Tactical Recovery Guide for Wrist & Arm Repetitive Strain Injuries (RSI) — Part 2 of my RSI Series
The Complete (and Continually Updated) Tactical Recovery Guide with Recommendations, Tools, and Examples to Manage Wrist & Arm RSI
Last updated: January 13, 2021
- Added Workrave as a Windows typing tracker tool
Why I created this tactical guide for wrist & arm RSI
When I was dealing with the worst period of my repetitive strain injury (RSI), I didn’t have a centralized place for tips, tactics, and recommendations to overcome RSI. I also didn’t have many people I could confide in about my injury, and it was a very lonely journey. I made every mistake possible, and I’m sure that these mistakes prolonged my recovery.
I put together this tactical recovery guide to address some of the shortcomings that I faced. If you’re struggling with RSIs and want a convenient resource with research and personal anecdotes from someone who learned the hard way, this is for you. And if you feel like RSI is something unique to you, let me tell you that you’re not alone. I put together a separate post (Part 1 of my RSI Series) detailing my journey that may be similar to yours.
This guide is my first draft and my first time putting together something like this. It has the tactical things you need to do to manage your RSI (minimize usage, stretch, exercise) and the necessary, but often unsaid, mental component. Using the guide as a reference, I hope you’ll be empowered with the right mindset, habits, and adaptations to prevent your injury from worsening and recovering faster.
My request for anyone reading this
I’d love for this to continually evolve and get better with more helpful resources and information. I welcome any feedback and suggestions to update this guide regularly and help more people with RSI.
Also, don’t feel like you have to apply every single tip or recommendation! I’ve tried everything on my journey, but your injury and situation may be different (my specific case was wrist & arm injury, which will be the primary bias in this guide). Figure out what makes sense for your case and consult with a doctor or physical therapist for your primary guidance and any questions.
Note: The following guide does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment because of something you have read from this post.
Table of ContentsDiagnosis, evaluation, and getting medical advice
1. What causes repetitive strain injuries?
2. Listen to your body!
3. Consult a doctor and/or a certified physical therapistHave the right mindset to prioritize health, recovery, and sticking with your routine
4. Being proactive is always better than being reactive
5. Your actions are a reflection of your prioritiesOptimizing your body mechanics and workstation
6. Proper desk posture
7. Chair and back posture
8. Monitor height
9. Footrest
10. Request an ergonomic evaluationErgonomic equipment
11. Ergonomics? What’s the big deal?
12. Ergonomic keyboards
13. Ergonomic mice
14. Don’t work with wrist and arm braces with hard rigid splints, unless specified to do soLifestyle adjustments and your core recovery habits
15. Why are these habits so important?
16. Recovery Habit #1: Wrist/arm stretches and exercises
17. Recovery Habit #2: Full-body exercises, workouts, and stretches
18. Recovery Habit #3: Minimizing usage and giving your body time to rest and healManaging wrist/arm usage at work
19. Take strategic break times with the Pomodoro technique
20. Track your keyboard/mouse usage
21. Control your calendar and create a meeting strategy
22. Be focused. Be efficient. Work smarter, not harder.Being productive without keyboard and mouse
23. Meetings instead of long Slack/emails
24. Use pen and paper, or whatever else helps you!Voice dictation and voice control software
25. Full computer control via voice
26. Voice for dictation only (think Siri to type)
27. Quick thoughts on using voice to control your computer and typeManaging wrist/arm usage outside of work
28. Identify high-risk vs. low-risk activities
29. Minimize phone usageBuilding good habits and breaking bad ones
30. Check your mindset and your priorities
31. Break bad habits about ignoring pain/discomfort
32. Have a long-term mindset, don’t think short-term
33. Set up your lifestyle and environment for habit-building success
34. Track your goals, habits, and to-dos in a daily notebook
35. Create habit streaks and find accountability partners
36. It’s better to do something than nothing! Don’t make excuses; make adjustments!
37. Be an athlete! Prep for your daily competition.Pain relief and management
38. Pain relief is for rest and recovery. Not for working.
39. Heat and cold
40. Massages
41. Other alternative pain relief, anti-inflammatory medicine, and treatments(Closing thoughts) Have a positive mindset and please reach out to me if I can be helpful!
42. Have a positive mindset and please reach out to me if I can be helpful!Appendix: FAQ and other topics not covered in detail
43. Overall wellness (e.g., sleep, diet, stress) impact on RSI
44. Other wellness practices/techniques (acupuncture, chiropractor, scraping, myofascial release, cupping)
45. Anti-inflammatory diets/vitamins/supplements
46. The impact of stress associations and Tension Myositis Syndrome (TMS)
Diagnosis, evaluation, and getting medical advice
What causes repetitive strain injuries?
RSI’s direct cause is the overuse of and accumulated damage to your muscles, joints, ligaments, and tendons. Symptoms include pain, stiffness, or soreness caused by your body’s inflammatory response to injury. Other contributing factors that may impact your chances of getting RSI are poor posture, lack of ergonomics, genetics, stress, and unhealthy diet.
Usually, your body has enough time to repair and manage the daily usage of your muscles, joints, and tendons. But overuse results in a vicious cycle of inflammation with insufficient time to heal, accumulated damage from continued usage and your body becoming more prone to injury.
Be aware that there is no magic pill, treatment, or surgery to heal your RSI. Proper posture, stretching, exercise, ergonomics, diet, and pain relief help you manage your injury. They do not undo or repair your injury. They can make your body more durable, resilient, and less injury-prone, but you are still susceptible to overuse.
TL;DR: Your body needs sufficient time and rest to gradually heal itself (in addition to all the other things that help your recovery).
“Want to get better? Stop and limit whatever activity that makes your RSI hurt or feel worse.”
Note: There are different types of RSIs, some from chronic inflammation (e.g., tendinosis/itis) and others from nerve compression (e.g., carpal tunnel syndrome). Surgeries can help for nerve compression but is usually a last resort for severe cases. There are no surgeries [that I know of] to heal chronic inflammation magically.
