Articles on repetitive strain injury

Repititive Strain Injury - Are You Always in Pain?

Dr. A Mohan Krishna, Orthopedist
Repetitive strain injury (RSI) is a collective term that covers a range of hand, wrist, forearm, neck shoulder, back, and knee and ankle disorders. The upper limb RSI’s are those that are most commonly encountered.Symptoms include:Sensation of tingling, aching or burning,Swelling and / or numbnessPins and needlesIncessant, nagging pain.There are no characteristic clinical signs in RSI. Due to the ambiguous nature of complaints RSI is included in the chronic fatigue syndrome category of diseases.There are two main groups of disorders are localized and diffuse RSI.Localized RSI:Includes:TenosynovitisCarpal tunnel syndromeEpicondylitis (tennis elbow, golfers elbow)These conditions are characterized by clearly defined symptoms and clinical signs. There is little professional disagreement over the existence of such conditions.Tennis elbow (Picture) is a painful inflammation of the tendon at the outer border of the elbow caused by the over use of the forearm muscles.Diffuse RSI:It includes:Poorly localized or diffuse patterns of painTenderness and loss of function in the upper limbThis group with muscles, nerves,tendons and soft tissues being affected, is controversial one, with opinions varying over origin (aetiology).Causes:The diagnosis of RSI may be made by GP’s, occupational health physicians, orthopaedic surgeons, or rheumatologists. The diagnosis rests largely on reported symptoms and nature of the patients work.Localized RSIs are more specific than diffuse RSI’s and may be more positively identified: for example, conditions such as carpal tunnel syndrome due to median nerve compression at the wrist, tennis and golfers elbow and tenosynovitis have more diagnostic criteria.Diffuse RSI’s on the other hand, are more problematic. The diagnosing clinician can only rely on symptoms, the type of work and its repetitive nature.There are three main causes:Fixed working positionRepititve motionsPsychological stress.The standard vies is that RSI’s are msuculotendinous injuries of the upper limb, shoulder girdle or neck caused by an overload of particular muscle groups, from repeated use, or by the maintenance of constrained postures, which results in pain, fatigue, and a decline in work performance. An alternative hypothesis is that RSI’s are not organic in nature and are not work- related.Some experts believe that the condition is due to conversion hysteria, whereby psychological conflict is converted into imaginary pain. Others consider the problem to be form of compensation neurosis, that is the patients having symptoms but retain a desire for secondary gain such as compensation payments or time off work.Treatment:Treatment of localized RSI’s is usually with well documented stratagies such asSteroid injection therapyRestSplintingOccupational health ergonomicsPhysiotherapeutic methods: in the more diffuse RSIs, treatment is much more difficult and controversial. Many sufferers resort to alternative medicine therapies such as:AcupunctureManipulation from osteopaths and chiropractorsAlexander technique for postureWork place solutions include:A humane working environmentErgonomically designed workstationsJob rotationIncidence:Most information on incidence comes from Australia, where there was a virtual epidemic of cases between 1980  and 1984. The Australian public service carrying out Audit between 1985 and 1987 , found that 2,706 persons years had been lost during the two year period. The prevalence ranged of cases wasOne percent in clerical administrative staff16 percent among data processor operators24 percent among data processorsRSI complainants were more likely to be female- perhaps because of the nature of their work.Understanding RSITrade unions are believed to have had considerable influence in protracting the problems, whereas health professionals such as orthopedic surgeons and rheumatologists have been less sympathetic towards the nature of the disorder.Consequently, the incidence of reporting has lessened markedly since those years. The Australian public service no longer issued statistics after 1987, and this led to a loss of public interest or awareness. A research project in USA in 1998 estimated that RSI disorders accounted for 56% of all occupational injuries.Prognosis:Conditions in the localized group of RSI disorders are amenable to treatment with steroid injections and physiotherapy. Diffuse disorders are far more difficult to treat mainly due to different attitudes of health professional. Often, the disorder will only resolve on change of occupation or satisfactory settlement of compensation. This latter may involve a costly process of litigation.Prevention:Good working practices and the provision of suitable office furniture, for example , may help in the prevention of RSIs. Employment medical services may provide advice, especially with ergonomic design, on providing the optimum work conditions for employees.

