RSIA AGM 96 Part II

Question:  The 2nd speaker was Vicki Harding from the Input Pain Clinic at St. Thomas’s Hospital London. The following is from the notes she gave out (9 sides of A4) and from what she said. Chronic pain is pain that lasts for more than 3 months. After a time you get the chronic pain state imprinted on the central nervous system. The longer you have it the harder it is to get rid of. Psychologists point out there is no psychiatric reason for pain. A lot of RSI people write with capitals or not joined up writing. RSI in their opinion is a condition that takes longer than many other chronic pain conditions to build back up to full fitness.
Secondary problems from pain:
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  1. People stop moving the part that hurts this in the long term leads to more pain. Muscle becomes tense with holding the limb still and this creates more pain. Also the pain then seems to spread.
  2. Searching for a cure.
  3. Drugs rarely help in chronic pain as they encourage people to do more and cause flare ups.
  4. Under/over activity cycles – you do too much, causes pain, so you rest.
  5. Stopping enjoyable or meaningful activities.

RSI – how input program can help
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RSI People are generally over acheivers – this leads to cognitive problems, so they have psychologists to help overcome these.

  • Teach you to rest and relax.
  • How to break out of over/under activity cycle.
  • Understand how the body works – how pain creeps round the body.
  • Pain does not mean damage. Use pacing to overcome it.

They have a large stretching routine for all the limbs. 15 months wait for screening to see if you are suitable for the program. Then 9 months wait to actually attend! There are other Input pain clinics in the country. If you go to a pain clinic at the local hospital make sure they have a clinical psychologist.
Sensations you may feel as well as pain: (in chronic conditions)
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Swelling. In the acute phase swelling is due to the buildup of fluid, the inflammatory part of the healing process. In Upper limb disorders you get it around the tendons. You can also seem to get swelling where a muscle has gone into spasm. An area that is very painful will feel bigger and swollen. In the chronic phase (after a month) swelling is not due to inflammation as it dies down in 3 days to 1 week. It is due to poor circulation and bad health of tissues due to lack of use, or muscle spasm, or bad posture. Things can feel very swollen when they are only slightly swollen.
Tenderness

  • May be due to hypersensitivity due to nerve damage, due to avoidance of touchand pressure on the tender part – the brain turns up the amplification as it expects
  • a signal and is not getting any, so when it is touched it hurts.
  • Also due to lack of normal movement and stretch.
  • Pins and needles
  • Due to lack of oxygen and poor circulation.
  • If there is a scar in a nerve or tethering of a nerve or its sheath.

This needs stretch to make the nerve/sheath more supple so they are not tight and don’t pull when stretched (do those AMT stretches!) You can get pins and needles in the hands (tingly, all over the hand) due to problems in the mid back between the shoulder blades improve the suppleness and blood supply by good posture, stretch and avoid long periods of sitting still.

Heaviness/weakness
Due to loss of strength due to lack of use. Happens very quickly when you stop using part of the body.
Stiffness
Due to length of muscles, tendons etc. which reduce from lack of stretch and use and stiffness due to scar tissue. The actual movement can feel stiff due to lubrication fluid being thicker, joints/tendons have not been used and so glands producing lubrication will not produce so much. Tendons may not move so well due to adhesions or tiny scars on the surface. Muscle tissues which are parallel bundles of wavy fibers are not stretched and get tighter and have less circulation and lubrication getting to them. If tissues are unhealthy they have an incorrect mineral content and are difficult to move.
Ways to speed recovery and prevent future problems:
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Exercise
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  • Improves general fitness (helps release endorphins).
  • Improves circulation.
  • Improves lubrication of joints and tendons.
  • Improves flexibility.
  • Do regular daily exercise or regular Yoga. (She really emphasised doing Yoga)
  • Do aerobic exercise – swimming, jogging, dancing, cycling etc.
  • Exercise yourself – exercise for less time and more often, rather than once a week with your physio.

Relaxation
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All the usual things…
Posture
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  • All the ergonomic things we all know and love.
  • Don’t support upper back with chair it is too static a posture.
  • Use nice flowing movements when working/typing.

Pacing
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Overcoming under/over activity cycles. Basically you have to pace yourself. Pain is a useless guide to setting baselines, sometimes it tells you to stop too early, sometimes too late. Do 2 to 3 baselines – activities you know you can do and for how long, then average them and begin at 20% less. Pace up slowly and gradually. Don’t stop if it hurts and don’t carry on beyond your set limit if it does not! Pain with activity may be inevitable to start with – it does not mean damage. Your arms/hands may be sore for up to half an hour after, this is about right (physioterrorist is the right description!) if your arms/hands hurt for 2 hours or more then you have started at too high a level. Keep to the same level of exercise for the day even if you are sorer than the day before. If you have much more pain for 3 or more days then revise your levels.

