Healing Chronic Pain and RSI

Photo by nikko macaspac on Unsplash

It’s been six months since I went back to work this past fall after taking medical leave for repetitive strain injury (RSI) in my hands. It’s hard to remember what it felt like to be in pain everyday now that I’ve been pain-free for half a year, and I’m back to all my favorite handsy activities — biking, cooking, writing, and typing. It feels important to reflect on what I’ve learned about chronic pain through my recovery, for both my future self and for others.

This blog post will focus on the narrative of my journey and mental health. See this post for more practical instructions if you’re experiencing hand pain or looking for resources specific to RSI.

Disclaimer: I am not a medical or legal professional and this is not medical or legal advice!

Getting injured

I was first diagnosed with de Quervain’s tenosynovitis in October 2020, after intensely cleaning my apartment to get rid of a flea infestation. It hurt to cook, clean, and type, a rough start for a newly independent young adult beginning a career as a software engineer. Luckily, a couple of rounds of occupational therapy (OT) with a hand therapist helped me recover.

Fast forward to early 2023. I worked long and hard one day because there was an incident at work related to a feature I was responsible for. I felt my hand pain come back in full force. I tried to keep working that week, but I ended up needing to take a whole week of sick time to rest. I started improving with OT from worker’s compensation and complete rest.

Work was exciting, and I didn’t want this injury to derail me, so I learned how to code-by-voice using Talon on Mac. Setting up Talon itself required some ability to type because there was a lot of configuration and learning that required navigating documentation and system settings, which was a struggle while I was still having pain at rest. Eventually I was able to set up Talon and get the right hardware to make it work, but it was still so slow and frustrating at times that I felt compelled to type to get my work done.

Getting stressed

I found myself caught in this frustrating and exhausting pattern:

1. type to get work done
2. pain!! back off
3. rest, wondering if typing made it worse and resolving to try workarounds again
4. code by voice to get work done
5. get frustrated by how slow and inaccurate dictation is and start typing again
6. repeat

This pattern stressed me out because I wasn’t able to be as productive as I expected. Even worse, it was actually getting in the way of my hands healing because I wasn’t able to rest completely while voice coding.

I wasn’t doing well emotionally or physically. My pain was cascading — suddenly old knee, shoulder, and ankle injuries were acting up, and I was starting to grind my teeth and feel TMJ symptoms for the first time. I talked to my manager about this, and a few days later I was on medical leave through worker’s comp.

Healing up

I was pretty devastated to leave work at a really exciting time at the early-stage startup I work for (Convex), but it turns out that it’s way easier to heal when you’re not juggling half a dozen appointments a week on top of a full-time job. During my leave, I discovered pain reprocessing therapy through the book The Way Out by Alan Gordon and Alon Ziv and immediately started feeling better.

The Way Out posits that pain is a sensation created by your brain to protect yourself from harm. Sometimes your brain detects structural damage to your body and creates the sensation of pain to stop you from hurting yourself more, but other times, your brain has developed neural pathways that create pain to respond to certain activities and physical motions that at one time caused harm. These neural pathways create chronic pain, and we are capable of retraining them to not cause pain.

I was skeptical at first because some of the OT manual therapy and exercises had helped. If the pain was “in my head” and not structural, why were these treatments successful in reducing my pain, at least temporarily? It’s hard to know for sure because the human body is complex and mysterious, but my hypothesis is that manual therapy helped with the initial injury and inflammation, and exercises helped me strengthen as I healed, but my pain kept “flaring up” because of trained neural pathways based on triggering activities.

For me, these chronic pain triggers were typing, cooking, and cleaning for my hands, walking for my knees and ankles, and swimming for my shoulders. Years and years of physical and occupational therapy to treat overuse injuries in these areas trained my brain to be hypersensitive to certain activities, especially when I’m stressed. I remember being told over and over again since I was a teen not to “overuse” my joints (a.k.a. do the activities I love) because I might permanently damage my connective tissue, especially since I have hypermobility spectrum disorder (HSD). Well-intentioned clinicians warn patients about long-term damage to encourage compliance with the treatment program (do your exercises every day or you’ll need surgery!), but anyone who knows me knows that I’m a type-A person who doesn’t need fear to motivate me.

Fear puts my nervous system on high-alert so my brain is more likely to create pain when I do activities that I fear will cause pain. This became obvious to me when my knees, ankles, shoulders, and jaw started hurting when I had RSI. I didn’t “do” anything to cause these injuries to flare up during the worst of my RSI. Rather, I was stressed about potentially having to modify my work forever or not be able to return to work at all.

Around the same time, I received MRI results that showed no current structural damage to my tendons. Together, cascading pain without cause and negative MRI results convinced me that my chronic pain was not tied to a structural problem, so I sought out pain-reprocessing therapy. I learned mindfulness practices to send messages of safety when I felt pain and started noticing my pattern of anxiety around pain. When I felt pain, I would search for reasons, blaming myself for “doing too much” of X or missing warning signs, which made me even more avoidant and hypersensitive to activities that might cause pain. Breaking these patterns meant interrupting them with nurturing messages of safety and compassion, framing pain as just another bodily sensation, and gradually exposing myself to higher levels of triggering activities. I worked my way up to typing for a full workday by starting at an hour and increasing by 10% each day up to 8 hours over four weeks. This might have been overkill, but it made me confident in my ability to go back to work.

This is the plan I wrote up for myself to build up to an 8-hour workday over the month of July 2023.

6 months later

It’s been six months since I went back to work, and I have experienced occasional moments of pain but none that persist and disrupt my activities. The same pain-reprocessing strategies I used to overcome RSI have healed my chronic knee pain and shoulder pain as I get more ambitious with physical activities.

• I had no knee pain on an 85-mile trek (the Via degli Dei from Bologna to Florence) this past summer despite pain the week before the trip.
• I swam butterfly for the first time last fall since I partially tore my rotator cuffs 11 years ago and managed to get through a butterfly master’s workout a couple weeks ago without lasting shoulder pain.

This year of struggling through chronic pain has been a lesson in calming my nervous system that I will be forever grateful for. A common refrain among my aging relatives is complaining about their aches and pains and telling me how lucky I am that I am young, assuming I don’t have these problems. But I did have chronic pain, and I used to resent having chronic pain so early in life and feeling like an “old” person. Now I appreciate that it has been an opportunity to empower myself for the rest of my life with this wisdom of how to retrain my brain and understand my pain. I only wish I had learned it sooner. Hopefully this blog post will be a helpful resource for other folks who are struggling with chronic pain!