Listen to your body!
If your body is in pain or symptoms are worsening, it is actively telling you something is wrong.
Don’t continue to work beyond when your wrists/arms/body starts to feel soreness/pain.
Don’t do exercises that cause significant pain.
Listen to your body and modify, adapt, and adjust as necessary!
And especially don’t trick yourself into thinking, “I don’t feel pain” and convince yourself it’s fine to continue your activity. For example, numbing your wrists with ice or taking ibuprofen/painkillers, and using the “lack of pain” to work beyond your capacity. Find out more at Part 1 of the RSI Series about how I made this critical mistake in my RSI journey.
Consult a doctor and/or a certified physical therapist
See a physical therapist/certified specialist based on your specific injury to give you the most appropriate guidance on a recovery plan. And make sure to follow their guidance!
The very first step I would recommend is to see a proper physical therapist/specialist. A certified specialist can give you a more informed diagnosis, which is much better than googling on your own and provide an appropriate treatment plan/recommendation. If you’re unsure of which specialist or therapist to see, consult with your primary care doctor (this step is also often necessary for insurance reasons). For my wrist and arm injury, I went to a certified hand therapist.
In each therapy session, you can expect pain relief, massage therapy, stretching, or exercises, depending on your specific needs. There is also a “take-home” component of physical therapy, which typically includes lifestyle modifications, adaptations for work and home activities, and exercises and stretches. Much of the tactical information in this guide (posture, ergonomics, stretches, exercises, pain relief tips) will also be provided to you by your therapist. This guide also touches on the behavioral component and the importance of discipline and follow-through (more on this later).
This next point is so important that I’m going to repeat it: just because you see a therapist doesn’t mean that you’ll magically get better. The responsibility and ownership of your recovery are 100% on you. They can give you a map, but it’s up to you to follow it.
The responsibility and ownership of your recovery are 100% on you. They can give you a map, but it’s up to you to follow it.
Have the right mindset to prioritize health, recovery, and sticking with your routine
Being proactive is always better than being reactive
RSIs are such a complicated injury because by the time we notice significant pain, it’s already way too late. In contrast to other acute injuries, RSIs are incurred gradually over an extended period of overuse and not because of one specific event. Therefore, your body needs just as much time, if not more, to naturally heal all the strain and injuries.
We’re programmed to be reactive rather than proactive when it comes to injuries, which makes being disciplined about RSI recovery difficult. Unsurprisingly, your motivation and discipline to take care of your health directly correlates with your pain levels.
One of the best ways to overcome RSI is with preventative measures through awareness and early correction of behaviors or habits that can exacerbate your injury. You’d prefer to treat your injury when it’s not as severe versus when it’s much worse and difficult to manage.
Your actions are a reflection of your priorities
If you choose to prioritize other things over your health, that is a conscious decision you are making. Just be prepared for the consequences.
Consider if you need to send that extra email or spend an extra hour finishing an assignment rather than giving your body a 15-minute break.
Or what it might mean to skip your physical therapy routine for the 4th day in a row because “what’s missing a couple of days gonna do?”
Now, I’m not saying you should become a hermit who never uses their wrists or arms. Or that you have to dedicate your entire life to becoming a wrist and arm health guru.
With all things in life, there is a balance. If you genuinely want to overcome your repetitive stress injury, prioritize your life towards actively taking care of your wrists/arms/body and being mindful of how much you’re overworking them.
Optimizing your body mechanics and workstation
Proper desk posture
Our desk posture makes a huge difference in the amount of stress we put on our hands, wrists, and bodies. Correct posture allows our body to work more efficiently with less fatigue and strain on your body’s ligaments and muscles.
If RSIs are an outcome of overuse and too much strain on our body, we should strive to put as little pressure and tension as possible.
The goal is to put your body into a natural/neutral position as much as possible. When you have a “bad” posture, you have less efficient usage of your muscles, reduced blood flow, and compression of nerves (this is not good for RSIs).
Here are some recommend desk options to consider:
Adjustable standing desks
Adjustable standing desks are great because you can customize the desk to your liking. Standing desks enable you to more easily adjust the height of your desk to create an optimal position for your wrists, elbows, eye, back, and neck.
Bonus: Not only do standing desks help you achieve an optimal posture, but they can also prevent you from staying in a static position for an extended period. The idea is to keep your body moving rather than idling.
The recommendation is to sit for approximately 40–45 min and stand for 15–20 minutes every hour (you can use a timer for this). Note that you also want to avoid extended periods of either standing OR sitting. If you start to feel tired from standing, it’s likely a good time to switch positions. Also, wearing supportive shoes or standing on an anti-fatigue mat can reduce tension on your body and decrease fatigue.
- Fully Standing Desks: I use Fully, but any standing desk option will do as long as it provides proper posture (see ergonomic posture image above)
- Further research and guidance: Best Standing Desks 2020 | Reviews by Wirecutter
Budget desk options
- Standing desks can be expensive, so any desk with properly adjusted height will do. Make sure to look at examples of proper desk ergonomics to ensure the correct height (in addition to your chair, arm-rests, feet rest, etc.)
- Standing desk converters: They are much cheaper than a standing desk. However, I’m not a big fan of them because they can encourage poor posture if not used correctly. Often they can mess up your arm or elbow angle (too low or high) or your neck posture by making you look down at a screen for extended periods. If you can keep proper posture with standing desk converters, feel free to use one.
Chair and back posture
The benefits of a quality (office) chair cannot be understated. A quality chair is essential in allowing your body to have a good position for long periods of time. It reduces the amount of strain/stress we put onto our back and spine and maximizes our productivity by providing a comfortable working posture.
Here are some recommended chair options to consider:
- Herman Miller Aeron: I use the Herman Miller Aeron both at work and home. These are pretty expensive when purchased new, so I bought mine used at a discount. There are many sellers of used Herman Millers on second-hand marketplaces (check Facebook, Craigslist, eBay, etc.).
