Costochondritis II – The wicked itch is almost dead

SternumIt’s time I revisited my previous costochondritis posting as it has been a while since I posted it and its well overdue an update.

It has been over 4.5 years since I was first diagnosed with costochondritis  in my sternum after heavy labour in the garden. It has certainly proven to have been a very long drawn out recovery.  The recovery seems to go on like a logarithmic decay graph with a never-ending tail.

The main symptoms vary between achy pain in the sternum area (a bad flare up) and a very itchy, achy feeling that actually results in a lot of scratching!

For a long time I had been getting on with life, but with a lot of pre-planning of my activities around what I could do (without triggering a flare up) and apportioning accordingly. The activities I knew would strain the chest more I either put off or scheduled for another time when I would be less busy.  Its all been about pain (and itch) flare up management over the last 4+ years.

I started off by using Devil’s Claw (as I couldn’t use ibuprofen due to stomach irritation), taking two capsules once a day. This helped reduce the symptoms to a certain level, but I stopped taking it about a year ago due to other side effects. I had also used (and still do) a pillow to ‘hug’ in bed every night which keeps the sternum area from compressing in on itself, allowing it to rest and heal.

The problem with this condition is the lack of blood supply to the sternum area and hence the long, drawn out healing time.

I am a physically active person. I kayak a lot, I do cardio workouts on a static bike and an elliptical trainer and I also do yoga. I have generally found these activities to be tolerable with costochondritis (except for the arm action on the elliptical which I sometimes have to forego). I have to take it easy with certain yoga poses, again scheduling practice around other activities to avoid  overuse. I always found kayaking to be quite beneficial, but didn’t really know why. I assumed that it just wasn’t straining the chest area.

At the start of 2013 I was still having bouts of itchy costochondritis and was getting quite fed up with it. I visited my GP and mentioned to him that I still had this itch going on and he advised me to continue with physiotherapy exercises (which I admittedly hadn’t been doing for a while). Having had the condition for 4 years, I contemplated that the underlying bad injury was likely healed, but just hoping the rest of the symptoms would go away wasn’t working, so I began to consider what else I could do.

As a result, for the last 2.5 months, I’ve embarked on a fitness programme to try to get myself into better physical condition. It’s been challenging for a long time to do this with costochondritis, as upper body workouts have previously been very limited apart from kayaking. As part of the  fitness program I have introduced swimming as a regular (2-3 times a week) activity. My GP had said a long time ago that swimming was good for costochondritis, but I’d always been too lazy to drag myself along to the pool.

So now I’ve been swimming, and added 3-5 mile runs and cycling, on top of kayaking, and I am also starting to do some light weight training workouts too. The swimming is proving to be very beneficial to the condition, and I have good, healthy “used muscle” feelings around the back between the shoulder blades and across the shoulders and chest too. It hasn’t aggravated the costochondritis, and has taken the itch away most of the time (which is a fantastic feeling after all this time!).

I am attributing a lot of the improvement to the shoulder muscles being fitter and stronger (especially the group of muscles between the shoulders). I suspect that this is what naturally pulls the sternum to be more open, taking a lot of the  pressure off of the area that an unfit shoulder’s forward, slouched position produces. I also suspect that this is the reason that kayaking has been good for it too.

As a bonus, I’ve found that I can enjoy swimming as an activity, and am currently swimming to 2.5km in the pool 2-3 times a week.

The wicked itch is not quite dead, but I have a full grip around it’s throat and am not letting go until it is!

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A mindful approach to cardiovascular exercise

Mindfulness in cardio exerciseIn addition to battling RSI in my forearms, I struggle with other ailments including problematic knees. Along with yoga, cardiovascular exercise is a means of retaining the fitness needed to allow me to keep on top of these physical issues. The exercise equipment that I use most often is the static bicycle (actually a regular mountain bike with a Cycleops trainer attached), and I try to aim for a minimum of two one-hour workouts on this per week. This is usually enough to keep the quadricep muscles strong and to hold the knee joints together sufficiently tightly so as to feel normal.

I have recently been using the excellent “The Sufferfest”  downloadable cycling workout videos to train with. These are played on a screen placed in front of the training bike. The workouts are varied in style and target different aspects of cycling, such as sprinting, climbing, endurance, interval etc, and they are a much used and well recommended tool in helping me stay fit.

