How I beat RSI

Posted on March 30, 2013 by Kristian Amlie

Update: I have written a followup to this article. You can read it here.

Introduction

For over three years I lived with a condition in my wrists that made it a dreadful, painful experience to use the computer and many other things in my daily life. Seemingly random pain patterns would be observed, for example I could use a button cell phone with no problems at all, but touch phones (or smart phones) became painful after mere minutes of use. I could lift a heavy crate easily, but I couldn’t lift a glass from the table without getting pain. Most commonly referred to as carpal tunnel, or repetitive strain injury (RSI), this was my everyday life.

Today I am sitting here writing this article, and yesterday I spent a good 13 hours at the computer, and neither has given me any symptoms to speak of. How did I get here? Well, this is my story.

If you came to this page by searching the Internet, chances are that you are suffering from a similar condition yourself. I know nothing about the condition that you may have, but I can tell you that beating mine was not easy, and took a lot of learning and quite some effort. But it is possible, and this article is written to try to shed some light on this very strange syndrome, which I believe is the cause of far more muscle pain than most people are aware of. I will do this by sharing what I learned along the way, my experience and my road to recovery.

If you have a pain syndrome and are looking for answers I advice you to read the whole article from start to finish. Resist the temptation to skip ahead to “the cure”. You need to be aware that the syndrome you may be suffering from is complicated in nature, and understanding it is key to beating it. If you still feel short on time, you should at least read the section Who are you?, to make sure that you are not seeking the wrong advice.

Disclaimer: I am not a doctor myself, and what I write here is based on my understanding of the subject. Therefore it may not be 100% textbook correct. However, I have first hand experience with this syndrome and have seen the treatment work in practice.

Contents:

• Who are you?
• History
• So… what is it?
• How does it work?
• The treatment
• Patterns
• The role of the therapist
• Post-recovery analysis of my history
• Foot notes

Who are you?

Here is the place to identify whether your symptoms are similar to what I had.

Symptoms

Your symptoms may have been brought on in a variety of ways. Maybe you worked a lot of overtime at the computer one month, maybe you were using the wrong type of keyboard, or maybe it just sneaked up on you for no reason. In any case, you experienced pain at one point while working at the computer, and since then it has not gone away. The pain may not always be as strong, sometimes it is barely noticeable, other times it is quite severe. It may come in waves that may last for a few days at a time. As you change working position to accommodate the pain, it may seem like it follows you, affecting another muscle that is now being used more.

You probably noticed that I used the word “may” quite a lot. This is part of your own self diagnosis. Due to the nature of this syndrome, it is difficult to diagnose with certainty, and it is easier to diagnose it by ruling out other types of injury.

So here is the first thing you need to do, if you haven’t already: Go to a physical therapist. Make sure that you do not have any serious tissue damage, or bones or ligaments being out of place. If you do, then you may need surgery, and you should talk to doctors about that. If, on the other hand, he/she cannot accurately pinpoint the injury somewhere in your body, either by examining you directly or by looking at x-rays/MR-images, then you are ready for the next step in the diagnosis.

Start by asking yourself these questions:

• Is it painful at night?
• Does the pain always occur in the exact same place, or can it move around a little?
• Does it hurt a lot if I haven’t had pain for a while and I press my finger on the affected area?
• When I sit down at the computer, does it take long for the pain to start?

Think about an answer for each one of them, and then see if your answer is similar to any of these.

• Is it painful at night? Not really, it’s worse during the day.
• Does the pain always occur in the exact same place, or can it move around a little? It’s not exactly in the same spot all the time. Sometimes I hurt in one place and sometimes in another near it.
• Does it hurt a lot if I haven’t had pain for a while and I press my finger on the affected area? A little, but not too bad.
• When I sit down at the computer, does it take long for the pain to start? No, it usually starts within the first ten minutes.

Can you identify with one or more of these answers? Then you may have the syndrome I had. These questions are meant to uncover the fact that the pain sensation you’re having is not because of physical tissue damage, but rather because of a neurological issue. This is why the pain can sometimes feel a bit inconsistent. It doesn’t behave like pain does when we break a leg. When we do that, it definitely hurts in the same spot all the time, and you certainly cannot press your finger down on it without feeling quite serious pain.

How you got here

If you are like me, you have probably already skimmed through a lot of other material on the Internet, and may have found much of it to be quite vague. I would often find articles that described symptoms almost exactly like mine, but when I tried to read about “the cure”, I would find that it couldn’t really explain how they got better. A typical example is “I just needed to get a more relaxed relationship to the computer”, or “as soon as I adopted a less stressful life, things got better”. What good does that do to me? Those are not explanations, merely observations.

