What Causes Repetitive Strain Injuries?

Repetitive strain injuries (RSI's) are a blanket term covering problems like carpal tunnel syndrome, tendonitis and "dorsal wrist syndrome." These problems affect millions of Americans today, but the cure, as always, depends on the cause. If you're experiencing symptoms of carpal tunnel syndrome, it may help to understand what's actually going on beneath your skin.

According to most recent studies, the damage caused by repetitive strain injuries results from structural changes in the muscle fibers as well as decreased blood flow in the affected areas. Nerves can also be involved (as in Carpal Tunnel Syndrome) but nerve compression is not the first problem that occurs. If you're experiencing nerve pain it's because something – usually damaged tissue and inflammation – is pressing down on the nerve, which is what causes the numbness, tingling and loss of mobility that goes along with carpal tunnel syndrome and other RSIs.

But don't take my word for it. If you're experiencing wrist pain, I recommend you do some homework to get a better understanding of what's really causing your pain. It might not be carpal tunnel!

A good place to start is this study on "Overuse Syndrome." A group of scientists took biopsies from the hand muscles of injured and normal subjects, which allowed them to study the structural damage in the muscle fibers and see how it lined up with the severity of the person's symptoms. In another study, biopsies were taken from neck muscles, which revealed that reduced local blood flow was found in the injured areas. In short, the greater the pain, the greater the reduction in blood flow.

So how should you deal with your wrist pain? One way may be to increase your circulation. Here's a pretty good article on how to increase circulation to your arms. Apparently, in this sedentary world of ours, we need to work a little harder to keep our blood moving.

Oh, and if you are using your trackpad to click on any of these links, STOP RIGHT NOW! Read my posts on the ergonomic carpal tunnel mouse and the joys of voice recognition software. I'm using it right now.

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The Best Ergonomic Keyboards and Accessories

How should you treat your carpal tunnel syndrom? 

If you have carpal tunnel syndrome, repetitive stress injury or tendinitis, or if you're trying to avoid it before it starts, the best thing you can do is get yourself an ergonomic workstation. I've been struggling with tendinitis for several years now, and every doctor I've spoken to has said that the best treatment is ergonomics. They even recommended ergonomics over rest, saying that the most important thing is to keep you arms in the correct posture to avoid further wrist strain.

If you can avoid typing, I would still recommend it. But when you do work, make sure you have the best products out there. Here are some of the things that worked for me:

Step number one: Get yourself some excellent voice recognition software.

Voice recognition software types as you speak. This will take a huge part of the burden off of your hands. Keep in mind, however, that you won't be able to use it for everything. Things like proper nouns (names, addresses, etc.) will be hard for it to recognize, as will some numerical data. So even if you have great software, you'll want an ergonomic keyboard and mouse to back it up. Also, I'd suggest spending at least $30 on a good microphone. 

Best voice-recognition software:

... for Mac users: MacSpeech

... for PC users: Dragon NaturallySpeaking

These two programs are essentially the same, since Mac ended up buying the Dragon NaturallySpeaking software. Basically it was the best thing out there, and still is. Don't bother with any other voice recognition program. These are the only ones that really work.

Best ergonomic mouse: Evoluent Ergonomic Vertical Mouse 3

As someone whose problems began from using a mouse rather than typing, I can say with authority that a good mouse is crucial to reducing carpel tunnel and wrist pain. The Evoluent mouse is also referred to as "the handshake mouse," because it allows your wrist to

 remain in the natural, handshake position, as illustrated below. The twisting of the wrist bones when you use a regular mouse puts extra strain on every muscle and ligament in your wrist, and is likely to be the primary cause of repetitive strain injuries associated with typing.

Best ergonomic keyboard: Microsoft Natural Ergonomic Desktop 7000 

This is what I use, and it's by far the most popular ergonomic keyboard out there. It works on a similar principle as the mouse, allowing your wrists to maintain their natural, un- twisted position. It's also called a split keyboard, because it's split in the middle with each side sloping downwards. Once I started using this I was able to type at least five times as much without pain. It's a very, very worth it. Read more about it here.

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Standing Desk May Alleviate Carpal Tunnel Symptoms

Bad posture is the number one cause of carpal tunnel syndrome, wrist pain, back pain and neck pain.  And if you think you can have good posture by simply sitting up strait, think again. According to recent studies, sitting in any chair for long periods of time is unnatural and unhealthy, no matter how good your chair OR your posture. So what should you do about it?

Until we all have computers installed in our sunglasses, it looks like the standing desk is the best option.  Standing while working is good for your whole body, not just your wrists, and it may help you correct the poor posture habits that are causing your wrist pain. Lifehacker has some great articles about the benefits of a standing desk, and where to buy (or build) one of your own. There's also a good how-to guide to the standing desk on wired.

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The Many Causes of Wrist Pain: Subscapularis Muscle

If you're experiencing carpal tunnel symptoms, the problem might not just be in your wrists. After three years of struggling with chronic, non-carpal tunnel wrist pain and elbow pain, I went to see a massage therapist who specialized in deep tissue massage, also known as rolfing. (Just a warning: this massage technique is not for the faint of heart). The therapist worked first on my wrists and elbows, especially the spot above my elbow. This hurt quite a bit, but it was nothing compared to the pain I felt when he massaged my armpits. Well, not my armpits exactly: my subscapularis muscle, which is responsible for rotating the shoulder slightly when the arm is lifted. Sound familiar? Unless your typing position is perfect in every way, this muscle will be flexing constantly to hold your arm in place. And my subscapularis, as it turned out, was tighter than a violin string. 

I had never felt pain in this muscle before, but once the massage was over I felt huge relief from my wrist pain and elbow pain. Afterwards I read this article on Massage Today, which lists the symptoms caused by an overly tight subscapularis muscle. The symptoms? Wrist pain. More specifically, referred pain (pain in an area that isn't the source of the problem) in the back of your shoulder, the underside of your arm, and wrist pain. Just follow the little red dots the picture below. If these are your symptoms, the subscapularis might be a cause.

Referred Wrist Pain from Trigger Points in the  Subscapularis

So, how do you self-massage your subscapularis muscle? Take a tip from the sky, and get yourself a foam roller. Your wrists may thank you.

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