As any of you who are used to doing cardiovascular  exercise know, however, sometimes it can become a slog. What triggers this feeling?  Is it a busy life? Clock watching? Tiredness? Maxing out? Mind games?

I always wondered what caused time to drag during workouts, and using the Sufferfest video programmes certainly offers you plenty of visual (cycling road races and humour) as well as audio (pumping soundtracks and audio cues) distractions. This serves to help immerse yourself in the workout and avoid dwelling on the time remaining.  Regardless, I was finding that I’d still be clock-watching. Additionally, for a long time, I have used a heart rate monitor when doing cardio exercise. (This stems from 10 years ago when I did a 2000 feet climb on my bike each weekend, and needed to monitor heart rate to ensure that I didn’t spend too much time in the red zone). During my static bike workouts, I was finding that I would reach higher levels of  heart rate too quickly. This generally is not what you want to experience in a workout, ie gritting your teeth and suffering (despite the name!) for the whole one hour or longer. It is certainly not conducive  to establishing a regular exercise routine if you know you are likely to struggle both mentally and physically.

With all this in mind, I started experimenting with mindfulness during exercise. It’s actually easy to do, especially on a static bike. I shut my eyes for periods of high intensity exercise and flip the brain switch to “off” (you know the one that says, “I’m hot”, “I’m suffering” and “Is this done yet?” 60 times a minute!). You don’t actually have to switch your brain off,  just close your eyes, block out any thoughts of the workout, and think of very little (or if you can’t, then think of something nice like a river flowing). Your lungs and heart can cope with the workout quite happily without  your brain being over-active. Just be  aware that your legs are spinning and your lungs are breathing, but let go of the mental stress of the struggle.

Now the interesting thing about this approach is that, not only do you stop looking at the clock, but your heart rate drops too. I have done this on a regular basis for a while now, with consistent results. As a 46 year old, I have a maximum theoretical heart rate of  220-46 = 174 beats per minute.  When I exercise non-meditatively, I will rapidly climb to 170 bpm(ish) during high intensity parts of the workout (ie 80-100% effort), while dropping to 140 bpm during reduced intensity (30% effort) intervals. When I introduce meditation during workouts, these figures drop on average somewhere between 8 and 15 bpm, which is highly significant. Why is my heart having a lighter load when outputting the same energy in the workout? It is the brain activity that accounts for the difference. When you listen to a pumping soundtrack and watch stimulating images and clocks, your mind is extremely active. In order for the mind to be this active, it’s requesting more and more blood supply to support it. It can be argued that this is wasted energy which could be conserved for the parts of the body that need it later on in the workout.

This is a major breakthrough in workouts for me. I can now synchronise mind and body, conserving energy for my legs whilst keeping my heart rate well below the theoretical maximum.  The technique also has the advantage that the perceived duration of the workouts is now much shorter. Time seems a whole lot more compressed in the meditative zone.

This could be very useful in all kinds of athletic training, as meditation can be done with your eyes open (with practice), and can help athletes improve performance. How many athletes would like to have the ability to conserve 10% of their energy output for when it’s needed? No doubt this is part of the reason why increasing numbers of athletes and teams are engaging mindfulness advisers and experts.

I also ponder the power of mindful meditation and how it could help with issues such as RSI conditions, where we have a tendency to let our minds race to the worst places. “I’m at work, I’m using the computer, my arms hurt, is it 5 pm yet ?” etc. Again, it’s little wonder that programmes such as Mindfulness Based Stress Reduction are becoming increasingly popular in the workplace.

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TMS a mindbody approach to RSI

mindbody prescriptionLet me first start out by saying that I have long been a skeptic of the assertion that RSI is a condition solely controlled by the mind. I can attest to the fact that it’s certainly not just imaginary pain. So it was with a somewhat critical eye that I started reading the book, ‘The Mindbody Prescription’ by Dr John E. Sarno. The book has been available for a while, from 1998, but is nonetheless relevant today.

What drew me to finally read it was the one or two comments on this blog referencing it as having helped in dealing with RSI, coupled with a previous awareness of the book a few years ago.

