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I am currently rehabbing hand pain right now and the number 1 thing that is helping is this book:

The Trigger Point Therapy Workbook: https://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-T...

I believe that the primary cause of my hand pain is my forward head posture. This can create trigger points in the scalene muscles of the neck which cause sattelite trigger points in my forearms (especially the extensor muscles) and in my upper arms as well. These trigger points then refer pain to the hands. Self-massage using a lacrosse ball has pretty much eliminated my pain and seems to significantly increase bloodflow to my hands.

NOTE: be very gentle the first time you do self massage of the scalenes with your fingers. I went too hard and my scalenes swelled up for 3 days and I experienced the symptoms of thoracic outlet syndrome, ie. I had numbness from my collarbone to my middle and ring finger on my left side. It went away once my neck healed.

It definitely seems circulation related: whenever I use a computer with cold hands, it causes tension and then pain. I make sure to never use a computer with cold hands. I recently purchased this Far Infrared heating pad to heat my hands. It really does work a ton better than traditional heating pads with resistive coils. https://www.amazon.com/UTK-Infrared-Electric-Therapy-19-Inch...

Also, it is critical to correct the weakness and structural problems in the body. I do yoga, strength training, and swimming and these seem to be helping keep the trigger points from coming back. I am also doing shoulder mobility exercises with a stick and following this guide to correct my forward head posture: http://posturedirect.com/forward-head-posture-correction/

⬐ dvtv75

Just under half of the exercises prescribed by my physio are in that last link, and I expect that many of the remainder are coming up in a future appointment.

Oh man, do I feel you on that. Doctors are fairly worthless in my opinion for these issues. I say this having dealt with various RSI/nerve pain issues for over 6 years, and tens of thousands of dollars in out of pocket medical bills. They'll pretty much always be like "just take an Aleve", or "I don't know, do some physical therapy or wait and see if it gets better. Next patient please!". Your health and getting better will be on your shoulders.

With that in mind, I'd like to preface all of the following by saying: I am not a doctor. This information is for educational purposes only, and is not meant to be a substitute for professional medical advice.

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Here is a long, varied guide on everything I've learned and things that have helped. Most of my knowledge has come from trial and error, and reading books and medical papers.

I have had tingling, burning pain throughout my arms and hands for many years. I also had several bouts of nerve pain in my legs. RSI and nerve pain stuff seem to go hand in hand. A lot of this advice ties into reducing nerve pain as well. I've had three surgeries total to move my ulnar nerves out of their ulnar tunnel so they would stop snapping over the bone and causing me pain. This wasn't the only cause of my issues though.

A lot of pain in your arms actually originates in your neck/shoulder area. There is an issue called Thoracic Outlet Syndrome that is suspected to be the cause of most of this kind of arm/hand pain. Chances are, you have bad posture.

Things that helped:

- Using a macbook pro for all computer use. Using a mouse or raised keyboard is awful for your hands. The trackpad placement with the keyboard, and the fact you can set the trackpad to register a touch (without pushing down) as a click are very helpful. Make sure you're not bending your wrists to the left or right when typing. It's a hard habit to break, and you're probably doing it now, but ideally you want your hands to be straight in line with your arm. Wrong - https://ehs.okstate.edu/modules/ergo/hand4.gif. Right - https://ehs.okstate.edu/modules/ergo/hand3.gif. Also, don't raise up your hands when typing or using a mouse, it stresses out your forearm muscles.

- No keyboard or mousepad wrist pads, they just constrict the nerve pathways in your wrists.

- You want to make sure your posture is good. When working at a desk, you actually should be sitting back against the seat, with your arms supported by the arm rests. You shouldn't be sitting straight up 90 degrees, but leaning back a little, with your back supported against the chair. This picture kind of shows it - http://cdn.makeuseof.com/wp-content/uploads/2013/06/computer... - though I would say you should be a bit less far back than the 135, maybe like 110.

- General posture stuff: when walking make sure your hips aren't tilted forward or backwards, make sure your shoulders are slouched forward, make sure your head isn't tilted forward (99% chance you do this one and don't even realize). Make sure your shoes' soles aren't worn down - if you see they look uneven buy new shoes.

