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Rarely has there been more confusion and fear about something which is just a simplistic label for a set of fairly standard physiotherapy conditions. What is it? Does it really exist? In this article we look to dis-spell some myths and give you the benefit of our experience in how to deal with it if you have it and how to avoid it if you haven’t.
If you are already suffering with an RSI type condition and you’re worried or would like to know what can be done then please give us a call (01793 613352) and we’ll be happy to talk through how we can help you get over what can be a very debilitating condition. It’s not as difficult as you may fear.
Does RSI Even Exist?
Not that I’m one to sit on the fence but kinda! Let’s look at the what it stands for. Repetitive Strain Injury. So you’ve done something too much. It might be computer work, bricklaying, golf, tennis any other activity you care to mention, but it’s usually caused by doing a lot of it. But then if you look around at other people doing the same amount of this repetitive action do they have the same problem? Probably not.
If we elaborate on the definition a bit we should get a little more insight into why these things affect some people and not others. Lets consider RSI as an overuse condition – you’ve used the muscles that perform a certain function too much. Lets make it more personal. The muscles you are using to perform a certain function are not currently able to cope with the demands you are placing on them.
This change may just seem like word play, but it gives us two options to sort the problem out. We can reduce the demands on the muscle, do less of the repetitive movement, which is fine if your livelihood doesn’t depend on it! Or, we can improve the way the body functions, make it more efficient, so that it can deal with the required demands. This is where Physiotherapy or Sports Therapy can help.
So What Is RSI?
For me RSI doesn’t actually mean anything. It’s a generic term used by the media and some health professionals to group together a set of conditions that with the right treatment and advice are easily cured. You could argue that any injury without a specific event that caused it is an RSI condition. However, RSI is usually used to refer to pain somewhere in the arm.
Some of the physiotherapy labels that are used to describe such conditions can be Carpal Tunnel Syndrome, Tennis Elbow, Golfers Elbow, Lateral Epicondylitis, Medial Epicondylitis, De Quervain’s Syndrome, Ulna Nerve Compression. Some of them can sound a bit scary but they are all different presentations of ultimately very similar bio-mechanical issues.
The symptoms can be far ranging. The pain can feel very “nervey” – pins and needles, bone ache, tingling and numb, usually caused by lack of movement. Or it can be more muscular in sensation, usually worse when moving or doing things. In all cases the symptoms are a combination of issues with both. Muscle affects nerve and vice versa.
So What Isn’t RSI?
Some people fear RSI, a lot. The fear is that it spells the end of their career. Their life as they know it will be over. In fact such fears will only add to the amount of pain that you feel from these conditions (read previous article on the Psychology of Pain). Surgery is very rarely required for such cases and about 95% of conditions can be healed with some simple treatment and slight changes to some habitual postures.
Remember, unless you have had a serious incident in which you’ve damaged to the tissues involved, nothing has actually happened. There is technically nothing to heal – when you’re in pain this can be difficult to grasp, I’ll expand more on that later.
What Causes RSI Pain?
The main source of the pain are the 3 main nerves which run down the arm. Ultimately these are the structures that report the pain sensation back to the brain. They are: Radial, Median and Ulna.
There can be tension on any of these nerves for a variety of reasons which means the muscles they serve will tire out or tighten quicker than they normally would. If we can identify where that tightening on the nerve is coming from then we can make the muscles last longer and so remove your pain. Sounds simple!
Obviously every case is very different and each case should be assessed and treated by a qualified professional (assume shameless plug at this point!). However, there are certain repeated mistakes people make and certain common factors that we discuss below which can help prevent and treat the RSI conditions.
The most common cause of tension is stiffness and tightness in and around the neck. This can cause an increase in tension on the main trunk nerve from which the others originate. This is known as the brachial plexus. Other than the neck anything in the clavipectoral fascia can affect the tension on the brachial plexus. To translate – any structure from your collar bone down to the bottom of your pecs can affect this trunk nerve.
Once you’ve sorted these issues out you can then move onto the structures where you actually feel the pain.
What Can I Do About My RSI?
So why and how do these muscles affect these trunk nerve things? The main answer is posture. It is entirely up to us as to how we hold ourselves. See previous post on How To Sit To Avoid Injury. We can do a personalised assessment for you but if your work offers an ergonomic assessment use it! It might not be as detailed as what we do but it may point out something very useful.
Next get a decent chair. It doesn’t need to be Starship Enterprise top of the range expensive number. Just something that is comfortable and doesn’t encourage you to slouch.
Before we go onto some exercises to help prevent getting RSI, a word of warning. The following exercises are great for avoiding getting RSI type conditions in the first place. They will also help ease minor conditions. If however you are in pain, please go see a professional before attempting these. If it’s not us, someone else. But just go and get it looked at, trust me your recovery will be so much quicker and less painful.
I suggest you try the following stretches in the order they are given here. If you get pain on any of the stretches or you don’t feel them stretching in the right place then that stretch isn’t for you just yet. All stretches should be held for 30 seconds and then increase the stretch for an additional 30 seconds. Never stretch to pain. This will be counter productive. See stretch reflex if you’re interested.
These muscles apart from looking good on body builders give us a round shouldered look. This in turn (without going into detail) can affect tension on that trunk nerve we spoke about earlier. Release these off, improve your posture and we have one happier brachial plexus. In a half surrender position walk up to a wall face first and get close enough to be able to kiss the wall! From there rotate your torso away from the arm that is against the wall and you should feel a stretch at the front of your chest.
Another muscle group that causes the round shouldered issues. Find the corner of a wall or door frame. Grab the door frame just above the level of your shoulder and stick your backside out behind you. You may start to feel a stretch already at this point. From here put your head down and rotate your torso towards the wall – think sniff your armpit! – and this should increase the stretch from your shoulder, across your back and all the way down to the crest of your hip. You may feel the stretch in any of these areas.
Simply place the hand on the side you are going to stretch behind your back. Take your other hand around your back and clasp the wrist to stop the hand moving. This is to stop your shoulder blade moving too much as you move neck. Now take your head to opposite side to bring the stretch on. As a variation you can release wrist and increase the stretch by gently pulling on your head with the opposite hand. If you’re feeling crazy you can hold onto a door handle and then use you hand to pull your head to ultimate stretch. Whatever you do don’t stretch to pain. Either in your shoulder or down your arm.
Stand with arm out stretched in front of you with the palm of your hand facing the floor. With your other hand bend the hand back towards the forearm. Pull until you feel a nice stretch. As always not to pain. Make sure it is a stretch and you don’t feel a compression in the wrist. To do the reverse start with your palm facing the floor and then pull the hand downwards towards the floor. Hold each stretch for 30 seconds and then stretch in a little further and hold for an additional 30 seconds.
So What Shouldn’t I Do?
Possibly more important than these stretches is to just keep using the area that causes you pain. Don’t be afraid of it. As we’ve spoken about in previous articles pain is not damage. When you start fearing making something worse you change your movement patterns. This increase your pain and means there’s more work for us to do!
If you don’t have any issues already and you now have the exercises from above you really don’t need to fear getting it in the future!
Don’t get stressed. Just generally in life! Easy to say, harder to do. Stress always makes us adopt our worst postures and increases our sensitivity to pain. Manage those stress levels as best you can. Most people know what they should do to manage their own stress levels, but how many people actually do what they know they should?
If your fear for your job and livelihood or you are frustrated not being able to do what you want you will feel more pain. Don’t just sit there getting stressed about what might happen give us, or anyone else you think might be able to help, and make that change now.
This article first appeared on our Brighton site.