At the time when I read the articles I couldn’t understand why people didn’t give a better explanation for how they got better. Well, now I understand that most likely it was because they didn’t understand what had happened to them, and why their pain went away, or why it was even there in the first place. Fortunately, I was lucky enough to have a very knowledgeable physician that made me fully aware of the process and not only how to beat it, but also how the mechanisms work.

I would also like to debunk the role of religion in this healing process. A lot of the pages I found about pain syndromes advised you to be at peace with yourself and your god, and your god would take away the pain. As a non-believer/atheist I found this advice quite dismissive and sometimes outright provoking. The last thing one needs when one has serious pain is to be told fairy tales that everything is going to be all right. I needed hard facts. Well, I’m here to tell you now, that the treatment I went through is all about science.

History

This part can be skipped if you are not interested. Here I go through what happened since day one, and the treatments that I went through that did not work. It’s an interesting read, especially considering that I came close to the real answer several times, but feel free to skip to “What is it” if you wish.

The first thing that happened to me was that I started to get pain in my wrist after getting very tired because I had been typing in an unusual way. I was trying to teach myself the touch typing method, but I had been using it too eagerly in the beginning, before I was really comfortable with it, and this caused me to get an inflamed muscle in the wrist.

However, as time went by, the pain did not go away. After over a week of vacation, I found that it still had not gone away when I came back to work, and started realizing that this was more serious than I first thought. Naturally, my first understanding was that I had an inflammation that would not go away (this later turned out to be wrong).

I booked an appointment with a physical therapist through my job’s health insurance, and started seeing her on a regular basis. What she told me was that the initial inflammation had left my muscles in a weakened state, and I needed to slowly rebuild my strength to sit in front of a keyboard again. We proceeded with a training program that consisted of exercises specifically for the upper muscle in the wrist, being the place where I had the most pain.

I kept at this for quite a while, training that one muscle. However the combined strain of that plus my job, meant that I was now putting even more pressure on the muscle. So I decided to get a wrist support to give my wrist some rest while I was not exercising it.

Despite the wrist support, and despite the exercises, I kept getting worse, up until the point where I was in such a bad shape that I had no choice but to take a leave of absence from work. This, I thought, will surely help, now that the wrist can finally rest.

To my surprise, I found that everytime I sat down in front of a computer, I was worse! Not only that, but the pain had started affecting other activities as well, and I started worrying if I could take care of myself in the future.

I was still doing the exercises and still talked to my physical therapist, but it was clear that her method was not working, and when she persisted in keeping up with the same exercises, I decided not to see her anymore.

A little later I booked an appointment at a specialist center for sports injuries, who apparently had expert knowledge about inflammations and muscle strain. When the guy heard my story, he claimed that no inflammation can last that long (this was six months in), and that pain may sometimes persist beyond physical recovery. What I should do is simply to use the wrist normally. In hindsight this answer was quite close to the real answer, but I was lacking context, and the guy was not specific enough on how to deal with that persistent pain.

However, this meant I could work again, which actually went quite ok, and I felt much better for a while. However, I never felt like I completely recovered, and slowly it started getting worse again. Finally, after another year of working, I decided that I couldn’t keep up with this pain, and I quit my IT job with the intention of seeking new treatment while working in a more physical work environment where I wouldn’t have to use the computer so much. So a few months later, I started my forklift driving job.

At the same time I started my treatment at a new physical therapy center. This guy was more focused on how the pain was generated, and he spent a lot of time making sure that my nerves were in order, not constricted anywhere, or being squeezed by a bone or something. He was very methodical, and would try one thing for a while, and then when that didn’t give any effect, he would try another, slowly ruling out causes of pain. In my opinion, much more professional than my previous physician.

In the meantime, at home, I had started my own methodical search for a correct diagnosis online, by finding stories of people with the same symptoms, or specialists that treated such symptoms. This meant a lot of computer work, but I was fairly certain at that time that my condition was not physical. I couldn’t believe after two whole years that my muscles would not have healed. So even though it was painful, I continued the search.

After a few months I came across an American specialist called John Sarno. Although he primarily dealt with back pain, his description of symptoms seemed exactly like mine, and he also listed personality types that are often victims of this syndrome, and they fit me very well. I bought his book and read it cover to cover.

His theory was that the pain had little or no physical origin at all, and that the pain was a cover that the mind had invented in order to distract me from some internal emotional conflict. Being a very emotionally stable person, I found this a little unlikely, but I couldn’t escape the fact that his symptom descriptions fit me remarkably well. He also underlined that these conflicts were often unknown to the patient, and I therefore decided to give his methods a shot.