The book is about a condition that Dr Sarno calls TMS (Tension Myositis Syndrome) which describes how there exists an ability in one’s mind (unconcious) to restrict the flow of blood (causing mild oxygen deprivation) to tired or injured areas which in turn causes those areas to stay continually sore, weak and painful (although not permanently damaged). The author states that the mind wants to create the pain as a distraction from other emotional/psychological conflicts or trauma that exist in the unconscious and have been repressed, perhaps things that happened a long time ago (eg as a child). If the issues in the unconscious mind were allowed to come forth, there would be an emotional mess in the concious mind. The unconscious mind therefore keeps a lid on these issues, and diverts one’s attention with pain which is focused on the body as opposed to the mind.  “The role of pain was to divert attention from frightening feelings” , as he puts it.  He states that it is only after confronting these issues, and accepting that you have emotional issues (“inner rage”, as he calls it) that need to be brought into your conscious and dealt with, that you can finally get over the masking symptoms, ie your pain. He attributes this process to causing all kinds of pain including back, neck and shoulder pain, as well as RSI conditions, other myofascial pain type conditions, back pain, and many others ranging from sciatica to tennis elbow and even cancer.

Dr Sarno also claims that the experience of continual pain can lead to the creation of an ‘inner rage’ which can be self-fulfilling, causing more pain. In his experience, the people who are more susceptible to this are the more conscientious workers who always strive to do their best in their jobs and life (ie perfectionists). This compounds their inner rage because it is impossible to live up to their own expectations of themselves. I can also admit to somewhat fitting this psychological profile.

He claims that treating this type of condition  physically (eg via physiotherapy) is a waste of time and that  any benefit is purely a placebo effect.

He recommends that firstly you need to accept that there is a psychological basis for your pain, that your body is not abnormal but is just being unconsciously made to feel abnormal . You should then identify all pressures in your life (old and current) that could contribute to ‘inner rage’ and deal with them consciously to reduce their possible negative effect in the unconscious. He says that accepting that your pain can be caused by the unconscious, and that it is nothing more than a distraction to your inner rage, can lead you to actually allowing your unconscious to release more blood flow to the injured (or painful) parts of your body and allow healing to take place and the pain to subside. This process can actually take place very quickly once you have established and realised the  psychological basis of your pain.

He does acknowledge that his views are far removed from mainstream medicine and clearly states that, “… mainstream medicine has yet to acknowledge the process whereby strong unconscious emotions can induce physical reactions”.

So where do I stand with this view? Well let me start by saying that Dr Sarno’s work is very well researched with lots of examples in his book and I certainly have no reason to doubt his findings. Indeed I have long stated that RSI is partially a psychological issue (but primarily a physical one). He does, however, flip this viewpoint around, albeit pointing out a psychological mechanism for creation of  the physical pain (restricted blood flow to injured areas, controlled by the unconscious) as opposed to just purely imagining you are in pain.

It has certainly led me to reassess my condition and review it from all angles and not to rule out the possibility of having inner stresses causing the restriction of blood flow into my injured arms. I am convinced that the human mind (both conscious and unconscious) does work in many mysterious ways, and wouldn’t rule it out as a potential cause. You certainly have to be prepared to open your mind to any possibilities with RSI, especially as I can concur that addressing the symptoms physically has done no long term good for me.

I do recognise, however, that we as humans are all made differently and, as a result, we will respond to a (TMS) mindbody approach differently. In the case of RSI, whatever you find that works is indeed the best solution for you and, let’s face it, the (TMS) mindbody option costs a whole lot less than endless physical treatments. If I achieve any results with this approach you will be the first to hear about it, in the mean time, it may be worth giving it a try…..

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Put your phone down!

Brilliant funny video from Fog and Smog films, but with a serious message for us RSI sufferers!

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Do 45% of Irish Workers have RSI?

IrelandIn an article entitled “Forty-five per cent of workers have suffered from RSI” published in siliconrepublic.com. There is a reference to a survey -

” … by IrishJobs.ie,  Enable Ireland and Assistive Technology Training specialists asked more than 1,000 employees about how comfortable they were as they work.”

