Home Treatment For Repetitive Stress Injury

A guest post by Heather Johnson

Biofeedback therapy has benefited many people who suffer from chronic pain, including those with Repetitive Stress Injuries. It is the technique of improving your health by monitoring your body signals and making slight adjustments to your temperature, blood pressure, or even the way you carry yourself. If you have ever used a thermometer or taken your own blood pressure, you have already been conducting biofeedback at home.

Many more advanced biofeedback also techniques exist to help relieve pain. There are ways to regulate one’s body in order to relieve symptoms of everything from wrist pain to migraines. Although biofeedback may not serve as a miracle cure for your symptoms, it can certainly make your life a lot more pleasurable.

A popular book entitled Healthy Computing With Muscle Biofeedback addresses the need for desk jockeys to take the guesswork out of their chronic pain and find its true source. This text is recommended for ergonomists but may also be of value to those suffering from computer-related overuse injuries.

In short, biofeedback is using one’s mind to improve one’s health. Many people use medical devices for biofeedback therapy, though it isn’t always necessary. Learning how to relax one’s back muscles is a form of biofeedback, for example, which can be done through standard relaxation exercises. If you do elect to use biofeedback devices, there are many available for home use.

Below are some valuable resources for getting started with biofeedback:

• Biofeedback Network – Dr. Eric Miller operates this site. He is a proponent of biofeedback and the many benefits it holds for a number of conditions.
• AAPB - The Association for Applied Psychophysiology and Biofeedback was founded in 1969. This is a non-profit organization that provides many services to those interested in biofeedback therapy.
• Biofeedback Infocenter – This handy introduction to biofeedback is provided by Holistic Online.com. Here, you will learn about the many types of treatment, as well as how to get started with home therapy.

Note: Always consult your physician before embarking on biofeedback therapy. Although it is generally considered safe, some treatments can interfere with medications related to anxiety and/or depression.

Heather Johnson is a regular commentator on the subject of CNA Classes. She welcomes your feedback and potential job inquiries at heatherjohnson2323 at* gmail .dot com.

A common complaint of patients who visit any health practitioner, from a general care physician to their massage therapist, is that doctors just don’t have enough time for their patients. In order to be successful, many clinicians stuff too many appointments in and then don’t have the time to spend carefully diagnosing problems and answering all of the patient’s questions.

The Internet is a great salve for this problem, because so much information is available online for anyone who cares to do a Google search. Additionally, care providers can spend some of their free time answering common questions in online FAQs and blogs, and helping out their patients without charging a dime for their time.

I want to point your attention over to the blog of one chiropractor who’s doing exactly that. His posts about how joint manipulation works is fascinating, and he’s also given some dedicated attention to the topic of the cause and solutions for Repetitive Stress injuries, including a discussion of how chiropractics can be helpful. More recently, he’s also given some attention to the question of whether it’s helpful to pop your own joints, and also begun a series answering common questions about chiropractic work. The links are my favorite posts but you’re sure to find other gems too. I didn’t know much about chiropractics when I started, but I feel much more educated after reading!

Kudos and thanks to any health care specialist willing to spend his free time contributing useful information to the internet community!

Having come of age in Santa Cruz, California, a little hippie haven on the coast, I’m a bit skeptical of large business chains like Starbucks that tend to set up shop on every other street corner, sometimes pushing smaller operations out of business. Yet, I have to admit that they know what they’re doing — the reason they’re successful isn’t just their business tactics but also the environment they create for their customers.

It’s not just the coffee, or even the local ambience — it’s also the chairs. Unlike many local coffee shops, most Starbucks shops offers customers their choice of seating, either small tables or large, cushy armchairs. Most Starbucks also have enough power outlets to allow laptop users to order coffee, plop down, and plug in.

As a freelance writer, I spend a good deal of time in coffee shops typing away on my computer. As a business user, what I value in a coffee shop is much different than what I value when I’m socializing with friends off-hours. In a local, friendly coffee shop where I’m reading a book or hanging out with friends, the ambience of the place is more important — give me unique, changing artwork on the walls, good lighting, a crowd of people chattering away, and friendly baristas.

Those things are still important when I’m working, but in a work environment, what I want most is a place for my laptop and a comfortable seat that I can stand to sit in for a few hours. Interestingly, one of my very favorite coffee shops (Gaylord’s on Piedmont Ave in Oakland) features all of the things I want in a coffee shop, except the cushy chairs and copious power outlets. It’s also right across the street from Starbucks — and some days, I choose Starbucks instead, even though their coffee and baristas aren’t nearly as fun.

