…Continued from Part 1 - everything you need to know about RSI

How do we manage it?

Ideally you would all come see me personally to manage your pain, but since that can’t happen (unless you are really in pain then please don’t hesitate to message me – I’ll do my best to help Ü)  I’ll give you the best quick tips to manage your pain. To manage a repetitive strain injury, we use a Five-Approach method.

1. Prevention
2. Rest
3. Exercise
4. Treating the Pain Pattern
5. Self-Massage

Preventative measures and rest should be the first step to make sure that the condition does not worsen. We supplement this with specific exercises and tools to provide faster healing and reduced strain. Prevention is always the first step in management. We want to make sure we have the proper ergonomics as well as general hand, wrist and forearm fitness. Double check that your gaming setup allows your wrist to be as close to neutral as possible and that extension (bending up toward the ceiling) is limited. While it may not bother you to assume the position on the right, prolonged activity in this position can put you at risk for pain and other painful conditions. I will go over the specific exercises below in the exercise section below that you can perform to both manage pain and keep your gaming tools strong. Gaming behavior is also an extremely important thing to consider. If you have already developed the symptoms above, it is important to re-evaluate how long you have been gaming. Keep track of the total length of time gaming and provide yourself with reasonable breaks throughout the duration of the game. An easy way to remind yourself to take breaks is to set an alarm/timer on your phone for 52 minutes (which has been identified as the optimal work period if you rest afterwards). To be realistic with your rest, take a 5-10 minute break as close as the alarm as you can. For Example, if I am playing league of legends I will take my break in between each game as they can typically last between 30-50 minutes. It may be hard to resist sometimes coming off the adrenaline of a fun game, but I do my best to not give in and jump into another queue. You have already taken a big step towards prevention by reading to this point and learning about the cause of the sensations that you feel with Repetitive Strain Injury. The more you know regarding what can cause pain, the more you can actively avoid those actions. Never underestimate the power of rest. We need time to have those tiny tears in our muscles/tendons or the compression in the nerves to heal. A day or two off of gaming can be beneficial not only physically, but also mentally. With a RSI, we can rest in two ways 1) PLAY LESS: This means if we are used to playing 3-4 hours, we should be resting cutting the amount of play-time down at least 50%. 2 Hours instead of 3-4. While it may be the most ideal to rest completely, I want to be realistic - Gamer's just can't stay away from gaming.  It is important to think long-term about managing your health and take this section to heart. Rest should absolutely be thought of as a part of gaming. During this time, be as aware as possible with your wrist and hand movements to avoid things that may cause you pain. Also, do your best to take breaks to stretch, exercise and grab healthy snacks. 2) Rest Completely: Taking a break from gaming can be very beneficial. It will only be 2-3 days and with the prevalence of things like twitch and youtube, you can maybe learn more about the game by watching professionals play. During this time, you can also do some exercises as well. Based on how long we have been dealing with the discomfort or pain, we need an appropriate amount of rest. The Table Below provides a basic guideline on how long we need to rest depending on how long we have been dealing with pain.

<10 Days	1-2 Days
10 Days – 3 Months	2-4 Days
> 3 Months	6-7 Days

With a Wrist RSI, it is important for us to maintain the conditioning of our wrist, forearm and hand muscles. Before I provide the exercise program, it is important for us to understand how to perform it, especially if we have pain. The rule of thumb is to perform the exercise right before the point of pain. So that means if I am asking you to perform a biceps curl. If it hurts halfway through the range, then curl it to the point right before it hurts. Mild Discomfort is okay, as long as the pain is not sharp. There are three types of exercises that we focus on in terms of rehabilitation and general exercise.

1: Forearm/Hand Strengthening

We perform the following exercises to improve the strength, endurance and coordination of our gaming tools 

Eccentric Wrist Flexion with Finger Curl

Eccentric Wrist Extension

Finger/Thumb Extension with Rubber Band

Grip Strengthening Exercises

2: Tendon Mobilization Exercise

The following exercise is important to relieve any potential stickiness between the layers of tissue (what we call adhesions) and improve the blood flow to the tendon sheaths.

Hand Tendon Gliding Exercise

3: Stretching Exercises

Stretching exercises are helpful to improve circulation and maintaining the proper ROM with your hand, wrist and forearm joints.  Stretching provides relief with the overused muscles associated with RSI's, which are shortened in an effort to protect the inflamed area.

