Stressing Out

Most of us have experienced stiffness in our wrists or shoulders after spending long hours at the computer or playing an instrument, especially when we
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Most of us have experienced stiffness in our wrists or shoulders after spending long hours at the computer or playing an instrument, especially when we have been working intently on a project. Usually, a good rest and shorter subsequent work periods help clear up any problems, but what about when stiffness and pain persist? That is a much more serious issue, because it could mean that you have a repetitive stress injury (RSI). Repetitive stress injuries, also sometimes called repetitive strain injuries, are medical conditions affecting your hands, wrists, arms, neck, shoulders, and back. By overusing and overextending certain muscles, tendons, and nerves, you can wind up with chronic pain or other debilitating symptoms.

Even though the link between excessive computer use and RSI is well-known, musicians often don't realize that similar injuries can come from practicing their craft. Think about the many repeated motions required when playing a musical instrument. That constant use, multiplied over extended time periods, can contribute to RSI.

Electronic musicians are at greater risk for RSI because many of us not only play an instrument but also log quite a few hours at our computers. This double-whammy can irreversibly damage your body in ways that interfere with your ability to play your instrument, work at your computer, and accomplish other tasks. It is important, then, to understand the causes of, symptoms of, and ways of preventing those injuries.

OUCH. OUCH! OUCH!!

Repetitive stress injuries can result from many causes, and sometimes more than one cause can come into play. Muscle, tendon, and nerve strain brought on by working and playing for long hours without breaks are common contributors to RSI, as are bad posture, improper workstation setup, general stress, insufficient rest, and incorrect keyboard, mouse, and musical technique.

What are the typical symptoms of RSI? At first, you may experience some mild discomfort or general fatigue in your fingers, thumbs, hands, wrists, forearms, elbows, shoulders, upper back, and neck. Those feelings often disappear with rest. If left untreated, however, the pain may persist or grow.

Next, you may begin to notice swelling, tightness, or stiffness. A tingling, numbing, or even burning sensation may accompany the overall soreness. You may notice your hands, arms, or shoulders “fall asleep” frequently. You may also find yourself consciously or unconsciously massaging your sore parts.

As RSI advances, you may experience difficulty using the painful region. Your endurance can diminish sharply. Say you used to play for hours — you may find it difficult to continue after only a few minutes. Also, a loss in dexterity, control, and strength might make it increasingly difficult to perform fine motor skills. You may slowly lose some of your playing skill, too. Those symptoms can affect other everyday tasks, such as fastening buttons, grasping certain objects, and picking up and holding heavy things. The pain may even begin to interrupt your sleep.

If you experience some or all of these symptoms, you may be suffering from a repetitive stress injury. It's time to consult a health-care professional. Start by seeing your primary care physician, who can diagnose and treat your injury. Treatment can include professional physical therapy, along with a specific regimen of home exercises. If your symptoms persist or get worse, your doctor may advise you to stop playing or using your computer until you heal fully. If your initial treatments fail to stem your discomfort, your doctor may recommend other RSI specialists such as an orthopedic surgeon or a neurologist. Chiropractic services and other alternative treatments are also viable options in reducing the effects of RSI.

RSI is a progressive condition, which means it usually grows in intensity and spreads if ignored. Some cases of RSI are so bad that only surgery can alleviate them. In some instances, there is little or no recovery from the ailment, and you may be left with a painful, chronic condition that haunts you for the rest of your life. The good news is that you can avoid that fate by identifying potential problem areas and preventing them from becoming serious ailments.

TYPES OF RSI

Several medical conditions are associated with RSI. The most widely recognized is carpal tunnel syndrome. The carpal tunnel is located in the wrist, where your forearm meets your wrist (see Fig. 1). Inside the tunnel are the median nerve and flexor tendons. When that area is strained, it causes swelling in the surrounding tissues, irritating the nerve. The result is a tingling or numbness in the hand and fingers. Aside from carpal tunnel syndrome, here are some of the more common RSI-related conditions.

Bursitis

Bursa sit between muscles and tendons, helping them to move smoothly. When inflamed, the bursa can cause pain. Bursitis symptoms are similar to and often mistaken for arthritis.

Epicondylitis

This condition affects the tendons that connect the forearm muscles to the elbow. Though there's nothing funny about it, it affects the area around the funny bone.

Tendonitis

Tendons attach muscles to bone. When tendons become inflamed or otherwise irritated, they can cause pain or stiffness. Movement usually aggravates this discomfort. Tendons located near joints are more susceptible to this condition.

Tenosynovitis

Tendons are surrounded by a thin sheath that can cause swelling and pain when irritated. This swollen sheath may also produce a crackling sound and crackling feeling when moved.

Trigger finger

Swelling in the tendons of the hand can also cause pain when the fingers or thumb bend.

