Dear friends and colleagues,

After a five year bout of struggling with repetitive strain injury

(RSI) in my hands due to typing, I believe that, finally, I am
completely cured. I emphasize completely because, in my
experience learning from and talking to many others about
this condition, I have found that a truly total recovery is
actually unusual. I can now type for hours, indefinitely,
without any lasting or cumulative symptoms of stress or
injury. Just a year ago, I could not type for more than five
minutes without considerable pain in my hands and arms.
Although I now type for hours every day, I never experience
pain or inflammation at all. Happily, I rock climb regularly and
play frisbee activities I had previously stopped due to RSI.
What follows is the story of how I solved the problem of RSI
for myself. I realize that people do not usually send out long
emails to their friends and colleagues about a strategy for
healing an illness. But RSI falls in a special category for
several reasons. First, I know many people who have been
affected by RSI, some severely, and some of who do not
seem to have yet found a lasting solution. Second, for many
people who suffer from RSI, symptoms can drag on for years
without a real recovery. For people like my nerdy friends and
myself who type for a living, this can be personally
devastating. Third and most importantly, the solution that I
found defies most of the conventional wisdom, literature, and
advice that is almost always thrust at patients of RSI. Finally,
it has been a life-changing and enlightening experience.
I should add that many of you have spent a lot of time
listening to my complaints and supported me through this
difficulty, for which I am very grateful, and I feel that you
deserve to hear a final report! I apologize in advance that the
story is somewhat long. But if I had read this story myself a

year ago, I would not have been able to really understand its
implications, or even find it credible, unless it was told in
pretty lengthy detail. In fact, the most important reason for
writing the story is that the story itself is of important
therapeutic value.
I need to first explain some history of the problem. I first
started developing RSI during graduate school about five
years ago. I had encountered some of the literature on RSI
and recognized that, according to the strong advice of
pamphlets given out by MIT Medical and others, I had bad
back posture, bad wrist posture, and a non-ergonomic work
space. Since my research project was completely computerbased, I looked at the pamphlets carefully and tried to
improve my habits. I talked to a doctor at MIT Medical to
make sure that I understood a broad scope of the issues I
should address. MIT Medical, to their credit, has a pretty
aggressive program to make students aware of RSI and
distribute literature on how to deal with it. I had
conversations with friends and colleagues about it, some of
whom were also experiencing symptoms or had dealt with
RSI in the past. In spite of my desire to work hard and make
progress in my research project, I made sure to take some
time off and rest my hands, sometimes for weeks at a time. I
was athletically active and, since RSI is a understood to be a
very circulation-based problem, aerobic exercise is often
recommended. I did stretches and took breaks while
working, which is highly recommended in the standard RSI
literature. While I did not exactly follow a rigorous
prescription of every single thing that has ever been
recommended in conventional medical literature for RSI, I
felt that I had made a number of positive changes across the
spectrum of my work and life habits. Most importantly
(according to the literature), I had become aware of the
problem, and I started thinking more about how my hands

felt and what I might do that would affect them.

This seemed to work for a while. My hands got better. But
then RSI would return and recede again, and I compensated
by taking time off and finding ways to streamline my typing
i.e., do some of my work in other ways and try to type only
when necessary. However since my project was completely
computer-based, it still simply required a lot of typing. For
some years I was sort of in RSI limbo; sometimes recovered
and sometimes worse. You have to understand that it was
not the physical pain of RSI itself that I found so concerning.
The mild pain was a minor inconvenience. However, by
broad convention in the medical literature, RSI symptoms
are considered a harbinger of what could eventually turn into
a very disabling injury. In the conventional understanding, if
you are feeling pain and continue to follow the activity that
causes this without getting rest and/or changing your work
habits, you might do lasting or permanent damage to the
musculoskeletal structure in your hands. In fact, at that time,
I already had one good friend who had suffered from carpal
tunnel syndrome so severely that it took literally several
years for him to recover. So, what worried me was the
possibility of creating a lasting injury to my hands. My hands
were obviously a precious vehicle for my work and for
sports, for things I loved to do.
As I approached the end of my graduate program, I worked
intensely and my RSI returned and got worse. The joints of
my fingers would hurt, my elbow tendons would hurt. If I was
not careful, I would overcompensate with my shoulders and
create knots in my back. I was putting a lot of pressure on
myself, as is typical for a graduate student nearing the end
of his or her thesis. I was concerned about the symptoms
and I started following the usual precautions more rigorously
frequent stretch breaks, exercise, and attention to posture.

