Treating Chronic Repetitive Strain Syndromes

by | Mar 19, 2011 | Sprains and Strains


If your job, hobby, or recreational activities involve repetitive movement patterns you may develop a repetitive strain injury, or RSI.  Also known as overuse injuries, cumulative trauma disorders, and musculoskeletal disorders these types of conditions are characterized by pain, inflammation, swelling, and reduced joint movement.

Some of the more well-know causes of RSIs include:

  • typing/data entry (wrist tendonitis, epicondylitis)
  • hair styling (wrist tendonitis)
  • using vibrational tools (wrist, hand tendonitis)
  • carrying small children (deQuervain’s syndrome)
  • tennis (lateral epicondylitis; i.e. tennis elbow)
  • golf (medial epicondylitis; i.e. golfer’s elbow)
  • running (achilles tendonitis)
  • bowling (medial epicondylitis, wrist tendonitis)

RSIs mostly affect tendons, ligaments, bursae, and neural sheaths but they can affect muscle fibers as well.  What happens is the offending activity places unusually high demand on these structures resulting in microscopic tears to the tissues. A very gradual inflammatory response follows, which then takes a life of its own.  At this point the patient notices that the pain is more frequent and doesn’t go away with rest, and he/she may reach for an over the counter non-steroidal anti-inflammatory like Motrin.

What makes repetitive strain injuries so persistent is that they are caused by an activity the individual needs ( job) or loves (favorite sport) to do, and essentially he/ she “re-injures” the condition with the activity until it gets to an advanced stage.

Most of the time a repetitive strain injury is transient; i.e. it appears for several weeks then disappears.  The patient resorts to icing, rest, temporary discontinuation of the offending activity, over the counter meds, massage therapy, bracing, and in some cases, cortisone shots.

In some people, the pain turns chronic; i.e. doesn’t entirely go away even after weeks and months since the onset.  If you are experiencing this, it can be due to improperly healed microtears causing abnormal muscle and tendon performance; and perhaps trigger points which are believed to be concentrations of nerve endings at an old injury site.

When the condition is chronic, you can attempt to do the therapy in the video above.  You use a flat edged massage instrument to “strip” the muscle close to where it attaches to the joint.  This can help loosen any fibrous adhesions (“stickiness”) that may be interfering with muscle and tendon movement.  It also mildly agitates the area (be careful not to overdo it) and increases blood flow, which can stimulate repair by fibroblasts, special cells that synthesize collagen.

This therapy is not to be done when the condition is acute (recent onset, hot, red, swelling).  Doing so will make it worse.  Try it only when it has reached a chronic stage and inflammation is absent.  If it causes an unusual increase in pain, discontinue and apply ice.

Wrist Pain and Treatment

Wrist Pain and Treatment

by | Aug 26, 2010 | Hand and Wrist Pain

Wrist pain from overuse affects over 50% of people whose job requires frequent typing on a computer keyboard.  However, any job or activity that requires repetitious finger movement is capable of causing this type of wrist pain.

wrist tendon anatomy

The leading culprit is tedonitis, or tendinitis — inflammation of the wrist tendons; more precisely the flexor digitorum tendons which pass through the wrist.  As you move your fingers alternating between flexion and extension, which is essentially what typing is, the wrist tendons rub against one another.  The tendons are protected by a slippery sheath to allow smooth gliding during movement, but if this sheath loses its protective qualities, it can cause the tendons to inflame and swell.  Certain drug side effects and illnesses can cause this; check with your doctor.

The problem with tendonitis is that, by nature it affects tendons of muscles that are needed for work or play; for example the wrist for typing, the elbow for golf and tennis, and the achilles tendon for running.   The individual therefore continues in the offending activity until she can no longer tolerate the pain, and by that time a lot of microtrauma has occurred.  The microtrauma (tiny tears and fissures in the tendon and sheath) releases inflammatory products and attracts scar tissue formation, which makes them stick together even more.  The tendons undergo trophic changes (changes on the cellular level) and don’t function as well as before leading to chronic pain.

Prevention is the key for all cumulative trauma/ repetitive strain injuries– these painful conditions are totally preventable and don’t need to happen in the first place.  You don’t want to ignore prevention because tendonitis takes a long time to resolve once it is entrenched.  In some cases, tendonitis can lead to carpal tunnel syndrome, where the median nerve in the wrist gets squeezed and injured leading to numbness and weakness of the hand.

For wrist tendonitis from typing, make sure your workstation is ergonomically set up:

  • Use an adjustable keyboard tray to lower and angle down your keyboard at a level where you don’t need to contract your shoulder muscles to raise your arms above the keyboard.
  • Keep your upper arms in the same plane as your torso, and close to your sides (don’t type chicken winged).
  • Keep your elbows angled at about 95-100 degrees, wrists straight in line with the forearm or slightly bent downwards
  • Use a good chair with lumbar support and if necessary a foot stool to rest your feet on
  • Head up, ears directly over shoulders, eyes in line with center top 3rd of  computer monitor; shoulders relaxed.

Take 30 second to a minute mini-breaks if you are going to be typing more than an hour straight.

Stretch wrists periodically in flexion and extension; hold for 10 seconds; do wrist circles ten times in both directions.

Do shoulder circles ten times in both directions.

Do chest and neck stretches every other hour during the day.

Stand up and do wall angel exercises (50) at least twice during the day to counteract the tendency for neck and shoulder flexion during sitting.

TREATMENT:

1. Do ice massage every two hours during the day if your pain is acute (feels hot, swollen and in some cases, reddish skin).  Here’s a YouTube video of how to do it.

2.  Apply Red Light Therapy to your wrist.  The Red Light torch is great for this.  Press it gently but firmly into your wrist and depress the button.  Do three times/ day, 10 minutes each.  Research shows that red light therapy reduces inflammation, almost as good as a non-steroidal anti-inflammatory medications.

3.  To further accelerate healing, apply Pulsed EMF to the painful areas.

SUPPORTING EFFORTS

Eat an anti-inflammation diet for 2-3 weeks:  go heavy on fish oils; reduce grain intake; eat plenty of alkaline foods (green leafy plants).

Don’t do stretches when your tendons still hurt; introduce light flexion and extension stretches when the pain drops by at least 75%.

Do your best to reduce the activity that precipitated the tendonitis for 2-3 weeks.

When you have cured yourself of the pain, implement the preventive strategies mentioned above so it never happens again.

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