I’m reading Bellis and Damany’s It’s Not Carpal Tunnel Syndrome! RSI Theory & Therapy for Computer Professionals. Their thesis is that many RSIs won’t be solved by surgery, at least not without an understanding of the larger system and it is possible to properly treat an RSI without giving up computer use.

Bellis is a computer professional who had surgery, his symptoms came back only to be resolved by working with an experience physical therapist: Damany. Their advice is in line with what my physical therapist is recommending and it’s working for me. I am now just over two months into my treatment of my RSIs and I am seeing improvement.

Of particular interest is the idea that just fixing an RSI through surgery, though often providing immediate relief will not provide long term relief if you don’t address the underlying cause of the damage. The hands, arms, back, neck, etc. work as a system: just operating on the wrist or the elbow doesn’t address the rest of the system. Further, in many cases RSI can be relieved by just addressing the cause and skipping the surgery altogether. That speaks to me.

Particularly interesting about nerve damage is there is really no way to strengthen or condition nerves. Physical therapy for muscles usually involves strengthening and the result is progressive rebuilding. Physical therapy for nerves involves moving your [arms in my case] in a way to take them through their full range of motion but otherwise just modifying behavior to not put stress on the nerves and hope they heal. And they do heal but over a course of months.

Sensory feedback from muscles is consistent: they hurt when you exercise them and then they heal.. While nerves presumably heal progressively they send confusing, misleading messages about what is going on: one day it will be pain in the hand, another it will be itching “inside” your hand that can’t be scratched. Some days I’ll work most of the day on the keyboard in pain only to have it clear up three quarters of the way through the day and not hurt at all the rest of the day even though I’m working as much as I was in the morning.

I am also a little surprised about how little modern medicine knows about RSIs.. Part of the problem according to Bellis and Damany is that modern medicine treats the body as regions and doctors are trained to focus on one part and so don’t always look at the big picture before treating the location of the pain: damage to the median nerve where it passes through the carpal tunnel for instance is often the result of bad posture and if you operate but don’t’ address the bad posture you will end up with the same symptoms sometimes in a matter of weeks.

It’s your responsibility as a patient to talk to multiple people and try to understand what is going on and help guide your treatment.. Your doctor may well know less about your condition than you do.. Bellis and Damany suggest physical therapy with a focus on the whole system and not just the wrist or just the elbow the most effective way to treat an RSI.