Dear friends and colleagues,

After a five year bout of struggling with repetitive strain injury (“RSI”) in my hands due to typing, I believe that, finally, I am completely cured. I emphasize “completely” because, in my experience learning from and talking to many others about this condition, I have found that a truly total recovery is actually unusual. I can now type for hours, indefinitely, without any lasting or cumulative symptoms of stress or injury. Just a year ago, I could not type for more than five minutes without considerable pain in my hands and arms. Although I now type for hours every day, I never experience pain or inflammation at all. Happily, I rock climb regularly and play frisbee – activities I had previously stopped due to RSI.

What follows is the story of how I solved the problem of RSI for myself. I realize that people do not usually send out long emails to their friends and colleagues about a strategy for healing an illness. But RSI falls in a special category for several reasons. First, I know many people who have been affected by RSI, some severely, and some of who do not seem to have yet found a lasting solution. Second, for many people who suffer from RSI, symptoms can drag on for years without a real recovery. For people like my nerdy friends and myself who type for a living, this can be personally devastating. Third and most importantly, the solution that I found defies most of the conventional wisdom, literature, and advice that is almost always thrust at patients of RSI. Finally, it has been a life-changing and enlightening experience.

I should add that many of you have spent a lot of time listening to my complaints and supported me through this difficulty, for which I am very grateful, and I feel that you deserve to hear a final report! I apologize in advance that the story is somewhat long. But if I had read this story myself a

year ago, I would not have been able to really understand its implications, or even find it credible, unless it was told in pretty lengthy detail. In fact, the most important reason for writing the story is that the story itself is of important therapeutic value.

I need to first explain some history of the problem. I first started developing RSI during graduate school about five years ago. I had encountered some of the literature on RSI and recognized that, according to the strong advice of pamphlets given out by MIT Medical and others, I had bad back posture, bad wrist posture, and a non-ergonomic work space. Since my research project was completely computer-based, I looked at the pamphlets carefully and tried to improve my habits. I talked to a doctor at MIT Medical to make sure that I understood a broad scope of the issues I should address. MIT Medical, to their credit, has a pretty aggressive program to make students aware of RSI and distribute literature on how to deal with it. I had conversations with friends and colleagues about it, some of whom were also experiencing symptoms or had dealt with RSI in the past. In spite of my desire to work hard and make progress in my research project, I made sure to take some time off and rest my hands, sometimes for weeks at a time. I was athletically active and, since RSI is a understood to be a very circulation-based problem, aerobic exercise is often recommended. I did stretches and took breaks while working, which is highly recommended in the standard RSI literature. While I did not exactly follow a rigorous prescription of every single thing that has ever been recommended in conventional medical literature for RSI, I felt that I had made a number of positive changes across the spectrum of my work and life habits. Most importantly (according to the literature), I had become aware of the problem, and I started thinking more about how my hands

felt and what I might do that would affect them.

This seemed to work for a while. My hands got better. But then RSI would return and recede again, and I compensated by taking time off and finding ways to “streamline” my typing – i.e., do some of my work in other ways and try to type only when necessary. However since my project was completely computer-based, it still simply required a lot of typing. For some years I was sort of in RSI limbo; sometimes recovered and sometimes worse. You have to understand that it was not the physical pain of RSI itself that I found so concerning. The mild pain was a minor inconvenience. However, by broad convention in the medical literature, RSI symptoms are considered a harbinger of what could eventually turn into a very disabling injury. In the conventional understanding, if you are feeling pain and continue to follow the activity that causes this without getting rest and/or changing your work habits, you might do lasting or permanent damage to the musculoskeletal structure in your hands. In fact, at that time, I already had one good friend who had suffered from carpal tunnel syndrome so severely that it took literally several years for him to recover. So, what worried me was the possibility of creating a lasting injury to my hands. My hands were obviously a precious vehicle for my work and for sports, for things I loved to do.

