How I Overcame RSI
My name is James and I am a 40-something IT worker in Birmingham, UK. This is my personal story of how RSI took hold of my life, ended my job, but through a lot of pain, effort and learning, I'm now completely free of it. jimj@live.com
First of all some important things to say:
1. I'm not a doctor or physiotherapist and have no medical training. Don't take my word for anything medical. Get professional medical advice – the only reason I am writing this website is to tell my personal story. But as I would emphasise throughout, there are not many medical professionals who have experience or skills with RSI. I spent a lot of time and money on multiple professionals before I found some who could help me.
2. This is NOT a commercial website. I'm not here to sell or promote anything or ask for money. If I recommend books or other products, it's because I found them useful but I don't have any affiliation with them. There are one or two websites that purport to describe how people beat RSI but they charge you to find out how. I think that is shameful.
3. This is just my personal story. In fact, my main motivation for writing out my story in detail is so that I have a kind of diary - I don't want to forget the details and also because if any of the symptoms reappear, I will have a log of what happened previously. That's why there's quite a lot of (boring) details. A lot of this is a record for my own purposes. It's not particularly entertaining and I make this public just in case it is of use to anybody else. I can't be the only one with these symptoms. If you don't want to read the details, see the bit in blue below where I give an essential summary.
4. What works for me might not work for you and as I explain below, if you are suffering from RSI, please get professional medical advice. I hope this website may help others but it's mainly a personal diary for myself so it's not meant to be entertaining! I've changed the names the professionals who have helped me. I don't want anyone to think that this is an advert for physiotherapy services or other such things in the West Midlands (England). If you desperately want to know more about the physiotherapists and Pilates teachers in the West Midlands I used, e-mail me jimj@live.com
5. The most effective treatment came from physiotherapists specialising in Pilates and treatment of trigger points (muscle knots).
Brief summary in case you don't want to read the rest.
I first experienced full blown RSI in mid-2007. At the time, I was a database administrator working full-time with computers, something I had done since age 21. The RSI came immediately, got progressively worse and by end of year, I was on medical leave. By summer 2008, I resigned. For the next 18 months, I tried everything to get better, did a lot of reading, saw a lot of specialists, saw NHS and private medical professionals, but with no results. In Dec 2009 I was at my lowest ebb. In early 2010, I sought a LOT of medical advice and began to get a lot better following work on trigger points and muscle rebuilding with several physiotherapists and a Pilates teacher. Every month I got slowly stronger and by October 2010, I was mostly fit and over RSI. I still had lingering problems that didn't clear themselves until early 2011. By spring 2011, I was as strong and healthy as I had been before 2007 so I made this website. The main resolution? Having several physiotherapists dealing with muscle imbalances, muscle weaknesses and especially trigger points (muscle knots) in my muscles. It was intensive and time-consuming but I'm pain-free now. But note one thing: I have seen 16 different physiotherapists, some awful, some average, but several who were amazing and who were able to help me. You may have to search long and hard and spend a lot of money to find a physiotherapist who knows how to deal with trigger points and RSI. Finally, I recommended reading ‘The Trigger Point Therapy Workbook’ by Clair Davies.
The Loooooooooong story begins...
Late 2006 / early 2007: I began to notice that in the morning, I had quite a stiff neck. I didn't think too much of this but it did grow gradually worse. I wasn't getting any RSI symptoms and the stiffness would disappear during the course of the day. Soon, I discovered that having a thin pillow helped and so I got rid of my normal pillow and used a very thin one instead. I had no more stiff neck problems.
Mid-2007: I had an IT job as a database administrator but I used to work from home slouching in bed with my laptop. I would prop my laptop up against my knees and type with my forearms in a raised position. Not very ergonomic but I had done this for about a year without any problems. Occasionally, I would get some RSI like pain in my wrists. I didn't think this was very important: I had occasional wrist pain since the age of 20 when typing in prolonged sessions. This was the case even when I used the proper ergonomic desk set up at an office job I used to have. I knew from past experience that if I just rested my arms, the pain would go away overnight.
July 2007: The pain started to get worse than "normal" so I abandoned my lazy posture and set up a proper ergonomic arrangement. I knew from previous training from my company's occupational health department on how to arrange proper keyboard, mouse, wrist rest, chair, monitor setups and followed everything exactly to plan. Unfortunately, the pain didn't go away. I thought I would be okay with a short two-week holiday. After all, my girlfriend and I were going to travel away so I booked 2 weeks vacation time. I genuinely thought that with a bit of rest and proper ergonomics, the RSI would just go away.
August 2007: Alarmingly, on returning from holiday, I discovered that the pain hadn't gone away. I found that day after day, I would still have the pain in my wrists and unlike any other time in my career, it didn't go away with rest. Moreover, I was getting pain also on the outside of my forearms. This was so bad that even if I set up a perfectly ergonomic computer environment, the pain was still there. Moreover, neither perfect ergonomics nor complete resting did anything to help.
August 2007: I soon found that I couldn't even rotate my forearms so that my palms face downwards. I could only hold my forearms in a completely neutral position, as when giving the thumbs up sign, or as when shaking somebody's hand. I could write with a pen because the forearm stays in a neutral position but I couldn't type because that involved rotating my forearms so that the palms face down. I purchased a pen mouse and found I could use it very comfortably. I couldn't really type on the keyboard so I used to hold two pencils in each hand as if writing and then use the pencils to prod the keys on the keyboard. I hoped I would get better. The occupational health department at work arranged for me to have an ergonomic keyboard, ergonomic mouse, and an ergonomic chair. These were very expensive (the chair, known as an Aeron chair, cost over £1000. Sadly, these did nothing for me.
September 2007: around this time, I went to see my GP who referred me to a local consultant. He said that I had RSI although apparently it is properly called "work-related upper limb disorder" (WRULD). He did a load tests and said I had nothing serious like carpal tunnel syndrome and the AND test was negative. He said that there was no sign of joint synovitis or tenosynovitis. He thought I might have something called thoracic outlet syndrome. I didn't really know what it meant but was glad when he said that with good physiotherapy, I should be fine. My GP referred me to an NHS physiotherapist but advised that it would take quite a few weeks because there was a waiting list. My GP also suggested I take 6 ibuprofen tablets everyday as an anti-inflammatory drug but it didn't really do anything to help me.
Autumn/Winter 2007: By this time, the pain had become so insufferable that I had to talk to my employer about it. They were very understanding and purchased a load more ergonomic equipment such as another ergo chair, another mouse, keyboard, and lots of other devices. I experimented with different types of trackball, rollermouse, pen mouse, handheld mouse, trackpad, but none were particularly useful. I found that if I could rotate using a different device each time, I could keep the pain at bay. I also started to use Dragon NaturallySpeaking which was extremely helpful. Anyone with RSI should definitely use voice dictation software and make use of a free online forum to discuss how to use it properly available at http://www.knowbrainer.com/PubForum/index.cfm?page=forum
November 2007: By now, I knew something was quite serious and began to look around the Internet for solutions. Clearly, using ergonomic equipment and having a proper, perfect position at the computer wouldn't help. Moreover, I started to get pain in my shoulder when driving and using the mouse so it wasn't just pain in my forearm anymore. I read online about how some people have benefited from osteopathy. I decided to give it a go and contacted a local osteopath. It costs about £40 a session and after six sessions, I didn't think I had improved. The hands-on manipulation certainly makes you feel better but I didn't think my RSI changed so I stopped going to the osteopath a couple of months later.
