3 Steps to Healthier

Computing

Cathy Wells

   

 

       

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Introduction

Which of these do you regularly use?

• Desktop computer • Laptop • Tablet (an iPad, for example) • Smartphone

Chances are you work on at least one or more every day and if you do you may be at risk of developing Repetitive Strain Injury (RSI), also known as Upper Limb Disorder (ULD).

And you won't be alone — here are some sobering facts about RSI...

According to statistics compiled by RSI Awareness [http://www.rsi.org.uk/] from a range of sources...

• Around one in 50 UK workers — more than half a million — have reported symptoms

• One in six people in the UK with RSI have to quit their jobs • RSI costs the UK economy as much as £20 billion a year • The US Occupational Health and Safety Administration records 700,000 cases a

year • It's estimated that up to 25% of computer users worldwide many be affected • Some 60% of Australian children report discomfort using laptops.

   

 

       

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Symptoms

 

The key symptoms of RSI revolve around a burning or aching sensation — or actual pain — in the elbows, forearms, hands and sometimes the shoulders. Pain round the elbow often leads to a diagnosis of tennis or golfer's elbow (lateral/medial epicondylitis), both conditions that can fall under the RSI umbrella.

As a result of any of these symptoms you may find suffer the following problems...

• Heaviness in your arm • Difficulty lifting everyday objects — even a kettle may be too heavy • Difficulty turning your wrist — door handles may trigger discomfort and driving may

be painful • A weak or unreliable grip • Headaches (usually associated with shoulder pain).

Do not ignore any of these symptoms! Visit your GP as soon as possible — and especially during the inflammation stage of the condition — to confirm a diagnosis. Most GPs prescribe rest and anti-inflammatory drugs, which may alleviate the symptoms but won't address the cause. Unfortunately, the pain may well recur as soon as you pick up where you left off.

But don't despair: it is possible to help yourself by following the Wells Clinic 3 Steps to Healthier Computing, but please use it alongside any medical guidance you may have been given. It's only here to help people who have already been diagnosed and does not replace that key diagnostic process.

   

 

       

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Step 1 — Evaluation and change

As most of us spend a significant chunk of our time seated at a desk or table in front of a computer, let's start there...

(If you're using a laptop, don't actually use it on your lap — it should always be placed on a desk or table.)

Have a look at Figure 1 on page 5 which illustrates the ideal workstation set-up and see how yours compares...

The three most important points to consider are

• The screen should be sited at eye level, which stops you looking up or down for long periods

• Your forearms need some support on the desk. Muscles tire easily if they're suspended or subject to wrist flexion and extension from using the mouse or keyboard

• Make sure your feet are on the floor and not dangling. Use a foot rest if necessary to ensure you maintain the right posture — a phone book is a good (and free!) alternative!

   

 

       

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Figure 1

   

 

       

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Step 2 — Self-treatment

At the heart of this approach is deactivating trigger points.

What is a trigger point? It's a specific spot in a taut band of muscle which causes pain elsewhere — what's known as 'referred pain'.

It's necessary to deactivate the trigger point to stop the process as treating the point of pain itself will not relieve the pain.

In Figure 2 on the left, the blue 'x's on the trapezius muscle marks the knots and the areas shaded blue shows where the referred pain may actually be experienced.

Figure 2

   

 

       

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So how can you deactivate trigger points yourself?

With the symptoms of RSI, you can use an ordinary tennis ball, applying compression from the elbow down to the wrist to seek out those knots in the muscles.

Always carry out the exercise while sitting down and resting your arm on your lap. Work on a 0-10 pain ratio and never exceed Level 7 once you've found a trigger point. Hold the ball in place for eight to 10 seconds — the pain should decrease a few levels and you should feel the tension ease from the spot.

You can use your knuckles in the same way, compressing just enough to see the skin move as you go up and down the arm.

You'll be working on two sets of muscles, the flexors and the extensors of the hand and wrist, and for maximum relief combine treatment with a series of specific stretches — details of both are outlined below.

   

 

       

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The flexors

These comprise five muscles arranged in layers in the inner forearm, with all the upper attachments made to the medial epicondyle (the bony projection at the inner elbow). Their lower attachments are by long tendons to the various bones of the hand and fingers.

The flexors are responsible for bending the hand inward at the wrist, cupping the hand and curling the fingers and thumb in towards the palm — that is, flexion of wrist and hand. They will be involved with any pain experienced on the inner forearm and with golfer's elbow.

You can find Flexor carpi radialis by locating the belly of the muscle about 3 inches below the elbow — some of the worst trigger points are right near the elbow.