I won’t go through all the background material for his treatment here, which is quite extensive, but in short it consisted of the idea that the most primitive mind is a selfish, self preserving mind, and the morality in humans is something we learn as we grow up. Therefore, even though things that happen to us may be completely fair from a moral standpoint, the primitive, selfish mind may still be angry about it, and this rage builds up inside of you, even if you are unaware of it. This selfish mind is very visible in children, who can often become irritated and disappointed when parents divide their attention between siblings, even though the opposite would of course be completely unfair.

So Sarno’s method consisted of bringing these enraging matters to the surface, and allowing yourself to be angry about them, even if not necessarily in front of others. Especially in times of great pain, you should think hard about this rage, to render the mind’s decoy useless.

For several months I tried this. I wrote down things that irritated and enraged me, even if it was not anybody’s fault. And for some time, it actually did work, at least to a certain degree. If I concentrated on my internal conflicts whenever I had pain, the pain would often fade out a bit. But it never disappeared, and after several months I had a hard time coming up with things to be mad about. I concluded that this simply was not what I was suffering from, and that the temporary pain reduction must have been coincidental (I will offer a possible explanation later, for why this might have happened). Hence I stopped using Sarno’s program.

However, Sarno had opened my eyes to the idea that the mind could at least be involved in the condition. It was not long after I quit Sarno’s treatment that my physical therapist showed enough professionalism to realize he had exhausted his options, and brought another specialist in. It was in my first talk with him that he mentioned a part of the brain which later became a keyword in my recovery. I will share the rest of that story in the following sections.

So… what is it?

Ask yourself this first: What do you think you’re suffering from? Is it carpal tunnel? Not likely, carpal tunnel can be seen on MR images and tends to hurt quite a lot at night. Is it an inflamed muscle or ligament? Doesn’t seem like it, since it moves around. An inflammation cannot move around. Maybe I’m just tired in the muscles? No, muscles don’t get tired after just a few minutes of light use.

What’s left then? Let’s start by looking at how pain is produced by the body and brain. Pain starts as a stimulation of a nerve somewhere, which then travels up to your brain. However, there isn’t an on/off switch for pain, which it triggers. It’s not quite that simple. When the signal from the nerve arrives, the brain initially has no idea what this signal means. It needs to weigh it against impulses from other nerves as well.

The strength of the signal certainly carries meaning. A very strong stimulation is very likely to mean something has been damaged, so the brain will almost certainly reach this conclusion and give you pain. But for weaker signals, it needs to take other factors into account. Have you ever experienced cutting yourself on something and then not noticing it until several minutes later? And then only when you look at it, you notice that “yeah, actually that does hurt a bit”. This is one of the factors that come into play when perceiving pain. The brain asks “This nerve has been triggered. Can the eyes confirm that there is an injury in that place?”

Of course this doesn’t mean that if you don’t look at it, it won’t be painful. Certainly it will, because there are many other factors the brain takes into account, such as:

• Do I have previous knowledge of an injury in this location?
• What’s the body’s alert level right now? Am I in danger?
• Can other senses confirm that there is injury?
• Was this nerve impulse expected?

This list is not complete. Pain perception is a complicated topic, only partially understood by science. But it helps demonstrate that pain perception is not a strict mechanical device where a triggered nerve equals pain.

Amygdala

Let’s move on to a specific part of the brain, the amygdala. The amygdala is a part of the brain which is responsible for “emotional memory”. The stronger the emotion associated with an experience, the more involved the amygdala is. Most notably, it is responsible for fear reactions. If you have fear of heights, fear of spiders, fear of needles, claustrophobia, social phobia, stage fright, or any fear at all really, the reaction starts at the amygdala.

The amygdala’s reaction to stimuli depends on what it has experienced before. If you had a bad experience where you nearly drowned earlier in your life, this may cause the amygdala to give you fear of being in water. Strongly emotional experiences like this “train” the amygdala. Its evolutionary purpose is obvious: If you nearly got eaten by a tiger one day, then it would be beneficial to your survival to avoid that animal in the future.

Fear is not the only emotion induced by the amygdala though. It is also responsible for positive emotional reactions, such as falling in love or feeling happy when you do something you like. It may be more appropriate to think of it as an emotion associator. Whatever emotional experience you had in the past, the amygdala will try to give you the same reaction again when you encounter the same situation. This effect is reinforced by repetition.

Putting it together

If we return to the pain syndrome, what does amygdala and emotional reactions have to do with anything? I cannot say how your pain started, so I will take myself as an example in this case:

I first started feeling my pain after about a week of intense typing on the keyboard in a very awkward position. I was trying to teach myself the touch typing method, after many years of typing with only one or two fingers. However, I aimed a little too high the first week, and got cramps and pain in my wrists because this was an unnatural way for me to type. Although I didn’t check with a doctor back then, I’m fairly certain that I had a small inflammation in the muscles.

