This solution to the problem of RSI is founded on the clinical experience that patients do not respond to the typical treatment program of strengthening, stretching and taking time off work. This is because the injury has affected the nerves and circulation of the body, which results in a physical narrowing of tunnels in the body (spinal canal, thoracic outlet, carpal tunnel etc.). This causes the development of a swamp within these tunnels, and a learning by the body of protective reflexes that become associated with the painful activity. These protective reflexes may have short-term value, but when prolonged, they lead to a cycle of greater and greater dysfunction.
The patient is the key to success of the protocol. The therapist must examine the patient to identify the characteristics of the complaint that indicate the involvement of the nervous and vascular systems. Once identified, these must be explained to provide the patient with a mental “picture of the problem” to use as a guide to self-treatment. At first, patients feel out of control, a feeling that acts like a padlock to the pharmacy in all of us. The feeling of being in control enables the patient to unlock the padlock and is an important component of success. Patients must be taught to use self-assessment techniques to measure the value of the self- treatments. They also must be taught to respect their bodies. No self-treatment should cause PAIN or an increase in PAIN.
The identified characteristics of the complaint are:
1 Reversible weakness of one thumb as measured by the physical therapist is experienced by about 80 percent of patients.
2. Restricted mobility and increased sensitivity of the brachial plexus is experienced by 100 percent of patients.
3. Coldness of the hands with asymmetry of temperature between the index finger and the little finger is experienced by about 75 percent of patients. The little finger is commonly colder than the index finger.
4. A chest breathing pattern with poor diaphragmatic control is present in 100 percent of the patients.
5. A forward head posture is present to some degree in the majority of the patients.
6. Sensory discrimination in one or more of the fingers is diminished in the abilities of localization, graphaesthesia or stereognosis in some of the patients.
Experience has taught that when these signs and symptoms improve, then pain reduction and eventual increase in function follows. One could measure other factors, but it is my experience that those listed above are the key factors. The therapist trains the patient to assess change in the first four factors following a particular treatment. For example, thumb strength is measured before and after the “THINKER with good posture” exercise. Hand temperature and range of motion of the brachial plexus are measured after the diaphragmatic breathing with spinal motion exercises to identify a warming and relaxation response. In addition, hand temperature and range of motion of the brachial plexus are measured after walking to identify a warming and relaxation response.