- Further research and guidance: The Best Office Chair for 2020 | Reviews by Wirecutter
Budget chair options
- If you’re unable to spend hundreds of dollars, try to find an affordable chair that allows you to maintain proper posture as much as possible. See the Wirecutter reviews of office chairs for budget considerations.
- The benefit of these expensive office chair recommendations is that they are highly customizable and adjustable to achieve an appropriate position. They also last a long time with adequate care and usage, so it is a long-term investment in your health. You may have to do more shopping to find an affordable chair that enables proper posture and comfort for your body type.
Back posture tools: There are devices and tools you can use to keep proper back posture. Because I believe the most important thing is a quality chair, I would spend money on a chair before one of these gadgets/tools. But, these are great add-ons to consider and add to your toolkit.
- Lumo Lift: this is the one I’ve used, but has since been discontinued. There are other alternative back posture tools available like Upright GO (see below link)
- BetterBack (from Shark Tank): I’ve tried this before, but only at home. Admittedly, it could make you stand out in the workplace, but perhaps this is less of an issue with work-from-home becoming more accepted
- Alternative options to consider: The 8 Best Posture Correctors of 2020
Monitor height
Having the right monitor height is critical because it maintains proper posture with your neck. Adjust the monitor height so that the top of the screen is at — or slightly below — eye level (2–3 inches). Your eyes should look slightly downward when viewing the middle of the screen. Position the monitor about an arm’s length away from your eyes.
I use a monitor mounted with a monitor arm that I bought on Amazon. But you can achieve the same result for cheap by using monitor risers, a stack of books, or anything you can grab around the house to adjust your monitor height.
The advice for proper monitor height is applicable for laptops as well (see example below). Instead of using your laptop by itself, try elevating your laptop to the appropriate eye height and use an external keyboard and mouse. This adjustment is not only beneficial for your neck posture but also for your wrists and arms.
Footrest
Typically you get footrests if you have a mismatch of desk height, armchairs, and your chair height. My desk and chair heights did not allow me to achieve a 90-degree bend in my elbow, so I had a footrest purchased at my workplace to correct my posture.
Request an ergonomic evaluation
You should be able to request an ergonomic evaluation at work to help correct your posture. But if not, you can follow the above visual. The visual is fairly consistent across multiple ergonomic evaluations I’ve gotten at different points in my life.
Common mistakes include the desk height and the monitor height, which can impact not only your wrists but also your neck and back. The body compensates for weaker/injured muscles, so proper posture is essential across the neck, shoulder, back, arms, etc. and prevents unnecessary strain and injuries overall.
Ergonomic equipment
Ergonomics? What’s the big deal?
Ergonomic keyboards and mice can reduce the amount of strain you put on your body by providing better posture and technique. When working, try to use proper ergonomic equipment and technique as much as possible and minimize situations where you’re not.
Getting ergonomic equipment is one of the most effortless adjustments to make. It can significantly reduce the strain you put on your body.
It pains me deeply to see people in sub-optimal positions (usually at a cafe or on your bed). Examples include being hunched over on your laptop, using a keyboard with your wrists at unnatural angles, or using a laptop trackpad. While I understand that you won’t always be at your desk, you should minimize your computer time spent without proper ergonomics and posture.
Just like posture, ergonomic equipment promotes using your body in natural/neutral positions to reduce strain/pressure.
For ergonomic keyboards, you generally see split keyboards that encourage a more natural position of your hand.
For mouse position, you generally want to keep your hands in a more neutral position. To reduce strain and pressure, think like a handshake. Contorted positions, in contrast, actively use more of your wrist/forearm muscles (your typical mouse position).
You should also avoid using your wrists to move the mouse. Instead, use your back and shoulder muscles to move the mouse while keeping your hand/wrist/elbow/arm straight.
The most common mistake is planting your wrists on the table, which forces you to move your mouse with your wrists. Avoid planting your wrists on your laptop, desk, or even the gel wrist support.
Some people use a full trackball mouse (see links below) because it promotes more usage of your entire arm to move the cursor rather than isolating the wrist/hand movements from a traditional mouse.
With all things RSI, the key is to minimize the usage of the overstrained muscles and spread usage across different muscles rather than concentrating.
Here are some common recommendations for an ergonomic keyboard or mouse. These are just a subset of many ergonomic tools you should consider based on your preference and comfort. I don’t believe there to be one right answer for everyone, and you should tailor your setup for your needs (I use the Kinesis Freestyle2 keyboard with the Evoluent vertical mouse).
Ergonomic keyboards
- Kinesis Freestyle2: This is the one I use and the one I find most comfortable. I’ve compared different options based on ergonomic features (split keyboard, adjustable height) and affordability to find my setup. As mentioned before, split keyboards create a more comfortable and natural wrist position compared to non-split options.
- Kinesis Advantage2: I’ve heard great things about this keyboard (as the higher-end keyboard from Kinesis), but have never tried it myself. The additional ergonomic features of a contoured keyboard design and low-force mechanical key switches could be worth the higher price for the incremental ergonomic improvements.
- ErgoDox EZ: This is the Wirecutter upgrade option and what I’ve noticed a lot of keyboard enthusiasts/super-ergonomic users use. It comes with a pretty steep price tag ($270), but I think the improvement details (ortholinear, programmable keys) could be worth it. This keyboard will be my next one to try.
- Further research and guidance: The Best Ergonomic Keyboard for 2020 | Reviews by Wirecutter
Ergonomic mice
There are three most common ergonomic mouse types to consider depending on your needs. The “best” mouse for you is the one that promotes the most comfort/reduces discomfort for your specific injury.
Vertical mouse
The standard vertical mouse, is usually the most common recommendation closest to a “normal” mouse. As explained above, vertical mouses are better ergonomically due to the natural position it puts your hands in and avoiding the planting of your wrists on the table.
