RSI Repetitive Strain Injury

Gomukhasana Pose I have a log of my running. A lot of 10K races, a few half marathons, two marathons and hundreds of training runs, across five countries. Even when I’m on holiday! As a runner, I do a bunch of stretching exercises before I run. One of them involves arm and shoulder muscles, reaching as high as I can and then trying to get my hands to meet behind my back (variously known as cow pose or Gomukhasana).

Naturally, over the years, I have had the occasional injury, particularly muscle strain. And oddly, one of my 5km training runs into Battersea Park and back, led to a weird pain in my left shoulder. I put it down to excessive enthusiasm in that morning’s “stretch” routine and I resolved to take a little more care with my pre run stretches.

It didn’t get better. At work each day, I would find that by mid afternoon my left shoulder was aching. It got worse. I couldn’t sleep well, rolling to my left caused such pain that it would wake me up. I saw my GP, explained, and he said relent on that stretch exercise and rest the muscles completely for 7 to 14 days.

It got worse, I kept waking up in the night, now groaning with pain. My wife wasn’t happy. I learnt to take my pillow to the dining table, sit upright, head on pillow, pillow on table, and that way I could sleep. We bought a new mattress. It made no difference. I went to the GP again. It made no difference. I was give a prescription for a muscle relaxant which eases the pain and has the side effect of constipation. Diclofenac made no difference to the pain level, but I can tell you that it does cause constipation.

Some days at work, I would give up at about 3pm and go home, because I could not endure the pain.

After about one month of this, something worse happened. The pain moved around. Variously, I identified 7 pain points in my left shoulder, upper arm, and shoulder blade at the back. Then it moved, to the front, towards my left nipple, and then towards my heart. A thrombosis I thought! I later learnt that a blood clot that moves about is called an embolism, not a thrombosis. Aged 50 something I went straight to A&E. The triage nurse got me in almost immediately and I was hooked up to an ECG to investigate. There was no embolism, there was no risk of an impending heart attack! The Doctor explained that I was one of the healthiest 50 somethings he had ever seen, my heart and circulatory system was in top condition, and I was sent back to the GP to discuss soft tissue injury (again).

A third visit to the GP achieved no more than the first two. I was still clocking off work mid afternoon. I was still sleeping sitting up, head bent forward, with a pillow on the dining table. And I was regularly trawling everything I could find on the web.

My pain “did not move around”, it just felt that way. I had 7 pain points, and the one that ached the most masked the sensation from the others, tricking my brain into thinking that there was movement.

I found the problem, and in my excitement and hurry I failed to note the exact URL of the Indian doctor, with a clinic in India, who explained that I had RSI, and explained what I should do about it! It had taken me about 6 weeks to self diagnose my RSI.

RSI was a wrist condition I thought, mainly brought about by relentless typing. It affected me (and according to the Indian blog, others as well) in the upper left arm and shoulder. Hence the Indian doctor who had seen this a number of times had written a really informative blogpost. The whole problem was nothing to do with running, nor stretching, and it had  everything to do with my desk at work. I needed a low keyboard tray and I needed to learn to touch type. An upright seating arrangement should also mean a raised monitor so that (a) my back is straight, and (b) the top of the monitor is level with my eyes.

I run my own business, I’m the boss, it’s my desk and I can do what the hell I like with it. Saturday, within 10 minutes of that self diagnosis, I was on a Tube train to work. I took a saw to my desk, cut a big gap in the surface, found some gash wood, and mocked up a sloping keyboard tray like the one the Indian web site had recommended.

This photo from 2012 shows that instant remedy brutally inflicted on my cheap Ikea desk. The keyboard tray slopes away from me, and mimics the natural angle of my legs, resting just a couple of centimetres above them. This is the place where your hands would naturally lie if we hadn’t adopted traditional flat topped desks. And I learned to touch type.

Into the bargain, I had a new mattress, I had learned how to sleep at a dining table, and I had the knowledge that my heart was in perfect health! Incidentally, I also bought an ergonomic kneeling chair although I gave up with that after a few weeks. In place of the old cheap Viking leatherette executive chair at about £45 (bought years and years earlier) I now have a newer decent quality mesh executive chair that cost about £250.

Within a week of cutting the desk, the RSI abated, the sleeping improved, and by week 3 I was back to normal. I can touch type, it’s a bit ropey, but it is authentic.

