RSI... or OTT?
Intro
The acronym RSI stands for ‘repetitive strain injury’ (no, not Rotten Stinking Injury or Really Stupid Incident) . The term does not infer a diagnosis in itself – it is an umbrella term for a hazy and frustrating group of symptoms in the upper limb. Using the term RSI is like the mechanic saying that the reason why your car won’t go is because “there’s something wrong under the hood”.
In the case of RSI, the mechanic has generally checked everything ‘under the hood’, and simply cannot find any concrete reason as to why the car won’t work properly.
RSI has repetitive overuse as its predominant causative factor, but it always has other factors associated with it, such as stress, poor positioning, lack of breaks, and depression. It is typically difficult to separate these issues from the condition, and recovery is, at best, frustrating, and at worst, negatively life impacting.
If everyone had the ability to take control of their own actions, this debilitating condition would no longer have a place. Read this chapter and become smug about feeling the power of having your health in your hands!
Anatomy Made Easy
This anatomy class is about as general as it gets! Our arms are basically made up of bones, muscles, ligaments, tendons, nerves and blood vessels.
When you were young, did you sing the song “The leg bone is connected to the…knee bone…the knee bone is connected to the…thigh bone”? (Google informs me it is called ‘Dry Bones’). Whether you have been enlightened with prior experience of this song or not, since being a Physio, I have enjoyed the principle that it conveys :– everything in our body is connected. In the case of our arms, our chest bone (sternum) is connected to our collarbone (clavicle), which is connected to shoulder blade (scapula), which is connected to our upper arm bone (humerus), which is connected to our forearm bones (radius and ulna) and then a myriad of small hand bones. Ligaments hold all of these bones together. Overlying this bony structure are muscles, which fuse into tendons to move our joints around, and nerves, which exit from our neck and then travel right down the arm, allowing us to feel touch, temperature, and pain.
As you can gather, our arms have many moving parts, and movement is the system’s way of staying healthy and in working order. By moving all joints in all directions everyday, and by activating all muscles and tendons in different ways everyday, the skeletal, muscular and nervous systems in our arms stay healthy.
What goes wrong?
As we have discussed in previous articles, we tend to move a lot less than we used to. The movements we do make tend to be repetitious, eg typing on a keyboard, writing an SMS, operating a specialized piece of machinery or driving. This means that load, damage or pulling, somewhere along the ‘body line’, can affect things further along the line.
Picture a lady who uses a computer keyboard a lot: due to a poorly set up workstation, fatigue from a large workload, and stiffness in her upper back, she slumps in her chair alot while she is working. This sets up a less-than-ideal pattern of muscle activation in her shoulder, elbow, wrist and hand. This poor positioning, combined with the sheer volume of time in it, leads to some muscles working harder than they should, and others becoming lazy.
Over time, something has got to give, and this is often a tendon, which develops pain, perhaps in the wrist area. As the lady continues to work with the tendon pain, the nerves in the area become sensitized, the lady becomes anxious about the pain, muscle imbalances become more extreme, the lady gets upset, the boss gets annoyed at her decreased abilities, the tendon gets sorer, the nerves get more sensitive, the lady gets more stressed and…round and round and round it goes. Once this cycle has developed, it is very hard to break, and it is very hard to separate out all of the different contributing issues.
Even if the original sore tendon heals and settles down, the pain can continue. People often think this means they are still ‘broken’ or injured, but in reality they feel the pain because the nerves and muscles are sensitized, weak and tight.
Turning this spiral of pain and distress around can be done, but it is time consuming and takes diligent effort on the patient’s part. Take the easy road, and prevent RSI from happening in the first place!
Take Action Before You Break
MOVE!
Naturally, you have to make sure your desk is set up well, but even with the best, most ergonomic desk set up money can buy, the bigger risk factor is still lack of variety of movement. If you are reading more than typing, go and stand, kneel or lie on your tummy. Make a cup of tea for yourself, rather than getting someone else to do it for you. Better still, volunteer to walk up the street for the coffee run to supply everyone’s caffeine hit (not that I am advising caffeine use!!).
Use your lunch break to walk around and use your legs, rather than your arms.
Make sure you are doing some general fitness work, to keep your tissues resilient and healthy (more about this later in the book). Manage your workload through open communication with colleagues and bosses, and try to get a decent night of sleep.
Avoidance of RSI can therefore be summed up by two words: MOVE and BALANCE, ie keep moving, and find balance in everything you do – not too much of any one thing!
Karen Finnin
Musculoskeletal Physiotherapist
karen@physios-online.com