convenience store. Throw away the curling part, and keep only the foam, which is cylindrical, with a hole about the diameter of a pen. Insert it over the pen, making a larger softer grip. I like to remove the clip part on my pens (the metal part for those who like to hold their pens in their shirt pockets.) The metal clip gets in the way of my foam curlers, so I remove it using a pair of pliers.
Proper writing technique can also help. Try to write using the large muscles of your upper arm. Make big movements. Write big. Don't grip your pen too hard. Try writing on a slanted surface (tilted with the top higher). Your physcial therapist can give you further instructions.
Elizabeth Wilmer, a former president of Harvard RSI Action, got RSI from writing. She recommends (in retrospect) a proper writing surface, ideally inclined slightly upwards. Her favorite is a fairly expensive model from Levenger's catalog (model BD550) editor's desk ($79). Levenger's also carries other useful (and expensive) items such as weights to hold books open. Call 800-544-0880 or see http://www.Levenger.com.
You can avoid writing quite a bit if you work at it. I was able to do almost all every day activities using speech recognition. Paying bills was one of the few that I had to do by hand. I did a few things to make this easier, including buying return address labels. You may be able to arrange with your electric and phone company to have the bills automatically deducted from your checking account or credit card. You can also overpay bills, saving a month of writing. When I was at my worst, I had a friend do everything but sign the check, but even then, having my friend write fewer checks and not needing to do the return address label made it easier for her.
Office & Study Equipment
Try to get somebody to buy better office equipment for you -- ergonomic desks, chairs, typing trays, etc. If your department or employer furnishes you with an office, figure out who it is who buys the furniture, and ask them to buy stuff for you. Or, ask your advisor. Or the department secretary. You probably have a legal right for safe office equipment, suitable for your disabilities. In the Division of Engineering and Applied Sciences, talk to Jean Humber.
Alternative keyboards. If you're not too badly injured, an alternative keyboard may be very helpful (if you are badly injured, e.g. pain at rest, it's probably too soon to start thinking about touching a keyboard at all.) Three of the most common alternative keyboards are the Datahand, the Kinesis, and the Microsoft Natural. http://www.tifaq.org The Typing Injury Archive has much more information than I care to repeat. But here are a few notes. First off, how people respond to ergonomic keyboards tends to be very individual. It's also hard to tell without weeks of experience (and the weirder the keyboard, the more experience is needed.) So, make sure you can try out the keyboard for at least a while before you are stuck with it.
NIOSH (National Institute for Occupational Safety and Health) did a crummy study on alternative keyboards, http://www.cdc.gov/niosh/keyboard.html which concluded they don't make a difference. But there were too many caveats to take the study seriously.
Two keyboards that are worth looking into are the Kinesis, which is reasonably well liked, weird but not too weird, and about $230. The other is the Microsoft Natural Keyboard (and variations), about $40. Some people hate it and some people love it.
Here are my personal feelings about the Datahand, one of the weirdest and most expensive of the keyboards. I tried out a Datahand (The Adaptive Technology Lab ordered one to try out -- if you want to try an alternative keyboard, talk to the ATL, after registering with your school's disability office.) I wasn't able to use it productively. The datahand is very difficult to learn to use, and your hands must be the right size and shape (my pinky was too short.) The data hand is a weird keyboard. When I couldn't use it, I tried to let other people use it: no one was very fond of it. There is however, a good sized group of people who like datahands -- I assume they have the right hand sizes and the "right" injuries.
I've been told that some Windows 95 keyboards make it difficult to hit the control key with your opposite finger, meaning good typing practice is harder. If this is a problem for you, consider using something else.
You might wish to consider a dvorak keyboard layout, especially if you type a lot of straight text. For english text, the dvorak layout reduces finger movement. For programmers, where a lot of time is spent on symbol keys, the advantages are probably reduced. Also, if you spend a lot of time hitting ctrl-key sequences, try modified typing first (use opposie hand to hit ctrl).
