Malady Makeover, June 07

Soothing the Strain
Chronic pain born of repetitive motion can tie you up in knots.

By Lisa James

   It begins so innocently: A tender spot in a muscle, weird tingling sensations in a hand, numbness in a couple of fingers. . .and always after a long day at the keyboard or cash register or assembly line. But over time the discomfort grows and the throbbing becomes more severe, cutting into your sleep and severely hampering your job performance—until you realize that you’re in intolerable pain, day in and day out.
   Welcome to the world of repetitive strain injury (RSI). While it may not be a comforting thought, you do have plenty of company—about 7% of the US population, according to the federal government. That makes RSI not only the most common occupational hazard but, at $20 billion a year in workers’ compensation costs alone, the most expensive as well.

Graduated Misery
   “RSI is not a diagnosis, but a term used to describe a very complicated, many-faceted soft tissue problem,” explains RSI expert Dr. Emil Pascarelli, author of Dr. Pascarelli’s Complete Guide to Repetitive Strain Injury (Wiley). “One reason it’s so complicated is that the symptom site is not necessarily where the problem lies.” Nerve compression, originating at either the spine or further along down the arm, is a key factor; using a computer mouse at an awkward angle can clamp down on nerves in your neck, shoulder, elbow and/or wrist—which can wind up causing pain and numbness in your fingers. Other symptoms include spasms, weakness, swelling and tingling.
   The disconnect between injury and symptom also helps explain why carpal tunnel syndrome (CTS), the best-known RSI, isn’t as common as you might think. CTS, in which the nerve that serves the hand is compressed as it passes through the wrist, is “by no means the major culprit,” Pascarelli says. “In fact, a study of 485 of my most recent patients shows that only 8% of them actually had CTS.” Problems that people will self-diagnose as CTS often fall into other RSI categories such as thoracic outlet syndrome (TOS), which originates in the neck; cubital tunnel syndrome, a nerve impingement at the elbow; and DeQuervain’s tenosynovitis, a tendon irritation involving the thumb.
   The unnatural practices of modern employment lie at the heart of RSI; the human body was not meant to remain relatively immobile for hours doing the same thing repeatedly. (See “BlackBerry Thumb.”) As a result, repetitive strain difficulties are “extremely common” among the people Jocelyn Joy, LAc, treats at Joy Acupuncture in San Diego, California. “Most of the cases I see involve typing—long hours at the keyboard and poor posture,” she notes. “I do occasionally get people with more physical jobs, such as mechanics.” Pascarelli also sees hurting musicians: “We are losing many talented musicians to injury early in their careers.”

Relaxing RSI’s Grip
   Making RSI go away is one thing; keeping it from returning is another. “It’s not all that difficult to treat—what’s difficult is not having it recur,” says Joy. “If you don’t change how you’re doing things, it’s likely that the problem will come back.”
   The first step, according to Pascarelli, is to get an accurate diagnosis: “I have spent as many as two hours on each first-patient visit to do a full history and complete upper-body examination.” He recommends making that visit more productive by coming with notes: When and how your symptoms began, the type and intensity of the work you do and the type of equipment you use (as well as any repetitive home or recreational activities), your stress levels and emotional state, and what tasks you are no longer capable of performing.
   Physical therapy, including a targeted exercise program, is the key to recovery; Dutch researchers have found that exercise even trumps such ergonomic changes as properly adjusted chairs and keyboards. Work with someone who has a background in RSI rehab. “I’ve been trained in a little bit of physical rehabilitation, but I often need to work with somebody who’s very good at isolating muscle groups and coming up with exercises for those muscles,” Joy says. But don’t place all the responsibility on that person’s shoulders. “You must rely on your own awareness,” says Pascarelli. “Relying on the therapist to carry the workload of your recovery means that you will not recover.” The temptation is to push hard in an effort to get back to normal as quickly as possible. Don’t. As Joy puts it, “Slower is faster and less is more.”
   Both acupuncture and massage can help relieve the pain. Regarding acupuncture Joy says, “As a general rule I like to go anywhere from six to 12 treatments, usually twice a week. That usually results in the problem being almost completely resolved, depending on what other areas are affected.” And in one study, people with early CTS who received a professional massage once a week—and learned how to perform a self-massage each evening—saw their symptoms abate.
   Though heat relaxes muscles, cold can also relieve RSI pain. Icing “is most effective if the ice is put in direct contact with the skin for 40 to 60 seconds,” Pascarelli says. “Move it over painful tissues until the skin gets slightly numb and reddish.” Supplements can help, too. “I often prescribe magnesium to help with muscle cramping and tightness,” says Joy. “I use supplement formulas that include turmeric and I also recommend omega-3 fatty acids—they really do help with inflammation. For acute inflammation I generally prescribe 3,000 or 4,000 milligrams a day (you might have to work up from 1,000 mg); always take it with food. After the acute problem is over, I’d say 2,000 mg would be great.” (If arthritic aches aggravate your RSI, add glucosamine, chondroitin and MSM to the mix.)
   To stop recurrences Pascarelli suggests a multi-step prevention plan: Assessing your injury risk by noting daily activities at work and at home, faithfully doing all recommended stretches and exercises, thinking ergonomically by fitting your equipment to your body and not the other way around, and pushing the healthcare system, including your insurance company, for the help you need.
   Don’t let RSI cramp your style. Get better and then do everything you can to keep the pain at bay.

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