Thank you Dr Indian Fella! I wish I had that URL, and in spite of trying, I have not been able to find it since. My GP does not know this. I have not been in the surgery since 2012, there has been no need, and I am now a very fit and healthy 60 something.

However, I have subsequently learnt from more than one source that the NHS is good at illness, disease, and bone injuries, but it’s not good with soft tissue injury. I tell you this in the hope that others with RSI like mine can now self diagnose too!

Inspiration

Chuck Close was an American artist with an unusual way of portraying the human face!

More importantly, he was also the inspiration to many people within and beyond his field, on account of this thought provoking quote:

“The advice I’d like to give to young artists, or anybody really who’ll listen to me, is not to wait around for inspiration.

Inspiration is for amateurs; the rest of us just show up and get to work. If you wait around for the clouds to part and a bolt of lightning to strike you in the brain, you are not going to make an awful lot of work. All the best ideas come out of the process; they come out of the work itself. Things occur to you.

If you’re sitting around trying to dream up a great art idea, you can sit there a long time before anything happens. But if you just get to work, something will occur to you and something else that you reject will push you in another direction.

Inspiration is absolutely unnecessary and somehow deceptive. You may feel like you need this great idea before you can get down to work, and I find that’s almost never the case.”

Selling your business – a five step guide

I like conferences and unconferences. And, for a while I’ve had a conference idea germinating, a 5 step guide to growing and selling your business.

opening slide saying a 5 step guide to growing and selling your business

Download the slides

The combination of TechMids and UKhealthcamp, spanning two consecutive days in October 2022, gave me the chance not only to commit the idea to paper, but also to present it to an audience. The material was half written on the train journey from London to Birmingham, en route to the TechMids conference (where I was a delegate, not a speaker). The other half was written on the return journey that evening.

And it was premiered in London the next morning, at the UKhealthcamp unconference (where I was both a speaker and a delegate). Moreover, because HealthCamp heard it first, it was also written with a deliberate HealthTech flavour. Psychology is a personal interest of mine, and I’ve been going to HealthCamp events since 2008.

I could probably talk non stop for about 4 or 5 days on the subject of growing and selling your business, although I had a mere 45 minutes in which to convey the key points. The audience was lovely, the Accurx venue was faultless, and  the presentation ran perfectly to time, even with a good deal of two way dialogue, and I was able to cover all of my material. The talk could also amount to a 30 page academic paper, so this blogpost is limited to the primary message, augmented by my slides, and I would be happy to present the full detail again to your audience.

Documentation is key! In healthcare you need to document everything anyway. Healthcare professionals need the case notes in order to deliver calibre services without going over the same ground twice. In tech circles, software developers need to document what they do in two different ways, once as reference material for the team that will have to maintain the software, and once as a guide for the end user.

Star Wars meme with Junior Dev: Where’s the documentation? Senior Dev: I am the documentation.

Growing a business, and selling a business, requires a substantial amount of documentation too. You can cut corners and get a lesser value, though the better the documentation, the better the price that your buyer might pay.

Let’s assume that you already have a business with substantial value and a valuable substance. Your documentation falls into two broad categories:

Operational docs cover Processes and Policies whereas Strategic docs include Business Plan and Opportunity Map

Percolating through everything there will be constant references and details about the omnipresent Research & Development work that is done.

Operational docs reside in what is variously called an “Operations Manual” or a “Knowledge Base”. In the old days they were kept on paper in ring binders and to give you some idea of the volume, think of McDonalds in the pre internet era. How many processes and policies does a typical McDonalds outlet have? Each outlet had a set of ring binders containing the full “Operations Manual”, and when they were stacked on top of each other they would stand about one metre high. I have never worked there, but have seen the docs, everything from how to cook a burger, how fries should be served, and how to clean a syrup tank!

Back in 1997, my first business initially prepared an “Operations Manual” in a single 300 page Word doc, with an index and dozens and dozens of hyperlinks. As the business grew (and as the web matured), that morphed into a 900 page “Knowledge Base” on a wiki. Some of those pages are so long that they equate to about 15 pages of paper. The first wiki then morphed into two wikis, one for the senior management team, and one for the operations team. The staff wiki contains all the processes and policies, and this information enables the team to deliver services in a persistent and consistent way. The “Knowledge Base” focusses on the core competencies of any business:

  • How do you get an order?
  • How do you fulfil an order?
  • How do you know when to bill for an order?

The “fulfil” bit is massive, because it covers 23 different products, and some of them have as many as 30 steps in a complex process! There are only 4 core products, but there are many extra ones that clients will legitimately ask for (sometimes), and expect us to be able to deliver.

