"(Amazon) It's Not Carpal Tunnel Syndrome: RSI Theory & Therapy for Computer Professionals"
ISBN 0-9655109-9-9 (June 2000, 234 pages, paperback)
Topics on this Page
How Computer Users Get RSI
Muscular vs. Neurological Trauma Paths
Will the Real Cause(s) Please Stand Up
Itís Not a Localized "Syndrome"
Our Treatment Recommendations
|(A pretty poor translation, I've been told)|
If, like me, you suffer from a repetitive strain injury (RSI), this article will provide valuable new information that may help you fight this insidious problem. If youíre fortunate enough to have survived computer use unscathed by RSI, consider yourself lucky and keep this information carefully stored away where you can recall itóyour likelihood of getting RSI increases as the years pass by.
As a sufferer of a repetitive strain injury, and unsuccessful surgery to cure my problem, I eventually sought help from a physical therapist, Suparna Damany. She has successfully treated many RSI sufferers and, over the course of time, has identified some important common denominators that are not widely addressed, even by the medical community. Although the "conventional wisdom" of improving your ergonomics, working in the neutral position, and taking breaks has become widely known, such information is not strong enough medicine for chronic sufferers. In this article we will explain a new view, that Suparna and I have composed together, of how RSI specifically attacks computer users, and what therapy is needed to reverse it.
The world of repetitive strain injuries is one of pain and frustration, muddled unfortunately, by a whirlwind of questionable information. Depending on whom you talk to, RSI can be either a form of fraud perpetrated by malingering employees, or a debilitating complex of nerve and muscle disorders. To anyone who has experienced its pain, numbness, and loss of strength, it is quite emphatically the latter. But if you seek out the prevailing literature on the subject, you will come away with your head spinning. You wonít know if your problem stems from pregnancy or bad genes.
Distinct from the prior literature, our theory will highlight three factors that are at the heart of many patientsí problems, and generally not known by many health practitioners, mainstream or alternative: 1) Thoracic outlet syndrome (constriction of the blood vessels and nerves in the chest wall) is a much more frequent problem than commonly recognized. 2) Muscle inflammation, although you wonít feel it until a therapist presses on the right spots to show you, is present in almost every RSI sufferer. 3) Nerve trigger points, spots where fibrous tissue entraps nerves, have been fairly well documented, but only anecdotally. We will show how these all fit into a larger scheme that can be more properly addressed as a whole.
Before diving in, letís dispel what we believe are the prominent myths surrounding RSI.
"... anyone suffering from chronic pain will have trigger points, due either to their lack of exercise or bad posture."
While exercise and posture are important factors and will be involved in our theory, posture is a result, not a cause. And we frequently see very active people with RSI; they are simply performing a deceptively dangerous job and have overdrawn their bodyís health bank account with too repetitive a workload.
Letís start with an analogy, albeit an extreme one. Imagine youíve been hanging upside-down, eight hours a day for ten years... and youíve been holding your arms out straight in front of you while hanging around. How do think your ankles will feel after seven or eight years? What sort of sensation do you think your toes will be capable of? How Ďbout if I told you, as your medical professional, that to repair the damage, I prescribe better nutrition and more sleepóyou have a horrible lifestyle! We better have you try braces on your ankle to keep them from stretching too much. Oh yes, and vitamin B6, lots of it. Acupuncture, homeopathic drugs, and electromagnets for the pain, gut-wrenching anti-inflammatories for the swelling, and if all else fails, surgery to separate that heavy torso from those poor feet. As silly as it sounds, these are some of the typical recommendations from the medical community. Get the point? Even if you believe our exaggerated analogy is only slightly applicable, it still presents the basis for our case. Hereís how we think it works when youíre right-side up:
Despite the dire tone you will read in many case stories about the supposedly irreversible "curse" if you cross the line into nerve damage, rarely is the nerve actually damaged. It is certainly under trauma, but in most cases, eliminating the trauma is sufficient. Too many people simply never get the right therapy to enable healing. Theyíre still hanging by their ankles. And thatís our theory.
Although we are steadfast in our conviction that this one general scenario explains how the problems occur, we have found that there are two separate paths that the damage can take, which we call trauma paths. In the first, muscular inflammation is the problem, and in other nerve entrapment is the problem. Generally, both will share some portion of the blame, because they will affect one another as you develop the classic pain cycle. But one or the other usually becomes the primary focus of the therapy.
Nerve problems are predominated by adhesions that cause changes in sensation such as numbness, tingling, pins-and-needles, or even electric shock-like spikes. Muscle problems are typified by trigger points that cause searing pain, loss of grip strength or stamina, pain with movement, and so on. With muscular trauma, your nerve is usually in fine conditionóit is simply reporting a very painful state.
Now that weíve laid out our theory, you can see there are many intertwined factors. But which ones are causes and which ones are results? Hereís a diagram that shows how the contributing factors relate to one another:
By our analysis, only items one through seven are true root causes, and you canít do much about number five. The others are results, although they do a good job of masquerading as causes once your situation begins to "snowball." We canít reverse every one of the root causes, so a fair amount of our recommendations will address the middle ground, factors eight to sixteen.
