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Ep. 25 -Repetitive Use Injuries

Repetitive Use Injuries Did carpal tunnel syndrome occur when people used manual typewriters? Is it a recently developed condition? If so, why? If you have a repetitive use injury, is there anything that can help? These are the topics on this edition of Straight Talk on Health with Dr. Chet Zelasko.

Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Together with WGVU in Grand Rapids MI, I examine the world of health research and news. Whether it’s research that makes the news, another miracle diet, a new food fad or an exercise trend, I look at the science behind them, and let you know whether it’s real or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.

I recently got a question about what a person should do if they suspect they have pain in their wrists. Given their job, it could be a RUI such as Carpal Tunnel Syndrome. First order of business – get a diagnosis from a joint specialist. We don’t treat ourselves for conditions we may or may not have. I can’t tell you the number of people who have said that “their symptoms sound like whatever.” Do yourself a favor. Get a diagnosis so that whatever treatment path is chosen, even if it’s exercise, it’s going to help the problem and not make it worse.

Why would I say it that way? Talk about my knee.

For arguments sake, let’s say that the diagnosis will support an overuse related issue given the nature of their job. The individual was most likely are too young to have osteoarthritis. I do have it in my thumbs and it affects my entire hand and wrist at times. What I would do is two-fold.

First, get Play-doh or something similar and squeeze it in their hand when they’re doing something else that doesn’t require both hands. 1-2 minutes at a time. Strengthening the muscles and tendons helps. More later.

Second, stand up against a wall. Have your nose and toes touch the wall if possible. Some people have too much middle in the way so begin with the toes and get as close to wall as possible. Then, raise your hands above your head like you’re doing an overhead press. You can let your fingers “climb” the wall until your arms are fully extended. Up and then down until your upper arm is parallel to the floor. 10-15 times, 2 sets twice per day. Then, reverse position with your heels and your head touching the wall and repeat. In this case, the hands against the wall is more important if your buttocks protrude and don’t allow simultaneous Touching. Do the same routine. Overhead press. Arm position, reps, sets, yada yada.

Finally, shrug your shoulders like you’re demonstrating “I don’t know!” Again, strengthening the muscles in the neck and upper back, trapezius primarily, may also help. Reps, sets, etc.

Why these exercises? Wrist issues often begin in the shoulder and these exercises stretches the muscles out. It may be that the nerves that control the wrist and finger muscles get pinched in the neck and shoulder region.

Is this a recent phenomenon? Did this happen with the old style manual typewriters or even the electric ones that followed them? There doesn’t seem to be any scientific examination of the issue. There are many opinions but none really routed in research.

What seems to make sense is that the resistance of manually having to strike the keys hard enough to have the letters strike the paper was the key. It was just like running. You don’t get repetitive use injuries from that because every foot strike absorbs shock and muscular contractions are required to move you forward. When someone types on keyboards today, there is little to no resistance so your fingers are moving many times but not really doing anything physically. Is that the real reason? Maybe.

Does it happen with piano players or other keyboardists? There was actually a dissertation written in the late 90s that examined the question via questionnaire to physicians of injured pianists. While the answer is yes, there were many reasons other than the repetition. Top two were misalignment of fingers on key strike and misalignment of wrists on key strike. That caused an inflammation of the fascia, the connective tissue that covers muscles and joints. That goes to learning how to do something correctly when you begin a new skill rather than just getting the job done.

Reference: An analysis of contributing factors to repetitive strain injury (RSI) among pianists. Hsu, Yu-Pin.   Teachers College, Columbia University ProQuest Dissertations Publishing,  1997. 9734067.

First step, people, first step. What does that mean?

After all of that, are there any OTC approaches that may help? Anti-inflammatories for pain as needed and that would be aspirin or ibuprofen. Acetaminophen is a pain reliever, not an anti-inflammatory.

As for dietary supplements, glucosamine and chondroitin may help as they contribute to the health of connective tissue. Omega-3 fatty acids may help with naturally reducing inflammation. Finally, vitamin C I critical to connective tissue health so that may be something to consider.

RUI can really set you back with inflamed and painful joints. My one experience with severe RUI was using a motorized weed whacker the first time. OUCH! But if it’s part of your job, make sure you’re using the correct mechanics and keep all tissues involved stretched and strengthened to help prevent problems to begin with.

Dr. Chet Zelasko is a scientist, speaker, and author. Dr. Chet has a Ph.D. and MA in Exercise Physiology and Health Education from Michigan State University and a BS in Physical Education from Canisius College. He’s certified by the American College of Sports Medicine as a Health and Fitness Specialist, belongs to the American Society of Nutrition, and has conducted research and been published in peer-reviewed journals. You can find him online at drchet.com.
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