- Evoluent Vertical Mouse — This is the mouse that I use. Still, I think any vertical mouse will do if it achieves that “handshake” position. See other brands below:
- Logitech MX Vertical Ergonomic Mouse
- Anker 2.4G Wireless Vertical Ergonomic Optical Mouse
Trackball ergonomic mouse hybrid
Ergonomic mouse hybrids are great for people who experience discomfort/pain primarily from moving the mouse cursor around. The trackball transfers the usage of your mouse to your thumb and away from your other fingers. Note, you should be careful that this doesn’t aggravate your thumbs from overuse.
- Logitech MX Ergo Wireless Trackball: Most common trackball ergonomic mouse hybrid recommendation
Full trackball mouse
A full trackball mouse is an alternative for people who may experience discomfort from the other mouses mentioned above. A full trackball isn’t necessarily “better” for everyone; it may benefit certain people and depends on your specific injury or issues.
A full trackball mouse transfers the mechanical load and usage to your entire hand/fingers, which may benefit those who have RSIs in specific fingers from typical mouse clicking and movements. It’s recommended to mix it up using your entire hand/palm/fingers rather than the same finger to avoid repetitive rolling of the trackball or clicking of the buttons.
You can use a full trackball mouse in different ways (with your fingers or palms), so find what works best for you by minimizing discomfort and spreading usage across different muscles.
Don’t work with wrist and arm braces with hard rigid splints, unless specified to do so
I generally do not support working with braces with hard rigid splints, unless specified by your doctor or hand therapist for your injury and use case. This is one of the most common things I see people with wrist pain try, and I also did the same before I consulted with my hand therapist.
I have heard that prolonged usage of these braces transfers the strain to other parts of your arm and weakens your muscles (since you’re relying on the splint/braces for support). They can prevent you from making normal motions and put you into unnatural positions while typing (e.g., your shoulder or elbow positions). The temporary relief in symptoms may create a false sense of security and cause you to persist with the activity causing your injury.
The primary benefit of wrist braces is preventing the bending your wrists at an awkward angle and pressing on your nerve during resting periods (e.g., in your sleep). I have fewer issues with wearing braces while doing other non-working activities and resting. I sometimes use them on long drives to help keep my wrist/arms stable, but I don’t wear it while typing for reasons mentioned above.
Again, your injury and situation may differ, so talk to your medical professional to see what’s right for you.
Lifestyle adjustments and your core recovery habits
Why are these habits so important?
Building good habits on stretching, exercising, minimizing usage, and breaking bad habits around overuse are the critical components of recovering from RSI and preventing it from getting worse.
A common misconception is that correct posture, stretching, exercise, and proper ergonomic equipment alone can prevent RSI from occurring. All of the above can and do help reduce the rate and risk of injury. However, there are people like me, where we’ve pushed our bodies beyond the point it can handle. As mentioned before, repetitive strain injuries are, put, injuries from too much use.
At some point, the scale will tip too far (even with all the stretching, exercising, and ergonomics), and you have to give your body time to heal.
Changing your lifestyle and accepting the need to change will be difficult. You use your hands, wrists, and arms very intensely during your regular working hours and in the evenings with other activities (eating, cooking, smartphone usage).
Creating the proper adjustments across your life around minimizing usage, taking breaks, stretching, and exercising will reduce strain and promote faster recovery.
Recovery Habit #1: Wrist/arm stretches and exercises
If taking breaks allows your body to heal, strengthening and stretching increases your wrist/arm usage endurance and reduces strain from usage.
Stretching keeps the muscles flexible, durable, and healthy. We need the flexibility to maintain a range of motion in the joints. Without it, the muscles shorten and become tight (i.e., more strain with usage). Strengthening makes your muscles strong and healthy, which increases overall endurance and capacity.
Wrist-targeted stretching routine
- Wrist, Hand & Finger Stretching Routine — Active Isolated Stretching: 3-minute routine per hand
- Wrist Stretches — Yoga Class by Kristi Rodelli: 8-minute wrist-targeted routine
- Neural Glides for Ulnar, Median & Radial Nerves — Ask Doctor Jo: 3-minute routine for ulnar, median, and radial nerve glides/stretching
Micro-stretches (stretches you can do any time anywhere)
- Doorway Pectoral Stretch: Example stretches for stretching chest, shoulders, and back
- Wall Stretches: Additional examples for stretching chest, shoulders, and back
- Ulnar, Median, and Radial Nerve Stretches: Nerve “gliding” and “flossing” stretches
Wrist/arm-focused exercises
Important Note: Check with your doctor or certified hand therapist before you try the following wrist/arm-focused exercises. Depending on where you are in your stage of RSI, it may be beneficial for you to focus on stretching before you incorporate wrist-focused strengthening exercises. If incorrectly included in your routine, it may cause more harm since you’re adding additional load and strain on top of your normal wrist/arm usage.
Most people don’t know when to stop or how to gauge what is appropriate when exercising, so consult with your doctor and certified hand therapist and follow their recommendations.
- How to Strengthen Your Wrists: These include various wrist exercises including wrist extension, flexion, supination, and pronation (these are terms for extending and flexing your wrists/arms in different ways)
- Power Systems Power Web (Super Heavy, Blue): Sports & Outdoors: As shown by the visual below, the “Power Web” adds some resistance as you try to grip and close your hand over the web.
- Theraband FlexBar: An additional tool for elbow, wrist, forearm and hand rehabilitation and strengthening. See example strengthening exercises below.
- TheraPutty: TheraPutty hand putty is like Play-doh, and you can use it for a variety of different finger, hand and wrist resistive exercises.
Recovery Habit #2: Full-body exercises, workouts, and stretches
Same important note as mentioned before with wrist-targeted exercises: Before exercising, consult with your doctor and certified hand therapist and follow their recommendations. You want to avoid anything that might cause you to injure yourself depending on your physical condition and where you are in your recovery stage. If you want to avoid inadvertently hurting yourself, consider partnering with a certified fitness instructor who will understand your condition, constraints, and help you minimize injury risk.