Some RSI symptoms may appear in areas unrelated to the site of injury. Your wrist may hurt, but that may be related to poor posture rather than your keyboard technique. Trigger points are hypersensitive areas in a muscle or muscle fascia that can cause irritability to surrounding nerves. A trigger point in your shoulder may manifest itself as wrist pain. Trigger points are activated just the way RSI is — through overuse, fatigue, direct trauma, and chilling. Treating these trigger points through massage therapy or chiropractic care may alleviate the symptoms.

EARLY INTERVENTION

A balanced mix of playing, using the computer, doing alternative activities, and resting frequently can all help you avoid the debilitating RSI specter. Here are some other general tips.

Because RSI is caused by many repeated small movements, give your affected body parts something different to do. Put them through larger ranges of motion. Do stretches and other exercises that move them counter to the routine of playing, keyboarding, and mousing. Consider making regular, vigorous exercise, such as taking a power walk, part of your plan, too.

Treat the affected area to some deep massage. Don't just rub gently; really get in there and palpitate the area aggressively. Consider regular deep-tissue massages with a qualified massage therapist as a preventative and prescriptive therapy for RSI. Also, tai chi, yoga, and dance are great exercises for preventing and relieving RSI.

Pain can also be treated through alternative methods, specifically acupuncture and acupressure. The Chinese have embraced those two treatments for more than 5,000 years. Acupuncture and acupressure are based on the belief that qi (pronounced “chee”) is the vital life energy force that flows through the body on paths called meridians. When the qi flow is blocked or restricted, illness results. Acupuncture uses fine needles inserted into specific points on the body to relieve blockages and stimulate qi flow. Acupressure uses massage on those same pressure points. Both treatments stimulate the nervous system and release endorphins, which are our own natural pain killers. Regular chiropractic care can also help stave off RSI by relieving pressure on your joints.

In general, your body is more susceptible to injuries when it is chilled, so keep your room warm. Be sure that your fingers, hands, wrists, arms, and shoulders are warm. My basement project studio can often get rather cold, so I've invested in a space heater to keep me comfortable during the Chicago winters.

The human body is made up primarily of water, so make sure to keep yourself hydrated. Caffeinated drinks and alcohol dehydrate you, which stresses your system in general. Reach for a glass of water instead, and have several glasses a day.

Other activities, such as participating in certain sports or hobbies, can aggravate RSI. If your idea of fun after hours of playing and computing is to spend several more hours playing video games, you put yourself at greater risk for developing RSI.

For immediate relief when RSI symptoms flare up, consider using ice and heat therapy. To relieve swelling, apply an ice pack (with a moist towel between it and your skin) to the affected area for no more than 15 minutes. For pain relief, use moist heat for no more than 15 minutes. If you feel worse after using heat, try the ice therapy. You can also alternate cold and warm (one immediately after the other) to stimulate blood flow through the affected area.

Keep a log of your activities and symptoms so that you can find any correlations and learn your limitations. You'll discover how long it takes when playing or using the computer before you start to feel some discomfort. Once you know your limit, stop a few minutes before that time.

It is also important to take breaks. For maximum benefit, take shorter, more frequent breaks. Be sure to stop what you're doing for at least five minutes of every hour. Really relax during your time off, and give your fingers, wrists, arms, shoulder, and back a much deserved respite. Additionally, perform some mild stretching exercises that work RSI-susceptible muscles and tendons contrary to your playing/working positions. Refresh yourself with some gentle self-massage, too. (See the sidebar “Stress Relief” for information on RSI treatment resources and workstation ergonomics.) Most importantly, get plenty of extended rest so that your body can properly rejuvenate and recover from overuse.

PREVENTION FOR PLAYERS

Most health-care professionals agree that learning proper techniques can help prevent RSI better than any other solutions. For players, start with the fundamentals. Are you playing your instrument correctly? Using too much force, staying in fixed positions for extended periods, and tensing up instead of relaxing can all contribute to RSI. Consult a teaching professional who can help you modify your technique and reduce or eliminate bad habits altogether.

Check your instrument to make sure that it is in good working order. Perhaps you're overextending yourself because of a problem. For example, setting the action too high on a guitar or using heavy-gauge strings can force you to use excessive pressure when fretting. Lower the action and buy some lighter strings if that is causing you problems.

Be wary of strength-building exercises and gadgets. Sometimes activities designed to make your fingers, wrists, and forearms more powerful can aggravate RSI. Consult a qualified health-care practitioner before going down that road. If you're already feeling pain, doing strengthening exercises can actually worsen the condition.

No professional athlete would think of stepping out onto the field, floor, or ice without warming up first. A thorough warm-up is the primary defense against injuries. Musicians are athletes, too. Make sure that you warm up your muscles and tendons before hitting the stage, studio, or practice room.