Many Web sites that tell you how to use a computer properly ask you to sit in a stiff position at a carefully calibrated computer workstation. But ergonomics isn’t just about finding the right position — it’s also about comfort. If you’re sitting in a desk chair all day, there’s only one way to sit–upright, leaning back, with your arms forward. In a large, cushy armchair (like the one I’m in right now), I can cross my legs with the computer in my lap, or lean forward and plant my feet on the ground, or sit with my feet to the side. The human body wasn’t meant to stay still for 8 hours a day. So for the sake of my body and my sanity, what I need in a coffee shop is a comfortable work environment, not just a hip atmosphere. What I need in a computer workstation is versatility, not just an ergonomic certification.

Of course, it’s best when I can find a local coffee shop that understands my needs, too. Living close to Berkeley, California, I’m lucky to have a great variety of coffee shops right nearby. Today I’m sitting in a comfy chair at a local shop that has plugs for every seat, a quiet work-friendly environment, and unique artwork on the walls (Mudrackers, on Telegraph, in Berkeley). Some days I love my job.

Some time ago, I wrote about the benefits of using Chinese medicine balls as therapy, particularly for hand pain such as carpal tunnel or deQuervain’s syndrome/tenosynovitis of the thumb.  The practice of twisting the balls around one another, using the fingers, helps to build dexterity and restore range of motion.  Also, the weight of the balls helps to massage the muscles in the hand and stimulate the pressure points.  This in turn helps increase circulation and reduce swelling and pain.

Many sufferers from carpal tunnel and related injuries suffer not just from stiffness and pain, but weakness too.  Here’s a new trick for using Chinese medicine balls to build back some of the hand strength you might have lost from an injury.

• First, master the practice of spinning the balls around one another in your palm, using your fingers to prevent the balls from touching one another.
• Make sure you are able to spin them both clockwise and counterclockwise, in both right and left hands.
• Then, try out this twist — slowly begin tilting your elbow when you practice.  Learn to spin the balls without dropping them at a 30 degree angle toward the ground, then 45 degree, then 90 — until finally, your palm is facing the ground and it is just your fingers holding the balls up as you spin them.

Don’t worry if you don’t get it right away, though — I’m sure even the strongest athletes, with no injuries at all, would need some practice to do this trick.  I bet it would be a great exercise for rock climbers in particular.

I’ve worked for start-ups, mid-sized and large organizations with vastly different corporate cultures, financial resources and approaches to ergonomic workstation setup. In my experience, larger organizations tend to have more resources in place and are more willing to purchase ergonomic equipment.

This might lead you to believe that ergonomically speaking, it’s better to work for a big company. But that isn’t always the case. In part, that’s because the corporate culture has a huge influence on the effect of a workstation on the staff. If you’re stressed at work, or have to put in long hours, you’re far more likely to sustain an injury, whether or not you use fancy equipment.

At a smaller company, the environment might be more humane – couches, snazzier décor, and more relaxed workplace in general make it easier to unwind and avoid pain. Again, the corporate culture can vary widely and doesn’t depend reliably on just the company size.

But just for the sake of perspective, let’s look at three companies and how they treat employees, to see if we can see patterns emerging.

Case 1: The Start-up

Start-ups I’ve worked for are short on the resources side. Simple economics determines that if you’re not yet a profitable company, you’re not going to become one by shelling out a lot for ergonomic equipment.

Staff might have to ask a few times for a keyboard tray. At one company, I quit before I ever received my keyboard tray. At another, I did the research and found the one I liked, then installed it myself when it arrived—with my own portable drill I brought in from home! I was one of maybe two people at a 25-person company who worked with a keyboard tray.

Also at a startup, there’s much less possibility to get an ergonomic assessment and other accommodations. But what you might get, that you’d lack at a large organization, is a more relaxed corporate culture. If you can dress casually, and sit in a more naturally-lit or colorful environment, you’ll be more comfortable and less stressed. Also, if you know everyone at the company, it’s easier to talk about what you need or take breaks when you need them.

Case 2: The Medium-Sized Corporate Bubble

When I developed RSI, I was working for a medium sized company. It was my first job out of college. The company’s HR Department was very kind and sent me to worker’s comp and gave me an ergonomic evaluation and purchased an expensive chair, keyboard tray and other equipment for me. They had those resources available, and didn’t hesitate to go all out for me.

What they failed to do, however, was to make the company a pleasant place to spend my time. I hated walking in to beige halls in the morning, to the smell of stale coffee and a dim office, and a culture where the VP of HR send out messages like, “If your sleeves aren’t four inches long, we’re sending you home.” I could even imagine her going around the building with a ruler, measuring people’s attire. It was ridiculous, and stuffy—and that culture wasn’t just confined to the HR rules. I worked about 45 hours a week, my boss was never pleased with anything, and any creative idea was shot down. VPs came to my desk an hour before I was ready to leave and begged me to stay to finish a job for them, on a regular basis. I quit after 10 months, my morale shot and my health in really bad shape.

