Splints & physio

Question: I’ve just been reading through the FAQ’s as I wanted to see if there is anything further I can do to help my RSI as my GP and physio don’t understand it at all. I have now been back to work for two days and I had ultrasound yesterday yet by last night, due to a heavy workload where I’d had 3 weeks off for this, my wrist was really sore and achy not as bad as it was when it first happened but not as good as it had been recently. I’m going to see how it goes today and if it starts up again I’ll have to go back to my doctor and push for something serious to be done about this as physio is not helping at all. I have a couple of queries about a few things I read on the FAQ’s.

There is mention there of physio giving you stretches to do and I have heard people on the list mention this. What sort of stretches are these, my physio has done nothing except give me ultrasound once a week for the past two weeks with only one more session to go! She did give me a splint and told me to use it for driving and if I’m doing a lot of computer work, but I note on the FAQ it talks about using the splint when resting and at night, so I’m a bit confused really as to whether I’ve been given the right advice or have just been fobbed off with some old flannel as she thinks I’m a hypochondriac! Can anyone give me advice on use of the splint and stretches that they have been given to do?

Answer 1: I use splints during today for typing and I take them off and stretch each 30 minutes. I also use the splint at night when I sleep. My employers are very kind and considerate and have purchased Dragon’s software for me to use. It has been a tremendous help to me. The stretches I use art in this book: Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries By Sharon J. Butler ISBN= 1-57224-039-3 (paperback) USD $20.00

I found the book on my own incentive. The orthopedic surgeon did not recommend this to me initially. I showed it to him and he told me he learned something from me! The doctor I visit is a hand and upper extremities specialist here in Houston, TX. You would think he would know more about this, would not you? I am blessed in that I have not had surgery and am doing my best not to have it. These stretches are very gentle and are based on Hellerwork. I have had very good results with them especially when I was in pain. I truly think it helps to do them at least twice a day and three times is preferable. I hope this helps you, too. I have also found that taking MSM (a biological sulfur by Futurebiotics) has helped my pain. I purchased it at the health food store and take 1/2 teaspoon per day.

Answer 2: If you are trying to catch up on three weeks work then you will indeed get a flare-up! Take it easy. The stretches are to treat AND/ANT (see the FAQ) and are to mobilise the nervous system to get the nerves sliding in their sheaves properly. If your physio knows of the book ‘Mobilization of the nervous system’ by David Butler (see review on RSI-UK web site) then the physio will know what they are doing. I must add that doing lots of stretches is going out of fashion; you are now supposed to massage the nerves instead. Wearing splints whilst you are active is not a good idea as they restrict movement and blood supply and causing weakening of the muscles which is the last thing you want in RSI. Just use them whilst you are resting.

Answer 3: I feel a bit smug about this as I’ve been massaging my hands and wrists ever since I got my (non-diffuse) RSI. But the real credit goes to Casparelli/Quilter, who recommended this all that time ago adding that it was a symptom as well as a treatment – one of those “self-healing”, “instinctively protective”, symptoms, I suppose. I do it fairly instinctively but also because they suggested it. Warning: It’s Social Death, far worse than wearing splints. But who cares?! “Wearing splints whilst you are active is not a good idea as they restrict movement and blood supply and causing weakening of the muscles which is the last thing you want in RSI. Just use them whilst you are resting”.I disagree with you slightly on this. I do think your advice is right for Gemma until she can get some better advice from practitioners than she is getting now. But generally I would say, there is more than one kind of splint and more than one way of wearing them. The cock-up splints with the curved metal inserts are good for resting (sitting down, holding the wrist in the “recovery position”; I can’t sleep wearing them; luckily I don’t clench my fists when sleeping and on the whole, don’t bend my wrists). The ones with straight plastic inserts are good generally. There are some thumb ones with very light inserts that are good generally too.

Of course and as I think the instructions on the good splints say, the inserts can be taken out, too. The dangerous thing is I believe to wear the cock-up kind, and perhaps any rigid kind, while working and particularly while typing  though any time when you might end up forcing your wrist against them is bad. But I may disagree with you for this reason. I’ve now realised – I wear my splints at least one size too big, because that’s the only way I can get ordinary ones to support my thumbs!

Answer 4: I went back to work yesterday after time off… And am now signed off work again for another 2 weeks, as I was experiencing a lot of pain! My physio has given me stretches to do, which involve holding my arm by my side and twisting it round as far it will go, and then once it has gone as far as it will go, I pull my hand back until I can really feel the pain of the RSI. I have been advised to do this both clockwise and anti clockwise, hold for 30 seconds each time, and repeat 4-6 times a day depending on how comfortable I find it! Supposedly this will help to release the strain that my nerves are under!! Although I will stress that on my first session my physio did point out that he didn’t think there was anything he could do to ‘cure’ me! These stretches are merely for my own piece of mind. I guess in some ways psychologically beneficial.

Also can I point out though, that my physio spent a lot of time teaching me how to do these stretches properly, and I wouldn’t do them without having been taught in fear I do myself more damage. My physio also pointed out that the only way to get better would probably be through not using a pc for 2-3 months in order to let my nerves heal themselves. They are not going to heal if I keep aggravating them, through use of the PC! Hence I think my family is not going to be too happy with my complete dependence on them from now on for checking my mails on RSI.

Answer 5: Sorry to blurb on again for those who have already read my mailings. “RSI” diagnosed for 12 years. Considered a “chronic” case: tenosynovitis, tendonitis, CT ops, trigger fingers ops – all to both arms/hands. I have developed arthritis (in the family): foot, knee, probably neck and back. (Also diabetic) Whenever I used splints (various kinds) my hands would either tingle, become numb, but the main thing is that my hands/fingers lock whenever held still for a short period of time (hence I don’t drive). Too much keyboarding obviously has the same effect. (I won’t mention pain/aches here) So what I’m trying to say is that, for me, splints were/are useless, maybe this is because of the trigger finger probs. I tend to rest my arms on cushions, but I’m still able to move hand/wrist when I feel them solidifying.

The ortho surgeon, who is the only one that takes a serious interest, has stated that physio won’t help me, we have tried physio for locked shoulder (tendonitis in the rotator cuff), but that didn’t help and the physio thought too much would aggravate the rest of the probs. The chief neurologist “argued” with his sub. about sending me for wax baths, etc. The sub won – I went, but of course it was no use. I do wonder if the various exercises mentioned in the list are suitable for certain complaints, but not all. After all RSI is an umbrella term for various different diagnoses and there are many different ones concerning shoulders, arms and hands. We are complex creatures aren’t we! So I carry on with normal tasks, etc, but at a slower pace. I don’t work f-t, so I consider myself retired and “helping the community” by being sec. of a local art soc.!  That keeps me going socially and mentally. I hope this doesn’t sound negative – that’s not how I feel right now.

Answer 6: Absolutely. What works for one person won’t necessarily work for another and some stretches and exercises shouldn’t be tried at all without supervision or advice from someone with appropriate training.

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