A repetitive strain injury is something that anyone who works extensively on the computer is at risk of developing.
In my industry (Sound Engineering), I think audio editors are the ones at greater risk. It happened to me, almost 10 years ago, after a particularly intense day of mouse use.
A small sting in my forearm was all that was needed for me to know things would never be the same. That was the beginning of my injury and it took a while to understand how to manage it.
Now that I’ve been doing it successfully for almost a decade, I’d like to share with you some tips.
Disclaimer: I’m not a doctor, and as far as you’re concerned, I may have no idea of what I’m talking about. What worked for me may not work for you. Consult with your doctor to get personalized advice. If you apply any information you read on this article, you agree to take full responsibility for any undesired consequences that may result from it.
A Brief Theoretical Explanation
Not all injuries to a tendon are the same. When discussing Repetitive Strain Injuries, a distinction very important to make is between tendinitis and tendinosis, because they require different treatments and timelines.
In the scientific article Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters, the differences are made clear, which I’ll sum up:
Tendinitis:
- Inflammation of the tendon;
- Occurs when the tendon is exposed to a force that’s too heavy and/or too sudden for it to handle;
- Can be treated with nonsteroidal anti-inflammatory pills or corticosteroid injections;
- Weighted training is harmful for recovery;
- Can heal in several days.
Tendinosis:
- Degeneration of the tendon’s collagen.
- Occurs due to chronic overuse of the tendon.
- Nonsteroidal anti-inflammatory pills and corticosteroid injections have been shown to inhibit collagen repair, making them unsuitable as treatment options;
- Weighted training is beneficial for recovery;
- Tendons require over 100 days to make new collagen, making the recovery time over 3 months.
Disclaimer: By now, you see that it is important to actually know what you’re suffering from. Be aware of the dangers of self-diagnosing. To be 100% sure, consult your doctor.
Treatment and self-care for tendinosis includes:
- Rest;
- Ergonomic and biomechanical adjustments;
- Light stretching;
- Applying ice;
- Eccentric strengthening;
- Massage;
- Nutrition;
The tips I’ll share will be regarding Ergonomic and Biomechanical Adjustments and Eccentric Strengthening.
Ergonomic and Biomechanical Adjustments at the Computer
After someone gets RSI from mouse use, it is common to think that the solution comes from switching to a different, more ergonomic pointing device.
However, there’s a problem: if you do that, it will only be a matter of time before you get RSI somewhere else, depending on the characteristics of the device you choose.
That’s because the problem is not the mouse itself*. It’s using a device – any device – repeatedly.
*Sure, vertical mouses are better ergonomic alternatives to regular mouses, because they prevent the rotation of the forearm and so on, but just switching to one of those won’t solve the main cause of the RSI.
The secret is not finding the perfect device – it’s avoiding repeating the same physical movement many times in a row.
Instead of getting rid of my mouse, I did this instead:
1. Using Windows Keyboard Mouse
On Windows, clicking SHIFT+ALT+NUMLOCK activates the Keyboard Mouse.
This will replace the Numpad of your keyboard with mouse functions. The most useful are:
- Key 5: becomes a mouse click;
- Key 0: mouse click hold;
- Key . : mouse click release;
- Key + : mouse double click;
Since the numpad is located on the right side of the keyboard, right next to the mouse, now the right hand can distribute how it operates the mouse: sometimes it clicks using the mouse itself, sometimes it clicks using the numpad (using your thumb to do it is very practical this way).
2. Getting a Second Numpad
To take even more advantage of the Keyboard Mouse feature, the next step is to buy a second numpad. This way, you can place it on the left side of the keyboard, so that it can be used with multiple finger of your left hand: index, middle finger and thumb.
With a mouse and two numpads, the number of mouse clicks is much better distributed over the various fingers of both hands.
3. Using an Ergonomic Mouse
It is possible to use a regular mouse in a way that resembles a vertical mouse and I have done it for many years, with the wrist slightly tilted to a more neutral position.
However, nothing beats using a nice vertical mouse.
It took me more than one try, but I used this technique while looking for a good ergonomic mouse.
I highly recommend the Perixx-519 mouse, it’s the most comfortable vertical mouse I’ve tried.
4. Getting A Pen Tablet
Acquiring a Pen Tablet is an important step to help dilute the load on the tendons.
This is because using a pen to interact with the computer is a quite different physical action from using a mouse or pressing a key.
I happen to be left-handed, so it’s convenient for me to use the setup like this:
I can operate the mouse with one hand and easily switch to the Pen Tablet. If you’re right-handed, you may have to adopt a setup different from mine, or learn to use your left hand.
I use one of the cheapest pen tablets that Wacom makes. I don’t think this model still exists one the market, but you can find a similar one like the Wacom Intuos.
5. Getting a Track Ball
Finally, I also use a Tracking Ball to add even more variety to my hand movements.
I tend to use it more when I have a lot of scrolling up and down to do. Its rotationary ring allows you to do that very quickly and comfortably.
