RSI Exercises 1

OOS mentioned in the article is the name used in New Zealand for RSI i.e we say Occupational Overuse Syndrome.

Why do workplace exercises?

F W Darby Senior Occupational Health Scientist (Ergonomics) Occupational Safety and Health Service, Department of Labour, Wellington

1 Introduction

Occupational health professionals advocate and teach workplace exercises, often for the prevention and treatment of back pain and occupational overuse syndrome. Why exactly, should workplace exercises be done?

This article seeks to answer some aspects of this question. A particular reason for doing exercises has perhaps been implicit in what the author has gleaned during several years contact with others in the occupational health field. The reason - that exercises can help develop dexterity and technique - seems to merit explicit description.

The principles to be discussed come, of course, from many sources. The exercises that will be described are for pianists, but seem to have equal application to computer users. By doing these exercises the innervation of muscles can be improved, and the efficiency of the use of the body can be increased. In theory, this should lead to more freedom from the aches and pains that beset so many keyboard operators. These principles are not new, and are doubtless known to many, but they seem to merit a fresh airing as they are quite new to the author.

One of the most enduring thoughts about exercises is that they need to be done in the right frame of mind. The mind needs to be engaged in the exercise. Many times the author has seen a group of keyboard users doing exercises, and it is evident that minds are elsewhere, typically in conversation with others in the group. How much more value seems possible if only minds were involved along with the muscles.

Students of Eastern martial arts appreciate this instinctively. In Tai-Chi and Yoga, for example, an aim is the integration of mind and body. (In documentaries of China, where the traditional shot of people doing Tai Chi is shown, we never hear any talking!) Students at schools of Indian classical drumming (in India) spend three years learning the drumming rhythms in their minds and verbalising them ("ta tiki ta" etc) , before they even touch a drum.

Some people don't wish to come into contact with religious overtones that they discern in these disciplines, and this, of course, must be respected. It seems easily possible, however, to improve technique and control without touching on the religious aspects.Here is a vignette that illustrates the importance of involving the mind:

Students enrolling at a University were divided into three groups - groups "A", "B" and a control group. At the start of the term, all the students were tested for their ability to shoot basketballs through the hoop, in the gymnasium. Group "A" then spent 20 minutes each day of the term practising shooting basketballs in the gym. Study group "B" sat in the gym for 20 minutes each day and thought about shooting the basketballs. The control group did neither. At the end of the term each student was tested again. The control group showed no average improvement. Group "A improved 24%, while group "B" improved 23% !

The principles of how exercises should be performed, as stated in the introduction to the pianists exercises, are as follows:

• Never work to the point of fatigue.
• Only exercises carried out with full concentration can be of use.
• Even when exercising with a single finger joint, the whole body should be kept ready for action in a relaxed posture.

There is a clear parallel between these exercises, for a specific purpose, and the intent of Eastern "exercises".

There are at least five types of exercises that can be used at work. Each of these are explained in turn, the first four in brief.

1. Aerobic warm up
2. Tendon stretching
3. Exercises to stimulate blood flow
4. Exercises to lengthen shortened muscles
5. Exercises to help develop dexterity and technique

1 Aerobic warm up

Warming up the body by gentle exercise which raises the heart rate has a role in all workplaces. Walking up and down several flights of stairs several times is a way of preparing the body for work. Minds need to be engaged so that you don't trip.

2 Tendon stretching

As aerobic exercises prepare the heart and lungs for activity, stretching prepares the tendons and the muscles for activity and has a place in all workplaces. The ACC has a set of posters called "Stretch after warm up". Stretches done before warm upmay overload the body. The mind needs to be engaged so that tendons are not overstretched.

3 Exercises to stimulate blood flow

Particular exercises to stimulate blood flow can be used to reverse the effects of muscle tension and to prevent occupational overuse syndrome. These can help all staff to relax, not just keyboard operators.

1. Arm shakes: Let the shoulder go loose and shake the whole arm.
2. Wrist flaps: Let the wrist go loose, flap the arm to make the hand flap about.
3. Shoulder rolls: In a relaxed manner, circle the shoulders (hold the rest of the body as still as possible) so that they describe the biggest circle possible. The arms hang inactively while the shoulders move.

Exercises to lengthen shortened muscles

Sometimes, our work causes us to hold some muscles short - (e.g.: the ones on the top of the forearm, if the wrists are held raised while typing). These need gentle lengthening.

1. Forearm turns: Straighten the arm, hold the fingers loose. turn the arm gently, both ways. Hold for a few seconds at the extremes.

The exercises just described have been found useful in the prevention (and treatment in some cases) of OOS. Other exercises are described in the OSH publication for the treatment of Overuse Syndrome. Some advise that we should "imagine the thick, warm, lifegiving blood flowing through the arteries" as we do these exercises. Certainly this manner of engaging the mind can do no harm!

5 Exercises to help develop dexterity and technique

Exercises can be used to promote dexterity and technique. Technique can be described as using the right muscles while avoiding the use of the wrong muscles.