14 Tips for Avoiding Overuse Strain Injuries

Dr. Vishwas Virmani, Physiotherapist
Here are 14 tips for avoiding overuse strain injuries.Up to 50% of industrial injuries are thought to be attributed to cumulative trauma or overuse injury. These can range from troublesome annoyances, to severe debilitation. For office, building and site managers, there are a number of steps you can take to minimise repetitive strain injury within your workforce.1. Identify and correct postural problems The aim is to eliminate fixed positions which impose static loads on the muscles of the back, neck, shoulders and arms. Poor or improperly-adjusted equipment, furniture or layout is often to blame.2. Identify and eliminate forceful movements The worst are those which involve fingers, hands and wrists, especially with bending or twisting. Check tools, knobs, processes, postures. Do things fit? Is maintenance happening?3. Identify and break up periods of repetitive work The aim is physical variety; use rest pauses and alternated tasks. Consult staff before introducing job rotation.4. Ensure that any tell-tale early-warning signs are noticed and acted upon Supervisors and staff alike will require (a) Training Induction trainingProduction of training videosStrain prevention: training seminars5. Educate supervisors in the recognition and correction of faulty workplace set-out and procedures They should then be accountable for managing this.6. Train staff to recognise and adjust their own workstations properly The benefits of “ergonomic” furniture may otherwise be lost. Be sure to include thorough instruction for all new staff.7. Identify and control work peaks These can be daily, weekly or even annually; individual work loads need monitoring.8. Know which staff are most vulnerable to overuse strain New staff (how thorough is your induction?); those returning from leave; jerky or tense workers; staff using hands and fingers a lot.9. Identify and control sources of individual pressures These may be related to work output requirements, to ‘pacing’ by workmates, to supervisors’ attitudes – or even personal problems. Financial need may push vulnerable staff into harmful overtime. Bonus systems are bad.10. Educate managers, engineers and designers in preventive measures Once they know about ergonomics, they should be able to apply it quickly.11. Carefully-selected tasks matched to individual needs (eg., as specified by a treating doctor) are essential. Close supervision is necessary.13. Keep close to people who are off work sick Letting people know you care about their welfare and recovery will help them a great deal. Weekly phone contact at least; have people come in to collect their pay, and keep them close to their workgroup.14. Keep close to treating doctors Let them know you’re keen to help. Ask them to give specific advice to assist even a partial return-to-work. Invite them to visit you.

