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fitness massage RSI

Muscle knots from repetitive motions

RunningI have been running more and more over the last three years for fitness purposes as well as for the prevention of middle age weight creep. It has been an interesting journey and one that forces you to analyse a lot of your associated aches and pains on a continual basis. Firstly, you try to identify and resolve them before they can manifest themselves into something more sinister and become a long term injury.

Running, especially longer distance road running, is a very repetitive exercise, with the same cadence, same stride and same motion again and again. This repetitive motion often leads to localised tight spots (knots) in the muscles that are doing all the repetitive work. I have found very sore tight muscle ‘knots’ in the calves, quads, hamstrings, and gluteal region. These points can be very painful in themselves or can refer pain to other areas. This can often curtail running activity until they are addressed.  Addressing muscle ‘knots’ is done via massage. Self massage can be done, and quite often it is useful to target certain areas with a foam roller or in the case of the hamstring by sitting down whilst laying the hamstring on top of a lacrosse ball  with the leg extended. Usually massage treatment can sort the tight spot very quickly and allow me to go back and run again within 24 to 48 hours.

The reason that I bring the running example into the discussion is that running as a repetitive motion can be used as an analogy for daily keyboard or mouse use, which involves constant repetitive motions of the hands and forearms for hours at a time. We are letting our hands and forearms do the equivalent of a long distance run every day, producing the same type of muscle knots in the forearm that runners experience in their legs. The muscle knots in the forearms then refer the pain via the tight tendons down into the hands and fingers causing the referred pain that we are all familiar with and call RSI. It is only through awareness, self treatment and education that we can learn how to prevent RSI from becoming a long term, debilitating problem.

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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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fitness Health Lifestyle RSI

Costochondritis a pain in the chest!

SternumFor the past 14 months (it seems like a whole lot longer!) I have had another overuse injury/health issue going on. The condition is called costochondritis, which is more simply know as a strain of the sternum (that flat area at the front and centre of your chest where all the ribs join on to). It may also be considered as another form of a Repetitive Strain Injury (RSI).

Up until I injured it, I didn’t even know that there was anything there to injure. I had been working out in the garden carrying stones in a bucket (a large muscle activity involving upper arms, shoulders, core, back) on and off for a day, when I finally sat down and noticed a general ache around the sternum area, as well as everywhere else I should hasten to add! Over the course of the next few days, all the aches disappeared except the one in the sternum. It was at that stage that I realised I’d injured something, I just didn’t know how bad it would be. Symptoms can include pain, tingling and an itching sensation around the centre of the chest area.

Over the course of the following week, I resumed my normal life doing picture framing, but noticed that I could induce bad pain in the sternum area when attempting to push against something heavy. This wasn’t good! At this point I did a little research and found out about costochondritis.  It is an injury to the soft connective tissue between the ribs and the sternum and can take a long time to heal due to the fact that there is not a huge supply of blood circulating to this area. I also got the advice of my GP who said that I just needed to rest it.

For the next 3 months I did my best to rest the chest area, which meant no lifting, pushing or carrying of anything remotely heavy in weight (including shopping bags!). One main difficulty I found was trying to rest the sternum while sleeping. The natural position of the body when sleeping on your side is to have both arms on the bed. This posture forces the sternum to be compressed and as a result does not give the area ample rest during sleep. Having restless nights also doesn’t help matters in this regard. One solution that I found is to sleep whilst hugging a pillow. The pillow has to be a puffed out largish one to keep the chest area open. It has proven to be a very useful method.

After 3 months of resting, the sternum had improved to the extent that I could actually do more. The question was, how much more? This, I found out by trial and error. If I did too much, the sternum would get more prickly, “itchy” and sore. It followed the same pattern every time: perform an activity, followed by prickly, itchy soreness for a few days, then it would calm down and I’d feel better again after a week. The trouble was that this went on for the best part of a year! Even now – some 14 months after the initial injury, I still have to be choosy about whether to try lifting something heavy or not. All in all, this injury has taken a long time to get better, and is one I could most certainly have done without!