As my thesis defense was only some months away, I did not

want to take time off. I made a bit of a devils bargain with
myself; I told myself that I would try my best to cope with the
RSI in the present and, after my defense, I would take a lot
of time off to heal completely. In retrospect I think this was
not such a responsible decision and I was not taking RSI
seriously enough. Some of you know my PhD advisor, and I
should also mention that, while I think that many of the
intense pressures in the program were very real, I do not
blame my advisor for my decisions at all I think he would
have been very supportive of giving me time off if I had
approached him with this medical concern. However that is
not what I chose to do, and by the end of my program, my
hands hurt almost all the time: when I was typing, when I
was walking home after work, and at night when I lay in bed.
I was stressed out with my thesis, also separately trying to
land a postdoctoral fellowship, and dealing with other strains
in my personal life. Based on my observations of colleagues,
I think my situation was a little unfortunate but not very
unusual for a grad student finishing a thesis. Later, I would
learn that my RSI symptoms were connected to my
emotional state in an important way.
After my thesis I stopped typing, and my hands quickly felt
fine. I went on a long beautiful bike trip through southern
France with a good friend, and everything seemed better.
After taking a month off, I started typing again to write a
funding proposal. Within a day or two the pain all came back.
This marked a turning point for me. I suddenly began to
realize that my problem was on a larger scale than I had
been willing to admit before. The supervisor at my new
appointment was extremely supportive, and we agreed that I
would take another two months off before I started work. I
started doing more serious research into RSI. Since I had
just graduated and was no longer covered under the MIT

insurance plan, MIT Medical absolutely refused to let me see

one of their doctors under any condition. This came as an
unpleasant shock: the injury I suffered was obviously
incurred while at MIT; MIT doctors knew my recent medical
history better than anyone; and the MIT medical community
has a lot of experience with RSI. However from the
standpoint of the MIT Medical administration, the relevant
issue is that grad students at MIT are treated under a
different legal rubric than employees, and hence workmans
compensation does not apply to grad students. I think this
will land MIT a big fat lawsuit one day, but I believe their
policy is not unusual.
I started taking RSI very seriously. I got an examination by
the head physician of Occupational Health at Cambridge
Community Hospital. She optimistically stated that she found
no evidence of lasting impairment in my hands. They looked
fine. She recommended a regimen of exercise and
stretching, and that I go back to work. Many physicians
recommend swimming as a good way to recover from RSI,
so I started swimming every day. I also wanted to apply any
other strategy that might help. I started doing yoga. I started
seeing an acupuncturist who had been involved in a doubleblind research study on the effects of acupuncture on RSI at
Harvard Medical. He was optimistic about our prospects.
Two months later in December 2004, I went back to work.
My hands were fine for a while much better than when I
graduated, but then the RSI returned and my ability to work
was slowly but inevitably curbed more and more. My project
was only about six months in duration. I decided that I
probably just needed more time off. I was able to take
another two months off before starting my next job. In
particular, I felt that swimming was very helpful, and
conversations with a friend who had also suffered RSI
supported this notion. By June 2005 I could easily swim the

