ian geckeler

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    How I Beat Carpal Tunnel, RSI, and Ulnar Nerve Pain

    Jul 12, 2020

    "I'm going to lose my job. I'm going to lose everything".

    These were the thoughts that were going through my head as I laid awake with pins and needles shooting down my arm and wrist.

    I had tried every trick in the book, so I thought, but nothing had seemed to fix my RSI pain. I laid in bed and wondered if I would ever type again.

    Two years later, and I have discovered a precise system that keeps me pain-free and productive. I spend nearly all day coding professionally and spend hours writing every evening without trouble. How did I get here?

    I didn't fix my problems overnight. It took me hundreds of dollars and countless days scouring the internet to discover all of the techniques I present here. But all of the work was worth it. I was able to craft a prevention and recovery system that took me from the lowest point (completely numb hands considering carpal tunnel surgery) to completely pain-free in just one month.

    I'm not a doctor, and I don't pretend to be. But I share the results of two years of hard work and research battling in the trenches with this condition. This post includes the best resources and techniques I gathered from Doctors, Physical Therapists, medical journals, and RSI communities across the web. I do so, I hope we can get one step closer to beating RSI together.

    If you don't have wrist pain from typing yet, you can learn exactly how to set up your workstation and what exercises to ensure you never develop problems. If you have extreme symptoms, I'll share the three things you can do right away that cut 90% of my pain and the steps you can take to regain your life. Let's dive right in.

    Start a Journal

    Everybody is different. The human body is one of the most complex biochemical systems. Some "scientific" solutions might do absolutely nothing for you, while some "backward" attempts might turn out to be the best thing for your RSI. That's why a journal is essential, so you can figure out what works for you and separate fact from fiction.

    Here's how I tracked my symptoms. I created a Notion template where I record the following every single day:

    1. my symptom score out of 10 - how good or bad were my symptoms?
    2. what's working or helping the most?
    3. what's hurting or causing the worst symptoms?

    rsi prevention

    The value of the journal comes in helping you track progress over time. RSI is a long term problem. In a month, when you are still battling symptoms, wouldn't you want to have a log full of things you've tried and things that aren't working? Your journal is your sidekick on your journey as you systematically experiment and improve until you find what works for you.

    Take a moment and define a place for your journal now. It could be your Apple notes, Notion, Evernote, even a physical journal. Your journal can be anything, as long as it's easy to access and record. With that in hand, now we can cover my two-pronged process for curing your RSI.

    My Fix in a Nutshell

    My strategy breaks down into two main approaches:

    1. Mitigate the damage in the short term.
    2. Build healthy habits and lifestyle changes to prevent injury and encourage healing.

    Let's jump right in.

    Mitigate damage

    What do RSI and Chinese water torture have to do with one another? Everything. When you sit down and type at a keyboard for hours on end, every day of the week, you subject your body to severe stress for years. The result is nerve damage and inflammation. When you experience wrist pain, you are witnessing the buildup of thousands of small traumas on your body over time.

    "Mitigating damage" means identifying and reducing the damage you are causing your body every day. Below I'll share the three of the most effective ways you can mitigate damage. But keep in mind, these are band-aid solutions.

    Bandaid solutions can help you cope with the problem, but they aren't going to be a long term fix. These should only be viewed as holdovers until you can address the root cause of your symptoms, which we will discuss later.

    1. NSAIDs

    One of the best ways to reduce the damage and inflammation if you are experiencing RSI symptoms is to take an NSAID like Ibuprofen or Aspirin.

    Why does this work? Inflammation is both a cause and a symptom of your problem. As your nerves are damaged, they become inflamed, leading to swelling. This swelling puts additional pressure on your already compressed nerves, worsening the problem.

    Want to know an even better version of Aspirin? It's called Naproxen, also sold as "Aleve".

    aleve

    Think of Naproxen as a slower-release version of Ibuprofen. Aspirin has a half-life in the body of about 2-hours while Naproxen's is 15-hours. This means that Naproxen is continuously working for you in the background to soothe those inflamed nerves. During the worst of my symptoms, I would take one before bed every night, and it halted the advance of my symptoms.

