Create Peace Yoga: Repetitive Strain Injuries (RSI)


Repetitive Strain Injuries (RSI)

A repetitive strain injury (RSI) or an overuse injury is a cumulative trauma disorder stemming from prolonged repetitive, forceful, or awkward hand movements. In opposition to what people may think, the hands are not the only part of the body that can have a repetitive strain injury. Many parts of the body can be overused and injured. Repetitive strain or overuse syndrome is created from strain to a certain body part that can become chronic and includes a wide range of conditions. Some examples of overuse syndrome include: tendonitis, tenosynovitis, bursitis, nerve impingements such as carpal tunnel and thoracic outlet, shin splints, and various other musculoskeletal injuries.

Overuse injuries are generally an outcome of repetitive use, inefficient movement, poor or static posture, and stress to the soft tissues of the body. Connective tissue hardens over time because the soft tissue is overused. This is a natural response for the prevention of injury. Any repetitive action that places excessive strain on the soft tissues can cause damage to the body. Microscopic damage occurs in the soft tissue and can build up over time. The damage that develops can cause excessive strain, tearing, and inflammation. Injuries to the soft tissue are common and can include strains, sprains, tendonitis, and possible tearing. Injuries can happen when there is not proper healing time for the soft tissue to repair. This type of injury is commonly seen in muscles, tendons, and ligaments.

Injuries are classified as either acute (traumatic), or chronic (overuse). Acute injuries come from a specific impact or trauma and occur suddenly during an activity. Symptoms of an acute injury are severe pain, inability to bear weight on a limb, tenderness and weakness in a limb, or decreased range of motion. On the other hand, chronic injuries are normally a result of overusing a part of the body while engaged in a sport or exercise and happen over a long period of time. Symptoms of a chronic injury are swelling, pain when performing specific activities, decreased strength, reduced range of motion, muscle soreness, numbness, or a dull ache at rest.

Dysfunction in the musculoskeletal system can cause a disturbance in the peripheral nervous system and create nerve compression. The symptoms feel as if they originate in the local tissues, most of the time, the cause is along the path of the nerve. Numbness, tingling, and burning are symptoms of nerve disruption.  The compression or entrapment can occur where the nerve passes through a moving joint structure. Nerve compression and entrapment happens, either when a bone or disk compresses a nerve, or can take place when soft tissue presses on a nerve.

Carpal tunnel syndrome (CTS) is a set of symptoms that occur from entrapment of the median nerve. Carpal tunnel syndrome can occur from overusing the muscles, thus creating inflammation within the tendons and nerves that pass through the tunnel. Carpal tunnel syndrome can cause pain, tingling, numbness, and weakness in the hand. The most common reason for carpal tunnel syndrome is the narrowing of the carpal tunnel. The carpal tunnel can decrease in size due to muscle tension or from the carpal ligament compressing above the tunnel. The reduction in space in the carpal tunnel also can be due to muscle imbalance between the flexors and extensors. The flexor muscles become shortened and thicker and the extensors become weak and are unable to hold the carpal bones in place. The tunnel can collapse in on itself and cause friction with the flexor tendons. This friction causes irritation and inflammation as well as, decreases space in the tunnel. The solution for eliminating muscle imbalance is to stretch and lengthen the flexors and stretch and strengthen the extensor muscles. Maintaining muscle balance is the key to stabilizing the carpal bones and preventing them from collapsing into the carpal tunnel. Edema is another common cause of carpal tunnel symptoms and causes added pressure in a space where there is no extra room. Edema caused from pregnancy, obesity, or menopause is common and usually bilateral. Essential steps to reducing nerve problems in the carpal tunnel area are to decrease the inflammation and rest the area completely. When the inflammation and symptoms have subsided, break up the scar tissue and release the flexor retinaculum. Massaging the muscles in the nerve related path could be effective in relieving the compression of the nerve. Receiving massage is indicated for carpal tunnel, but with caution. If any of the same symptoms become present when massage is applied to the hand and wrist, disregard the treatment immediately. Certain types of carpal tunnel respond well to massage. It is important that you confirm that a medical doctor has diagnosed the disorder and know the main cause of the symptoms before applying massage to make sure it is indicated.