The First Important Step
January 2008: my referral to see an NHS physiotherapist had finally arrived. This was the first step in getting better. I went to see one at the local hospital and discussed my symptoms: sharp pains in the rest, generalised and along most of my forearm, sharp pain to the front and outside right of my shoulder. I had the symptoms along both sides but was more pronounced along the right-hand side which is not surprising since I am right-handed. The physiotherapist gave me some exercises to do. They were aimed at strengthening my lower trapezius muscles. The physio explained that my shoulders have become rounded forwards and I was using my upper trapezius muscles too much. She encouraged me to try to adopt better posture. She also gave me the following exercise
Lower trapezius exercise with thera-band This involved hooking a 1m long piece of resistance band around the door handle at chest height and pulling on the two ends of the resistance band with my elbows on my side and squeezing my shoulder blades together. You can find lots of videos on how to do this on the Internet if you just do a search for "Lower trapezius exercise with thera-band" or "Lower trapezius exercise with resistance band." As I shall explain later, I subsequently discovered that I was doing this exercise wrong. To do it properly, you really have to try to squeeze your shoulder blades down and together otherwise you are not exercising the lower traps properly. As we shall see, it was months before I realised I was doing this exercise badly.
Early 2008: during this period, I began to notice a different kind of pain. It was much more localised, fatigue-like pain in the front of my right shoulder. Moreover, unlike the wrist and forearm pain, I would also get this fatigue like pain when I was driving. Whereas the pain in the wrist and forearm was quite generalised, and more like an ache, the front of shoulder pain was sharper, more piercing. Later, (over two years later) I would learn that this was caused by a trigger point in my infraspinatus muscle. Today, I still occasionally get this pain albeit in much reduced severity but I treat it instantly with some deep massage and it goes away straightaway. Untreated, it would doubtless lead to debilitating RSI.
One of the things I want to suggest on this website is that RSI sufferers might benefit from learning about trigger points (muscle knots). It took me over two years to discover that a trigger point in my infraspinatus was to blame for my RSI. It was incredibly important that I found two physiotherapists who were willing and able to treat trigger points. In The Trigger Point Therapy Workbook, the author states, "though located behind the shoulder, infraspinatus trigger points are the most common source of pain in the front of the shoulder… Many hours can be wasted rubbing all these places when you don't realise that the problem may be in the infraspinatus." (p.91)
[I recommend the book The Trigger Point Therapy Workbook, by Clair Davies: I learnt a huge amount about trigger points and RSI. But I don't earn any money by making this recommendation by the way, and I have no affiliation with the author or publisher]
Early 2008: Around about this time, I had another, separate pain appearing in my right shoulder. This was more painful than any of the other aches and pains I had. It was as if I had a sharp pin buried deep inside my shoulder joint. Looking back at this "sharp pin shoulder pain", it was the hardest thing for my medical professionals to diagnose and resolve. A consultant thinks it was related to thoracic outlet syndrome [TOS] where the nerves around my neck and shoulder area were being compressed or trapped. I had a physiotherapist who noted in early 2010 that my upper trapezius muscles were seriously overworked and were in a constant state of spasm. This led to a 'head forward' posture, rounded shoulders and tight pectoral muscles.
She said I badly needed to do daily exercises to build up my lower trapezius muscles, thereby reducing the strain on the upper trapezius. As I will explain later, this pain very quickly went away. I will discuss this in more detail later on. In the book by Emil Pascarelli titled Complete Guide to Repetitive Strain Injury, he discusses neurogenic thoracic outlet syndrome and how 70% of RSI patients exhibit this kind of situation: "nerves encounter a series of tight spots as they travel from the neck to the arm and hands. The brachial plexus nerves encounter what is their first soft-tissue obstacle in the scalene muscles. Two of the three scalenes act like a pair of pincers when they are shortened and tightened and can squeeze the brachial plexus nerves." (p.47) [I also strongly recommend Emil Pascarelli's Complete Guide to Repetitive Strain Injury btw]
February 2008: I decided to take of swimming in the hope that this might bring about improvements to my RSI. Unfortunately, I didn't know how to swim so I had to take adult swimming lessons and it wasn't until mid April that I was competent enough to swim several lengths. Looking back, I think swimming was useful for general health and general posture improvement but it didn't do much for RSI in particular. My RSI would need much more targeted, aggressive physiotherapy and Pilates exercises that recruited and built specific muscles that had been underused and inefficient.
June 2008: My RSI symptoms were debilitating: I had a maximum capacity of just a few minutes work before I was in excruciating pain. My forearms were really a problem in other areas too. If somebody telephoned me, I had to lie down so that I could hold my mobile without having to raise my forearm because they were too weak. Alternatively, I would put my mobile on a shelf at head height and talk into it without having to hold it. When people phoned me on my landline, I would put the telephone onto loudspeaker, so that I didn't have to hold the phone to my ear, such was the weakness of my forearms.
I had no option but to resign from my job. I e-mailed my boss to tell her and then began to think about what I was going to do next. Thankfully, I had others who could support me so I knew I was very, very lucky to still have a roof over my head.
A False Dawn
July 2008: by now, I had been swimming for several months and I chanced upon what I thought was an amazing discovery. For one week towards the end of July, I seemed to exhibit great improvement in RSI. For several consecutive days, I was able to increase my computer workload by 5-10 min every day. On one day, I was able to work at my computer (albeit with voice recognition) for as long as 40 minutes without any of my "front of shoulder pain / fatigue" problems. This was far longer than I had achieved for many months and quite an achievement even though I was still getting pain in my wrist, forearm and a "sharp pin" pain deep inside the shoulder. Nevertheless, to be free of the "front of shoulder pain / fatigue" was very pleasing and I thought it was down to a revised swimming technique. I had adapted the way I did breaststroke by lengthening my arms and thereby recruiting more of my shoulder and back muscles. I had this idea that using more of my shoulder and back muscles might somehow improve RSI and it looked like it did! Unfortunately, by August, I had reverted straight back to where I was before with terrible RSI pains.
Looking back, I now understand what had happened. The pain in the front of my shoulder was being caused by a trigger point in my infraspinatus muscle. The infraspinatus muscle is at the back of the shoulder around the scapula. However, it refers pain elsewhere and in my case to the front of the shoulder. There are many ways in which trigger points can treat RSI: injection, ice treatment, dry needling, spray and stretch, deep massage (my preferred option). All of these aim to release the trigger point and thereby take away the pain. What seems to have been happening is that my unusual swimming technique was recruiting and exercising muscles that were not ordinarily used. Indeed, after swimming, I could really feel that the muscles in my shoulder had been worked. These temporarily released the trigger point meaning that I had less pain. Unfortunately, I was not actually treating the trigger point properly so when the trigger point returned, the pain returned also.
Pains in the forearm, wrist, deep shoulder - of course, as I said already, the front of shoulder pain was not the only problem I was having. However, it was the most noticeable. I found that the forearm and wrist pains would come and go and if I rested my forearms on the table and avoided lifting them up I could be relatively pain-free. I also more or less resolved my forearm problems on a temporary basis by using a wrist support whenever I could. That meant that I could hold a phone to my ear or hold an umbrella without feeling pain. Later, I would learn that wrist supports (wrist splints) a very bad idea for RSI sufferers as discussed by Dr Pascarelli in his Complete Guide to Repetitive Strain Injury book. Looking back, I am able to understand that the forearm and wrist problems were also caused by trigger points, but again, I didn't know that at the time. These days, I still occasionally get the same old aches and pains in my forearm and wrists but when I immediately treat these through deep massage, they go away.