Exercising is essential (like stretching) because it makes your muscles flexible, strong, and healthy. You want to build strength and flexibility across your entire body, including your back, shoulders, and neck, because they help support your arms.
I primarily advocate for full-body workouts for most people unless you have specific mobility issues or constraints. I used a 3-day split of push/pull/legs (PPL) weightlifting routine, which was an excellent fit for my schedule and allowed me to maintain consistency.
I’m a big fan of major compound exercises like squats, deadlifts, chest presses, shoulder presses, and back rows. And I substitute exercises that overly strained my wrists and arms with alternatives (e.g., pull-ups → dumbbell rows, bench presses → dumbbell presses).
Again, talk to your doctor, certified therapists, and fitness instructors if you have specific concerns or want direction on what exercises are right for your situation. Listen to your body AND your medical professionals!
Sample routines pulled from online fitness communities (e.g., Reddit, which is my go-to):
Overall body stretching routine (neck, back, shoulder, chest, etc.)
- THENX — Chris Heria Warm-up Routine: 8-minute full-body stretch routine
- 30 min Yoga for Weightlifters, Powerlifters & Crossfit: 30-minute full-body Yoga stretch routine
Recovery Habit #3: Minimizing usage and giving your body time to rest and heal
The goal is to give our body enough time to naturally heal and repair the damaged muscles, tendons, and ligaments in our hands/wrists/arms from our daily usage. You do so by reducing the frequency and the duration of usage, which includes our primary usage at work and our “resting period” outside of work.
An analogy I like to use is a car and managing fuel usage. We should not exceed what we have left in our fuel tank and stay at an appropriate speed limit to promote fuel efficiency.
Managing wrist/arm usage at work
Take strategic break times with the Pomodoro technique
Take frequent breaks while still getting done with short periods of hyper-focus using this time-management method. Customize the focused working periods and your break times depending on your body’s needs and work schedule. You might have shorter working periods and longer break times.
What is the Pomodoro technique?:
1. Create a list of tasks to accomplish
2. Choose a task to be accomplished
3. Set the Pomodoro to [25] minutes (the Pomodoro is the timer)
4. Work on the task until the Pomodoro rings, then put a check on your sheet of paper
5. Take a short break (e.g., [5] minutes)
6. Repeat for your next task
7. Every 4 Pomodoros take a longer break- Download Link: Pomodoro timer Chrome extension
Track your keyboard/mouse usage
Self-tracking helps monitor your progress and understand the amount of usage that makes your health improve/worsen. Make sure not to exceed your daily threshold to give your body more time to rest and recover.
- OctoMouse: Open source application for Mac OS that measures mouse and keyboard usage. Before downloading this software, evaluate the source code (see the “Privacy” section in the Github link) and do additional research to see if it’s okay to install software to count keystrokes on your computer.
- Workrave: Free software that’s excellent for Windows users. Per their website, “It monitors your keyboard and mouse usage and using this information, it frequently alerts you to take micro-breaks, rest breaks, and restricts you to your daily computer usage.”
- Use Google Sheets or Microsoft Excel with Octomouse to track keyboard/mouse usage and your self-assessed health scores (e.g., 10 = bad, 1 = good) over time.
Control your calendar and create a meeting strategy
The basic strategy is to take more breaks between your working sessions, be more efficient when you’re working, and actively schedule ways to be productive without typing. The most important thing that I found is proactively planning break times to avoid long continuous periods of using my keyboard/mouse.
Don’t check Instagram or Twitter while you’re working. Try using a video call, live meeting, or voice dictation to discuss something with a coworker, rather than typing on Slack and email.
Quick tips for your calendar
- Proactively schedule blocks of typing time and non-typing time
- Don’t have too many continuous periods of typing time
- Strategically scheduling meetings (i.e., non-typing time) in between typing working time
- Be flexible — it’s okay to move things around. Make sure that you’re prioritizing your health with your calendar
- Block out times where people CAN and CAN’T schedule meetings with you
Be focused. Be efficient. Work smarter, not harder.
You have limited typing time. Each moment is precious due to your body’s endurance and ability to endure typing/usage strain.
Turn off all notifications from emails/Slack/phone (in conjunction with the Pomodoro technique) to help get work done more efficiently.
Figure out ways to work with teammates.
Take on and volunteer for less detrimental tasks for your health and see if your teammates can take on those that put your health at risk.
Being productive without keyboard and mouse
Disclaimer: I don’t condone pushing yourself to be “productive” if it hurts your body further. But there are ways to be productive without injuring yourself. For me, using pen and paper doesn’t aggravate my injury, so it’s a tactic I rely on to still be “productive” and maximize the efficiency of my keyboard/mouse time.
Meetings instead of long Slack/emails
As mentioned before, try using a video call, live meeting, or voice dictation to discuss something with a coworker, rather than typing on Slack and email.
While meetings can sometimes be less efficient or more disruptive than email/Slack, there are health benefits for YOU. It’s okay to prioritize your health over minor efficiency gains or convenience.
Use pen and paper, or whatever else helps you!
Most of my day-to-day consists of writing long documents, emails, or creating presentations. And our standard workflow usually consists of multiple rounds of drafting, deleting, and editing.
For example, when typing up an email or a presentation, I may draft one version, re-read it, delete it because I don’t like it, and re-draft new variations. This workflow is a LOT of typing that proper planning could help prevent.
I use pen and paper to create bullet-point outlines of emails/long documents I plan to write. I also sketch drafts of my presentation slides before creating them digitally on Powerpoint/Keynote. And even before I think about creating a dashboard, I’ll sketch out the questions I’m trying to answer and the visualizations I may need.
Find out what works for your injury and your work stream! Get creative.
Voice dictation and voice control software
Use assistive technology like voice dictation to be productive when your wrists and arms need a break (e.g., voice dictation to write emails/documents/Slack).
Full computer control via voice
These solutions allow you to control your computer almost entirely hands-off by just using your voice. You can do things like open applications, move and click your cursor, scroll up and down web pages all via voice commands.