  • Do little and often, it is better than once a day or once a week.
  • Be kind to yourself – recognise small as well as large achievements.
  • Time your rest breaks and either make the rest break shorter or do more periods of activity in a day as you build up your strength or do longer periods of activity taking long rest breaks in between.
  • Time all exercise and work you do and keep records and build up slowly.

That way you can see trends and if you get a problem you can look back and see what caused it. You can also look back and see how much you have improved over time, to remind yourself that when you have a flare-up it is not as bad as when you started. Review the buildup pace weekly.
What hampers the body’s health and fitness:
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  • Prolonged rest.
  • Lack of movement when doing activities.
  • Tension in muscles while resting or being active.(restricts blood flow)
  • Prolonged activity without a break, beyond tissues peak endurance capability and their ability to lubricate.
  • Imbalance of muscles. (over-use of some, under-use of others)
  • Imbalance of joints.
  • Stiffening and shortening of tendons. Restricts their micro circulation and fibre lubrication.

Summary:
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Stretch, exercise and pace yourself, gradually increasing the level at which you do things. However she did not say what you do if you are constantly in pain, nor what you should do if you start developing RSI symptoms. There were stands from various suppliers showing Dragon Dictate, Kurzweil, the Microsoft Natural Keyboard, a keyboard from ICL/Fujitsu (similar to MS Natural), the Back Store, Wendy Chalmers Mill (Interact), Logitech (with their mice) and Maltron. They had most of the Leaflets on Industrial Injury/Benefits etc. and a leaflet on the Royal London Homoeopathic Hospital NHS Trust, Dept. of Musculoskeletal Medicine. (Great Ormand St. London) They offer ‘a natural meeting of orthodox and complementary medical care’ this means they offer: pain blocks, dry needling and acupuncture, trigger point therapy, electro acupuncture, TENS, manipulation, osteopathy, myofascial stretch and spray, postural assessment, exercise programmes and orthodox and homoeopathic medication. You can be referred by your GP (or by consultant) on the NHS to this hospital using District Health Authority or GP Fund Holding contracts or by Extra Contractual Referral (the last is how you get to see someone who your GP would not have a contract with and who they don’t normally send people to.)
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If you want the full notes she gave out I suggest you contact the RSI Association. Maybe they could become part of their information pack. I am now off on holiday for 2 weeks to recover. Keep doing those stretches.

Comment 1: I recently attended the input in patient course having had RSI related pain for over 5 years and I recommend their approach highly. Since finishing the course, I do their exercises and stretches daily, on top of the physio stretches I have always done and my pain and mobility is notably better. Following their approach requires a great deal of self discipline and also needs the patient to accept that they no longer have active RSI or whatever, which is difficult. If you go on a course at another clinic, make sure it’s an inpatient one – the brainwashing aspect of Input is one of the things that makes it work! If anyone wants to ask any questions, email me and I’ll send you my phone no offline – I don’t have enough spare hand capacity for lengthy email correspondence.

Comment 2: Interesting that they require you to accept you don’t have active RSI – seems a rather fine distinction to me, in that many of the suggestions in the original message are not about pain management but rather actively treating the symptoms of RSI (e.g. stretching, exercise, etc.).

Comment 3: Rather a belated reply but here goes.The first part is definitely true, and a good reason for mobilisation of the shoulders, back etc before working on the arms. However, I think that the second part is from the school that ‘chronic RSI cannot be treated so the best you can do is manage the pain, hence searching for a cure will just frustrate you and make things worse’. While there are undoubtedly people for whom this is true, this is IMO not at all true of many people with less deeply embedded RSI (e.g. last few years vs five years or more). There is really a decision to be made by each person as to which ‘form’ of RSI they have:
– chronic pain => managing your condition, vs.
– recoverable condition => active recovery possible
I would encourage people to try as many treatments as are applicable to the second case before they decide that they fit into the chronic pain case. I had RSI symptoms with varying severity for as much as three years before I got diagnosed and started recovering, and am now basically pain-free with some minor symptoms, so some people at least can go from ‘chronic RSI‘ to ‘mainly recovered’

  1. Drugs rarely help in chronic pain as they encourage people to do more and cause flare ups.
  2. Under/over activity cycles – you do too much, causes pain, so you rest.

I agree with these two, the latter can be viewed IMO as trying to ignore the condition rather than working within its limits; ignoring the RSI is something I tried to do from early on. All part of denying you have a problem… The rest of the Input pain management message, however, is excellent IMO, and is the best overview of RSI that I have seen – far better than the average book, and more aimed at practical remedies. Thanks for contributing this to the list. Hope you are recovered now!


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