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Living with RSI


“They were funny little things like I couldn’t manage chopsticks and I couldn’t roll spaghetti with a normal sized fork because it was too heavy. I couldn’t keep my hand up in the air to hold the hair-dryer.”
“Inventing and changing is constant. Even now I have to stand back and think about changes that can be made. For example, I recently asked myself – does she still need to use the high chair? I decided that she was ready to use the kid’s table and chairs I had bought, which means that I don’t have to lift her into the high chair any more. I look at each activity and ask myself ‘is this the best way?’ If I decide it’s not, I find or invent another way.”

Looking after yourself

A couple of points to remember:

  • If it hurts – don’t do it, try another way.
  • Experiment with new ideas.
  • Be creative in your new approaches.
  • Look after yourself – it is more important to keep your sanity than to scrub the bathroom.

Use your hands sparingly

This means not doing anything that may aggravate your injury or cause more pain than is necessary. It is easy to jump in and undertake tasks in the same manner you once had, and then become frustrated when you can’t complete them.

Don’t try to do everything at once

You will be much more productive if you look after yourself and don’t rush things. You probably can’t work at the same pace you once had and if you try, you will be putting yourself in danger of a flare up.

This will involve some thinking and planning ahead. Ask yourself if the tasks you want to do are likely to cause you pain. If so, try to think of another approach or determine if they need to be done at all. Remember, a flare up can force you to miss out on things that are more enjoyable than the task that caused the flare up.

Another option is starting tasks a day or more before you want them completed. This way you can complete them at a pace you are comfortable with and limit the stress you are putting on your body. Can you do something at night before you go to bed so you don’t have to do it in the morning?

Keep stress at bay

Limiting the amount of pressure on your body requires more planning than you may be used to. It is an important step, however, not only to keep flare ups at bay but also to keep your sanity. Don’t weigh yourself down with unnecessary stress, you will only be setting yourself back.

Learning new ways to do old tasks

One of the major impacts of RSI is on a person’s capacity to perform the ordinary tasks of everyday life: things like cutting vegetables, opening doors, turning taps, hanging washing on a clothesline and even dressing yourself can become very difficult. It can also be hard to come to terms with not being a fully independent adult.

The period of learning new ways to perform old tasks can be very trying. It will help you greatly if you have appropriate support: moral support from others who suffer from RSI and have learnt to adapt their approach to everyday tasks; practical support from family members who recognise that they need to do more; and professional support from a counsellor to help you through this difficult period.

Many others have had to meet these same learning challenges and there is a lot of prior experience to help you in learning to simplify your life. There are many more strategies that you can discover for yourself, through reading and through discussions with other people who have RSI .

Tackling difficult tasks

There are four broad ways of looking at tasks that have become difficult:

  • Don’t do it at all.
  • Get someone else to do it.
  • Change the way you do the task.
  • Use special equipment.

First, make a list of tasks you find particularly difficult. Look at each task and ask yourself.

Does it really need to be done?

  • If not, don’t do it.
  • If yes, then prioritise the task.

Am I the best person to do it?

  • Re-allocate, share, roster, exchange tasks.

What is the best place/time for this task to be done?

  • What is the best method?
  • In what ways could I use my body more effectively?

Plan a work schedule

  • Balance rest and activity, heavy and light work, body parts, etc.
  • Spread tasks over the week swapping from one task to another.
  • Tune into your body – is it signalling you to stop?

Get organised

  • Set up things to reduce the strain (eg, in the kitchen, store frequently-used items at the top, rarely-used items at the bottom).
  • Move tasks to the warmer part of the house.
  • Have double sets of items to avoid carrying (eg, cleaners kept in both the kitchen and the bathroom).
  • Only fill containers with the necessary quantity (eg the kettle).

Would a special piece of equipment help?

  • When moving large or heavy objects the rule is push, slide, pull – don’t bend or lift.
  • Use the larger body parts to shift things (eg, palms not fingertips, thighs/buttocks not arms etc.).
  • If it’s necessary to lift, hold items close to your body.
  • Experiment with different equipment to find things that suit you.
  • Share with others in a similar situation.
  • There are many great ideas for labour-saving equipment, devices, food and ways of doing things.

Problem-solving

Kate Lorig and James Fries in The Arthritis Help Bookshow a way of problem-solving that helps many people with arthritis. Their suggestions are just as relevant to RSI, so we’ve included an adapted extract here. There are eight steps.

Step 1. Identify what is difficult for you.

Think about the last 24 hours. Which tasks caused problems? If this is hard, write down everything you did. Tick the things that were difficult, painful or made you tired.

Step 2. Pinpoint the reason for the problem.

  • What part of the task made you sore, tired or stiff?
  • How fast did you do the task? For how long?
  • Why couldn’t you do it as well as you’d like? Pain? Not enough movement? Stiff? Not strong enough? Worried about what others would think?

Step 3. List ideas that might help.

Ask your family and friends for ideas.

Step 4. Choose an idea you think will work.

Try it.

Step 5. Check how you went.

Did you solve the problem completely?
If you still have problems, try the next step.

Step 6. Try other ideas from your list.

Check how you go each time.
Keep going until you run out of ideas.

Step 7. Find out more.

Get some more ideas from the RSI Association, therapists or books.

Step 8. Accept that you might not solve the problem now.

The problem-solving you have done might help later.

Example

Identify I can’t open jars.
Pinpoint Sometimes it’s painful; I’m too weak.
List options
  • Ask spouse or neighbour.
  • Buy cans and use an electric opener.
  • Buy a jar opener.
  • Use a sheet of rubber to produce more friction by placing over the lid.
  • Release suction with a knife.
  • Tap strongly with a knife on all four sides of the lid and then open it.
Choose Tried to release suction.
Check Worked on some jars but not others.
Choose Buy a jar opener.
Check It’s wonderful!

