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RSI and other mythical creatures
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RSI and other mythical creatures - November 30, 2005 11:15:00 AM
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ginger
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From: Melbourne Victoria
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I was skimming the local press the other day when I came across a narticle in a "healthwatch" format. The editoe had a short spread on "RSI", where he described various upper limb pain problems as caused by "microtrauma". and muscle tearing that was due to repetitive movements. I was a little taken aback , though not surprised, it was a tabloid) that this level of ignorance is still around. I wrote to point out the error, , that RSI is now well understood to be a referred pain and neuralgic dysfunction, caused by hypomobility and inflammatory events of the upper spine and adjacent nerves.
I'm wondering wether you folks in the US still come across references like this . The press is often wrong as we all know, but this seemed to much for me not to respond. Something about a shared responsibility to disseminate facts blah blah.
Happy holidays
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: RSI and other mythical creatures - November 30, 2005 1:11:00 PM
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MPT
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I know that we have been through this before with you, but I will bite.
How do we know that "RSI is now well understood to be a referred pain and neuralgic dysfunction, caused by hypomobility and inflammatory events of the upper spine and adjacent nerves"?
Who is this well understood by and how do they know it?
I don't think that your views are as mainstream as you think they are (at least not in my neck of the woods). I am not saying that you are wrong but I have not seen evidence for your stance in the literature or in practice.
I perform facet jt mobilization quiet frequently but I do not get the amazing results that you get. Maybe I am doing something wrong. Please let me know what your secret is.
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Re: RSI and other mythical creatures - November 30, 2005 2:26:00 PM
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nari
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I would agree that ginger's views are not mainstream in my neck of the woods, either.
Where's the evidence that RSI ( totally defunct term, anyway), is caused by hypomobility and inflammation in the upper spine? There is more evidence that pain is not related to hypomobility.
Nari
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Re: RSI and other mythical creatures - December 1, 2005 4:21:00 AM
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JLS_PT_OCS
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Asking Ginger to provide evidence for his opinions?
Speaking of mythical creatures....
:)
J
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"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: RSI and other mythical creatures - December 1, 2005 7:03:00 AM
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Geert Jeuring
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As a dutch physiotherapist working in Germany, one of the most astounding things is, that RSI seems to take a halt at the border between Holland and Germany. In Holland RSI is and has been a hot item for maybe 10 years and has caused a lot of misery for employers and employees. In Germany it is very seldomly mentioned or diagnosed. For me it has al the characteristics of a trend disease just like chlorose or the railwaybackspine in the 19. century.
Geert
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Re: RSI and other mythical creatures - December 1, 2005 7:11:00 AM
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Matthew
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Reading tabloids and being shocked to find misleading or false information is like shooting oneself in the foot and being surprised that it hurts.
These studies however support the "traditional" view of RSI:
http://www.temple.edu/acb/faculty/drbarbe/drbarbepub.html
If any spinal problems arise those are most certainly due to the effects of the peripheral problem.
Matthias
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Re: RSI and other mythical creatures - December 1, 2005 10:12:00 AM
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nari
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Geert
The old term 'RSI' certainly had its border markings; and the frenzy of the 1980s epidemic has all but faded away now. Certainly there was increased awareness and fear of litigation which did lead to improvements in the workplace; and this is a good thing. But there are millions of people who work at repetitive, labour-intensive jobs in the world and there does not seem to be a problem. The other possibility is that they don't complain and put up with the consequences, qv the slave labour camps producing casual clothes and 'posh' sneakers for the world.
Matthias
Thanks for the references. Cadaveric studies may not reveal all that needs to be revealed, but the abstracts are interesting. It is a rather contentious topic with many variables.
nari
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Re: RSI and other mythical creatures - December 1, 2005 11:03:00 AM
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ginger
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From: Melbourne Victoria
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No it is not surprising that reading a tabloid would be an unlikely way to find truth, even facts are short in supply . It is not surprising either that there is such disparity of opinion on this issue. As those of you will know that have followed my posts here and there, I'm firmly of the opinion that not all the bullshit is in the tabloids either.
So much ignorance , so little time.
The English seem to need a reference book, a professional guide and their hand held to go anywhere off the beaten track. The Germans will go without the book and not mind if they are lost. The Swedish don't need the book but take back roads till they find a group who agree with them and party. Americans would love a book if they could only agree which book, but wait for the guru or hero figure to lure them in to strange territory, then take over and assert conrol. The Aussies and Kiwis don't need book compass or guru, they usually find what to do and where to go in time for last drinks then settle in to laugh about it, and wait for the Swedish.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: RSI and other mythical creatures - December 1, 2005 2:48:00 PM
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SJBird55
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Quite the generalization Ging... but you had me chuckling with the assumption that you are focusing on our profession.
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Re: RSI and other mythical creatures - December 4, 2005 10:39:00 AM
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Dr.Wagner
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Hey what does RSI stand for...in medicine it stands for something completely different.
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Re: RSI and other mythical creatures - December 4, 2005 10:47:00 AM
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Jon Newman
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Hello Dr. Wagner,
Nice to see you posting a bit more. RSI means repetitive strain injury. At least that's my understanding.