OK, this was a smallish survey of 1000 employed individuals in Ireland, but perhaps it provides  a glimpse into how widespread Repetitive Strain Injuries actually are in the workplace. The findings showed that -

“… workers now typically spend from two to more than six hours seated at work, typing at the computer or on the phone. Of the 45pc who have experienced RSI symptoms, the back was the most affected area, followed by the neck, wrist and hand. Arms and shoulders were also seen as problem areas. More than half of survey respondents said they only suffered from mild discomfort, but 44pc said it was painful enough for them to be aware of it. Four per cent described their RSI symptoms as “extremely painful.” “

I have suspected for a long time that a larger percentage of workers than officially register an RSI do actually suffer from mild forms of RSI quite frequently. They are, however, perhaps just trying to deal with the symptoms themselves and are reluctant to appear like they are complaining to their employers about anything that may impact their job security or the perception of their ability to work.

Note: Despite searching for the actual survey results from  Enable Ireland, I can’t find an original source for it. If anyone has a link, please drop me a comment.

I did however come across this very useful looking document titled “A Tool For Everyone” about RSI for employers and managers on Enable Ireland website, which does reference a 45 percent figure, just not the survey I was looking for!

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The future is here

As I’ve alluded to before, for me, one of the most memorable scenes from the film, “Minority Report”, was when the “precrime” police officers interface with a large, transparent computer screen using arm movements, gestures and voice. This concept has immediate appeal to any RSI sufferers – imagine no longer using a tendon/muscle disabling device such as a mouse in order to interact with a computer. Ever since seeing  that in the film, I have had high hopes of reality catching up with science fiction, as often happens.

KinectAs it turns out, the movie was indeed quite prescient. Already we are seeing the trend towards computer tablets and anyone who has marvelled as they swished their fingers around an iPad screen, for example, will question whether they would ever willingly choose to use a mouse again. Not only that, Apple have now introduced some (by most accounts) rather impressive voice recognition software, namely Siri. Microsoft can’t be left out of the future, and the promise that their Kinect technology holds, if their slick ads are anything to go by, takes it well beyond the realms of Xbox games. Indeed, it has just been announced that Kinect is continuing its move towards Windows compatibility (next year) with the release of a SDK (software development kit) which will allow developers to create applications and games enabling the use of the Kinect add-on in Windows 8. After Kinect for Windows is released in 2012, in the words of Microsoft, “… the potential goes exponential”.

So I am feeling encouraged that the days of punishing input devices are numbered and that users will soon be able to interact entirely through natural body movement and voice. I picture the day when we see a mouse on display at the museum and chortle at how primitive a tool it was.

The future is arriving and it’s looking bright!

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Stress – No. 1 long term sickness absence cause in UK workforce

StressSeveral news articles yesterday referenced the findings by the Chartered Institute of Personnel and Development (CIPD) which show that, “… stress has become the main cause of long-term sickness absence for the first time across the British workforce”. Two main articles appear in The Telegraph as well as The Guardian. The Guardian article states:

“Worries about job losses have helped stress become the most common cause of long-term sick leave in Britain, according to a report that underlines the pressures on workers in a deteriorating labour market.

Stress has overtaken other reasons for long-term absence such as repetitive strain injury and medical conditions such as cancer.”

The article continues:

“The report highlights the strong links between job security and stress levels, with employers that are planning redundancies most likely to see a rise in mental health problems among staff.”

This is certainly to be expected given the current challenging economic times that we live in. I think the main disconnect in these articles about stress is that they infer that stress is a condition on its own, when stress in actual fact can lead to people being more susceptible to injuries and illnesses including Repetitive Strain Injuries (RSI) and many other health related conditions and, as such, we may not really have seen the full impact of stress on the British workforce.

Indeed I said as much in my article (from Dec. 2008) about it in the last major economic downturn in 2008 titled “RSI potential in these stressful economic times“.

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Elbow pain from kayaking

sea kayakingI have had more than my fair share of connective tissue injuries in my life so far. Indeed one of the reasons for getting into sea kayaking was because of cartilage  damage to both of my knees. As documented in this blog I have also had serious repetitive strain injuries in both forearms from working with computers for a long time.  So maybe it doesn’t come as a surprise to me that kayaking can also cause injury, since paddling is repetitive and can be a strenuous activity.