Unrelated RSI problems: at this point, I just want to mention a couple of pains I have had which were unrelated to RSI but are interesting learning points. The first was an instance of lower back pain that began in Autumn 2008 and was not fully resolved until early 2010. Throughout this period, I suffered from a lot of lower back pain and physiotherapists gave me stretching exercises which helped. I also used abdominal support belts and products such as thermal care heat treatment packs. These gave some relief but didn't thoroughly resolve it until I met my Pilates teacher in early 2010. He told me that lots of people with low back pain have symptoms caused by weak core muscles (in other words, weak tummy muscles!) . He gave me some very gentle exercises to build up my core strength – I can best explain these as very low level assisted situps (nothing like the difficult setups that school PE teachers used to make us do). Anyway, within a couple of weeks or so of doing these, my back pain which had troubled me for 18 months went away and never came back.
Another interesting story relates to a general pain I had on the left-hand side of my right knee. My physiotherapists and the above Pilates teacher had suggested stretching and simple exercises to build up other supporting core muscles but none of these ready worked. It was not until I chanced upon a section in the Trigger Point Therapy Workbook discussing trigger points in the knee area that I tried some treatment along these lines. Within days, my trigger point (muscle knot) pain had gone away. Of course, I'm not suggesting that trigger points are a magical cure for everything (they're not) but it is interesting that trigger point release was able to resolve not just my RSI but also an unrelated knee pain problem.
Autumn 2008: At about this time, my condition was getting worse despite having been swimming almost every day since April. Two problems were particularly noteworthy: the first was that my 'front of shoulder pain' was worse than ever. It was like I had a permanently fatigued right shoulder. I kept wanting to exercise or shrug my shoulders in an effort to reawaken the muscles but nothing was helping. Swimming didn't help (unlike in July 2008) and worse, some lower back pain was preventing me from swimming easily.
I had some brief respite by doing a rather strange exercise given to me by an NHS physiotherapist in January 2008. This involved being on all fours hands and knees, keeping my arms completely straight and pushing down into the floor with my arms. This was so that I put as much "force" as possible into my shoulders. This helped a little bit but didn't do a great deal. Looking back, despite trying this exercise periodically throughout 2008/2009, it did very little to help. Moreover, my neck pain was getting progressively worse. Sleeping with a thin pillow was no longer helping and by this time, I had to abandon the pillow altogether, sleeping flat in bed. This was very uncomfortable but the only way in which I could get up in the morning without having bad neck pain.
December 2008: just before Christmas, I realised things were not getting better despite lots of swimming. I booked in with a local physiotherapist called Mary (name changed) and explained to her my symptoms. At the time, I was more bothered about my lower back pain because it was with me all the time and preventing me from swimming. I still held to the thought that general exercise and swimming would make the RSI 'go away'. We did talk about the RSI as well, but I didn't get the impression she had many ideas. She gave me some stretching exercises for my lower back in order to ease the pain. As I've said already, these are pretty standard physiotherapy exercises and were helpful in giving temporary relief. However, I would not be fully over the back pain until early 2010 when I discovered that strong core muscles in the stomach area would give me a permanent resolution.
I never went back to see Mary again because there was little she could do for me in terms of RSI. The back pain would be generally manageable so I had no reason to discuss it again with her. Also, she was quite fond of using acupuncture and I must admit to having some doubts about the scientific validity of that technique.
Part Time Work
January - February 2009: I needed to work again so began a new job in IT; I was lucky to have a good friend who could offer me some work. It was only part-time, so I was only working short stints. I found that the only way I could keep the pain at bay was to continually switch between different types of mouse. I amassed a huge number of devices: various types of trackball, pen mice, trackpads, handheld mice, contour rollermouse and I became quite adept with Dragon NaturallySpeaking. I would have to continually switch between different device. Looking back, I think what happened is that my muscles were overused. By switching between devices, I will be using slightly different muscles each time and therefore, by swapping around my muscles could at least get just enough rest to avoid being in agonising pain. However, it was mostly Dragon NaturallySpeaking that got me through.
Work was hard because of the pain. I tried to do as much as possible with voice recognition software and minimal mouse movements. I also had great success purchasing a USB hub and plugging in lots of different mice, all available at the same time. I'm right handed and a typical setup would be:
- Have a Contour rollermouse in the usual position as a wrist-rest-come-mouse but only use it left-handed.
- Have a 'standard' mouse to the right of the keyboard in the 'normal position'.
- Have a trackball next to the standard mouse.
- Have a wow pen mouse right in front of me, just in front of the Contour rollermouse like it's a real pen and paper.
- Have a microphone headset for Dragon.
That way, I would have various different devices to use, alternating all the time. The next day, I would choose another set of gadgets.
March 2009: By now, my neck pain was very severe. At times, I would wake up in the morning with such a painful neck that I could hardly move my head. It was like my neck muscles were permanently in spasm. I went to see two more physiotherapists called Pete and Emma (not real names). They were based in different practices in different parts of the West Midlands. My basis was that a second opinion is always helpful. I had already seen an NHS physio and Mary, so this was me trying to find a third and fourth opinion! (As we shall see later, I subsequently went to see another 12 physiotherapists!)
When Pete was looking at my neck pain, he immediately remarked on how incredibly tense my upper trapezius muscles were. He also noticed that my pectoral muscles were very tight, all of which led to a kind of 'hunched over', head forward posture. He reckoned that all of this was related to RSI. To stretch my pecs, he recommended putting my arm against a door frame and leaning away from it thereby stretching the muscles. For my neck pain, he recommended more stretches -- putting one hand on my head and leaning my head to one side to stretch the neck muscles, before repeating on the other side. These are pretty standard physiotherapy exercises so if you do a search for "physio neck exercises" you'll get plenty of good advice.
He also gave me exercises for my lower back but these were essentially the same as those I had from Mary. Incidentally, you can find all of these exercises in two publications titled Treat Your Own Back & both Treat Your Own Neck by Robin McKenzie. I had purchased these books in February 2009 so I was already aware of these exercises when Pete gave them to me. These physiotherapy exercises were useful in limiting pain and giving temporary relief but they did not give me a permanent solution and did nothing for my RSI.
I went to see Emma at another physio practice in the W. Midlands. She gave me much the same advice as Pete and Mary but added something new: Pilates. I hadn't heard of Pilates until this point but Emma thought that my neck pain could be resolved by strengthening my postural muscles in my upper back. In Pilates, it is called a diamond press exercise. Basically, the main point of exercises to lie face down on your front, with arms out to the side and front, and use your upper back muscles to lift your head away from the floor (arms stay still and DON'T press down on the floor with your hands). This strengthens the important postural muscles that hold up your head.
It was not until a year later that I discovered that I was doing this exercise wrong. I must have misunderstood what Emma asked me to do because I used to push down with my hands against the floor in order to raise my head. it was only when I met a new physio in early 2010, that I discovered you should use your upper back muscles to lift up your head. Very annoying! Despite Emma's advice, I was not able to benefit from this technique for another year. These days, I still have to occasionally do this exercise because the neck pain does come back from time to time. However, after a few days of diligent effort, I find the neck pain goes away when I do this exercise.
