Click here to view the embedded video.

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.

” … 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!

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.

As 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!

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.

“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“.

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.

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.

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.

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.

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.

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

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!

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.

** Post updated with additional material at end on 16 May 2011 **

Trigger Points and RSI

I’m delighted to be given space to say a few things about RSI and trigger points. I battled with RSI for several years before finally overcoming it several months ago and I now have a very small website that details my journey back to full health. What helped me was discovering that trigger points (a.k.a. muscle knots) can be a significant cause for repetitive strain injury. Alan has already posted on the essentials of what I found in an earlier post titled “Does forearm extensor trigger point massage offer a potential cure for RSI?” He talks about an excellent book by Clair Davies and how trigger points can cause referred pain elsewhere. I will try not to be repetitive and just highlight a few points that I would make in addition to Alan’s post.

Trigger Points Refer Pain Elsewhere

What this means is that the pain you feel is not necessarily at the site of the actual problem. Normally, injured tissue is painful at the site where the damage occurs — if I cut myself with a knife, the pain is located at the very site where the skin is pierced. However, with trigger points, we feel pain in places where there is no problem at all. What seems to happen is that the brain gets confused about where the pain stimulus is coming from and we end up feeling pain some distance away from the real source of the problem. In other words, the trigger point (or muscle knots) refers pain to another location. The site of the trigger point itself is often not particularly painful.

This is very important to realise because the danger is that you will end up pointlessly rubbing away or massaging muscles to no avail. For example, I had searing pain along the outside of my forearm (i.e. the upper side) but this was actually caused by a trigger point on the inside forearm (i.e. palm side or inside forearm) near the crease of the elbow. If I massaged the top of my forearm where it hurt, it did nothing to resolve the problem. Not until I started to massage the underside (palm side) of my forearm at a specific spot near the crease of the elbow did the forearm pain go away. If you have the book by Clair Davies, this is described on p116 with the accompanying diagram figure 6.9.

I mention this because I recently had a conversation with a work colleague about trigger points and RSI. He was getting pain in his arms. He was very interested in my success with massage. Unfortunately, I forgot to explain to him about referred pain and he thought you had to simply massage the spots where you feel pain. Thankfully, I later managed to explain to him how trigger points refer pain elsewhere and he’s now purchased a book which is hopefully setting him right.

Another example is that I had a very sharp pain in the front of my right shoulder. I used to rub away at this place because it was so painful. Unbeknownst to me, there was nothing wrong with my shoulder. The real pain came from a trigger point in the infraspinatus which is a muscle round the back over the shoulder blade. Only by treating a trigger point some distance away from the pain did this help. In Davies’ book, this is on pp90-91.

Trigger Points Weaken Muscles

If you have been suffering from trigger points for a long time, the affected muscles can weaken. In the words of my physiotherapist, they “shorten”. So, getting rid of a trigger point (by deep massage) may not be enough. You may also have to rebuild weakened or shortened muscles with targeted exercises. Having suffered from RSI in my forearm for several years, my muscles had become quite weak. I found it difficult to hold an umbrella or a mobile telephone to my ear. Even after the trigger point had been “deactivated” (to use the proper term), I still needed to rebuild strength in my shortened muscles. My physiotherapist told me to use very small weights of 1 kg max and gently hold them in the way I might hold a microphone. I would then gradually rotate my hand and bend my wrists to slowly rebuild the muscles. It’s important not to use weights that are too heavy because the point about computer usage (and other RSI-inducing activities) is that they are “low load” work. You need to rehabilitate the muscle’s ability to cope with low load endurance. By the way, my physiotherapist said that a tin of baked beans serves as a very good alternative to a hand weight! Another alternative is a Powerball which if you spin SLOWLY, can achieve the same effect. I actually used the Powerball more than small weights but I tend not to recommend it so much because there is a danger that users will spin it too quickly and therefore not achieve the “low load” effect.

Massage Immediately after a Session on the Computer

I found it was quite useful to do massage after working on the computer for a short time (say 5 mins). In other words, I deliberately waited until the RSI symptoms had arrived before doing the massage. Typically, I would spend about 5 min on a computer whereupon my arms and shoulder would start to hurt a lot. I would then do the massage because it’s easier to find where the trigger point is when my muscles were raging with pain!

Other Good Books

I recommend The Trigger Point Therapy Workbook by Clair Davies but there are other very good books too. I really like Simeon Niel-Asher’s Concise Book of Trigger Points which has very good colour drawings but I found that it doesn’t contain quite as much detailed information as Davis’ work. Also, some of the trigger points I suffer from are not mentioned, although to be fair, it is a “concise” book. There is also a useful book by Donna and Steven Finando called Trigger Point Therapy for Myofascial Pain. It is not especially well presented but has some useful information that can serve as a supplementary details. It’s not as good as Davies or Niel-Asher but it is certainly an interesting resource.

Okay, well that’s all I would add to the previous post. You can find out more on my website  How I Overcame RSI.  Don’t hesitate to e-mail james@howiovercamersi.co.uk if you have any questions.

James J

Additional Information  16/05/11 (from James J)

One thing I would note is that I don’t think the book by Davies’ covers all of the possible trigger points ( and nor do the books by Niel-Asher or Finando). I am convinced that I found some other trigger points causing pain along the topside (outer side) of my forearm; these points are not mentioned in those books so I may be wrong but I am personally 100% convinced that I had trigger points at those spots. Until I started massaging those spots, I didn’t get much better.

Have a look at the image on the right. you will see that all of additional spots that I found are on the inside part of the forearm. Whenever I pressed them, they would have the characteristic pain of a trigger point i.e. they were exquisitely painful. Quite often, they referred pain elsewhere, although not necessarily to the outside of the forearm. You might want to give it a go. One of the spots, to be fair, is mentioned on page 116 of the book by Davies. It is figure 6.9 for the Brachioradialis. However, the pain pattern shows that only part of the outside forearm is shaded. I think that more of the forearm should be shaded – at least that was my experience. Of particular importance were the parts in the middle region of my inner forearm – see the four red dots placed together.

James J

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.

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….

Rate this post! Note: There is a rating embedded within this post, please visit this post to rate it.