Repetitive Strain Injury [RSI]

Repetitive Strain Injury [RSI]

With the increasing amount of hours spent at a desk its no wonder RSI is increasing in incidence. But what is RSI?

RSI or repetitive strain injury term used to describe an overuse injury. Continuous repeated movements such as typing and using a mouse or prolonged postures cause strain, inflammation and damage to soft tissue (muscles, tendons, ligaments, nerves and tendon sheaths). RSI can affect a wide range of people from baristas to office workers to musicians. RSI commonly occurs at the wrist and elbow.

RSI symptoms include

  • Tightness, discomfort and stiffness
  • Burning, aching or shooting pain
  • Tingling, numbness and loss of sensation
  • Tremors and clumsiness
  • Fatigue
  • Weakness especially in the hands or forearms
  • Difficulty performing normal activities
  • Chronically cold hands
  • Hypersensitivity

What causes RSI?

RSI is usually caused by a combination of multiple factors. These can include but are not limited to

  • Continuous repetitive movements
  • Prolonged postures
  • Not enough micro breaks
  • Poor work ergonomics
  • Lack of training
  • Poorly fitting equipment

RSI treatment

Acute cases of RSI are relatively simple to diagnosis and to treat successfully. Treatments include

  • Chiropractic treatment massage, adjustments, dry needling, rehabilitation exercises
  • Stopping or reducing the tasks or activities that are causing the injury.
  • Altering the work environment and desk ergonomics

Common RSI conditions include carpal tunnel, golfers and tennis elbow

You can also read more information on golfers elbow and tennis elbow.

If you are suffering from any of these symptoms book an appointment today on 02 9922 6116 or visit our clinic at Ground Floor, Suite 6, 157 Walker Street in North Sydney for more information.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

How to treat tennis and golfer’s elbow in tennis players

How to treat tennis and golfer’s elbow in tennis players

I recently conducted an experiment with one of the patients of my practice, lets call him Arnold. Arnold is a 51 year old man, recreational tennis player and cross fitter. The combination of playing tennis and intense cross fit activity saw Arnold develop both pain and weakness in his [dominant] right forearm.

Specifically, Arnolds pain was centred mostly at the inside aspect of his elbow joint. The pain radiated about half way down the inner aspect of his forearm. He had suffered this pain in excess of three months and, at the time, his symptoms included, poor grip strength, inability to shake hands without pain, and exquisite tenderness at the inside aspect of the right elbow joint.

Tennis and Golfers elbow are both repetitive strain injuries that arise because of the repetitive force experienced by the common forearm flexor and extensor tendons originating at the elbow. Whilst playing tennis is a common cause, other physical activities such as crossfit, jack hammering, and even gardening can also be to blame.

Initially, rest will be the best means of pain reduction. However, there are many other things one can do to accelerate their recovery. Heres what I found worked with my approach to Arnold:

Accurate diagnosis

I made the diagnosis of medial epicondylitis, otherwise known as golfers elbow. I was able to do this through a thorough history take and using orthopaedic testing to confirm this diagnosis:

  1. Palpation assessing muscle tonicity in the forearm flexors through touch and feel.
  2. Handshake test I actually noticed on greeting Arnold, with a handshake, as he came in to the office that he had poor grip strength. He almost winced as he shook my hand.
  3. Finger tapping merely tapping a finger at the origin of the common flexor tendons can be extremely sensitive in golfers elbow patients.
  4. Resisted wrist flexion a muscle test that assesses the functioning of the forearm flexor muscles.
  5. Arm wrestle test inability to resist opposing force in the arm wrestle position is a strong indicator for golfers elbow.

I also added two extra tests to rule out tennis elbow:

  1. Resisted wrist extension a muscle test that assesses the functioning of the forearm extensor muscles.
  2. Middle finger sign the patient will hold their hand out with fingers fully extended and palm facing the ground. Inability to resist a downward pressure on top of the middle finger will indicate damage to the common extensor tendons of the elbow.

Equipment

Like many recreational tennis players, Arnold had no idea that the setup of his tennis rackets might be contributing to his elbow pain. There are essentially three crucial racket specifications that will influence how your body responds to hitting tennis balls.

  1. Weight if it is too light, the racket will not have enough mass on collision with the ball. The shock will travel straight through your racket and into your arm.
  2. Grip size if it is too big, you will strain your forearm musculature unnecessarily.
  3. String the tighter your string bed and the tougher the string (eg. Kevlar), the more shock you will experience into your arm.

Treatment

Golfers elbow is fundamentally a problem with the tendinous portion of the forearm flexor muscles. It is however, vital to consider the surrounding structures involved with this condition. Simply put, this includes the elbow and wrist joints, the bellies of the forearm flexor muscles, not to mention sparing consideration for the shoulder and thoracic spine (mid back).

  1. Soft tissue work I used active release technique with Arnold. This is a fantastic modality for treating tendinopathies. Essentially, it is a combination of massage and stretching applied at the same time.

  2. Joint mobilisation/manipulation the elbow and wrist joints demonstrated restricted motion. I was able to restore full range of motion through the use of gentle mobilisation and manipulation techniques.

  3. Dry needling following the above therapies, I used acupuncture needles to introduce a different stimulus to the injured muscle tissue. This is a highly effective technique for restoring vital blood supply to the damaged tendons as well as facilitating a loosening effect within the tissues.