Another false dawn
March/April 2009: Starting around March, my back pain was not quite so bad, largely because of the stretching exercises I had been doing. I was able to start swimming again properly and once again, I tried the slightly modified breaststroke technique I had used a year earlier. This technique was the same as ordinary breaststroke but I kept my arms straight for longer thereby recruiting my shoulder muscles more. As with the situation in July 2008, I could really feel my shoulder muscles being exercised and there was a typical soreness that one gets after exercising muscles. I really hoped that I could be back to where I was in July 2008 where I was able to work at the computer for as long as 40 min uninterrupted. (At the time, I still believed that the secret to overcoming RSI was something to do with shoulder muscles – something that my physiotherapists had indicated.) Unfortunately, nothing was really happening. At times, things did seem to be better and I remember telling some friends in March 2009 that "I'm back" believing that I was just about to recover from RSI. In fact, what seems to be happening during this time is something I personally called the two-week rule.
The Two-Week Rule
From autumn 2008 onwards, I had noticed an interesting pattern. If I had lots of things to do on the computer (like searching online for jobs) there were times when I might "overdo" things and my RSI symptoms would get much worse than normal. By "normal" I mean that ordinarily, I could probably work for 5-10 min at a time before the RSI symptoms appeared and caused me to stop. But if I overdid things, the RSI would get so bad that I could literally do no more than a few seconds work before I had to stop. What is interesting is that when things got really bad, I literally had to stop all RSI work for about two weeks, after which, I would be back to "normal" again whereby I could work for 5-10 min a time again. This two-week rule was extremely precise. In fact, from Autumn 2008 onwards, I have become accustomed to the idea that if I overdid things, I could simply rest and after about two weeks, I would be okay again ("okay" defined as being able to do 5-10 min at the time, as opposed to a few seconds). Occasionally, I would try to rest for longer but I never seemed to get any better than the 5-10 min. As I will explain later, the two week will seem to disappear sometime in late summer of 2009.
August 2009, Knee pain: after going on a walking holiday, I came back with pain on the left side of my right knee. This didn't have anything to do with RSI directly but contributed to making me feel depressed and powerless. At least in the past, when RSI was really bad, I could go into town and have a walkaround, or visit lovely towns like Lichfield, Worcester and other places. Now, I was unable to walk for more than 10 min before I would have a really bad pain in my knee. I soon discovered that a knee support kept everything at bay but that was quite uncomfortable to use. Since this is not particularly relevant to the RSI discussion, I won't discuss this matter any further suffice to say that I would have knee pain until about December 2010 before I overcame this problem. I discovered it was due to a trigger point, probably in a muscle such as the vastus medialis. After following advice in Clair Davies' Trigger Point Therapy Workbook, I was free of this problem in a matter of days.
RSI gets worse
August-September 2009: With some alarm, I discovered that the two week rule no longer applied. In other words, if my RSI got really bad, I couldn't just rest for a couple weeks and then be back to where I was before. No, I found that my RSI was now permanently in a really bad state. I could use a computer for literally seconds before pain would kick in. Things were starting to get genuinely worrying at this stage. The added problem was that a physiotherapist called Racquel had told me that my knee pain might mean I had to stop doing breaststroke. She thought that the knee pain might be caused by a medial knee ligament issue and that breaststroke, with its characteristic frog leg kick, would put undue pressure on the knee. This was not good news because I had been hoping that increased swimming might mean that my RSI pain would go away. Indeed, I remember that sometime in August, I had a marathon two-hour non-stop breaststroke swimming session!
Perhaps the only god thing was that in late August, I discovered that my exercise with the resistance band hooked over a door handle was done wrong. I realised that I wasn't squeezing my shoulder blades together so I wasn't exercising my lower trapezius. When I began to do it properly, I was amazed that the day after, I had muscle ache (delayed onset muscle soreness) of the type you normally get when you've been exercising muscles for the first time in ages. I would later be told by a physiotherapist was a good thing but I realised that anyway. I began to do this exercise daily, really pulling the resistance band back and bringing my shoulder blades together to exercise the lower trapezius. I had muscle soreness everyday for the next eight months or so from this exercise. That gives you an idea of how weak my lower trapezius was.
September 2009: At this time, I was trying to find more solutions for my "front of shoulder pain/fatigue". I had realised that several times during the last 18 months, I had used resistance bands with some good effect. I had developed a modified version of the exercise my original physiotherapist gave me so that after hooking both ends of the resistance band over a door handle, I would hold each end of the band and raise my elbows to shoulder height before pulling back in a rowing like motion. This seemed to keep the "front of shoulder pain/fatigue" problem at bay. I reasoned that it was quite similar to doing breaststroke so perhaps it was unsurprising that the results were similarly quite good. Unfortunately, round about this time, this resistance band technique, and breaststroke, began to stop working as a means of keeping the pain at bay.
November 2009: things were now getting very serious. My RSI was as painful as ever, meaning that I could spend no more than a minute at the computer before the pain would kick in. Happily, I was at least able to do some things on the computer because I was now getting quite competent with Dragon NaturallySpeaking. Nevertheless, my knee pain problem meant that I couldn't swim and my neck soreness seemed to be worse than ever. In fact, my neck was so bad that I found that if I held my neck still as when watching TV, it would be very painful. I was depressed and in despair at this point. I couldn't walk because my knee was in pain. I couldn't sit still because my neck was in pain. My back was still occasionally sore and I could do nothing at the computer because of RSI. And to compound this, my "front shoulder pain/fatigue" was now worse than ever meaning that I could hardly drive without pain in my right shoulder. I now resorted to driving one-handed with my left arm only. This called for some decisive action so I decided that December 2009 could be a time of complete rest with no computers in the hope that my pains would go away. I also decided to take six ibuprofen tablets every day as my GP had once prescribed.
December 2009: I did nothing this month, apart from resting at home. As the month went on, I became aware that nothing seemed to be getting better. I was now fully in despair. I was waking up in the morning with an incredibly sore neck. My right shoulder was constantly in pain/fatigue. I couldn't hold my forearms up without pain (something you do a lot when you have a mobile phone or hold an umbrella for example). I couldn't do any typing or mouse work on the computer without pains in my wrist, forearm or shoulder. I couldn't write with a pen. My lower back was often in pain. I couldn't walk very far because my knee was in pain. Moreover, I was now having problems my shoulder blades 'winging' which means that whenever I was lying flat on my back (as in bed) I could feel the bottom part of my shoulder blade (scapula) pushing into the mattress and it was very uncomfortable. I could only sleep on my side. I was at my lowest ebb. In late December, I decided that a new approach was necessary.
The next major breakthrough
2010 would prove to be the year when I would finally get better. But it all started with might have been a very brash and expensive 'everything but the kitchen sink' approach.
January 2010: I was now at my wits end. Things were looking really bleak so I decided to throw money at the problem. I took the last £3000 out of my savings account and decided I would allocate it all to private treatment. I decided to book appointments throughout the Birmingham/Coventry area for multiple private physiotherapists, two pilates trainers, one Alexander technique teacher, and an osteopath, all very expensive since most would charge £40-£50 per session. I also went back to my GP to ask for further specialist consultations. That may sound like overkill but this was the next major step in getting better. Although over half of the people I went to see were unable to help me, I managed to find several people who together, have today made me fit and healthy. I actually think the despair of December 2009 was good because it helped set up this "everything but the kitchen sink" approach.
