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

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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Career commentary Ergonomics faq Input Devices Lifestyle RSI Tips

New RSI Frequenty Asked Questions (FAQ) Page

rsi_faq_mdI am happy to announce the release of my latest update to this site, a Repetitive Strain Injury (RSI) Frequently Ask Questions (FAQ) page along with answers! This is basically a download of information from my head as to my understanding of RSI, along with relevant links and information, and is without doubt the largest information release I’ve done on this site. Hopefully you will find this useful. Please feel free to comment and share.

commentary Ergonomics RSI

RSI – Mouse use biting people

An excellent RSI article has appeared on BBC News technology section title “The mouse is biting some PC users“. The article quite concisely summarises the main issues at hand (no pun intended) with RSI.

The article indicates that RSI is part of an ever increasing phenomena affecting 115,000 workers last year a staggering 34% increase from the previous year. If ever we needed evidence that RSI is reaching epidemic levels, then this is it.

It also contains a quote from Pauline Cole (a spokesperson for the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE))

“A lot of people are using computers more, even in jobs you wouldn’t traditionally expect it”.

This is the trouble with RSI conditions. Just about every job these days requires interaction with computers, and this can present major challenges when a worker is affected with RSI, there are few options out there to allow them to work whilst avoiding computer use and allowing their bodies to recover, except for perhaps manual labour.

In another revealing quote from the article, this time from Bunny Martin (who runs charity Body Action Campaign)

“schools tend to have a single standard computer set-up for nine and 15-year-olds alike.”, and alarmingly she notes that “around 60% of children she meets have first symptoms of RSI, including strain-related pain in the neck and shoulders.”

This is a staggering fact and if RSI is impacting children years before they start looking for employment then we truly are sitting on a RSI health time bomb.

All in all an excellent summary article on where we are at with RSI.

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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).

Ergonomics Input Devices

Computers Controlled by Gesture

In an interesting video clip from the BBC’s ‘Click’ programme called ‘Computers Controlled by Gesture’, there is a summary of current developments in the world of human gesture control as an input device. It brings back memories of Tom Cruise in “Minority Report“.

Whether this form of computer input technology will ever see serious light of day or not, or whether it will replace the keyboard and mouse, is anyone’s guess, but it is interesting to see trends in technology moving away from using the standard devices (although it is hinted that currently there is no good replacement for a keyboard for text entry).

Whether this technology can save us from RSI related injuries is open to debate; it may well transpire that they just mean we are susceptible to different types of injuries, but it is a good sign that developers are at least rethinking the now traditional methods of interacting with computers. It could lead to opportunities in computer use for people with all kinds of different disabilities, and not just RSI.

Is this the start of a new age in ergonomics, or is it just the latest phase of hi-tech gimmickry ?

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Ergonomics RSI Tips

RSI – What to do? (Part 2 – RSI Dealing With Progressive Symptoms)

This is a follow on article from Part 1 which dealt with managing Initial RSI Symptoms.

The following is relevant if you have been experiencing RSI symptoms for a few months and they are now persistent in nature.

wrist_pain.jpgThe rate of success in dealing with RSI symptoms is proportional to the speed that a sufferer can diagnose the causes of those symptoms, and their understanding of the corrective actions required to avoid further injury.

The onset time for RSI injuries can be fairly rapid (in my own case I went from having initial symptoms to intermediate symptoms within 3 to 4 months. It is therefore vital that sufferers glean RSI knowledge as fast as possible, try to understand the causes of their symptoms, and make the necessary adjustments to their working practices.

So the scenario for this article is of a worker who has had RSI symptoms for a few months, and is experiencing any of the following –

Ergonomics RSI Tips

RSI – What to do? (Part 1 – RSI Initial Symptoms)

It can be a very confusing time for a computer user when they first experience RSI symptoms. The symptoms can often develop after a protracted period of intensified work, which may be ongoing. Initial injury symptoms can be very mild and will more than likely be ignored by the worker who will continue to work through them. This may be because the worker feels that the symptoms are very slight, and are manageable, or they may simply be confused about what those symptoms are. At this stage it is highly likely that the worker will not consult anyone about their symptoms eg an ergonomist, a company doctor, GP etc, and will more often than not want to avoid exposing their problem (however small) to their employer.

The danger with this is that, if symptoms are left unchecked, it can lead to their rapid worsening and the long march to a more debilitating (and difficult to treat) condition.

This need not be the case. There is a lot you can do at this early stage of RSI symptoms to help yourself.

Miscellaneous RSI Tips

Sleeping and RSI

If you suffer from an RSI type condition, it can be aggravated when you least expect it to be ie. during your sleep.

When you actually analyse what position your arms , wrists and hands are in when you wake up, you will more often than not, find them in all kinds of contorted positions. Quite often the wrist can be bent or twisted, causing blood flow restrictions, pinched nerves, and RSI symptoms can be worse when you least expect them to be.

Ergonomics RSI Tips

Lateral wrist deviation angle and RSI

Lateral (Ulnar) wrist deviation

A very common bad ergonomic practice is wrist deviation when using a keyboard. Keyboards have never been the most ergonomically designed devices, and users tend to hold their wrists very central to the keyboard whilst inducing a lateral deviation in their wrist angle.

bad wrist angle keyboard RSILateral (ulnar) deviation can eventually lead to wrist pain, both centrally and at the outer edges of the wrist. This can occur due to nerve pinching and tendon compression which can ultimately lead to RSI like conditions.

The image on the left shows lateral deviation in both wrists. This deviation can be further worsened by the user reaching for keys at the more extreme end of the keyboard, most commonly by little lateral wrist ‘flicks’.

This is a very common ergonomic problem, and can be easily rectified by the user once they know what to look for. The biggest problem being that most
users don’t start paying attention to wrist deviation this until pain develops.