The anatomy of the RSI Epidemic
Repetitive Strain Injury, or RSI is rapidly becoming a common form of disability in the workplace. It is the leading cause of permanent and temporary disability in some industries. Here’s how and why we create the elusive RSI.
Definition of RSI
A repetitive strain injury refers to pain and discomfort in the upper limb. A’repetitive injury’ could occur anywhere on the body. Doctors typically refer to arm pain, which can include the neck, upper back, forearm, and arm. It is usually related to repetitive tasks. RSI, which is a general term, can refer to any pain in your arm. Common forms are: tennis, golfer’s elbow; metacarpalgia; metacarpalgia; ulnar neuritis; chronic neck pain, upper back pain, limb numbness and chronic neck pain.
The following are the symptoms of RSI
The exact signs and symptoms for RSI depend on where the pain is occurring. But the top RSI symptoms are:
Tingling and/or numbness in the hand and arm
The upper arm, forearm and wrist are all affected by pain and weakness.
A reduced range of motion, stiffness, and/or weakness of the elbow, shoulder, wrist, or fingers
Difficulty lifting and /or tendency to fall objects (dropsy).
With repetitive activities and rest, the tendency for pain and /or numbness increases
History of RSI
RSI can be described as a soft-tissue pain syndrome. The pain results from a problem in the muscles, tendons and limbs. It is crucial to be familiar with the basic principles of myofascial disorder (MFD) and myofascial pain.
Exercise or injury can cause muscle to shorten. At rest, this process is usually exaggerated. Muscles that are used repeatedly for a specific action will eventually shrink and develop scarring in the muscles. These scars are known as microinfarcts and, most commonly, trigger point. Traumatic cases will cause scarring to occur faster and more severe in muscles.
If nerve conduction is disrupted, muscles will continue to shrink. Cannon’s Law can be used to explain repetitive strain injuries. Walter Cannon clearly demonstrated that muscles can become hypersensitive, eventually causing scarring and persistent shortening. The disk that compresses either the C4 nor C5 nerve root can cause the nerve supply to the extensors of the forearms to become cut off. This will result in chronic tennis elbow.
A joint’s static position will change if there are shortened muscles near it.
A persistent compression of the joints can cause abnormally fast wear of cartilage. Common side effects of joint problems include stiffness, pain in the joints and reduced motion. As time goes by, osteoarthritis and destruction of joints are inevitable complications. When the spinal nerves are damaged, they can cause persistent compression. Disk herniation can result from vertebral compression, as well as spinal stenosis. Herniated disks can cause damage to the spine, discs, nerve roots, and spinal cord.
These deep spinal muscles alter the spine positioning and cause mal-rotation. It can cause premature wear or acceleration of disks, disk herniation, arthritis in the facet joint, and increased risk for compression fractures. Although this is true for all parts of the spine it is particularly prevalent in the C1 to C2 and C4 toC6 levels. RSI causes compression in the C4-7 segments.
These principles can be applied:
Let’s examine the assembly worker. They will frequently perform the same task group and exercise the same muscle groups in the neck and arms as many times as possible, sometimes up to six hundred per day. Overworking/exercising the neck or arm muscles is the main effect. The most common changes are a shortening and shrinking of deep spine muscles at the base of your neck (multifidus, deep rotators), and the shoulder outlet as well as the forearm and forearm muscles. I am most concerned with the scarring that occurs at the C4-7 levels, the back of your shoulder (latissimus posterioris and subscapularis), the front and rear of your shoulder (pectoral minor or major) as well the scarring and shortening in the forearm.
An exam that begins early on will reveal mild trigger points or tenderness in the muscles mentioned. Sometimes, weakness occurs when muscles have been shortened and are not working at their full potential. The range of motion in the arm and neck will be reduced. The condition worsens over time and causes pain to increase. A CAT scan image and an X-ray will detect a loss in normal curvature. Exams will find forward rolling of shoulders and winging.
A loss in normal neck curvature is a sign of a persistent and prolonged shortening the deep spine muscles. This phenomenon is known as the tenting effect. Tension causes the muscles to ratchet and tighten the neck, causing it to look like a tent pole. It causes persistent compression to one or several vertebrae, and it can cause damage to the spine. Affected is also the normal or natural positioning of vertebrae, disks. Due to the fact that some vertebrae are unable to move, it reduces the motion range of spinal segments. As a result of pressure, disks begin to wear down at their sideswalls. It is similar in appearance to an under-weighted car that has a flat tire. Because of the pull from the intrinsic muscles, affected vertebrae can experience slight rotation. There are two possible outcomes: disk bulging and disc herniation. In the beginning phase, however, it is common for the spine to oscillate between bulge or herniation. This explains the lower diagnostics for disk herniation in the supine position compared with the Standing MRI. Eventually, frank herniation can be seen with supine MRI.
