Why Biofeedback Training is Used in Preventing and Treating Repetitive Strain Injuries


Updated  December 2001
Original version from The RSI Network - Issue 31 - September'98

Julie Weiner, MS, BCIAC, Fellow
(914) 633-2991

Pressure on a nerve only partly explains the pain of repetitive strain injury. Why can some people work at a word processor all day for years and be fine, while repetitive tasks soon injure others?

The answer: different people use their muscles differently.

Muscle tension and bracing are usually involved in repetitive strain injuries. Even if you sit at an ergonomically correct work station, if you are unconsciously hunching forward, breathing shallowly, or tensing your jaw, neck, shoulders, back, or arms as you work, this can cause muscle strain and excessive pulling on tendons that normally glide smoothly through other tissues. Chronic, sometimes severe, pain can result. 

People who are unlikely to experience a repetitive strain injury are able to relax and rest their muscles, even while working. Learning this skill is not difficult, and can be done with biofeedback in order to prevent and recover from the injury.

What Is Biofeedback?
Biofeedback is a safe, noninvasive, painless, and effective use of instruments, now usually computerized, to provide continuous information about subtle changes in aspects of your body's functioning related to your symptoms. Its purpose is to teach you to regulate the physical responses underlying symptoms. It thus falls into the categories of behavioral medicine and mind-body education. (In other words, it can be seen as both a medical intervention and an educational experience.)

What Is Biofeedback Training Like?
Surface electromyography, or EMG biofeedback, makes it possible to see when you are tensing muscles and unnecessarily during habitual activities. Unlike needle electromyography, a medical-diagnostic procedure, EMG biofeedback involves placing flat, not sharp, sensors on the surface of the skin over the muscles to measure the amplitude of the electrical signals that tell muscle-fibers to contract. Guided in relaxing by the feedback, you learn new skills and habits that enable recovery from pain. The biofeedback equipment is either connected to a computer, which allows you to see your actual reactions, or to a device that emits sounds.

After a thorough evaluation to find out which muscles are involved, and consultation with your physical or occupational therapist or other providers, as appropriate, RSI patients (and those at risk of RSI because of work or leisure activities) are given a course of biofeedback and pain management training that may include diaphragmatic breathing, muscle relaxation, mini-break training, muscle-symmetry, postural awareness, stress management training, and help in establishing good basic health habits. Each of these training procedures has a distinct purpose, as explained below.

EEG biofeedback: EEG, or brain-wave biofeedback, may also be used to help you learn relaxation skills, and to help “recondition” the nervous system to help you respond with greater flexibility and less tension to the stressors in your environment.

Diaphragmatic breathing: Many people breathe shallowly as soon as they start working at a repetitive task that requires concentration, such as word processing, assembling parts, or playing a musical instrument. Through biofeedback training you learn how to relax the muscles of your neck and shoulders while breathing abdominally--and then learn to do it while working or practicing

Muscle relaxation: With the help of EMG biofeedback to become aware of muscle tension in your neck, shoulders, arms, or back, you can learn to reduce tension in the muscles that are symptomatic. Afterwards, you learn to keep the same muscles as relaxed as possible while working.

Mini-break training: Once you know how to relax your muscles, you learn how to do it quickly and efficiently, so you can give your muscles frequent, quick breaks--enabling you to work for longer periods of time without pain.

Muscle-symmetry training: Balancing tension levels in muscles on opposite sides of the body helps reduce activation of trigger points--those tender knots in muscles that, when pressed, cause radiating pain. (This has been demonstrated in controlled studies by a Canadian research group, including biofeedback specialist Stuart Donaldson, PhD, which found that symmetry-awareness training alone--even without biofeedback--significantly reduced hospital workers' absences due to injuries.)

Postural awareness: EMG biofeedback enables you to test the effects on muscle tension resulting from your habitual work postures. Guided by the feedback, you then learn repeatedly to return to the best postures for your task. Finally, you learn to find your least stressful work postures without external guidance.

Stress management: Stress is a factor in muscle tension. It has been learned only recently that muscles are signaled by fibers of the sympathetic nervous system (not just by motor neurons, as students are still taught in biology classes). The sympathetic nervous system controls the fight-or-flight reaction--the gearing-up for action that occurs every time you estimate that a situation might be beyond your ability to cope. If you've noticed that your arm, hand, neck, or back pain is worse when you're under stress, it's because any trigger points you have are electrically activated by the sympathetic nervous system whenever you encounter even mildly anxiety-producing or annoying situations. 

In other words, whenever you say to yourself, "Uh-oh!," your muscles become tense. And if you think this way often, without a corresponding, "Oh, well . . ." and a philosophical shrug, or a shift to a "Let's see, what shall I do about this now?" problem-solving approach, you set up a vicious cycle in which stress increases tension, which increases pain, which exacerbates stress, until you're in a full-blown setback. 

Thus, biofeedback treatment for RSI, in addition to muscle-relaxation and EEG biofeedback training, may include measurement of an additional physiologic stress signal that reflects sympathetic nervous system arousal, such as fingertip temperature or galvanic skin response (nervous perspiration), and an introduction to cognitive stress-management tools: how what you do and say to yourself and others in response to stress or pain can exacerbate tension or help you feel better. Stress management training helps you learn how to substitute physiological and psychological "comfort cycles" for previous stress-related vicious cycles.  

Establishing good basic health habits: You may be offered help finding an exercise routine that fits your lifestyle, making time for healthy meals, getting a good night's sleep, or quitting smoking. (Smoking increases the risk of muscle injury.) You also may be advised on the role of nutrition in maintaining relaxed, healthy muscles, tendons, joints, and cartilage.

Biofeedback training is growing in popularity because it is noninvasive and pain-free, and its efficacy is well documented in medical literature. Because of this, it is reimbursed by some insurers. A short-term time investment (usually eight to 20 sessions, depending on the severity of injury and previously learned relaxation and stress-management skills), combined with a willingness to practice and establish new pain-prevention habits, can yield long-term health benefits. 

About the Author
Julie Weiner, MS (Nutrition), is a Fellow of the Biofeedback Certification Institute of America (BCIA-certified for over 12 years), and has been using biofeedback to teach relaxation, pain-alleviation, and stress-management skills to patients with chronic pain for 16 years. She is also certified in EEG biofeedback. Through the Sleep Laboratory at CCNY, she has participated in research on sleep, nutrition, memory, and attention deficit-hyperactivity disorder.  She was staff biofeedback specialist for nine years at Lenox Hill Hospital’s pain center.  She has developed expertise in applying biofeedback to patients with insomnia, anxiety, and asthma, as well as such chronic headaches, back pain, temperomandibular joint syndrome (TMJ), and repetitive strain injuries. 

Ms. Weiner was formerly a book editor, and collaborated on The Complete Guide to Health and Nutrition, by Gary Null, PhD, and The Body Electric, by Robert O. Becker, M.D.

 For more information, Ms. Weiner can also be reached by mail at: Biofeedback Learning Center, 5997 Riverdale Avenue, Bronx, NY 10471. (This office is easily accessible by car, commuter rail or express bus from Manhattan.)


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Last Updated: 12/23/01