When you go to see a doctor or other healthcare professional write down the
symptoms you have, consider the following questions:

Where exactly do you have the pain? - in your arms?, hands?
What sort of pain? - aching?, tingling?, burning?
How long have you had pain? - weeks?, months?
Are you in pain all the time? or just when you do something?
When is the pain worse? - morning?, evening?
Do your hands feel cold? or sweaty?

Diagnosis of RSI is diagnosis by elimination. Everything else is tested
for and if your doctor cannot find anything wrong then you probably have RSI.
Your doctor will have to rule out things like rheumatoid arthritis and
heart problems so don't be surprised if they get you to have a lot of blood
tests.

There is no 'Cook Book' approach to treating RSI as each person has different
problems caused in a unique way. However the person treating you should look
for problems with your neck and shoulders as well as with your arms and hands.

When you are referred to a specialist or see a therapist always ask:
"How much experience do they have in treating RSI?"; "How good are they
at treating RSI?"; "How does this treatment work?"

Always check for the relevant qualification when seeing any therapist outside
the NHS. Also ask to see a current insurance certificate, this is a good check
to see if they are qualified.

     *  Your GP is your first port of call. They will refer you to the
        relevant specialist, either a consultant or physiotherapist. They
        will also know of the local private health care professionals and
        can guide you in selecting one of these. If you are claiming on
        Private Medical Insurance then your GP will have to refer you to
        the healthcare professional.

        The consultants you are likely to see are:
                Orthopaedic surgeon (surgical specialist in bones and muscles)
		Rheumatologist (specialist in diseases of joints and muscles)
		Neurologist (specialist in nerves);

	The consultant may get you to have some x-rays and possibly a Nerve
	conduction study (NCS) or EMG test.

        Try to get a referral to a neurologist or rheumatologist who has a
	special interest in RSI as many do not have the experience in
	treating RSI satisfactorily.

     *  Nerve conduction studies (NCS) and EMG tests

        In the NCS an electrode is connected to a point in the hand, and a
	small electrical current is passed through the arm. The speed of the
	nerve responses can then be determined.  Any time delay picked up
	along the nerve may suggest there is a problem.

        A similar test is done on the muscles which is called an
        Electromygraphy (EMG) test. In this test an electrode is pushed
        into the muscle, and then the muscle is tensed up. The level of
        electrical activity that is recorded can give an indication of any
        muscle weakness or wastage.

        Both tests only take a few minutes to complete and for most people
        they are not too painful. However, most RSI sufferers record a
        normal response.

     *  Diagnostic Imaging

	You may have an X-ray taken to check for skeletal problems, for
	example of the wrist or the back and neck and to check for an extra
	rib in the case of thoracic outlet syndrome.

	An MRI scan might be taken to assess your shoulders or back/neck,
	however any MRI scan is expensive so it is unlikely.

     *  Pain Clinics - normally run by rheumatologists. Look for one which
	does pain management not just pain relief. The INPUT pain clinic
	at St. Thomas's hospital in London is one. Normally they only accept
	you after you have suffered from pain for more than six months.

     *  Physiotherapy - normally the first treatment you will get.

        On the NHS, most physiotherapists only do 6 sessions maximum before
	you need to see your GP or consultant again.

	The physio you see should have experience of treating RSI, they should
	know about AND, trigger points and manipulation of the back. If you
	are selecting a physio for private treatment (or indeed on the NHS),
	then you need to ask if they have the relevant experience.

	The physio should test for: AND, trigger points, back and neck
        problems.  They should also look for any postural problems.  The
        treatment you receive will depend on what is wrong with you, it can
        be: AND stretches (the physio will 'twist' your arms around and
        teach you some stretches to do yourself); ischaemic compression on
        any trigger points (with more stretches to do yourself); ultrasound
        to reduce any swelling, TENS to reduce any pain and joint
        manipulation to re-align the vertebrae. They may also carry out some
        acupuncture on you.

	Intensive physiotherapy including lifting weights is likely to make
	your RSI worse.

     *  Occupational Therapy

        You may be referred to occupational therapy by a doctor or by social
        services. Occupational Therapists will provide education on the
        condition, joint protection, ways of conserving energy and promoting
        desirable habits in personal and domestic tasks, leisure, and work
        including looking at bad ergonomics. They will develop a home
        program to include: wearing splints, exercise and rest breaks plus
        all the above points. They will also help find you aids to help you
        in your home.