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Re: RSI and other mythical creatures - December 4, 2005 12:05:00 PM
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nari
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The name RSI (repetitive strain injury, as jon says) is not used anymore. It has been replaced by CRPS Type 1 (the 'old' RSI) and CRPS Type ll.
The idea was to get away from the misleading word 'strain' meaning it was a muscular condition in itself.
I don't think doctors generally use RSD anymore which is why it may have seemed unknown to you, Dr Wagner.
Nari
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Re: RSI and other mythical creatures - December 4, 2005 12:39:00 PM
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ginger
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To AR15 in New York, No secrets, but a quick overview I will attempt . The difference in my approach to mobilisation , from for instance the maitland version, is sensitivity and persistance.
Maitland taught that facet joints had "lesions", that could be improved functionaly by movement, where that improvement could be judged from an active movement , function perspective. Ie mobilise a joint x many times and reassess by an active movement. This is both time wasting and incomplete.
I maintain that facet joint behaviour, inflammatory irritations, altered neural activity and resultant symptoms are the result of normal , powerful protective responses. Those responses are initially muscular, where joint movement is reduced or prevented. The extent to which facet joint movements are lost is matched by inflammatory events of synovial membranes to produce increased flow of synovium to provide for hypomobile, therefore poorly oxygenated hyaline cartilage within the facet joint.
The aim then of mobilisation is to turn off the prtective response, beginning with increased tone of muscles intimate to facet joints. A sensitive therapists thumb then can achieve this by mobilising with pain as a feature of the movement , till both tone is decreased and the pain associated with it is turned off. This may take up to twenty minutes for a highly irritated hypomobile joint, or as little as 45 seconds for one less so. Mobs continue for as long as it takes for PASSIVE movment to be normalised. I find active movment tests irrelevant and time wasting, in the context or reintroducing a non protected mobile state. As normal movments are regained , and inflammatory events are reduced, the kind of referred pain and altered recruitment effects commonly seen , for instance, with CRPS ( RSI ), dissapear and don't return.
cheers
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: RSI and other mythical creatures - December 4, 2005 1:23:00 PM
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Diane
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Sounds very chiropractor-esque, sublux-sational.
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Re: RSI and other mythical creatures - December 4, 2005 1:30:00 PM
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ginger
Posts: 660
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From: Melbourne Victoria
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You really know how to hurt me Di, you've read my thoughts on the chiro subluxation business , I'm as distant from that pile of reindeer droppings as you are.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: RSI and other mythical creatures - December 4, 2005 1:47:00 PM
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Diane
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Oops, sorry then.. but can you explain to me how what you think is essentially different? To me it sounds the same:
1. All body pain/problem/dysfunction comes from vertebral joints
2. Treat same until all is well.
Any differences seem to be in speed and force. The rationale seems awfully similar/overlapped.
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Re: RSI and other mythical creatures - December 4, 2005 2:22:00 PM
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nari
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ginger
How are your thumbs? I am curious as to how you maintain such lengthy pressures so constantly and consistently. Do you use any of those gadgets that are supposed to protect physios' thumbs? (splints, etc)
How well do your patients tolerate the pain produced?
Nari
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Re: RSI and other mythical creatures - December 4, 2005 3:03:00 PM
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Dr.Wagner
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Hey thank you for the info...RSI stands for "rapid sequence induction or intubation" in medicine.
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Re: RSI and other mythical creatures - December 4, 2005 3:08:00 PM
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ginger
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From: Melbourne Victoria
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I'm not really hurt Di, The difference is really in the practical application of long lasting manual treatments that work , against the ethic and means that draws the ignorant into a dependant relationship with a provider that gives only short term relief. That short term effect derived from pulling joints apart is simply not able to effect long term value for discrete spinal joint stiffness and pain , and is not the means to relieve the majority of referred events.
Prolonged mobs is that means. It is also the means to redundancy for therapists.
Ethicaly my model and the philosophy that guides most physiotherapists is to cure not create dependancy. If Chiros were to use my method they would put their luxury lifestyles on the line , by finding their long term crackem agains gone.
As to the similarities of cause /effect being found at spinal joints, if it's true and can be repeatedly shown to work, can be taught and seen to work where others perform according to their training, then it must have value. I see these kinds of results every day over and over again Di . I'm not suggesting there is no other way, just that those who are willing to treat according to my model and directions, will find , as I did , that most musculoskeletal pain and dysfunction problems are referred from spinal joints.The means for a permanent fix for musculoskeletal pain is there for all to use. No secrets, no bullshit.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: RSI and other mythical creatures - December 4, 2005 3:14:00 PM
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ginger
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From: Melbourne Victoria
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Hi Nari , thumbs are totally fine thanks, I do about 6 hours of mobs every day , have done for 20 years. Its just persistance that toughens them up. I find most studenets can tolerate five minutes at first, progressing to 20 after a four week ( fourth years) stint woth me. Further practice helps till discomfort is a thing of the past. I teach that the thumb need to be hyperextended, contrary to most orthodox schools. I don't use or advocate gadgets.
Patient tolerance is uniformly good.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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