    It's not all sunshine and rainbows, though. Be careful about taking NSAIDs every day and consult your doctor before using, as they can cause stomach issues for some people if used on a long-term basis.

    2. Ice

    When I first started to treat with ice, it felt like Prometheus had just delivered me fire. I found that only one minute of icing my wrists could buy me another pain-free hour of coding or writing.

    Whenever I start to deal with symptoms, ice is honestly the first thing I employ. Ice your wrists frequently and liberally. I've used the Thrive ice packs to great success.

    ice wrists

    The best way I found to ice is to bring ice packs wherever you go. When I was working out of a WeWork in Santa Monica, I would bring three ice packs - two of them would go in the freezer, and one would come with me to my desk. Whenever I had a break or even a lull in the coding, I would slap on the ice pack.

    Whenever the pack I was using went cold, I would put it back in the freezer to cool and swap out one of its chilled buddies to be my new companion. This strategy allowed me to build an entire full-stack app while I was in the worst of my symptoms, so do not underestimate it.

    3. Brace

    Another powerful temporary solution is to use a brace. I've found the RCA M-Brace to work wonders. When I slapped this thin on, it eliminated most of my pain immediately.

    brace

    The brace supports your wrist to allow for proper circulation or functioning. Again, I err on the side of not needing to understand exactly why it works if it just works. Whatever it does, it works for me, try it out. I have one for each wrist.

    Another thing to try is to wear a brace at night. While you sleep, your hand can clench and unclench, causing even worse symptoms when you should be resting! To allow yourself to heal, you can wear a brace at night. I use the Futuro brace and leave it on whichever wrist is giving me the most trouble.

    wrist brace

    Mitigate Damage - Wrap up

    Okay, let's summarize the top three bandaid solutions to try to buy yourself some more time and comfort when your symptoms start to develop.

    1. NSAIDs - Naproxen
    2. Ice
    3. RCA M-Brace during the day, Futuro brace at night.

    These three things were the most effective out of tens of different products that I've tried. But as I've said before, these are only temporary solutions. You should only rely on them as a holdover until you can identify and fix the root causes of your problem, which I'll cover next.

    Fixing the Root Cause.

    Imagine you had a roach infestation. One approach you could take is to buy roach traps, stop sprinkling crumbs on the floor and hope they stop coming into your apartment. Or, you could go after the hive. Or nest? Whatever, you get the point. Find where they live and get rid of them. That's what we need to do for RSI. Identify and fix the root cause of your symptoms.

    There are only two components for fixing the root cause.

    1. Change how you work

    2. Fix your posture

    Change How You Work.

    Don't die of a heart attack at age 45. It's not a revelation that some aspects of our modern lifestyles are killing us. Our bodies are designed for the plains and savannas, where we spent most of the day walking and foraging in bands of 150 max. Guess what Grok the Caveman didn't spend 90% of his time doing millions of years ago - building full-stack apps hunched over a tiny laptop monitor with fingers repeatedly tensing to hit intricate patterns on pieces of plastic.

    Coding is not natural, and we aren't designed to do it. And certainly, most equipment is not set up to help us do it in a way that the body should operate. To adapt, we need to be inventive with the way we use our tools. Below I'll share the top ways you can change the way you work, so it fits the way your body is designed.

    Take Breaks i.e., "Stop doing that"

    Patient: "Doctor, doctor, it hurts when I do this."

    Doctor: "Well, then stop doing that."

    If spending all day on the computer typing away is hurting you, the first answer is to stop doing that.

    One of the essential pieces of exercise is recovery. If you work out all day and never give your muscles time to rest, your muscles will SHRINK. You have to give yourself time to recover from the damage. So take breaks.

    On the week level, try to design at least one day a week where you are limiting doing the same repetitive work on the computer. Every day, try to plan times where you step away from the computer and do other real-life things, like go outside (with a mask) and spend time with loved ones.

    The most important thing you need to stop doing? The one thing every programmer does: marathon sprint where you don't get up from your chair for 11 hours. You need to get up, walk around, and stretch. The issue is that the longer you go, the worse your posture gets, and the more compromised you are going to get. So stay fresh by setting timers for your work time and doing stretches in between. I'll give you the exact stretching routine that I use in this article.

