It would appear that the main factors in giving an increased likelihood for RSI fall into the following categories:
RSI is a general term used to describe a primary cause of a condition. It can also indicate an aggravating factor of a pre-existing condition. It simply refers to the repeated use of particular muscle groups as causative and/or aggravating factors.
Most often it is used to classify conditions related to computer work. It also includes most commonly writing with pen/pencil, activities involving prolonged periods of gripping, playing musical instruments, typing and mousing.
Thus, any action repeated too many times, no matter how light, will produce a repetitive strain.
RSI is a general term used to describe a primary cause of a condition. It can also indicate an aggravating factor of a pre-existing condition. It simply refers to the repeated use of particular muscle groups as causative and/or aggravating factors.
Most often it is used to classify conditions related to computer work. It also includes most commonly writing with pen/pencil, activities involving prolonged periods of gripping, playing musical instruments, typing and mousing.
WRULD or Work Related Upper Limb Disorders is a term coined by the TUC (the British Trades Union Council) meaning repetitive strain induced by one's employment. This term includes conditions such as 'beat hand', 'white finger syndrome' and various other work related syndromes.
The principle is simple. For example if I were to stroke my cats' chin with my index finger once, there would be no problem, but if I were to do this one thousand times in an hour, both my index finger tendons and my cat would complain bitterly. The muscles and tendons effecting the movement would become tired and begin to ache. They should recover soon. But if I were then to perform the same activity each day for a week, I would probably find that I could only repeat it a few times before my muscles would feel tired and achy, plus, my cat, now with a bald chin would not be pleased.
Thus, any action repeated too many times, no matter how light, will produce a repetitive strain. 'Nintendo and Blackberry thumb' are classic examples.
From my observations it would appear that the main factors in giving an increased likelihood for RSI fall into the following categories:
Musculo-skeletal factors consist of the shortening and tightening of any or all of the following trigger areas:
All of these areas must be examined thoroughly for any hypertonus (tension) and deficient ranges of movement where the joints are involved.
The trained hand will know precisely where these areas are and then with the right skills, 'undo' them. The skills needed are primarily the educated sense of touch, like a potter or pianist, and then the techniques to do something about what you find.
The most commonly involved trigger areas are in the deep extensors and flexors of the wrist and fingers as well as the muscles of the Thenar eminence (thumb). This is most evident in cases where practice and performance have over-tightened the deep extensor tendons, the deep flexor tendons and the thumb muscles. These, in order of appearance constitute the basic building block of RSI of the forearm and hands.
When you add in the all too common shoulder and neck tension patterns, you will become very likely to suffer from RSI.
If there is a tendency for nerve compression, especially involving the Median nerve, there are specific points where nerve compression can occur, They are as follows:
The thing to realise with trigger areas is that every point of compression you have adds to the tendency to produce both musculo-skeletal pain and pins and needles/numbness. It works like an 'amplifying' process. Each sections' tension pattern adding to its neighbours' along the same nerve pathway. It is a process of attenuation of the nerve signalling, whereby the entire nerve becomes more excitable, thus making subliminal pain spring into consciousness manifesting as a symptom. This overall excitability affects the excitability of the reflexes and thereby the tone of the muscles involved in the highest activity rises and tension mounts. You know how it is when someone presses your shoulders and finds places of tension that you didn't realise were there. These areas of hypertonicity are generally not needed by the body, unless you are a lumberjack!! The point being that we are all on the verge of being in pain all the time in many places of our body its just that our nervous system cleverly 'damps' it down so that we don't suffer too much.
I too have suffered many repetitive strain injuries as a result of the hands-on work that I do in clinic. Intense guitar playing and ‘mousing’ my PC for hours creating websites such as this one don’t help either. However, such episodes have served to edify me with regard to the general and specific nature of finger, wrist, arm, shoulder, neck and upper ribcage interactions. Said interactions manifest via lines of tension, nerve pain, pins and needles, muscle ache and joint ache by virtue of a sequence of shortening of adjacent structures in response to habit and irritation.
I have found that the majority of symptoms arise from the deep muscles, however, often the tendons of the superficial muscles are irritated as they pass over areas where the carpal bones, for example, are misaligned and or inflammed.