I had a full time job though, so I couldn’t simply put down the keyboard and rest for a few weeks. I needed to keep going and I pushed through the pain, telling myself that it would probably go away soon. As time went by, I realized that it didn’t. I tried switching positions, wearing wrist supports, and I even took a leave of absence for three months, but it still didn’t go away. In fact, during the leave of absence, it got worse! Why on earth would it get worse?

My quest for finding that answer is portrayed in the history section. I won’t go through all of that here, but instead fast forward to the solution that I finally found with the help of my physical therapist.

The answer is that during those first crucial weeks when I had not put the keyboard down, I had conditioned the amygdala to associate the computer situation with a stressful situation. Or rather I had associated it with fear: Fear of pain and fear of injuring my wrist.

I can hear what you’re thinking now: “Hold on! Are you telling me that the whole problem is in my mind? That I am imagining it? That’s bullshit! This is as real as anything I’ve felt before!”

And you’re right. It is real. It is as real as taking a knife and slicing your own skin. It is exactly as painful as that. But you live in your brain. Your brain is your whole consciousness. If your brain tells you to feel something, you will feel it. Isn’t it then possible that your brain can be wrong about something and give you a feeling or sensation that doesn’t make sense? This is a hard pill to swallow for many. Don’t stop reading!

The brain is a fantastic device. It can learn complex tasks and solve problems it has never encountered before using logic and intuition. And it gives us consciousness. But it is just a machinery, and like any machinery it has flaws. Accepting this is critical to understanding why this pain syndrome is happening.

After all, wouldn’t a perfect brain remember everything worth remembering and forget everything not worth remembering? Instead, it forgets everything it should remember about your course exam, while the melody from the latest pop song, which you hate, is stuck on repeat inside your head. People cannot really control their brain, only influence it.

The conscious functions are only a small part of the brain. It has a whole ton of responsibility that most people do not normally think about. An obvious one is making sure you keep breathing, even while asleep. Then you have others like making sure food moves through your digestive system, maintaining your blood pressure, keeping body temperature constant…. the list goes on. And one of these unconscious processes is the emotional reactions from the amygdala. I say unconscious because you cannot choose not to react. The reaction comes whether you want to or not.

Compared to the conscious, “thinking” part of your brain, the subconscious part of your brain is quite dumb. It doesn’t understand complex causes or indirect consequences. It only understands simple relations, like “I did X, and while I did that I felt Y, therefore if I do X again, I should feel Y again”. Through experience, this is imprinted in the amygdala, just like riding a bike, and that is why you tend to be afraid of something that has hurt you before. Sounds sensible, right?

But sometimes, this mechanism fails, and gives an unintended effect. This is what happened to me, and maybe also what has happened to you. The first few weeks when I still had sore wrists from my intense touch typing, I didn’t stop. I continued using the computer, each time reinforcing amygdala’s idea that what I was doing was something painful and therefore dangerous. The physical symptoms were real at first, no doubt about that, but an inflammation doesn’t last forever. It receded over time, but by then amygdala had become so convinced that this was a dangerous activity, that it didn’t need any nerve input anymore. It already knew it was dangerous and would therefore turn on the pain immediately.

At the time, this scared me. I thought I was hurting myself, and I kept my attention intensely focused on the wrist whenever I did any activity which I thought could be harmful, including non-computer activities that also involved the wrist. But exactly this focus was my own undoing. The message I gave to amygdala was “I am scared. I am doing something that could be dangerous right now, and I need to pay close attention to this part of the body”. So the amygdala responded by turning up the sensitivity tenfold, looking for even the slightest sign of nerve input from there. And of course, it got it. Even regular sensation of movement can be painful if it’s turned up enough. So in short, the amygdala had learned that whenever I sit in front of a computer, turn up sensitivity ten times, because even a little stimulus can be dangerous.

How does it work?

Still not convinced? Let’s look a little at how it works and why it causes some of the strange symptoms.

The fear

Maybe you’re thinking now: “Fear is not causing this! I’m not scared when I sit down in front of the computer”. Well, are you really not? Think about it, if I had asked you to sit down right now and type a 50 page document, all in one go, would you not be scared? Would you not be worried about your condition while doing this job?

Fear is not necessarily an all-consuming, adrenalin pumping experience. Fear comes in little doses too. Things you find uncomfortable, or things you worry about, even if not necessarily life threatening. Over time, with enough repetition, these associations can generate quite strong responses too, like the pain you are experiencing.

The pain that moves

Recall the question I asked earlier about whether your pain could move around a little. If it does, then there is a perfectly reasonable answer to why the syndrome causes that. First of all, if you had real tissue damage, then pain moving around is physiologically impossible. Pain from tissue damage is there because those nerves are experiencing much higher stimuli than the other nerves around them, and the injury cannot suddenly move to another muscle.