January-April 2010 I am going to start with some negatives and talk about the things that didn't work. I knew that throwing money at the problem would mean that much would be wasted but it was the only way I could get the treatment I needed. There was no way of knowing what would or wouldn't work beforehand.
What didn't work: Alexander technique: this did next to nothing for me because it was too gentle. Also, it was not helped by the fact that initially, I went to see a near useless "teacher" in Handsworth who charged me £30 for half an hour of patronising nothingness. I later learned the Alexander technique from another teacher called Andy who was much better but he said that the problem with the Alexander technique is that it is too gentle, too passive to help somebody with severe muscle weaknesses even if taught properly. The problem with Alexander technique is that it is good for most people who just need to maintain good posture or need some correction of mild postural problems but RSI need something much stronger, more targetted. I didn't need maintenance or correction of posture, I needed rehabilitation and Alexander technique wasn't going to be enough. Andy suggested I try something else like Pilates or physiotherapy which helped confirm what I was beginning to realise for myself. Also, he warned also that there is no official accreditation for being an Alexander technique teacher so the quality of training can be quite variable. If you are going to try Alexander technique, search long and hard for the right person but it may not be helpful for RSI anyway.
What didn't work: Osteopathy: I have past experience of osteopathy and it didn't help but I was willing to spent £80 on two sessions with a different osteopath to try again since some websites advocate osteopathy for RSI. Sadly, it didn't help. However, I was impressed that the osteopath told me this in my very first session. She was very honest and said that she didn't think my problems were going to be resolved by osteopathy and that it might be best if I didn't book a second session. I really appreciate the honesty there. If anyone wants a recommendation for osteopathy in Birmingham, I can certainly recommend one.
What didn't work: Some physiotherapy: During the early part of 2010, I went to see 12 physiotherapists in the West Midlands. Unfortunately, most of these were unable to help me. Two in Coventry didn't really think anything was wrong and merely believed that stretching exercises would help; they noticed that my pectoral muscles seemed a bit tight so they recommended I do some stretching. One of them thought that neural stretching might help and gave me some exercises to stretch nerves running along my arms. One in Moseley thought that I needed to pay better attention to desktop ergonomics and general posture but sent me away without helping very much. Two others in Birmingham both thought that I needed to do rotator cuff exercises. Looking back, I don't think any of these were helpful.
What did work: Some physiotherapy: Other physios were much more helpful which didn't surprise me. After all, the reason I booked to see a dozen different physios was because I knew that RSI is very difficult to treat and multiple opinions help. Three physios in particular had some very good ideas about what was going on. They all recognised that some of my muscles were very weak, such as my lower trapezius, serratus anterior, and the postural muscles that hold up the neck and upper trunk. Interestingly, two of these physiotherapists were specialists in Pilates and strongly recommended that I undertake Pilates lessons to build up my core strength. In fact, I had already started to take Pilates lessons from two trainers in Birmingham, one of whom had experience with RSI and had seen problems like mine before. The other Pilates teacher was not quite so helpful but I still really appreciated her help because she helped hone my general posture even if she had little direct influence on the RSI. Of further interest is that the two physiotherapists who specialised in Pilates also had knowledge and understanding of trigger points (muscle knots) and both firmly believed that trigger points with the ultimate cause of my RSI problems.
In short, what these physiotherapists/Pilates trainers did was to give me exercises to strengthen my lower trapezius, serratus anterior and take the load off my overworked upper trapezius. One of the best exercises was called "Pilates arrow" but there were others as well. They all gave me various exercises to do at home, which I did diligently every day. I knew they were very helpful because after each session, I would feel very different, much better in fact. Some of my muscles would ache (called delayed onset muscle soreness) because they had not been used for a very long time. I could feel my posture being very different and I could tell that their particular exercises were making a difference for me.
There are loads of exercises that you can find on YouTube if you do a search for the muscles I have mentioned ie lower trapezius, serratus anterior. I mentioned before that I had discovered in late August 2009 that I wasn't doing the lower trapezius resistance band exercise properly. Months later, I was still doing the exercise every day and STILL feeling daily muscle soreness afterwards. On top of that, I was doing new exercises every day from my new physiotherapists/Pilates teachers. In fact, it would be 8 months of daily lower trapezius exercise before I would stop having the feeling of delayed onset muscle soreness.
What did work: Trigger Point Therapy: I will talk more about this later but for the first half of 2010, I mainly believed that rebuilding weak muscles would cure my RSI. Although it did a lot to alleviate the pain, it still didn't take it away completely. It was not until I discovered that trigger points (muscle knots) were ultimately the cause that I was able to get free of RSI. Trigger points and weak muscles are linked because trigger points tend to cause muscles to be shortened which in turn weakens them. Looking back, trigger point probably initially caused my RSI which in turn weakened my muscles which in turn exacerbated the problem.
What did work: Physiotherapy exercises / Pilates. I had joined a health club and was going every day for least an hour of physiotherapy exercises and Pilates. I also booked regular 1:1 Pilates sessions with two Pilates teachers called Adam and Carmen. This was costing me a lot of money but was very necessary. I could feel the difference every day. I was getting delayed onset muscle soreness DOMS in key muscle groups such as the lower trapezius after nearly every session. In spring 2010, I mentioned this to a physiotherapist and he wasn't surprised: apparently my muscles were very weak and he had seen cases like mine before.
I went to see another physio, Andrew in Warwick, and like others, he saw that my lower trapezius was seriously weak and contributing to overuse in my upper trapezius. The same message was given to me by a physio in Coventry called Angela. More than anyone else, these two encouraged me to really rebuild the lower trapezius muscle so that my upper trapezius could take a rest. This one bit of advice was very important. I mentioned earlier that I had a "sharp pin" shoulder problem that was quite severe. It was different to the "front of shoulder pain/fatigue" issue and felt like I had a sharp pin embedded deep inside my shoulder. When I first went to see Angela, she felt that there was a block of tissue in my upper trapezius like a small dense rubber ball. On one occasion, she even said it felt like bone even though it was of course very tight muscle tissue. They encouraged me to try to relax the upper trapezius and depend more on my lower trapezius for shoulder and arm movements. They gave me exercises to rebuild the load traps and before long, my permanently tense and tight upper trapezius began to feel more relaxed. Soon, Angela was unable to find this dense tissue and at the same time, the sharp pin pain in my right shoulder disappeared. A consultant had once told me that I might be suffering from thoracic outlet syndrome whether nerves are being compressed and causing pain. It may have been that the tight upper trapezius muscles were causing this particular sharp pin pain but none of the medical professionals I spoke to were able to be completely sure about this.
Another major problem was forearm pain. If I used the computer for more than a few seconds, I would get pain. Several physios believed that this was due to weakness in the muscles and suggested I do some work to strengthen these forearm muscles. My Pilates teacher suggested an NSD Powerball, which is a hand gyroscope for exercising the muscles in the arm. I purchased one from Amazon. I used this daily and could really feel the muscles in my forearm been developed. This brought me mild relief over the course of the next few months so I could use the computer for a little longer. Looking online, I note that many people have found power balls (hand gyros) to be very helpful in RSI. They weren't quite so helpful for me but they certainly gave me some relief by rebuilding weakened muscles. Later I will explain that trigger points were the cause of this pain.
