If your job, hobby, or recreational activities involve repetitive movement patterns you may develop a repetitive strain injury, or RSI. Also known as overuse injuries, cumulative trauma disorders, and musculoskeletal disorders these types of conditions are characterized by pain, inflammation, swelling, and reduced joint movement.
Some of the more well-know causes of RSIs include:
RSIs mostly affect tendons, ligaments, bursae, and neural sheaths but they can affect muscle fibers as well. What happens is the offending activity places unusually high demand on these structures resulting in microscopic tears to the tissues. A very gradual inflammatory response follows, which then takes a life of its own. At this point the patient notices that the pain is more frequent and doesn’t go away with rest, and he/she may reach for an over the counter non-steroidal anti-inflammatory like Motrin.
What makes repetitive strain injuries so persistent is that they are caused by an activity the individual needs ( job) or loves (favorite sport) to do, and essentially he/ she “re-injures” the condition with the activity until it gets to an advanced stage.
Most of the time a repetitive strain injury is transient; i.e. it appears for several weeks then disappears. The patient resorts to icing, rest, temporary discontinuation of the offending activity, over the counter meds, massage therapy, bracing, and in some cases, cortisone shots.
In some people, the pain turns chronic; i.e. doesn’t entirely go away even after weeks and months since the onset. If you are experiencing this, it can be due to improperly healed microtears causing abnormal muscle and tendon performance; and perhaps trigger points which are believed to be concentrations of nerve endings at an old injury site.
When the condition is chronic, you can attempt to do the therapy in the video above. You use a flat edged massage instrument to “strip” the muscle close to where it attaches to the joint. This can help loosen any fibrous adhesions (“stickiness”) that may be interfering with muscle and tendon movement. It also mildly agitates the area (be careful not to overdo it) and increases blood flow, which can stimulate repair by fibroblasts, special cells that synthesize collagen.
This therapy is not to be done when the condition is acute (recent onset, hot, red, swelling). Doing so will make it worse. Try it only when it has reached a chronic stage and inflammation is absent. If it causes an unusual increase in pain, discontinue and apply ice.
Thoracic outlet syndrome is a condition where the neurovascular (nerves, blood) structures that service the arm get compressed outside of the spine (a peripheral neuropathy). The compression can come the collarbone, the scalene muscles at the base of the neck, an apical tumor or other mass. Thoracic outlet syndrome can be unilateral (one side) or bilateral (both sides).
The brachial plexus is a bundle of nerves that eventually form the major nerves of the arm: median, radial, and ulnar. It passes directly underneath the center of the collarbone. The subclavian artery, which becomes the brachial artery, is right next to it and supplies blood to the arm. The collarbone (clavicle) connects your shoulder blade (scapula) to your breastbone (sternum). There is only a few millimeters clearance between the bottom of the collarbone and the ribcage, so proper alignment of these structures is absolutely critical for the nerves and blood vessels to work unobstructed.
Trauma to the shoulder complex, repetitive shoulder movements (like a baseball pitch), a long history of sleeping on your side, and a habit of carrying a heavy bag with a strap over your shoulder, or a history of carrying any other heavy objects on the shoulder such as a 5-gallon water bottle are some of the things that can cause the collarbone to close down on the neurovascular bundle. Symptoms can include numbness down the arm; hand numbness, arm and hand weakness, pins and needles sensation in the fingertips, and poor circulation in the arms (feeling of swelling or fullness).
A cervical rib can predispose one to thoracic outlet syndrome. A cervical rib is a congenital anomaly where a small rib branches from the lower neck vertebrae. A cervical rib can easily obstruct the brachial plexus on that side.
A syringomyelia or syrinx is a slowly expanding fluid filled sac in the spinal cord, usually at the neck level, that places dangerous pressure to the cord; enough to cause muscle atrophy (wasting) of the areas served by the affected neurons. Although syringomyelias are rare, they must be ruled out first.
If you are experiencing upper extremity numbness, see your doctor. You should get referred to an orthopedic specialist who can do some tests to properly diagnose your condition. If thoracic outlet syndrome is suspected, your doctor may order a nerve conduction or needle electromyograph (EMG) study to determine if the nerve is compromised. Typically, physical therapy is prescribed for several weeks. If there is no improvement, surgery may be recommended.
The exercise below can be helpful for some sufferers of thoracic outlet syndrome, especially the type that involves the collarbone pressing down on the neurovascular bundle. It is simple to do, and generally safe. This exercise attempts to lift the collarbone repeatedly off the ribcage, creating more space for the brachial plexus and subclavian artery. Do at least 100 per day for a week; if relief is felt, continue doing as needed. If at any point your symptoms feel worse, stop immediately.
Most people are aware that sitting at a desk in front of a computer can be hazardous to your health. The body simply isn’t designed to be placed in such an uncomfortable position for such a long period of time, and will rebel if forced to do so.
The universal desk job has the following ill-effects on the body:
Increases pressure to the lumbar discs by over 50% than standing which can accelerate degenerative disc disease
Inactivates the erector spinae muscles of the back, which has been shown to increase bad cholesterol levels in the bloodstream, contributing to cardiovascular disease
Increases pressure to the sciatic nerves, which can lead to sciatica
Makes it more difficult for blood in the lower extremities to return to the heart
Reduces the natural curvatures of the spine in the neck, mid back and lower back (referred to as the cervical and lumbar lordosis and thoracic kyphosis), which are needed for the spine to support body weight more efficiently
When typing, can lead to strain of the shoulder, arm, wrist and hands due to the unnatural and biomechanically disadvantaged position of the upper extremities during this activity
Of course, we need to work, and if our jobs require sitting at a desk… well, there’s no getting around it. The solution then is to condition your body so that it can better withstand these physical onslaughts.