But with the syndrome, this is entirely possible. The amygdala is scanning for even the slightest nerve impulse, and differences in pain location can be simply because your hand is in a slightly different position from the day before, so nerve B gets a little more stimulus than nerve A. The amygdala knows that these two nerves are close, so it has heightened its sensitivity to both of them.

The time scale

Another question I asked earlier was how long it took for pain to start when you sit down at the computer. The time varied quite a lot, but I’d say that it was rarely longer than ten minutes for me.

Ten minutes is nothing. Computer work is an extremely light activity, and there is no muscle in the body that cannot take such a light work load for ten minutes. Before I got my condition, I could easily do 12 hour shifts at the computer, and I’m sure you could too, before the pain started. If enough time has passed that any inflammation should have healed, then you should be able to do many times that workload without injuring yourself.

The reason it is happening, is of course that amygdala has recognized that you are at the computer, and is turning up the stress level and sensitivity in your body as emotional response.

A very revealing test you can try on yourself is: Do something else for a while so your pain goes away. Come back to the computer and put your hands on the keyboard and mouse (or in the position you find gives you most pain) and prepare yourself to start working. But don’t do it. Just relax your hands while keeping them in the ready-to-work position, and keep them there for a while. Do you sense any symptoms or maybe the precursor to pain? If you do, then you should know that getting pain from such an exercise is also physiologically impossible. Your hand is relaxed, and no muscles are working, so you cannot possibly irritate any injury. The only explanation is that you’re experiencing a response from amygdala which is turning up the pain sensitivity in your nerves.

The injury that isn’t there

Remember the press test? You wait until a time when the pain is gone or almost gone, and then you press down on the place that it normally hurts. Doesn’t hurt that much, does it? Of course not, you are not at the computer, so the sensitivity is not so high right now. If there really was an injury, like an inflamed muscle, do you think you could do the same without experiencing much pain?

The final diagnosis

When my physical therapist finally diagnosed me with a non-physical disorder, he used the term “computer phobia”. Phobia may sound like it’s way off, but it is actually exactly what it is. A self reinforcing phobia towards computer work. The only misleading part is that this sounds like fear is what is primarily experienced, and doesn’t say anything about pain. I personally think Wikipedia’s term “Psychogenic pain disorder” or “persistent somatoform pain disorder” (link) are most fitting: A pain syndrome prolonged by emotional and/or behavioral factors.

As such the title “How I beat RSI” is not totally correct, since there is no “repetitive strain injury”. However, RSI or carpal tunnel is what most people will probably have searched for when they get here.

The treatment

So how do you treat this condition? Like I said earlier, amygdala is in the subconscious part of the brain and cannot directly be controlled. Drugs may dampen the pain effect temporarily, but in the long term they could make the problem even worse since your brain may turn up the sensitivity yet another notch to compensate.

Theory

The key to the treatment is to realize that even though the subconscious mind cannot be directly controlled, it can still be influenced. This is what is called cognitive therapy. It is based on one of the most basic functions of the brain: learning. I don’t mean the kind of learning that happens when you read this article. This is information learning. I am talking about subconscious learning¹, where the subconscious mind is taught to respond differently to a situation.

You may be thinking: “Why isn’t it responding differently already? Every time the pain comes I get angry at it. Should it not understand that it is the wrong response?”

Unfortunately, the way in which the subconscious mind decides whether a response is correct or not, isn’t the same as for the conscious mind. What the amygdala observes when you get angry is that this situation is upsetting you, hence its negative reaction to the situation is correct. Maybe you even got up and left the computer. This just further reinforces amygdala’s response, because you chose to leave the “dangerous” situation. I’m afraid amygdala isn’t clever enough to understand that its own pain induction plays a large part in your emotional state, and that this has nothing to do with the actual situation. All it observes is: The conscious mind is upset, hence my negative reaction was correct.

To unlearn this response we need to be talking the “subconscious language”. We need to give it feedback that it will understand and interpret correctly, and remove the amygdala’s distorted illusion that the body is in danger.

One of the strongest influences on amygdala is the internal stress level during an event. On a typical pain syndrome patient, this level is higher than in normal people when sitting at a computer. You will be worried about your health, you’ll be constantly switching position to try to lessen the pain, etc. In other words, you are not relaxing.

So in short terms, the cure really is: You need to relax and not worry about the problem.

Sounds a lot like those vague Internet pages I talked about earlier, doesn’t it? Well, this is most likely what cured those people, it’s just that they didn’t understand why it cured them. But hopefully you have some new knowledge now, so you can understand why it works. And don’t worry, I’m not going to leave it at that sentence. There is a practical approach, which I used successfully and will now turn to.

