This is a recap of my personal experiences with Repetitive Stress Injuries, mostly for my own reference. I have no medical training and no business telling other people what kind of care they should seek.

The short version is that I wish I’d taken my pain seriously, written down my symptoms, and sought medical attention sooner. I’m now working with a physical therapist and experiencing some short term relief with credible hopes of a full recovery in a few months. I used the NHS website to figure out how to choose an appropriate provider. The solution is specialized physical therapy exercises (and strength training for longer term protection).

I’ve been glued to a computer since I was 11 years old and playing video games longer than that. I’ve always had sloppy posture, and sometimes a long run of browsing the internet while sprawled sideways in a chair would give me an ache in my mousing arm. I would sit up straight and switch hands if possible. The pain eased up on its own and I forgot about it until it happened again.

Even after I started working at a desk full time, I didn’t have persistent problems. Aside from remapping caps lock to control, I didn’t make any ergonomic adjustments. I figured that those things just didn’t apply to me. And then a year or two ago, the pain returned, and instead of fading away, it intensified over time. I kept telling myself that all I needed to do was rest and double down on my posture, since it had always worked before. I looked up instructions on how to precisely adjust my desk height, chair height, etc, and I stopped using apps on my phone that put pressure on specific areas.

While it did occur to me to seek out medical attention, I was scared for two reasons. My main concern was that finding a specialist meant finding a provider I could trust to recommend only evidence-based medicine and not weird mystical nonsense. I was also worried that treatment would end up being more aggressive than necessary — I have a relative who sought treatment for similar RSI pain and was convinced to immediately undergo surgery that reduced her range of motion.

The incident that finally spurred me into action was attempting to play Super Mario Party with a group of friends. The mini game that was randomly selected for our ninth round involved holding the Joy-Con horizontally (grasping one end with each hand) and flexing the wrists sideways as though the Joy-Con were being flipped up and down, or fanned. I’m at a loss for how to describe it and I’m not even sure I’m remembering the gesture correctly. What I do know is that my hands and wrists were filled with an intense ache that lasted for the next two hours and made it hard to even grasp things. The next week, I started my research in earnest.

As I noted earlier, I wanted to focus on evidence-based medicine. I know that scientific discovery is an ongoing process and that we don’t know everything yet, but I’m not going to throw away the things that we do know. It was important to me to at least try the most reliable thing first. I started by looking for research from the National Institutes of Health (NIH), but I realized that even if I could read and fully understand what a given article said (not necessarily true), I didn’t know how to ensure I was reading the best, most representative articles. I found a much more helpful layperson’s reference in the UK’s National Health Service (NHS).

The NHS page on RSI described my situation exactly: repetitive activities with poor posture that results in aching, tingling, and weakness. I was already taking steps to modify my tasks and reduce my activity, and my pain wasn’t severe enough that I needed to relieve symptoms before trying to fix the root cause, so I skipped over their first few lines of treatment and landed on this: “You may also be referred to a physiotherapist for advice on posture and how to strengthen or relax your muscles.” (A subsequent line does suggest osteopathy, and the full page on osteopathy provides the exact kinds of caveats I’d want to hear when making my decision: it’s recommended for back pain and there’s limited evidence for certain other kinds of pain, but there is no evidence that it can address things unrelated to bones and muscles.)

I searched for physical therapists in San Francisco and got overwhelmed by reading reviews and trying to figure out which providers were in-network for me. I finally broke through my indecision when I realized that patients are expected to attend one or two sessions every week for multiple months. That night, I sent a message to my primary care physician to ask for a referral to a place that was three minutes’ walk from my front door.

My physical therapist examined me closely, talked over my symptoms in detail, and affirmed my reports of pain when we couldn’t isolate them with her tests. She talked over my recovery goals and she didn’t laugh when I said that I just wanted to live my life normally, which includes being able to play some occasional video games without debilitating pain. She listened to my concerns when she suggested a practice (cupping) that I found sketchy, took the time to talk about the evidence, and didn’t try to convince me to do it when I still didn’t want to. Our weekly sessions focus on my pain journal (what I was doing and which areas hurt, e.g., “After a lot of typing on my phone, the underside of both forearms are sore”) and she translates those reports into a custom exercise routine.

My physical therapist confirmed that I have some amount of hypermobility, including in my fingers, wrists, and shoulders / back, which makes me particularly vulnerable to this kind of overuse injury. We don’t know for sure why my injuries are worse this time when they always went away on their own before (I personally blame phones getting heavier and a PopSocket distorting my posture when I tried it for a few weeks), but we do know the most reliable way to address it: improving muscle strength to protect joints. I’m advised to avoid heavy things for now, especially anything that emphasizes grip strength, but my long term plan is to take up weight lifting again for the fourth or fifth time. Maybe now that I have a very serious incentive, it’ll actually stick this time.