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April 20, 2021  
SHOULDER NEWS: Feature Story

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  • Avoiding Repetitive Motion Disorders

    In It for the Long Haul – Avoiding Repetitive Motion Disorders


    August 31, 2006

    Part One

    By: Jean Johnson for Shoulder1

    Tap, tap, tap. Peck, peck, peck. It seems that we’ve turned into bird people except instead of having beaks, we use our fingers to make tiny, repetitive movements on the keypads of our phones, our PDAs, and most of all our computer keyboards. It’s not like fine motor movements are all that new. People have been doing things that can cause repetitive stress problems like sewing, playing musical instruments, assembly line work, meatpacking, carpentry, gardening, and tennis practically forever.
    Take Action
    Stuck at the keyboard all day?
    Ellen Serber, certified yoga teacher in Northern California since 1970 offers the following exercises for keyboard breaks:

  • Relax your shoulders, and place your hands in prayer position, slowly bringing the heel of the palms together. Hold for a few breathes and if the stretch causes no discomfort move the hands over to the right and hold for a few more breaths before doing the same on the other side.

  • Make fists and place your hands thumbs up on the desk with your lower arm supported on the desk top. Slowly stretch the fists to the right and the left without moving the lower arms.

  • Lift arms off the desk with hands in fists to make slow circles in both directions.

  • Release fingers and place them tips up on the edge of the desk. Press into the desk for a slow stretch, both with fingers splayed apart and together.

  • But what’s happened as we’ve become more efficient – particularly at the keyboards that seem to dominate our lives – is that our bodies don’t get the breaks they used to. Instead of stopping typing for a moment to file some papers away or send a message, those tasks are managed by yet another key stroke.

    The double whammy is, of course, that even as we are exacting these new tolls on our bodies, we are living longer thanks to modern medicine and state-of-the-art healthcare. Thus, the name of the game is to not wind up in your 80s with hands and perhaps even arms that have given up.

    Causes and Symptoms

    As the National Institute of Neurological Disorders and Stroke (NINDS) confirms: “Repetitive motion disorders (RMDs) are caused by too many uninterrupted repetitions of an activity or motion, unnatural or awkward motions such as twisting the arm or wrist, overexertion, incorrect posture, or muscle fatigue.” The NINDS also points out that “RMDs occur most commonly in the hands, wrists, elbows, and shoulders, but can also happen in the neck, back, hips, knees, feet and ankles.”

    As far as symptoms, the NINDS states: “The disorders are characterized by pain, tingling, numbness, visible swelling or redness of the affected area, and the loss of flexibility and strength.” The institute observes that most people with repetitive motion or strain injuries can recover completely and avoid re-injury by “changing the way they perform repetitive movements, the frequency with which they perform then, and the amount of time they rest between movements.”

    That said its experts do make the attention-getting observation that “Over time, RMDs can cause temporary or permanent damage to the soft tissues in the body – such as the muscles, nerves, tendons and ligaments – and compression of nerves or tissue.” Indeed, NINDS underscores that “without treatment, RMDs may result in permanent injury and complete loss of function in the affected area.” If that’s not enough, they add the caveat that “For some individuals, there may be no visible sign of injury, although they may find it hard to perform easy tasks.”

    Like Mother Like Daughter?

    Complete or partial loss of function is something that’s always on the mind of fiction writer Laurie Swanson of Tigard, Oregon.

    “Since I’m just starting out, I write more than I should I suppose. I’ve been at it for a few years now and recently my right arm has started acting up. Last week before I was really forced to take a few days off, I could feel the heat from the inflammation in my forearm. Also when I raise my arms over my head like you’re stretching, I have pain clear up into my upper right arm deep in the muscles. I type really fast and make a lot of mistakes, so I use the backspace and delete keys constantly. Also, I suppose my ergonomics have been off.”

    Swanson is anxious to hear what we come up with as far as answers in this article, especially since she fears that between nature and nurture she might follow in the footsteps of her mother.

    “The loss of function part really does scare me because my mother is getting older and has carpal tunnel – she was a secretary so I guess it was from typing. Also she did a lot of needlework in her day – needlepoint, hooking rugs, crocheting afghans. We’re a lot alike. For us, it’s busy hands are happy hands.

    “Anyway, she had the surgery but they told her that because she put it off too long, it was a long shot. They were right to caution her, because it ended up not helping. Now she has trouble holding heavy books, and we have to only bring her lightweight ones to read. She even mentioned once that she’s worried some day she might not be able to feed herself. Wouldn’t that be horrible? I can’t imagine a worse fate,” Swanson said, her voice taking on a higher pitch.

    “So I guess I’m just trying to let what she’s going through be a reminder to myself to try not to be so hard on my body. I did go out and buy a wrist splint. Also I work on my laptop a lot and figured out that I needed to prop it up with a rolled bath towel so that I wasn’t reaching so far.”

    Advice from an Expert: Getting Professional Assistance Quickly

    As we expected, Sybil Fisher, occupational therapist and certified hand therapist with Providence Milwaukie Rehabilitation Services in Portland, Oregon, says not dealing with repetitive stress injuries is asking for trouble.

    “A lot of people are good intentioned, thinking it will go away. But they often wait too long,” said Fisher. “If something’s hanging around two or three weeks, it’s a good time to go see a doctor and therapist, because once something becomes chronic it’s a different ball of wax.”

    As far as why chronic conditions that are longer term and ongoing are more serious than short term acute situations, Fisher said, “Any time a condition is acute, it’s less than three months. You’re body hasn’t quite adapted to that inflammation so it’s more responsive to therapy, and we’re much more successful.

    “Past that time and we’re dealing with scar tissue that the body has laid down. There’s less blood supply to scar tissue so once that happens, the stress injury problem gets harder and longer to reverse and repair. We can still treat it with good results when people wait – it’s not impossible then, but it is much more difficult.”

    Tendonitis is what Fisher says is at the bottom of most repetitive strain injuries. “The tendons connect the muscles to the bones and when they are overstressed, the sheaths surrounding them get inflamed, a condition that can be very painful.” She explains that this is the reason many physicians will often prescribe splints to wear at night and anti-inflammatory drugs before they start talking about therapy.

    As far as certified hand therapists like Fisher, she said they will work with patients on “very specific stretching and strengthening exercises.” Here the key is correctly identifying the problem and knowing which muscles to work on in which ways.

    For tips on seeing what you can do at home before going into to see your physician, join us in Part Two of this series for further insights from Sybil Fisher, O.T.R., C.H.T.

    Continued in Part Two

    Last updated: 31-Aug-06

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