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RSI & Me

Scott Clark
© Copyright 2001


I’m fairly biased about RSI — my point of view has been tested through working with many people who were having real problems using their hands and arms. But the foundation of this was my own difficulty, when my own hands and arms were bad enough that it hurt to turn the pages of a book. It was a hard time for me, physically and emotionally, but in the long run very positive. I want to write here about that experience, and about some of the ideas and tactics that grew out of it.

A few years after I had qualified as a Feldenkrais Practitioner, my business started to pick up. That meant that more people were coming to see me, and, with my hands, I would help them feel how movement in one part of them was connected to movement in other parts. The movements involved in Feldenkrais are of course small, slow and gentle — that’s our trademark. But a lot of small, slow and gentle can add up ... At the same time, I was getting very involved in playing musical instruments, principally viola da gamba (something like a cello) and keyboards (I built my own clavichord). And I was doing a fair amount of typing on the computer. It was all getting better and bigger, and all at the same time. Wonderful!

The first disaster started small. A friend had come over to play duets, and, after she casually mentioned that I wasn’t good enough yet to play with most of the other people she knew, we launched into some pretty tricky music. Perhaps I’ve learned since then that such situations don’t have to be challenges — then again, maybe not. I certainly played that evening as if I had to prove something: with much more force than I needed, with a fair bit of anxiety and gritted teeth.

The next morning my left thumb was pretty sore. As in guitar-playing, that’s the thumb that goes behind the neck of the instrument, while the fingers of that hand press down the different strings. I’d clearly been mashing my thumb in my anxiety and determination; the pain would go away with some rest.

Of course it didn’t. Instead it spread to the other thumb, and gradually to everything that I did with my hands: picking up a cup of coffee, turning pages. It spread to everything that I enjoyed (I had never realised how hand-oriented I was) and it spread to the way I earned my living.

The most frustrating thing was that this wasn’t supposed to happen to me: I was the one who helped other people out of their difficulties. What did it say about my competence if I had difficulties myself? For me, this has been one of the biggest learnings: knowledge, especially self-knowledge, doesn’t exist in some abstract and inhuman intellectual world, but in a world of conversations between people. Through conversation we can learn about ourselves — and thereby grow — far beyond what we might do alone. I owe a lot to many people who talked to me about their experience and ideas.

Feldenkrais provided a vital guiding idea, and that was the difference between a broken thing and a bad way of using things. My thumb was hurting; did that mean that the thumb was damaged? Perhaps, but it also seemed possible that the way I was using my thumb was less than perfect. This is a tricky point for many, so let me go back to the unfolding of the story in order to elaborate.

I had of course tried to treat my thumb in the usual way that you might treat an injury. I rested, and used ice and aspirin to calm the inflammation, but as soon as I did anything that used the thumb, the alarm bells would ring. Rest and ice and aspirin (and even some stronger anti-inflammatories when I got more desperate) didn’t touch the situation. I also looked at the movement of the thumb itself, and of the hand and the arm. By exploring very small, gentle movements, I could calm the pain; but that didn’t last either. Movements in the real world continued to set off the alarms.

The first real breakthrough came with a chance conversation. A violinist who was seeing me because of a sprained ankle mentioned something about the ideal posture of the left hand being a circle: If the thumb and one finger touch, they should make a circle without any flat bits or sharp angles. Holding an object in the hand (like the neck of a violin, or even a piece of paper) should be an extension of this, with the object becoming part of the circle. I noticed that whenever I used my thumb, the last joint was usually bent backwards as far as it would go. That certainly didn’t fit into the idea of the circle — it bent completely into the opposite direction. What is so magic about this circle idea? Well, it isn’t very far from the resting position of the hand. And none of the joints involved is bent very far either one way or the other; instead, they’re close to the middle of their range.

Holding a piece of paper that way was ok; it didn’t hurt, I didn’t drop the paper, it wasn’t difficult. It was difficult to remember to do, but the pain reminded me if I forgot. Every separate item that I held in life seemed to require its own process of relearning. But the viola da gamba was hardest. It was already difficult enough to play the thing, without having to perch my thumb on its tip, in such a ridiculously unsteady position. The broad flat of my thumb seemed much steadier, even though it hurt. I started watching all sorts of string players. Some held the thumb one way, some the other. Some told me they had been taught never to hold their thumbs the way I had been used to: “It ruins your thumb!” Others seemed to have got away with it for a lifetime.

Another conversation, this time with a Feldenkrais colleague, brought up a principle from Aikido: you can push through the length of a long bone and deliver a lot of power, but you can’t deliver any power by pushing a long bone sideways. In other words, if you want to push a piano across the room, your arms need to line up with the direction you want to go, rather than being crossways to it. For most of us, that matches up with our intuition when we think about big and heavy objects. But my hand on the neck of the viola da gamba, or for that matter, my fingers on the typewriter keys — there’s nothing big or heavy or powerful in that situation. But the principle still applies. Even to deliver a small amount of force, we’re better off in the long run pushing through the length of the bones. That means the fingertips, rather than the flats of the finger pads. This connected with the idea of the magic circle of the hand, but extended it further.

I had to look at each activity of my life in this new light, and relearn the most basic things about touching and holding, pushing and pulling, for all the objects around me. As I did, pain alarms went off less and less. Residual background soreness died away. When I sometimes thought “Oh, this time won’t matter,” the pain would tell me that every time mattered. Sometimes the pain would let me get away with bad habits, then spring back with new intensity. My typing, for instance, was very sporadic, in that I would have weeks of no typing followed by a week or two of intense typing. The time off would be just enough to forget my newer and healthier habits, and for a day I would type the old way. The next day, pain would remind me to do better.

Of course, it wasn’t as simple as this makes it appear. There were many other steps backward that I haven’t mentioned, many other learnings that eventually made it possible to move forward again. And it isn’t over. But I was lucky, in that my thumb wasn’t significantly damaged as a thing — what was damaged were my movement patterns, and the pain was a warning rather than an announcement of something that had already happened. It certainly does seem that my pain alarm bells are more on edge now, and perhaps forever — but that’s surely a good thing, if it helps me stay out of trouble. Isn’t that how pain should work? I was also lucky in being able to recognise that my movement had to change, and in having tools to make those changes.

Scott Clark: Feldenkrais Classes & Lessons in London

or phone [44] 20 8469 0245