The main reason that I have been able to do kayaking is that my repetitive injuries in the arms have been localised in the forearms, wrists and hands. Kayaking is is an activity that is mainly done using the upper arms, shoulders and body for rotation and, as such, is not an activity that aggravates computer related RSI in the forearms.  I do, however, have to be careful with my bad right hand wrist. I have also had to use a neutral bent crankshaft paddle to keep the wrists from flexing, which does create pain with a more straight shafted paddle.

What I have recently been experiencing is pain around the elbows, that becomes apparent when kayaking, but goes away when I stop paddling for the day. Having been acutely aware of repetitive injuries, and also having read some good resources, I have at least identified what I believe is causing my elbow pain, I just haven’t yet figured out how to stop it from occurring in the first place!

A very useful resource for sore and tight muscle tissue and referred pain is “The Trigger Point Therapy Workbook” by Claire Davies a book which I have referenced in previous posts. From doing an analysis of the pain in my outside elbow, I was able to see that  a common referrer for such pain is the triceps muscle group. According to the book (ref pg 101-103, ‘Triceps’) there are trigger points in 5 separate  areas of the triceps than can refer pain into the outer elbow. Probing the triceps with my thumb identified an extremely sore and tight inner triceps muscle (referred to in the book as number 1 trigger point), about 4 inches down from the armpit. There were also very tight and sore muscles at the lower end of the triceps right where it meets the elbow (referred to in the book as triceps trigger point areas 2, 4 and  5). I had no tightness in the outer triceps (called triceps trigger area 3).

The tricep/elbow pain issue has come about as a result of a few windy, ‘slog’ like paddles where I am perhaps gripping the paddle tighter than normal, whilst pushing against the wind, coupled with perhaps a non optimal paddling technique. I maybe need to work on more torso rotation on those windier days out, or perhaps switch to a more straight arm paddling style. I may also have to introduce  some warm up stretches before setting off to paddle.

The triceps are one of the harder muscle groups to stretch out, and one of the only ways seems to involve putting your arm right over your head whilst pushing against your elbow or holding a weight to stretch the triceps further, which involves rotating the shoulder joint  as far as possible, which isn’t ideal.

I have started some nightly massage as well as stretching of the triceps muscles and some weights exercises in the hope that I can get them to quickly settle down to a less tight state and obtain some pain free paddling as a result.

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Trigger Point Therapy Update

I thought I’d write a post as a follow up to my trigger point therapy post since its been a while since I updated you on my status.

Let me start off by saying that trigger point therapy has been a fantastic tool for finding muscle knots in my arms, relieving and deactivating those knots through massage, and generally helping me understand a large part of what is going on with my arms. In the process of the trigger point therapy, however, I experienced (and still have) some ulnar compression going on in the nerve of the right hand which manifests itself in numbness in the outside edge of the pinkie (I don’t know whether this is related to the therapy or not) and I have currently greatly reduced trigger point massage to focus on the ulnar issue.

Does this put me off trigger point therapy? No! On the contrary it is one of the best methods I have encountered in understanding my RSI condition (and other painful soft tissue conditions), and potentially fixing it long term.

I am a 15 year sufferer so my condition is most likely a bad case, but what I have found with trigger point therapy is that you can deactivate a lot of the larger trigger points (muscle knots). I have also noticed that I still have many sites of smaller, much deeper tissue that still generate a lot of referred pain. As these are deeper down in the forearm, they are harder to access, massage and deactivate. I am also amazed at how many trigger points that I have found in many areas of the forearms. It is apparent that computer use, repetitive injury and continual adjustments to try to ease the pain when using a computer can lead to muscle knots forming in all kinds of places in the forearm. It’s not much wonder that such conditions are hard to diagnose, treat and recover from.

So in summary, I have currently backed off from trigger point massage due to the ulnar nerve numbness, but I am still 100% bought into this therapy for helping RSI.

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Microsoft Kinetic soon to be available for PC?

After much success with the Kinetic motion capture/control system (formerly project Natal), Microsoft is thought to be soon releasing the gesture control system for the PC, including laptop and tablet type devices. This could soon start a revolution in computer input. According to this article Microsoft has applied for a US patent called ‘Gesture Keyboarding’ and this article suggests Kinetic for the PC may be imminent, so we have potentially revolutionary times for all RSI sufferers. It will however remain to be seen whether any gesture control system can match the productivity of the keyboard and mouse, but its about time we had a viable alternative!

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