Thumb Flexor Stretch

Wrist Flexor Stretch

Wrist Extensor Stretch

Hand Stretching Series

Address your Pain Pattern Pain is not black and white. It behaves in different patterns and based on the type of pain you feel, we use different treatment approaches. Based on what symptoms you are feeling with RSI, you will be utilizing different approaches.

Pain Characteristics	Inflammatory	Compressive (Lack of Blood Flow)
Age of Injury	< 3 weeks	> 3 weeks or 1 month
Peak of Symptoms	End of Day	Middle of the Night, First in the AM
Symptoms of a Wrist RSInjury	Aching, Throbbing, Stabbing pain in the wrist and up the forearm that lingers	Sharpness along the palm side of the wrist, Immediately Subsides with Rest
Treatment Approach	PRICE, NSAIDs	Heat, Stretching, Exercise Program (Above)

See my Brief Guide on Treatment Modalities for details on how to PRICE, Use NSAIDs and Heat the area affected.With a Wrist RSI, we will be targeting the muscles most typically used while you are gaming. Wrist RSI’s are typically associated with PC gamers as they utilize their wrists and fingers to move the mouse and type excessively.

Most Common Movements of PC Gamers: Wrist Warriors

Because these are the most common movements that PC gamers utilize. We target the muscle groups that are in charge of these movements! There are several ways you can massage your own forearms and hand, depending on what you have available to use. Out of our household and recreational items, a can of food and a tennis ball are the best to use.  If you want a more formal tool, you can purchase a small foam-roller

1: Forearm Muscles Self Massage

Massage Each Region between 45 seconds and 1 Minute, twice if you feel that it is extra tight.

Palm Side of Forearm/Wrist Massage

Back Side of Forearm/Wrist Massage

2: Hand Muscles Self Massage

There are two primary regions that we focus on with the hand - Hand Massage Regions and Technique

THE BIG QUESTION

When will it go away? When can I get back to gaming without thinking about it?

This is truly the big question. We gamer's want to know when we can get back to our binges! While a repetitive strain injury may appear to be a simple injury to deal with - Just wait for the muscles to heal right? - There are actually quite a few things that affect the healing time: Your Behavior, Posture, Ergonomics, Non-Gaming Activity, Rest (diligence with properly resting and exercising), and many more. Because of this, there is a simple and more complex answer. The simple answer is that it takes 2 to 3 weeks for the muscle injuries to completely heal while tendon overuse  injury takes at least 6 weeks to completely heal. This is assuming the gamer completely stops gaming and follows everything I mentioned above to a T. Pain goes away first while the tissues continue to heal. The more realistic and complex answer is that it can take 1-2 weeks for the symptoms to decrease drastically. And even more quickly (after several days) depending on how well you follow my methods above.  The pain can go away quite quickly as most gamers have only mild muscle and tendon strains. But even with less pain....

Just as with the patients I treat, we always have the tendency to resume our level of activity when we have less pain. This can set us back put us in a chronic cycle of pain and numbness (which I’m sure no one wants). Less pain is not a green light to return to a crazy gaming binge without breaks. You experienced your symptoms for a reason, something in your gaming life HAS to change in order to break out of this chronic cycle of pain or numbness. The guidelines I provide help you understand what you truly need to address.

TL DR, aka THE BOTTOM LINE:

Wrist RSIs involves Tendons, Muscles and Nerves. We stress the tissues in our wrist and forearms to the point that it becomes and stays inflamed.  Whether it be the repetitive motions of the mouse with computer games or the excessive use of the wrist with a console game like wii sports, our tissues are unable to heal quickly enough to respond to the stress of gaming for hours on end. You will typically feel:

• Muscle or Nerve related sensations: Aching, Burning, Prickling, and Soreness - especially during gaming positions.

It is typically a result of our ergonomics, posture, and poor gaming habits that cause our wrist, forearm and hand muscle to be overused. Poor conditioning of the forearm, wrist and hand muscles can also be a contributor. Ergonomics should be the first thing addressed as it can be the root cause of the overuse. The 5 ways to address the pain are:

1. Prevention (Ergonomics, Posture, Gaming Habits)
2. Rest
3. Exercises
4. Pain Pattern Treatments
5. Self-Massage

Following the treatment method should help to decrease the symptoms significantly in the course of 1-2 weeks. Let me know how this has helped you! Don't be afraid to leave a comment