Sunday, May 8, 2011

Repetitive Strain Injuries

Almost everyone has suffered with repetitive strain injuries at one time or another.  Conditions like rotator cuff tendinitis, plantar fasciitis, carpal tunnel and iliotibial band syndrome are very common and end up becoming a chronic issue for many people.

According to Paul Ingraham (, there are 5 important facts about repetitive strain that everyone should know.  These tips will help you in understanding what exactly you are dealing with, and therefore aid in your recovery! 

First and foremost, most of the conditions we consider tendinitis (meaning tendon – inflammation) have nothing to do with inflammation!  The tendon is degenerating due to overuse, but isn’t actually inflamed.  This means that common treatments, such as anti-inflammatory drugs, topical creams and ice have little or no effect on the problem.

Second, although it is often thought that many overuse issues develop due to biomechanical abnormalities (leg length discrepancies, tilted pelvis, scoliosis), the real issue is overuse of the body part, plain and simple. 

I can’t tell you how many times someone has come into my office and told me that another health care professional told them that their right shoulder is lower than their left, as if this somehow proves that their entire body is out of alignment.  Usually all it proves is that they are right handed, and have hung their purse or back pack off their right shoulder for years.  If we were meant to live our lives with perfect posture, we would all be ambidextrous. 

This doesn’t mean that you can do any activity you want without paying attention to proper form, but you aren’t predisposed to injury just because you have a mild curve in your spine.

Third, overworked, degenerating tissues need time to heal.  Rest and avoidance of the repetitive activity is required (in most cases) if you want the area to heal.  Basically repetitive strain injuries occur when the break down of tissues from activity exceeds your body’s ability to heal it.  The logical way to reverse this then is to allow your body time to heal, while avoiding anything that contributes to the break down. 

This simple fix can be very hard to implement in many cases, because if it is work related, most people can’t easily take weeks or months off work.  If it is activity related (running or tennis, as examples), it can be difficult to stop doing the things you love the most.  Think about it this way, you can either take three months off now, and then work your way back up to your current level of fitness, or you can suffer for years possibly, thereby never really enjoying the activities you used to love.  Seems like a no-brainer to me!

The fourth point to consider is that every tendon is connected to a muscle, and those muscles can harbor trigger points, which can mimic, predispose to or exacerbate symptoms of repetitive overuse injuries.  Muscle tightness and trigger points can also be exacerbated themselves by repetitive strain injuries.  This can be an interesting little cycle – sometimes a tight muscle can predispose you to developing a repetitive strain injury, which then causes muscle tightness!

The final point to consider when tackling your tendinitis is that it is frustrating, scary, and stressful, and this emotional component can actually make the severity of the pain increase.  Remember last month, when I was talking about the brain controlling pain.  It isn’t just that your brain interprets pain as more intense, anxiety can actually change the way your central nervous system perceives pain, making you more sensitive to it.

So what is the take home message here?  If you are suffering with a repetitive strain injury, rest the area for as long a period as possible, realizing that full recovery could take months.  Try getting some muscle and trigger point massage to help alleviate tight unhealthy muscles around the area.  Finally, keep yourself as healthy as possible, and know that your body will do what it needs to in order to heal itself.