October 28, 2017

Here’s how repetitive strain injury landed on me like the end-Cretaceous asteroid, wrecked my life and career, and how I managed to come back from it.

I’m not using the real names of the professionals I encountered, because I need to be frank about how often I was let down. Some of these people meant the best for me. Some were twats. But it’s not just about the individuals – as you’ll see, I reckon there’s a huge flaw in the entire system of treatment.

If you have RSI, if you know someone who does, or if you’re at risk of getting it in the future – and you are – I hope you’ll pick up a few things.

 

Forty

I’ve never been a big one for my own birthdays. Normally I just get on with whatever I was doing, maybe pausing once or twice to face into the wind and sigh and think about the years running away like wild horses over the hills.

Forty felt different. Forty felt good. Polly, my wife, treated me and the kids to a glamping weekend. I swigged beer and relaxed to the howl of vuvuzelas on medium wave radio, this being the month of the 2010 World Cup in South Africa. I took a moment to look both ways, forty being a handy mid-life vantage point. I liked the view. I had a family I loved very much, some good friends, and two parents in fine health. As a cartoonist, I’d had a weekly strip in a national paper and some hit books – the best known being the Bunny Suicides series. As a comedy scriptwriter, I’d met childhood heroes, honed sketches with them, drank with them. I was filling my days by making stuff up and getting paid for it, and I couldn’t ask for much more than that.

Obviously I’m building up to a sentence which goes something like ‘I had no idea what was coming’, but we’re not quite there yet, so bear with me.

I kept myself (I thought) in good shape. I ran, I swam, I did weights. A couple of Saturdays before, I’d been at a club where I ended up in a spontaneous dance-off with a stranger. Buzz Lightyear in Spanish mode, that’s my fighting style. If I can still dance-battle on the eve of my fortieth I must be doing okay, I thought, as the sun sank into the haze and I shouted “Lampard you div!” at the radio.

I had no idea what was coming. Look! We got there.

 

What Was Coming

I drew a lot in 2010; three whole humour books, all on top of a full time writing career. Me and Kevin Cecil had been writing together for eighteen years. Each writing partnership has its own methods, but there’s usually a typer and a pacer. I was the typer.

By late July there was a weird pain running from my right elbow down to middle and ring fingers. A local osteopath gently prodded my right shoulder for fifteen minutes, then said “there you go, you’ll be alright now.” Obviously this turned out to be massively fucking wrong, but I had no reason to suspect that. I’d never had an ache which hadn’t vanished in two or three weeks. And now August was here, and that meant summer holidays.

On the plane home I knew something serious was up. I was playing Marvel Top Trumps with my son Bill. It hurt to shuffle and deal the cards. I hadn’t written or drawn a thing for two weeks yet my right arm hurt more, not less. You wouldn’t have guessed it if you’d seen me laughing with Bill as I handed him Wolverine and The Hulk, but inside I was freaking out.

I soldiered on for a month to get the books finished, then threw the pen in the drawer. Plainly I had a repetitive strain injury, and now I had some healing to do. I didn’t actually have to draw anything until January, when I would start my next humour book for Hodder and Stoughton, my publishers. Then there was the script writing. “Please can you do the typing now Kevin?”  I said. He was fine about it. Which is good, because he’s had to do it ever since.

Money was fine. The cartoon books had earned a fair bit, and my spending habits had never caught up. Whenever I bought sandwiches at the supermarket, I would still heft them all and buy whichever was heaviest for the money. Cheapskate.

So I had a war chest. Time to smash the lock off. I lived in London, which has thousands of overpaid specialists. I would use any and all of them to make my arm better. And four months would be enough. Wouldn’t it?

 

Hammers

I found a hand specialist called Victoria. Great at listening, she was. Great at sympathy. For a whole string of Tuesdays, she would coo over my arm then impale it with pins. She thought she’d found a lipoma that might be pressing on a nerve.

I took a dual track approach, and found another osteopath called Rhys who was boisterous where Victoria was gentle. “Your arm’s knackered up mate!” said Rhys. Not exactly medically precise, but I knew what he meant. My whole right shoulder projected a little further forward than my left. I’d leaned that right shoulder forward when writing and drawing. I’d never had a naturally steady hand, so to get the precise line thickness I wanted with the dipping pens I used, I engaged every muscle in the upper right quarter of my body. I drew like I was lifting weights. That felt great for half a lifetime. Now it didn’t.

