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commentary fitness Health RSI

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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commentary fitness Health Lifestyle mindfulness

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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commentary video

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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commentary Health RSI

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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commentary Lifestyle RSI

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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commentary forearm extensor Health RSI trigger point therapy

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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commentary Input Devices RSI

It’s a mouse! Ouch!!

Computer mouseI constantly see advertisements for ergonomic mice. It seems like every company has an ergonomic mouse out there that has been specifically designed to reduce RSI, improve ergonomics, help avoid injuries etc etc.

Just about every time I eagerly check out a picture of the new super ergonomic mouse, however, I am usually confronted by a picture of – well, a regular two/three buttoned mouse with scroll wheel. So I’m expected to continue clicking and scrolling and reaching out to one side to use these ‘ergonomic’ devices? I take one look at this and automatically think – ouch!

It is my opinion that designers need to start thinking outside the box when developing ergonomic equipment, and not just try to flog to the general public the same old mouse design with perhaps a shinier, rounder, more colourful appearance and expect them to believe it’s a major breakthrough. It is actually amusing to see how many ‘ergonomic’ mice there are available now. Obviously, no-one wants to be responsible for selling ‘un’ergonomic mice, so it has become an over-used label with a view to seeing how many gullible people bite.

If any of these manufacturers were serious about producing an ergonomic product then they should test these with a wider group of RSI sufferers with different types of RSI. Let’s face it, there are enough of us around these days!

One reason I recommend the Contour Rollermouse is that the designers obviously used some lateral thinking when designing this product. I can also attest to the device allowing me to prolong my working life by 2-3 years. I only wish I’d found one earlier so I could have avoided a more permanent injury.

I  don’t know about you, but I have a knack for looking at an ‘ergonomic’ mouse and saying ‘ouch’ without having to try it. Maybe I’m just an old timer at this….

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Career commentary fitness forearm extensor Lifestyle RSI

Understanding RSI

One of the particular frustrations with having an RSI condition is that, as devastating as its impact can be upon lives and careers, it can be easily dismissed as insignificant or “all in the head” by those who have had no insight into its nature. When even the medical community can be guilty of dismissiveness, it’s little wonder that others can be skeptical too.

It doesn’t help that RSI isn’t a terribly visible condition. Even so, when I was wearing 2 arm braces pretty much on a permanent basis, initially they attracted some comment along the lines of, “What have you done to your arm(s)?”. After some time, however, my colleagues became accustomed to seeing me wearing them and I simply became the guy with the arm braces. It also doesn’t help that an RSI such as mine can preclude the movements that caused it, ie working at a computer, but does not necessarily (and thankfully) mean that other activities can’t be undertaken, ie ones that do not employ the same worn-out muscles. When the activities that can still be engaged in happen to be recreational in nature, this only serves to feed suspicion that the RSI somehow isn’t genuine.

I am fortunate in that I can participate in an outdoor activity that involves the use of my arms, and that is kayaking. To the uninformed, that might seem like a contradiction. How is someone who gave up their career because of forearm pain able to paddle? Some brief consideration of the movements involved should answer that question. There is a substantial difference between clicking a computer mouse and a keyboard all day every day and lifting a paddle in and out of the water over a period of a few hours per week. Indeed, the latter could be deemed as a healthy movement involving mainly the upper arm muscle groups including biceps/triceps and shoulders, with minimal forearm motion, and only a light grip. Regardless, I do still have to be mindful of my paddling technique as, for example, incorrect paddle grip could lead to exacerbation of my RSI, especially in the right hand wrist. Indeed, I have invested in a “neutral bent shaft” paddle that is ergonomically designed to lessen the impact of paddle stroke upon the wrists. It is also exceptionally lightweight.

It is easy to form immediate judgements about others’ conditions, but I would encourage anyone who is suffering from an RSI, or who knows someone who is, to educate themselves on the subject thoroughly before jumping to conclusions concerning capabilities.

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Career commentary Ergonomics Lifestyle RSI

The many forms of RSI

Speedcubing - a potential cause for RSIIn this blog, I have focused substantially on RSIs associated with computer and mobile device usage, specifically wrist and arm injuries. Of course, there are many other types of injury that can result from occupational overuse, whether you are a programmer, a checkout assistant or a chainsaw operator. Injuries are not confined to work of course, but can also result from leisure pursuits such as piano playing, golf, tennis, running or even Rubik’s cubing! Examples of the types of conditions that can be caused by such activities are: tennis and golfer’s elbow, thoracic outlet syndrome, De Quervain syndrome, as well as the more classic carpal tunnel syndrome and cubital tunnel syndrome.