- TMS (Tension Mytostis Syndrome) - basically is stress and anxiety making your brain subconsciously cause your body pain. Really helpful with me way after my surgeries in getting from 3-4 pain level to 0-1. I read this one - http://www.amazon.com/gp/product/0446675156/ref=pd_lpo_sbs_d....

- The Trigger point therapy workbook - http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr.... Your muscles get tight and get these things called trigger points. This causes them to tense up and pull on other muscles, starting a bad chain reaction causing pain all over. This will teach you not only how to do trigger point self massage, but how groups of muscles can affect other parts of the body far away from them. You’ll also want to pick up a pair of lacrosse balls, they’re super helpful for self massage.

- OTC pain pills – this I discovered recently – NSAID’s like Aleve work by reducing inflammation, while Tylenol works more on your Central Nervous System by increasing your pain threshold so it takes higher levels of pain before you can feel them. Also way gentler on your stomach than Aleve. Aleve can also cause some damage to your digestive system, making it harder to absorb…

- B12 vitamins – a deficiency of b vitamins, especially 12 can cause neuropathy (nerve pain). This b vitamin combo is really good, has all the best options for each one inside of it - http://www.swansonvitamins.com/swanson-ultra-high-potency-ac...

- Sleep – I find that if I get less than 8 hours of sleep over a period of a few days my nerves start to light up a bit (not sure how else to describe it). Sleep is super important, it’s when your body does most of its repairing and healing.

- Anti anxiety meds – klonopin, xanax, etc - if you can get prescribed these, I’ve found them more helpful than painkillers sometimes, they definitely take the edge off. From what I've read they can be very addictive though, so watch out for that.

- Actual nerve pain medicine – I learned about this reading Wolf of Wall Street. Turned out he had terrible, chronic nerve/back pain that drove him to do all those drugs. He was at the end of his rope, multiple surgeries and still a lot of pain. His doctor ends up prescribing him Lamictal, which at the time was a medicine for seizures, and it’s like a switch was flipped and he wasn’t in pain anymore. There are better options these days for that though, Lyrica is a popular, as is Neurontin. They can have some side effects, but apparently can be very effective (I’ve never tried them myself, was able to get my pain down to a manageable level for the most part, though I do have them in my mind as a back up if it gets really bad again) - http://www.mayoclinic.org/diseases-conditions/peripheral-neu...

If you would like to do more research on top of what I described above:

- If you want to go to a doctor, try a neurologist or a good physical therapist. Most doctors are infuriatingly ignorant and incompetent when it comes to these kinds of issues.

- Read about the nerves in the arm, and thoracic outlet syndrome

Good luck, and try not to lose hope, I know how being in pain every day can wear someone out. Remember that there’s a good chance you won’t be in pain or at least it will be manageable at some point in the future, even if that may be a while out. If you want to ask me any questions, I'd be happy to help.

⬐ mahyarm

Wow thank you! I'm not at that level of pain myself, but I've started to notice symptoms that started to worry me, one of them being that numbness you originally described. I want to prevent a disaster before it happens, since my livelihood depends on it.

⬐ kdamken

No problem, hope it helps!

Obvious question is obvious, but may also be helpful: have you seen a competent psychotherapist?

If the tension is indeed psychosomatic, then treating the psychological cause may be the way to go.

Other things that would be worth investigating: Alexander Technique, Pilates (yes, seriously. What you're describing could be breathing-related in particular, and Pilates is good at that stuff. Go for a teacher accredited by an organisation with a multi-year training program.), Tension Mytosis Syndrome, T'ai Chi (again, seriously. Good t'ai chi can be very useful), trigger point therapy (read http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...), deep tissue massage (painful but effective).

⬐ dimfisch

Tried a few of the techniques you mentioned, as well as therapy, but I'll check out the other ones. Thanks.

Trigger point therapy has made a world of difference for me, too, both for RSI and for neck problems due to and old motorcycle accident. Check this out:

http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...

I was first introduced to it by a physiatrist (no, not psychiatrist), which is a real MD. They had a team of essentially physical therapists that worked on trigger points. Even if your insurance doesn't cover massage, most will cover visits to such places, since it's under the care of a doctor.

⬐ graeme

I may get that book.