When the deep ‘stabilising’ muscles of the forearm become hypertonic or overly tense they lose Oxygen and rapidly tire, causing pain. This reaction in the deep muscles is more likely than with the superficial layers due to the type of reflex tone setting mechanism and because of restriction to their expansion. The girth of the deep muscles is more tightly constrained than the superficial muscles. This physical constraint to expansion is due to the membranous sheath which envelopes every skeletal muscle of the body. Described as a 'stout' membrane, the epimysium is a layer of connective tissue which ensheaths the entire muscle. It is composed of dense connective tissue and is continuous with the fascia of adjacent muscles and the internal connective tissue wrappings within the muscles.
The density of this sheath varies from deep to superficial muscle layers. Thus, when the deep muscles expand through constant and also unique occasions of overuse they become constrained by the limits of the dense membranes enveloping them. When this state of hypertonus has persisted for some time the nervous system registers the increased tone as normal and automatically maintains the tension even though it is no longer appropriate. Pain will be generally perceived at the anchor points of the muscles and their tendons i.e. the elbow and upper forearm, and the fingers and wrist.
Often I have observed that the superficial layer is weak and flaccid whilst the deep layers are very dense and shortened. Observation of top professional pianists demonstrates that the relaxed, flowing approach to playing, honed by many years of skill acquisition and the relative absence of poor postural and technique habits plus familiarity with their own repertoire serves to maximise their performance abilities. However, even these performers can be struck down by injuries such as falls on to the hand, gardening, decorating, writing, carrying heavy bags, and a host of other trauma.
The Carpal bones form a cute little paired arch which sit, tightly bound together. They can suffer from what might best be described as 'disruption'. Some of the Carpal bones can slip slightly out of line with its' neighbours. Adhesions which make the Carpal bones glue together are common, usually as the result of a fall or twist strain. The Carpals which are stuck will no longer function in their required movement ranges. These 'disruptions' are frequently painful. The type of pain can be sudden, the type that makes you whince and then it is suddenly much less when you move your hand to instinctively relieve it. These can be inflammed in very specific areas and very persistent unless corrected by accurate joint articulation and manipulation.
The experienced hand sees by touch, the shapes, densities, heat, textures, resistances of the body, the trained mind puts it all together. The trained hand stretches and softens the specific muscles, tendons and joints as mentioned above, the experienced mind asks questions pertinent to usage and the particular trigger area under investigation. These can reveal additional information about any other activities that the RSI suffer is engaging in which might be adding an additional trigger area.
I am able, by virtue of specialised and unique hands-on techniques that I call ‘Myo-articulation’, to reverse deep tension patterns quite swiftly. If there is carpal bone derangement present, I can very specifically locate and ‘undo’ adhesions and re-align these delicate little bones of the wrist. I will ‘track’ the tension patterns along the arm and identify shoulder, ribcage and neck involvement. These I will then release using a variety of techniques such as articulation, massage and manipulation where necessary.
It is even possible to identify, by palpating the tensions in individual muscles, specific playing related patterns of overuse such as the little finger in trills on the violin, over- gripping and over-flexing in the bowing hand and much more.
Whilst 'weakness' in the muscles' is much ballyhooed, it is more usually the best procedure to save strengthening exercises until the last, once the deep muscles and joint problems have been corrected. The action of correcting a muscle will induce muscle growth anyway. It is often wise to tone up the secondary muscles involved in a given action. Typing, for example, has the Deltoid muscles as secondary stabilisers holding the arms slightly out from the body. If you strengthen these muscles the arm will feel lighter. If the Deltoids are too underused then the deep primary stabiliser, Supraspinatus will become hypertonic and will constitute another trigger area.
When I began many years ago, I took it all for granted. Having been brought up as a boy in an Osteopathic environment I didn't realise that there were many things that people didn't know about in connection with the workings of the body and what makes them function that I took for granted. Hence, trying to take the thorny subject of RSI and shake some common sense into it for you.
Sure, there are other factors potentially involved. Psychological elements, metabolic factors, ergonomic, posture, hydration levels, diabetes, hypoxia, hypercalcemia, even pollution levels, but here I have restricted my talk with you to those things that seem to be least understood by sufferers. I hope it helps you to understand more deeply the whole painful subject of RSI.
Whilst a small number of RSI and spinal problems can be chronic, the majority are relatively easy to avoid and to correct using a precise diagnosis, examination and treatment of the structures involved. Thus, any physiotherapist, massager, osteopath, chiropractor, gym, trainer, GP or other specialist will find the reports from Workplace Wellness to be of tremendous use in comprehending and treating conditions.