Overy cycles

Question: Is there a connection between tendon/ligament damage and a change in environment? Recently there seems to have been a few emails from people who have been unemployed and returned to work and then develop RSI-type problems. I ask because that is exactly what happened to me about 20 months ago. Also, you talk of ‘several plateaux in recovering’; I am currently stuck on one. I don’t have constant pain, but I still can’t/won’t risk doing too much as it brings back pain. Problem is, sometimes I think it is getting worse, which is frightening as I don’t want to go back to the days of pain even whilst I brush my teeth! How can I tell if/when I can get back doing normal things without further damaging my wrists? It’s not always as simple as ‘if it hurts stop’. I am aware that I am not physically active; can anyone suggest hands-free-activities?NOT anything as active as sailing, please!

Answer 1: Hi I’m in one of the plateauxs at the mo and my RSI is back. I do believe that you go through phases and I know that an incorrect PC set-up is contributing to it, but I also think stress in general doesn’t help. My RSI has always been bad in the first couple of months starting a new job and usually gets better once I get the PC set up and know what I am doing in the job. But when its back it’s depressing. At the point of offending people, in NZ we don’t talk that much about recovery – we talk about management, and that is what I try to do. Surely if RSI is caused through lots of things like nerve damage then the damage doesn’t go away but you need to minimise more damage. Thoughts (and flames if need be) read. I’m not active but found that a form of yoga that looks out how we move helpful and I’ve started running (yuck which I hate) but it helps as it relaxes me.

Answer 2: Sorry for the delay in replying, I am currently in New York and for the last two weeks was convinced I had fried my modem on a digital phone system (in fact it was Windows 95’s hardware profiles not working as claimed). It may be non-tendon/ligament RSI as well, but yes there certainly seems to be a pattern. The physios and ergonomists talk about work hardening, whereby while you are working your muscles/tendons etc somehow ‘get used’ to the patterns of usage involved. If you are on a long holiday or unemployed, you do need to be careful on returning to work – take extra care with breaks, stretching, etc. See my web site’s prevention bundle for files about what to do – URL is in my sig. Well, you just have to be continually vigilant when you start doing new things, and keep trying to break down the remaining RSI – e.g. if you are not doing any relaxation/meditation, try this.

One block to recovering, at least for me, was that I wanted to be able to stop all the RSI-focused treatment and activities, as a way of proving to myself that I was ‘fully recovered’. The net result was that I tended to do less work on the RSI than I needed to. It really is important to keep focusing on improvement from month to month, and to change what you are doing if this is not happening. Ultimately you may reach the final plateau and just ‘manage’ your remaining RSI symptoms, but it is hard to know when to stop. I have a bias towards continuing to work on recovery, but others may prefer to just accept their level of symptoms. The main things I think you need to address are (note that the suggestions are by no means exhaustive):

  • workstation setup and ergonomics
  • taking sufficient breaks
  • stress management: relaxation, meditation, exercise, Tai Chi, qi gong, etc.
  • flexibility/mobility: stretching and exercise
  • body usage/posture: Alexander, Feldenkrais
  • muscle trigger points/stiffness: stretching, trigger point or other deep tissue massage, plus stress management stuff
  • mechanical nerve tension: AMT stretches and other stretching

The more self-treatment you can manage, the better – this lets you fix pains and stiffness immediately, rather than suffer until your weekly session with a therapist. For example, yesterday I had some back pain and leg stiffness, and some right arm aching, which was fixed with some trigger points, Alexander and a trip to the gym. The same should apply to much of the RSI pain you are having. There are lots of interactions between the problem areas and the activities/therapies – e.g. relaxation helps with stress and muscle stiffness, and fitness. The simplest place to start is walking – avoid carrying anything, of course, and try to avoid anything on your shoulders. If you really must carry things, get a day pack and use both shoulder straps. The gentle arm swinging and back movement is normally excellent for helping RSI. Even during a lunch hour you can walk four miles, with a short stop for a sandwich – you will also benefit psychologically from a real break, and of course this will help cardiovascular fitness if done briskly.

If you are motivated and have the cash, a gym subscription may be another good way of getting fitter. Or take up any sport that does not involve arm use (maybe football?). Later on you will be able to do other sports, though I would not recommend windsurfing for a while) Whatever the route, fitness work definitely improves shoulder mobility and frees up the back (just avoid weight lifting unless under the supervision of an RSI-aware physio). I find that my leg is much less frequently stiff (sort of an RSI side effect for me) since I have started going to a gym several times a week. I used to get very stiff after presenting a class all day, from stress, but these days I don’t, which is largely down to being fitter.

