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.


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…..


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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Do 45% of Irish Workers have RSI?

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

” … by,  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“.

Kayaking Injury RSI trigger point therapy

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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Trigger point therapy for RSI progress report – 6 weeks

UpdateOK, time for a progress report on trigger point therapy, its been six weeks since I started to do some trigger point massage. Have I seen some improvements? Yes. Has my RSI pain improved? Yes!  Has my RSI gone? Not yet!

Trigger point therapy, as discussed previously in my post “Does forearm extensor trigger point massage offer a potential cure for RSI?”, is a method of massaging trigger points (muscle knots) that refer their pain elsewhere eg forearm extensors into hands and fingers.

Before starting Trigger Point Massage it is essential to understand the anatomy of the forearm muscles and what they do, where they form muscle knots and where they refer pain to, and as discussed in a previous post, the Trigger Point Therapy Workbook is a great place to start with this understanding.

Weeks 1/2

The first two weeks were mainly spent in a lot of pain, easily finding extremely sore trigger point muscles of the forearm extensor groups. I had exceptionally sore areas in the Extensor Carpal Radialis Longus, Extensor Carpal Radialus Brevis and the Extensor Digitorum. Couldn’t find anything going on in the Extensor Indicis despite having had a history of index finger overuse and pain previously.

Massage was done mainly by supported thumb, and knuckles, 3-4 times a day. Excruciating pain was experienced during massage from many of these trigger point areas, and as such can lead to a reluctance to continue, however I just had to keep saying to myself  “this muscle is sore and it shouldn’t be”, grit my teeth and keep massaging!

Most of this period was spent in continual pain from the massage. It is a recurring theme with trigger point massage. Your arms spend a large portion of time in pain from the massage as well as the RSI condition. So there is very little opportunity to asses any progress. I reckoned, however, that if I am massaging sore tissue then that must be a good thing!

Weeks 3/4

As the sore extensor muscles recovered from their intensive massaging of the previous weeks, the forearm felt less painful, but it was a gradual process. Sometimes taking a day or two off of massage treatments helps, just to give the arms time to recover and to allow you to assess progress. I had massaged out the eye-wateringly sore extensors, but there was some deeper down trigger points in lower muscle  tissues to try to access, as well as a persistent ache at the point where the extensors attach to the elbow. I also found a sore trigger point in my Extensor Carpi Ulnaris, which I subsequently found massaging can lead to a nerve type pain down the outer edge of the hand wrist and  little finger, which wasn’t good, and is something to be wary of. If you are trying trigger point therapy yourself, please be careful not to massage nerves!

I have used my thumb for massaging, but as stated in the Trigger Point Therapy Workbook, extended use of heavy pressure with the thumbs alone can lead to sore thumbs pretty quickly and as such is not advised.  The book recommends the use of balls eg tennis balls (or denser rubber ones) to roll your arm muscles against beside a wall. They also recommend a ‘Knobble’ which is a hardish object that you can grip with a knobbly protrusion which can be used as a pressure point for massage. I have generally just used my hands (knuckles and supported thumb) and a beach pebble (with smooth rounded edges) for massage through a fleece top, and both have worked quite well, although its very tempting to resort to using the thumbs which really should be avoided!

Weeks 5/6

After massaging out most of the extensor trigger point (muscle knots), I still have sensitive tissue areas around the elbow where the extensors attach, and this area is still being worked on. After a suggestion from James of How I Overcame RSI I also checked the inner forearm muscle called the Brachioradialis which is a muscle on the inner side of the arm that attaches to the lower end of the upper arm, and is used to bend the elbow. Under this is a smaller muscle called the Supinator which turns the hand palm side up. Much to my surprise, I found trigger points in both of these especially at the points close to the elbow/lower upper arm. The book suggests that trigger points here can refer pain to the thumb area as well as the inner forearm, but James also indicated that in his experience they also referred pain to much of the forearm too. I also found a small trigger point on the Brachialis (bicep) of the right arm, and have massaged it too. The Trigger Point Therapy book says that this point can refer pain to the thumb.


Progress is actually a difficult thing to asses on an ongoing basis. As I have mentioned before this is because you are in quite a lot of  pain from the massage for a large part of trigger point therapy. You literally spend a lot of time massaging, and even after the sorest muscles are less sore, there are still a lot of aches around and you are still stressing the forearm muscles with massage. The only real way to assess progress is to take a two/three day halt in proceedings, and see how they are. I’ve done this a couple of times, and yes the arm muscle pain of RSI does seem to be improving, it’s just not gone yet!

I am, however, very encouraged by the less screamingly sore muscles in my forearms, and am tending to focus on secondary areas now. I still feel pain from typing and mouse use, but much less intense than before, which must be a good thing. How sore the pain would be after a more demanding day of computer use is another question altogether though!

There are also other potential areas according to the Trigger Point Workbook that can refer pain to the arms and hands, including the Scalenes (shoulder neck area) and Triceps (back of upper arms), so more investigation of these areas for trigger points is required. I also am doing a lot of deep probing of the forearm extensors and finding a lot of  trigger points down there, which are very hard to reach and even harder to massage on a continual basis. Some of these small painful muscle fibres appear to be narrower than a fingers width and as soon as you get a finger on them to do massage they disappear to the left or right of your massaging finger before you get the opportunity to truly massage them, very frustrating!

I should also add in that I am doing some wrist rotations to work the extensor muscles in a fluid motion using a weight of about 1kg, and am also doing some work with a Powerball in slow motion.

I will continue to update on my progress here as therapy progresses, although I am at this stage very encouraged by Trigger Point Therapy as a potential solution!