6 Ways to Avoid Sports Injuries

Mr. Kaleem Mohammed, Physiotherapist
Most of us like to play some or the other sports. As long as we are injury free, it is always great fun, but sometimes sports injuries may take place, which can be a bummer!Sports injuries are commonly classified into trauma/acute injuries and overuse/stress injuries. The difference between the two is simple. Trauma injuries are due to a sudden twist or pull, or any other impact. Stress or overuse injuries occur when a part of our body is over-exercised without enough rest in between.Many lists describe the most common sports injuries in men. These lists have minor disagreements, but in general, they agree that the most frequent sports injuries are sprains (tearing of ligaments) and strains (over-stretching or tearing of muscles or tendons). Bruises or contusions are also a common result of trauma, but bruises rarely cause serious complications.Most common sports injuries include:BruisesKnee joint injuries: Pain, swelling, and stiffness ligaments or tendons injuriesAnkle sprain: Sprain, strains, fractures.Cuts and abrasionsDehydration: Excessive fluid loss causes heat exhaustion and heat stroke.Groin pull/strain: Symptoms include pain and swelling.Hamstring strain: Symptoms are a pain, swelling and bruising.Stress fractures: The impact of repeated jumps or running on hard surfaces can stress and break bones.Playing sports is much fun. Getting hurt is not.Follow these 6 steps to prevent injuries so you can stay in the game:1. Warm UpIt is not a good concept to just bolt on to the field and start playing. You should not even start stretching until you are a little warmed up. So take a light jog to get loosened up and ready to play. Increasing the heart rate and circulation; this loosens the joints and increases blood circulation to the muscles. Full-Body Stretch helps muscles to prepare them for physical activity and prevents injuries.2. Wear Protective GearProtective gears are anything you wear that helps keep you from injuries. The gear you use depends on the type of sports.The helmet is a most frequently used protective shield. It keeps you safe from head injuries when you are playing football, cricket, ice hockey, or baseball. Make sure you are wearing the right and comfortable helmet for your sport. Other sports require eye protection, mouth guards, pads, wrist, elbow, and knee guards, and a protective cup (for boys only). Moreover, don't forget your feet. Shin-guards are a must have gear for preventing trauma induced fractures in sports such as soccer and hockey.3. Proper healthy nutritionHealthy nutrition can enhance sporting performance because protein rich diet should provide enough protein to promote muscle mass growth and injury repair. Water is an excellent choice of fluid for athletes to help performance and prevent dehydration. Foods rich in unrefined carbohydrates, like whole grain bread and cereals, should form the basis of the diet.4. Early intervention and restMost of the sports injuries such as painful pulled muscle or sprains and strains are treated immediately with R.I.C.E. (rest, ice, compression, and elevation) protocol.Many sports physical therapists and athletes remember this short-form to help with sports injuries.Rest (minimizes motion and pressure over of the injured joint)Icing (apply an ice pack) to reduce pain and swelling and decrease blood flow to injured areaCompression (light pressure wrap to stop bleeding and swelling)Elevation (to drain the fluids from injured area to prevent swelling)5. Slow-fast-slow RhythmDuring physical activities, adding interval (slow-fast-slow) training into your exercise routine helps to improve your heart’s ability to beat at a high rate for prolonged periods. That is a real plus for your aerobic fitness. Moreover, oxygen is circulated in your body at a slower rate, so it increases your ability for a longer stay during workouts. The simple rule is that always warm up before any sports or exercise, and always cool down at the end by gently stretching your muscles and breathing out slowly.Further, when starting any weight bearing exercise after a while, always take precaution that you do not start off with a heavyweight, but a much lighter one that you can easily exercise with. Don’t worry if anyone is looking!If you manage to follow these simple five rules, you can easily avoid most types of sports injuries and continue to enjoy the sports you like.6. Do not over-stretch yourselfIt is critical to take part in physical activities, to listen to your body and know your physical limits. When you begin a new sport, begin steadily and slowly to avoid muscle pull. If you have not undertaken a strenuous exercise for some time, it is especially crucial to building up your endurance and strength gradually to avoid injury. It is essential when taking part in physical activities, to listen to your body and know your physical limits.

Better Workplace: Ergonomics at Work

Dr. Amol Kadu, Orthopedist
What is "ergonomics"? Ergonomics means “Fitting the job to the worker.”Ergonomics... is the science and practice of designing jobs and workplaces to match the capabilities and limitations of the human body. As early as in18th century doctors noted that workers who required to maintain body positions for long periods of time developed musculoskeletal problems.Within last 20 years, research has clearly established connections between certain job tasks and RSI or MSD. To understand the problem we should know what are the reasons behind these problem. What two elements are at work?•       Static work: Musculoskeletal effort required to hold a certain position, even a comfortable one.•       Force:  Amount of tension our muscles generateThese forces cause excessive and repetitive stresses on the muscles, joints and tendons and gives rise to various musculoskeletal problems. Hence, it becomes imperative for us to create a working environment which is ergonomically fit for the work.Benefits of Ergonomics•       Ergonomics helps to prevent injuries •       Ergonomics Improves quality of work •       Improves quality of life & Reduced fatigue and discomfortWhat? Overuse injuries, soft tissue injuries which occur gradually also known as Cumulative Trauma Disorders (CTDs) or Repetitive Strain Injuries (RSIs) are Work-related  Musculo-Skeletal Disorders(WMSD). Common WMSDs are:•       Carpal tunnel syndrome•       Slipped spinal discs•       Rotator cuff tendinitis•       De’quervain’s tendinitis•       Trigger finger•       Carpet layer’s knee•       Tennis elbow       Heavy, frequent, or awkward lifting, pushing, pulling or carrying loads, working in awkward postures, intensive hand work, like pinching, gripping, repetitive postures, vibrations are the common causes of WMSDs.The common symptoms are painful joints like wrist, knees, shoulders, tingling, numbness in fingers, severe nagging pain in both legs and feet, severe back ache or neck pain, reduced range of movements in joints, loss of grip or difficulty in holding objects.To avoid these problems, dictum "Prevention is better than cure" fits perfectly... So ,lets start by knowing how we can avoid these problems. To get started:a)      Warm up & stretch before activities that are repetitive, static or prolongedb)      Take frequent breaks from ANY sustained posture every 20-30 minutesc)       Respect pain   -  positions or stop painful activityd)      Recognize early signs of inflammatory process, & report  earlye)      Maintain proper postures while sitting and standingf)       Avoid lifting heavy weights.g)      Slide objects instead of lifting them h)      Store heavy items where  you won’t have to bend or reach to lift themi)        Use ladders to get items down from high shelves.j)       Hold objects closer to your body when liftingThe key is to Relax yourself at work. Its really important to create ergonomical habits and environment at work place to protect yourself.•       Take "stretch pauses": Take frequent breaks from ANY sustained posture every 20-30 minutes. •       Improve your posture •       Move around as much as possible•       Warm up & stretch before activities that are repetitive, static or prolonged•       Recognize early signs of inflammation •       Help yourself to avoid such problems.•       Understand your work and do it right way.•       Work towards improving your working conditions•       Be ergonomical at work.•       Reporting problem early is important.It's really important to realise the importance of ergonomics at work and follow it at work. Otherwise , over the months & years the work will take its toll on your body.So, be fit and keep ur workplace fitter!

