Physical Therapy for Repetitive Motion Injuries


Reprinted from The RSI Network - Issue 30 - Aug'98

Randall Helm, PT
Ontario, Canada
(519) 579-9926
August 1998

Physical therapy is a health profession specializing in the rehabilitation of people from all walks of life. Areas of specialization include orthopedics, cardiovascular and neurological rehabilitation, pediatrics, gerontology, and sports injuries. You will find physical therapists working in hospitals, industry, homes, and private practices. Whether you are undergoing a heart transplant operation, recovering from a stroke, or trying to recover expediently from an injury prior to a trip to the Olympic games, it is likely you will be seeking a physical therapist for help.

Physical therapists are among the primary caregivers in the fight against repetitive motion injuries. RMIs, RSIs, and CTDs are terms that are often interchanged to describe a host of work-related upper-extremity dysfunctions. In a computer-based environment, however, the term RMI is the closest in actually describing the problem. Physical therapists design their treatment approach based on their knowledge on how the entire body needs to work as a unit. As rehabilitation specialists, physiotherapists can design a strengthening, stretching, and muscle balancing program that is tailor-made for each RMI sufferer. Physiotherapists may also use such modalities as ultrasound, biofeedback, and acupuncture, along with various hands-on stretching and joint mobilization/manipulation techniques. Many therapists have taken specialty courses in office ergonomics, and can go into your workplace to assess your workstation and how you interact with it.

Thoughts on RMIs

I believe, as do a great number of my colleagues, that many of the RMI problems that people develop in their shoulders, elbows, wrists, and hands have their origins in dysfunctions in the neck region. Many computer operators spend a great deal of their time sitting in the forward-head position. This poking chin posture leads to tight spasmed muscles in the neck, which can alter the nerve and blood supply to the arms. A common problem seen in the RMI population is the development of increased neural tension. A simple way to view neural tension is to think about how muscles can become shortened and tight when constantly strained or placed in a compromising position. It is the connective tissue of the muscles that often becomes shortened and immobile, leading to stiffness. Neural tissue also has connective tissue. When it is strained or put in compromising positions it can shorten and tighten, similar to injured muscle tissue. Often the burning, numbness, and tingling RMI sufferers feel is caused in part by these neural adhesions.

In treating RMIs it is therefore very important to look at the whole person, and not just the part that hurts. If carpal tunnel is treated only by addressing the wrist problems, the initial cause of the RMI — poor posture, leading to altered nerve and blood flow to the arms — is actually ignored. Therefore, physical therapists treating RMIs usually correct posture, work on neck and neural tissue mobility, and then address the chief RMI complaint.

It is also important to understand the role that overall poor health plays in the development of RMIs. A major concern in western societies is obesity. Obesity leads to many other health problems, including adult-onset diabetes. Diabetes negatively affects blood vessels, nerves, and energy transportation, depriving muscles and other soft tissues of nutrients and oxygen and making diabetics more susceptible to RMIs. When injuries do occur in the diabetic population, recovery is much more difficult. At the other extreme, many people develop eating disorders in their quest to stay thin, leading to malnutrition. People who are malnourished develop sprains and strains very easily. It is easy to hypothesize from this that anyone with poor nutrition is more susceptible to RMIs.

Difficulty dealing with stress is another area that cannot be ignored when considering RMI risk factors. Research reveals that elevated stress levels affect sleep patterns, food digestion, circulation, and muscle tension. Most of us have experienced an increase in neck stiffness when a deadline or difficult project is hanging over us. If you live in a stressful environment too long you can expect a sickness or injury in your future. In the computer workforce, all too often it is the development of a RMI.

Treatment of any RMI sufferer should therefore address nutrition, stress management, present physical fitness level, posture, and overall health. With this approach it is easy to see why it makes sense to have someone with carpal tunnel syndrome exercise aerobically, attend stress management seminars, and consult with a dietitian. If you walk into most physiotherapy clinics you will hear bikes humming, weights clanging, and encouraging therapists. The active approach works!

About the Author:
Randall Helm is a physical therapist from Kitchener/Waterloo, Ontario, Canada. He is the author of ComputerFit: Staying Healthy in a Computer-Based Workforce (Lifelong Publishing Health/Computers, 1997). For more information about his book or educational sessions for computer users please visit his Web site at http://www.computerfit.com.

Included below is a list of recent references that support some of his beliefs on computer health. His book is written from a scientific knowledge base and includes a thorough list of references.

Skubick, D.L., et al. "Carpal Tunnel Syndrome as an Expression of Muscular Dysfunction in the Neck." Journal of Occupational Rehabilitation 3 (1): 31-44 (1993).

Aiello I., et al. "Tonic Neck Reflexes on Upper Extremity Limb Flexor Tone in Man." Experimental Neurology 101: 41-49 (1988).

Harvey, R. and Peper, E. "Surface Electromyography and Mouse Use in Position." Ergonomics 40 (8): 781-789 (1997).

Straker, L. M., et al. "The Effect of Shoulder Posture on Performance, Discomfort and Muscle Fatigue Whilst Working on a Visual Display Unit." Int. Journal of Ind. Ergonomics, 20: 1-10 (1997).

Fernstrom, E., and Ericson, M.O. "Computer Mouse or Trackpoint Effects on the Muscular Load and Operator Experience." Applied Ergonomics 28 (5/6): 347-354 (1997).

Waersted, M. and Westgaard, R.H. "An Experimental Study of the Shoulder Muscle activity and Posture in a Paper Version Versus a VDU Version of the Monotonous Work Task." Int. Journal of Ind. Ergonomics 19: 175-185 (1997).

Shieh, K-K. and Chen, M-T. "Effects of Screen Color and Combination, Work-Break Schedule, and Workplace on VDT Viewing Distance." Int. Journal of Ind. Ergonomics 20: 11-18 (1997).

Boucsein, W., and Thum, M. "Design of Work/Rest Schedules for Computer Work Based on Psychophysiological Recovery Measures." Int. Journal of Ind. Ergonomics 20: 51-57 (1997).

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