RSI
TREATMENTS
Conservative therapy provides the highest rate of
recovery for Repetitive Strain Injuries affecting the
upper extremity. Tendonitis, Carpal Tunnel Syndrome,
Trigger Finger and countless other Repetitive Strain
Injuries can be eliminated with the implementation
of a few simple training techniques. The combined effects
resulting from soft-tissue therapy, and a good stretch
and exercise program have astoundingly quick, yet long-term
results.
Surgery, cortisone injections add other invasive procedures
are no longer necessary in more than 90% of those receiving "proper" conservative
treatments. The term "proper" is very important as
many therapists, although conservative in their treatments
are performing inadequate therapy/ techniques, often
creating treatment protocols that contribute to an
increase in patient symptoms and dysfunction.
Below is a list of conservative treatment techniques
that are being utilized for Repetitive Strain Injuries.
- Rest the Affected Area. This
is often the first recommendation. Moving the affected
area is important, but avoid stressing the joint.
In conservation, this is often not practical without
taking time-off from work. Too much inactivity can
cause atrophy of muscles and increase the severity
of the disorder.
- Stretching Routines are implemented to
help reduce hypertonic muscles and increase their
flexibility and dexterity.
- Splinting and Analgesics may
help "mask" symptoms for a while, but unless
the "real" cause of dysfunction is eliminated,
the symptoms come right back. The long-term success
rate of Splints and Anti-Inflammatory Medications
is extremely low.
- Wrist Braces and Splints are
not effective in treating carpal tunnel syndrome
and repetitive strain injuries, but can assist if
worn during nighttime only. These devices are meant
to keep the wrist from dropping into flexion so that
the wrist stays in the straight, neutral position
in order to reduce impingement of the carpal tunnel.
But instead, wrist braces often increase the symptoms
of carpal tunnel syndrome and repetitive strain injuries,
especially if worn during the daytime.
- Daytime use of wrist braces
while performing daily activities is not recommended
because the wrist braces / splints hold your own
wrist up for you instead of the extensor muscles
having to do it. Since the wrist brace is doing
all the work in order to hold the wrist in the
straight, neutral position, the extensor muscles
atrophy and become even weaker than they already
were, and the muscle imbalance between the flexors
and extensor becomes even greater. Another major
problem is that even though the wrist is still
held straight, you can still use your fingers to
perform repetitive or static flexion, such as typing,
writing, etc., which again, will contribute to
the muscle imbalance even more.
- Nighttime use of wrist
braces and splints is more appropriate in keeping
the wrist in the straight, neutral position. Wearing
splints/braces at night for those with severe symptoms
can be very crucial as it prevents individuals
from making a "fist" or "curling" their
wrist into flexion. Sleeping with the hands in
this position causes the flexor muscle group to
become even tighter and shorter; causing further
impingement and more damage to the median nerve
with the carpal tunnel.
- Squeezing and Gripping Devices tout
themselves as the cure-all for Carpal Tunnel Syndrome
and Repetitive Strain Injuries, but they exercise
and strengthen the flexor muscle group that is commonly
already overdeveloped from performing repetitive
and static flexion activities that require "closing" of
the hand. Using gripping and squeezing devices duplicate
the exact same motion that caused the muscle imbalance,
and will only continue to increase the strength and
rigidity of the flexor muscles; exacerbating the
injury even further.
- Vitamin B6 Therapy can help increase
the health of damaged nerves, although it does not
correct the real cause of dysfunction; which is a "muscle
imbalance" between the stronger, shorter and
tighter flexor muscles that "close" the
hand and the weak, underdeveloped extensor muscles
that "open" the hand. The tight, restrictive
flexor muscles compress/impinge the underlying nerve(s)
blood vessels, causing the nerve "signal" to
travel at a much slower speed. If the muscle imbalance
is treated/corrected, nerve conduction/velocity is
normal and the symptoms disappear.
