Guide to Navigating RSI as a Software Engineer
This blog post is the result of many friends and acquaintances asking for advice on how to deal with repetitive strain injuries (RSI) at work. I’m a software engineer, and it’s almost a rite of passage to go through some form of RSI, usually accompanied by nerding out over different keyboards (and keyboard layouts, if you’re really geeking out on ergonomics).
I put together this list of useful tools I discovered during my recovery from RSI. (To hear more about my recovery, see this blog post). I hope folks can use this as a resource if their hands start hurting. Pain is real (even if it’s not structural), and it sucks. But it’s good to know that your body is designed to heal itself! Sometimes it just needs some help.
Disclaimer: I am not a medical or legal professional and this is not medical or legal advice!
Consult a medical professional if you are hurt. I wrote this guide for myself and my coworkers to highlight some of the most useful tidbits I learned through my experience healing from RSI.
If you’re in pain…
When the pain is acute or present at rest, do contrast baths. Fill two buckets — one with iced cold water and the other with hot water. Submerge your hands and forearms (up to your elbows ideally) and switch every minute for a total of 10 minutes. This is what helps me the most with pain and inflammation. It’s better than ice or heat alone because it alternates vasoconstriction and vasodilation to increase blood flow and reduce inflammation.
Also start taking ibuprofen (or your favorite NSAID) and be consistent about it for a few days until the acute pain is gone. Be sure to take it with food to avoid an upset stomach. If you don’t like pills or prefer a more localized treatment, there are NSAID gels that work too.
Rest. Take note of what movements and activities hurt, and avoid those for now. Wear socks on your hands to stop using them if you find yourself accidentally doing things that hurt.
- I had mixed experiences with splints — they forced me to compensate with other fingers that started to hurt while my thumb got rest, but they did help me from waking up with pain after sleeping in an aggravating position.
- Accessibility tools: Your phone and computer have voice control if you’re on iPhone or Mac. (I’m not that familiar with other operating systems). Learning to use voice control will help you get by with your “necessary” phone/computer usage without worsening your symptoms. If you want to work, use Talon, but I would recommend waiting until your hands are well enough to do some typing to set it up. The tech is not what you’d hope for in 2023 so be cautious if the frustration of using it interferes with your rest.
Understanding pain, even if you just have twinges of it
It’s important to understand that pain is a sensation created by your brain to protect yourself. Consider why you started feeling pain. Don’t skip this step! It’s easy to jump to hand exercises or distract yourself doing contrast baths, but those will just address the symptom in many cases. The root cause of your pain for a repetitive strain injury (not an acute I-tore-something injury) is likely tied to some combination of changes in habits, your mental state, and your environment.
Ask yourself, what is the pain trying to tell me? Sometimes it’s obvious — “Please have better ergonomics! Your thumb keeps going under your hand when you try to copy + paste.” Sometimes there are easy solutions — using the opposite command key instead of the one on the same side.
Other times, the reason is less obvious. If your pain is telling you, “You’re doing too much typing! Pls stop,” it’s important to acknowledge that and take a break. I found it incredibly useful to pay attention to the emotions I was feeling: fear that stopping now would mean stopping forever, worry that I wouldn’t be able to catch up on my work, and anxiety that I was causing permanent damage to my tendons.
Going to an occupational therapist who specializes in hands will be useful if you would benefit from ergonomic advice, learning strengthening exercises, or if you have scar tissue that needs to be broken up. However, if your pain is chronic and does not respond to the “obvious” treatments, it might require some additional mental work. (This was the case for me).
At first my pain was caused by overuse/repetitive motions that were not ergonomic, but the doctors and occupational therapists I worked with instilled fear in me as an incentive to make me adhere to the treatment plan. They unintentionally sowed the seeds of anxiety by telling me that if I didn’t heal well, I would likely need surgery later and that my wrists would never be the same again. Well-intentioned but not very reassuring words!
Fear and anxiety put your brain on high-alert, a state of constantly assessing the potential for danger. For me this manifested as:
- worrying if I was doing “too much of X” or “not enough of Y”
- avoiding certain activities due to fear
- blaming myself for pain I was experiencing “if only I had not done Z”
Hypervigilance and oversensitivity led to my brain to create more pain every time I tried to go back to my activities. I learned that the only way to truly reduce the pain outside of avoiding the triggering activity was to do the activity in small doses and reassure myself that actually, [insert your painful activity] is _safe_. This strategy comes from the book The Way Out by Alan Gordon and Alon Ziv. They also published a helpful app called Curable with guided meditations, exercises, and podcasts with more information about how you can retrain your brain to stop creating pain in response to triggering activities.
Prevention and healthy work habits
Humans did not evolve to be mostly stationary all day. Humans did evolve to do complex tasks with their hands.
Ergonomics
Experiment with your setup. Everyone’s body is different, so ergonomics look different. There’s no one ideal keyboard, mouse, chair, desk etc. If it works for you, it’s great! Here are some general guidelines:
- monitor should be at eye level, avoid looking down at laptop or to the side to another display if it’s always on the same side
- elbows at >=90 degrees
- wrists neutral — that means your hand and the top of your forearm form a straight line. You can tape a pen to your forearm to get used to this position
- both feet flat on the ground
- hip angle >= 90 degrees
- The best posture is your next posture. In other words, don’t stay in the same position for too long. Alternate sitting and standing if you can.
- Stack head, shoulders, hips, knees, feet. This position should not feel straining. If it is, it won’t be sustainable. In particular, shoulders and lower back muscles should be relaxed. (I do this by breathing into my back and abdomen). See 8 Steps to a Pain-Free Back by Esther Gokhale for a full guide on posture.
- keyboards: there are so many options! Split, tenting, curvature, distance to modifier keys are all features to pay attention to.
- keyboard layout: likely unnecessary to go down this rabbit hole, just remap the modifier keys to be more convenient. That’s probably good enough. (I have caps lock remapped to be control).
- mouse: try different types — trackpad, vertical, ball
Avoiding mouse usage
- vimium browser extension to make navigation by keyboard easy
- shortcat: like vimium but for mac
- vim (or equivalent keyboard-based text editor): for code editing this is super helpful. Also a prerequisite for talon, if you want to learn voice control.
- learn your keyboard shortcuts! especially in your code editor, terminal, browser, slack, discord, whatever apps you use most frequently
Take frequent breaks
Work in short chunks — I do 25 minutes on, 5 minutes off. A watch timer works great for this. My breaks vary, but it’s good for your eyes to look 20 feet away if you’ve been staring at a screen and to walk around a bit. This increases circulation, focus, and gives you a chance to stretch or do exercises for RSI. Usually I take this opportunity to switch sitting and standing.
Break ideas:
- grab a snack
- stretch
- massage yourself
- refill water
- use the bathroom
- be mindful for a minute
- listen to a song
A benefit of working in chunks is that you learn just how much you can accomplish in 25 minutes of focus, and it incentivizes you to break big tasks into small ones. The downside is that it can sometimes feel like it’s interrupting your flow.
RSI can be stressful and take a big toll on your mental health too. I share more about my recovery here. I hope these resources are helpful. These are some supportive online communities: Talon slack and Hands Free discord, and here are some links to other blog posts I found helpful:
