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What is RSI?

 

In the last decade, hundreds of thousands of otherwise healthy individuals have developed a painful, debilitating and sometimes disabling condition known as Repetitive Strain Injury (RSI).  
 
RSI is a multifactorial complaints syndrome affecting the neck, upper back, shoulder, upper and lower arm, elbow, wrist or hand, or a combination of these areas, which leads either to impairment or to participation problems. The syndrome is characterized by disturbance in the balance between load and physical capacity, preceded by activities that involve repeated movements or prolonged periods spent with one or more of the relevant body parts in a fixed position as one of the presumed etiological factors. (Health Council of the Netherlands, The Hague, 2000: Publication No. 2000/22E, p. 18).

RSI is a diffuse disorder of muscle, fascia, tendon and/or neurovascular structures. Some sources include disorders of the lower back and lower extremeties in the definition of RSI.

RSI is also known as Work Related Musculoskeletal Disorder (WRMSD), Cumulative Trauma Disorder (CTD), Computer Related Injury (CRI), Work Related Upper Limb Disorder (WRULD), and Occupational Overuse Syndrome (OOS).

 

High Risk Groups                                                                                                  

  • Computer Users
  • Musicians
  • Health Professionals: Surgeons, Dentists, Nurses, Massage Therapists
  • Laboratory workers
  • Teachers
  • Manual Labourers, Assembly Line Workers
  • Check out clerks
  • Hairdressers
  • Butchers  Sportspersons
  • Children
  • Housewives

 

Prevalence

  • 15-25% of all computer users worldwide (both vocational and recreational) are estimated to have RSI. By this estimate, over 5 million Indian computer users (out of an estimated 28 million) may already be having RSI.
  • RSI accounted for 66% of all work-related illnesses in USA (1999).
  • A survey of 500 software professionals at Hyderabad in 2000 revealed that over 50% had symptoms of established RSI.
  • Preliminary results of our ongoing prospective study among over 35,000 Indian computer professionals (2001-2009) found that over 75% reported musculoskeletal symptoms. This is the largest study ever undertaken to identify the prevalence, causes and results of treatment of Computer Related RSI

 

Why should you bother about RSI?

  • If you are reading this, even YOU could be at risk! NO ONE is immune to  RSI: whether you are a week old in the industry or whether you are the C.E.O.
  • RSI can seriously disrupt work and domestic life. We know of 75 young Indian computer professionals who have lost their jobs due to advanced, neglected RSI, since 2001.
  • RSI is not a compensable occupational illness in India, even though over $250 billion are spent every year in USA as a consequence of RSI. There are no protective laws once workers get injured and are unable to work  productively. The onus of RSI prevention is entirely on Indian workers.
  • If RSI is not diagnosed and treated correctly and at an early stage, it can lead  to a dreaded and crippling complication called Complex Regional Pain Syndrome.

 

Social costs of RSI

  • Diminished health
  • Psychosocial consequences, e.g., anxiety, stress and depression
  • Diminished community involvement 
  • Diminished ability to participate in recreational activities 
  • Overall diminished quality of life

 

Economic costs of RSI

  • Decreased productivity & quality
  • Lost wages
  • Doctor visits, cost of medical procedures  and ergonomic modifications
  • Employee turnover
  • Recruiting and training new staff
  • Retraining injured workers
  • Decreased employee morale
  • Compensation expenditures

 

Current scenario in India

Early identification of RSI and competent medical intervention is critical to arrest and reverse the injury in its early stages

Unfortunately, Indian medical professionals (in general) are not equipped to diagnose or treat RSI's, since it is a relatively recent phenomenon here. Ergonomics, RSI and Myofascial Disorders do not even find a passing mention in the Indian Medical Curriculum and it is not unusual to find Indian doctors (even specialists) and physiotherapists who have not even heard of RSI, let alone have the ability to treat it.

 

Top pitfalls in RSI Treatment in India

 

  • Misdiagnosis as "Spondylitis, "Arthritis," "Slipped Disc," or "Muscle Sprain" seems to be the rule rather than an exception. Diagnosis of RSI is entirely based on a skilled musculoskeletal examination by an expert, and no "special" tests including MRI scans or nerve conduction studies can reliably diagnose it.
  • Inappropriate medications, e.g., corticosteroids (or Cortisone), antidepressants, Vitamin B12 and multi-vitamins, Unspecified Health Pills and Oils, etc. Medicines and potions (whether Allopathic or Alternative) make little difference in the long term.
  • Conventional physiotherapy is usually ineffective (Ultrasound, Short Wave Diathermy, etc.) and sometimes dangerous (traction and isometric/resistive neck exercises).
  • Inappropriate surgery for a presumed diagnosis of Carpal Tunnel Syndrome or Slipped Disc, with disastrous consequences.
  • Total reliance on fancy ergonomic gadgetry, special chairs, wrist rests, split keyboards, anti-glare screens, etc. to prevent RSI, while ignoring human factors (e.g., practical training in posture, body awareness, typing technique, breaks)
  • Often, RSI sufferers are told "it's all in your mind" and the only way to recover is to get "it out of your mind!" No further clues are usually provided as to how to achieve this laudable goal. Worse, others are condemned to referral to a psychiatrist because the "specialist" could not find anything wrong on examination or investigations.
  • No significant attempts at identifying and correcting predisposing factors for RSI, e.g., ergonomic or postural problems.
  • Alternative medicine practitioners who practice a single technique often have a single-track approach to diagnosis and treatment ("when the only tool you have is a hammer, everything looks like a nail!"). Most have no knowledge whatsoever of RSI and can severely aggravate an existing RSI and prolong the recovery period. However, some modalities like Yoga, when used appropriately (in the recovery stage rather than in the acute stage) and in a holistic environment, are beneficial in RSI.

