Tag: RSI

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forearm extensor Health RSI trigger point therapy

Trigger Points and RSI

Guest Post by James J of http://www.howiovercamersi.co.uk

** 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.

forearmHave 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

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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 attachment I have sent to this e-mail. you will see that all of additional spots that I found are on the inside part of the forearm. Whenever I prsssed 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.
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commentary Input Devices RSI

It’s a mouse! Ouch!!

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

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

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

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

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

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

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Career commentary fitness forearm extensor Lifestyle RSI

Understanding RSI

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

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

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

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

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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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Career commentary Ergonomics Lifestyle RSI

The many forms of RSI

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

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

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

Examples of occupations at high risk of RSIs include:

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

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

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

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

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

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Career commentary RSI

The rise and fall of a promising career

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

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

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

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

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

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

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Career commentary RSI

It’s the little movements that hurt with RSI

I came across an article on the Dorset Echo’s website that referenced an employee who had been sacked by her employer for an alleged attempt to defraud them over an RSI claim. As part of their legal challenge to her claim, her employer produced over 60 hours worth of surveillance footage of her outside her home, shopping and going to the gym, and relied on around five minutes of this in her disciplinary hearing to disprove that she had a computer induced RSI ailment.

Civil liberty infringements aside, this example shows how ignorant some employers are to RSI and how it manifests itself. RSI is pain induced by micro movements of a repetitive nature, which ‘flares up’ and produces painful symptoms when doing many small micro movements over long periods of time eg typing on a keyboard or clicking a mouse. In bad cases, it can cause pain and weakness, for example in wrists, which may affect other activities, or other repetitive everyday tasks. The condition does not, however, generally affect the muscles groups associated with doing many tasks requiring larger motion, including most motions involved in working out at the gym.

The irony is that with RSI, activity that is based on large non-repetitive motions and especially cardio based activity should be encouraged since movement of the larger muscular groups will enhance blood flow to injured areas and promote natural healing. It should not be criticised and brought up as evidence against an RSI claim. To do so just shows the complete ignorance of the individuals and organisations involved.

It is a travesty that the perception is that someone with an RSI condition should be effectively seen to be in a wheelchair and/or doing nothing before they look like they have RSI to an employer. If they were observed continually texting on their phone or playing video games all day that would be a different story! However, being criticised for living a normal macro movement life whilst trying to keep fit and healthy is an outrage.

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commentary Lifestyle RSI

When is the last time you really listened to music?

A good few years ago, whilst visiting a Biofeedback practitioner (in the US), before they got a chance to attach electrodes onto my shoulders arms etc and do the technical task that is part of biofeedback, they did a talk through to find out my background, and observe what stresses may be involved in my life. It was part of a holistic approach to dealing with RSI before the technical measurements.

One question they asked that has stuck in my mind to this day was, “When was the last time you listened to music?”, to which I replied well, “In the car driving here”. Their response was, “No, when was the last time you listened to music just to enjoy the music, not as part of something else?”. I really had to rack my brain to think that one through. I couldn’t remember. Not for many years and probably when I was a lot younger, had a lot more time on my hands and a lot less to worry about – probably in my teens! I had to be honest and say, “I really don’t remember”.

The lesson she was trying to impart was that we rarely take the time in life any more to just enjoy simple things that once were a source of relaxation. Music should have been there to enjoy and relax to on its own. By then my life was so busy that music had been demoted to something less.

It may be a part of the reason we hanker after music during our childhood to teen years. Back then, we had more time to listen to music with fewer worries and distractions in our lives. Not only that, but we spent time listening to whole albums from start to finish (which back in my day were on vinyl) and playing them to death whilst memorising the lyrics. This changed in my busier twenties, demoting music to be something listened to when I was driving about, at my desk whilst working or when I went for a workout at the gym. It just wasn’t something I had time for any more on it’s own, yet it was still an important part of my life, just not for relaxing to. In other words I always added something else into the mix with music without obtaining any of the mental relaxation that could be found from listening to an entire album and doing nothing else.

Move forward a couple of decades, and we find ourselves in a completely different situation. The invention of home computers, MP3 files and players have completely revolutionised music and the way we listen to it. We now have thousands of files on our players that are very easily mixed and are frequently listened to in random order, which can be great, and really allows you to find stuff in  your collection that you’d forgotten about. However it has led to being spoiled for choice, and we tend to flick through music tracks at the push of a button, not listening to albums in the way they were intended to be appreciated. Many artists spend a lot of time sequencing an album into a specific order which ‘flows’ or tells a story, and is really part of the overall experience of that music. This sequencing is more often than not completely wasted with shuffle plays of MP3 players, and really adds to the sense that music is just a cheap commodity in our already over commoditised life.

If we spent a dedicated hour a day to do nothing but listen to a favourite album the way it was intended to be listened to and for no other reason but to enjoy that album, we’d find that the music does a wonderful thing and takes us to a different place, where we can lose our worries and stresses for an hour and start to relax again, just as we did when we were younger. It may also help us to de-stress and unwind from tension induced conditions such as RSI.

So when was the last time that you really listened to music?

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commentary Input Devices RSI

Text input controlled by thought?

In an interesting article in Hplus Magazine entitled ‘By thought alone: Mind over keyboard’, the author describes studies into how we can use the brain’s thoughts to control a keyboard input. The findings indicate that people with electrodes implanted in their brains can learn to type by using thoughts alone. It’s also possible to achieve this without these electrodes by using  an EEG type interface, although speed rates for typing seem to be slow if we take the current findings –

“Tweeting by thought alone is a somewhat slow process using this prototype technology –- we speak at approximately 120 words per minute. But, as with texting, users can improve as they practice using the interface. “I’ve seen people do up to eight characters per minute,” Wilson says.”

Ouch.. that would be a significant downturn in workload!  I can see this form of input being a considerable benefit to people with severe disabilities, however I do wonder what the long term health impacts are of having an electrode implanted in your brain. My guess is that it must surely at this stage be a large unknown. It is, however, an interesting area of research.

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Ergomatters RSI Blog page on Facebook

facebooklogofreshErgomatters RSI Blog is reaching out with our RSI awareness effort with a presence now on Facebook, one of the world’s largest social networking web sites. Come and join us, become a fan and help spread the word!