Muscle movement is controlled by nervous impulses. Skill occurs when we send nervous impulses to the right muscle(s) at the right moments AND when we avoid sending unnecessary impulses. This applies to the muscle(s) involved in the movement and to the muscles not involved in the movement.

Skill therefore involves the brain, not just the muscles, and is a process of learning (to send the required impulses) and unlearning (to not send nonessential impulses). The area of control of skilled movements is in the lower part of the brain stem - an area beyond conscious control. This is essential - walking wouldn't be possible if we had to think about making every muscle move.

That we can walk is evidence of the high level of integration that takes place in movement control. Toddlers show this to perfection as they struggle to get upright, take a few steps, and then display ever increasing skill in walking. They also demonstrate that musculoskeletal habits take some time to learn. This is the same as saying that it takes time for the control of a new movement to pass from the conscious part of the brain to the brain stem. An analogy is that it takes time to design the software.

That technique is located in the brain stem is demonstrated easily. Whenever I type the word "muscles" it usually comes out "muslces". My fingers have got into the habit of pressing the "lc" rather than "cl". It's the same with words like "fortunatley". This is like a bug in the software.

The disadvantage of this highly integrated control is that if we learn a muscle action incorrectly it becomes difficult to reverse. Once a bug is in the program, it stays there, and is difficult to locate. Sir Yehudi Menuhin, in his autobiography, describes the lengthy struggle he had to reverse an aspect of his technique that was preventing him from going on to (even) greater ability in the particular skill of playing the violin.

It is therefore vital that we begin keyboard work with a good technique. If we have a poor technique, then there is good news - it can be reversed through help from exercises. What we need to do, effectively, is to reprogram the software that controls movement. The brain stem is very receptive to reprogramming. Exercises, that break the complex movement (of, say keyboarding) down in to small parts by concentrating on each individual muscle action have been used for centuries. Pianists exercises, for example, go back to the time of the early French composer, Couperin.

An obvious exercise for keyboarders might be exercising to practice how to raise the arms to the keyboard! This is not trivial - one of the most common observations about keyboarders is that the muscles in the shoulder region are tense.

In doing exercises for this purpose, we must be prepared for time to take its course and do its work as we do exercises in a relaxed and patient manner. Frustration over slow progress will fight against the reprogramming process, and must be put aside.If we do exercises in a relaxed and flowing manner with the confident expectation of success, then we can expect that our technique will improve.

This principles is mentioned in the introduction to the exercises for pianists:

"The gymnastic movements given below are intended, first of all to facilitate correct innervation of the movement required in piano playing."

There are further reasons for exercising. The introduction to the pianists' exercises shows why the development of technique for typing (using the fingers, hands and arms) requires attention to the entire body:

"...complementary training is necessary because the movements required at the piano do not make thorough use of the full mobility of the muscles. Gymnastics help to develop the muscles more quickly because, in addition to the smaller and more strongly controlled movements required by the instrument, they also involve full and free movements"

In the normal course of events, many of the muscles involved in keyboarding will never get the opportunity to become fully innervated. So we need to prepare the entire body so that the small movements done by many of the muscles not directly involved in the keyboard movements can be done with the least effort and, therefore, the greatest effect.

Looking at it another way, an important biomechanical principle is that muscles should not be involved in holding and fine work at the same time. This, of course, happens in keyboard work, computer or piano. The shoulder muscles are required to position the arms, and in turn the wrists and hands, so that the fingers can perform very finely controlled, accurate and sequenced actions. One researcher thinks that this conflict between the roles of the muscles is a main contributor to the OOS problem.

Even though the shoulder area appears to be still and, we might be tempted to think, uninvolved in the execution of keyboard work, it is probably the most vital area to concentrate on. So the shoulder muscles must be part of the exercise regime so that their use occurs in the most relaxed, least tense manner possible. (It is worth noting that we need to know about posture and relaxation if we are to do exercises well).

A theoretical analysis reported in the ergonomic literature is relevant at this point. It concerned the way in which the three muscles run across the knee joint. The analysis examined the way these three muscles could be co-ordinated to sustain a posture with a small amount of knee bending. The analysis showed thatthe endurance time of the posture depended on the efficiency of muscular co-ordination. With efficient co-ordination the holding time for the posture was eight times longer than with inefficient co-ordination. The consequence of this is exactly in line with the principles we are discussing - that it is possible to use the body efficiently or inefficiently. The author of the analysis suggested that retraining of workers could be employed to improve the efficiency of muscle co-ordination. Here, of course we are outlining a way of doing this retraining - using exercises.

Another factor is that if the muscles of the shoulder area become shortened, they may restrict the flow of blood to the arms by pressing on an artery that runs across the chest and supplies blood to the arms.

Fifty seven exercises are described in the original article. Here is a selection of seven of them that apply to the upper part of the body. They give the flavour of the exercises and are ones that seem good for computer keyboard users. The titles of the exercises are the ones in the article and apply to pianists, but the parallel with computer use is obvious.

Next, read a sample of exercises for dexterity and technique.