Edit: As I’m digging more into this area, I realize how much I don’t know about voice computer control. There seems to be a vast ecosystem, and I haven’t even scratched the surface of all the solutions out there (Vocola, Caster, Knowbrainer, Utter Command, etc.).
My original draft was a basic high-level understanding. So I would only refer to this as a starting point and not as the definitive answer for which voice dictation/control solution is best for you. As I learn more about this area myself, I’ll update this section in the future to reflect my refined understanding.
Dragon Speech Recognition
- Dragon Speech Recognition: This is the most common recommendation and what seems to be the oldest/longest-running solution (not necessarily a good thing).
The solution isn’t perfect, but it works for many people who are willing to invest the time/energy in learning how to use the software.
Pros:
- Primarily useful for typing and dictation, but can do a few commands to control your computer
- Learns your voice and improves accuracy over timeCons:
- Support for Mac is discontinued (Windows is still supported)
- Doesn't have the same amount of full computer control via voice as other alternatives listed below
- Costs money
- Outdated
Mac Voice Control
- Mac Voice Control: Similar to Dragon, but works well with Mac OS software/apps (Safari, Pages, Notes, etc.)
Pros:
- Full control of your computer
- Compatibility with your Mac operating system and laptop, so doesn’t run into compatibility issues with other non-Mac solutions
- Free
- Easy to learnCons:
- Voice accuracy is not great
- Intermittently slows down your computer when voice control is switched on
- Only works well with Mac app software (Safari, Notes, Pages) and not so well with everything else (can’t do many things in Chrome, Outlook, Slack, non-Apple apps and software)
- Has limited customizability. Not as customizable as Windows Speech Recognition or Talon.
Windows Speech Recognition
- Windows Speech Recognition: Window’s equivalent of Mac’s Voice Control.
You can leverage the customizability and program custom voice commands specific to your needs (Windows Speech Recognition macros).
Pros:
- Highly customizable (via macros)
- Compatible and works well with Windows operating system and laptops
- FreeCons:
- Voice accuracy is not great (but can be improved via voice recognition training)
- Customization has a learning curve and helps to have basic programming understanding
Talon
- Talon: Primarily for programming/coding by voice (coding demo) with additional benefits and use cases (hands-off gaming, hands-off mousing via eye-tracking, etc.).
Talon has several cool features benefitting people with hands-off control/typing/coding. It would be a disservice to say it can only be used for programming by voice, as it can do much more if you learn how to use and customize the software. See their website for more information.
Pros:
- Highly customizable, can program (mostly) anything via voice
- Works on Mac, Window, and Linux operating systems
- Strong community of developers, users, and supporters on Slack
- Continually being updated with new features
- Supports hands-off mouse movement via eye-tracking (sensor technology to detect where you're looking on your screen)Cons:
- Initial setup is more complicated (due to the customizability) than easier-to-use alternatives like Dragon, Mac Voice Control, and Windows Speech Recognition
- Customization has a learning curve and helps to have basic programming understanding
Voice for dictation only (think Siri to type)
Useful primarily for typing sentences, emails, or documents. It still requires keyboard/mouse usage to use your computer since you can’t issue computer commands via voice (e.g. switch applications, close a tab, or open a new window).
- Mac Dictation and Windows Dictation: Easy to use, only for talking to type. Not entirely hands-off as you will likely need to use your keyboard for text editing/formatting
- Google Docs Voice Dictation: Great to use if you just have to use your voice to type long documents like essays, emails, or notes. Anecdotally, Google Doc’s voice dictation seems to have fairly accurate speech recognition (I’m guessing due to Google’s other assets that also rely on speech recognition like Youtube, Google Assistant, Google Home)
Quick thoughts on using voice to control your computer and type
Google, Apple, and Amazon have made fantastic progress in technology, voice assistants, and machine learning. However, I think voice control still has significant room for improvement. Basic usability commands, steep learning curves, and error rates in voice control all make it extremely difficult to use.
The industry has designed all of our devices/tools (keyboard, mouse, phone) for our fingers and hands. Hands-off productivity/accessibility is often an afterthought. I genuinely believe that a solution that re-imagines and re-designs the optimal way of using computers and software has a ton of potential, and not just for people with RSI.
Managing wrist/arm usage outside of work
One of our common mistakes is that we neglect our hand and wrist usage outside of work, even if we’re disciplined about our at-work usage. When we should be resting our hands and wrists outside of work, we are instead extending our 8-hour marathon of wrists/arms usage to 12–16 hours.
Identify high-risk vs. low-risk activities
Listen to your body and avoid high-risk activities that you know that you shouldn’t be doing. Video/computer games, specific sports and hobbies, long periods of driving, or anything that heavily uses your arms can further strain your injury.
Where necessary, adapt your life to minimize usage. Split high-injury risk chores with other housemates, take turns when driving, use public transportation, and take frequent breaks in your hobby. I’ve certainly made the mistake of prolonging my recovery by not being diligent in adapting my overall lifestyle, and not just my at-work lifestyle.
Think about the various activities you do as you go through your day. Identify times or events that aggravate your injuries. Once you can identify the major contributors, you can think about how to minimize or eliminate them.
Minimize phone usage
You’d be surprised by how much the average person uses their phone on a given day. Especially with COVID, we are now spending more of our time at home with our devices.
For me, using my smartphone was a significant contributor to my wrist/arm injury. I noticed my RSI would feel worse after prolonged periods of usage, and it would happen without me noticing how much time I spent on my phone.
Here are some common tactics to minimize your phone time:
- Delete certain addictive apps from your phone (Facebook, Twitter, Instagram, Reddit) — and yes, I know this is difficult.