Feel the muscle contract in isolation by bending the hand inwards, as in Figure 3 (left). Pain may be sent to the inner wrist near the base of the thumb.

You can make Flexor carpi ulnaris contract in isolation by bending the wrist towards the pinky finger side of the hand — the muscle runs along the inner edge of the shaft of the ulna (the bone on the inner edge of the forearm). Pain may be sent to the ulnar (pinky) side of the wrist, the heel of the hand, or the inner elbow, and may cause the ulnar nerve to be compressed, which in turn can lead to a weakened grip and a sensation of burning or numbness in the

fourth and fifth fingers. (See Figure 4, left)

   

 

       

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The Palmaris longus is a narrow muscle lying between the Flexor carpi radialis and Flexor carpi ulnaris on the inner forearm. To locate the belly of this muscle, feel it contract in isolation when you bring the tips of your fingers and thumb slightly together. Trigger points can be found from mid-arm to the bony projection of the inner elbow. These may cause a burning or prickling sensation in the palm of the hand, as well as pain in the lower half of the inner forearm. (See Figure 5, left)

Flexor Digitorum profundis and superficialis are difficult to distinguish just by contraction. Their trigger points are located in the upper half of the inner forearm, and you can expect them to be very deep. They can send sharp pain to the inner sides of the fingers, and uncontrolled twitching of the fingers can sometimes by caused by trigger points in these muscles. (See Figure 6, left)

One other muscle group is the Pronators. These turn the hand into a palm-down position, which is called ‘pronation’. Trigger points send pain to a large area on the thumb side of the wrist, and this may extend into the base of the thumb as well as up into the inner forearm. To locate Pronator teres, place fingers just down from the inner elbow and feel the muscle bulge when you turn your hand over hard, palm down, as far as it will go. For Pronator quadratus do the same, but this time place your fingers on your wrist where you take your pulse.

   

 

       

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For trigger point release, using a supported thumb works well for massaging all the flexors, as shown in Figure 7 (left), or use your knuckles or a tennis ball.

One useful approach is to view your forearm as comprising two or three strips (depending on the size of your arm). Follow each strip down, starting from the elbow and ending at the wrist.

For trigger point release, try placing your arm behind your back and then leaning onto a wall with a tennis ball on the area near your elbow — see Figure 8 (left). This is the best way to go deep into these thick muscles. For maximum impact, start the ball 2-3 inches below the elbow and roll it along your forearm down to the wrist.

   

 

       

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The extensors

These are four muscles located alongside each other on the outer side of the forearm (the hairy side). Their upper attachments are to the lateral epicondyle, which is the uppermost bony protuberance on the outer elbow, and their lower attachments are by long tendons to various hand and finger bones.

The extensors are responsible for bending the hand back and straightening or raising the fingers — that is, extension of the wrist and hand — and will be involved with any pain to

the outer part of the forearm (the hairy part) and tennis elbow.

You can locate Extensor carpi radialis longus by placing your fingers in the thick roll of muscle at the outer elbow and feeling the muscle bulge when you turn your wrist in towards your body, as shown in Figure 9, (left). This is where the trigger points are commonly found.

Trigger points in this muscle are a common cause of tennis elbow. They can also send a kind of burning pain to the outer side of the

forearm and the back of the wrist and hand. Any intensive wrist action will exhaust all the muscles of the forearm.

For trigger point release, use your knuckles, fingers or a tennis ball to massage this muscle, as shown in Figure 10 (left). Massaging deeply all around the head of the radius (the bone on the thumb side in the forearm) will also help to deactivate trigger points in brachioradialis (found alongside this muscle) and Supinator, which lies beneath both muscles. The brachioradialis helps bend the muscle and the

supinator turns the hand palm side up.

   

 

       

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When influenced by trigger points, the supinator can squeeze the radial nerve, causing numbness in the thumb side of the hand. (Note that the trigger points in this set of muscles are difficult to differentiate from each other.)

When you use a tennis ball and a wall, keep both on the thumb side of your arm and exert pressure by leaning the body against and towards the arm — see Figure 11. You need to roll the ball slowly and repeatedly over the trigger point with short, deep strokes.