- Anti-Inflammatory Medications to
reduce swelling and relieve pressure on the median
nerve, but again do not correct the underlying cause
of dysfunction. (Extended use of Anti-inflammatory
medications often leads to irritation of the stomach
lining.)
- Steroid Injections into the wrist
may be prescribed, but are usually painful and not
effective. Steroid injections cause the tendons to
develop a "rubber-like" consistency, which
can easily be damaged further (Usually due to being
overstretched), if the individual continues to perform
the same tasks that caused the original injury. If
steroid injections are utilized, the injury needs
to be immediately addressed / corrected through a
conservative physical therapy program utilizing stretching
and strengthening techniques. (This form of treatment
is suggested for all areas of injury.)
- Contrast Baths (Hot/Cold) (contrast
baths) are often recommended by a physical or occupational
therapist. Typical treatment protocol is approximately
three (3) minutes of heat followed by one (1) minute
of cold alternating 3x, ending in cold. Heat alone
is not recommended.
- Ultrasound: Ultrasound is ok
if used in conjunction with a treatment program that
includes soft-tissue work, stretching of the flexor
muscle group, and the strengthening of the extensor
muscle group. Ultrasound can help reduce inflammation
in an acute case of tendonitis, carpal tunnel syndrome,
or other form of injury, but does no good when used
alone.
- Massage: It is good to have the
flexor muscles massaged and stretched-out, but unless
followed immediately with strengthening exercises
for the extensor muscles that extend the fingers,
elbow and wrist, and the abductor muscles of the
fingers, it will have little effect on correcting
the muscle imbalance that causes carpal tunnel syndrome
and repetitive strain injuries.
Massaging and stretching the stronger, shorter and tighter flexor muscles
will only result in temporary relief because the longer and weaker extensor
muscles have not been shortened and strengthened through extension exercises
which will ultimately hold the stretching and lengthening of the flexor muscles
in place.
- EXAMPLE: If your flexor muscles
that close your hand are 6-inches long on one side
and they are normally 8-inches, (but they've shortened
in their relaxation state from overuse), and your
extensor muscles on the back-side of the hand and
forearm are10-inces long and they are normally
8-inches, but they have lengthened because of no
direct stimulus through exercise and movement),
than a muscle imbalance has been created.
Now if you stretch the flexor muscles which were 6-inches to the point
where they are now the normal 8-inches long that they should be, and the
extensor muscle have not been strengthened so they remain 10-inches long,
the flexor muscles will just tighten right back to their original position
because there is nothing to hold them in their stretched position. Now,
if the 6-inch flexor muscles were stretched to where they were 8-inches
long, and the extensor muscles were strengthened and shortened to where
they are 8-inches instead of the 10-inches they had been, than you now
have equal pull on both sides of the joint. Both muscle groups are now
8-inches long, and the extensor muscles can now provide enough counteractive
support to keep the stronger, tighter flexor muscles from narrowing the
carpal tunnel and impinging the structures within.
- Extension Exercise Devices: There
are a number of extension exercise devices on the
market that ALMOST provide the correct motion in
order to treat the dysfunction of Carpal Tunnel Syndrome
and Repetitive Strain Injuries. But they all fail
in providing the correct biomechanical hand, wrist
and elbow movements, and varied resistance levels
that will result in the successful treatment of these
injuries.
This is because most of the extension devices on the market:
- Do not allow a complete
range of motion of the fingers, wrist and
elbow joints from flexion into full extension, and full abduction
(splaying) of the fingers, which is absolutely
critical in effectively rehabilitating carpal tunnel syndrome
and repetitive strain injuries.
- Provide finger extension
of only 1-5 of the digits, and with most
of the emphasis on the Metaphalangeal joint (most
proximal finger joint). This means that there
is only one joint being exercised, while
the others stay stiff and are only affected by
isometric, (non-moving) exercises.
- Provide only wrist
extension without finger extension and
finger abduction!
- Do not include finger, wrist and elbow extension, along
with full abduction (splaying) of the fingers, all in
one exercise motion, without any type of gripping or
squeezing action required.
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