    Lifestyle Change Part One: Ergonomicize Your Workstation.

    Can you avoid taking your car into the shop to get your oil changed and drive it like you stole it everywhere you go? Sure. But you wouldn't expect that car to make it to 250,000 miles. Think of your body in the same way. I guarantee that if you're like 99% of people the way you work right now is slowly chipping away at your health and could cause problems for you down the line.

    homeOfficeErgonomics

    The tricky thing about RSI and posture problems is that they are long-term problems. It may take months, years, even decades before you start to experience issues, but once they start, they can take a long time to resolve because you have been unknowingly damaging yourself for so long.

    Here are the patterns your desk should be in. If you are not in this position. Expect to have problems. Simple as that!

    ergonomic seated posture

    Ideally, you'd like to stay productive for a long time. Careers should last decades. Treat your body with care and respect now, so you don't have to run into problems ten years down the line. Invest in yourself. Don't let your fear of "looking funny" stop you. People who make fun of other's ergonomics are like the high-school kids making fun of the kids who study. They're the losers in the long-run.

    Here you may have to do lots of experimentation to figure out what exactly is working for you and what is not.

    The four musts for an ergonomic work-station:

    • A monitor
    • A keyboard tray
    • Ergonomic Keyboard
    • Ergonomic Mouse

    Monitor

    Trying to defend why hunching all day over a 15-inch laptop is "optimal" for your posture is like saying junk-food doesn't make you obese. If you haven't experienced problems from working straight off your laptop, it's because you have a high tolerance for non-ergonomic conditions. But as even the frat-stars who have tried one too many kegstands know, everyone breaks eventually. Working without a monitor is a recipe for carpal tunnel. You can get a cheap one on Amazon for just \$90.

    Even once you have a monitor, you might still slouch. One handy trick I use is to take a lacrosse ball and place it in the middle of my shoulder blades between my back and the back of my chair. If I lean forward, the ball falls down, and I have to reposition. Try it and let me know if it works for you.

    Keyboard tray

    Most people don't get this right because putting the keyboard or laptop on the desk and working off it is the norm. But you want your elbows and wrists at a 90-degree angle with your elbows by your sides like this:

    image

    Keyboard trays are non-negotiable for me, yet it's another trick that I find people being quite reluctant to try. My hunch is that getting a keyboard tray is the first sign that you are actively working on your ergonomics and outs you as "that guy" at the office. Don't be afraid to take the leap. Keyboard trays can be had on the cheap, I found this one for around \$50, and they can last a lifetime.

    Keyboard

    Keyboards are already a deep rabbit hole. Finding a keyboard that works for you is where the journal comes in handy. Ultimately you need to experiment around with what works. For example, I found that I need mechanical switches. The reason? I am a forceful typer by habit, and so when I don't have tactile feedback, I end up exerting extra force on the keys.

    So for me, the Microsoft Sculpt (a typical recommendation when people suggest ergonomic keyboards) did not do much for me.

    The things you want to avoid are twisted wrists in and pronated down.

    So as you experiment, you will see keyboards start to tilt vertically and also split apart. Here's a typical progression based on how extreme you want to take it.

    1. Standard laptop keyboard
    1. Ergonomic keyboard / Mechanical Keyboard

    1. Split-keyboard

    1. Custom keyboard setup

    I'm currently using the Kinesis Freestyle Pro split-keyboard with mechanical brown-switches and it has been awesome.

    Mouse

    Most people who develop wrist pain problems have problems with their "mouse hand" first. This is not a coincidence. Finding a mouse setup that works for you is one of the highest impact things you can do to be pain-free. When picking a mouse, it is essential to experiment and find a setup that works for you.

    I've found that I can get by with the standard Apple Magic Trackpad, whereas the vertical mice and rolly-ball mice cause me problems even on a good day. It's so much better than a mouse for whatever reason. Again, not questioning what works.

    A typical progression goes like this.

