What Helped Me the Most, by rdgray

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Through my struggle with a pseudo-RSI my understanding of what was going on with me has been evolving. Below I offer you a framework that has helped me achieve a 99% recovery and fend off any setbacks.

"Pain as a reflex"

To summarize, this theory views RSI symptoms as a reflex that one can develop through repeated conditioning. This reflex develops at the very basic level of our nervous system and we have no direct control over it. Since it is a reflex, you can get rid of it by breaking the feedback cycle that supports it. And since your actions caused it, it is in your power to undo it.

Step 1: "Something is fishy about my RSI"

The premise is that your symptoms are caused by your brain/nervous system rather than a physical injury. The first (crucial) step is to find evidence of that. Play a detective for a bit. Look for those little inconsistencies with your RSI that you dismissed before. I'll give you some examples from my experience:

  • Sometimes, my symptoms would get worse after a long period of not working. Shouldn't I feel better with rest?
  • Sometimes I would find myself working on something I enjoy with no pain. How is this task different from the other?
  • The pain I felt was very different from the standard overworked/abused muscle pain.
  • Sometimes I would get pain just by thinking about an unpleasant task at work.
  • The onset of my symptoms was suspiciously close to the day when a friend of mine showed up with wrist splints and told me it was for his RSI. I never gave a thought to this disorder before.
  • I developed symptoms in my left hand/forearm within days of switching to use it for mousing. That invalidates the "repetitive" part of RSI.
  • My pain did not stay in one place; sometimes it would shift (wrists to forearms, forearms to arms, etc.)
  • Often I would be in pain and decide to visit my doctor. At the time of the appointment I often felt embarrassed as my pain was almost gone, I could not pinpoint its exact location or strength.

In my case, this was enough for a reasonable doubt.

Step 2: "Break the cycle"

Pavlov's dog

You might have heard about the Pavlov's dog. Researchers would ring a bell to signal feeding time to a dog. After a while the dog would salivate at the sound of the bell even if no food was forthcoming. Similarly, a human being can develop a reflex that brings pain when she sits to type at a computer. Particularly if the computer use is associated with some negative emotions and if the pain can stop the person from using the computer and experiencing those negative emotions (more details on those emotions in step 3).

So, the cycle is "start using the computer"; "experience pain"; "stop to rest and recover"; "avoid some negative emotions".

How do you learn to experience pain?

Now, it is not easy for your body to learn to produce pain. It is clear that salivating is associated with food, but pain? How did it happen?

Well, initially, the pain/discomfort you felt was likely caused by overworking your hands (or injury/surgery/etc). Like any muscle pain it would have gone away as your muscles recovered and got stronger. Except this time you signaled to your body that the pain can be useful. You stopped working AND you felt relieved (most likely subconsciously) that you did not have to experience some negative emotions. Then it happened again, and again, and again. Then, your body learned to produce pain on demand whenever you might "need" it (i.e. when working at a computer). Your body is now thoughtfully giving you a way out if you want it. You don't have to face negative emotions anymore because you are in pain and you have to rest.

I also believe that some people are more predisposed to this affliction than others. I, for example, have a hyperactive autonomous nervous system that is in charge of these reflexes. My perspiration function is pretty much unrelated to any need to cool down, but rather reflects my comfort level in a particular situation. I also often blush and tense in a variety of settings.

The question on the back of your mind should be: but how can my body produce pain and other symptoms? This is actually pretty easy, just think about all those times that you experienced blushing, sweating, nausea, tension caused purely by emotions. Reduce blood supply here, add some stress hormones there, and sprinkle some neurotransmitters on top (all those regulated by the autonomous nervous system) and you got yourself very real physical symptoms and pain.

Your body can be very successful at mimicking some real physical problems. The disguise is almost perfect: e.g. the pain started when you overworked your hands, and now you get it whenever you use them. Thankfully, you can always see through it if you try (see step 1). Actually, it is very important that you do, it is the first crack in its armor.

The fix

How do you fix this? You break the cycle that reinforces the reflex. If you want the Pavlov's dog to stop salivating you stop giving it food after a bell. Better yet, you take it for a walk instead. This translates into modifying the last two components of our cycle: "stop to rest and recover" and "avoid some negative emotions". This is crucial positive feedback necessary for the reflex to live on. You get rid of the feedback and the reflex will weaken and disappear after a while.