Extensor carpi radialis brevis can be found by placing your fingers on

the upper side (hairy side) of your forearm near the crease where your arm bends, then feeling the muscle contract when you bend your hand straight back at the wrist. Trigger points in this muscle send pain to the back of the wrist and hand, along with a sense of tightness, burning, or aching in the back of the forearm. (See Figure 12, left)

   

 

       

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Trigger points can sometimes compress the radial nerve, causing numbness and tingling in the hand. They are found 7cm-10cm down from the elbow, right against the shaft of the radius (bone on the thumb side of the forearm). (See Figure 13, left)

You can find the belly of Extensor carpi ulnaris and its trigger points by placing your fingers just below the elbow on the outer side of the forearm. Feel it contract when you bend your wrist in the direction of the little finger. Pain is felt in the ulnar side (pinky side) of the wrist and hand, and the sensation can feel like a sprained wrist.

Massage this area with a ball against the wall, palm facing down and the thumb side of the hand away from the wall. The arm can be either straight down or held horizontally, with your body weight providing pressure. Stroke repeatedly toward the elbow. (See Figure 14, left)

The trigger points in Extensor digitorum can cause stiff fingers, pain to the outer elbow, to the second knuckle of the third and fourth fingers, an ache in the back of the forearm, and a spot of pain on the inner wrist.

Trigger points from Extensor indicis can refer pain to the back of the wrist, hand and index finger.

   

 

       

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To locate these muscles, place your fingers on the outer (hairy side) of the forearm, 5cm-7cm down from the elbow. (See Figure 15, left) You can feel the separate parts of the muscle contract independently when you raise the third, fourth or fifth fingers one at a time. If you move your index finger about 5cm above the bony knob on the outer side of your wrist, you can feel the individual extensor indicis muscle.

To treat these muscles massage with a ball against the wall with the back of the hand parallel to the wall, forearm horizontal. Roll the ball slowly along the muscle from the middle of the forearm to the elbow, leaning hard in to it. The trigger points are usually very deep, right at the bone. (See Figure 16, left)

Trigger points associated with Anconeus refer to the uppermost bony protuberance on the outer elbow (lateral epicondyle) and contribute significantly to tennis elbow. To locate this muscle, place your finger between the point of the elbow and the lateral epicondyle — you'll feel the muscle contract when you turn your hand over, palm down. Just use your fingertips for massage in this vulnerable area, as the ulnar nerve runs through this space, which we know as the 'funny bone'. (See Figure 17, left)

   

 

       

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You can use the same approach as described for the Flexor muscles. View your forearm as comprising two or three strips (depending on the size of your arm). Follow each strip up, on the hairy side of your forearm, starting from the wrist and ending at the elbow. This is a little more awkward on this side!

Remember the de-activating of any of these trigger points works best with multiple sessions spread across the day, with each lasting no more than a minute or two. Always take care not to raise the pain level above a maximum of 7.

You can also use a wheat bag to alleviate some of the pain — as long as you're past the inflammation stage: if you're not, you need to be using cold therapy. A warm wheat bag can be placed on the arm or elbow — or over your shoulder. In this position, the wheat settles at the bottom of the bag and on your shoulder blade and relaxes the muscles. This in turn re-sites the shoulders, as though the shoulder blades were being pulled down. When the wheat bag goes cold, it's a sign you've been sat at your screen too long — get up and move about!

   

 

       

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Step 3 — Stretching

Stretching is a great way of both treating existing problems and preventing future ones. Those illustrated in Figure 18 and Figure 19 show some that are recommended for loosening and strengthening your forearm extensor and flexor muscles.

With the extensor stretch, hold your fingers and turn you palm outwards. Straighten your arm and then pull your fingers back using your other hand. Do not overstretch this area by applying too much force too quickly

Figure 18

To get maximum benefit from the flexor stretch, hold onto your fingers while straightening your arm and then pull your fingers towards your body. As with the extensor stretch, do not overstretch by applying too much force too quickly.

Figure 19

   

 

       

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One other specific stretch you may want to incorporate into your routine is the rotating neck stretch, shown in Figure 20 (below).

Stand upright while keeping your shoulders still and turn your chin towards one shoulder. Keep your head up throughout, and do not let your chin fall towards your the shoulder.

There are many other stretches that benefit anyone who uses a screen — if you're in discomfort choose those that are most relevant to the point of your pain. Twelve recommended stretches are shown below in Figure 21.

One other tip: If you're typing or using your mouse a lot, try putting your hands into a praying position on the mouse support — this gives the hand muscles some welcome respite...

   

 

       

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Figure 21

With thanks to Brad Walker and Clair Davies for the illustrations and for some of the techniques outlined in this guide.

© Cathy Wells, 2013 The copyright holder is licensing this under the Creative Commons Licence

Attribution 2.0 (England and Wales) and Attribution 2.5 (Scotland) http://creativecommons.org/licenses/by/2.0/uk/

http://creativecommons.org/licenses/by/2.5/scotland/