Thoracic outlet syndrome (TOS) is a neurovascular entrapment and is common among therapists who have poor posture. Poor posture such as slumping and anteriorly rotating the shoulders can bring the clavicle close to the first rib and reduce the size of the thoracic outlet. Reducing this space entraps the nerves of the brachial plexus and can disrupt nerve impulse. In turn, this reduction in space can initiate loss of strength and create numbness and tingling from the thoracic outlet to the fingertips. In the early stage, discomfort can occur while doing massage. In the later stage, pain and discomfort becomes more prominent and frequent. Thoracic outlet can be caused from anything that impairs functioning of the brachial plexus. Some examples that can cause reduction in nerve impulse from the brachial plexus are subluxation of cervical vertebra, misalignment of the first rib, spondylosis, and atrophy of muscles. Signs and symptoms of thoracic outlet syndrome (TOS) are numbness, tingling, shooting pains moving to or from the arm, or a combination of both. Have orthopedic tests to determine the diagnosis.  Pain in the shoulders, arms, and hands have many different reasons and can often be misdiagnosed because soft tissue injuries do not always show up on medical tests. Like carpal tunnel, the treatment for thoracic outlet depends entirely on what produced the symptoms. Resting of the affected area and reducing the entrapment is important to treating the condition. If the condition is related to tight muscles or muscle spasm, receiving massage to the scalenes and pectoralis minor is recommended. Also, specific stretches and exercises for the pectoralis minor, scalenes, and their antagonists can make a difference in the reoccurrence of symptoms.

Double crush syndrome is more commonly seen than people think and can be noticed with TOS and CTS. Cervical root compression is found in combination with CTS. It only takes the weight of a nickel to compress a nerve. If the nerve is compressed with this small amount of pressure, it can impede the nerve flow by thirty percent. With nerve compression, a safety margin could be exceeded if you have an additional, more proximal nerve lesion. Two minimal nerve compressions are more severe than a single compression. The diagnosis of double crush syndrome can be made only if the same nerve fiber is compressed at two different sites. In addition, the clinical manifestation of a double crush is caused from loss of nerve conduction. Examples are nerve dysfunctions such as sensory deficits or muscle weakness. Conservative treatment should be used initially and each entrapment needs to be located. Treatment should be conducted at each lesion for the best results. Double crush is still treated as a theory and challenged by medical professions but is a very real disease to the patients involved.

Myofascial pain is a widespread cause of pain today. The constant overloading of muscles on the job is common these days. Overusing and overloading the muscles can lead to myofascial pain. Trigger points can occur in the myofascia, skin, ligaments, and bone lining and can contribute to myofascial pain. A trigger point is a hyperirritable, localized spot in muscle or soft tissue that is palpable as a knot or rigid band that can cause local or referred pain. Trigger points can occur from overuse, injury, and fatigue of muscle tissue. Joint problems and surgery can also create trigger points in the tissue. Trigger points can entrap the nerves, blood, and lymph vessels and can cause a variety of confusing symptoms. Active trigger points produce pain locally or in a more remote location. Each particular trigger point has a referral pain pattern. An active trigger point hurts when the specific muscle is used and can continue to hurt even at rest. A latent trigger point exists but does not actively refer pain until the area is strained. A latent trigger point does not usually hurt unless it is pressed yet it can restrict movement, weaken, and shorten the affected muscle. Latent trigger points can be made active by overuse, overstretching, or chilling of a muscle. Central trigger points are located in the center of the muscle where the motor nerve is located and where tissue can get bound up. Treating trigger points and myofascial pain starts with locating the central point in the belly of the muscle, which is helpful for reducing referred pain.