Mice. Mice are as much a problem as keyboards for many people. Many people have found trackballs to be a good alternative. A few have liked foot mice (but watch out for ankle tendonitis). Some have liked a stylus on a touch pad. Don't forget to clean your mouse (flip it over; twist off the circle holding the ball in place; remove the mouse ball; scrape the gunk off the rollers inside with your finger nail or a pen or something.) If you switch which hand you use your mouse with, be careful -- you might screw up the other one -- and don't forget to reconfigure your mouse to be left (right) handed, since otherwise you will tend to use your index finger on the left button, unnaturally twisting your hand. http://www.rsiguard.com is another webpage that has shareware for auto-clicking. RSIGuard also has break-timer features. http://www.savant-software.com has a shareware "RSI Monitor" program that gives you information about how much clicking you're doing and gives you break and stretch reminders. At KnowWareGlobal, you can download (for free) a book which tells you keyboard shortcuts to avoid using the mouse all together.
Consider a head-set phone. Joshua Margolis suggests Hello Direct, a catalogue selling phone equipment, including low budget head-set telephons: 1-800-444-3556. Radio Shack, including the Radio Shack in Harvard Square, also sells headsets.
Buy yourself plastic cups (I found them at Ann and Hope, the Arsenal Mall) for 30 cents each. They may be easier to hold. If you're cooking for yourself or your family, you may want to switch to plastic plates, since they are lighter than china plates.
All sorts of things are bad: shoveling snow, kneading bread, etc. Use a snow blower or a bread machine or hire someone.
The pressure of the mattress on your arms may cause you pain and tingling. (It certainly has for several members of the group.) Consider buying a foam pad for your bed if this is the case; the foam will bother your arms less since it is softer. You can buy a foam pad for around $30 at a foam store; there are several in the Boston area. We have found that the best width for a foam pad is around 2 inches.
Consider an electric toothbrush (a light one); consider an electric razor (a light one.)
Consider putting padding (I use pipe insulation, held on by elastic fabric from Pearl Art and Crafts center) on your steering wheel, to build it up and make it easier to grip. Be careful to do this safely! You don't want it to come off while driving, or to get your hands stuck in the elastic or anything...
Buy sharp knives for cooking. And an electric can opener, maybe. And a non-stick frying pan (who wants to scrub pans with RSI)?
Start your morning with a nice hot water bath for your hands to get the blood flowing.
Use a straw (or even two straws stuck together) in restaurants, so you don't have to lift the glass.
Consider a topical anti-inflammatory, such as Aspercreme, especially if you haven't had success with other anti-inflammatories. But watch out: see the warnings about anti-inflammatories in general, and also, if you had side effects or allergies from other anti-inflammatories, the topical anti-inflammatory may be dangerous: read the warning label carefully.
Keep hands warm, especially while typing (if you can type). I keep a heating pad on my lap, and rests my hands on it during breaks. Consider fingerless gloves (they did nothing for me, but some people like them.) The best deal was the following, taken from the RSI newsletter: OccuMitts Therapeutic Support Gloves are similar to the well-known Handeze gloves but are less expensive. They come in sizes XS through XL. The suggested retail price is $9.95 per pair, but say you're an RSI Network reader and you'll get them for $4.95 (plus $1 s&h). Call 1-800-466-0071. They'll fax you a size chart if you like.
They seemed identical to me. You can also buy regular cotton gloves. Or, you can buy any pair of gloves, and snip off the fingers. See what works for you.
Tips for Musicians
Watch out for foot problems. People with RSI, especially severe cases, seem at increased risk for foot problems. Wear good shoes, and watch for pain, etc. in your feet. Whether it's because RSIs are often caused by underlying problems which exacerbate problems in the extremities, or because people with RSIs tend to overdo things, or because without hands we use our feet more, I don't know, but be careful.
Buy yourself two new packs. You probably shouldn't be carrying things around in your hands, if you can avoid it. So, you'll need a backpack. Normal backpacks used by students tend to cut into the pectoral muscles, cutting off circulation to the arms, or impinging on the nerves. Instead, you should get a very good pack. There are backpacks available with padded shoulder straps, and thick padded belts, as well as semi-hard (cardboard?) internal backs. These are designed for hikers. They're much less overwhelming than an internal or external frame backpack, but much better for carrying things than a regular pack. You'll need to go to a hiking store to get these. Cost is about $80. The other kind of pack you'll want is a giant fanny pack. These are also available from hiking stores. They come large enough to hold 8.5 x 11 binders, so you can carry a few books in them. Cost is about $40. The two nearest hiking/camping stores I know of are Eastern Mountain Sports, and something across the street from it (Wilderness House?) both on Commonwealth Avenue, in Boston. You might also check out Hilton's Tent City, down town, near North Station (?).