The organization was well-intentioned, but the culture it created wasn’t conducive to healthy work – so I developed injuries, and left the company.

Case 3: The Safety-First Enterprise

A friend of mine works for a Fortune 500 company and recently described the experience as being babied. They take extreme care that their employees have the ergonomic furniture and workstations they need, and they’ve gone so far as to purchase sit-stand desks for some staff, and to load all the computers with rest-break software that requires staff to take breaks and stretch at regular intervals.

Surely all Fortune 500 companies are not so careful. In fact, I could imagine that some employees might even be annoyed at the requirements imposed by software that freezes your computer if you don’t stop and stretch. But, it also makes it easier for employees to ingrain healthy work habits, more difficult for them to push on through or worry about what their coworkers might think if they take breaks.

On the other hand, my friend also works long days of 9-10 hours, then gets a day off once every other week. Such long hours are bound to cause overuse problems if they aren’t carefully regulated.

What are your experiences, dear readers? Do you think the size of an organization has a large effect on whether it’s a healthy place to work? Experiences that reinforce or contradict some of my observations above?

Tell us your stories in the comments section.

I spent Saturday at the Maker Faire in San Mateo, and found some cool related tutorials for modifying your own computer input devices like mice and scroll wheels. Some of them don’t require much electronics savvy, while others are serious mods that need a few tools and some background. Either way, they’re fun to browse and might inspire you!

Check ‘em out:

Making a Multi-Touch Trackpad — good video of the process. I’d so make one if I didn’t already have a wacom and touchpad.

Making your own USB Scroll Wheel — Video, and Instructions, and some Spanish language Instructions

Hacking Mice to Control Cameras in 3d Space — list of Links and How-to Instructions

Making your own Laptop Stand — Here are variations of a laptop holder made by using a plastic letter holder, PCV, or even a paper towel holder from Ikea.

Also at the Maker Faire, I demo’d a couple new computer input devices. In one, kids used a modified Sharpie pen, against a white screen, to draw into a computer Paint program being projected onto the screen.

At the same booth, they were also demo’ing a 3D input device, using sensors mounted on either side of clear eyeglasses, to move around the computer screen. A camera up front tracks distance and place of the glasses and you can move around on a 3d grid on-screen. Useful for pilots and other 3D simulations. Also reminded me of a cooler version of the mouse-like device that uses a dot on your forehead to track movements.

In the future though, we might not need sensors and buttons and scroll bars — there are companies like NeuroSky who are experimenting with thought-controlled mechanical devices and robotics, translating brainwaves into signals. Check this out, it looks like fun and very useful too.

It’s not just computer users — many workers across many different industries and skill levels are at risk for repetitive stress and strain injuries.

So, what other careers are reporting high rates of injury? Here’s a random sample from the almighty google.

• Musicians
• Factory Workers
• Trade workers –(carpentry, painting, bricklaying, plumbing, etc)
• Waitresses, Pizza Cutters and others in the food service industry
• Archaeologists
• Sign Language Interpreters
• Construction workers… meat and poultry processers… crafters and hobbyists…sports enthusiasts…and the lists go on.

  So it seems the real question isn’t who’s at risk, but who ISN’T at risk?

  Our ability to create and use tools partly what separates humans from other animals on our planet. We’ve developed tools, machines, factories, and whole systems that help us improve our lifestyles, assure us security and bring us comfort.

  Yet these very tools are causing a global epidemic of injury and dysfunction. This seems to be the irony of our age.

  The practical picture is that you might not be able to escape RSI by leaving your career and finding another occupation. Whatever you do for a living, there are risks you’re going to have to take and overcome in order to stay happy and healthy. That doesn’t mean you have to resign yourself to pain, either, but it means there’s no easy out and no easy escape.

  On a positive note, it also means the grass isn’t necessarily better on the other side of your cubicle wall (or wherever you work). There are things you can do within those walls to make your life better. Whatever you do, take it slow and think about ways to take care of your body. And be grateful, too, for the quality of life that you do get to enjoy.

I’ve posted previously about alternate types of treatment for relieving the pain and helping to heal from repetitive stress injuries. One treatment I have not thought much about or explored (but have heard good reviews about) is chiropractic work.

A friend of mine recently threw out his back and visited his local chiropractor, who had him healed in about three days, after a total of about 40 minutes of treatment over two sessions. That’s pretty remarkable, but I was still doubting whether RSI would benefit the same way an acute injury does.