Answer 3: At the risk of stating the obvious, you might well be helped by some stress management work (relaxation techniques, meditation, tai chi, etc.) during the early months as well as later on in a job. Certainly PC setup is a big issue. If you are continually changing workplace (reading between the lines) you might want to look at working with the keyboard on your lap, perhaps with some sort of velcro to keep it in place; this would let you sit with a reasonable posture. You could also invest in a track pad, or even a keyboard with built in track pad, so you are not dependent on the desk (which is probably too high in many cases) for keyboarding or mousing. I emphasise recovery more as a way of encouraging people to continue to try to reduce their RSI symptoms, though at some point this becomes management, which is probably the phase I am in now with my remaining fairly innocuous symptoms. I have seen a lot of people just get the physio for many months, come out of this, and just stay on that plateau – this was only the first phase of recovering for me, not the end, so I think it is important to look at all aspects as mentioned in another message in this thread.

Of course, people with irreversible RSI symptoms may prefer to just manage their condition, rather than continually striving for an impossible improvement, which can be highly stressful and potentially damaging in itself. I don’t think anyone really knows enough about RSI yet to definitively say when someone cannot recover further, particularly since conventional medical treatment will usually not avail itself of the wide range of useful complementary treatments and activities. For example, AMT type RSI seems to be somewhat reversible, though probably it will require continuing management post-recovery.

Answer 4: You wrote that you find swimming useful. There seems to be mixed feelings about this. I read that because Swimming is a repetitive motion, it could make things worse? So I stopped swimming, even though I didn’t actually do a lot in the first place. If I swim, it is with the aid of a float so I don’t use my arms/wrists. Also, has anybody been to a Tai Chi or Alexander Technique class in the Swindon (Wiltshire) UK, area? Finally, can anybody give some feedback on their use/pain cycle? As an example, I’ve just had a very busy weekend at a kiddie’s birthday party; I’m expecting some pain due to the fact that I’ve been throwing babies around! BUT I NEVER GET pain when I use my hands, so does this mean that the pain I get four days after ‘heavy use’ is due to overuse or due to the fact that I tend to rest my hands more after a bout of overuse?!!

Answer 5: I found that breast stroke was very bad unless you have excellent technique (i.e. keep neck in line with spine), and that back stroke was fairly good. However, swimming with the arms before you have had a fair amount of physio, trigger point massage, or whatever is probably not a good idea, since it may trigger off a flare-up. I also found that using Alexander or meditation type techniques while  swimming helped a lot in staying relaxed and keeping the right posture (not straining, just using the muscles actually needed, which is a big part of Alexander). I found that I would get a flare-up within the next day or so – perhaps your cycle is different, or perhaps large-muscle movements cause you no problem (as in throwing babies!), while fine-muscle movements (e.g. writing, typing) do cause problems. Try keeping a diary of pain vs. usage to see if there is a pattern – if writing/typing is out, use a cassette recorder.

Answer 6: They do say don’t do the front crawl as it aggravates the wrist. Back stroke is good apparently. It helped me just to strengthen my shoulders and arms but obviously not suited to everyone. You wrote that you find swimming useful. There seems to be mixed feelings about this. I read that because Swimming is a repetitive motion, it could make things worse? So I stopped swimming, even though I didn’t actually do a lot in the first place. If I swim, it is with the aid of a float so I don’t use my arms/wrists. Have you tried contacting your local community education centre or further Education College? I did my Tai Chi class at Abingdon FE. Also, has anybody been to a Tai Chi or Alexander Technique class in the Swindon (Wiltshire),UK, area?

Answer 7: I went on an introductory course to Tai Chi on Wednesday and I felt the benefits after one day. It exercises all your muscles with no pain and it is not exerting yourself strenuously. Ok it doesn’t suit everyone but I’m going through the process of finding something that suits and helps RSI and stress in the shoulder. Alexander Technique I’ve heard is good too. Also swimming I find good too.

Answer 8: Yeap, yeap that’s the name of the one I went to and it was very good and interesting. Looks at the way we use and move and how to correct the bad habits we get into. So much of it has to do with posture really doesn’t it? Have a good weekend all.

Answer 9: Both of these are excellent in addressing different aspects of RSI – tai chi helps with relaxation, muscle flexibility and ‘chi’ improvement (as in qi gong, this can probably directly reduce RSI pain, at least it did for me), while Alexander is more aligned with muscle relaxation and postural improvement. They are pretty complementary.

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