    1. Standard mouse

    1. Ergonomic vertical mouse

    1. Rolly-ball mouse/Trackpad

    VIM

    vim

    VIM deserves its own section because it has been such a game-changer for me. I found that before, typing thousands of words on the computer is a super high-risk activity, far more than coding, and causes almost all of my symptoms. So I just eliminated my need to go back and forth between the keyboard and the mouse.

    Yes, learning VIM has a steep learning curve, but I cannot understate how much longer I can work at the computer without running into issues by completely eliminating my mouse usage. Something to at least consider. I found that the fastest way to learn VIM was using vimtutor in my terminal along with this article.

    Lifestyle Change Part Two: Fix Your Posture

    I messed up big-time and got two surgeries that I didn't even need. Why? Because our medical system focuses on symptoms whack-a-mole and not holistic prevention. Our first instinct is, "Oh your wrists are having problems? Let's do wrist stretches and wrist surgery." Meanwhile, the problem could actually be upstream in your neck.

    These physical therapists changed the way I think about carpal tunnel forever. They describe how carpal tunnel and repetitive stress injury are often correlated with Thoracic Outlet Syndrome (TOC). The reason? Because the nerves and blood vessels essential for bringing nutrition and healing to the wrists and extremities can become pinched, restricting proper flow throughout the body.

    Many experts discuss how poor posture in the neck and torso can cause nerve problems in your arms. In his book "Deskbound", renowned Sports Physiologist Kelly Starret harps on the importance of going "upstream" to fix your "downstream" problems. So if you are experiencing problems "downstream" in your wrists, you have to look "upstream" to your chest, shoulders, and neck.

    Bad posture provides a deadly double-whammy:

    1. Bad posture worsens the damage from typing
    2. Bad posture prevents proper healing

    If you look like the hunchback of Notre Dame, you're going to have problems with your RSI. And if you continue to work with bad posture, you're pouring gasoline on the fire. But there's an upside. Curing your symptoms and becoming pain-free is a "lagging" outcome of good posture. Fixing your posture is the number one thing you can do to improve your RSI symptoms.

    After I underwent two ulnar nerve surgeries in high school, my ulnar nerve problems persisted. But when I finally fixed my posture, my symptoms disappeared magically.

    I have a rule of thumb. I don't start worrying about my symptoms or going to a doctor or getting surgery until I have perfect anatomical posture for two weeks. If you can get and maintain perfect anatomical posture for at least two weeks, I guarantee you are going to see your symptoms improve. If you don't have perfect anatomical posture, and you are experiencing symptoms, don't get frustrated or worry, just fix your posture!

    I'm going to share the exact exercises and routines I use to stay in good posture.

    Keys To Good Posture

    Fixing your posture comes down to three things:

    1. Stop doing things that cause bad posture

    2. Stretch tight muscles

    3. Strengthen weak muscles

    The Problem

    We aren't cavemen, yet we're looking more and more like a race of cavemen every day. The key is to dust off our anatomy textbooks and read up on what muscle imbalances are causing our caveman posture.

    Tight and overdeveloped muscles: chest, scalenes, anterior-deltoids (front-shoulders).

    Weak and underdeveloped muscles: upper back, lats, rear-deltoids (back-shoulders), intercostal muscles, and deep neck-flexors.

    Chill Out on Chest Day

    The first way to improve your posture is to stop doing the things that cause bad posture. We've already talked about fixing your workstation, but there's one other place where your posture is getting worse, and it's the opposite of what you'd expect. The gym. It doesn't matter how many corrective exercises you do, or how ergonomic your workstation is if you are over-developing the wrong muscles in the gym.

    When I had ulnar nerve issues, I was a massive gym rat. And guess what muscles I worked out the most? My chest and front delts. I would crush my chest and front-delts every other day with weighted dips and bench press. The result? I slowly became a caveman, that's when my ulnar nerve issues starting cropping up.

    The issue is that the muscles of your back are larger and stronger than those on your chest, but we rarely more attention to our back muscles. If we're lucky, the back gets the same amount of attention. This is backward.

    One problem with a lot of body-weight work-outs at home is that they often center around pushups, which work your chest and not your back. Get a pull-up bar at home and do pull-ups instead of pushups for your morning routine.