The practical approach

Simply being told to relax is not of very much use, I know. I have been there. We are dealing with a complicated process in your mind though, and not all methods will be equally beneficial for everybody. While I believe that the basic method is sound, this is training your mind, and like any new learning, people will prefer to move forward at different paces and using different approaches. I will describe the methods that I used successfully, and hopefully they will inspire you to try methods that work for you.

In the beginning I was a little lost as where to start. Simply trying to relax at the computer didn’t seem like a method that was focused enough, and I wanted a more tangible method. What my physical therapist told me (and I also confirmed myself later on), was that emotion plays a larger part in amygdala’s response than does actual thought. So previously I had been trying hard not to think about the problem while using the computer, which I found nearly impossible. I call it the “polar bear problem”. If you’re told not to think about a polar bear, you will think of one.

But I realized from my therapist’s advice that it doesn’t matter if you’re thinking about the wrong thing, as long as you feel relaxed. This became the cornerstone of my practical approach. The first practical exercise was given to me by my therapist, which he named “the yoga trick”. Here is how it works:

Take a deep breath and hold it. Hold it long enough that you start feeling the urge to breathe, but not so long that you will be gasping for air. Then release it. After this you will naturally take several deep breaths to make up for the air you were missing a few moments ago. Take about five of them, and then repeat holding your breath. Do this altogether five times.

This method exploits the fact that immediate stress level in the body is heavily influenced by your breathing pattern. Short, erratic breathing is negative, while deep breaths are positive. After you’ve done the above exercise you probably haven’t stopped thinking about your condition, but maybe you can agree that you feel a little more relaxed? At least the first few minutes after you’ve done it. Don’t worry, even if you don’t, your body and brain feel it, and it will still work.

After being told this trick I tried doing it whenever I sat down at the computer, and whenever I felt that I was tensing up again. But I still felt that I was thinking too much about my wrist, and therefore keeping my body tense. This is where I invented my own method, the “reverse psychology trick”. This one is built on a kind of self deception. I thought that the reason I’m tensing up all the time is that I fear that the pain will come, and when it does (like always), it confirms my fear that I’m not getting better, I’m getting worse. Let’s turn that around! From now on I will tell myself that pain is good, that means I’m getting better, whereas absence of pain is bad, then I should worry. My thinking was that absence of pain is very rare, so I won’t be worrying much, and if there truly isn’t any pain, I probably won’t be thinking about the wrist anyway.

So I started thinking like that. Whenever I started thinking about my condition, I took a second to feel how my wrist was, and if there was pain (which was almost always), I told myself: “Ah good, the pain is still there. I can relax.” Not having to worry about that pain was really liberating, and I think subconsciously it made me calmer inside.

Of course, it takes some confidence in this method to be able to fool yourself like that. The first thing you should realize is that you have nothing to lose. The pain is not dangerous, and you cannot possibly injure yourself by having a little too much of it. So the only thing you need to fear, is the sensation of pain. But it’s just pain, it goes away, and meanwhile you can keep telling yourself that that pain is good, because it means you are healing.

It’s also important that you use the computer while doing these relaxation exercises, otherwise you are never exposed to the situation where you want to retrain amygdala. The keyword here is association. You want amygdala to associate the computer situation with a calm, relaxed state of mind. So using it is crucial, but probably not too much in the beginning. If the pain becomes too overwhelming over too long a period, then most likely you will tense up no matter what relaxation method you use.

If you are looking for a specific number. I would say ten minutes is minimum. If your pain is as bad as mine was, then this should be plenty of time for it to be triggered. The reason I don’t think it should ever be less than ten minutes of use is because of the “escape theory”. The amygdala takes a little bit of time to register your emotional state and associate it with a given situation. If you get up too early, then what you are doing is that you are telling amygdala that you escaped the situation. Amygdala will conclude that since you preferred to leave the situation, it must indeed have been dangerous, therefore it will keep associating it with a negative response.

My therapist also pointed out that relaxing is not the only positive emotional state one can use to train the amygdala. In fact, relaxation is a quite weak emotional driver. It’s actually more of a neutral state of mind, rather than a positive one. One of the most effective positive states that involves the whole body, he pointed out, is exercise. Exercise activates all the right receptors in the brain, and causes the whole body to be in a positive state. You are breathing heavily, joints are moving, muscles are activated, all the things that the body was designed for. He advised me to use exercise as a break between computer sessions, to drive away the negative association with computer work and replace it with this wildly positive, whole body experience.

