Dealing With RSI

I started having pain in my left wrist in 1995, and the problems got progressively worse in spite of (and partly because of) various attempts at treatment. In 1996 I started using a speech recognition system and stopped using my left hand for any typing at all. I have been able to get by pretty well with this approach, and can even do activities like coding without a major loss of productivity.

People often ask me for advice about RSI problems and how to deal with them, so I finally decided to collect some random thoughts into a Web page. Be careful how you use this information: RSI problems and treatments vary enormously from person to person, so what worked for me may not work for you.

• I tried a lot of different treatments for my RSI problems and didn't have much success with most of them. I was never even able to get a reasonable diagnosis of exactly what is wrong with my arm. Some of the treatments I tried (prescribed by supposed health experts) actually made the problems worse.
• The one treatment that I did find very useful was biofeedback training. The idea behind biofeedback is that a lot of problems are caused by muscle tension. In biofeedback they attach a bunch of electrodes to you to measure muscle tension and then teach you to relax while working. This made a substantial difference in my comfort level; it's amazing how tense you are under normal conditions and how much you can relax if you know how. Before biofeedback training I had reached the point where I was having pain in my left arm even though I wasn't using it for typing. Just sitting in my office chair, dictating and occasionally using my right hand, I would get RSI symptoms in my left arm! As soon as I would get up out of my chair and do other activities, the symptoms would go away again. After biofeedback training, these problems went away almost entirely. Unfortunately, the place where I got my biofeedback training (Biofeedback Associates of California) no longer seems to exist.
• My experience suggests that once you start having RSI problems it is very difficult to get rid of them: it will probably be an issue for the rest of your life, and if you don't act quickly things will get much worse. Everyone I've ever heard of with RSI problems (myself included) ignored early warning signs and didn't take action soon enough, even when the symptoms started becoming severe. So, I'd encourage you to take action as soon as you start having any problems, even if the problems seem minor. Switch to a more ergonomic keyboard, improve your work set up, stop using emacs (chording editors put a lot of strain on your wrists), or start using dictation for things where it works in order to reduce the load on your wrists. Things don't just get better on their own!
• For many years I thought that significant recovery was impossible; the best I could hope for was to plateau at a particular level of impairment. However, over 15-20 years my wrists have gradually improved. By 2010 I had began to type again, only occasionally at first, but gradually more and more. A of 2015, I can do modest amounts of typing without pain (perhaps 25-50% of what I did before symptoms first appeared?). I still use dictation for activities where it works best, such as email and this text. I save my typing for activities like coding, where dictation doesn't work quite as well.
• I have been using Dragon Naturally Speaking for dictation since 1999. It takes a while to get used to a dictation program like Naturally Speaking, partly because the system trains itself to you and partly because you learn to talk in a way that it can understand. It also takes a while to get comfortable talking to yourself as you work (I felt pretty self-conscious at first). However, I'm now at the point where I can dictate ordinary text such as email and papers about as fast as I could type them (and I was a fast touch typist).
• One of the interesting things I've learned from this whole experience is that speech recognition technology is really quite good! I think many people will find that dictation is faster than typing even if you don't have RSI problems.
• An interesting consequence of dictation is that you won't always notice errors in recognition, resulting in rather odd words in your documents. I call these "speakos" because of the analogy with typos: speakos make absolutely no sense at all but happen to sound close to what you intended. For example, the words "email" and "female" sound almost the same and are often confused by Dragon Naturally Speaking. I have had several amusing incidents where I almost sent out emails containing sentences such as "Thanks for your female" or "I have enjoyed our exchange of females".
• Programming is more of a problem with dictation because of all the symbols and nonstandard word spellings. Over the years I have learned to spell out words quickly using alpha-bravo-delta-charlie lingo, which Naturally Speaking recognizes. Overall I would say that dictation hasn't hurt my overall programming productivity much.
• Dictation systems don't help much with mouse pointing. They have facilities for moving the cursor under voice control, but I found them extremely clumsy to use. Fortunately for me, my right hand is fine so I can mouse normally. I don't know what I would do if I lost the use of my mousing hand.
• Naturally Speaking runs on Windows. If you use Unix as your primary computing platform, one possible approach is to run Naturally Speaking on a laptop sitting next to your workstation. You can run a program called a2x on your Unix workstation and set it up to communicate with Naturally Speaking over the network, so that everything you dictate appears wherever the insertion cursor is on your workstation.