First off, I understand that many RSI issues are caused by problems in the musculature, rather than the nerves and joints. Although in reflection, that’s not necessarily the case either. Chiropractic work is interested in the alignment of the spine and the bones, with the understanding that if bones are out of alignment, the nerves and muscles will be affected. Naturally, since all of the above are inter-related, the play between nerves and bones and muscles is inter-dependent, and it’s difficult to separate cause and effect. One source suggests that in some cases, problems with the spine can radiate and cause problems with nerves and pain in other areas of the body, causing or exacerbating a flare-up or injury: “Spinal misalignments reduce normal vertebrae movement and will interfere with the nerves supplying different areas of the body.”

In doing some research into chiropractic treatments for RSI, I found some interesting links, suggesting chiropractics may be useful depending on the circumstance, and the type of treatment. Like any treatment, some doctors are going to be able to look at the problem holistically, and treat it comprehensively, while others who just focus on one area are not going to be successful in treating it.

In particular, an essay from a chiropractor in Castro Valley (about a thirty minute drive from where I live), suggests that neither chiropractics nor any other treatment can really be effective on its own; a doctor must take a holistic view of the injury in order to properly treat it.

I recommend you read the entire essay, but here’s an excerpt –

The doctor that singles out the symptom as your main problem, and only works at
reducing your symptom is doing a disservice to you - and is
wasting your time and money. The prime example is the musician
who is experiencing wrist pain and abnormal finger sensations.

The substandard doctor is one that only investigates the wrist
and hand, and fails to investigate the forearm, elbow, shoulder,
neck, posture, playing technique and style, and the other
factors mentioned.

There are chiropractors who limit their practices to spinal
manipulation only, and although effective in some conditions, I
do not recommend it for the complex nature of repetitive strain
injuries.

My friend who recently received chiropractic treatment recommended that RSI sufferers might get benefit from chiropractors who also perform other types of treatment, to help work on the muscles and break up scar tissue. Who knows, maybe I’ll try it one of these days.

Has anyone had experience with chiropractors for your RSI? If so, what were you getting treated, and did it provide you any relief? I’m curious to your thoughts.

If you have a hand injury and seek treatment, you may end up in a physical or occupational health center being treated by a hand therapist. While you sit there receiving treatments, you might wonder what training they’ve received before working on you.

Hand therapists have to demonstrate the following experience to receive certification:

• A demonstrated 5 years working as an occupational or physical therapist
• A current credential to practice
• Direct practice in hand therapy of at least 4,000 hours
• Passing of an examination
• A re-certification every five years

Given that therapists need 4,000 hours direct experience, it’s likely that not all practicing hand therapists out there are certified, but according to the above, they do have a certification in occupational or physical therapy at the least. Of the 4966 certified Hand Therapists worldwide, 4742 of them are in the U.S., according to the Hand Therapy Certification Commission (HTCC).

So, what exactly is the job description of the Hand Therapist? The HTCC has a published mission statement for its practitioners, defining the expertise its therapists offer. Here is a summary:

Hand therapy is the art and science of rehabilitation of the upper quarter of the human body.

• a merging of occupational therapy and physical therapy
• requires comprehensive knowledge of the body and its functions
• requires knowledge of specialized skills in assessment, treatment, the prevention of dysfunction, restoration of function, and reversal of pathology

Naturally, these therapists work on many more problems than repetitive stress injuries. Broken fingers, arthritis, and other pathologies — anything that pertains to the hands or arms — falls under their domain.

Last week, I mentioned a lot of good alternative therapies you can turn to for pain relief.  Of course, you can also perform massage, acupressure and trigger point therapy on yourself.

You can use your own fingers, knuckles, even the palm of your hand or elbow.  However, you might prefer to use some of the tools below, to help save your hands from the extra pressure, or to help you put extra pressure on those hard-to-reach places, like your back.

Before you jump and buy a special tool though, keep in mind there are all sorts of objects around your house that might do the trick.  Many physical therapists recommend wrapping a golf ball or tennis ball in a long sock, then grasping the end of the sock and leaning your back against the ball, either leaning into a wall or while lying on the ground.  The ball will help put pressure on the tense places and you can roll it around by moving.

You can be creative using other tools around your house, too.  For example, aluminum cans of food are great for a foot massage, or for the palms of your hands.  Just put them on the carpet on their side, then roll your palms or soles of your feet along the arch of the can.  

If the objects you have lying around just aren’t doing the trick, you can also check out the following tools, designed specifically for massage.  

The Knobble – small, wooden and handheld, used often by therapists for general massage.

TheraCane — a long curving tool to help you reach your back or neck easily 

BackKnobber and other tools — alternatives to TheraCane 

Comfort Channel – offers many kinds of tools, a web site with many images

Pressure Positive  – offers many kinds of tools, another web site with many images

Armaid  – a standing contraption designed specifically for forearm massage

Please note that I don’t know anything about the vendors.  I chose these sites because they give good images of the available options.

If you’ve used any of these, feel free to share your thoughts and reviews in the comments section.