     *  Chiropractic and Osteopathy

        Chiropractors and osteopaths manipulate joints and muscles which help
	with a wide variety of conditions, especially neck and back pain.
	There is usually a great deal of overlap between chiropractic,
	osteopathy and physiotherapy treatments. Chiropractors tend to take
	more x-rays, whereas osteopaths use massage in addition to
        manipulation.

        Osteopathy and chiropractic will have similar effects - they will work
	in some people, not in others. They are more likely to be effective
	where symptoms are less chronic.

     *  Alexander Technique - is good for problems with the
        back/neck/shoulders and to improve your posture.

     *  Relaxation/Meditation - to help reduce the stress in your life.

     *  Exercises

        Swimming - A good exercise for the whole body without putting too
	much stress on any one part. However don't do breaststroke as you
	have to support your head in a strange position which puts a lot of
	strain on the neck.

        Walking - go for a brisk walk as it increases the blood flow,
        endorphins etc. This reduces the pain and gives you something to do.
        Keep your hands in pockets to take the weight off your shoulders if
        you need to, otherwise swinging your arms as you walk can help.

     *  Operations - a last resort. CTS release is the most common, but must
	only be carried out after a nerve conduction test to prove you have
	CTS.

     *  Drugs - Pain killers, NSAIDS

        Buy the generic drugs rather than the named brands, they are much
	cheaper and have exactly the same ingredients.

	The common over-the-counter ones are: paracetamol (take care not to
	exceed the stated dose) which does not have any anti-inflammatory
	effect; aspirin and ibuprofen which can cause stomach problems.

	Don't take pain killers to mask the pain so you can continue working.
	You will just make your RSI worse and more difficult to treat. Do take
	pain killers when you go to bed so you get a good nights sleep and are
	relaxed, not fighting the pain, when you are asleep.

	Tri-cyclic anti-depressants can be used as pain killers as well as
	for depression.

	Anti-inflammatory gels can be rubbed into the area of inflammation
	or pain and get round the risk of stomach problems.

     *  Steroid injections - avoid if at all possible, they don't have a long
	term effect unless you stop the activity that causes the problem. Can
	have some bad side effects, and you can only have a limited number
	of injections into the same site.

     *  Ultrasound - useful to reduce swelling and can help reduce trigger
        points.

     *  TENS - temporarily blocks the pain signals in your nerves by
	stimulating the nerves with electrical pulses.

     *  Trigger points - treated by ischaemic compression, acupuncture
	or stretch and spray. You should be taught some stretches to prevent
	them re-occurring.

     *  Heat - improves blood flow to the heated area. Use infra-red lamps
	or heat packs to warm the required area.

     *  Ice - reduces inflammation and stimulates blood flow in the iced
	area. Apply ice packs or a bag of frozen peas to the required area.

     *  Acupuncture - works wonders for some people, has no effect for others.

     *  Splints - only wear on the advice of a physio. Don't wear them all the
	time as it can lead to atrophy of the muscles. The body also needs to
	keep moving to work properly. Wear them when you are resting or at
	night.

     *  Massage - If it does not make your condition worse (it may hurt a bit
	when it is being done - even when you are completely normal) then
	massage is very good. It improves the blood flow, releases toxins and
	makes you relax. Have your back/shoulders/neck/arms/hands massaged as
	often as possible. If you have a partner buy them a good book on
	massage as your birthday or Christmas present or go to an evening
        class together to learn. The sufferer must not do any massaging
        themselves as it will aggravate the condition.

	Qualifications for massage vary from the basic swedish massage and
	aromatherapy through to remedial massage which requires a higher
        degree of training.

     *  Rest  - Reduce or even remove the aggravating factor from your life,
        however don't rest completely. The normal movement of your arms keeps
	the muscles/tendons/nerves 'lubricated'.  When you rest your arms,
	any part of them that has a problem will no longer be getting the
	gentle work-out it requires to keep it functioning normally. In mild
	cases of RSI rest is all that is needed to make the pain go away.
	However complete rest can make your condition worse.

     *  Adverse Neural Dynamics stretches

	AND is treated is by a series of stretches for your arms which
	stretch the nerves and removes/relieves the tethered points. Doing the
	stretches relieves the pain because it untethers the nerve and allows
	it to slide freely again.

	Your physio will tell you how to do these. He/She should also teach
        you exercises to mobilise your back/neck as a lot of RSI sufferers
        have problems here without realising it and these can cause symptoms
        in the hands and arms.

        What I found good for treating my AND and associated RSI problems was:
             *  Learn the AND stretches and do them as often as you can.
             *  Find a good masseuse/aromatherapist to get any knots out of
		your back/shoulders and try trigger point therapy for any
		residual pains.
             *  Take up the Alexander Technique to improve your posture.