Sports Injuries In Young Athletes - An Overview

Dr. Senthilvelan.R, Orthopedist
The prevalence of injuries in young athletes is on the rise as more and more young children take upon more intense sports training. There are multi factorial reasons which contribute to overuse injuries in young athletes. Targeted interventions are necessary in prevention of these injuries.Children have numerous benefits when they stay active and physically fit by participating in sports, however there is concern regarding safety of intense sports participation of young athletes. Almost 1/3rd to 50 percent of injuries in this age group is as a result of overuse.Chronic overuse injuries are generally defined as injuries that occur because of increased levels of physiological stress without sufficient recovery time. A number of prevention strategies are available to prevent which target the athlete's neuro-muscular control mechanisms to reduce the likelihood of injury.Numbers of extrinsic risk factors are often implicated in over use injuries. These can occur in a number of scenarios. In the first scenario the athlete may attempt to rapidly increase training load after period of inactivity and this could result in stress fractures. In this situation the body does not have enough time to adapt to higher level of stress and is not adequately prepared to dissipate repetitive forces.A second scenario is when an athlete attempts to participate at a level that exceeds individual’s skill level. There could be potential mismatch between skill and fitness level to that of imposed physical demand and can potentially lead to injury.Coaches or PT masters at school should understand the physical fitness levels of children at school and design training in a  way to provide appropriate progression of training.Ways to prevent Overuse injuries:1. A young athlete needs to be assessed in regards to readiness of running and his/hers relative risk of running related injury. Determining the fitness level before running, length of running and prior running injuries and previous sports needs to be documented.2. Modifying training volumes for athletes who have recently undergone growth spurts are recommended to reduce stress on growing bones.3. Provision of individualized training programs taking into account their fitness level, and injuries._______________________________________________________________________________________

Is Your love for Selfies Giving You Elbow Pain?

Dr. Sonia Talreja Dhawan P.T, Physiotherapist
After blackberry thumb, iPad hand and Text neck syndrome,  a new tech-driven condition makes the headlines.The name is self-explanatory -  "Selfie Elbow". Yes !!  Your love for selfies can now land you with this new medical condition!! What is it? Just like other tech-driven conditions, or even similar to tennis elbow or golfer's elbow, this is also a form of repetitive stress injury.  Repetitive stress injury occurs when you repeat the same movement over and over again. Add to this the tricky agonising postures your elbow has to go through to get that perfect pic of yours.Thus repetitively clicking selfies just to get that perfect pout would make you end up getting your elbows sore.Is it common?So obsessed are we with capturing the perfect snap of ourselves, that according to research over 17 million selfies are uploaded every week on social media!!! So if you are a selfie addict, beware!!Do I have "Selfie Elbow"?If you have pain or uncomfortable feeling every time you click a selfie yes you may have it.You need to check the warning signs to visit your practitioner:Persistent muscle tensionMuscle fatigue and aching  Sudden twinges of pain in your forearm, wrist and elbow area.Waking up to a stiff and sore arm in the morningSo if you have these warning signs please visit your practitioner at the earliest.Can I prevent it?Prevention is always better than cure. Selfie stick is a good option but it still puts your elbow in an extended position to give that stress to the elbow. So if you click selfies like 15-20 consecutively, this won't help much.Exercises and stretches are the best available option to prevent selfie elbow.TreatmentTreatment remains same as tennis or golfer's elbow:RestIce packAnti-inflammatory pillsPhysiotherapyStretching and strengthening exercises.Some suggested exercises for managing selfie elbow.Hence ditch the selfie and switch to the old and easy style of creating memories-ask a friend to click and remain free of this tech originated condition.