Trigger points can be deactivated if treated correctly and perpetuating factors can be avoided. Trigger points that are left untreated or not treated thoroughly can still cause pain. Movement is sometimes restricted to avoid pain and the trigger point can become latent. If the muscle is still overworked without being treated, active trigger points can develop secondary and satellite trigger points. Secondary trigger points arise when a muscle is stressed because it has to take over the job of another muscle. Satellite trigger points can occur in the referred pain zone of another trigger point. Without proper treatment and deactivation of trigger points, widespread pain can develop.

Some injuries are very apparent and some are more subtle. Even so, overuse injuries occur progressively over time and the damage that occurs from constant and repetitive straining of the body part is cumulative. Remodeling is an internal process that includes the breakdown and build-up of tissue. If breakdown happens faster than build-up, an injury can occur. Chronic, overuse injuries come about if you do not pay attention to the warning signs your body gives you. Warning signs can be subtle at the beginning of an overuse injury, but become more apparent when damage has occurred. Warning signs vary from person to person and from each specific injury. Warning signs of an overuse injury could include: reduced range of motion, comparative weakness, joint pain, persistent pain in the area of repetitive use, swelling, tingling, or numbness. If you notice any of these warning signs, stop the activity you are doing. It is highly suggested to pay attention to these sensations at the first sign, in the initial phase. The main goals are to prevent further damage, find the source of injury, and begin treatment immediately.

A repetitive injury can turn into a syndrome if not cared for properly. Repetitive strain injury (RSI) can also be called overuse syndrome, cumulative trauma disorder, or occupational overuse syndrome. This condition results from overuse of a part of your body or an activity that involves repetitive movement. Overuse syndrome occurs when a group of muscles are used repeatedly without adequate rest. Repeating a movement over and over can create tightness and overuse in one muscle group while the opposing muscle group becomes weak and underused. Repetitive stress on the tissues can cause a muscle or tendon to be overstretched, a muscle or tendon to be shortened from constant contraction, joints and tendons to be overloaded, or nerve impingement. Overuse causes hypoxia, possible muscle spasms, and microtearing in the tissue. If the area is not allowed to heal, the effects can be cumulative and an overuse injury can take place.

The terms, repetitive use injury and repetitive use syndrome, are used concurrently, although the term syndrome can be used with a more serious or chronic condition. Repetitive use injuries have different levels that range from a grade one to a grade five. In a grade one overuse injury, pain is only present when performing work and daily activities. With a grade two overuse syndrome, pain subsides by evening and daily activities are mildly affected. Pain and tenderness are only mild. Therapists with grades one and two can still normally work with some modifications. With a grade three overuse injury; pain continues into the evening but is not present upon waking. Signs of pain are evident a short time after you begin working and daily living is affected. Grade three requires an absence from work. You can return to work, depending on recovery time and job modifications. It is a good idea to take time off until the symptoms dissipate completely. With a grade four overuse injury, pain upon waking is present during each working day and at night. Symptoms can subside on weekend or days off; but, if you want the injury to heal and not repeat itself, let the symptoms dissipate completely. People with grade four injuries infrequently return to the same working position unless they are off for months. Finally, with a grade five injury, pain is ongoing and daily life is completely restricted. People with a grade five, overuse syndrome rarely return to their line of work or to the job force at all. Physical symptoms that occur with each grade and severity consist of tenderness, swelling, numbness, redness, spasms, tingling, burning, and numbness.

Repetitive strain injuries (RSI) are complex for the medical professional, as well as the patient. Symptoms are different for each person and the recovery process and time frame can be unique to each person. Advice from each professional can be contradictory and the process can get very frustrating, particularly if you cannot continue to work until the injury is fully healed. Contact a specialist and find the root cause of the symptom(s). A repetitive strain injury is biomechanical and muscle imbalances needs to be addressed. A quick-fix solution will not usually work since it takes time, patience, and perseverance to restore proper functioning to a body that has been misused over time.

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