I sometimes suffer from RSI. I’ve heard several people I respect say that they think most RSI is a psychological phenomenon. My understanding of their view is that they think there’s a feedback loop where you notice your wrists hurting and then you are anxious about the pain, causing you to pay more attention to it, which causes more pain though some mechanism we don’t yet understand. For the purposes of this post, I’m interested in the hypothetical of if something like that story is true.

I have some stories for what I’d do differently:

  • Ask a doctor to prescribe some psychiatric drugs, like SSRIs if I thought it was related to anxiety

And some things I’d do the same:

  • Continue to rest my wrists and do voice work when things get bad

But some things I’m uncertain about:

  • Do ergnomics matter?

I know several others who also suffer from RSI, and honestly I think the question is even more complicated there. Am I making my friends’ conditions worse if I talk about my condition?

(As a side note: I’m super glad that I can do voice work and give my wrists a rest. I honestly enjoy it, which is for sure not the typical experience. I am very grateful that I drew ”enjoys voice input” in the lottery of fascinations. While I admittedly haven’t seen many people get the benefit I have, if you’re reading this and would like my help getting set up using Talon Voice, send me a DM.)

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My personal experience is that it's true hence I would caution against too much rest. Wrist pain is a very vague term, no idea what you have, but I have battled RSI for over half a decade (mostly of the fingers) and at some point it got so bad that I wanted to quit my degree and it felt like even reading a book or newspaper was too painful. By all means, use your voice, contralateral arm or legs and feet to take over some repetetive tasks.

However, you need to use, strengthen and stretch your wrists as well. Targeted massage and strengthening with a physiotherapist should help. As workoholics we often forget how to listen to our body. Pain tells you to take a break, not do an allnighter. Then when having pain, it is easy to try to "protect" the affected bodypart, putting undue stress on other parts of the body, while the muscles, tendons, ligaments of the affected bodypart continue to weaken because they are unloaded and/or not used throughout their physiologic range of motion.

Before I jump to SSRIs I would start with psychotherapy, meditation, taking a real vacation, a healthy anti-inflammatory diet (standard food pyramid will do as a start), sleep hygiene to get 8h+ for recovery, sports (both endurance and strength, preferably something involving your arms and hands!), whole body sports massage etc.

I did find that the pain was to some extent in my head, to some extent real, and exacerbated by both overuse and chronic misuse.

"All in your head" describes the entirety of your experience in life.  All pain is experienced in the brain, as is pleasure, anxiety, etc.

Most experiences have a causal link from the outside, and the question isn't "whether" but "how much" should be externally mitigated vs "just" perception/attitude adjusted.  "just" in quotes because that's often the more difficult intervention.

RSI is pretty real-world, for many people at least.  No clue if yours is, but it seems reasonable to experiment on the easiest parts first.  Ergonomic setup of work space, exercises, attention to posture, etc. are the first things to try.  Simple rest probably isn't sufficient if you're not examining/understanding the causes of injury.

In parallel if you like, or afterward if you're apprehensive about it, talk to a psychiatrist about your anxiety or other symptoms - not just the wrist pain, but why you think it's psychiatric vs physical, and what other difficulties it's causing you in life.

First, pain in the wrists is often to due to muscle knots (“trigger points”) in the forearm muscles that you may not be aware are there until you go probing for them. There are many online resources for treating such knots if you find them. My advice: don’t overdo it, or you’ll bruise yourself and make it worse.

Second, the main thing you should not do if it is psychosomatic is take pain medication. Your brain and body can easily become psychologically and physiologically dependent on even “benign” drugs like NSAIDs, leading to situations where you’ll be in pain when you don’t take them.

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There's a commonly-hypothesized version of the feedback loop that has one more step: paying attention to the pain causes you to tense muscles in the area that don't need to be tense, and which hurt if they are. This mechanism implies that certain physical interventions will work (things which un-tense the muscles). It also de-mystifies what "paying attention to the pain" means, in a way that's more actionable and less psychology-flavored.

I don't have RSI but I'm curious to know more about voice input. My assumption (having done zero research) is it's slower than hand input.

I worked on speech recognition (really, more NLU and question-answering, but close to the ASR team), and we have a few other LW members actively working in the area as well.  

For careful (trained or at least practiced) speakers compared to touch-typing, on material that's amenable to ASR (mostly not very precise and hard-to-predict symbols), speech can be faster by 1.5-2.5 times (80-120wpm typed, 120-200wpm spoken).  But that's not really the normal use case - many people find that for written output, they need the control and editing capability of keyboards more than pure speed.  

Unless you've got a medical, safety, or convenience reason to use voice input (of which there are many!), typing is probably much better.  The dream is a hybrid - switching seamlessly between spoken and typed input, depending on what's best for any given unit of input.  I haven't seen any consumer-usable examples of this, though.

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