- Turn off notifications (push and red badges) for social media or other apps
- Minimize phone usage when you wake up and before you sleep by putting your phone in a separate room rather than by your bedside
Hands-off phone usage tactics:
- Speakerphone or headphones rather than holding your phone for phone calls
- Using Siri/voice to text
- Videos, podcasts, and audiobooks instead of scrolling using your fingers through web pages, mobile apps, and holding physical books
For an incredibly thoughtful (and probably the best) guide on minimizing phone usage and addictiveness, check out this post: How to Configure Your iPhone to Work for You, Not Against You
Building good habits and breaking bad ones
Check your mindset and your priorities
To truly improve and overcome your RSI, you must have the proper mindset and prioritization of your recovery. With the right mindset towards this injury, you will have the discipline to break the bad habits and build the right behaviors that promote a faster recovery.
Now that you know what to do, I want to emphasize HOW to do it. It is the most critical part of this guide and the part where most people fall short.
I’ve talked to many people who have seen therapists, know the proper stretches/exercises, and want to overcome their RSI. However, due to circumstances with their life or work, they fail to stick to their recovery program and never seem to get better.
RSIs are particularly tough because they require a mindset shift to recognize the cost of “just one more email/Slack message/minute of browsing Instagram.” While these seemingly innocuous moments of micro-usage don’t cause pain or discomfort immediately, the culmination of all this usage eventually results in further aggravation. What’s necessary to curb this is the proper mindset and attitude towards the injury, mental discipline, and consistency in your habits.
Break bad habits about ignoring pain/discomfort
Pain is your body’s way of actively trying to tell you something. If, at any point, you feel soreness or pain, you should immediately stop whatever is contributing to it. No exceptions/no but’s.
This thought also applies to stretches/exercises, but know how to differentiate between pain that is bad for you vs. the mild discomfort that you may experience when stretching/exercising.
Have a long-term mindset, don’t think short-term
Most times, an extra keystroke or 1 minute of keyboard and mouse usage won’t make a difference. But when done repeatedly and consistently, that’s when the RSI issues start. You have to recognize the real cost of that extra minute. The short-term impact may not seem significant, but you have to actively and consciously remind yourself of the long-term consequences.
Have the proper mindset and embrace the identity of being a health-conscious person. Assume the habits and behaviors of someone who prioritizes their health. You want to be more mindful about that “extra minute of work” or dismissing your break reminder (for the third time!).
Set up your lifestyle and environment for habit-building success
I am a firm believer in habits and setting up your environment for success. For me to remember or be motivated to do something, I have to make it as easy, effortless, and frictionless as possible.
I strive to be as consistent and disciplined with my habits and routine because I know it will help me become healthier quickly and reduce the rate of injury. With all good habits, like weightlifting or dieting, consistently doing something compounds the benefit over long periods, though it’s not immediately apparent.
Here are some common tactics that I’ve incorporated into my life to help manage my usage, take more breaks, and be consistent with my routine.
Track your goals, habits, and to-dos in a daily notebook
I use a daily notebook to track my goals and to-dos for the day. I jot down my goal of being a physically healthy person. My to-do includes my morning and evening routines, as well as my personal/work tasks. You can also explore other variations, such as the Bullet Journal, or create your own custom template.
You can add anything you want to your daily notebook. My basic structure includes:
[1] Goals
[2] Daily tasks
[3] Habit streak tracker (and a number to indicate my “streak”)
a) Morning wrist routine
b) Morning exercise
c) Post-work wrist stretches
d) Evening yoga
[4] Reflections / gratitudesCreate habit streaks and find accountability partners
Habit Streaks: As mentioned above, I tracked my habit consistency with a daily notebook and Google Sheets. The motivation to extend and continue a streak, particularly when it’s long, motivates me not to break it and get my routines done. Feel free to use whatever helps you create your habits and keep your habit streaks going (notebook, post-it notes, mobile app).
Accountability Partners: Having accountability partners or someone who you promise or commit to doing your routine. It helps if you and your partner are both striving for some consistency or development of a habit. You can up the stakes by using friendly wagers with friends to see how long we can keep up our “daily exercise streak.” Here’s a sample spreadsheet that’s similar to what I’ve been using with a friend.
For more on effective habit building, try reading one of my favorite books, Atomic Habits. The book has examples and guidance on how to build habits and why these methods are so effective.
It’s better to do something than nothing! Don’t make excuses; make adjustments!
Have a few spare minutes before your next meeting? Woke up late so you can’t do your full 1-hour morning routine anymore?
Having different time blocks of stretches/exercises is convenient because it allows you to slot in meetings based on your availability.
I have stretches and exercises of varying lengths (1 minute, 5 minutes, 8 minutes, 20 minutes, 30 minutes) favorited in my phone bookmarks.
Ten minutes until your next meeting? Slot in a quick 5-minute routine!
See the Core Habit: Stretching + Exercising section above for different examples of stretches with different durations. Better yet, create your list of favorites on your own or with your hand therapist!
I’m also always doing micro-stretches whenever I can — whether I’m walking to/from meetings, during meetings, waiting in line, or watching TV on the couch.
Ultimately, find out what works best for you! Part of the fun is figuring out how to hack your productivity and health. Doing something is better than nothing, and it’s perfectly OK to start with small changes. I believe the most important thing is just to get started.
Be an athlete! Prep for your daily competition.
I recently heard a great analogy about managing RSI. You can think of yourself as an athlete preparing for their daily sports competition (your workday).
Create a structured routine of training (strengthening your body and stretching your wrists/arms), active use (typing during your workday), rest, and recovery that you adhere to maximize your productivity, effectiveness, and minimize your chances of injury.
With the same amount of focus and discipline on your “sports routine,” you can keep improving your stamina and performance on competition day.
Create a structured routine of training (strengthening your body and stretching your wrists/arms), active use (typing during your workday), rest, and recovery that you adhere to maximize your productivity, effectiveness, and minimize your chances of injury.
Pain relief and management
Pain relief is for rest and recovery. Not for working.
Managing pain and injury is an integral part of your recovery. My primary tools for managing pain and discomfort are heat, cold, and massages. I use heat and massages to relax the muscles and get them loose/warmed up while cold reduces and manages inflammation.
