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Healing from Repetitive Stress Injuries
by Denis Dettling Kalthofer, LMT, Reiki Master, Arlington Reiki Associates
My interest in and specialization as a massage therapist in Repetitive Stress Injuries (RSIs) developed as a result of my own experience with RSI from my computer work in combination with increased massage work. I underwent several forms of treatment for this condition and researched the topic. Since I have successfully recovered from this condition, I wish to share the following information with you.
"RSI is the number one  occupational illness ..." RSIs are the result of performing the same motions over and over many times a day. According to the Occupational Safety and Health Administration, RSI is the number one occupational illness, accounting for about 65 percent of all illnesses reported, and over 2 million compensation claims paid per year by private industry. In addition, many people never report their injuries to worker's compensation and are treated by their own doctors. About two thirds of claims involve back injuries and one third upper-extremity injuries. However, upper-extremity injuries require more days away from work and higher treatment costs. Two of the most common upper-extremity injuries are Carpal Tunnel Syndrome (CTS), and Thoracic Outlet Syndrome (TOS). Diagnosis is often controversial, slow and inexact because there are many conditions that cause similar symptoms.


"Signs and symptoms of CTS ...." Signs and symptoms of CTS can include numbness and tingling or burning sensations in the fingers and hand, chronically cold fingers, joint pain in the fingers, pain in the wrist which radiates down the forearm or palm, loss of strength in the hand, and worse pain or numbness at night after a day of forceful hand or wrist use.
The number one cause is swelling and inflammation due to repetitive stresses such as typing, hammering, playing musical instruments, or doing massage. It can also be caused by diabetes, rheumatoid arthritis, excessive water retention during pregnancy, or vitamin B6 and other nutritional deficiencies. All of these factors add to the risk of developing the condition.
"Signs and symptoms of TOS ..." Signs and symptoms of TOS include altered sensations in the upper arm and pain on the border of the forearm or hand, which is often aggravated by pulling in of the arm, lifting, or holding the arm in a fixed position. It can be caused by repetitive stress involving excessive work in front of the body (such as typing), spasms of the neck and chest muscles, an extra rib or other causes. A history of head and neck trauma, such as whiplash, is often the cause.
"Exact diagnosis usually requires a specialist and special equipment ..." People with RSI's are often frustrated and confused about their condition. It often takes a while to diagnose the specific RSI that is causing their symptoms, because there are so many similar types of RSI's. Exact diagnosis usually requires a specialist and special equipment, and because there is a good deal of controversy about RSI diagnosis.

For instance, Osteoarthritis, Tendinitis, Tenosynovitis (inflammation of the synovial membranes of the tendons), CTS and TOS, as well as a host of undifferentiated RSI's can all create similar symptoms. Sometimes there is no clear diagnosis. Often, the symptoms are related to the person's occupation or other daily activities.

"Treatment may include ..." Treatment may include temporary immobilization of the hands, long periods of leave from work for recuperation, or even complete career changes. Pain and weakness in the arms and hands can make everyday tasks like combing one's hair or holding a glass difficult or impossible.
The best treatment is prevention. A massage therapist can help with massage as well as by teaching exercise and self massage techniques. Icing, supportive wrist bands, and stretch and exercise breaks should be suggested. For CTS, massage is usually indicated. Local massage is indicated in subacute cases.
"Some forms of  treatment that may be effective ..." Proper modifications to work environment, work habits, and posture are important for all RSI's because recovery takes longer the more the condition is aggravated. Rest and ice are useful in reducing pain and inflammation during acute flare-ups. Some forms of treatment that may be effective include massage of the arms, shoulders and neck, acupuncture, shiatsu, chiropractic manipulation of the back, shoulder, wrist and finger joints, and stretching and strengthening exercises for the upper body. Surgery is sometimes performed on the Carpal Tunnel or first rib (for TOS), but more conservative measures should be tried first.


Workstation Adjustments
For clients who do computer work, it is important to have chairs that support them in an upright position, with their chest open and their feet squarely on the floor or foot rest. The desk and/or chair height should be adjusted so that their hands are at the same level as or slightly below their elbows, with their elbows hanging freely from their shoulders. This reduces the muscle tension needed to keep the arms in position and encourages blood flow to the hands and forearms. Keyboards should tilt down instead of up, to promote blood flow to the fingers and avoid holding the wrists in extension.

Computer screens should be at eye level directly in front of the keyboard so that the head is in a neutral position with no strain on neck muscles. If  they use a phone for extended periods while typing, the client should use a headset to avoid holding the phone between the head and shoulder. If the work environment and habits that aggravate the condition are not alleviated, the condition will eventually prevent them from doing their work.

Exercises and Self Massage
Teaching the client with CTS exercises for the upper body and self massage for the forearms can be very beneficial, and empowers the client to help themselves. Any exercises and mild stretches that promote circulation in the arms, bring the shoulders back, open up the chest and raise the clavicle are helpful for both CTS and TOS. With self massage, the client can control the pressure according to their own sensitivity and needs.
Relaxation/Healing Tape
My wife has found Peggy Huddleston's healing/relaxation tape to be helpful in relieving chronic pain in treating RSI clients. Clients with RSI's may want the support of others who have similar conditions. Please contact me for a list of RSI related organizations and publications. My bodywork sessions with RSI clients include self-care education and information about appropriate treatment options and referrals.

For more information or to schedule an appointment please call Denis at 781-648-9334.

1998 Denis Dettling Kalthofer
This article provided courtesy of Denis Dettling Kalthofer, Arlington Reiki Associates. This is copyright material. For reprint permission, please contact Denis Dettling Kalthofer by e-mail or visit his Web site,  Arlington Reiki Associates, for other contact information.

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Last Updated: October 19, 2002