“Do you think I need physiotherapy?” I said, as Rhys merrily pummelled me.

“No,” said Rhys. “For you, osteopathy, definitely.”

“What about this lipoma thing then?”

“Nah,” he said, “he’s just found one of your trigger points,” and before I could ask him what a trigger point was, she turned me over and mashed my trapezius.

There was one thing Victoria and Rhys had in common, and that was how each half hour session ended.

“Shall we book you in for next week then?”

Next week. Remember ‘week’. It’s going to be important later.

Of course Victoria thought her acupuncture sessions were the answer. Of course Rhys thought his osteopathy would do the trick. She was an acupuncturist. He was an osteopath. To the hammer, everything looks like a nail.

 

The Lowest Point 

At Christmas everything went wrong.  My whole left arm decided it had RSI as well. The ache in my right arm scrambled up into my torso, linked with its new friend on the left, then upped its wattage. I wore a matador jacket of pain. Two very sharp pain points appeared: one in my right forearm, one just inside my right shoulder blade. It felt like someone had sunk two meat skewers in me. Then my upper spine locked up.

Here’s what a lot of people don’t know about RSI, or at least the version I now had: they think it only hurts when you’re doing the activity which caused it. Nope. It hurts all the time, every waking minute. All movement aggravated it; even turning a key or the pages of a book. And people always asked, “is it carpal tunnel syndrome?” – which is like if you tell someone you’re from Scotland, and they ask if you know their auntie Jill in Fife.

I spent every weekend in early 2011 lying flat. It was too painful to do anything. I couldn’t play with the kids. I rigged up a Heath Robinson contraption from coat hangers which held my iPhone above my face. Now I could at least watch TV. Pointless got me through these months; I’ll always be grateful to that show.

The pain was, at this point, destroying my sanity. I was still writing with Kevin, but I had to spend half the day lying on the floor and it was all I could do to not burst into tears. My entire body was having a blazing argument with itself. What was happening to me?

Five months under Rhys’s care, and I was worse. At no stage did Rhys consider that maybe, somewhere along the way, he might have been getting something wrong.

“Do you think I’ll ever get better, Rhys? Well enough to draw anyway?”

“No, you’ll have to get someone else to draw the cartoons now!” he said cheerily, not quite realising he’d just ripped out my soul and snapped it over his knee. I stumbled home weeping, not for the first time.

Also: Rhys’s bedside manner needed a bit of work.

It was Polly who fished me out from my bucket of despair. You’ve got to change tack, she said; try the physiotherapy you’ve been told wouldn’t help. She found the website of a high-end physiotherapist called Louise, who gave me a decent set of exercises and kneaded my sore body on a weekly basis. Soon my upper spine was no longer locking up – a big improvement. My last visit to Rhys’s place was around this time: his colleague, who was handling me that day, tried to sell me some homoeopathy. Fuck that noise.

I noticed something. Louise, who was plainly better than Rhys and Victoria, wore ordinary casual clothes. Both Rhys and Victoria wore white short-sleeved tunics. If someone is wearing cod-medical clothing when they don’t have to, be wary. That jacket is a piece of theatrical costume, for your benefit. I bet you they’re making up for something.

 

Fresh Hammers

My progress stalled. I tried more angles.

Wondering if the way I walked had some knock-on effect up my body, I started seeing a podiatrist. She was the first of three foot experts who changed my gait and made me expensive custom orthotics. This did nothing for my upper body, but within two years ruined my previously fine feet. Recovery took two years of doing the exact opposite of everything they’d said. So this lot were by far the worst of the professionals I dealt with. But that’ll be a different uplifting blog post, all about podiatry being – in my experience anyway – a pile of steaming shite.

I took lessons in Alexander technique, which was like trying to learn advanced driving skills while your car is still wrapped around a tree. Not harmful, but you kind of need to get the car back on the road first. A nerve surgeon gave me steroid injections; no effect. A shoulder consultant examined me for all of three minutes, shrugged, billed me for £195, showed me the door, then flew his gold helicopter to a consultant golf course where the bunkers are brimful of rubies, where the buggies are drawn by mane-tossing unicorns, where a gentle shower of Champagne falls at quarter past three, where instead of going to the toilet they shit in Ming vases then smash them over the servants’ heads for a laugh.