The temptation in traditional diagnosis is to find one of the individual problems described in our scenario, such as tenosynovitis, and fix it by itself. But thereís more than enough evidence in the literature to demonstrate that most sufferers donít have just one of these problems. The "syndromes" that are alluded to earlier are often presented in the medical community as causes, but in our view they are all results. And you almost always have symptoms from several of them. This is confirmed by the following diagnosis of one particular, very severe RSI patient, by Dr. E. Pascarelli, a pioneer in RSI theory. He diagnosed her with:
"Neuro-vascular thoracic outlet syndrome, RSI/myofascial pain, lateral and medial epicondylitis, postural mis-alignment, finger, hand, wrist and arm tendonitis."
Contrast this with other doctors who diagnosed the patient with lupus and rheumatoid arthritis! She eventually found her way to Suparna for her actual treatment, and is back at work. The multiple factors explain why so many RSI patients report that, after employing what had seemed like a successful remedy, their symptoms recur, perhaps slightly altered. For instance, I had surgery to move my ulnar nerve from my "funny bone" area to the inside of my elbow, and was better for a few months. Then the symptoms came back, just as they were.
RSI, particularly in computer users, is a systemic malady of interdependent structures, more like an engine with wearing parts than a flat tire. When one part is compromised, the others are all overtaxed. If you donít attend to the real trouble, expect a chain reaction. The factors that predispose one structure to injury are equally dangerous to all of the parts, so you must address the root causes.
Consider an analogy to a suspension bridge. Your shoulder and arms are actually highly analogous to a suspension bridge (actually a cantilever bridge, but this is an article on physiology, not engineering), suspending your hands out over the keyboard for years. If, a few days after a new bridge is built, a couple of rivets pop, the odds are that the rivets are defective. But what if the bridge is 30 years old, and this time in addition to some rivets popping, the pavement cracks. You would have to be concerned that the incidents are related... that they have a single cause. Perhaps the stresses on the system, combined with the ravages of time have conspired to weaken the entire suspension system. Perhaps the foundation has settled and the main span must now stretch six inches farther than when the bridge was built. That is our basis for generalizing. Most of what are regarded, by conventional diagnostic wisdom, as localized problems such as carpal tunnel syndrome or tenosynovitis are in fact results, not causes. Any therapy that attempts to simply "repave the road" is destined to fail. Continuing the analogy, imagine if several engineers of aging bridges were sitting around discussing their popping rivets and cracking asphalt, oblivious to the collapsing superstructures. We would rightfully suspect them of outrageous negligence.
The ideas that follow could easily fill 100 pages, but weíll do our best to capsulize them for you. Keep in mind that this is for serious cases. Some of the techniques really need to be done by a therapist, and note that none are quick fixes.
Now that you know what we recommend, what does this imply about some of the more commonly prescribed remedies? Letís look at three: wrist braces, surgery, and anti-inflammatory drugs.
Doctors prescribe wrist braces in the belief that the bending of the wrist is the cause of all the problems, aggravating the carpal tunnel. For some initial sufferers, braces help. But, for chronic sufferers we believe that you must train yourself to work in the neutral position and that any crutch will actually contribute to the conditions that have caused your problems, namely loss of muscle vitality and stamina.
What about surgery? Typical carpal tunnel surgery consists of cutting the ligaments that constrain the tunnel. You may ask, "How can we simply cut the ligaments... donít we need them?" Surgeons would have you believe that we don't because we donít need as much support as, say, our four-footed friends who use their wrists to walk. Others would disagree, convinced that the carpal bones can drift and the hand become misshapen. Surgeons probably have an excision or transcision for every part of the anatomy that might be subject to symptoms. The problem, however, is that in the case of computer-related RSI, the surgery almost always treats the symptoms, not the source.
Doctors frequently prescribe anti-inflammatory drugs call NSAIDs, non-steroidal anti-inflammatories, to combat initial RSI symptoms. Weíre in favor of anything like aspirin that can eliminate your pain, but NSAIDs are extremely irritating to your stomach, particularly if itís not made crystal clear to you how much food you must consume along with them. Your muscles are inflamed because of a habit of activity that will very likely continue even while you are taking the medicine. The only certainty is that your stomach, which was initially healthy, will now hurt as well.
In our experience, serious RSI problems take about a half a year or longer to heal. The healing process is not the same for chronic RSI as for a broken bone because RSI attacks soft tissue and your nervous system. When your nervous system is attacked, your normal defense mechanisms are, frankly, confused and the road will have lots of ups and downs. But donít get discouraged.
When you do get on the road to recovery, keep in mind that your body has declared new rules for the game, and you must forever play by its rules. You wonít be able to abuse your body in the same maniacal but surreptitious way. You'll have to learn new ways to work: to be more careful about taking breaks, working in less stressful positions, warming up much like an athlete does before competition, and reducing the overall extent of the repetition involved in your work. But your body has an incredible capacity for healing and your RSI will heal if you address the true root causes.
2004 RSIRescue.com Jack Bellis and Suparna
Damany All Rights Reserved
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