Repetitive Strain Injury
What is it?
Repetitive Strain Injury is defined as a cumulative trauma disorder caused by prolonged repetitive, forceful or awkward movements. Damage is typically to muscles, tendons and/or nerves of the neck, shoulder, forearm, or hand. Other names for complaints which are or may be forms of RSI include:
- Carpal tunnel syndrome
- Neck and shoulder pains
- Headaches
- Back pain
- Tendonitis
- Computer-use pains
- Everyday aches and pains
Symptoms
Common symptoms of RSI are
- pain, numbness, or tingling
- hypersensitivity to touch
- weakness
- impairment of motor control
Causes
RSI can be caused or aggravated by:
- repetitive movements (especially fine movements of the hand)
- poor posture or positioning
- ill-fitting furniture
- badly designed equipment (e.g. a computer keyboard)
- pressures of a heavy or fast paced workload
- other job environment stresses
- an out-of-shape worker
- vision problems (causing compromised posture or movement)
- emotional attitudes - shyness or fear can contribute to poor posture
- genetics - inherited tendencies to aggravating factors such as arthritis, diabetes, thyroid disease, double-jointedness, obesity, etc.
- medication or other causes of swelling.
- lifestyle: fatigue, diet, caffeine, alcohol, tobacco, long fingernails, etc.
Office-Specific Aggravating Tendencies
- Resters- resting hands on wrist pad causes too much effort from the dorsiflexors, up against gravity pulley using small tendons vs. using the large shoulder mms.
- Leaners- arms of chairs or desk, can lead to nerve damage.
- Loungers- Slumped posture, and rounded shoulders, with head forward.
- Clackers, and pounders-1.5oz. of pressure/ # per day= 1.5tons/day.
- Pressers- press down keys sometimes until knuckles go white.
- Pointers- hunt and peck, least likely to nre, but be
- careful to keep fingers well rounded.
- Thumb or pinkie extenders- Tendonitis risk. Tendons fight each other.
- Grippers- grip mouse too tight, diff. b/c all stress falls on one finger sharing the load. track ball also dangerous.
- Craddlers-hold phone up with their shoulders while typing. Neck/spine problems.
Cause Specifics
Most commonly seen in the hand, fine movements repeated 8 hours a day can cause micro tears, which inflame the muscles and tendons of the forearms, wrists, and fingers. Eventually the tendon sheaths run out of lubrication so tendon and sheath chafe. Now the insulted tissues become painful.
Less obviously, many underlying factors can come together to produce the pain of RSI. The sudden onset of sharp pain, say in the elbow, may be due to disc swelling or nerve entrapment in another location.
Treatment .
- Hands-on manual therapy to myofascially release the tensions in the muscle tissue, restoring normal blood flow and oxygenation.
- Massage of myofascial trigger points is also a critical part of this therapy. Travel & Simmons trigger points are points in the muscle that have become stirred up by chronic stress on the muscle, such as chronic repetitive motion, or static holding postures.
- Home stretching of your trigger points is a big part of the rehab process. Your therapist will show you very specific stretches for every trigger point that she finds.
- Manual therapy also includes spine and joint mobilization and/or manipulation, which can be a critical technique in releasing hidden nerve entrapments and joint impingements.
Self Care
A very specialized specific program is created for your body type. One needs to know how to stretch, relax, and correct breathing, posture, and over-all body mechanics.
- Breathing exercises are not a small part of the program. In fact, these are often introduced in the beginning to restore normal function of the thoracic outlet, rib cage etc.. Most people breathe too shallowly, creating great static tension inside the chest wall that makes the upper ribs stiffen, and thus stimulating the sympathetic nervous system, which in turn elevates muscle tone (the bad kind). The goal in breathing programs is to teach you how to shift into the parasympathetic nervous system, which promotes healing.
- Listening to subtle cues, stop the offending activity, take rests ,mini-breaks, stop before the pain begins.
- Ice reduces pain and swelling.
- Heat is an old-fashioned treatment, still recommended by some, however ice is most often the treatment of choice.