A spine surgeon checked me over and got a maverick-cop hunch. “One of the discs in your neck might have prolapsed,” he said. So we did a scan; you’ve never seen a straighter, healthier looking spine, or a cartoonist so devastated to find out he had one. By this time I was desperate for answers, even if they were bad answers. Why the hell wasn’t I healing?

But there was nothing to do but carry on, so that’s what I did for the rest of 2011. Louise worked me over every seven days. I saw a new osteopath when I needed unbolting like a shithouse Frankenstein. Another nerve surgeon; no use. An elbow specialist; nothing. The spinal surgeon gave me a steroid jab behind my right shoulder blade, just where that skewer of pain was. It didn’t fix anything, but I’ll always remember the anaesthetist’s words as he injected me.

“This is the stuff that doctor gave Michael Jackson!” he said, at the exact moment that he sank the plunger.

 

The Lowest Point (Again)

At the end of 2011 the pain was getting worse again. I had tried to tough out RSI. I wasn’t bad at that, but everything has a limit, and mine came at seventeen months. I became depressed and angry. I didn’t have a clue what to do next – physically, medically, emotionally. For the cartoonist, drawing isn’t just a job; it’s how you relate to the world. It’s part of the process of being you. And now that part was severed, and replaced by unending ache. I couldn’t lift my mood with exercise because the exercise hurt. Dealing with chronic pain takes energy. Depending on how bad it is that day, you have to pretend it’s not there, or negotiate with it, or work your way around the sides of it. That’s a constant psychic toll. Most of us can do it for a day, or a week, or a month or however long, so long as we can see there is an end to it. I couldn’t see an end.

And 2011 was the year of Fifty Shades Of Grey, so I kept reading that pain is sexy. No it fucking isn’t.

I wasn’t much fun to live with at this point.

Once again, when I couldn’t see a step forward, Polly saw one for me.

 

Some Answers

She found the website of a place nobody had told me about, even though I later discovered that one of the surgeons I’d seen took referrals from it. It was a specialist pain unit. That’s what I needed. The same day, Polly found an blog post by some who’d been from pillar to post, just like me, and eventually discovered that what he had was myofascial pain.

I haven’t hit you with technical stuff about nerves, tendons and muscles so far, but this one needs explaining. All your muscles are surrounded by this stuff called fascia which holds them together. As your muscles contract and expand, the fascia contracts and expands with them.

Except for when it doesn’t.  Sometimes your fascia fails to expand again properly. This makes a little lump in your muscle called a myofascial trigger point. Everybody gets these. They can press on your nerves and cause referred pain – that is, pain caused in one place in your body but felt in another. The blog post recommended a book, which Polly ordered straight away: The Trigger Point Therapy Workbook by Clair Davies. As soon as it came I spent a merry hour finding and rubbing these spots all over my body. I was absolutely riddled. Head to toe.

Then I had to leave the house for work. As I waited for the bus, I felt unsteady on my feet, a strange taste in my mouth. This was an exhilarating moment. By self-massaging, I’d released so many toxins from my knotted muscles that I’d become nauseous. In the scores of pummellings I had received from physiotherapists and osteopaths, this had never happened. I was on to something – trigger points, which had been mentioned to me exactly once and even then dismissively, might be the key to the whole thing.

At the pain unit, Tom, a jovial doctor, thoroughly inspected me in exactly the way they the shoulder specialist hadn’t.

“Yep, I think you’re suffering from myofascial pain,” he said.

“Great! Let’s throw everything at it!” I said, and we did.

Firstly: new physiotherapists. They gave me new daily exercises with huge rubber bands. Much more effective than Louise’s, as was their massage.

Secondly: a psychologist. Tom sent me to someone who was good on the emotional effects of pain. I picked up new ways to think about it and deal with it. All my therapeutic talking revealed no hidden career deathwish, no secret urge to stop drawing. My great urge to draw cartoons concealed only a bit more urge to draw cartoons. Wow, I thought, I’m really shallow.

Thirdly: painkillers. Tom put me on the good stuff for a few months. People who decide brand names for drugs are very good at what they do. The lab names of my pills were Celecoxib and Pregabalin. The first sounds like a vengeful Aztec god, and the second like a goblin having baby goblins – but the branding people sold them as ‘Celebrex’ and ‘Lyrica’. So, my morning tablets conjured visions of celebration, breakfast, music and song. They might help my muscles relax a bit, which would give the new physio regime a chance.