As I approached the end of my graduate program, I worked intensely and my RSI returned and got worse. The joints of my fingers would hurt, my elbow tendons would hurt. If I was not careful, I would overcompensate with my shoulders and create knots in my back. I was putting a lot of pressure on myself, as is typical for a graduate student nearing the end of his or her thesis. I was concerned about the symptoms and I started following the usual precautions more rigorously – frequent stretch breaks, exercise, and attention to posture.

As my thesis defense was only some months away, I did not want to take time off. I made a bit of a devil’s bargain with myself; I told myself that I would try my best to cope with the RSI in the present and, after my defense, I would take a lot of time off to heal completely. In retrospect I think this was not such a responsible decision and I was not taking RSI seriously enough. Some of you know my PhD advisor, and I should also mention that, while I think that many of the intense pressures in the program were very real, I do not blame my advisor for my decisions at all – I think he would have been very supportive of giving me time off if I had approached him with this medical concern. However that is not what I chose to do, and by the end of my program, my hands hurt almost all the time: when I was typing, when I was walking home after work, and at night when I lay in bed. I was stressed out with my thesis, also separately trying to land a postdoctoral fellowship, and dealing with other strains in my personal life. Based on my observations of colleagues, I think my situation was a little unfortunate but not very unusual for a grad student finishing a thesis. Later, I would learn that my RSI symptoms were connected to my emotional state in an important way.

After my thesis I stopped typing, and my hands quickly felt fine. I went on a long beautiful bike trip through southern France with a good friend, and everything seemed better. After taking a month off, I started typing again to write a funding proposal. Within a day or two the pain all came back. This marked a turning point for me. I suddenly began to realize that my problem was on a larger scale than I had been willing to admit before. The supervisor at my new appointment was extremely supportive, and we agreed that I would take another two months off before I started work. I started doing more serious research into RSI. Since I had just graduated and was no longer covered under the MIT

insurance plan, MIT Medical absolutely refused to let me see one of their doctors under any condition. This came as an unpleasant shock: the injury I suffered was obviously incurred while at MIT; MIT doctors knew my recent medical history better than anyone; and the MIT medical community has a lot of experience with RSI. However from the standpoint of the MIT Medical administration, the relevant issue is that grad students at MIT are treated under a different legal rubric than employees, and hence workman’s compensation does not apply to grad students. I think this will land MIT a big fat lawsuit one day, but I believe their policy is not unusual.

I started taking RSI very seriously. I got an examination by the head physician of Occupational Health at Cambridge Community Hospital. She optimistically stated that she found no evidence of lasting impairment in my hands. They looked fine. She recommended a regimen of exercise and stretching, and that I go back to work. Many physicians recommend swimming as a good way to recover from RSI, so I started swimming every day. I also wanted to apply any other strategy that might help. I started doing yoga. I started seeing an acupuncturist who had been involved in a double-blind research study on the effects of acupuncture on RSI at Harvard Medical. He was optimistic about our prospects. Two months later in December 2004, I went back to work. My hands were fine for a while – much better than when I graduated, but then the RSI returned and my ability to work was slowly but inevitably curbed more and more. My project was only about six months in duration. I decided that I probably just needed more time off. I was able to take another two months off before starting my next job. In particular, I felt that swimming was very helpful, and conversations with a friend who had also suffered RSI supported this notion. By June 2005 I could easily swim the

length of Walden Pond and back. Feeling that I had learned much more about RSI, I optimistically dove into my “summer break” with a serious daily schedule of swimming and stretching and exercise. All of my vacation plans were coastal, and my swimming goggles accompanied me everywhere. Beating RSI was an obsession. By the end of the summer I was in good shape and my hands were well-rested. I was excited about my new project, and also nervous. I was about to start a two-year project involving only computational work, so putting RSI behind me was imperative.