But wearing a backpack can press on nerves in your shoulders or elsewhere and exacerbate problems like thoracic outlet syndrome. Carrying a briefcase can also hurt. One solution is to wear a backpack or book bag around one's waist--you can secure it by tightening the straps around your waist.
Wear your watch on your belt or belt-loop, rather than on your wrist. I've even known someone who said his wedding ring caused problems, and took it off while typing. Or, you can get a nurse's watch, which is on a lapel pin with an upside down dial, from a place called the Vermont Country Store.
Don't be afraid to ask for help. For instance, when my hands were bad enough that any typing at all hurt me, I would ask librarians to type in Hollis searches for me. And to fill out library forms, too. People are pretty sympathetic if you briefly explain your problem.
Student Disabilities Resources
Student Employment Office
Adaptive Technology Laboratory
Environmental Health and Safety
Health and Fitness
Many pianists who have RSIs have found Taubman techniques extremely helpful in allowing them to play the piano again. This is especially important because pianists so often develop RSIs. Non-pianists with RSI can also benefit greatly from Taubman techniques; amazingly, a Taubman seminar for computer workers with RSI helped the majority of them return to work! Taubman techniques are equally applicable to typing as they are to piano. The Taubman Institute is a summer institute at Williams College that teaches their techniques. More information is available at: http://www.taubman-institute.com/
Since many repetitive strain injuries are diagnosed as soft-tissue injuries, treatments that focus on those tissues can be helpful. The RSI Action Group does not recommend any one particular massage therapist for this task, but Arun Jaine of Integrative Body Therapies (424-0255) is a practitioner in the area who is familiar with repetitive strain injuries. Ask about student rates. You can also get some less expensive massages at student clinics in the area.
A somewhat controversial field in medicine that has provided significant benefit to those with RSI. It is a structural form of treatment that focuses on improving bone alignment and mobility. Osteopaths have a medical education equivalent to MDs, and as a result are lawfully able to prescribe medications and even perform surgery. Sessions with an osteopath are highly tailored to the individual patient, and also vary greatly with the practicioner; most, however, make use of subtle forms of bone and muscle manipulation intended to free up restricted areas. From the patient
perspective, osteopathy involves less patient involvement than other forms of therapy described below, but personal experiences have been highly positive nonetheless. However, given the major role of the practitioner in this form of treatment, success with osteopathy seems to have a lot to do with how carefully you choose your doctor.
Acupuncture seeks whole body healing based on Chinese medicine. Yes, it involves needles. No, it’s not too painful. Some say that success is highly dependent on the practitioner. There are student clinics in the Boston area for the student budget (individual sessions cost approximately $15-$20).
The Harvard Tai Chi Tiger Crane Club has free classes in Tai Chi. Visit their webpage at http://hcs.harvard.edu/~htctc. The club is very aware of the Harvard RSI community and has several techniques designed to help people with RSIs.
Alexander Technique/Feldenkrais Method
These are methods that incorporate and combine many structural and mindbody elements. Both methods involve significant levels of subject involvement and offer a means to guided self-improvement. The teacher acts to foster improvement, but ultimately the learning process has to be self-motivated. Lessons usually consist of a combination of hands-on bodywork and verbal teaching to develop self-awareness of one’s body through movement. Through application of the technique, the student learns to integrate physical and mental aspects of the body in a highly conscious way. For
RSI sufferers, this can offer a means of taking control of a situation that might otherwise seem hopeless.
"F.M. Alexander (1869-1955) demonstrated that the difficulties many people experience in learning, in control of performance, and in physical functioning are caused by unconscious habits. These habits interfere with your natural poise and your capacity to learn. When you stop interfering with the innate coordination of the body, you can take on more complex activities with greater self-confidence and presence of mind.More information can be found on the comprehensive website http://www.alexandertechnique.com. The site includes numerous links to the different associations of Alexander teachers that will help locate a teacher near you. We're fortunate in Boston to have one of the largest Alexander teaching communities in the world. There are several teachers in the direct vicinity of Harvard Square. In addition, the Alexander Technique Center, located up Mass Ave from Harvard towards Porter Square, may have information regarding affordable group classes (1692 Massachusetts Avenue, 3rd floor, 617-497-2242). A good description of the Feldenkrais® Method can be found at http://www.wellspace.com/offerings/feldenkrais.html.