Fourthly: Botox injections, which can help knock persistent trigger points. Tom did a few spots in my chest, which suddenly looked younger on the right hand side.

The fifth one was down to me, not Tom: self-massage, several times a day. Mostly with massage tools bought online – the Knobbler and the Thera Cane, which look like a slightly scary sex toy and very scary sexy toy respectively. I found, then removed, the trigger point that was making the pain-skewer behind my shoulder. It was in my neck all along. For all the money I was splurging on botox, therapy, drugs and physio, the greatest engines of progress were one book and two bits of funny-shaped plastic.

I had a revelation about the entire system of musculo-skeletal pain treatment. The problem is this bullshit unit we call the ‘week.’

Some time spells found in nature mean something to the human body: the day, and the lunar month. But the week is bollocks. It’s a unit invented in Mesopotamia just a few thousand years ago – an eyeblink in human evolution. There is no physiological reason to string the days into bunches of seven. It’s just a cultural habit, like cheese-rolling or the macarena. Same goes for the hour and the minute. So why did osteopaths and physiotherapists keep offering me half an hour, once a week? Because it was what my body needed?

No. They did it because it’s straightforward to schedule. A majority of people can, if they really need to, pull together the time and money for a short spell of weekly osteopath or physio sessions. It’s convenient enough for both parties. It’s a perfectly fine business model. Even if they didn’t realise it, the specialists were putting that business model first – even before my health.

That’s also why so many of them never said “you know, what I can offer isn’t working, you need to try something else,” even when that was plainly the right thing to do.

My very last spinal lock-up happened around this time. I went along to the osteopath I’d used a few times in 2011.

“I’m making a bit of headway now,” I told her, “because I know what I’ve got. It’s myofascial trigger points.”

“Well, yeah!” she said, clearly feeling patronised. “That’s a really big part of what osteopathy is.”

“But you didn’t tell me that,” I said. “Nor did anyone else, all through eighteen months of pain. That’s the problem.”

As I fished around for my wallet to pay for the session, I pulled out a Knobbler.

“Ah, you’ve got one of those!”

Six months before, I’d paid her money and asked her what to do. She could have told me about myofascial trigger points, about how I could massage them myself. But she’d held all that back to make me dependent on her and people like her.

In one of my check ups with Tom at the pain clinic, I shared my theory that weekly osteo/physio treatments are based on a calendar system dreamed up by ancient Sumerian priests and that maybe it was time for a rethink. What a great patient I was.

“Self-massage is really working,” I said. “Because I’m doing it all the time, not just weekly. And my physios are great, but they’re never going to tell people to try that.”

“Well, they don’t want to put themselves out of a job do they!” said Tom, with a nervous laugh and some paper shuffling.

“But that’s the point, Tom. They’ll protect their bottom line. But you could tell people in the same position as me that they could massage themselves too. Will you do that?”

Tom didn’t promise to do that. He changed the subject. The pain clinic and my new physios were the good guys as far as I was concerned, yet even they closed ranks on this.

 

The Long Climb

Nothing’s quick with RSI. Through 2012, 2013 and 2014 I slowly scaled the walls of the canyon. Progress, slips, more progress.

I learned that Pilates helped.

I learned about Syrian cartoonist Ali Farzat, whose hands were broken by Assad’s security forces. Well, I thought, some cartoonists have it worse than me.

I learned that Ali Farzat was drawing again after a few months.

I learned it’s possible to feel a flash of envy for a cartoonist who’s had his hands broken by Assad’s security forces. I’m not proud of that.

I learned that Siri is a godsend. Most people with iPhones only think of it as a personal assistant, but it’s a terrific dictation system. That little microphone symbol next to the spacebar: press it. Speak clearly. It’ll get most of what you say.

I learned that muscle memory in my right hand made it curl inwards, a relic of my old drawing style. A specialist made me an ulnar gutter splint – a little brace to wear on my hand.