Which is what I did. And so should you. I cannot possibly overstate this. Exercise had such a profoundly positive effect on my pain situation that I dare say I would never have recovered without it. It wasn’t necessarily that I did not feel any pain in my wrist while exercising, I did, but at the end of a session, even if I had pain, it would be this good kind of pain, like, “I really did a serious workout” kind of pain. Don’t be afraid to exercise the area where your pain is. You don’t have to exercise that very muscle in isolation, but do include it in the exercise program, perhaps in an exercise that involves other muscles as well. The positive input from the other muscles will strengthen amygdala’s idea that nothing dangerous is going on. In fact, it’s pretty much reversed when dealing with this pain syndrome, compared to muscle injury: If you’re in pain, exercise more! It only adds to the positive feedback.

So I repeat: Exercise is absolutely critical. I tried to plan my computer work so that I would have a workout session following it. This way I would immediately follow the “dangerous” computer work with a very positive experience, making amygdala doubt its earlier conclusion. This seemed to work quite well for me.

So in addition to regular exercise I did mainly the yoga trick and the reverse psychology trick for some time. I didn’t expect quick results and neither should you. Retraining amygdala takes time. The very first effect came after about three or four weeks, and what I noticed was not a reduction in pain at all, but rather that the pain started going away faster. It would be just as painful sitting at the computer, but instead of taking days to go away it would take mere hours, then one hour, then half an hour. Soon I was not so worried anymore about the consequences for the rest of the day whenever I used the computer. It seemed it would go away quite quickly anyway.

This is also where I hit a slight roadblock. Because I would rarely have pain in between computer sessions anymore, the reverse psychology trick started working against me. Since I couldn’t feel pain I started worrying that it might come back. And quite right: After a little while of thinking like that, it did come back. Now, I don’t think that the reverse psychology trick was a bad method, it was good in the beginning. But I was in a different place now, and needed to adapt it.

So I came up with reverse psychology trick version 2. Whenever I did not feel pain, but I was still thinking of my condition, instead of worrying about whether the pain would come back I encouraged myself to think about the pain. Just think about it all I wanted. Since I was now allowed to think about it, it didn’t seem so worrying anymore, and often I would find myself drifting off and thinking about something else. It simply wasn’t as “tabu” to think about anymore, and that took away the reason to think about it in the first place. Maybe this sounds weird, but at least it’s the way that my mind works. If you’re not allowed to think of something, you’ll think about that all the time, but if you are allowed and even encouraged, then you end up getting bored with that thought and moving on to something else. The fact that I allowed myself those thoughts also meant that I remained calm and would not tense up.

Slowly, over a long time I would notice that the pain was not quite as bad anymore. I could often sit and type for half an hour and the pain would not be that bad at all. I still tried to do the yoga trick as often as I could.

But one big fear remained in me: I still had not even attempted to use the mouse with my right hand. Keyboard had already been bad enough before, and I had switched the mouse to my left hand long ago. I was scared. I knew that using the mouse gave me the absolute worst pain, and I had been bracing myself for it for a long time. Of course bracing myself means that I was worrying about it, which was the opposite of what I should do. So one day I decided: “Seriously, it cannot be that bad. I have had remarkable progress with the keyboard already, and what’s the worst that can happen? I’ll get some pain, but like I’ve already decided: Pain is good, and means I’m healing”. So I did it. And I followed the ten minute rule. In fact, ten minutes turned into half an hour. I won’t claim that it was pain free, certainly not, but it wasn’t nearly as bad as I had built it up to be. I was relieved. It was working, and I could seriously stop worrying so much. This was about three months in.

The experience with the mouse in my right hand was a turning point for me. After this the progress became more rapid, and it wasn’t long before I could do quite long sessions at the computer, an hour or even more. Less than a month after the “mouse incident”, Christmas was upon us, and I decided to take one week off from work² before the official holidays to work intensely with the computer, to see how far I could really go. As it turns out, the week was almost problem free. I worked full eight hour days (I had some hobby projects to tend to) the whole week, and it wasn’t until Thursday that I got any pain to speak of. This didn’t scare me though. It was just a matter of time before that would be gone too.

I decided after New Year’s that I was ready for trying to work with IT again, and I resigned from my old job. Just doing this was a big step in confidence for me, and I hadn’t even thought of a new job before I resigned. For me, the most important thing was acting, not planning ahead or worrying too much.

Next week, I’m starting my new job, and I know it will be fine, because I have used the computer tons of times in the past months with no problems. It seems amazing to be where I am now, whereas only six months ago I thought I was doomed to a life of pain and computer aversion.

Patterns

I’d like to share with you how both my behavior and thought pattern changed as a result of this treatment. I was trapped in a state where pain was the only thing I could associate with computer work and many other activities. If I so much as tried to be optimistic about my problems I would immediately be faced with a stark reality of pain, and all my optimism would evaporate. It was impossible to see outside of this box how it would be like without pain, and so this destructive thought pattern continued, against my will.

