RSI / Tendonitis Advice for Programmers

Having experienced fairly serious RSI ---and pulling off an excellent recovery---I get asked for advice on it occasionally. Here’s what worked for me—your results may vary.

  • Seek medical attention from a professional who specializes in hand injuries, as there are several conditions with fairly similar symptoms and different treatment strategies for each.
  • Rest. In RSI your connective tissue gets inflamed, and rubs up against the stuff around it, If you try to work through it, it keeps rubbing against the stuff around it which keeps it inflamed-leading to scarring and worsening symptoms over time.

  • During rest, RICE and bracing. Keeping the wrist stable and unloaded gives time for inflammation to go down. Talk to a doctor / physical therapist about how long to rest in a brace vs. when to begin stretching, pt, etc.

  • Physical therapy, stretching, massage, and general health, to the extent you are able. Keeping bloodflow up promotes healing. You will be able to start PT during the rest phase. Learn the 3 major wrist stretches. (flexed, extended, and ulnar deviated).

  • Eventually move to night bracing only, concurrent with gentle PT (tons of stretches and eventually resistance) training to rehab your wrist or hands.

  • When you return to typing work, do so slowly. Don’t work nonstop even if it doesn't hurt, reinjury can be subtle and sudden. You'll need to find out for yourself what your limit is. You can get a doctor's order to strictly limit typing during work while recovering if you need it. If you follow a healthy PT regimen you can hopefully return to zero pain and a normal workload.

  • Use an ergonomic keyboard to type (I like the kinesis advantage) and use an efficient nkeyboard layout like dvorak if you can. You can also try voice recognition, use a stylus, and/or switch up your mouse grip.

  • Be aware of stress in your life - people with chronic injuries may be more likely to feel stress as physical pain. Your mind may have learned an aversion to typing and you may feel pain that isn’t rooted in real physical distress. If this affects you, a useful mental technique is to think of all the reasons you may be stressed, and why your body may be reacting to this stress by sending you pain signals. Check out the book 'The Mindbody Prescription: Healing the Body, Healing the Pain' by John Sarno for more info.

  • Return to weightlifting SLOOOWLY, but be aware you have a hand injury. Try machine chest presses instead of pushups etc. at first so you can keep your wrist in a stable, neutral position.

  • Hand and extremity injuries are notoriously slow to heal. Don’t give up, if you take care of yourself things will look a lot better after a year.

  • There isn't a magic pill to fix RSI, including injecting anti-inflammatories or taking them orally. These just treat the inflammation—really there’s no way around the fact that you have to give yourself time to heal and put in the work and effort to do it. Surgery, if appropriate, is often a ticket to a year of rehab before any positive outcome manifests, so carefully evaluate your options before commiting to it.

Also, I say I’m cured, but I still avoid wrist-intense stuff like climbing or multiple all-nighters. In exchange for this good behavior I can type 8 hours a day without issue, pull the occasional 48-hour code frenzy, and live an otherwise normal life.

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