“I used to think that the only way to get things done was to do everything at once, so it was a hard lesson to learn to slow down and to learn to focus when I had to put things down and pick them up again. I had to curtail my impatience. But, I was finally learning to work with my RSI and becoming more efficient.”

Budgeting your energy

“A big plus for me with this whole episode has been my change in attitude towards work and my lifestyle in general. I have learnt to respect and listen to my body. I take life a lot more slowly and I certainly don’t take my health for granted any more.”

Many books on RSI speak about ‘budgeting’ the use of your upper body. This means conserving your energy and not over-working muscles. While this sounds reasonable, it can be difficult to achieve. Before RSI, you were able to complete tasks as you wanted or needed. But you now have to find new ways of working that don’t aggravate your injury. This can be difficult and frustrating.

How many times have you completed a task and been in so much pain that you couldn’t do anything else for the rest of the day or even the rest of the week? More often than you’d like to think? It’s easy to work yourself to that point. You still want to work at the pace you did before RSI, but you can’t. Instead of limiting yourself to what you can do, you push yourself and aggravate your RSI.

However, there is a system that limits pain and aggravation – pacing and switching. This process can be applied to all situations that are repetitive or likely to cause you pain. It is very simple and easy to apply.

The technique of pacing and switching requires you to break down tasks into small, manageable portions. These portions are interspersed with rest or other tasks using different muscle groups. By pacing out tasks and switching between them there is less chance of aggravating your injury.

Possibly the hardest part of dealing with RSI is admitting that you have an injury and working with it rather than against it. Pacing and switching are techniques that help you to work with your RSI. They give you the ability to take some control of your injury by combining work and rest.

Pacing

Pacing means you don’t complete a task in one block. Instead you break it up into portions and rest between each one. This way you are not exhausting your body and you thereby lessen the chance of aggravation. An important part of this process is stopping any task before you feel pain. Once you feel pain you have gone too far. At this point it is unlikely you will be able to do anything else until it subsides.

However, it is often difficult to know when you have overworked yourself. Many people with RSI don’t feel pain until later in the day or even the next day. Sometimes you don’t know that you have aggravated your injury.

The way to overcome this problem is working to the 70% rule. That is, do 70% of what you are capable of, not what you think you should be capable of. Then, stop and rest or switch to conserve your energy and prevent aggravation. If you apply the 70% rule, you will be stopping a task before you put yourself at risk. Therefore, you should never work yourself to the point of aggravation. Essentially this rule gives you control over your pain levels.

Switching

Switching means you switch between different tasks so that you don’t tire out one group of muscles. You complete one task using a certain muscle group and then switch to another using a different muscle group. This requires you to be aware of your body and which muscles are used for different tasks.

Examples of pacing and switching

Here are a couple of examples of how it could work:

  • Instead of trying to clean the whole bathroom at once, you could break it down into four parts – shower, bath, floor and vanity. In between each part (or even half way through each part) you stop and rest, preferably for at least five minutes (this will vary depending on your needs).  Depending on the extent of your injury, you may want to do two parts one day and two parts the next day.
  • At work you could break tasks down into small portions and mix them up. You could type a letter, then make a phone call, then do some stretches, then do some filing. Each of these tasks uses a different set of muscles.

This technique can be applied to any situation. The rules are the same for any task that is repetitive or is likely to cause you pain – break it down into manageable pieces and do one piece at a time.

Pacing and switching sounds simple; in reality, it can take a while to get used to. It may mean changing your priorities and your standards. For example, you may not be able to get the whole house clean in an afternoon. But remember, the most important thing is being well. If having a spotless house means you are in pain for a week, is it really worth it? If you clean the house over a couple of days you are conserving energy to do other things that you will enjoy more.

You will also have to experiment with the process. It helps if you keep a diary to record how you felt after each section and the pain levels at that time. This will tell you exactly how much you are capable of. It may help to set out a timetable or schedule. Write down all the tasks you want to get completed. Then add sleep time, rest time and time spent with others. This will help you to see exactly what you want to do and how possible it is.

There is no point to being in pain if you don’t have to be, so don’t push yourself too hard. Working harder doesn’t mean you get more done, especially when you have RSI. Take lots of short rests and allow your muscles to recuperate before commencing the next task or continuing with the previous one.

“I learnt the miracle of pacing. The more breaks you take, the more efficient you become. You need to let go of the desire to have everything completed right away.”

You need to work with your RSI rather than against it. Using the pacing and switching technique helps you to work more efficiently. This means that you have taken a step towards managing your RSI.

Guidelines for pacing and switching

  • Set out what you want to get done at the beginning of the day or week. Be flexible – recognise it may not get done and that’s OK!
  • Break the tasks down into manageable portions. If possible, list them so you can refer back.
  • As you do each task – pace and switch. Be conscious of how much you have done and are capable of.
  • Lots of small rests are proven to be more effective for conserving energy. Further, if you stop for too long, you may not get started again!
  • Stop any task before you feel pain. If you do feel pain, stop immediately and rest.
  • Work to the 70% rule, that is, do 70% of what you are capable of doing (not what you think you should be doing) then rest or switch.
  • Note down how you are feeling after each task (see Managing RSI section for ways to keep a pain diary).
  • Think about what is more important to you – that you push yourself to get something finished, or that you are able to enjoy your day without pain.
  • You may have experiment with the process at first. But stick with it, eventually you will be aware of exactly when to rest or switch.

For more information about Managing Daily Life, order the latest edition of our book RSI: A Self-Help Guide.

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