I started my new project in mid-August 2005. It was my first time typing again after two months of aggressive “rehabilitation”. On my first day I started typing and within minutes my hands started hurting again. Having carefully tracked the symptoms for the last year, I felt that the symptoms were just as severe as they were before my two months of recuperation and rest – in fact, maybe worse. I didn’t know what to think. Maybe I was just nervous. For the next couple of weeks I tried to type sparingly, but it quickly became apparent that nothing had changed. Nothing. My RSI was just as bad, or maybe worse, as it had been in the spring before I had taken time off to rest and recover. I started to feel desperate, and I thought about RSI constantly. I quickly moved to set up my new health insurance and I made an appointment with a local doctor.

I was totally perplexed. Having dealt with many sports-related injuries in my life, I think I am somewhat knowledgeable in how to recover from musculoskeletal problems. With rest and physical therapy, a musculoskeletal injury always recovers, unless there is obvious evidence of significant physical damage such a torn ligament. I started to wonder if I had developed arthritis. At the age of thirty? It

seemed possible. I had reviewed many many aspects of my life that might be relevant. I had considered my posture while I sleep, because some physicians think this is an important promoter of RSI. Some physicians think that small alterations in the shape of your spinal column in your neck actually cause RSI in your hands and arms. So I started thinking about my posture while sitting anywhere, doing anything. In spite of all of my stretching and exercise and time off, I had developed some chronic knots and tension in my upper back over the previous six months. I worried that this might be related to the symptoms in my hands. It was like a wild goose chase. In retrospect, it is critical to observe that in at least one regard, I was accurate in my analysis: a big important factor existed that was entirely missing from my observations. I just could not figure out what it was. After attempting to consider and explore almost all of the medical explanations I could find, none of the recommended therapies really seemed to have an impact on my recovery. I thought: either I have arthritis, or something big is missing. It didn’t make any sense. Maybe I needed to take much more time off, like a year or more. I waited for my doctor appointment and I thought about RSI all the time, and I became quite depressed.

At about that time I met Jared. He was in town visiting my girlfriend, and he had suffered and apparently recovered from RSI. I had gotten used to exchanging “RSI stories” with other sufferers of RSI, and we started talking about it. I did not know Jared, but he made me review the history of my RSI in more extensive detail than anyone that I had ever met. I think he asked me about my experience for no less than two hours. Then he explained his recovery. Jared is a Harvard computer science major who loves to play the piano, so he was definitely a poster-child for RSI problems. He encountered the precautionary RSI literature at Harvard,

and then he started having problems in his arms and hands. He did an obsessive amount of research, talking to doctors and reading books and medical literature on RSI. I sheepishly discovered that he seemed to have done more independent research on RSI, in a short time, than I had done over the past several years. Jared had learned that none of the conventional medical approaches have a general, reliable record of success. Many people seem to suffer from RSI for years without ever getting better, even with physical therapy and rest. And “full recoveries” – meaning recovery to a state resembling that before the onset of injury – seem rare. This was entirely consistent with my experience and people I had talked to. It was also very depressing. Jared had learned that the physiological underpinnings of RSI are not really well-characterized. This I also knew. Hence the conventional literature often states that each problem is unique, and therefore different people have to find different approaches for recovery. It is another way of saying the problem is not really understood. I should briefly mention that by contrast, carpal tunnel syndrome, in which wrist inflammation pushes against the nerve in the wrist (and can do serious, lasting damage), is more physiologically understood. Carpal tunnel syndrome is reasonably straightforward to diagnose and it does not fall in the categories I am talking about. The common RSI which is often called “tendonitis” in the fingers and elbows does not seem to behave like other known instances of tendonitis; it often fails to recover with rest and physical therapy, the conventional treatments. Another discovery that Jared had made is that research groups doing so-called “biofeedback” studies had found a strong link between mental state and blood flow in the hands. It has been shown that, once properly trained, people can control the amount of blood flow in their wrists by acts of simple conscious will. Finally, Jared discovered writings of a doctor named John Sarno, who

treats RSI (and some other disorders, notably back pain) as a psychologically-induced disorder. To be clear, Sarno treats these injuries as very “real” in the sense that they are physical, painful, and potentially debilitating, like any serious injury. But he proposes that they are instances of pain that have no clear physiological cause, and that the pain can be entirely removed by having the right state of mind. The most convincing argument for Sarno’s theory is that his treatment apparently has a far higher rate of success than any other existing treatment for RSI.

