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. One pupil recently told me that her tendinitis came after spending a whole day weeding her garden, which had involved her twisting and pulling on the weeds in a repetitive way 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’. These figures are rising, with approximately 115,000 people in the UK having some form of RSI, which costs the economy 300m per year.
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 practising 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 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. The most significant of these is perhaps the least recognized by the medical establishment: the manner in which we misuse ourselves so that we create movement habits and poor posture that interfere with our functioning and strain our musculoskeletal system.
A young man came to me for Alexander lessons, who had developed pain in the left shoulder. This had developed as a result of trying to teach himself to play the double bass, without having any lessons from a bass teacher or thinking about his body use whilst playing. He was twisting around and lifting his left shoulder, in order to reach over the instrument to the strings. He had also been over-practising and repeating phrases for hours on end, whilst using this tense and distorted position. This sudden increase and over-use of his muscles was bringing about the shoulder pain – and he had only been learning the instrument for one month. Without a change in his use and playing technique, it is likely that he would soon be unable to play because of the pain.
So some of the causes of RSI are:
- 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 and overuse, 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.
- High stress levels can result in extra tension and ‘feeling down’ which can interfere with our poise, restrict our movements, create mis-use and sometimes lead to RSI.
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.
Medical treatment for Repetitive Strain Injury includes rest, anti-inflammatory medication, pain killers, steroid injections and physiotherapy, all of which treat the symptoms but do little to address the habits of mis-use the person has which usually causes the problem.
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, behaviours 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. As can be seen from the testimonial at the end of this article, the use of the Alexander Technique can transform the way a person approaches their work, so that conditions such as RSI can be greatly alleviated.
A few simple things that you can begin to do which can begin to help RSI, particularly if you are using a computer, are listed here:
- Make sure that furniture, equipment and instruments are well placed and suitable for your body size and movements. Place your monitor at eye height. If necessary, order different furniture and use voice-activated software until you learn how to change the way you compute and work. Vary the type of mouse you use, so that you use different sets of muscles.
- When using a keyboard, use your arms with your elbows at a 900 angle and your feet resting comfortably on the floor, with your knees also at a 900 angle. If necessary use a footrest.
- 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 regular 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. (A workout at the gym may make matters worse if you push yourself too hard and end gain)
- 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. I have taught several people who have done just that and importantly, they are also able to use the Technique to help prevent the condition from recurring.
“When I first visited Hilary I was in constant pain and could not even hold a cup of tea, let alone play the guitar. None of the medical professionals I visited had offered me a diagnosis, much less a cure. After my first session the pain was greatly relieved and six months later I’m playing the guitar again, albeit very carefully…..”
Andy Hopkins ~ Composer and Guitarist
You may read the full testimonial here. Andy is now able to work full time as a composer for TV and film, using computers and many musical instruments plus coping with frequent deadlines and ‘rush jobs’.