length of Walden Pond and back. Feeling that I had learned

much more about RSI, I optimistically dove into my summer
break with a serious daily schedule of swimming and
stretching and exercise. All of my vacation plans were
coastal, and my swimming goggles accompanied me
everywhere. Beating RSI was an obsession. By the end of
the summer I was in good shape and my hands were wellrested. I was excited about my new project, and also
nervous. I was about to start a two-year project involving
only computational work, so putting RSI behind me was
imperative.
I started my new project in mid-August 2005. It was my first
time typing again after two months of aggressive
rehabilitation. On my first day I started typing and within
minutes my hands started hurting again. Having carefully
tracked the symptoms for the last year, I felt that the
symptoms were just as severe as they were before my two
months of recuperation and rest in fact, maybe worse. I
didnt know what to think. Maybe I was just nervous. For the
next couple of weeks I tried to type sparingly, but it quickly
became apparent that nothing had changed. Nothing. My
RSI was just as bad, or maybe worse, as it had been in the
spring before I had taken time off to rest and recover. I
started to feel desperate, and I thought about RSI constantly.
I quickly moved to set up my new health insurance and I
made an appointment with a local doctor.
I was totally perplexed. Having dealt with many sportsrelated injuries in my life, I think I am somewhat
knowledgeable in how to recover from musculoskeletal
problems. With rest and physical therapy, a musculoskeletal
injury always recovers, unless there is obvious evidence of
significant physical damage such a torn ligament. I started to
wonder if I had developed arthritis. At the age of thirty? It

seemed possible. I had reviewed many many aspects of my

life that might be relevant. I had considered my posture while
I sleep, because some physicians think this is an important
promoter of RSI. Some physicians think that small
alterations in the shape of your spinal column in your neck
actually cause RSI in your hands and arms. So I started
thinking about my posture while sitting anywhere, doing
anything. In spite of all of my stretching and exercise and
time off, I had developed some chronic knots and tension in
my upper back over the previous six months. I worried that
this might be related to the symptoms in my hands. It was
like a wild goose chase. In retrospect, it is critical to observe
that in at least one regard, I was accurate in my analysis: a
big important factor existed that was entirely missing from
my observations. I just could not figure out what it was. After
attempting to consider and explore almost all of the medical
explanations I could find, none of the recommended
therapies really seemed to have an impact on my recovery. I
thought: either I have arthritis, or something big is missing. It
didnt make any sense. Maybe I needed to take much more
time off, like a year or more. I waited for my doctor
appointment and I thought about RSI all the time, and I
became quite depressed.
At about that time I met Jared. He was in town visiting my
girlfriend, and he had suffered and apparently recovered
from RSI. I had gotten used to exchanging RSI stories with
other sufferers of RSI, and we started talking about it. I did
not know Jared, but he made me review the history of my
RSI in more extensive detail than anyone that I had ever
met. I think he asked me about my experience for no less
than two hours. Then he explained his recovery. Jared is a
Harvard computer science major who loves to play the
piano, so he was definitely a poster-child for RSI problems.
He encountered the precautionary RSI literature at Harvard,

and then he started having problems in his arms and hands.

He did an obsessive amount of research, talking to doctors
and reading books and medical literature on RSI. I
sheepishly discovered that he seemed to have done more
independent research on RSI, in a short time, than I had
done over the past several years. Jared had learned that
none of the conventional medical approaches have a
general, reliable record of success. Many people seem to
suffer from RSI for years without ever getting better, even
with physical therapy and rest. And full recoveries
meaning recovery to a state resembling that before the onset
of injury seem rare. This was entirely consistent with my
experience and people I had talked to. It was also very
depressing. Jared had learned that the physiological
underpinnings of RSI are not really well-characterized. This I
also knew. Hence the conventional literature often states that
each problem is unique, and therefore different people have
to find different approaches for recovery. It is another way of
saying the problem is not really understood. I should briefly
mention that by contrast, carpal tunnel syndrome, in which
wrist inflammation pushes against the nerve in the wrist (and
can do serious, lasting damage), is more physiologically
understood. Carpal tunnel syndrome is reasonably
straightforward to diagnose and it does not fall in the
categories I am talking about. The common RSI which is
often called tendonitis in the fingers and elbows does not
seem to behave like other known instances of tendonitis; it
often fails to recover with rest and physical therapy, the
conventional treatments. Another discovery that Jared had
made is that research groups doing so-called biofeedback
studies had found a strong link between mental state and
blood flow in the hands. It has been shown that, once
properly trained, people can control the amount of blood flow
in their wrists by acts of simple conscious will. Finally, Jared
discovered writings of a doctor named John Sarno, who