 

RSI victims, on the lookout for a quick-fix requiring minimum effort and time off work, usually run from pillar to post seeking effective treatment and often fall victims to quacks. Inaccurate and unmoderated information abundantly available on the Internet is swallowed up by the gullible computer users, adding to their plight.

 

 
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Indian RSI Patients
 
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LOW BACK PAIN


Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Low back pain is the most common cause of job-related disability and a leading contributor to missed work.

Types of low back pain
Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is mechanical in nature — that is musculoskeletal low back pain.

Musculoskeletal low back pain can be caused by problems with the alignment in your vertebrae, pelvis, or sacroiliac joint (where your spine meets your pelvis), tightening or shortening of muscles in the area, lack of or too much mobility in your spine or a specific syndrome termed "myofascial pain syndrome". Myofascial pain is pain arising from active trigger points in a muscle or its fascia (connective tissue around the muscle). A trigger point is a tender, irritated area that can cause pain in areas along the muscle; an event called "referred pain". This referred pain can usually be reproduced when the trigger point is "palpated", or pushed on. The pain can be felt at rest, as well as when the muscle is being used. Trigger points over time cause the muscle to shorten, leading to a tight, pulling, or stretched feeling. Problems with your alignment can trigger nerve receptors in joints and other areas.


Chronic back pain is measured by duration — pain that persists for more than 3 months is considered chronic. It is often progressive and the cause can be difficult to determine.

The factors that contribute to back pain include:


•    Poor posture (Slouching when sitting)
•    Improper footwear and walking habits
•    Improper lifting, lifting heavy objects
•    Straining individual muscles
•    Calcium deficiency
•    Prolonged sitting, especially in a chair that does not adequately support the back
•    Sleeping on a mattress that is too soft
•    Kidney, bladder, and prostate problems
•    Stress
•    Pregnancy
•    Female pelvic disorders
•    Constipation may produce back pain
•    Arthritis
•    Rheumatism
•    Bone disease
•    Abnormal curvature of the spine

The conditions associated with low back pain


Conditions that may cause low back pain and require treatment by a physician or other health specialist include:
1.    Bulging disc (also called protruding, herniated, or ruptured disc). As discs degenerate and weaken, cartilage can      bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain.
2.    Sciatica : The compression of sciatic nerve causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, & it reaching the foot.
3.    Spinal degeneration : From disc wear and tear can lead to a narrowing of the spinal canal.
4.    Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.
5.    Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength.
6.    Spinal deformities: The irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward.
7.    Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.
8.    Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints.
9.    Osteomyelitis  : Infection in the bones of the spine
10.    Ssacroiliitis : Inflammation in the sacroiliac joints.


Diagnosis
1.    History
2.    Physical examination
3.    X-ray imaging
4.    Discography
5.    Computerized tomography (CT)
6.    Magnetic resonance imaging (MRI)


Treatment of low back pain
1.    Trigger point release
2.    Myofascial release
3.    Spinal mobilizations
4.    McKenzie back regimen
5.    Spinal stretching & strengthening exercises
6.    Back school

 
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ARTHRITIS


Arthritis is actually an umbrella term used for a group of more than 100 medical conditions that collectively affect a large number of peoples all over the world. Among this the most common form of arthritis is osteoarthritis (OA) and is most prevalent in people over 60. Also some arthritis in its various forms can start as early as infancy.

Arthritis is defined as an inflammation with in a joint which results in pain stiffness, swelling which leads to joint damage & decreased movement.

Arthritis-related joint problems include pain, stiffness, inflammation and damage to joint cartilage (the tough, smooth tissue that covers the ends of the bones, enabling them to glide against one another) and surrounding structures.


Forms of arthritis


More than 100 forms of arthritis and related diseases exist. Some of them are
1.    Ankylosing spondylitis
2.    Osteoarthritis
3.    Psoriatic arthritis
4.    Rheumatoid arthritis
5.    Rheumatic fever
6.    Septic arthritis
7.    Gout
8.    Seronegative arthritis
9.    Arthritis of Ulcerative colitis


Clinical features


The damage can lead to joint weakness, instability and visible deformities that, depending on the location of joint involvement, can interfere with the most basic daily tasks such as walking, climbing stairs, using a computer keyboard, cutting your food or brushing your teeth.

Principles of Arthritis Management

1. Each person is an individual and should be viewed as a person with a type of arthritis, rather than as a type of arthritis seen in a person.

2. There is no best treatment for everyone who has a particular type of arthritis, as each individual may respond differently to different treatments.

3. No single type of arthritis is always better or worse than another type.

4. Information and input from a person with arthritis can be as valuable in diagnosis and management as information from laboratory tests and X-rays.

5. In arthritis management, the emphasis is on improving function of joints and relieving pain.

6. Your doctor and health-care team need your involvement to help you to the fullest extent. People with arthritis and health professionals are partners in care.

7. Something can always be done to improve the situation for a person with arthritis.

Diagnosis


1.    Clinical features
2.    Physical examination
3.    Radiography
4.    Lab investigations

Treatment of arthritis


1.    Myotherapy
2.    Electrotherapy 

3.   Taping techniques

4.   Joint Mobilisations

5.   Exercise therapy for strengthening muscles

 
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