The following are a few recommendations I would make for anyone suffering from costochondritis –

  • Rest up well for 2-3 months, avoiding all lifting of things including heavy shopping bags.
  • Hug a pillow while sleeping on your side to keep sternum area from being compressed.
  • Gentle reintroduction to exercise – yoga can be a good form of exercise to start recovery, so too is swimming.
  • You can use NSAIDs, eg ibuprofen to help with symptoms, but consult your GP first. I have also found much relief by taking Devil’s Claw (a natural anti inflammatory)
  • Have patience and don’t rush your recovery. After 14 months I feel like I am back to 90%, but I’ve been in the 70-80% range for a long time (nearly a year) and have frequently found a way to aggravate it somehow, usually by carrying something heavy.  This has happened even up to the 13 month mark!

This condition has certainly been very persistent, and has been quite frustrating to deal with mentally as well as physically, but after 14 months I am finally feeling like I am getting there. Fingers crossed!

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See my newer follow up post on this subject at Costochondritis II – The wicked itch is almost dead

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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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fitness forearm extensor RSI

My latest forearm extensor RSI rehab effort

homedics massager
Homedics massager

As you will know from reading this blog, I have had a chronic RSI condition in my forearms for over 14 years. I live with it by avoiding computer use as much as possible. Whilst resigned to having this condition long term,  I am always looking at ways to try to rehabilitate it somehow. Usually when things get more painful I resort to digging out an old, vigorous Homedics massager that I bought in the US. It’s a heavy duty one that is probably more designed for deep tissue massage of the back and neck, however, it can and is used by me to reach deep into the forearm extensor muscles for a relieving massage (although you have to be careful not to overdo it). This usually takes the pain down to background levels, at least temporarily.

The massager is, however, still only treating the symptoms of the RSI. What I really need is to try to strengthen the forearm muscles to an extent where they can resume being normal muscles tissue again (as opposed to the knotted, tense mass that is there right now). I have always drawn a blank as to how to do this.

NSD Power Ball gyroscope

I recently came across a friend with a NSD PowerBall Gyroscope (which I’d seen plenty of advertisements for but hadn’t got round to trying out), and my curiosity got the better of me. Amongst its claims is that it can be used as a “Rehabilitation product bringing gentle non-impact relief  to Carpal Tunnel syndrome (CTS), Repetitive strain injury (RSI), tendinitis, arthritis, and all wrist related ailments. Spinning for just five to seven minutes per day is enough to start your rehab!”.  Lofty claims indeed! I was keen to get my own Power Ball and get started!

The units are actually quite inexpensive (less than £10 for the basic model). The more expensive ones have electronic counters in them so you can count rotations and gyroscope speed RPM, which I decided was superfluous to my requirements. My NSD Power Ball arrived in a few days from Amazon and I ripped the package open with great enthusiasm and interest, as well as much hope!

The theory behind the Power Ball is that spinning the gyroscope inside the ball offers a resistance to motion of the ball. Spinning  the gyroscope is started by means of a short piece of string (or alternatively by means of an additional electric base unit at extra cost). Rotation of the ball with the hand/wrist keeps the gyroscope running and maintains resistance. The gyroscope, when in motion, will actually start to produce a gentle whirring sound. The faster the hand/wrist rotation, the faster the gyroscope spins and the more resistance the ball offers and vice versa. The resistance that you encounter is therefore  controllable in infinite degrees, and can be tailored to your own needs (or degrees of injury) which is useful.

Gripmaster

What I have found thus far (after about 1 week’s use) is that it is a really good way of getting the forearm extensors exercised in an aerobic manner (as opposed to the continuous micro movements that computer keyboard/mouse input dictates, which can lead to RSI conditions). I can honestly say that I have never felt the forearm muscles heat up as much, which is surely a good thing (I can sense blood rushing into them, which will hopefully be good to promote healing).  I am also coupling this with using a medium/low strength Gripmaster hand exerciser, and adding in a few forearm stretches too. I am keeping this routine to 2 to 3 x 10 to 15 minute timeslots each day. I realise that it’s important not to overdo it!

Having had such a long term injury, I am under no illusions as to the uphill battle I face to rehabilitate it, and it’s still too early to assess the long term benefits of using the Power Ball Gyroscope with a forearm extensor RSI injury such as mine, but so far I haven’t needed to use the big massager for forearm extensor pain relief again which is a good sign! I will report back here after more prolonged use to let you know how things are working out. I at least have a little hope to cling on to for now!