Note that using pain relief and “not having pain” is NOT a valid excuse to keep working and pushing your body beyond its limits. This bad habit was a big mistake that I made in my RSI journey.
Heat and cold
Situational and strategic usage of heat and cold is critical. You want to know when to use what. I’ll use heat throughout the day while I use cold/icing only after a long, intensive day.
Heat is my go-to and something I use very frequently to promote relaxation, increase blood flow, and warm-up my wrist and arm joints and muscles. I use heat packs before using my hands for work, in between meetings, and after my workday.
I only use cold/icing after a particularly long, intensive day when I’ve overly strained my muscles and want to reduce pain, swelling, and inflammation. However, I am very disciplined not to use my hands after an icing session. I only use ice after I know I am 100% done for the day. Otherwise, I keep using heat for temporary relief.
Massages
Massage therapy helps relieve tension in my wrists/hands, and I generally do them after my workday during the rest period. For me, the primary benefits of massages are reduced muscle tension/tightness, improved blood circulation (to promote recovery), and increased flexibility/mobility of the joints/tendons. Talk to your doctor and certified hand therapist on which massages you should do (incorrect ones can potentially make your injuries worse).
Like exercises, I won’t recommend specific massages to do because incorrect ones can worsen the problem. You want to make sure you’re doing the correct ones and not to over-do them. Injuries can differ, and each of our bodies is different, so what works for me may not work for you.
Examples of massage techniques I use:
- Two Tennis Balls Taped Together or Peanut Massage Ball: This is really great for self-massaging your wrist and arm area.
- Graston scraping: This is a massage that I’ve tried with my hand therapist. It feels great, and my wrists/arms feel more relaxed after a scraping session. This massage is related to the practice of myofascial release, which is a technique that focuses on loosening and stretching myofascial tissues — the tough membranes that wrap, connect and support your muscles.
- RockPods myofascial cupping set from RockTape: Similar to scraping, cupping therapy is also a part of my toolkit after having tried it with my hand therapist. The benefits are similar to scraping and are also related to myofascial release.
One quick note on Graston scraping, cupping, and myofascial release. There are differences in the medical community on whether scraping or cupping helps with recovery. Personally, it seemed to have helped despite my initial skepticism. The benefits I felt could have been some “placebo effect” for me. Still, my attitude was to keep trying it as long as there was some correlation with “feeling better” or improving symptoms.
Here are some links for you to read. I would recommend you both do your own research and consult your medical professional on whether scraping and cupping are right for you.
Other alternative pain relief, anti-inflammatory medicine, and treatments
I’ve personally tried cortisone shots, anti-inflammatory patches, painkillers, and ibuprofen. But, I generally avoided them as much as possible as I preferred using heat/cold/massages instead. I would speak to your medical professional on the proper usage of any and all the above.
(Closing thoughts) Have a positive mindset and please reach out to me if I can be helpful!
I hope that this guide will be helpful in your recovery and managing your injury. Repetitive strain injuries are some of the most challenging injuries to manage. Having gone through all the ups-and-downs myself, believe me when I say it’s not easy.
Proper recovery requires us to actively put in the effort and motivate ourselves, even when we’re not feeling any pain/strain. Consistent practice is challenging and takes willpower — so we build mental discipline, practice routines, and develop good habits to overcome this challenge.
The critical thing to remember is to design your lifestyle in a way that works for you. You want to be in control of your health — not let your health control you. Live your best life by making the right adjustments. With a recovery plan that incorporates proper stretching, exercises, and minimizing usage, you’ll be on your way to overcoming this injury.
Thanks for reading and wishing you all the best.
Appendix: FAQ and other topics not covered in detail
This section includes my quick thoughts on important topics that did not make it into the tactical guide due to my insufficient knowledge/research. Some of the topics may be considered unproven or not yet validated by the medical community. Due to this nature, I felt that it was better to include it in the appendix as my personal opinion and not “guide-worthy” advice.
Please feel free to check back as I will be updating this section as new questions or other notable topics come up.
Overall wellness (e.g., sleep, diet, stress) impact on RSI
Unsurprisingly, having great sleep, healthy diets, and low stress can only help you. The contrast is terrible sleep, unhealthy food, and high stress, which I don’t think anyone would debate as helpful for your injury.
Self-explanatory.
Other wellness practices/techniques (acupuncture, chiropractor, scraping, myofascial release, cupping)
I’ve tried and incorporated all the above and found them to provide significant pain relief and relaxation. I haven’t had a bad experience and scheduled these sessions whenever I felt I needed it (i.e., after a particularly intense period of usage).
I’d recommend giving these a try as my mentality was “it probably doesn’t hurt to try” and that there was some potential benefit to the placebo effect. Consult with your doctor if you have any questions before trying any of the above.
Anti-inflammatory diets/vitamins/supplements
I took some Turmeric and Glucosamine supplements. I can’t say for certain whether or not they helped, but I took them anyway.
Turmeric is supposed to help naturally reduce inflammation. Glucosamine helps support the healthy structure and function of joints to support mobility.
In addition to these, I also took my daily vitamin and fish oil supplements. Fish oil is supposed to help manage your inflammation among other health benefits.
The impact of stress associations and Tension Myositis Syndrome (TMS)
Tension Myositis Syndrome (TMS), states that your mind, which includes the stress/emotions you’re feeling, is a significant contributor to the physical pain that you experience. Our brain and our bodies are overly conditioned to trigger pain, even when our body is physically fine, due to associations of stressful moments and our bodily injury.
I haven’t explored this myself fully yet, but I anecdotally agree that stress made my injuries feel worse. My recovery correlated with a period in my life where I had less stress (related? connected? circular maybe?).
My attitude towards stress is the same as sleep and diet. Having a good quality of life and holistic health can only help you, not hurt you.
As I continue to experiment with TMS and try to figure out ways to overcome some of my mental associations with pain, I will update this guide with personal anecdotes.
If you’d like to explore this for yourself, feel free to check out the following resources:
