I wrote this is a quick reply to Christian Graus asking me about my RSI on the code project website. So if it doesn't read too well, or there is repetition in another article on this site, that is why. I still have RSI (although much milder), so I'm not going to edit this much.

RSI, a very complicated subject. I'll describe what happened to me. There is some strange bits of history that I'll include as for some readers, they may recognise bits of themselves.

I was first started showing signs of RSI in about 1988, I guess, which just manifest as back pain (early signs of a posture problem, not sitting properly, etc). I finally got ill at the local folk festival in July 1993. I noticed that the tingling I'd had in my hands in the past that had always gone away over a weekend, this time I had it all weekend and it was still there on Monday morning. Fast forward to December of the same year and I went horse riding (which always provided some release from the pain, because of the stretch tension provided by the reins), after that the release from the pain had gone in about 15 minutes. I hadn't even got to work. So I went in and told them I needed medical help. We managed to find an RSI specialist on Harley Street, London. I went to see him, practically passed out twice because the tests he did were so painful (and wouldn't be painful to a healthy person). A very expensive 20 minutes consultation. However he then found my a suitable specialist that he had trained that lived only 45 minutes from where I lived.

I got very ill, ill to the point where I couldn't hold a pint of beer (0.6 litres for you metric folk) with using both hands and being in pain. I ended being registered disabled and I banned myself from driving for a while (changing gear and turning the wheel were too painful). Later on, at one point, both of my arms were warm down to the wrists, and both my hands were cold and blue. Weird, but caused by RSI.

My RSI was caused by being a very prolific software engineer (I was 3 months *ahead* of the plans my manager had for the work I was doing at the time (X11/Motif on 7 Unix platforms, GIS work) - and yes his plans were realistic, everyone else was on schedule). Unreal. I was also playing guitar in the evening. This is referred to as "double hand use". In other words you never give your body any time to recover. The damage builds up over years and years. Often you get a small does of RSI and it goes away. My physio tells me that typically the third time you get it, it doesn't go away and thats the one that changes the rest of your life.

Fundamentally, RSI is a posture injury. Get the posture right and you'll start to heal. Get the posture right and you can do more, whilst damaging yourself less. At the end of the day your body is a machine, albeit an organic self repairing one (I sound like Babylon 5). If you use it incorrectly,through bad posture, or you overuse it, by over coding, or playing musical instruments or high impact sports (squash - high impact on your wrist), then you'll get damage.

There are many views on how to treat the many forms RSI. I was suffering from epicondylitis (tennis elbow), carpal tunnel syndrome (tired wrists is how you'll tell) and tendonitis. Fortunately I didn't get bursitis (spelling) or tenosynuvitis (which is where the fluid in your knuckles dries up, then your body overcompensates and produces so much your hands may end up looking like boxing gloves (no exaggeration).

I was treated by a phsio that specialised in back injuries and RSI. She stressed that a physio that is a generalist and not a specialist in RSI may do more damage because RSI is a specialist injury and treatment is not obvious. I was given a series of exercises, firstly to increase my range of movement (by the time I met her I had been off sick for a while, in bed and my posture was really bad). Once we had the range of movement back to normal, I was given more exercises to increase my strength (I had lost much of my strength as it was painful to do anything, so you tend to stop). This treatment lasted for about 6 months, when I could finally type again.

At that point I resigned my job (as I felt I was at the front of the redundancy queue because of my illness) and became an independent consultant. This was in part so that I could manage my RSI better by only working when I wasn't in pain. Some people think that RSI is an excuse for the lazy to claim sick pay. I find the view that RSI is a malingerers disease very offensive. Why would I want to be off work, when my mortgage and other bills are not being paid? So if anyone comes at you with that argument, point out to them that you are suffering from a genuine illness.

RSI may well cause you mental stress, as you don't know what to do, or how to cope, and don't know where to get advice. I had to spend months doing my exercises 3 or 4 times a day, 20 to 40 minutes each time. Then go for a long walk to improve my posture. I live in the middle of the fens (marsh flatlands) in East Anglia, so I had plenty of space to do this. However I couldn't handle what was happening at the time, and spent much of my time in oblivion, courtesy of the local off-license.

Most of the exercises take the form of various stretches. Don't assume any old stretch will do. It won't. Get advice from a physio. And pay for it. Waiting on the national health, or whatever you have in your country, is wasting time. RSI doesn't wait for anyone. Also, I found that bypaying for the advice, I one day found myself not wanting to do the exercises. I was fed up. Then I thought "why am I paying this money out, only to ignore her advice?". That was a real turning point. The therapy they use on my was called "Adverse Mechanical Tension", where they put stretches along your nerves to undo the nerve compression injuries that are common in RSI. To stretch a human nerve it needs to be stretched for 7 seconds (so count to 10). Nerves are elastic and don't stretch until they have been stretched for 7 seconds. Strange but true.

I still suffer from RSI, although I manage it a lot better. I no longer play the guitar, but do play mandolin, bagpipes and meleodeon (all of these need a shorter hand stretch to play). When my RSI gets worse, I stop playing the instruments, maybe do some research instead of programming work, go walking, and start doing the exercises again. I swim 4 times a week and take vitamin B6. Vitamin B6 is associated with tendon sheath healing. Other B vitamins are not a substitute for B6. In the UK, you need to go to your doctor to get sufficient does of B6 because then made this a restricted vitamin a few years ago because of media/health scare over-reaction.

Fast forward 8 years to the present day, and I'm working for Software Verification, working on the types of software tool I always found interesting.

RSI won't end your life, but it will change the way you live it. If you treat it soon enough and learn to listen to your body (you'll get very good at this if you get ill enough) you can carry on pretty much as normal. I think one of the worst things for me, is that I often find holding hands can be quite painful, depending on my RSI. Thats not very nice when you are walking in a forest or on a beach with your girlfriend...

My advice to you, Christian, is to stop the out of work coding immediately (or after Monday so you can finish your screen saver , and see a suitably qualified physiotherapist. If you play any instruments or do any sports that are not running or swimming, again I'd stop doing those temporarily.

Get an egonomic keyboard, a split keyboard. Get a good quality chair. Set the chair up so that you sit up straight, with your hips slighlty higher than your knees. *Then*, and only then, setup the desk to suit the height you are now sitting at. That means propping the desk up, or shortening the desks legs. Yes, the furniture should match your dimensions, not the other way around. Now you've got the desk sorted out, set the monitor up, so that the top of the monitor screen is roughly level with your eyes. Measure an 11' angle and follow that. That should be where the bottom of the screen is. Roughly. Using that you can work out where the monitor should be (how far away).

Hand use:

• From above, your forearm and hand should be in line (not bent).
• From the side, your fore amd hand should be in line. Your wrist should not be below or above this line.

These requirements mean that you are putting less strain on your arms.

Don't let anyone inject you with cortisone. You can only have this 3 times in your life (it is not good for your bones). Also this is treating the symptoms, not the cause. Its a painful injection, I'm told, but does provide short term relief.

Carpal tunnel surgery. I'd advise against it, if you can get proper medical treatment you won't need it. I've heard some nightmare stories about it taking up to 6 months for the operation to heal. However I met a doctor last year, and she had had both her wrists done for this operation and was back at work a few weeks later. I guess there is a lot of variance with this operation.

Do seek advice. Don't think I'll live with it, it won't happen to me. Everyone thinks that and they always realise they were wrong, when it is too late.

I was lucky, not many people get as ill as I did and get to keep their career. I had no idea what I was going to do if I couldn't use my hands to type. This is just part of the story, but I have never gotten around to writing it.

Please seek medical advice

I hope that hasn't terrified anyone too much. The reality was worse than what I've written here.

I've tried to write down roughly most of what happened, even the darker bits. Its not completely in chronological order, as writing one things makes me think "I should mention this now.." and I change subject.

Do everything you can to prevent this happening to you.