One of the ways is to do a posture-improving exercise called wall angels. To do this simple exercise, find a wall that is free from obstructions.
Stand back against the wall, heels touching and back of head touching.
Lift both arms and touch the back of your arms, wrists and hands to the wall remembering to keep your wrist straight at all times.
Raise your arms as high as you can, keeping them in contact with the wall at all times. You will feel the urge to bend your wrist and break contact with the wall as your chest muscles tighten; do not let this happen (in the video above, the patient is unwittingly doing this with her left hand. Watch, and try not to do this).
When you can’t go any higher, lower your arms in the same way, as low as you can go without letting your arms break contact with the wall. In fact, exert mild pressure against the wall with the back of your arms, wrists and hands (actively push against the wall during the exercise).
Those are the basic motions, do them at a fairly moderate pace (not too slow, not too fast– one cycle up and down should take about 2 seconds); about 50-100 repetitions per exercises session. Do 3-4 sessions throughout your day.
The exercise will activate the upper back muscles, which tend to be inactivated when sitting at a desk, and stretch the chest and anterior (front) neck muscles, which tend to be overactive and gradually shorten over time, causing the familiar rounded shoulders and stooping head posture. This exercise sort of “equalizes” muscle activity of the chest and back, improving your posture.
Most people who have general back pain and stiffness don’t question it enough; i.e. wonder why they have it. All they want is for it to go away in the quickest amount of time. A person suffering from back pain will first wait and see if it goes away with rest and time, and if it’s really bad, over the counter medications. If this doesn’t work, he will make an appointment with his primary care physician, who will usually prescribe pain medication and muscle relaxants to address the symptom (not the cause). The patient may be referred for physical therapy, which typically consists of modality application (heat, ice, lumbar traction, electric muscle stimulation and possibly low level laser) and exercises. Some people with lower back pain consult a chiropractor, who will address the problem usually be employing some form of spinal manipulation; and some will seek an acupuncturist.
But what if all these treatment forms are on the wrong track; i.e, they are based on errant assumptions? What if there is more to the back pain than sore muscles and stiff joints?
If you suffer from back pain; particularly lower back pain, it may be the result of dysfunctional nerve signals coming from the brain. The brain controls voluntary and involuntary contraction of your muscles, like a finely tuned machine run by a super fast computer. It’s analogous to a world-class conductor conducting a symphony so that every note, tempo, and timing is perfect.
If the nerve impulses (millions of them occur just standing) are dysfunctional, it can cause certain muscle groups to contract when they aren’t supposed to, forcing joint surfaces together and limiting their movement. It can cause one side to be inactive, resulting in unbalanced muscle tone. Abnormally functioning nerve signals to the muscles can throw off the synchronization of muscle contraction, which would be a big problem right in the middle of moving a heavy piece of furniture.
I believe that most cases of gradually occurring lower back pain are the result of degraded communication between the brain (cerebral cortex and cerebellum) and the musculoskeletal system. Even if the onset of pain was a specific incident such as bending forward to pick something up, it is secondary to a malfunctioning brain-muscle communication.
So, what does one do? Realize that for lower back pain, one shouldn’t simply focus on external means to reduce the pain; whether it be pharmacological (drugs) or manual (physical therapy, chiropractic). These methods can help reduce the pain and make you feel better, but if they don’t address the true problem, the pain is guaranteed to return.
Somatics is a form of therapy that treats muscular conditions by attempting to remove emotional or subconscious factors that may be contributing to the problem. The idea here is that the brain’s ability to properly regulate the body’s muscular function has been compromised by an old injury; inactivity, or harmful thought patterns. Somatic therapy addresses the problem by attempting to restore the connection using specific exercises, concentration, and breathing techniques.
If you have lower back pain that just won’t respond permanently to physical therapy or chiropractic, consider Hanna somatic exercises. This technique seeks to restore proper brain-muscle function using deliberate, specific targeted exercises (not your typical strengthening and stretching exercises). The system is taught by Lawrence Gold, a certified Hanna Somatics practitioner and is available on DVD or internet download. A sample of one of the exercises can be found here.
If you notice a gradually developing pain in your forefoot (just past your instep) between the tarsal bones of the 3rd and 4th toes that is worse when you press it between your thumb and index finger, you most likely have what’s called a Morton’s Neuroma.
Despite it’s name, it is not a true tumor. It is a buildup of fibrous tissue that surrounds the sheath of one of the nerves that innervate the foot. The nerve lies between the muscles that connect the tarsal bones and due to the fibrous buildup gets compressed within this narrow confine. It is worse when standing and walking.
Morton’s neuromas are usually treated with orthotics (custom shoe inserts to help counter flat arches, over pronation, or other abnormalities of the foot) and cortisone injections to the painful nerve. Sometimes surgical removal of the excess fibrous tissue is done if the condition does not resolve.
A simple remedy that can provide welcome relief, and perhaps allow the nerve to heal faster is inserting rolled up gauze or cotton between the 3rd and 4th toes. This spreads apart the tarsal bones and creates more room for the nerve. Sometimes simple things make for effective remedies, and this is one of them.
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