  4. Taping I used some kinesio [stretchy] tape to provide some extra support to the soft tissues in between Arnolds treatments. Amongst other things, this special tape is most effective in facilitating optimal muscle firing sequence patterns in the affected areas.

  5. Take home exercises I prescribed Arnold some club bell exercises. Club bells are the only effective means I have found to target the forearm flexor and extensor tendons adequately. The use of normal dumb bells to target these areas, in my opinion, simply does not work. You can see my club bell in the picture above.

Arnold came to see me three times a week for just two weeks, totalling six treatments. He has told me that since this course of therapy, his symptoms have not returned. He is playing tennis and continuing with his crossfit regularly throughout the week. Each time I see him, he always greets me with a firm hand shake.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

Lateral epicondylitis (Tennis Elbow)

Lateral epicondylitis (Tennis Elbow)

Cause of tennis elbow

What is it? – pain on the outside of the elbow joint, specifically at the lateral epicondyle of the humerus bone, where your forearm extensor muscles attach. Not to be confused with medial epicondylitis (Golfer’s elbow)

Causes – any activity involving repetitive motions of the wrist that simultaneously requires constant gripping or squeezing. Examples include racket sports or golf, hedge clipping, excessive use of a hammer or screwdriver, etc.

Mechanism of injury – tennis elbow pain results through a process known as cyclic stressing. Cyclic stressing is how you break a coat hanger by bending it back and forth. Eventually, with enough stress cycles the tissues would rupture, even without any tremendous force. Rupturing these tendons is extremely rare however, usually micro-tears form in the tendons from all the aggravation. In turn, the area becomes inflamed as part of the natural healing process which can be painful.

Typically, people do not understand the mechanism of injury nor the healing process required for such a condition. They then return to doing the same activity that incurred the injury. As a result, the injury becomes chronic and never heals properly.

Tennis specific mechanism – poor technique is frequently accused. Whilst there are certain stroke technique tips you can employ to help reduce the stress on your forearm extensor muscles, the real cause is to do with your racket and how it impacts the elbow joint complex.

When you swing your racket at the ball, it travels at a certain speed. On impact, there is a sudden deceleration of the racket as it collides with the ball. During this collision there is also a reflex shortening of the forearm extensor muscles. These muscles continue to contract so as not to let go of the racket handle, so it suddenly shortens and yanks on the tendons that attach it to the elbow. This yank is a cyclic stress which if repeated over time, may be a contributing cause to tissue failure.

Impact with the ball twists the racket head backwards in relation to the direction you are trying to hit the ball. The resultant twist of the handle (a torque force) is clockwise for a right-handed forehand. This twist winds up a catapult. When the ball leaves the racquet, the catapulting force is counterclockwise for the right-handed forehand. The final effect is two opposite twisting forces experienced in an extremely short time interval during impact with the ball. Even for a dead-center hit, these consecutive forces create a severe stress cycle to the extensor carpi radialis brevis muscle, the muscle that attaches the middle of the hand to the elbow.

During impact, this muscle is either straining on the backhand, or slack on the forehand. On the backhand, the first twist yanks this straining muscle, further stressing the tissues attaching it to the elbow. Then the muscle suddenly loses resistance but continues to work against the combined stress, so it suddenly shortens after impact, giving an even more severe yank to the elbow. For the forehand, the muscle is slack on impact, so the catapulting stress cycle cracks the muscle like a whip, stressing the points of attachment at the wrist and elbow. Elbow straps can help because they damp this whip effect.

The shock from impact becomes internal energy, which is felt as frame vibration. This vibration is transmitted to the arm holding the racquet unless it is damped somehow. Vibration disappears quickly in wooden rackets because it is damped by the flex of the wood. The stiffer and lighter frames of today do a poor job of damping, thus they efficiently transfer the vibration to the arm. Undamped high frequency frame vibration can stealthily sabotage the elbow, so the price of power may be pain. Vibration of the frame is another form of cyclic stressing on the extensor carpi radialis brevis muscle.

Risk factors for tennis elbow

  • light racket weight – momentum is what counts in a collision (momentum = mass x velocity). A light racket won’t plough through the ball, instead it will bounce off, making it less comfortable on impact and less accurate. Light rackets can’t put much pace on the ball if you don’t have time to develop a long stroke, such as when you”re stretched out wide.
  • head-heavy balance (balance point further from the hand than the midpoint of the racket’s length) – has significantly higher resultant twisting forces from impact.
  • Stiff frames (thick beam width) – unsafe because they absorb minimal twist (torque) from impact, with the energy transmitted directly to your arm instead of going into bending the frame material.

Racket choosing criteria

  • heavier racket
  • head light balance
  • flexible frame

Remember, tennis elbow is not an injury caused by one defining incident, it is a repetitive strain type injury. These injuries develop over a long time, and thus take a long time to fix. It is the frequency of a certain activity rather than the tools used to perform it that leads to pain and is therefore more likely to affect regular players. The racket choosing criteria is merely consideration for the individual looking to modify their racket as a means to reduce risk of injury. In other words, try to avoid giving your five year old prodigy a 400g racket.

If you’ve noticed elbow pain recently or suspect you might be developing tennis elbow, see someone about it. Tennis elbow requires early treatment to the relevant soft tissues and if left for too long, may give rise to problems elsewhere such as in your shoulder. It will not go away by itself nor is rest alone sufficient treatment!

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.