arganoid | RSI: The Non-Early Months

Last time I was telling you how, three months after I had to stop work, my ability to type was showing little or no signs of improvement. In early May 2008, I felt very weak and stopped doing my keyboard training and some of my exercises.

On seeing my physiotherapist a few days later, she advised me that despite the weakness, I shouldn't have stopped my exercises and keyboard training. If I was to improve, I would have to work through phases like the one I had just experienced. I resumed my swimming and exercises (although started doing a few of the exercises on alternate days), and restarted keyboard training at one minute. I soon got up to two minutes, but once again, seemed to get stuck on that level. After about two weeks I started increasing to 2m 30s, and soon after the start of June had reached three. My swimming ability continued to improve. By the end of June it seemed like there had been a breakthrough - I was up to 5 minutes of keyboard training. When I reached that point I had to stop the increases for a while, since my symptoms had got slightly worse, but within a week or two I felt able to push myself a little harder, and the increases continued.

I also continued to keep a log of my symptoms on a daily basis, to help myself determine whether to increase my keyboard training each day. In the past, I had often thought about the idea of keeping a log of my symptoms, but a problem with this was that my symptoms were so variable (in terms of location, type, duration and severity) that it was hard to work out a decent system for it. I ended up simply rating each day based on how tolerable it was, on a scale of 1 to 5. A rating of 1 would mean there were no RSI symptoms at all. I have not had a day like that so far, but I have had quite a few 1.5s, which indicates that there were few RSI symptoms during the day, and the symptoms I did have were both brief and very mild. At the other end of the scale, a rating of 5 would indicate that my symptoms were extremely difficult and upsetting to live with - worse than they have ever been in the history of my RSI problems. Most days I rate the symptoms as 2 or 2.5, where 2 means they are mostly mild and tolerable. The highest I've rated my symptoms in the last two months is 3.5. Symptoms this bad are tolerable if they only occur on rare occasions, but if they were to be consistently this bad, I would have to reassess whether I could continue my current career - or indeed any job involving computer use.

In the pool, I had by this point made a few breakthroughs. From an early stage, my physiotherapist had suggested that my swimming sessions should include a lot of backstroke. I was mainly doing breast stroke, with a bit of side stroke. It took months to become confident enough to swim on my back, but by early June I had finally got the hang of it. I also started using goggles and allowing my head to dip under the water while doing breast stroke - this probably helped reduce tension building up in my neck due to constantly craning it out of the water. On the 8th of June I managed to swim 52 lengths in 53 minutes. It took quite a while before I was able to manage that again - I'm not exactly sure why - but in mid-July, I made another step forward by reaching a point where I could repeatedly swim four lengths without stopping - a far cry from the days when I would have to rest for five minutes after every length. This soon helped me reach a new record of 56 lengths in 53 minutes.

I also started seeing an Alexander Technique teacher, who has helped me improve my posture. From the early days of my RSI, I have been aware that bad posture is a significant contributor to the problem. The correct posture is to be sitting up straight with the head balanced over the shoulders (although it is important to bear in mind that even if you can attain that ideal posture, you must not remain static in it for long periods of time). Although I knew what posture I should be in, putting it into practice has been a lot harder than I expected. I would frequently video myself from the side while doing my keyboard training. But each time I watched the video, I would find that my head was usually forward where it should be. Seeing the Alexander Technique teacher has been useful in improving my posture, although it seems like it's going to take a lot of time and practice to be able to get it consistently right when I'm at the computer. It's very easy to focus so much on what I'm typing that I stop focusing on posture.

In late May, I made my first visit to the meeting of the London RSI Support Group, which meets once a month in a pub near Kings Cross station. One piece of useful advice I picked up here was to try typing with the keyboard on my lap. I've been doing this ever since, and I think it may have helped somewhat, although as with so many things it is impossible to say for certain whether it has been a factor in my improving ability to type.

Following my meeting with my employer in April, I asked my doctor to be referred to see a rheumatologist so my RSI problems could be more thoroughly examined, and so that I could be checked for other conditions that could be contributing to my problem. It wasn't until nearly 3 months later that I actually got to see the rheumatologist. I explained the history of my condition and she did some basic tests on me. It was her opinion that my problems seemed to be 'mechanical' (i.e. not caused by rheumatoid arthritis or suchlike), and that I seemed to be on the right track with my physiotherapy, exercises and so on. I will soon be having some more tests in order to see if they show up anything more. I have already had some x-rays, and will also be having an MRI scan and an electromyography.

In late July I tried an eye tracker for the first time, namely the EyeResponse ERICA system. This allows you to move the mouse pointer based on where you are looking. I had been doing a lot of research into such systems, as I thought they might offer a safer alternative to the head mouse I talked about last time. However, I found the system very awkward to use, plus it seemed to make my eye ache a bit. I'll write a bit more about eye trackers in a future post.

By the end of July, I had reached 10 minutes of keyboard training per day. When I reach landmarks such as 5 and 10 minutes, it initially seems like a huge breakthrough, but then I imagine myself going to my employer and saying "I can now type for 10 minutes per day!". Clearly I'm still some way off being able to return to work. The challenge now is to see how quickly I can progress to even more typing breakthroughs. The danger is that I will push myself too hard, too soon.

My physiotherapist's advice was that after reaching 10 minutes of keyboard training, I should add an extra keyboard training session at a different time of day, rather than continuing to increase the time I spent on the original session. As discussed in the previous part, the keyboard training I had been doing so far consisted of full-speed typing, without stopping for more than a few seconds to think about what to write next. At first I tried a slightly different approach for my second session. Instead of doing a short period of full-speed typing, I attempted a longer session of highly intermittent typing. I used this session to do a bit of programming. I started off with a session of about 20 minutes, but soon noticed a worsening of my symptoms, so I cut this right down. I'm still experimenting with how best to proceed - partly because it is becoming increasingly difficult to do the standard keyboard training, due to the need to type something that requires relatively little thought, and because I want to do something productive - namely programming, which requires plenty of breaks to think about what you're going to type next. If I did want to carry on with full-speed keyboard training, I could copy text out of books, but the aforementioned desire to be productive makes me reluctant to do this.

So that's where I am now. I'm on about 7000 keypresses per day, and am hoping to make an attempt at going back to work in just over a month, although I don't know how realistic this is. In the last month, my keypresses per day stat has almost doubled. If I can make a similar improvement this month, this will make me more confident about returning to work. Another thing that might help me is that I have Visual Assist installed on my work PC, which reduces the number of keypresses required for programming.

In my posts so far, I've mainly focused on how my ability to work decreased when I got RSI, and then how I very slowly started to recover. In a future post I'll go into more detail about some of the symptoms I've experienced (and still experience). However, the next post will focus on my voice strain problem.