Introduction Seven months ago Suparna started treating a patient who learned about her from our book. Our book includes patients A through F, so we'll call him George. On the strength of what he read in the book, George came from his home in California to live on the East Coast (!) until he was either cured or convinced otherwise. When I first heard that someone would take such a plunge, I was amazed. And worried. Surely there were enough talented therapists in Silicon Valley that Suparna was destined to determine that George was incurable, or so chronically involved that any hint at success would be elusive at best. After all, we've never suggested that chronic RSI was easy or straightforward to resolve.
Predisposition George is a power programmer (C++) and a guitarist, a talented guy, I'm sure. I've often remarked to folks that it's increasingly common to hear folks detail their litany of computer-related RSI symptoms and observations but end with a statement presented almost as an afterthought... "Oh yes, and I've been a musician for 30 years," or, "I've been a portrait artist since high school."
Do I think the prior career (guitar) was the problem? Not exactly. Rather, I believe that the phenomenon is that a lifetime of traditional occupations is bearable for the body, but those careers set you up to be more easily taken advantage of by computers. After working in jobs that have a lot of repetitive, BUT VARIED motion, the Wintel mouse/keyboard is enough to put you over the RSI edge in as little as six months. Yes, lots of folks have developed serious RSI through traditional jobs long before computers, but the combination is deadly. I believe that your susceptibility is further enhanced if your previous career involved constant hands-suspended postures such as playing musical string instruments, traditional easel painting, or hair styling. (I've said before that I'm worried we're in for an avalanche of injured graphic artists, transitioning from traditional tools to non-stop mousing. We'll see.)
Symptoms When he arrived, George had pain levels typical of the worst RSI patients. He couldn't open jars; he couldn't drive a car; he couldn't play the guitar; he had aching, burning, throbbing arms. Suparna found that his muscles were tight all over the upper body. His tendons at the wrist were thick and ropy. His programming career was long since abandoned, whether temporarily or not only time would tell.
|
Diagnosis Suparna found that George had signicant compression of the blood vessels at the thoracic outlet where the nerves and blood vessels pass under the collarbone, above the first rib, and between muscles in the neck vicinity. He was extremely tight in the pectoral muscle area. The reduced blood flow contributed or maybe caused soft tissue (myofascial) problems up and down the whole arm, inflammation, irritation, guminess where there should be suppleness, ropiness where there should be smoothness. George even had the notorius nerve adhesion (that I too had) on the ulnar nerve 2 inches up from the elbow on the inside of the upper arm. Are such adhesions brought on by the reduced blood flow, the static position? I'll let the physiologists fill in the blanks.
Treatment Suparna used all the techniques that have helped lots of chronic sufferers. Here's what she does. She uses several hands-on techniques to create "mobility" (you and I might say "make room") along the path of the nerves and blood vessels in the chest and neck. She probes and pushes and pulls on the collarbone, first rib, the muscles, and the recesses between structures in the area. She moves the arm through its full range of motion, while simultaneously pressing on soft tissues that attach to the joints being manipulated. Some refer to this as myofascial release, I think.
Not insignificantly, she also helps counsel the ego and spirit, bringing back into balance the life and work attitudes of the patient. For those who cannot relate, if you've gotten to the point where you can't open a jar, no one is totally immune to psychological factors that contribute to the downward RSI spiral. Positive reinforcement and good advice have more often than not been a part of recovery from chronic RSI.
George also found some benefit to focusing techniques that are based on a chiropractor's work on the sympathetic nervous system. He even used modified Sarno methods to recondition his pain responses by rewarding himself for working without pain. Apparently this helps break the mental patterns that one develops, when working through pain for years, that automatically link work and pain. Dr. Sarno is author of the Mind Body Prescription.
Once George was in better shape, strengthening and stamina were addressed by various exercises. Most notable were exercises to strengthen the scapular area (shoulder blades) which provide the cantilever superstructure of the upper extremity. He also worked on aerobic capacity by doing time on the treadmill.
Results I recently met George and asked him the "Million Dollar Question": So can you use the computer again? (Are you "cured?") His answer: he hasn't gone back to programming but he's been using the computer, for games he said. He's still learning what his capacity is. He's taking a teaching position instead of programming but believes he could program if he wanted. (Me, I'm skeptical; I'll believe it when I see it.) But he can open jars. He can drive. He can play the guitar for 1/2 hour at a time. He's not in constant pain.
Even while asking him the Million Dollar Question, a part of me struggles with the presumption. Is 8-hour-a-day computer use the appropriate goal? What a preposterous measure of success! Would I aspire to a "cure" that enables me to be chained to the oar of a boat all day, so I might row with a whip at my back? All of us must answer this question for ourselves, within the realities of our own lives. I simply seek the ultimate physiological remedy. I'll leave our audience to do with it what it must.
Treatment Duration And now, for those who wonder what sort of effort George's remedy took... 7 months of 4 hours per week! But he started to improve after 8 weeks.
I put together this case study specifically to help address two issues that I've noticed on some posts on Sorehand (http://www.ucsf.edu/sorehand/) recently: 1) What do we mean when stating that "massage" helps heal RSI, and 2) How much time and effort are we really talking about?
In our book, we lump together lots of techniques by referring to massage. But as you can see from George's treatment, this was no weekend session on the table at the neighborhood spa. The "massage" we're talking about can now be re-labeled more specifically as "directed soft tissue manipulation by a professional healthcare provider who intimately knows the anatomy and physiology of the upper extremity and is an expert on chronic RSI etiology." Hardly synonyms are they?
The Difference Finally, I asked George to summarize what Suparna did that was different from what he got on the West Coast, where surely there were RSI experts?
She spent a huge amount of time with him.
She wasn't hesitant to cause discomfort (knowing the difference between productive techniques and mere irritation)
She targeted the thoracic outlet (chest, neck, armpit) with definite techniques and expectations
But don't be discouraged. There is a huge range of difference between various sufferers' severity and "chronic-ness." We got a gushing testimonial recently from a patient who said stretches and glides "saved her" from searing pain in short order. Presumably she was early in the progression of her symptoms and she did what we encourage you to do: get busy addressing your symptoms now.
Jack & Suparna
© 2001 Jack Bellis
and Suparna Damany All Rights Reserved
You may freely copy any material from RSIProgram.com if you credit the
source as RSIProgram.com
http://www.rsiprogram.com
Revised April 12, 2000