February 2010: Some of the symptoms had gone away by now, such as my winged shoulder blade problem. A physiotherapist called Sara had given me an exercise called "push-up plus" to help build up my serratus anterior muscle. If you do a Google search for this, you will find many, many pages. It's very effective for getting rid of the problem of winging scapula. Incidentally, since then, I have occasionally had bouts of a winged scapula which I feel in bed when my shoulder Blade digs uncomfortably into the mattress and I have to resort to doing the push-up plus again to get rid of the problem.
Sara also took a look at my painful neck. For well over a year I had been waking up every morning with a very painful neck. The only way I could keep it at bay was by changing pillow every night and continually doing neck stretching exercises. Sara suggested I do a Pilates exercise called the 'diamond press' -- I have mentioned this already above -- and I was quite reluctant at first. However, she wanted to see me do it and I'm glad she did! She immediately saw that I was doing it improperly by pushing down on the floor with my hands. She taught me to do it properly which is to lie face down and use the upper back's postural muscles to lift the head. After doing this, I could immediately feel the muscles running along my spine having been used. Very soon, I was much better. One slight problem I had with this is that I tried to improve things by adding a weight to my head so that I was lifting a heavy weight. This proved to be a very bad idea, as we shall soon see when I talk about trigger points (muscle knots) in the neck. Anyway, when I later returned to doing the diamond press exercise properly, it resolved my sore neck problems. The problem, Sara explained, was that my neck muscles were doing the job of holding my head and they were becoming fatigued because they were constantly in use. This fatigue led to the neck muscles being very sore when I woke up in the morning. By building up the postural muscles in my upper back, my neck muscles did not have to hold my head which meant they could relax and not become sore.
At this time, I was seeing loads of physiotherapists. I saw 12 different physiotherapists in all in the West Midlands in the early part of 2010. Since most of them didn't do anything useful (two even believed there was nothing particularly wrong) I won't bother mentioning them. There were really three that were useful: Andrew in Warwick, Sara in Birmingham and Angela in Coventry. Andrew believed firmly in gym work and rebuilding weak muscles. Sara and Angela agreed but added trigger point therapy and Pilates to the mix.
March 2010: I was seeing real progress by now. I was telling my friends that I would be back to full health within weeks but little did I know that it would be another six months. Most of my symptoms have either become less severe or had disappeared. Annoyingly, the most important pain (in the wrist, forearm, shoulder) which stopped me from using a computer still persisted, albeit with slightly less severity than before.
March-April 2010: Although my symptoms were getting better, I still wanted to run things through with my GP, who is an excellent and very knowledgeable chap. He recommended taking a course of Amitriptyline which in low doses can be very effective for RSI patients. My GP recommended I take it for a few weeks to see if there is any improvement but sadly, it didn't do much for me, and neither did another drug called pregabalin.
During this period, I began to invent my own exercises. By now, I was quite adept and knowing when my lower trapezius muscle was being exercised. A number of physiotherapists had identified this as being a major area of concern so with the help of some resistance bands, I was soon hooking them all over hooks and nails and doors in my house and exercising. After each session, I could really feel my lower trapezius having been exercised. I would get delayed onset muscle soreness every day until about May 2010.
Work was proving to be reasonably acceptable. I was still changing my input device quite a lot, using a kneeling chair for better ergonomics and making good use of voice recognition software. I was working about four hours a day which although painful, was necessary in order to pay the bills.
June 2010: At around this time, I began to find that I couldn't tilt my head forwards and hold for any reasonable time, as for example when reading at a desk, or looking down at a newspaper held in front. My neck could be very sore if I tried to do this. This was very different to the neck pain I had been having for a long time. I soon realised that I was making it worse by doing the Pilates diamond press exercise with a weight on my head. I immediately stopped using the weights and return to doing the diamond press exercise properly. Unfortunately, I still couldn't tilt my head forwards and for the rest of the year, I was unable to read a book or newspaper unless it was held specifically at eye level. This in turn was very difficult because my forms were still very weak. It would not be until late November 2010 that I figured out this particular neck pain was being caused by trigger points in the levator scapulae. More about this later. Meanwhile, I was about to discover something new:
The next breakthrough: Trigger Points as a major cause of my RSI
Of the 16 physiotherapists I had seen up until this point, only two believed that trigger points were the major contributing cause of my problems. As a result, I hasn't really believed them and preferred to think about things like rotator cuff, pectoral stretching exercises and exercises to develop my lower trapezius. Although these were certainly important, it was not until the beginning of the summer that I began to realise that these two physiotherapists (Sara in Birmingham and Angela in Coventry) were right.
June 2010: I remember one day visiting Angela in Coventry and as usual, she was looking for muscle knots all around my upper body. I had been to see her a number of times already and mostly valued her for the Pilates work in which she sought to reduce the tension in my upper trapezius and rebuild the action of my lower trapezius. I didn't really think that trigger points were going to be very helpful but I was still being bothered by this "front of shoulder pain/fatigue problem". Angela was sure that this particular pain was being caused by a trigger point in the infraspinatus. On a number of occasions, she had hunted around this muscle, pressing firmly to see whether I reacted. Up until now, she found nothing and was getting exasperated, even a little embarrassed because she had been certain this was the cause of my shoulder pain. Anyway, on this particular day, I decided to reach round with my left hand and see if I could feel a trigger point in my infraspinatus. A trigger point, when you press on it, is exquisitely painful. There is no other way to describe it but when you press on an active trigger point in a muscle, it is very painful, and sometimes refers pain somewhere else. To my surprise, I found the trigger point very quickly – it was exquisitely painful but most importantly, exactly reproduced the feeling of pain/fatigue in the front of my right shoulder. This was an extremely important breakthrough.
I had been suffering from this pain in the front of my shoulder for a very long time. Since the end of 2009, I had been driving one-handed because my right shoulder was in a constant state of fatigue/pain. Now, with the help of Angela, I discovered that it was caused entirely by a trigger point in my infraspinatus muscle. The only other physiotherapist who believed that trigger points were the cause was Sara in Birmingham. She had also occasionally looked into the infraspinatus but hadn't found a trigger point. The next time I visited her, I told her about it, and she treated it straightaway.
I only saw Sara and Angela each once a week and although the trigger point was effectively dealt with at each session, I was still in pain the rest of the week. In late June, I purchased a copy of The Trigger Point Therapy Workbook and discovered that trigger points really need daily treatment, especially if they are deep-seated and have been around for a long time. Interestingly, Sara and Angela had very different ways of treating trigger points. Sara preferred dry needling using acupuncture needles whereas Angela preferred using ice or gentle strokes across the skin. Both were effective but The Trigger Point Therapy Workbook suggests deep massage and I think this is the best method personally.
July 2010: It was very difficult to treat the infraspinatus trigger point by myself so in early July, I purchased something known as a Body Back Body from Amazon which is a long S-shaped rod that enables you to massage your own back muscles. Several times a day, I was able to use the back buddy to deep massage the trigger point. It was initially quite painful to do because trigger point are exquisitely painful to press. It would take over a month of daily self treatment before this particular trigger point would go away. Since then, I have never again experienced this pain in the front of my right shoulder. Occasionally, I feel a slight sense of fatigue in my right shoulder, and I find that a quick massage of my infraspinatus will reproduce the characteristic exquisite pain and referred pain indicative of a trigger point. Massaging it for a short time releases the trigger point and the pain always goes away.