Increased neck compression can cause nerve conduction to the neck to become more impaired. The nerve can be interrupted temporarily, but not completely at first. The nerve interruption will become worse and more frequent as spinal compression and rotation intensify. According to Cannon’s Law, the supply pattern of nerve roots affected will cause muscle tissue down the affected arm to shrink. Repetitive work and repeated muscle injuries can cause further muscle loss.
There are different types of symptoms like tingling or numbness and pain in certain Muscle groups. The pectoral (chest) muscle shortening in carpal tunnel will result in a traction injury at the median nerve, which is located just ahead of the shoulder. The pulling force on the nerve causes it to be lifted, and the nerve is then trapped under the carpal tunnel. This will cause pain, tingling, and numbness in the thumb index, middle, and half the ring finger, creating the popular carpal tunnel syndrome.
Ulnar neuritis will cause the muscles of the subscapularis and lattissimus to shorten due to a reduced nerve supply from C6-T1. This will cause the same traction phenomenon to the ulnar nervous at the shoulder. This will cause the ulnar to become caught at the elbow. It can also lead to pain in the elbow and elbow when you lean on it. The ulnar nerve rolls over the medial epicondyle or inner elbow. This can be felt by flexing your elbow and palpating the medial epidondyle. The ulnar nerve is traction from the back of your shoulder, also known as the posterior thoracic outlet disorder. Classic symptoms include numbness, tingling and pain in the hands and fingers.
The tennis elbow scare can occur when the external elbow (extensors), is compressed between C4 and C6 by contractures in deep intrinsic muscles. Forearm shortening can cause tension in the extensor tendon, which will lead to inflammation. A persistently shortening extensor tendon will result in traction at the lateral epicondyle. This can cause pain, swelling, and bony changes. This mechanism explains the difficulty in treating tennis elbow and also the high rate of failure with local elbow therapy.
Similar to tennis elbow but with golfer’s, elbow uses a similar mechanism. The spinal segments that are affected in this case are usually C6 through T1. Because the same spinal segments play a role in golfer’s elbow, ulnar neuritis is often associated. Similar spinal muscle patterns can also be used to recreate other conditions.
Sometimes, computer-related RSI is more serious than the effects of assembly work. Problem is, keyboarding can cause static injuries. Static repetitive work can be the most dangerous type of work. The static muscles also shrink after an injury and at the same time as the injury. The static repetitive activity does not permit for an increase in muscle strength, so the effect of this on the muscles may be even more severe.
The computer-related RSI also often effects the upper back, or thoracic spine. This area has secondary nerve supplies to the arm. The treatment of the thoracic spinal problem can prove difficult, particularly if there are kyphosis symptoms. Computer-related RSI results in a person who has a humpback, forward neck, forward shoulders and compressed disks. This can cause diffuse muscle shortening, multiple entrapped nervouss and often affects both arms.
How to Treat RSI
*The treatment of a complicated/chronic RSI begins with a detailed history and examination often indicating far more disease than initially thought.
*Detailed patient education of the mechanism and exercise physiology is important such that they ca be aware of aggravating factors and to succeed with personal exercises.
*Physicians and nurses need be more aware of the various patterns of RSI for their early recognition and proper treatment.
*The key part of actual therapy must include the implementation of spine and limb “neuropathic”Stretching and resistance training (the Lamb Program), which allows all affected muscle groups to be treated and spinal and limb segments can be properly repositioned.
*It is important to recognize the limitations of imaging technology, i.e. An estimated 40% of disk diseases are not detected by MRI.
*The Implementation of injury avoidance and education of RSI-injury factors for the patient helps to reduce re-injury and progression of disease.
*The use of specialized injection technologies-surgical dry needling, the Patented Lamb Method of Spinal Botox, injectable NSAIDS can drastically reverse the compressive effect within the spinal anatomy and help most RSI’s and other pain syndromes.
*Specialized relaxation training systems help to reduce RSI-related muscle tension (i.e. ASeRT Systems
*Positional education for sitting, standing and sleeping, as well as proper sleep education help to reduce the progressive pattern of bad sleep and bad pain.
*The implementation of laser/magnetic combination therapy and MET has demonstrated effectiveness as an adjunct to various pain syndromes including RSI.
*MET or micro-current therapy is the latest in electronic or electro-medicine that properly addresses the abnormal electrical potential concerns in chronic pain and RSI versus TENS or EMS which are demonstrating oxidizing potential of soft tissue with repeated use.
*Obviously the addition of medications can be a major adjunct to RSI and other chronic pains, and I will quickly comment on two medications.
*Anti-inflammatories have a beneficial effect in RSI, but must be tapered when stopping, otherwise reactive inflammation and spasm can occur. Lyrica is a brand new medication. “anti-neuropathic”The agent is helpful for chronic pain. Many patients showed improvement in their deep spine muscle pathology. This indicates that the cessation or transmission of pain information can have a relaxing effect on spinal and skeletal muscular muscles.