How I stopped the RSI pain that almost destroyed my programming career

If it hurts to type you’ll have a much harder time working as a programmer. Yes, there’s voice recognition, but it’s just not the same. So when my wrist and arm pain returned soon after starting a new job I was starting to get a little scared.

The last two times this happened I’d had to take months and then years off from programming before the pain went away. Was my career as a programmer going to take another hit?

And then, while biking to work one day, I realized what was going on. I came up with a way to test my theory, tried it out… and the pain went away. It’s quite possible the same solution would have worked all those years ago, too: instead of unhappily working as a product manager for a few years I could have been programming.

But before I tell you what I figured out, here’s what I tried first.

Failed solution #1: better hardware, better ergonomics, more breaks

When I first got wrist pain bad enough that I couldn’t type I started by getting a better keyboard, the Kinesis Advantage. It’s expensive, built like a tank and amazingly well designed: because Ctrl, Alt, Space, Enter are on the thumb are you don’t end up stretching your hands as much.

As an Emacs user this is important; I basically can’t use regular keyboards for anything more than a few minutes these days. I own multiple Kinesis keyboards and would be very sad without them. They’ve definitely solved one particular kind of pain I used to have due to overstretching.

I reconfigured my desk setup to be more ergonomic (the days I do this via a standing desk). And I also started taking typing breaks: half a minute every few minutes, 10 minutes once an hours. That might have helped, or not.

The pain came and went, and eventually it came and stayed.

Failed solution #2: doctor’s orders

I went to see a doctor, and she suggested it was some sort of “-itis”, a fancy Latin word saying I was in pain and she wasn’t quite sure why. She prescribed a non-steroidal anti-inflammatory (high doses of ibuprofen will do the trick) and occupational therapy.

That didn’t help either, though the meds dulled the pain when I took them.

Failed solution #3: alternative physical therapy

Next I tried massage, Yoga, Alexander Technique, and Rolfing. I learned that my muscles were tight and sore, and ended up understanding some ways I could improve my posture. A couple of times during the Alexander Technique classes my whole back suddenly relaxed, an amazing experience: I was obviously doing something wrong with my muscles.

What I learned was useful. My hands are often cold, and all those classes helped me eventually discover that if I relaxed my muscles the right way my hands would warm up. Tense muscles were hurting my circulation.

At the time, however, none of it helped.

Giving up

After six months at home not typing I was no better: I was still in pain.

So I went back to work and got a new role, as a Product Analyst, where I needed to type less and could use voice recognition for dictation. I did this for 2 or 3 years, but I was not happy: I missed programming.

Working part time

At some point during this period I read one of Dr. Sarno’s books. His theory is that long periods of pain are not due to actual injury, but rather an emotional problem causing e.g. muscles to tense up or reduced blood flow. There are quite a few people who have had their pain go away by reading one of his books and doing some mental exercises.

I decided to give it a try: release emotional stress, go back to programming, and not worry about pain anymore. Since I wasn’t sure I could work full time I took on consulting, and later a part time programming job.

It worked! I was able to type again, with no pain for four years.

The pain comes back

Earlier this year I started another job, with more hours but still slightly less than full time. And then the pain returned.

Why was I in pain again? I wasn’t working that many more hours, I was still using a standing desk as I had for the past four years. What was going on?

An epiphany: environmental causes

Biking to work one day the epiphany hit me: Dr. Sarno’s theory was that suppressed emotional stress caused the pain by tensing muscles or reducing blood flow. And that seemed to be the case for me at least. But emotional stress wasn’t the only way I could end up with tense muscles or reduced blood flow.

The new office I was working in was crazy cold, and a couple of weeks earlier I’d moved my desk right under the air conditioning vent. Cold would definitely reduce blood flow. For that matter, caffeine shrinks blood vessels. And during the four years I’d work part time and pain free I’d been working in a hackerspace with basically no air conditioning.

I started wearing a sweatshirt and hand warmers at work, and I avoided caffeine on the days I went to the office. The pain went away, and so far hasn’t come back.

I spent three years unable to work as a programmer, and there’s a good chance I could have solved the problem just by wearing warmer clothing.

Lessons learned

If you’re suffering from wrist or arm pain:

  1. Start by putting a sweatshirt on: getting warmer may be all you need to solve the problem.
  2. If Emacs key combos are bad for your wrist, consider vi, god-mode, Spacemacs… or the expensive option, a Kinesis Advantage keyboard.
  3. Next, consider improving your posture (standing desks are good for that).
  4. Finally, if you’re still in pain after a month or two go read Dr. Sarno’s book. (Update: After posting this blog I got a number of emails from people saying “I read that book and my pain quickly went away.”)

This may not work for everyone, but I do believe most so-called repetitive strain injury is not actually an injury. If you’re in pain, don’t give up: you will be able to get back to typing.

By the way, taking so long to figure out why my arms were hurting isn’t the only thing I’ve gotten wrong during my career. So if you want to become a better software engineer, learn how you can avoid my many mistakes as a programmer.

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