- Hot-cold contrast baths 1 to 4 times a day.
- Strengthening exercises for postural muscles is preventative, but need to be consistent. People often stop once they feel good.
- Learning to break up routine postures; - dynamic, not static, keeping bones aligned through movement, and in stillness. With the muscles at optimal length, ease of movement, and balanced usage of mms. Prevents tensions and pains.
- Ergonomics; positioning- correct configuration of chair to desk, and angling of body to monitor, and keyboard, and positioning your hands to the keyboard.
Prevention is the best program
Seven step program- “ Seven P’s of Prevention (and Management)”
- Physician- underlying medical problems that can make it more complicated.(lymes dis., arthritis, diabetes etc.)
- Physical Therapy / Manual Therapy/ Chiropractic/
- Pain.- pain is information: muscles need to move to keep healthy, need to maintain normal Range of Motion, need to stretch, strengthen, massage, to remodel scar tissue, or abnormal soft tissue habits
- Posture- corrections, Preventative exercise- stretch and strengthen corresponding muscle groups. Wrist extension, ulnar deviation, two useful terms! Keyboard tilted up too much, no windshield wipers..wrist moving to ouside is ulnar, to inside is radial etc.. HANDS IN NEUTRAL!
- Positioning- correct configuration of chair to desk, and angling of body to monitor, and keyboard, and positioning your hands to the keyboard.
- Pacing- pace yourself, 5-10min. break every 1/2hr. of work. One break /hr. should include stretching, the other non-keyboard Activities.
Related Diagnoses
The following terms and diagnoses are subcategories of RSI:
- Tendonitis- if you hold your tendons rigid over time they can microscopically tear or become inflamed from the constant friction. It occurs from overloading tiny muscles in forearm instead of the big groups.
- Muscle damage- Myofascial pain, sore to touch, at rest or in use.
- Tenosynovitis- Tendons curve around bones, and travel thru tunnels called sheaths, lubricated with synovial fluid. If rub sheath and tendon too much get tenosynovitis, over rubbing can cause swelling, nerve compression, etc.
- Stenosing tenosynivitis- tendon tight space moves with great diff. through the space in the sheath.
- DeQuervains- Where the tendon and sheath merge at the wrist- and thumb. Acute pain when moving thumb.
- Trigger finger- locking of the finger in a bent position. Occurs whena nodule or a ganglion cyst form on the tendon. Common on ring finger and thumb.
- Shoulder tendonitis- biceps inserts in front of arm, result of poor posture.slumped shoulder., or repetitive movmts.of mouse on too high of a desk.
- Rotator cuff tendonitis- Overuse with arms winged. Pain reaching into pocket, or hooking bra.
- Forearm Tendonitis-
- Flexor carpi radialis tendonitis - Extensor Tendonitis, flexor tendonitis
- Cervical Radiculopathy- Phone shoulder syndrome, often a compression of C5,6,7 c/s discs. Also shows with weakenss in shoulder, upper arm, numbness in fingers.
- Elbow Tendonitis - Epicondylitis-Lateral, and medial elbow-
- Ganglion cysts- On synovial sheath, tendon, or lining.
- Tunnel syndromes- Tunels are created by the bones, ligaments and other soft tissues, mms. In area causing a tunnel. It can swell with a lot of friction causing pains, muscle weakness and numbness.( radial, ulnar, median)
- Median Nerve Syndromes- CTS- ligament over the wrist, thru this tunnel passes 9 finger tendons, art. Veins, median nerve. Friction causes szwelling of the synovium the membrane of this tunnel, it cannot expand, so pressure on median nerve.
- Other causes of CTS- fluid retention, PG, oral contraceptives, thyroid dis.
- Radial tunnel syndrome-pain on bothe sides of forearm, and hard to make a fist.
- Ulnar syndrome- Sulcus ulnaris syndrome- groove near edge of medial elbow, shallow groove, etc.leaning on elbows, causes clawing 4, 5th digits, and numbness tingling, etc..
- cubital tunnel syndrome. Elbows bent at right angles for many hours.