treats RSI (and some other disorders, notably back pain) as

a psychologically-induced disorder. To be clear, Sarno treats
these injuries as very real in the sense that they are
physical, painful, and potentially debilitating, like any serious
injury. But he proposes that they are instances of pain that
have no clear physiological cause, and that the pain can be
entirely removed by having the right state of mind. The most
convincing argument for Sarnos theory is that his treatment
apparently has a far higher rate of success than any other
existing treatment for RSI.
Then what is the cure? According to Sarno, to cure the pain,
you have to become personally convinced that the activity is
not injurious. In your actions and your attitude, you have to
believe that the pain is not really injuring you. You have to
treat it as though your body is giving you the wrong
information, and therefore you are choosing to ignore it. So
you have to ignore the pain. You have to do a Jedi-mind-trick
on yourself. That definitely flies in the face of the
conventional wisdom I had previously learned about RSI.
At this point I need to briefly explain to the reader that I am
not easily moved by philosophies involving faith. I am a
skeptic, a rationalist. I seek systematic, logical explanations
for lifes questions and my career is predicated on the
scientific enterprise. In this respect, Jared was very helpful to
me because he is very like-minded in this way. From Jareds
point of view, a reason-based solution to the problem was
imperative. So it was important for us to realize that the
medical community suggests physical explanations for RSI
that are not very consistent with observations, as is partly
evident from the wealth of unreliable treatments. By contrast,
Sarno suggests a mechanism for RSI that seems more
difficult to accept that it is psychologically founded. But
Sarnos explanation has the immense advantage that it

apparently cures people at a much higher rate than any

other strategy.
What did Jared do? Like I, he had begun to treat his hands
like they were made of fragile glass (unfortunately this is a
common outcome for those who experience RSI for an
extended period of time), doing as little with them as
possible. After reading Sarnos book(s) and several related
testimonials on the web, Jared decided to take the plunge.
He went to his piano and started playing his favorite pieces,
as if everything was fine. His pain disappeared and it never
came back. Jared was convinced. Suddenly he was cured,
and he returned to normal life. Based on my recent contact
with him, this is still true. Jared types for long hours every
day with bad posture, and he does not experience hand or
arm pain. He says that he rarely even thinks about RSI
anymore.
I was excited about this new approach to treating my RSI,
but I also had doubts. I had several years of reinforced
preconceptions about RSI that now needed to be reversed.
Taking a leap of faith is not one of my strong qualities. Not
only that, but according to the conventional wisdom about
RSI, choosing to start typing and ignoring the pain could
really severely worsen the injury. In terms of choosing
between these philosophies of treatment, there is no middle
ground.
Inspired, the next day I began to find information on the
internet by others who had followed Sarnos philosophy
about RSI. I found doctors who give long testimonials about
how they have similarly cured RSI using Sarnos approach. I
learned that people who suffer from this type of RSI are often
found to be highly motivated, self-demanding, prone to
stress-related problems such as acid stomach, concerned

with being a nice person, and having difficulty expressing

anger. It was like listening to part of a personal biography.
My head spun as I thought about others I knew who have
suffered from RSI, and how they often seemed to fit this
concept in various ways. Admittedly this is not a very useful
sample: many of my friends are MIT graduate students, so it
is not a big surprise that many of my acquaintances are
high-achieving stressed-out types. On the other hand,
according to thesis research done by a recent MIT graduate
(Fleming Ray), a survey of MIT graduate students suggests
that as many as a quarter of them experience RSI
symptoms. This is definitely consistent with the notion that a
high-achieving, stressed-out slice of society is prone to RSI.
After thinking about all of this, I decided to try to take the
leap of faith. It is important to understand that it is not
something that you can compromise upon or only try
halfway. At work the next day, I started to type. I typed all
day. At the end of the day, my hands hurt badly. They
experienced more pain and tightness than they had in
months. That night I got scared, and I wondered what
mistake I might have made. The following day I typed less,
but my hands hurt badly just to open doors or do any normal
thing. I tried to find other things to do. On the third day, my
hands still hurt badly and nothing had changed. I thought
about them constantly.
In the middle of that day, I started surfing the internet to find
more information about Sarnos ideas. My hands were very
stiff and were constantly in pain. I found many testimonials
that were much like Jareds story. Some people report
having symptoms for ten years and are essentially disabled
when they discover Sarnos ideas. Then their life is changed
with a sudden recovery. It was compelling. After about fifteen
minutes of reading people's accounts of how they had