And by late 2014, I knew that my career as a visual artist was over. My progress had plateaued for eighteen months. I no longer wore a matador jacket of constant pain, but my long gloves of pain wouldn’t shift. I still had that skewer through my right forearm. I’ve never believed in the five stages of grief. The whole ‘five’ thing smacks too much of marketing; five signs of problem hair, five tips to kickstart your business. Yet here I was at stage five: acceptance. Like an old footballer whose knees have gone, I just had to be grateful for the time I’d had.

Maybe Rhys had given me the best advice after all. I wrote a children’s book in secret. If I ever showed it to anyone, and if it got published, someone else could draw the pictures. I was an ex-cartoonist. And that was okay.

 

Everything That Makes A Black Line

Just after Christmas 2014 I looked at my right hand and turned it in the air. The skewer was gone. The arm felt, if not painless, then a lot better. So did my left hand. I hadn’t changed my massage or exercise recently. But a cloud had lifted. I’ll never know for sure, but I suspect it was all linked to me giving up. I no longer spent the days in a state of simmering frustration. Did this make my muscles relax in a way I couldn’t even sense? Did that enable me to finally get past the worst of the pain? It’s unknowable. But I entered 2015 ready to attempt drawing again.

I went to the art shop and bought literally every single item that makes a black line, then experimented. My old method – shoulder thrust forward, Hand curled round, every muscle engaged – would wreck me all over again.

Eventually I hit on a style which kept the muscular lines of my old technique, with a slightly more scratchy finish. For this I used an ultrafine Sharpie. When I needed a line to be thicker, I no longer pressed harder on the nib – I just scribbled over the line a few times, with a light grip. The ulnar gutter splint kept my hand flat and my shoulder back.

My publishers and my agent Gordon Wise had been waiting for a new book since 2011. Now I could work something up.

Slowly.

I remembered a Ted Hughes poem called Wodwo. It’s about a spirit which suddenly come sinto existence in a wood, and tries to figure out what it is and how the world works. What if I took that situation, made it about a puppy and a kitten, and put some jokes in? I could combine toilet humour and philosophy in one book. That became Puppy Versus Kitten. That’s just come out. I polished up the manuscript of my children’s book too – but the artist would be me, not someone else. That was picked up by Hodder Children’s, and became the King Flashypants series. Now that I’ve drawn four books in just over two years, I can safely say I’m a cartoonist again.

My body still hurts. I’m careful how I draw. I do it standing, not sitting. I avoid typing wherever I can and I never use a computer mouse because those are the devil. Every day I’m coping with some sort of pain, but it’s mostly low-level. Pain is part of life; you have to let it in some time or other. I still have an RSI condition – I’ve just reached an accommodation with it.

But I can draw! I can make stories with pictures and put them in front of people! That was a hell of a thing to lose. And a hell of a thing to get back again.

 

It Can’t Happen To You Oh Wait Yes It Can

RSI is a bit like depression was some years ago – not talked about enough. And like depression, everybody’s is different.  If you do any action repeatedly, and nearly everybody does, then it can happen to you. Right now our society is sitting on an RSI time bomb. We punish a particular set of muscles almost every minute of the day. You don’t have to be a cartoonist; if you use a computer at work, a smartphone on the train and an ipad or PS4 in the evening, you’re giving your body no let-up. This stuff is cumulative. If it catches you, your life is going to get a whole lot harder, trust me.

So here’s some advice, for what it’s worth, on how to avoid getting repetitive strain injury.

• Rest more. Put down the iPad. I said put it down!

• Dictate more emails, texts and documents. Your phone can do it, your computer can do it. You’ll have to type in a few words which the software got wrong, but that’s still saving your body a whole lot of tappy tappy.

• Find a good physiotherapist before you have a problem. I whatever your lifestyle is, it will be putting some strain on your body. Learn your bad habits early, then get exercises and relaxation techniques to counteract them.

And if you have RSI:

• Remember that osteopaths and physiotherapists work for their business model, not you. They might individually be good, but the model isn’t. Treatments based on the arbitrary horseshit calendar system should be tried, but in the knowledge that they rest on a dubious foundation.

• Learn about trigger points. There are several books available, but the Trigger Point Therapy Workbook by Clair Davies is the best.

• If you can afford it – when seeking help, cast the net wide. Try lots of people in different disciplines until you find someone who can really get you places.

Your RSI might not be just like mine. The causes will be slightly different; your body’s different. But keep searching, keep experimenting, and you should find your own path back.

Eventually!

Andy Riley, October 2017