- Guyon’s canal syndrome- Ulnar nerve in tunnel next to CTS.
- Thoracic outlet- Probs. With nerves and circulation-pain in entire arm, numbness, weakness, in fingers hand, and forearm.
- Reflex Sympathetic Dystrophy (RSD) - Severe constant pain- burning pain, leads to trouble initiating movmt, involuntary movements occur, adv. Skin is mottled, shiny, blue, or pale. Atrophy, loss of calcium, Focal Dystonia- writers cramp, DJD-Oeteoarthritis- compounds RSI, morning stiffness, diminishes ROM, cracking, or grating sensations.
- Fibromyalgia- painful tender points at specific sites, aching stiffness swelling in back , neck mms. sh., pelvis. Cold makes worse, heat helps.Treated with low dose Anti-depressants.
- Dupuytren’s Contracture- thickening of fascia of palm, or a nodule on the fingers pulling towards palm.
- Computer Vision-Eyestrain, headaches, neck, and back pains most common complaints.
- Distance of monitor, bifocal swrong distanceMeasure the distance from your eyes to computer, and have eye doctor check this vision on you.
Physical Therapy and Occupational Therapy
Modalities, deep tissue massage,work on preventing scar tissue,posture, exercises/preventative,stretching, overstretching, positioning, patience,
SELF-CARE; taking charge of your recovery
Listen to subtle cues, stop the offending activity, take rests,mini-breaks, stop befre the pain begins.
Ice- except diabetes, raynaud’s or rheumatoid like sxs. Don’t do heave duty stretching, etc..after icing as it will risk injury, when cold and brittle, reduces pain.
Heat- also can relieve chronic pain, ti helps with long term issues, assists with stretching.
Hot-cold contrast baths- 3-4X/day
1min. cold, 3min. hot, open and close hands during, and do cycle for 2-3X’s. at work use tap water.
Strengthening exercises- postural muscles is preventative, but need to be consistent, people often stop once feel good.
Home exercise for computer Athletes-
1. time of day, reps-build salowly 3-5, 10, then sets.
Scapula stability-
Hold ups 1- elbows in line with shoulders, palms down, elbows bent at right angles, do this lift in one unit keeping the arms on the same plane loft and squeeze the blades together.
Hold ups 2- Sames but with blades squeezing towards the feet, or tailbone .
The swimmer- Right arm up, left down, head turned to the left.
Whole arm lifts- sidelying horiz.abd.
Forearm lifts- Sidelying with elbow at waist, 90deg.
Arm circles sidelying.
Office ex’s for eyes, neck, pectoral, and forearm circles.
Eye- Circles or eyes in a box-4 corners
Yoga clock for the eyes-
Neck- shoulder circles- up to ears then back and squeeze, and front again.
Head tilts- Lf, Rot, FF, single sh. Circles, neck rolls,
Small micomovmts. Good keep posture dynamic
Forearms, flexed forearm stretch with and without fingers curled.Dorsiflexion stretch with fingers down, and up positions.
Corners
Tendon glides make a fist, tips to base of palm, or make a hook.
Self Care pointers-
Pay attention to pain, learn your own symptoms, perform exercises faithfully,
Get a massage as needed, don’t let RSI overwhelm your life.
RSI- Log
Guided relaxation, visualization- breathing and relaxing thru the entire body.
ADL’s---pg 123
Pillows, chores, kitchen, car, bedroom, office-headsets, speakerphones
Emotions-
Five stages of injury:
- Denial- fear big role, or lack of awareness. False sense of security.
- Panick-
- Anger-
- Deppression- deep despair,
- Mastering RSI- Experimenting, trail and error, creativity.
Sense Memory- trauma related to these tissues, held down with wrists.
Fear- coping with chronic pain syndromes, primary, secondary gains,
Dealing with the boss- explain, negotiate lighter keyboard work, be assertive.
The Rest Period- if cannot rest on job, may need to take a break,
If your Pt has progressed to a point where you can identify, and heed your bodies warnings, control pain.
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