Knee Sports Injuries

Dr. Rajat Jangir, Orthopedist
Problems in the knee are extremely common. These injuries range from sprains and anterior knee pain, to meniscus and ligament tears, to arthritis. With the current increase in activity that we are seeing in today’s population, knee injuries will only become more common. Fortunately, as knee injuries become more common our understanding of these injuries and ability to treat them successfully continues to improve. From improved understanding of how musculoskeletal dynamics affect knee injury, risk, and prevention; to using the latest minimally invasive techniques to treat surgical knee problems; our knowledge and techniques for treatment of the knee continues to evolve and improve.ACL InjuriesThe anterior cruciate ligament (ACL) is one of the four major ligaments of the knee. Ligaments are strong, dense structures made of connective tissues that help stabilize a joint. In this case, the ACL connects the femur to the tibia and helps provide stability to the knee and minimize stress across the knee joint. Twisting or pivoting movements can often cause the ACL to strain or tear.ACL tears occur in athletes participating in cutting and pivoting sports such as basketball, football, soccer, and skiing. At the time of an ACL injury the athlete typically feels a “pop” or a tearing sensation. This is followed by swelling within the first six hours of the injury. The most common injury associated with ACL tears is a meniscus tear.It is well recognized that ACL injuries are much more common in females. There are multiple reasons for this including bone anatomy, hormonal differences, muscular balance, and the way they perform certain sports. Of these factors, the ones we can potentially change are muscular balance and the way sporting moves are completed. Females tend to cut and jump with their knees only slightly bent, which can predispose them to ACL injury. The hamstring to quadriceps strength ratio is also different from males. Studies have shown that strengthening exercises and plyometric programs aimed at changing these factors can prevent ACL injuries.ACL strains can sometimes be treated with physical therapy and muscle strengthening. However, most complete tears require surgery in active patients. Modern ACL surgery involves completely removing the torn ligament and reconstructing the torn ACL. The most common grafts used to reconstruct a torn ACL are the patella tendon, hamstring tendons, or cadaver tissue (allograft). Each graft offers specific advantages and disadvantages, so it is important to understand the differences.Meniscus InjuriesThe meniscus is a pad of specialized cartilage that is located between the femur and tibia bones in the knee joint. There are two menisci in the knee – one on the inside of the knee (medial meniscus) and one on the outside of the knee (lateral meniscus). The meniscus has several functions including: acting as a shock absorber or cushion, distributing load across the knee, decreasing friction, and adding to stability of the knee.Meniscus tears typically occur as a result of twisting injuries to the knee. They can be caused by traumatic injury, often seen in athletes, or they can be degenerative in nature, tearing from minor trauma as the meniscus becomes more brittle with age. The symptoms of a meniscus tear include pain, swelling, locking, and inability to completely straighten the knee joint. An MRI is frequently obtained to diagnose a meniscus tear.Treatment of meniscal tears depends on several factors including the type of tear, the location of the tear, and the activity level of the patient. Some patients can be treated nonoperatively. If surgery is necessary, minimally invasive arthroscopic techniques are used to either trim out the torn portion of the meniscus (partial meniscectomy) or to repair the meniscus.The PCL InjuriesThe posterior cruciate ligament (PCL) is one of the four major ligaments of the knee. The PCL, along with the ACL, is located in the center of knee. Its primary function is to prevent posterior translation of the tibia on the femur. The PCL also plays a role in the side-to-side stability of the knee.The PCL is injured less commonly than the ACL. The most common mechanism of injury involves a blow to the front of the tibia (shin bone) when the knee is bent. PCL tears can occur as isolated injuries or can be associated with other knee injuries.The symptoms of a PCL injury are usually less dramatic than those of an ACL tear. Swelling is often only mild. The pain from a PCL injury is usually resolved within 2-4 weeks. However, a sense of instability may persist, especially when changing directions.Treatment for isolated PCL injuries