healed themselves, I became engaged and encouraged by

the stories. Then, unexpectedly, warmth started travelling
down my arms and pumping into my hands. It was a strong
feeling of increased circulation. I thought about this and,
obviously, I felt more positive. Literally within minutes, the
pain and stiffness simply disappeared almost entirely.
Spending more time to examine this, I convinced myself that
I could actively produce the sensation of circulation in my
arms and hands, just by thinking about it in the right way. It
sounds rather ludicrous, I realize. That day my perspective
improve dramatically. I felt that I had finally crossed the
barrier of conviction. I felt strong, enabled, cured. On just
that same morning, my hands had been so incapacitated
that I had experienced severe pain just gingerly trying to turn
a door handle. Nonetheless that night I played frisbee with
friends, and I hurled several throws far across the field with
all my strength, as a matter of proof of principle. The
dramatic change was amazing. After that memorable day,
my hands got better and better. I typed every day for hours. I
started rock climbing and doing other normal activities with
my hands. That was about a year ago and I have had no
signs of injury since.
In Sarnos view of RSI, the act of being concerned about the
pain in my hands actually exacerbated the pain itself. This is
consistent with my observation that the only activity which
really correlated with my worsening symptoms was how
much I thought about them. It is consistent with observations
in other testimonials about RSI, in which people find that
they start having symptoms after they read the company
literature telling them to be careful. So in this case, ironically,
MIT Medicals well-intended dispersal of awareness
literature about RSI could be a principal factor in causing
high rates of RSI at MIT. Notably, I now work in a
computational research group in Switzerland, where no one

has heard of RSI. Although we all bang away at computers

for long hours, no one in the history of the research group
has ever complained of hand or arm pain from typing. It is a
large group and they work hard, and I have asked around.
But no one realizes that they should be concerned, and so
there is not a problem. My supervisor has never even heard
of RSI.
At the same time, the legitimate recoveries that do result
from the conventional treatments are also consistent with
Sarnos view of the injury: what is required is for the patient
to really believe that the pain is not causing an injury. The
patient has to stop being concerned that an injury will result
from their activity this is a classic placebo effect. It is
totally psychological. Therefore, if some stretches give you
sufficient confidence in the prognosis, then you will probably
be cured. I am not saying that the stretches, swimming, and
physical therapies did not have inherent therapeutic and
beneficial effects in my experience, they definitely helped.
But for me and many others, these activities did not
ultimately provide a lasting cure. The cure required a more
fundamental understanding of the problem. Sarno also
proposes that personal stress and pressure promote RSI,
and he suggests coping strategies specifically pertaining to
this connection.
A final note. About a week after my discovery that I was
cured from RSI in my hands, I decided to also make the
muscle knots in my back go away. Months of rest, yoga, and
stretching had not improved the cramps in my back. Based
on this evidence and Sarnos arguments about back pain, I
decided that my back stiffness could not really have a
reasonable physical origin. The stiffness went away on that
same day, and it has not returned since. Notably, I had not
had a long history of back pain. I originally only developed

cramps in my back around the same time that I discovered

that some doctors think that RSI (in the hands) may be
related to a back injury.
In my experience with RSI, self-education was literally power
over the problem. For that reason, patients of RSI should
spend time learning as much as they can about the problem.
Ultimately, they have to convince themselves of the best
explanation based on the evidence that they find. For those
that are interested in learning more about Sarnos ideas, I
recommend the recent book The Mindbody Prescription:
Healing the Body, Healing the Pain. It is not expensive, and
Sarnos recommendations do not suggest that he is trying to
soak RSI patients for money. Several doctors in the US now
offer treatments based on Sarnos ideas, but in my view such
treatment appointments are usually not necessary. In the
accounts of many others and myself, a cure can be achieved
simply by learning about Sarnos studies, listening to the
stories of others, and examining ones own personal
experience.
Samuel Arey
Sept 29, 2006