Also useful is a theracane. Lets you self-massage and apply trigger point therapy to your back and other hard to reach areas. Not too expensive either, only $40. It helped clear up a tight trapezius muscle which was causing a shoulder ache.

http://www.theracane.com/index.html

(this was recommended by the same therapist who helped my hand)

⬐ lutorm

Yeah, the Theracane is pretty good. My favorite gadget for forearm trouble is the ArmAid: http://armaid.com/ It's very good for kneading your forearm extensors and flexors. When my forearms get tight, a few sessions with this usually fixes it.

⬐ graeme

wow, I'm glad I posted, that looks to be very useful. Do you need the leg strap, or do you just balance it on your leg?

⬐ lutorm

I never use the leg strap, personally, though I can imagine that, if your hands are in bad shape, it would reduce the force needed to hold it in place.

It's actually also really good for kneading your calves for people like me that have perpetual trigger points there. It's a bit undersized, so I've been meaning to email them and suggest they make a "LegAid" that's larger and more robust...

I will make my standing recommendation for "The Trigger Point Therapy Workbook" now: http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...

⬐ stretchwithme

That's the book that got me started on this whole thing. $13 well spent.

A little late to the party, but I went through a bout with wrist/arm pain for over a year. I did physical therapy for more than 6 months, saw a doctor that said I needed to have surgery on my arms, neither helped (did not have surgery BTW). I then finally saw a myofascial specialist. She identified the cause of my pain from trigger points in my upper back and shoulders. After just one visit and a follow up visit a year later, I've been relatively pian free. She basically taught me how to address the trigger points my self using a tennis ball and 'The Trigger Point Therapy Workbook' http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...

I'd definitely give this book a try since it clearly identifies which trigger points are causing the referred pain/numbness along with the ways to treat them.

Also if you are in the Chicago area, check out http://www.myopain.com/. Like I said, they were able to help me with only 2 visits.

About 4 years ago, I was 22 at the time, I started experiencing pain in my right wrist and forearm. Once the pain became unbearable, I started using the mouse with my left hand. Almost immediately I experienced pain in my left wrist and forearm. Initially I thought it was Carpal Tunnel Syndrome. I went to physical therapy 3 times a week for about 6 months with little or no benefit. I started reading books on RSI, trigger points, and myofascial pain. I was afraid that I would need to switch careers (I'm a programmer). My attitude towards work changed drastically and my want to use a computer outside of work became nil. I started cutting out of work early and going to more meetings. I did anything that would keep me away from the computer. Driving became painful. I had to quit lifting weights and playing sports since they worsened the pain. I then saw a surgeon who (you guessed it) said I needed surgery on my forearms. I left his office confused and psychologically broken. I decided surgery would be my last resort and I would try any noninvasive approach. I enrolled in physical therapy (different therapist) for another 3 months and stopped going. This round of therapy was actually making the pain and numbness worse. I tried wrist braces which also made the pain worse. My wife found a myofasical treatment center in Chicago (http://www.myopain.com/). After my 1 hour visit, the intensity of the pain decreased. I left armed with the knowledge to treat my pain. That was almost 2 years ago and I have been virtually pain free. I had a week where the pain started coming back about 6 months ago. I went back in for another hour appointment and she diagnosed my problem again. So to sum things up:

* I started experiencing pain in my wrists and forearms about 4 years ago

* After 6 months, the pain became so intense I started working less and avoided my computer as much as possible

* Went to physical therapy where they misdiagnosed my problem

* Stopped physical therapy after 6 months or so

* Was recommended to a surgeon who (big surprise) wanted to do surgery.

* Tried a different physical therapist

* Tried wrist braces

* Went to the myo pain center in Chicago http://www.myopain.com/

* I was able to treat myself after a 1 hour visit at the myopain center * Went from being able to work on a computer unbearably 35 hours a week to 70+ virtually pain free (when I worked for a YC startup)

* I now work from home and have made some ergonomic changes that have also helped:

The top of my monitor is at eye level.

I use a trackball and the Microsoft 4000 ergonomic keyboard.

I got an overstuffed thick pillow which helped support my neck when sleeping on my side.

I use this book to find and treat the trigger points: http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...

⬐ thalur

Thanks for that - I'll definitely give that book a look.

* Went from being able to work on a computer unbearably 35 hours a week to 70+ virtually pain free (when I worked for a YC startup)

That's definitely encouraging. At the moment I can manage about 40 hours a week. Any more than that (like I'm doing at the moment) and the pain comes back :(

As a longtime RSI sufferer, I agree with the need for strengthening. However, working out is a long-term preventative measure, not for when you are inflamed and in pain!