Lastly, there are members of RSI Action very willing to discuss and
explain these techniques with anyone interested.
Yoga offers a means of exercise and stretching as a means to increasing whole body awareness. Most Yoga teachers focus on breathing as a unifying and integrative body mechanism. The emphasis of each yoga class varies widely with the instructor and the particular form of yoga being taught. Some yoga classes have a more spiritual emphasis, while others (proliferating rapidly these days) seem like aerobic classes in disguise (e.g. "Power Yoga").
For RSI sufferers, though, yoga can provide an opportunity to exercise in a way that is surprisingly pain-free. Many people with RSI who have tried yoga comment that it allows one to do things that normally cause a good deal of pain otherwise. It’s also very affordable, here: $5 a semester at the MAC (495-2219)! Or, you can find classes at the Center for Wellness and Health Communications (495-9629, see above).
Boston Voice Users Group
There is a local, low-volume mailing list for meeting arrangements. It's at firstname.lastname@example.org. To subscribe, send an empty message to: email@example.com, with subject line SUBSCRIBE.
Meeting announcements for those who need phone contact are being coordinated by Mary Hopkins, (h) 666-2517.
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Job Accomadation Network
MIT's Adaptive Technology for Information and Computing lab maintains a web page http://web.mit.edu/atic/www/rsi/mitrsi.htm with useful information and links.
If you want more information on prevention, a really good place to look is Paul Marxhausen's RSI page at http://www.engr.unl.edu/eeshop/rsi.html with even more pictures and even some mpeg videos. There are also references to good books on prevention, including easy links to on line book stores so you can order them right now.
The The Typing Injury FAQ http://www.tifaq.org is a gold mine of information. If you are looking for information about ergonomic devices, these archives are a good place to start.
IBM's Healthy Computing website (http://www.pc.ibm.com/us/healthycomputing/) is an excellent and comprehensive guide to computer ergonomics.
Amara's RSI Page http://www.amara.com/aboutme/rsi.html contains prevention and background information on RSI.
The Hand Book by Stephanie Brown, is a good book on how to type (if you can type at all!). It's going through revision and not available until about February or March 1997, but there is a copy on reserve in Baker Library.
|The Mind/Body Approach: What is RSI?
John Sarno's work is an important counter-current to the structural hypothesis. His premise is that repetitive
strain injuries are one of many pain syndromes caused not by any structural injury, but by a
complex interaction of mind and body. He calls the painful syndrome which results Tension
Myositis Syndrome (TMS). In essence, he argues that the pain exists not because there is a
structural injury at the site of the pain, but because your brain has somewhere deep inside
chosen to latch onto the pain as a mechanism to divert you from painful feelings that have
been pushed deeper than your conscious level. He boasts a high rate of treatment success,
and there are many Harvard students in the RSI Action Group who have been healed by his
program (and they are available to talk to you). The following several pages have been
adapted from a handout which the RSI group has produced about Dr. Sarno, and are a summary
of Dr. Sarno's research on TMS. Much of its information came from an online document that
can be found at this Premier Health
In particular if you have had RSI and/or back pain (or other symptoms) for a long period of time (i.e. more than a month or two), you should really take a long look at the work of John Sarno.
In April 2000 the RSI Action group held an information session about Sarno and his work. The info session started off with a summary of Sarno's theory, and then followed up with a panel in which five Harvard students spoke about being cured of RSI after reading Sarno's book and applying the concepts therein to their lives.