    Reduce the number of chest days you take at the gym. Think pull-ups, chin-ups, rows, reverse-flys, and deadlifts. These will strengthen the muscles of your back. Make sure you do more time and sets on your back than your chest when you're at the gym. Once you do that, it's time to fix the imbalance you've already created with stretching.

    Correction Exercises Part One - Stretch Tight Muscles

    The next step is to take the muscles that get tight throughout the day and lengthen them out.

    Most RSI resources online will recommend you do wrist stretches. I'm not saying these won't help, but I do think that focusing on wrist stretches is going to leave the "upstream" issues caused by tightness in your chest and neck to go untreated.

    Stretch the Chest and Scalenes

    Here are the top three chest and scalenes stretches I have found:

    1. Foam-roller or towel stretch

    snowangels

    1. Wall-angels

    wall angels

    1. First-rib mobilization

    "Mashing" and Massage

    Stretching alone may not be sufficient. Why not? Because muscles can get "locked" into certain positions through chronic neglect. For that reason, it is important to go in with some form of massage.

    For this purpose, you can go in with a set of massage balls, a a massage stick, or even an electronic point-massager to break up the stuck tissues and lengthen those contracted muscles. I've used both the stick tool and am currently experimenting with the Renpho massager, which has been quite useful for me.

    These are the two "mashing" exercises that have helped me the most:

    Correction Exercises Part Two - Strengthen the Upper Back

    Remember, maintaining a particular position requires relaxation of one set of muscles and contraction of the opposing set of muscles. As we lengthen and stretch the chest, we will need to strengthen and tighten the back muscles, which are continually weakened by our poor posture.

    There are a number of ways you can strengthen the upper back. The easiest and most cost-effective way I have found is with a set of resistance bands.

    I use this this set of bands which can attach to a doorframe (you'll need this for the face-pulls).

    Here are three excellent exercises for strengthening the back and neck-flexors:

    1. Band pull-aparts

    pull aparts

    1. Chin-tucks

    chintuck

    1. Face pulls

    face pull

    Practical Implementation Program

    Most people will fail to improve their posture after reading this. Why? Because knowing the right exercises is not half the battle. The real work takes days and days of compounded and consistent attention to improving posture.

    To do that, you need to make it a habit. You have to commit to having good posture and make a lifestyle change. This means you should create a program for yourself. The easiest way to build a habit is to do it first thing you wake up and right before bed. These are "bookend" habits because they bookend your day, and they are a perfect opportunity for you to improve your posture.

    Start by taking one stretch and one strengthening exercise and do it first thing in the morning and first thing when you go to sleep. As that becomes a habit, you can slowly add the others to your routine. I have such an ingrained habit that all of my stretches take about ~15 minutes each day, split 7 minutes in the morning and 7 minutes at night.

    Putting It All Together

    Okay, so what did we learn?

    1. Use bandaid solutions to become pain-free
    2. Adjust your workstation and work habits to put less pressure on your wrists
    3. Fix your wrists by addressing the upstream issues with your posture

    Many highly-talented athletes have had their superstar dreams ripped away from them by career-ending injuries. As a professional in tech, you are at a similar risk. Don't wait until it's too late, and you are reduced to typing for one hour a week. Take care of yourself, follow the suggestions I've laid out here, and you'll be well on your way to a productive career for your entire life.

    Want to learn more?

    There's so much I left out of this article because it was getting long. If you want to get even more in-depth tactics and strategies, just reach out and say hi if you want my full four-week implementation program or any of the following:

    • the exact purchases you should make to improve your posture given your budget
    • the exact morning and evening routines I use to stay pain-free in just 15 minutes each day
    • a step-by-step implementation calendar and habit tracking template to get you fully recovered

    If you found this helpful, please share it with someone you think could benefit. Let's get rid of RSI for good!

    Resources

    Athlean-X Physical Therapy

    Bob & Brad Physical Therapy

    Deskbound by Dr. Kelly Starrett

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      Hi! I'm Ian Geckeler. I read 100 nonfiction books each year and share the best of what I learn! I'm also a Software Engineer at Hello Alfred. Previously Growth at CoEfficient Labs and B.S. Computational Math at USC. Follow me on on Twitter!

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