In response to my previous blog, I
got a mail from my senior and old friend asking me why I did not contact his
Department, which he heads now in Bangalore, as I had worked along with him.
I had mentioned that there is no specialty
that deals with muscles in medicine. I was wrong, as there is a department
which deals with this. It is Department of Physical Medicine and Rehabilitation
(PMR). The specialists are called Physiatrists. We have MD and DNB courses in
this subject. I have hardly seen any medical professional knowing about the
existence of this department. St John’s Medical College in Bangalore and
Christian medical college in Vellore have these departments. They deal with kinesiology
which is about muscles. Very few departments exist in the country. And most of
the practising doctors do not know about this.
RSI is
increasing in number. Some are having full blown condition and have left their
jobs; many are in different stages of this condition and are in the process of
going in for serious trouble. I have seen many who are suffering yet not
willing accept the reality. I have spent hours explaining so many people, though
it was none of my business to lecture them to get help.
I
did mention about Recoup which came out with this new treatment. The problem in
that centre is the attrition of therapists and insufficient knowledge of the
newer therapists. There is lack of comprehensive treatment with non involvement
of Doctors with therapists. Most of the therapists treat blindly without
understanding the real problem. So they can only treat the earlier stages
completely. You all know about how some centers work in our country which, I
won’t talk about. Most of the therapists themselves develop RSI treating continuously.
As it is manual work most are not willing do the job.
RSI patients have multiple trigger points. The
trigger points were first described by Janet travell almost fifty years back.
Still this has not found its way into medical textbooks. It was later
popularised by Claire Davies a piano business man who wrote a self help book. Other
day I found an article in journal of rheumatology about the relation of latent (non
active) trigger points with depression. That is to say everybody have trigger
points, some are latent and do not cause pain. Active trigger points cause pain
and contractile state of a muscle.
Whenever a muscle is strained, it goes in to a
contractile state by formation of a nodule which is called a trigger point.
This trigger point has been studied by electron microscope and contents have
been found. Trigger points hold the muscles in contractile state as a defence mechanism.
In this process they shorten. These points are extremely painful and can be
released by massage or needling them. If they are not released and continued
abuse of the muscle causes trigger points in the assisting muscles which are
called satellite trigger points. Over time if proper treatment is not done,
most of the muscles develop trigger points. They involve the muscles who get in
to action to correct posture and so on.
I have come to realise that there are
two types in neck pain. First is with People
working with neck bent posture and developing TrP (Trigger points).
Second type is with people working
with outstretched hand. First type develops trigger points in specific muscles
which can be treated easily by TrP therapy. The second type is the one which is
causing havoc. Continuous outstretched hand without rest seen in computer users,
causes lot of strain on the shoulder muscles. The primary shoulder muscles are
Rotator cuff muscles which involve four muscles which develop TrP’s when are
strained. If continued working the supporting muscles get in to action and tire
easily only to develop TrPs themselves. Later the muscles which attach from
neck to shoulder try to assist and they also bite the dust. Because of this the
posture changes and constant correction to keep straight causes the opposite
side muscles get in to action and join the rest of the crowd to bite the dust. So
we have all these poor guys with TrP’s causing contractile state and shortening
pulling on bones causing osteophytes which are bony projections termed as
degenerative changes.
Then there is muscle pull between the
head and shoulder causing compression of the spine causing discs to rupture and
herniate just like when multiple cream biscuits are compressed cream comes out.
If
there is a disc herniation and nerve root compression it is a clear case for
surgery. Others end up with physiotherapy, which happened to me initially,
where I was given Isometric exercises aggressively. I had to put my head
against wall and push it on all sides. Next was cervical traction. This has
been followed from years by our medical community. These are the worst things to do for a strained
neck. If muscles with TrP and contractile state are abused further by contraction
and stretching only makes it contract further. There by causing more shortening
and discs to rupture. Any muscle with a TrP should not be exercised or
stretched.
My junior colleague was the first to
develop RSI more than 3 years back. He was put on one month of cervical
traction and ended with disc herniation.
By now I hope you understand the
logic of neck pain. The approach to treating neck is difficult in the second
type of neck pain if it has progressed. The problem with people treating neck
pain is that they have not understood the logic of neck pain. I have seen them
working on only neck and treating the ones pointed by the patients which is
symptomatic. The moment they are off the table they get their TrP’s back with
this type of treatment. That is the reason the RSI has been elusive. I have
read many articles written by therapists who are also not giving a proper
picture to approach.
Whereas the logic of treating stubborn TrP s lies
in solving other muscles which are pulling them and causing TrPs more than the
work or posture.
Finally
it is the ignorance of comprehensive treatment and not understanding the real
problem which has led this increasing number of RSI. The prevention of RSI lies
in understanding it. I would suggest people who work with computers keep their shoulders,
back and neck fit. People who have developed RSI, can only hope they get a
therapist who understands this. Otherwise you are wasting time, instead you
should learn about this yourself by reading about it. At
present I am in the process of treating people myself. I have almost come to a
state where I can help those who have not been solved by others from years. I have injected myself on many trigger points and have solved them. It is a tedious process.
Take care and please do forward this
to as many, because RSI can hit anybody anytime as long as the computers are
there. And please comment so that I can put forward some more points.