The Strategic docs are a different animal altogether, and are in the domain of the board, not the full workforce. You need a Business Plan. A Business Plan is the one thing that will make the single biggest difference to your business growth. In the UK, 95% of businesses have no written plan. Hence you can elevate your business into the top 5% simply by writing down your plan!

And for a business that really wants to go somewhere you need an Opportunity Map. Where are the growth opportunities, what do they mean in financial terms, where are you going to find a buyer, how do you satisfy the buyer’s expectations, and what figure can you reasonably expect to secure? An Opportunity Map is in effect a “Forward Price Instrument”, it sets out what your business will be worth two years from now, or three years from now, if everything goes to plan. The Opportunity Map is not the starting point in any negotiation, it might not even be put on the table, although it is a key document in the array of meticulous documentation that will help you get to where you want to be.

three lever arch files packed full of paperwork

What the buyer really wants is scalability, your as yet unrealised scalability, and that should be clearly defined in your Opportunity Map. A buyer does not want to baby sit your half a million pound profit making business, and continue to bring in half a million every year. The buyer wants to leverage your operation and scale it significantly.

The scalability may come from diversification in . . .

  • Markets
  • Products
  • Teams

. . . or any combination of those. For each area I have a case study which I can elaborate on. The slides have screen shots of the relevant web sites.

Getting to this stage is a challenge!

Once the foundations are built you’ll discover that you have to move from “selling your product” to “selling your business” and that requires a different sort of mindset. You will need to build credibility and visibility, and you’ll need to explore the various “exit” routes open to you.

Preparing a business for sale is a multi disciplinary endeavour. It requires a combination of skills rarely found in management scientists and accountants. It requires a bit of creativity in order to pull together all of the facets outlined above.

Steve Jobs sums this up nicely:

Creativity is just connecting things. When you ask creative people how they did something, they feel a little guilty because they didn’t really do it, they just saw something . . .

Unfortunately, creativity is too rare a commodity. A lot of people in our industry haven’t had very diverse experiences.

So they don’t have enough dots to connect, and they end up with very linear solutions without a broad perspective on the problem.

I said to my audience, if you remember nothing else about my presentation, please just remember these words:

  • Documentation
  • Business Plan
  •  and most importantly, Opportunity Map

Who else do you know who needs to hear this?

UKhealthcamp 2022

The unconference UKhealthcamp took place at the offices of Accurx on Saturday 15 Oct 2022. A combined team hosted a session towards the end of the day, with a title which may be abbreviated to:

Broken user journeys. Feedback, complaints and constructive dialogue.

It was a lively session with lots of participation, thoughtful dialogue and respectful comments. It covered many things and this is news of only one of the issues raised by the hosts, and only one of the (many) responses from a packed room.

Hosts:

Please give examples of things that have worked well.

clip art young man in thoughtful pose with one hand raised against forehead

Respondent:

Thank you London. This is the report from Team Non-Judgemental. We have identified 4 good observations; things that have worked well; that has led us to establish 4 guiding principles; and we have detected a single, unifying undercurrent.

Good Observations

  1. There is value in a system which promotes continuous feedback, especially among co-workers, and encourages action.
  2. The Care Quality Commission (CQC) is a public sector body which has a valid, competent feedback & complaints process that has demonstrated the value of handling issues sensitively and responding positively.
  3. Care Opinion, a social enterprise, offers patients an opportunity to provide feedback about their experience of health and social care. Being independent of government, it adds authenticity to patient stories and equally to clinicians. Its processes are transparent.
  4. The hallway track, the time and space between formal sessions at conferences and unconferences, provides an opportunity for ad hoc dialogue, and has been shown serendipitously to generate valuable concepts and ideas which are not covered in the mainstream sessions.

Guiding Principles

  1. Authentic listening skills are valuable.
  2. An ethos of openness promotes authenticity in everything.
  3. Clearly identified roles enable the presenter, the aggrieved, the respondent, and all related parties to act cohesively and beneficially for all.
  4. Diplomacy in dialogue is valuable, with an emphasis on eliminating personal biases.

Undercurrent

Think things through. The presenter, the aggrieved, the respondent, and all related parties benefit from careful thought. Authentic, deep thought, both in conveying an issue; and in responding to it.

Footnote

The team at UKhealthcamp, the staff at Accurx, the session hosts and all of the delegates gave their time and resources freely. A good day was had by all! Thank you.