If your muscles and tendons are struggling, the last thing they need is more to do. I would strongly recommend doing whatever you can to give your hands a break for a while, and then start strengthening. And for giving your hands a break, you should absolutely feel justified in getting whatever ergonomic gadgets you think will help.

If you are suffering from numbness, that means your nerves (ulnar nerve, etc) are irritated. There are indications that this is not just a hand problem, but is due to postural problems in the upper back and neck from sitting statically in front of the computer for long hours. Google "thorassic outlet syndrome".

I highly recommend you check out the following books:

"It's not Carpal Tunnel Syndrome", http://www.amazon.com/Carpal-Syndrome-Therapy-Computer-Profe...

"Trigger point therapy workbook", http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...

I give these books a lot of credit for my almost complete recovery.

⬐ joe_the_user

Yes, extremely important. Be very careful about any advice to dive into exercise if you have an existing problem.

Trigger point therapy is worth looking into...

I'd recommend buying this book: http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr.... It shows you the trigger points which cause referred pain. I reference this book quite frequently and would also recommend (no joke) taking a woman's nylon and putting a tennis ball in it. You can then hold the open end of the nylon and hang the tennis ball over your shoulder with your back towards a wall. By applying pressure (by leaning) on the tennis ball for a few seconds, you can alleviate trigger points or sore muscles.

A few other tips to add here beyond the other great ones already mentioned. I had to learn about these the hard way.

1.) Massage.

You may not think it's the manliest thing ever, but if you can afford it you should find a good local masseuse and get yourself an hour session. Even if you go once and never go again, you'll get an education in just how kinked up your back and shoulders probably are.

I tweaked my back lifting a lawn mower out of my car a couple years ago and didn't think much of it at the time. Over the next few weeks I started to have all kinds of shoulder problems and other various pain to the point where my arms were getting tingly and I couldn't sit and code for more than 30 minutes at a time.

Long story short, I went through a few doctors before I finally just decided to see a masseuse and see if it helped. I was lucky to find someone that knew what they were doing and helped get me straightened out. It took about 5 sessions over 5 weeks, but I've never had problems since.

2.) Trigger points.

Learn what they are and how you can fix them. This was my problem that the masseuse turned me on to. Trigger points are essentially little micro-knots in your muscle fibers that can add up to cause big problems for you. For me, lifting that mower was really just the straw that broke the camel's back. It just exacerbated all the trigger point problems I'd been creating over years of coding and not stretching out my back and shoulders properly.

If you know where the common trigger points creep up and how to get rid of them you can save yourself a lot of pain and downtime (not to mention massage bills).

Buy these two things: The Trigger Point Therapy Workbook (http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...) and a TheraCane (http://www.amazon.com/Thera-Cane-Theracane-TheraCane/dp/B000...)

The book will show you how to identify and treat the trigger points all over your body, and the TheraCane will help you reach the places on your back that you can't reach yourself.

3.) Yoga.

Once you get all your issues straightened out, yoga and/or a good daily stretching regimen can help keep you kink free.

Hopefully some of this advice is helpful. I was really messed up for a while until I figured all this out. Again, echoing what others have said, please take care of your body. It's the only one you have.

⬐ juliend2

I second Yoga too.

I particularly recommend the "Sun Salutation" exercise : http://ca.youtube.com/watch?v=yuvfHTaftLQ (she's an expert, but you can do the movements as far as you can)

⬐ Todd

I second yoga. It is the only exercise that I know of that is built around the back and posture. It does wonders for people who sit at desks all day. I have only done it occasionally over the past several years, but it has helped every time.

The other important exercise is walking. As imperfectly designed as our bodies are for bipedal locomotion, walking turns out to be one of the best exercises for them. For example, the disks in our backs don't have blood vessels bathing them in oxygen. One of the only ways to oxygenate them well is to walk (due to the back and forth motion).

A healthy spine, back muscles, etc. will go a long way to making your 8+ hour stints in a chair bearable. Think of it as the penance that our body demands for our hacking.

⬐ davo11

pilates is great for back strength - it focuses on your 'core' muscles that keep your back straight.