July 2010: I now began to work full time albeit in pain. I had been part time since January 2009 varying between 3 and 5 hours per day.
September 2010: By now, I was free of my front of shoulder pain/fatigue problem but I was still finding it difficult to use the computer because my forearms were still very weak. Various physios from the beginning of January had been giving me exercises to rebuild the muscles in my forearm. My Pilates teacher had suggested a power ball to strengthen my forearms but I was beginning to wonder whether there was more than just muscle rebuilding required. Indeed, I could visibly see that my forearms were bigger but I was still getting pain. When I thought about my other RSI symptoms, I remembered that it wasn't just a case of rebuilding the lower trapezius muscles but also eliminating the trigger point in my infraspinatus.
During this month, I concentrated heavily on treating trigger points in my forearms. The most serious problem was a general pain along the top of my forearm which for 3 years had typically prevented me from using my computer for more than about 10 minutes. Throughout the spring and summer, I had been using a Powerball and a small 1 kg weight to rebuild strength in my forearm but although my symptoms improved, I was still getting RSI pain.
NSD Powerball (A quick word on Powerballs by the way. I've seen a number of articles on the web about Powerball and RSI but as my Pilates teacher explained, what is not always emphasised is that RSI sufferers must spin the Powerball SLOWLY if they are trying to rehabilitate muscles for endurance and spin quickly ONLY if they are trying to bulk up muscle and build raw strength. I originally made the mistake of spinning the Powerball very quickly thinking I was saving time by getting necessary exercise done faster. In fact, for RSI sufferers with weakened forearm muscles, low-level long-duration Powerball work is better for rehabilitation. My physio Sara was not so fond of Powerball and preferred small 1 kg weights but she also made the same point: she said to never use heavy weights because for RSI, it is not more strength that is needed but low-level endurance and rehabilitation.)
For several months, Sara and Angela were both convinced that this general "top of forearm" pain was due to several trigger points located closely together where the muscle is at its thickest (near the joint between forearm and upper arm). Originally, I wasn't very convinced by this because although the muscles were sore at the top of that thick part of muscle, it wasn't producing any referred pain when it was being treated. However, by now I had learned that trigger points (muscle knots) do not necessarily refer pain elsewhere. They are always painful when pressed but they don't necessarily refer pain. I decided to see if trigger point therapy might eliminate RSI pain.
I decided to follow the instructions given in The Trigger Point Therapy Workbook and began daily massage of the trigger points in the thickest part of the muscle at the top of my forearm. I found it was quite useful for relieving the pain but not a lot happened at first. It was only after several weeks of doing this that I began to notice significant differences. In fact, by end September, this generalised RSI pain was largely resolved. This was a big breakthrough because until then, I was largely relying on the Powerball to rebuild weakness in the forearm muscles. But as Sara had explained with my other symptoms, the rehabilitation of weakened muscles was not enough: I also needed to deactivate the trigger points. Remember, trigger points cause muscles to be used inefficiently and shorten the fibres thereby weakening the muscles and exacerbating the problem. The rehabilitation of weakened muscles resolves part of the problem but the trigger points also needs to be deactivated.
Looking back, Sara and Angela were both correct. The generalised pain along my forearm was caused by my muscles complaining about being overworked. They were utterly fatigued and that was causing the pain. Two things needed to be done: rehabilitation of the weakened muscles and release of the trigger points that were the underlying cause.
In fact, I should have fixed this earlier because months previously, Sara and Angela both thought that trigger points might be causing pain in my forearms. The problem is, at the time, I was a bit dubious about whether trigger points could be causing my forearm pain so I didn't really take them seriously. Now, I realised they were right so I looked more closely at the pain patterns in Simeon Niel-Asher's excellent book The Concise Book of Trigger Points as well as looking at information in Clair Davies' Trigger Point Therapy Workbook. I found several pain referral trigger points causing the pain not just in my forearm but also in my wrist. Between September and early October, I daily massaged various muscles in my forearms. Of course, I didn't find trigger points in every part but there were a number of locations around my forearm where I was able to reproduce the characteristic exquisite and referred pain that was producing the pain along my upper forearm and wrist.
Remember: Trigger Points Refer Pain Elsewhere
What this means is that the pain you feel is not necessarily at the site of the actual problem. Normally, injured tissue is painful at the site where the damage occurs -- if I cut myself with a knife, the pain is located at the very site where the skin is pierced. However, with trigger points, we feel pain in places where there is no problem at all. What seems to happen is that the brain gets confused about where the pain stimulus is coming from and we end up feeling pain some distance away from the real source of the problem. In other words, the trigger point (or muscle knots) REFERS pain to another location. The site of the trigger point itself is often not particularly painful.
September-October 2010: During this time, I began to get pain on the outside of my upper right arm. It would appear as a debilitating pain that became increasingly sharp the longer I use the computer. I suspect I would have encountered it earlier in my RSI journey but because other pains would kick in first, this one never had the opportunity to arise. By late September 2010 I had fixed the problems in my forearm and wrist so I was working for long periods at the computer. it was then that I would start feeling this "outside of upper forearm" pain. I only had this pain in my right arm, probably because I'm right-handed use the mouse a lot with that arm.
I looked up the symptoms in the Trigger Point Therapy Workbook and initially thought that the pain was coming from my deltoids. When I tried to treat for trigger points in the deltoids, I didn't have any luck. I looked more carefully in the book and realised that the pain was actually related to a trigger point in my bicep. Indeed, I found the trigger point right in the belly of the thickest part of the bicep. I massaged this regularly with the knuckles of my left hand. The pain relief was near instantaneous and within days, this problem had disappeared. I do still occasionally feel a twinge of ache in the outer part of my upper arm and I always discover that a trigger point has emerged in my bicep. Upon treating, the problem disappears straight away.
Fit again!
Mid October 2010: I went out for a delicious curry near my house! This was a celebratory meal. For over a week, I had been able to work at the computer for over an hour at a time without any RSI pain. I was elated and declared myself free of RSI! I still had other aches and pains (see below) but at least I was able to use a computer and return to the kind of job I had been doing before. For the next few months, I still regularly needed to massage my forearms to eliminate pain caused by trigger points that threatened to return, but since October 2010, I can pretty much work at the computer for as long as I like, usually about eight hours of a day.
Separately, I was still suffering from pain in my right knee and although this was unconnected to RSI, I mention it again because I went to see an NHS physio who advised various stretching exercises for muscles in my legs. This brought temporary relief but I needed to do the exercises daily in order to keep the pain at bay. I would later discover that trigger points were behind this problem as well.
November 2010: Although I was free of computer RSI pain, I was still having raging neck pain, essentially unable to hold my head in any position except "head-up vertical". Although this meant I could use a computer, watch TV, drive a car and many other things, I couldn't do anything like write on the desk. In the middle of November, I had dinner with a friend who was much shorter than I was. We were in the middle of a busy city and often I couldn't hear her talk so I kept having to lean over to my site to trying hear her properly. Unfortunately, it was very painful to hold my neck out in the leaning position. It was also becoming very painful to turn my head around or look behind me. I knew something had to be done about this neck pain. A week later, in a flash of inspiration, I decided to look through Clair Davies' Trigger Point Therapy Workbook and discovered that my symptoms exactly matched the problem of trigger points in the levator scapulae and trapezius. This is what the book says on page 60:
"Trigger points in the levator scapulae muscles cause pain and stiffness in the angle of the neck. When sufficiently active, they also refer a lesser degree of pain along the inner edge of the shoulder blade and to the back of the shoulder. A levator scapulae trigger point is what keeps you from turning your head to look behind you when you're backing up in your car. You may not be able to turn your head at all toward the side that has the trigger point."