Then what is the cure? According to Sarno, to cure the pain, you have to become personally convinced that the activity is not injurious. In your actions and your attitude, you have to believe that the pain is not really “injuring” you. You have to treat it as though your body is giving you the wrong information, and therefore you are choosing to ignore it. So you have to ignore the pain. You have to do a Jedi-mind-trick on yourself. That definitely flies in the face of the conventional wisdom I had previously learned about RSI.

At this point I need to briefly explain to the reader that I am not easily moved by philosophies involving faith. I am a skeptic, a rationalist. I seek systematic, logical explanations for life’s questions and my career is predicated on the scientific enterprise. In this respect, Jared was very helpful to me because he is very like-minded in this way. From Jared’s point of view, a reason-based solution to the problem was imperative. So it was important for us to realize that the medical community suggests physical explanations for RSI that are not very consistent with observations, as is partly evident from the wealth of unreliable treatments. By contrast, Sarno suggests a mechanism for RSI that seems more difficult to accept – that it is psychologically founded. But Sarno’s explanation has the immense advantage that it

apparently cures people at a much higher rate than any other strategy.

What did Jared do? Like I, he had begun to treat his hands like they were made of fragile glass (unfortunately this is a common outcome for those who experience RSI for an extended period of time), doing as little with them as possible. After reading Sarno’s book(s) and several related testimonials on the web, Jared decided to take the plunge. He went to his piano and started playing his favorite pieces, as if everything was fine. His pain disappeared and it never came back. Jared was convinced. Suddenly he was cured, and he returned to normal life. Based on my recent contact with him, this is still true. Jared types for long hours every day with bad posture, and he does not experience hand or arm pain. He says that he rarely even thinks about RSI anymore.

I was excited about this new approach to treating my RSI, but I also had doubts. I had several years of reinforced preconceptions about RSI that now needed to be reversed. Taking a leap of faith is not one of my strong qualities. Not only that, but according to the conventional wisdom about RSI, choosing to start typing and “ignoring the pain” could really severely worsen the injury. In terms of choosing between these philosophies of treatment, there is no middle ground.

Inspired, the next day I began to find information on the internet by others who had followed Sarno’s philosophy about RSI. I found doctors who give long testimonials about how they have similarly cured RSI using Sarno’s approach. I learned that people who suffer from this type of RSI are often found to be highly motivated, self-demanding, prone to stress-related problems such as acid stomach, concerned

with being a nice person, and having difficulty expressing anger. It was like listening to part of a personal biography. My head spun as I thought about others I knew who have suffered from RSI, and how they often seemed to fit this concept in various ways. Admittedly this is not a very useful sample: many of my friends are MIT graduate students, so it is not a big surprise that many of my acquaintances are high-achieving stressed-out types. On the other hand, according to thesis research done by a recent MIT graduate (Fleming Ray), a survey of MIT graduate students suggests that as many as a quarter of them experience RSI symptoms. This is definitely consistent with the notion that a high-achieving, stressed-out slice of society is prone to RSI.

After thinking about all of this, I decided to try to take the leap of faith. It is important to understand that it is not something that you can compromise upon or only try halfway. At work the next day, I started to type. I typed all day. At the end of the day, my hands hurt badly. They experienced more pain and tightness than they had in months. That night I got scared, and I wondered what mistake I might have made. The following day I typed less, but my hands hurt badly just to open doors or do any normal thing. I tried to find other things to do. On the third day, my hands still hurt badly and nothing had changed. I thought about them constantly.