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Ergonomics fitness Lifestyle Miscellaneous Review

Move Well and Avoid Injury DVD : Review

DVD : Move Well Avoid Injury : What everyone needs to know about the body (by Barbara Conable and Amy Likar, Andover Productions, 2009)

movewell_frontcoverI may not be a medical professional, but I am able to tell when I encounter descriptions of body motion that just make plain sense, and this DVD contains some enlightening information. In a collection of well narrated chapters complete with diagrammatic video illustration, the evidence is laid bare of our common tendencies to keep our bodies out of balance, causing pain through muscle tensions that, in turn, keep our bodies in bad posture. This is due in part to us having mapped the body in a particular way, eg in relation to position, when in reality the position is entirely different.

This DVD is broken into multiple sections covering the many aspects of posture imbalance, and covers areas from the head to the feet and just about everywhere in between. Posture is translated by the authors as ‘Body Maps’ which are essentially memories in your mind of where you think your individual body parts are and how you use them. The DVD highlights how you may have had a flawed map (understanding) of your various body parts in your mind from a very young age. This may have led you to actually move according to those flaws and results in the straining of some parts of your body which can lead to pain. As the narrator tells us, “We move in the way in which we think we are constructed …”, either consciously or unconsciously. Wrong body maps can be responsible for many bad posture related problems, from walking to sitting, to using a computer.

Subjects covered in the DVD include –

  • Body maps – identifying flaws in the human body map and how to recognise those errors
  • Balance – identifying correct balance with core posture, and identifying posture related pain
  • Kinesthesia – learning free and fluid movement to correct body imbalances
  • Arms – covering shoulders, elbows,  wrists and hands
  • Legs – covering hips, pelvis, knees and feet
  • Breathing – covering lungs, skeletal/muscular system, diaphragm
  • Mapping the whole body
  • Correcting the map
  • Inclusive attention

The areas I can relate to most pertain to the shoulders, arms, wrists and hands. These are covered in detail and are very applicable to the RSI sufferer. The main posture/skeletal issues with RSI type injuries are listed, adding to the viewer’s knowledge and understanding through plain and straightforward explanations along with clear diagrams and video.

From previous experience, I knew that over-supination of the wrists was a bad thing, but now I know about the natural axis of rotation of the forearm and how it ties in with a neutral position wrist, as well as why supination causes so many injuries.

The company website rather generously shows sample videos of some chapters which are well worth checking out, and will give you a sneak peak of the DVD content and style as well as some key body map information!

I also found the section on breathing very interesting. It’s probably the first time I’ve been able to picture the role of the diaphragm in breathing, and I certainly had my lungs mapped as being a bit lower than they actually are. The related section on the ribcage was also revealing to me having just recently strained my sternum connective tissue whilst gardening. It  also reinforces the benefits of some breathing practices including Yogic breathing (Pranayama).

The DVD run time is a substantial 2hrs,  and certainly lends itself to being watched in stages. There is the temptation to skip straight to the section you are most interested in, however it should be watched as a whole to get the complete picture and overall message firmly ingrained in your mind. I expect that multiple viewings would be best to fully absorb the detail.

All in all this DVD is an excellent resource for just about everyone. It is not solely aimed at one specific group of people eg RSI sufferers, but covers the whole body, and should be a useful education tool for everyone, including ergonomists, physiotherapists, fitness instructors, yoga teachers etc, as well as many others including in the medical profession.

If you have posture related pain it’s likely that it’s down to your bad body map and it’s certainly time to re-educate yourself!

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fitness Miscellaneous RSI Tips

Yoga as a tool to combat RSI

YogaDuring my RSI awareness presentations I refer to the need for people at risk of RSI as well as those who already experience its effects to adopt physical activities. Yoga is one of those activities that I suggest. Why yoga?

In a nutshell, it combines a fairly physical activity encompassing muscle and tendon stretches from your head to your toes, with core conditioning and balance practices. This is coupled with controlled breathing techniques to allow the participant to focus their mind on the present moment. As well as the physical practice, yoga teaches techniques to promote deep relaxation and the ability to clear everyday thoughts from the mind with meditation. This powerful combination really can address a lot of the factors that lead to conditions like RSI (primarily driven by the overused micro-movements of muscles and tendons coupled with bad ergonomics and stressful working conditions).