I use one of the cheapest Kensington trackballs, the Orbit Trackball.
6. No More Double Clicks
It is possible to modify the Windows settings to allow access to folders and files with one click instead of two.
Step 01: Go to This PC;
Step 02: Go to View tab;
Step 03: Click on Options;
Step 04: Select Single-click to open an item > Underline icon titles only when I point at them;
It may take some time to adjust to this new way of operating your Operating System, but eventually it becomes something natural, and has the advantage of reducing the number of clicks required per day.
7. Getting RSIGuard
As far as I’m aware, this is the best RSI software on the market.
It monitors your clicking and typing activity and makes you take a break when you exceed a certain limit. The threshold for these breaks can be adjusted: higher threshold and longer breaks, or lower threshold and shorter breaks.
During these breaks you will rest your tendons. You can also get up and walk, stretch, drink water and rest your eyes.
I don’t have this software turned on all the time, only when I know I have a lot of work to do, and need a reminder and extra help to take breaks.
RSIGuard can be downloaded at https://www.rsiguard.com/
8. Software Adjustments
There are some software that allows to find optimized solutions through customizable keyboard shortcuts. This can reduce the number of clicks and key presses needed to perform a certain task with the software.
One example is the software from Adobe.
In my case, as an audio editor, I am certainly fortunate. If you also share this profession, be aware that the Steinberg Cubase and Nuendo software are extremely flexible in this sense, due to their keyboard shortcuts and, more importantly, the macros.
Strengthening
According to the study, another aspect that helps to improve the injury is eccentric exercise, 1-2 times a day for 12 weeks.
Eccentric strengthening is “lengthening a muscle while it is loaded and contracting.
In another study (Tendinosis: Pathophysiology and Nonoperative Treatment), it is said that eccentric exercises had benefits to the tendon, while concentric exercises showed no benefits (but it’s not harmful either).
Disclaimer: One of the studies also suggests that it can be helpful to consult with a physical therapist to maximize the benefit of strengthening exercises and to minimize the possibility of re-injury.
If you proceed with the following exercises without medical supervision, you agree to take full responsibility for any undesired consequences that may result from it, which can include no improvement of the injury or even physical harm.
Forearm Extension
The forearm extension should be done with a light barbell or dumbbell, sitting down with a straight back.
The concentric portion of the exercise happens during the upwards motion of the barbell or dumbbell.
The eccentric portion of the exercise happens during the downwards motion of the barbell or dumbbell. Since this is where the benefits occur, slowing down the movement during this part is important.
Dumbell Neutral Wrist Curl
The dumbbell neutral wrist curl should be done with a light dumbbell, sitting down with a straight back.
I always felt this exercise is the best at targeting the portion of the tendon that’s affected by mouse clicks.
There should be no tension on the hand. There’s also no need to grip the dumbbell hard. The forearm commands the motion, not the hand or wrist.
Powerball
The powerball is a gyroscope that produces great resistance to the hand and forearm in a rhythmic and non-impactful way. This stimulates the muscles and tendons in a way that barbells and dumbbells don’t.
You can find many people suffering from forearm RSI saying good things about it. Here’s professional violinist Rik Evans testimony:
“I am a professional musician in a symphony orchestra in Glasgow, and experienced RSI problems down the front and back of my left forearm as a result of playing viola for a living. My arm and wrist were constantly throbbing from the moment I woke up in the morning.
I tried many different remedies for my problems: massages, acupuncture, ibuprofen cooling gel, stretches. Nothing helped. Then I tried Powerball. Withing 48hrs, my problems were already getting noticeably better. After a just week the RSI had disappeared entirely. This was after a solid 8 months of problems.”
There are many Powerballs on the market. Mine is one of the cheaper Powerball models.
Fat Gripz
Fat Gripz are, essentially, a rubber grip you can attach to barbells and dumbbells to make them thicker, helping you activate more muscle fibers.
When I go to the gym, I use Fat Gripz. Not on every exercise – mostly when training back and biceps. Ironically, I don’t feel they’re the best option when doing forearm exercises.
I don’t like the regular blue Fat Gripz version because they’re too thick for my overall grip strength, and many times I just end up feeling all the tension on my fingers, instead of on my forearms. And that’s not good…
The thinner, Fat Gripz One Series version, is perfect for me.
Ultimately, though, I consider the Fat Gripz an optional accessory, only for those who train at the gym. Still, I like them because they give my forearms a good workout, and stronger forearms are better than weaker forearms when it comes to RSI management.
Conclusion
As far as I understand it — and my personal experience tends to confirm this — it is very unlikely that a tendon suffering from tendinosis will ever recover to its original state.
However, with proper care and discipline, it is very possible, and even expected, to be able to return to a pain-free, fully functional tendon, and staying there most of the time.
Of course, the key term here is proper care: besides the things I talked about in this article, let’s not forget that other self-care recommendations were mentioned in the scientific article Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. Applying them all with discipline will surely make things a lot better for those suffering from tendinosis.
Take care and get well soon!
