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Prevention and Treatment of Repetitive Strain Injuries

Carpal tunnel syndrome prevention, range of mo...

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As the name implies, repetitive strain injuries are caused by repetitive activities, but there are other ways to develop repetitive strain injuries (RSI) too.  Sustained positions, awkward postures, vibration and sustained exposure to temperatures below 40 degrees also contribute to RSI.  Repetitive strain is the most obvious and common form of injury and involves doing the same activity over and over without rest or job rotation.   Sustained positions occur when we are holding something for long periods.  This requires our little muscles to produce an isometric muscle contraction.  This is a contraction when the muscle is working but not moving and requires a great deal of force for the muscle.  Assembly line workers often use sustained positions while soldering.  Awkward postures are positions out of the midline that we hold for long periods such as positions required of dentists, dental assistants, and dental hygienists.  Vibration is especially irritating to the nerves and often happens in construction with jack hammers or electric tools.  Although men often think they are protecting themselves by using gloves, they may not realize that they must then grip with more force to overcome the resistance of the gloves.  Sustained exposure to cold can happen in our local tofu company where the workers have their hands immersed in cold water for long periods or with workers who are in refrigerated or freezer areas all day without proper protection or breaks.The trick to prevention is job rotation, limiting the exposure, and stretching.  Stop and actually look at your hands and think about how small the muscles are.  The thumb is especially at risk as the muscles are often the size of your thumb nail.  Many of the tendons going to the tip of your finger are the size of fettuccine.  These muscles are asked to do very stressful tasks.  Think of the force required to open a new jar of pickles.  Job rotation is ideal when each station is using a different set of muscles allowing the muscles from the last station to rest.  Limiting exposure is used in job rotation when we only do one task for a short period, 1-2 hours.  Stretching is also really important and most often neglected.  It is important in the prevention of RSI to be proactive instead of reactive.  This means stretch even if you don’t have muscle fatigue or tightness in order to prevent it from occurring in the first place.  Prevention is always easier than treatment. 

Early signs of RSI are muscle soreness or pain in your thumb, fingers or forearm, often just below the elbow.  Numbness and tingling can also occur in your hands.  Many people immediately assume this is carpal tunnel syndrome, but often these symptoms are from tight and irritated nerves in the arm that originate in the neck.   Treatment is most effective early on.  Soft tissue mobilization is important to decrease muscle tightness and promote increased blood flow and oxygenation for tissue healing.  This also helps decrease swelling.  Most Physical Therapists use iontophoresis which is a treatment that delivers a local steroid and is very effective for acute tendonitis to decrease swelling and pain and therefore promotes healing.   Stretching and icing are critical to any home exercise program.  Most injuries take 6-8 weeks for the healing process to occur and tendonitis is no exception, so seek treatment earlier than later.

Not all Physical Therapists have extensive training to treat RSI, so make sure you interview your therapist prior to starting treatment.  Occupational Therapists may also be very skilled in the treatment of RSI.  We are lucky to have Susan Hartman Silberman, OTR, CHT in our community.  She is a certified hand therapist with over 30 years of experience and is skilled in the treatment of hands following complicated surgeries, crush injuries, burns and other traumas, including fabricating custom splints for these patients.  She can be reached through Performance PT and Hand Center at 255-3676.

Mary Boyd, MS, PT is the owner of Mountain View Physical Therapy and a member of the Sandpoint Wellness council.  She can be reached for questions at 290-5575 or on the web at www.MtnViewPT.com.

 

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