PREVENTION AT THE DESK

Make sure your computer workstation is set up properly (see Fig. 2). Position the monitor directly in front of you with the top of its screen at eye level. Position the work surface at the proper height so that your wrists and arms are parallel to the floor. Leave ample room for your knees and legs. Get a good, comfortable chair that easily adjusts to your body. It should have lumbar support and arm rests. Sit up straight in your chair, feet flat on the ground. You should feel comfortable at your workstation, not awkward, and you shouldn't strain to reach the keys or mouse. Take a break every half hour; get up, move around, and work those neck, shoulder, and back muscles.

Arm and wrist rests are fine for relaxing, but you shouldn't use them while keyboarding or mousing. Wrist supports in particular often create a situation in which your wrists are bent back when they should be in line with your arms. Lift your hands up above the keyboard and mouse when working. Lightly touch the keys while typing and hold the mouse gently. If you're not typing or mousing, move your arms and hands to different positions instead of leaving them in place.

Try to reduce the amount of time you spend using the mouse by learning keyboard shortcuts. Also, cut back on your overall computer time by finding alternatives such as using the phone instead of typing e-mails. Purchase a device that can help you reduce your mouse time and help you avoid keeping your arm and your hand in the same position for too long. I use the Contour ShuttlePro (see Fig. 3), which functions as a control device for many programs. (An updated version called the ShuttlePro 2 has just been released.) The ShuttlePro has a jog/shuttle wheel and programmable buttons. Adding a device like that gives your left hand more to do than just type. As with a mouse, position the device comfortably and use it gently without bending your wrist or reaching awkwardly.

Follow these tips to prevent RSI, alleviate minor discomforts, and protect your ability to make music now and in the future. However, seek medical attention immediately if your pain persists or grows. Pain is your body's way of saying something is wrong. Pay attention to the message. In general, if it hurts, stop and do something else. Take a break or quit for the day, because proper rest truly is the best medicine.

Even though he is busy at his project studio,Jeffrey P. Fisheralways finds time to take RSI-preventing breaks. Discover what he's up to at his Moneymaking Music Web site,www.jeffreypfisher.com.

DO YOU HEAR WHAT I HEAR?

Don't forget to take care of your ears. While Messrs. Fletcher and Munson tell us that 85 to 90 dB is the ideal listening level for making critical sound judgments — it's the level at which the ear's frequency response is most flat — those excessive sound levels can cause damage over time. Protect your ears from prolonged exposure to loud levels by turning your monitors down most of the time and taking frequent rests when in extended mixing sessions. Get more information at Hearing Education and Awareness for Rockers (HEAR) at www.hearnet.com.

DO YOU SEE WHAT I SEE?

Eye strain is every bit as serious as wrist and ear strain. Make sure your workspace is well lit with bright overall lighting supplemented by task lights. Keep glare off the computer screen, though. Adjust the brightness and contrast settings on your monitor so that viewing is comfortable. Also, did you ever notice that working at higher computer resolutions makes the type smaller? Consider working at lower resolutions or at least making the fonts bigger. I recently switched my word processor to 120 percent magnification and find that my eyes no longer need to work so hard.

STRESS RELIEF

The following resources are just the tip of the iceberg when it comes to getting information on and relief from repetitive stress injuries. Check with your doctor, acupuncturist, chiropractor, or other health-care professional to find further information about these avoidable ailments.

Contour Design, Inc.

Contour Design manufactures the ShuttlePro 2 desktop control device; tel. (800) 462-6678 (U.S. only) or (603) 893-4556; e-mail info2003@contourdesign.com; Web www.contourdesign.com.

Ithaca College Office of Public Safety

This section of the Ithaca College Web site has information on proper workstation setup and usage. The site also shows several stretches and exercises. Visitors to the site can choose to view the exercises as a series of photos or as animated GIFs. Web www.ithaca.edu/safety/ergonomics/index.htm.

Occupational Safety and Health Administration (OSHA)

OSHA offers an array of safety tips for just about any occupation you can think of. The computer workstation section of the OSHA Web site is particularly useful to electronic musicians. Tel. (800) 321-OSHA (6742); Web www.osha.gov.

University of Nebraska-Lincoln Electrical Engineering Department

Okay, so this is a little off the beaten path, but the RSI section of this Web site is extensive and extremely informative. Web http://eeshop.unl.edu/rsi.html.

WebHealthCentre

Check out the extensive section of stretching exercises on this healthcare-related site. Web www.webhealthcentre.com/general/ft_flexi.asp.

WebMD

This site is helpful for looking up symptoms, ailments, and types of treatments available for RSI, as well as recent medical reports on ailments and the effectiveness of treatments. Web www.webmd.com.

Yoga Without Tree Hugging

The Office Yoga section of this site offers good stretching exercises that can be done at your desk. Web www.zenyoga.co.uk/yoga/office.htm.