Let's see how you can do it. Next time you feel pain (or anytime if you are constantly in pain) try to do an activity that is most associated with pain for 5 minutes. Try to accomplish something. Then, give yourself a reward (TV, ice-cream, time with family). Next time, work a bit more and reward yourself. What you are doing here is you are providing negative feedback to the reflex mechanism. Instead of stopping and feeling relief (subconsciously), you continue and get an alternative reward for the effort. This way you let your body know that you don't need that pain. Thanks, but no thanks. You depriving the reflex of the crucial positive feedback it requires. You might need to go through the same process with a variety of activities that got to be associated with some negative emotions (working at a computer, doing chores, playing music, driving). A great source of information on this is Fred Amir's "Rapid Recovery From Back and Neck Pain".

Step 3: "Why did it happen to me?"

The good news is that you can get rid of your pain by completing step 2. It might take weeks or months but you'll get there (remember: you can take away the "food" from the "dog" but still continue to get pain for quite a while). The bad news, however, is that you have not fixed the underlying problem that led to your RSI. I am talking about the part of the reflex feedback cycle that got it all started: "avoid some negative emotions". Those emotions might still be there, or they can come back at any time in your life. You remain at risk of slipping back. Once your body has learned how to produce pain, it does not fully forget and can quickly supply it if necessary. You are now much better equipped to deal with the pain and can handle it fairly quickly. But even if the pain is a distant memory you might find that your life is not that much better now than before. So, it is as crucial to learn about the negative emotions and how to deal with them.

Dr. Sarno's books offer a take on those emotions. He talks about internal rage, "id", and other things. Those books are a very educational read. However, I found a much more accessible and, more importantly, actionable description of those emotions in Neil Fiore's "The Now Habit". That book is about procrastination and how people use it to deal with negative emotions. Read it. And when you read it substitute RSI/TMS or any other applicable abbreviation instead of the word procrastination. You'll find that with this substitution the book will be ringing all sorts of bells (unrelated to the dog example).

The main idea of the book is that people procrastinate because of the fear of failure, fear of success, or to resist authority. Procrastination is one way of coping with those negative emotions, with threats to our self-image as a smart, competent individual, good parent, etc. We'd prefer to avoid or postpone any action that may potentially destroy this image. Let me give you some examples:

Fear of failure:

- I need to write (type?) something for my work or school. But what if it is not perfect? What if somebody criticizes it? That would mean I am not as good as I think. I'll lose my job or drop out of school. My life will be over. I'll do anything to avoid this outcome. Not starting or not finishing seems like a good idea. (I am not necessarily exaggerating here. Even if we don't think this way, we act as if we did)

- I am facing a large project (an annual report, dissertation, etc.) that I am not fully certain how to complete. If I start, there is a chance I'll discover that I can't complete it. I'll lose my job...You get the idea.

Fear of success (fear of delayed failure):

- I am getting close to a promotion. But if I am promoted I'll have to move across the country, I'll have to do stuff I don't like as much, I'll have more responsibilities...or I may fail.

- If I complete this project successfully, my boss will give me an even harder project, I won't have as much time to spend with my family, on my hobbies...or I may fail.

Resistance to authority:

- My boss keeps giving me more responsibilities. I like the guy and can't refuse to his face.

- My mom and dad made me go to law school and now I am a lawyer doing stuff I don't like.

Some people can deal with these everyday threats to their self-image. Many others resort to procrastination as a coping mechanism.

Now, procrastination may not even be a word in your vocabulary. Your employer or you yourself may not tolerate procrastination. But think about this. What if instead of procrastination you develop an RSI, a widely recognized medical condition? What if you feel physical pain or disability whenever you are facing an action that raises those fears and threatens your self-worth? In this way, RSI would be an even more effective coping mechanism than procrastination. I can't do it because I am in PAIN.

So, these are the emotions that you might have managed to avoid by feeling pain in your hands and stopping for a break that first time. These are the emotions that created a need for the pain reflex (it also probably did not help that you had that RSI-awareness seminar that day). I think it is very important to understand this point and learn how to eliminate the need to protect yourself from emotional pain. "The Now Habit" is an excellent guide on how to do that without resorting to procrastination (or RSI as the case may be). I can't recommend this book more strongly.

Well, here it is. I hope this framework helps somebody in their struggle with RSI or any other mysterious pain disorder.

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