Repetitive activities, including computer use, can adversely affect more than just the wrist, hands and arms, but also the neck and shoulders. Some years ago, my wife developed a constant and debilitating shoulder problem on her right side. At the end of each day in the office, her shoulder would ache such that the muscles would feel as if they were exhausted. Being right-handed, the most obvious association was with her computer mouse, yet it was apparent that this type of large-muscle ache would most probably not be addressed by using a different, more ergonomic mouse. It wasn’t until she moved jobs and her new desk included a drop down keyboard and mouse tray that the shoulder injury disappeared. Simply lowering the mouse pad had solved the problem. Even today, should she momentarily use a laptop and external mouse on a table top, for example, the shoulder issue will recur.

In addition, the range of occupations potentially affected by RSIs is wide. On several occasions now, I have encountered checkout cashiers wearing tell-tale arm braces which I instantly recognise  as probably indicating an RSI. I have chatted to such individuals and, indeed, they inform me that the repetitive motion of swiping products in front of the barcode scanner has caused their injury. I have recently heard of a tree surgeon having to scale back workload due to pain in his arms from the constant overhead operation of a chainsaw.

Examples of occupations at high risk of RSIs include:

  • Journalists, programmers, software engineers – anyone using a computer to do their job
  • Construction workers
  • Checkout cashiers
  • Production assembly line workers
  • Machine operators
  • Postal sorting workers

Sometimes it is not necessarily repetitive motion that is at fault, but holding the same position for hours on end. For example, many neck problems develop after possibly years of bad posture and/or inadequate breaks whilst staring at a computer screen, or performing any occupation that involves looking downwards (eg a jeweller). Even sleeping is not without hazard, if you are in the habit of lying on your front with your head to one side for example.

Of course, the key words here include “repetitive”, “overuse” and “habit”. The same principles apply in addressing these conditions:

  • Awareness
  • Good ergonomics
  • Adaptive software or hardware (this can include anything from computer mice to chairs to running shoes!)
  • Adequate breaks
  • Improvement of posture
  • Therapeutic exercise such as yoga, pilates etc
  • Avoidance, if necessary

So, regardless of whether you are at work or play, upon experiencing the first twinges of pain, it is time to become aware of the cause and to address them accordingly. The choice is yours – you can make the necessary adjustments to your work or leisure habits now, or be forced to give them up entirely later.

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Career commentary RSI

The rise and fall of a promising career

I have touched on many of the practical dos and don’ts about RSI, but what about its associated stigma and how it has the potential to change your employer’s perception of you?

Usually RSI sneaks up on you and hits you when you are most under pressure and least able to cope with or, indeed, rest from its causes. Often it seems RSI hits conscientious hard workers. In my case, I went from being a top performer to a problem employee in the space of  less than 10 years. This steady decline was not something that I wished for, wanted or felt happy about, but there was very little option, later at least, to change course. I could make management happy by working harder and thus continue to hurt my arms and hands, and I knew that backing off work would mean less throughput, less visibility and fewer financial rewards. It’s a vicious cycle.

I can remember how it ultimately felt when I quit. In one respect, there was the relief of being free from the cause of pain but, on the other hand, there was the bitter feeling of how the injury had made me fall from being a top rated performer to simply a problem employee in the space of 10 years. In truth, the injury had led me from loving my job to becoming almost disillusioned with it when I realised that I just couldn’t perform my role any more due to the pain. It’s a nightmare journey with a lot of frustration along the way.

It was also a sad day to finally say goodbye to my engineering position, in which I was qualified and had spent the best part of 20 years doing, in a career that I really had enjoyed. And, of course, the future lay before me with a very large question mark over it. There were a lot of mixed emotions.

The one thing that still rankles me is how the transition from a star employee to a problem one can happen. An injured worker isn’t very useful to a company and there is a breakdown in relationship between employer and employee when you get injured, which I guess relates to the business ethos. It’s a fact of life that, if you are limited in learning new things because you are injured, then you are becoming less and less useful. The only contribution for a long term employee is knowledge of the job. This can be tapped into in an advisory role for a while, but once that knowledge is imparted or becomes dated, your usefulness rapidly diminishes and you become a problem that needs to be addressed. Should I have done more? Should my employer have done more?  There are many open ended questions that linger with me to this day, ones that I know will never have an answer.

If I could change one thing, I’d have taken the injury more seriously a lot earlier. I can’t over-stress this point to anyone reading this who has just developed an RSI. It is very important to break free from the underlying causes before you too end up going from star employee to company problem.

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