This is surprisingly similar to the patterns one can see in patients suffering from depression. Even though the underlying causes are different, the feeling of having no way out is at the core of both disorders, and is as much cause to the problems as anything else. This is also the reason why cognitive therapy is effective in treating both.

I have realized that thought patterns like this are the source of so much of our behavior. It doesn’t matter if the pattern is perceived as positive or negative, if you repeat it enough, the brain will learn it, and you are increasingly likely to repeat it yet again, even if you know in advance that the outcome is not in your favor. A mundane example is someone who goes to bed too late every evening. He knows that it will make him tired the next morning, he doesn’t even have a reason to be up, other than to surf Facebook and Wikipedia, and yet he does it night after night. It takes will power to break out of this pattern, and say that you’re not going to do it tonight. And it takes even more will power to keep that spirit going several nights without falling back into the same behavior again. But one day, it comes natural. It doesn’t seem so appealing to be up late anymore, and seems more comfortable to go to bed in time. It has become a pattern.

For someone who used to have the habit of going to bed late, it is of course easier to fall back into that pattern than someone who has never had that habit, no matter how long it’s been. Once something is imprinted on the brain, it stays there forever, all you can do is make another pattern stronger than the first. This has its effect on my pain disorder too. Every now and then I will get a small relapse. The pain will return for a moment. The difference is that I know how to handle it. I know not to get afraid of it. And I know it will be gone again in only a short time. My new pattern is to not pay attention to it, but to concentrate on the outside world. That is what makes amygdala happy.

The role of the therapist

I can write a hundred more pages about this subject to try to convince you, but nothing is as convincing as hearing it from a specialist. Just like most people would prefer talking to a real person about their loan rather than an automated bank terminal, people prefer hearing things from another human face, especially if they’re hard to believe.

I was lucky enough to be recommended to a specialist in the area of pain disorders and I encourage you to try to find one as well. Look for people who deal not only with nerves and tissues, but also pain perception and phobia/psychiatry, especially if you have already ruled out the typical physical syndromes. The best type of therapist is someone with a foot in each camp, so not a pure physical therapist, but not a pure psychiatrist either. Ask them if they are open to the idea of psychological causes of pain.

Another big advantage of having a therapist is that he can tailor the treatment program specifically to you. Certain methods will work better for some people than others, and your therapist can help you find exercises that work best for you.

Post-recovery analysis of my history

If you read the history part, there are a few of things I would like to bring up in the light of what I now know.

My first physical therapist, the one that gave me wrist exercises, is in my opinion an example of a bad therapist. She had chosen the treatment five minutes after I walked in her door, and refused to change it even when results showed that things were not getting better, not even after several months. My advice to others is to avoid such therapists. I don’t think they do a good job unless they are willing to admit failure in treatment and try different things. Ever seen “House” on TV? It may not be very believable as a way real doctors work, but it does display one important property that any doctor should have: They come up with the most likely theory, then either test for it or try treatment for it, and then move on if it is incorrect. This is not what happened to me.

In contrast, my second physical therapist showed great professionalism by both testing for and trying several theories, and finally by bringing in another expert when his own options had been exhausted.

Sarno’s method was also an interesting one. I think the theory I have presented here is much closer to the truth than Sarno’s, but I can’t really say that the man is completely incorrect either. The brain is a complicated device, and in the end, it’s the result that counts. I think the reason that thinking about my inner rage worked to certain degree is that it did take away attention from my wrist, and shifted my focus to something else. But it didn’t really calm me down, and this may be why the pain never really stopped completely, or got better over time.

I can completely believe that some people may be healed by following Sarno’s method, but not for the reasons Sarno describes. I do not believe that the brain is smart enough to start using pain as a coverup tactic to hide repressed emotions. Instead, I think that these emotions may be causing a lot of unrest and stress in your body in general, and this leads to your pain sensitivity being turned up more or less permanently. In this heightened state of sensitivity, it’s much easier to start complaining about pain in any particular place in the body. If you also start associating certain situations (such as computer work) with this pain, you get a downward spiral where both your repressed emotions and amygdala’s reaction is increasing your stress level and pain sensitivity. If you follow Sarno’s method and deal with the repressed emotions in your subconscious, then I would assume that your overall stress level would decrease, and might cause you to fall under the limit where pain is induced in front of the computer.

Then again, I am not a professional, so this is just my own theory of what happens, based on my own experiences and learning.

Foot notes:

• ¹ “Subconscious learning” probably isn’t the correct scientific term, but hopefully the meaning is clear.
• ² I wasn’t working in a desk job at the time, so my exposure to computers was limited. I took a forklift driving job after I quit my old IT job in order to let what I thought was an injury, heal. I don’t believe taking a different kind of job is required for recovery, but I do recommend getting a leave of absence for at least a few months to lower the stress factor. Stress is the last thing you need.