Here is what it says about trigger points in the trapezius muscle on page 57:
"It's important to know that they are a major cause of pain at the base of the skull, which may be felt as either a headache or a sore neck. This referred pain very often induces satellite trigger points in the muscles of the back of the neck. When neck massage feels good but doesn't get rid of the pain, the problem may be in the trapezius muscles not the neck."
I treated the trigger points (muscle knots) with deep massage of the muscles and the pain went away within a week! Today, months later, I still occasionally get slightly sore neck muscles but when I look for a trigger point (or muscle knot), I always find one and with a few massage strokes, it goes away and my neck pain disappears.
December 2010: I still occasionally had some lingering pain in my wrist but this was easily resolved each time it appeared by massaging deeply the parts of my inside forearm (the palm side of the forearm). There are two significant trigger points for wrist pain. One is located in the thick part of the muscle near the elbow on the inside forearm. The other is located halfway up the forearm on the lower side of the inside forearm. Pressing and massaging deeply these two trigger points would give very effective relief from RSI pain in the rest.
Separately, I was also still suffering from pain in my right knee. I was finding the daily stretching exercises to be a real chore and wondered whether trigger points might be the reason. I looked up the trigger point symptoms in the two books by Niel-Asher and Davies and discovered that the pain on the left-hand side of my right knee might indeed be related to a trigger point. I immediately found a trigger point and treated it with deep massage. The pain went away straightaway and has never been back.
January-February 2011: Most of this period was about consolidation. I was essentially free of pain and working full-time but occasionally, at the end of the day, I could feel the various aches and pains and fatigue beginning to reappear. I learned that it was useful to continually massage troublesome trigger points (muscle knots) in my forearm and bicep and I kept a back buddy with me all the time so that I could deal with any troublesome trigger points in my back.
March 2011: This webpage was built at the end of March after I had been free of RSI for a few months. I must admit, there are still occasions when I feel very slight degrees of pain in the same locations as before but I have always found that treating the trigger point underlying the pain immediately resolves the issue. I am now full-time back at work in an IT job once again. I have found that on occasions, the neck pain and the winging scapula issue returns but some Pilates / physiotherapy exercises soon awakens important muscles (e.g. serratus anterior) and the problem goes away.
Finally, let me repeat something very important: I'm not a doctor or physiotherapist and have no medical training. Don't take my word for anything medical. Get professional medical advice – the only reason I am writing this website is to tell my personal story. But as I would emphasise throughout, there are not many medical professionals who have experience or skills with RSI. I spent a lot of time and money on multiple professionals before I found some who could help me. This is really a personal diary, which is why so much of it is long-winded but I need to write down what I've been through. If it helps somebody else, that's great too.
May 2011: Still fine and very healthy thank goodness. The Ergo Matters website has a blog entry dicussing this website and trigger points. I was also given the opportunity to write a guest post in which I cover briefly some of the most important points mentioned here.
Jun 2011: Still healthy but for a few days at the end of May, I was slightly hampered by a small ache/pain in my right forearm at the back of my wrist. It didn't stop me from working but it was an unwelcome feeling. If you were to wear a wristwatch on your right wrist, the location of the watch would mark the place where I felt ache/pain. The strange thing is that I've NEVER had pain here before. Previously, my forearm pain had been further up my arm, in the thickest part of the forearm, not at the back of the wrist. I looked at the referred pain patterns in Davies' Trigger Point Therapy Workbook and found that the best fit seemed to be the subscapularis located near my shoulder blade (pp 93-95). However, the book says that this also causes pain at the back of the shoulder as well as the back of the wrist. I only had pain in the back of the wrist so it wasn't a perfect fit but I decided to investigate for a trigger point. To my surpise, I did indeed find a very sore trigger point at the site of the subscapularis. I treated this and the pain seemed to go away very quickly. For several days it returned but I treated the trigger point each time with success. For over a week now, I've had no pain at all, and my subscapularis is completely free of the previously very sore trigger point.
This is very interesting because it demonstrates a few things: (1) I seem to be prone to new trigger points and new pain appearing in places where I never had problems before. (2) From experience, I am now able to recognise when a 'new' trigger point has emerged. In this case, it started off as an ache/low-level pain and I just got the 'feeling' that it was trigger point induced (3) As a result, I was able to treat the newly emerged trigger point immediately with very quick success perhaps demonstrating that trigger points disappear more quickly when treated quickly. (4) I am totally dependent on books like the Trigger Point Therapy Workbook. This trigger point is located underneath the shoulder blade near the armpit. There's no way I would have guessed that this could be causing pain at the back of my wrist. If you have the book, take a look at Fig. 5.23-25 to see how awkward it is to massage the spot. (5) You have to research trigger points quite carefully. I wasn't convinced that the subscapularis was responsible but since no other referral pain pattern matched, I went with it. Glad I did too: it was indeed the correct trigger point location.
Anyway, apart from those few days of minor ache in May, I'm still in full health thank goodness.
August 2011 : Everything is still okay and I'm still free of RSI. However, I had a brief scare in mid-late July when I began to find some pain in my biceps and forearms appearing. I also found some minor pain occurring in the front of my shoulder. My usual massage from previous experience described previously didn't help so I took a look through the trusty Trigger Point Therapy Workbook and decided to check out my scalenes. It is quite hard to find scalene muscles so I just decided to gently prod the side of my neck with my fingers. I found it quite easy to reproduce the pain pattern appearing in my forearm, bicep and shoulder. Within days, the pain has subsided although I was left with a numb thumb which after several weeks, is still here. Anyway, the pain soon disappeared (thank goodness) but it does prove once again that I am very prone to re-occurrence of RSI-like symptoms and that new trigger points can appear in places I've not previously had them. I don't think I've ever had trigger points in my scalenes before so this is a new one on me. Thankfully, I've learned from experience to be super-aware of trigger points and immediately look for them as soon as I feel any pain.
Also in late July/August, I developed frozen shoulder. I was unable to raise my right arm-shoulder level. Fortunately, I had already learned from the books by Davies and Niel-Asher that frozen shoulder was caused by trigger points. I immediately set to work on my shoulder muscles and was over this particular problem within weeks. I've met a couple of other people who've had frozen shoulder and their recovery (using typical physiotherapy solutions such as stretching and light exercise) took around a year.
January 2012: Everything is still fine. I get a lot of e-mails from people with RSI and some from people who have recovered. It is amazing to learn about the number of times when trigger points have been the root cause of this condition.
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If you want to write to me, I'm at jimj@live.com
Links: Useful websites on RSI to look at:
Ergomatters RSI Blog http://www.ergomatters.co.uk/blog/
How I Beat RSI (Repetitive Strain Injury) http://www.howibeatrsi.com
The Trigger Point Therapy Workbook website http://www.triggerpointbook.com
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