The handout from the session is available as a Microsoft Word document. There is also a tape of the session. Many people find it helpful to hear about the stories of others. If you would like a copy of the tape of this session, please email firstname.lastname@example.org. You will be asked to mail a blank tape and a self-addressed, stamped return envelope. Be warned that the audio quality of the tape is poor.
|The Mind/Body Approach: A Diagnostic Quiz
You may find the following quiz useful in assessing the possibility that
you have TMS. The quiz was developed by Dr. David Schechter, a doctor who studied under John
|The Mind/Body Approach: Progression of Symptoms
The progression of Tension Myositis Syndrome (TMS), summarized:
|The Mind/Body Approach: How to Cure
In order to cure this syndrome, you must treat the root cause. Conventional treatments such as pain relievers and ultrasound may treat the physical symptoms, but they don't address the psychological source of the pain. The physical symptoms are present for a reason: They distract your attention away from the unacceptable emotions. In order to completely eliminate all symptoms, you must identify which unacceptable emotions are threatening your self-image. Once you acknowledge the threatening emotions, the symptoms no longer work as a distraction, and they go away - in some people, quite dramatically. It's not that you need to eliminate the source of the stress - you just have to become aware of it.
Of course, this is easier said than done. Since we're talking about unconscious emotions, they might not immediately be apparent, and recognizing them might take some work. You may find it useful to make a list of expectations or requirements that you have for yourself, and see which are being threatened by your current situation.
You also have to completely believe in the TMS diagnosis. That means that you have to completely accept the fact that your symptoms are emotionally induced. If you still believe that there may be something physically or structurally "wrong" with you, you're not yet "cured." If the symptoms can still work as a distraction then your brain's trick is still working, and the symptoms can return. In a similar vein, it's important to completely resume your normal activities. As long as you're living in fear of another attack, the physical symptoms still have your attention, and chances are good that they'll return.
Don't go home and just try to start typing. If it starts to hurt, you might get scared and start doubting yourself. Read Dr. Sarno's books and then decide if this is right for you. You will find more instructions there on how to proceed and get better.
Many people can eliminate their symptoms simply by reading one of Dr. Sarno's books. Some people need a little more help. If reading his book doesn't "cure" you, there are a few other options:
Check out other information resources. Understanding and completely accepting the TMS diagnosis and treatment approach is crucial. It helps to have these ideas reinforced by several sources. If possible, you may want to see an MD who is trained to diagnose and treat TMS. The last page of this handout contains information on these and other resources.
Sometimes, if you're not making progress, it's beneficial to meet with a psychotherapist. As mentioned before, it's not always easy to make unconscious emotions become conscious. Dr. Sarno typically recommends psychotherapy to 10-15% of his patients.
Be patient, be persistent, and be kind to yourself. Nosing around in your unconscious mind can be very uncomfortable. Several people have described the weeks in which they made their physical recovery as being very volatile emotionally - little wonder, given that the mask which their emotions had hidden behind had finally been removed. Some people are not quite ready for this approach, which is understandable considering the current state of western medicine. Don't beat yourself up if you don't immediately find relief. But please don't throw in the towel. Those of us on the panel believe that Dr. Sarno's method works.
|The Mind/Body Approach: Further Resources
This handout is not designed to cure you of TMS, but merely to give you background so that you can begin your own journey. The following are sources for your exploration. Remember: when we advocate TMS, we're not suggesting that the pain is "all in your head" (just about the most insulting thing you can say to someone who's miserable). We're saying that the pain and symptoms are most definitely real, but that their cause is in your head.
And the good news is, there is a way out.
Dr. Sarno's recent books:
The Mindbody Prescription (1999): Sarno's most recent book, on the NY Times best-seller list. More Freudian than Healing Back Pain - anti-Freud people might prefer HBT. However, TMP gives a more thorough set of instructions than HBT for curing yourself.
Healing Back Pain: The Mindbody Connection (1991): More in-depth than The Mindbody Prescription, but it doesn't talk about RSIs as specifically. There is enough different between the two books that it is worth reading both of them.
Some useful links:
RSI Action group lendables
In April 2000 the RSI Action group held an information session about Sarno and his work. The info session started off with a summary of Sarno's theory, and then followed up with a panel in which five Harvard students spoke about being cured of RSI after reading Sarno's book and applying the concepts therein to their lives. Many people find it helpful to hear about the stories of others. There is also a tape of the session. Many people find it helpful to hear about the stories of others. If you would like a copy of the tape of this session, please email email@example.com. You will be asked to mail a blank tape and a self-addressed, stamped return envelope. Be warned that the audio quality of the tape is poor.
Contact us with questions, or just to talk. Although our phone numbers are not all listed here, that is only because they are changing with the changing semesters.