initially focuses on rehabilitation and strengthening after the pain and swelling subside. Partial tears of the PCL do not usually require surgical treatment; even isolated complete tears of the PCL do not always need surgical treatment.If symptoms of instability persist after rehabilitation, surgical reconstruction of the PCL is recommended. Modern PCL surgery involves completely removing the torn ligament and reconstructing the torn PCL using a minimally invasive arthroscopic technique. The new PCL is made using a tendon graft, obtained from either the patient or cadaver (allograft). Furthermore, PCL reconstruction surgery is typically performed as an outpatient procedure.Cartilage InjuriesCartilage is a type of specialized connective tissue. There are three main types of cartilage: hyaline (articular) cartilage, fibrocartilage, and elastic cartilage. Hyaline (articular) cartilage provides a smooth, white, glistening layer covering the femur, tibia, and undersurface of the patella. The main functions of the hyaline cartilage is to provide shock-absorbing properties and allow for a frictionless smooth surface. Articular cartilage lacks blood supply and therefore has a limited capacity for healing. It can be injured by trauma or repetitive injury.Cartilage injuries may cause pain, swelling, and/or locking if the fragment has separated into the joint. The surgical treatment options for cartilage damage are: debridement (cleanup), microfracture, cartilage (osteochondral) transplant, allograft, and chondrocyte transplantation. These cartilage restoration procedures can be done using minimally invasive arthroscopic techniques.MicrofractureThe microfracture technique is used for full thickness cartilage defects with exposed bone. Articular cartilage has a limited capacity to regenerate itself due to its lack of blood supply. Therefore, the microfracture technique was designed to stimulate a biologic repair for this type of cartilage. A minimally invasive arthroscopic technique is used to place microfracture holes into the exposed bone, which allows the release of blood and bone marrow contents into the cartilage defect. This activates a healing response and stimulates the production of the fibrocartilage layer, which forms over the exposed bone. This technique is very effective for cartilage restoration.Transplant (OATS)Osteochondral (cartilage) transplantation (OATS) procedures are designed for full thickness chondral defects. Small chondral defects are treated by removing an osteochondral cylinder (plug) from a specific area within the knee joint that does not require cartilage to function properly. This osteochondral cylinder (plug) is then transplanted to the affected area in order to repair the chondral defect.Large chondral defects can be treated using an allograft (cadaver) osteochondral graft. The typical patient considered for this procedure is a young, active individual with a traumatic isolated chondral injury. The advantage of this procedure is that it allows placement of hyaline (articular) cartilage into the chondral defect. This technique is performed through a minimally invasive arthroscopic procedure, or through an open technique depending on the size and location of the lesion.AllograftSome cartilage lesions are too large for microfracture or autograft OATS to work successfully. Thus, an allograft OATS surgery may be required in some of these cases. In this surgery a cylindrical area of bone is removed where the cartilage lesion is located. A similar sized bone plug with overlying articular cartilage is then removed from a matched cadaver. This cylindrical area of bone is then placed in the defected area in order to repair the cartilage lesion.Chondrocyte TransplantationChondrocyte transplantation is used for relatively large cartilage defects in the knee, where the underlying bone is normal. This procedure is usually done in one of two ways. Cartilage cells can be harvested from the patient, sent to a lab, grown, and then later implanted into the patient via a second surgery. The other option is to use fetal chondrocyte cells, which requires only one surgery. In either case the lesion is cleaned of any residual cartilage. A tissue patch is then sewn into the lesion and cartilage cells are injected into the area. These cells then grow into hyaline (articular) cartilage.SummaryMicrosoft PowerPoint - IOC Diploma presentation [Compatibility Mode]Knee injury extremely commonHistory will direct the examination and helpwith diagnosisPhysical examination directed to the history– Keep in mind the rules of thumbTreat based on the injury and also the patientMost knee injuries can be treated withoutsurgery– Need to rehabilitate the athlete