In the middle of that day, I started surfing the internet to find more information about Sarno’s ideas. My hands were very stiff and were constantly in pain. I found many testimonials that were much like Jared’s story. Some people report having symptoms for ten years and are essentially disabled when they discover Sarno’s ideas. Then their life is changed with a sudden recovery. It was compelling. After about fifteen minutes of reading people's accounts of how they had

healed themselves, I became engaged and encouraged by the stories. Then, unexpectedly, warmth started travelling down my arms and pumping into my hands. It was a strong feeling of increased circulation. I thought about this and, obviously, I felt more positive. Literally within minutes, the pain and stiffness simply disappeared almost entirely. Spending more time to examine this, I convinced myself that I could actively produce the sensation of circulation in my arms and hands, just by thinking about it in the right way. It sounds rather ludicrous, I realize. That day my perspective improve dramatically. I felt that I had finally crossed the barrier of conviction. I felt strong, enabled, cured. On just that same morning, my hands had been so incapacitated that I had experienced severe pain just gingerly trying to turn a door handle. Nonetheless that night I played frisbee with friends, and I hurled several throws far across the field with all my strength, as a matter of proof of principle. The dramatic change was amazing. After that memorable day, my hands got better and better. I typed every day for hours. I started rock climbing and doing other normal activities with my hands. That was about a year ago and I have had no signs of injury since.

In Sarno’s view of RSI, the act of being concerned about the pain in my hands actually exacerbated the pain itself. This is consistent with my observation that the only activity which really correlated with my worsening symptoms was how much I thought about them. It is consistent with observations in other testimonials about RSI, in which people find that they start having symptoms after they read the company literature telling them to be careful. So in this case, ironically, MIT Medical’s well-intended dispersal of “awareness” literature about RSI could be a principal factor in causing high rates of RSI at MIT. Notably, I now work in a computational research group in Switzerland, where no one

has heard of RSI. Although we all bang away at computers for long hours, no one in the history of the research group has ever complained of hand or arm pain from typing. It is a large group and they work hard, and I have asked around. But no one realizes that they should be concerned, and so there is not a problem. My supervisor has never even heard of RSI.

At the same time, the legitimate recoveries that do result from the conventional treatments are also consistent with Sarno’s view of the injury: what is required is for the patient to really believe that the pain is not causing an injury. The patient has to stop being concerned that an injury will result from their activity – this is a classic “placebo” effect. It is totally psychological. Therefore, if some stretches give you sufficient confidence in the prognosis, then you will probably be cured. I am not saying that the stretches, swimming, and physical therapies did not have inherent therapeutic and beneficial effects – in my experience, they definitely helped. But for me and many others, these activities did not ultimately provide a lasting cure. The cure required a more fundamental understanding of the problem. Sarno also proposes that personal stress and pressure promote RSI, and he suggests coping strategies specifically pertaining to this connection.

A final note. About a week after my discovery that I was “cured” from RSI in my hands, I decided to also make the muscle knots in my back go away. Months of rest, yoga, and stretching had not improved the cramps in my back. Based on this evidence and Sarno’s arguments about back pain, I decided that my back stiffness could not really have a reasonable physical origin. The stiffness went away on that same day, and it has not returned since. Notably, I had not had a long history of back pain. I originally only developed

cramps in my back around the same time that I discovered that some doctors think that RSI (in the hands) may be related to a back injury.

In my experience with RSI, self-education was literally power over the problem. For that reason, patients of RSI should spend time learning as much as they can about the problem. Ultimately, they have to convince themselves of the best explanation based on the evidence that they find. For those that are interested in learning more about Sarno’s ideas, I recommend the recent book “The Mindbody Prescription: Healing the Body, Healing the Pain”. It is not expensive, and Sarno’s recommendations do not suggest that he is trying to soak RSI patients for money. Several doctors in the US now offer treatments based on Sarno’s ideas, but in my view such treatment appointments are usually not necessary. In the accounts of many others and myself, a cure can be achieved simply by learning about Sarno’s studies, listening to the stories of others, and examining one’s own personal experience.

Samuel AreySept 29, 2006