Reprinted from The RSI Network - Issue 18 - Jun'94

Peter Bower, MD
June 1994

1. RSI is not just one thing.

2. You don't need to have much repetition to induce it.

3. If you smoke, you always get it worse.

4. If anti-inflammatory medications work, you didn't have a bad case.

5. All the ergonomic workstation modifications in the world won't make a significant difference if you don't correct your posture and start taking care of yourself.

6. If you're under stress, you'll do worse.

7. If you've had it for more than three months and are told it's "just tendinitis," you can be sure it's not tendinitis.

8. If you're seeing an M.D. who says he or she doesn't know what you have, you've found an honest physician.

9. If you're told to have carpal tunnel or cubital tunnel surgery and you have a normal EMG test, find another surgeon.

10. If you haven't gotten an opinion from a skilled physiatrist and/or osteopath, you should without delay.

11. Splints are fine only if they work.

12. Ice is fine only if it works.

13. Heat is fine as long as you apply it to muscles in spasm.

14. If you're sick of taking pills of one sort or another and they don't work, you're not alone.

15. If physical therapy flares up your symptoms without producing a distinct improvement in function over the next several days, that type of physical therapy is causing more harm than good.

16. The "natural" supplements like B6 and Omega-3 fatty acids won't hurt you as long as you don't drown yourself with mega-doses.

17. Most people with RSI have a variation on the "double crush" or thoracic outlet syndrome to one degree or another. (For more on double crush, see Issue 17 -- Ed.)

18. Addressing just the painful part in therapy and not the entire neck to fingertips is substandard treatment.

19. Insurance companies are uniformly ignorant, or obstructionist, or both, when it comes to treating these problems.

20. The clearest clinical measure of these conditions by physical examination is by the upper limb tension testing technique described by Robert Elvey, P.T. If you have access to a therapist or physician who knows about this, you'll get a clear picture of what the underlying problem really is.

About the Author
Peter Bower, M.D.,(cyberdoc@crl.com), (707)829-7596, treats many RSI sufferers in Sebastopol CA. The techniques he uses in the diagnosis and treatment of RSI are from many disciplines, including traditional allopathic (M.D.) medicine, osteopathy, and Elvey's techniques of physical therapy.

THE ELVEY TECHNIQUE: REFERENCES
In his article Twenty Clinical Truths About RSI in Issue 18 of this newsletter, Dr. Peter Bower stated that the clearest clinical measure of RSI-related conditions by physical examination is by the upper limb tension testing technique described by Robert Elvey, P.T. Several people asked for references for this technique.

• Elvey RL (1979) Brachial plexus tension tests and the pathoanatomical origin of arm pain. In: Glasgow EF, Twomey L, Aspects of manipulative therapy. Melbourne. Lincoln Institute of Health Sciences. 1979: 105-110.
• Elvey RL (1986) Treatment of arm pain associated with abnormal brachial plexus tension. Australian Journal of Physiotherapy 1986: Vol 32 No 4.
• Kenneally, Rubenach, Elvey (1988) The upper limb tension test - the S.L.R. of the arm. Grant R, (ed) Clinics in Physical Therapy. The cervical and thoracic spine. Churchill Livingstone: New York. 1988.
• MacKinnon SE, (1992) Hand Clinic Vol 8 No 2 May 1992 (the first American M.D. to report the use of the Elvey Test clinically in the diagnosis of brachial and peripheral neuropathies).
• Mobilization of the Nervous System. David Butler.

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