Repetitive Strain Injury (RSI)

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Repetitive Strain Injury, Overuse Syndrome or Work Induced Upper Limb Disorders

These are all general terms that cover a variety of overuse injuries to muscles, tendons and nerves, predominantly of the forearm, wrists and fingers. Some of the conditions considered to be overuse syndromes, are bursitis, carpal tunnel syndrome, rotator cuff syndrome, tendinitis and tenosynovitis.

 

RSI is an increasingly common condition that affects many people who, for instance, use machines that vibrate constantly, play a racket sport, use a keyboard or play a musical instrument. Such activities require repetitive movements of the fingers and wrists, often at speed, for hours on end.

A recent report on the BBC news quotes Professor Peter Buckle, University of Southampton, as stating that his research has shown that 'In some populations that we've studied, between 22% and 40% of people have evidence of RSI' .

Symptoms

The symptoms of Repetitive Strain injury are pain, weakness and tingling in the muscles and joints of the fingers, wrists and forearms. These symptoms tend to worsen over time if the condition is not addressed and treated. Initially the discomfort may only be experienced for short periods, during the activity that initiated the condition. This is the point at which changes need to be made in the person's habitual manner of use and probably in their conditions of work, so that some of the damage can be healed and the condition halted before it gets worse.

If the person with RSI ignores the early warning signals and continues to end gain, working or practicing in the same habitual way, the pain can gradually become continuous, chronic and disabling. At this point, it may be extremely hard to heal the condition. This really is a case of prevention being better - and easier - than cure.

Unfortunately, many people do go on working without addressing the problems they are experiencing. BAPAM (the British Association for Performing Arts Medicine) is familiar with this problem in musicians, who are often afraid to ask for help in the early stages of RSI, in case they are seen as unfit to play and thus lose work. However this unwise decision often leads to severe problems developing and by the time performers eventually seek help, they find they have to stop playing, sometimes for months and occasionally completely.

As Elizabeth Langford so clearly puts it in her informative chapter in which discusses how the Alexander Technique can help people with Repetitive Strain Injury 'You... need to become receptive to warning signals before they become pain, before they become strain, before they become injury'

Elizabeth Langford ~ Mind and Muscle p.209

The causes of RSI are many and often interact to contribute to the condition but the most significant of these is perhaps the least recognized by the medical establishment, the manner in which we use or misuse ourselves:

• Overuse and misuse of the same set of muscles whilst performing the same activity over and again, so that they become fixed and tense and the circulation becomes sluggish. Sometimes this can be linked to feeling 'bored stiff'.
• An end gaining, perhaps driven attitude towards work, which usually goes hand-in-hand with an intense manner of performance, along with a reluctance to take short breaks during the working day, let alone holidays. These habits will tend to escalate with high stress levels, so the person's mind and body cannot unwind and free-up without help.
• Poorly designed or badly placed equipment, or a musical instrument that is held in a way that hampers movement, can contribute to the condition.
• Even with good ergonomically designed equipment, many people still have poor posture and general misuse which contracts muscles and reduces the capacity of the body to function properly. These muscle tensions can irritate the nerves and build up to RSI.
• Over-long working hours and a too-heavy schedule put too many extra demands on people, so that they become exhausted and far less able to take care of their use whilst working and performing.
• Cold temperatures can contribute to the condition - for instance, working whilst sitting under the cold draft from an air conditioning unit.

In her book 'Save Your Hands!' Lauriann Greene describes how she had to give up her career as a massage therapist, because her training had left her with painful RSI. Greene also saw that other therapists had similar problems. This had come about largely because of institutional end gaining, with tutors omitting to consider the means whereby trainees were working.

Greene states that 'As I read texts on massage, it struck me that the emphasis was always on ensuring the comfort and safety of the client, not the practitioner' p 4. Greene sees that an important part of helping other massage therapists to avoid such an outcome is to encourage them to work on their body alignment and to notice what is going on in their own body whilst they work, saying 'Movement centered disciplines like... Alexander Technique teach students how to move their body in less stressful ways to encourage overall health' and ' can be extremely helpful for massage therapists'

Lauriann Greene ~ Save Your Hands! p 105.

Treatment

Medical treatment for Repetitive Strain Injury includes rest, anti-inflammatory medication, pain killers, steroid injections and physiotherapy.

The NHS Direct Website also states that learning the 'Alexander Technique... may help' and the RSIA Website goes further, saying 'The effectiveness of the Alexander Technique is well documented and has been the subject of several scientific studies. It is increasingly recommended by doctors, and many medical insurance companies will pay for lessons if these are prescribed by a consultant'.

It is important to remember that no amount of pain killers will actually change the condition. The work situation needs to be altered and the old habits and thought patterns that helped cause the condition need to be inhibited, so that a new way of working may be learnt which puts less strain on the body.

• Make sure that furniture and equipment are well placed and suitable for your body movements. If necessary, order different furniture and use voice-activated software until you learn how to change the way you compute and work.
• Take regular short breaks and vary the tasks and range of movements made, to help re-balance muscle usage. Make use of software that monitors your computer use and indicates when it is a good idea to stop for a while. Use the break to move around, let go of tensions and free-up your muscles.
• Most important is to pay particular attention to your use and the means-whereby tasks are performed. This is most easily done with the help of an Alexander Teacher. Make sure you are poised, your movements are free and that you inhibit any urge to resort to being driven, contracted and tense whilst working.
• Take gentle exercise such as walking, which will help your general muscle tone and circulation, particularly if you pay attention to the manner in which you walk, so that you avoid creating different patterns of tension and allow your body to work freely as you move.
• Avoid sitting in draughts and keep warm enough.

An interesting case study by Pedro de Alcantara, an Alexander Teacher who describes working with a pianist with RSI, is to be found in his book Indirect Procedures (p 22).

By taking a course of Alexander Technique lessons, someone with RSI who is willing to allow themselves to change their way of working can learn how to manage their condition, let go of entrenched habits of misuse, reduce and sometimes even eliminate pain in the process. Importantly, they will also be able to use the Technique to help prevent the condition from re-occurring.