overuse injuries, carpal tunnel, bursitis, tendonitis, systemic enzymes, tennis elbow

Overuse Syndromes: At Work & At Play

Overuse Syndromes: At Work & At Play

© 2006 Wellness Clubs of America.com

Musculoskeletal injuries sideline millions each year. Some are recognized immediately, as when an athlete makes a sudden movement and feels a sharp pain in his or her thigh or when an individual misses a step and turns an ankle. Many injuries, however, are subtler in onset and do not become apparent until hours or days after the triggering activity.

Overuse syndromes fall into the second category. These injuries are caused by overworking or overstressing tendons, ligaments, bursas, and other areas. Carpal tunnel syndrome, tennis elbow, runner’s knee, and shin splints are all examples of this type of injury. Unlike sprains and strains, which involve a tearing of the tissue, overuse injuries are characterized by swelling and inflammation. Since inflammation develops over a period of hours or days an individual most commonly completes the activity with no awareness that an injury has occurred. By the time he or she awakens in pain two or three days later the activity that triggered the problem may have been forgotten.

Ironically the pain may actually improve while the causative activity is being performed but return with a vengeance several hours later. This is because the pain is related to swelling. Movement may temporarily ease the swelling, but the movement further irritates the tendon, ligament or bursa resulting in additional inflammation and swelling once the activity has been completed.

The first most important principle in managing an overuse injury is to review the activity that triggered the problem. In nearly all cases simple measures may be taken to ease the stress on the part of the body that is involved.

Most activities may be curtailed allowing time for the injury to resolve. This does not necessarily mean that the activity must be completely avoided. In many instances simply reducing the intensity of the activity is sufficient. For example, if exercise machines or free weights are being used the weight or resistance can be lightened and the number of repetitions decreased. Runners can slow their pace and decrease the distance covered.

In the case of tennis elbow or golf elbow a professional should be asked to watch the swing of the racquet or club. He or she can quickly identify errors in technique such as bending the wrist rather than keeping it straight. Correction of these errors can facilitate healing of the initial injury and prevent future problems.

Correction of workplace injuries may be more complex and challenging. Unlike recreational activities, work activities often cannot be curtailed significantly. While some principles apply to nearly every situation it may be necessary to have someone knowledgeable in employment-related overuse injuries come to the work site and observe the activities to determine the measures that are required.

While assembly line jobs requiring repetitive movements accounted for most injuries in the past, the majority of workplace injuries today are associated with computer use. Many of these problems occur at the wrist, but others may involve the elbows, shoulders, or even the back and neck.

Carpal tunnel syndrome is the most common of these injuries. It is typically caused by using a mouse or keyboard with the wrists bent upward rather than in a “neutral” position. The hand should extend out in a straight line from the forearm. Imagine that you are using a rope to lift a weight. If you are pulling straight up there will be less resistance and significantly less wear on the rope than if you are pulling at an angle with the rope rubbing on a surface. When the wrists are bent the tendons that work the fingers are extended and they must pull around a curve rather than being relaxed and pulling in a straight line.

As the tendons begin to swell from the stress of improper positioning of the wrists and repetitive activity pressure is applied to the nerve that supplies the muscles of the thumb and first two fingers. Everyday activities such as holding a cup or glass, ringing a doorbell, lifting a package or pushing a shopping cart may aggravate the problem.

The initial symptoms of carpal tunnel syndrome may simply be numbness or tingling in the area, but if the factors triggering swelling in the tendons is not addressed severe pain and muscle weakness can develop.

While surgery is often recommended in cases of carpal tunnel syndrome it is rarely necessary, provided the measures needed to reverse the situation are instituted and faithfully followed. The first measure is to use a wrist support to assure that the wrist is not bent when using the mouse or keyboard. This may be adequate in itself in mild cases.

In more severe cases the wrist may need to be put at rest in a splint.

Dr. Houshang Seradge of the University of Oklahoma Health Sciences Center has demonstrated that carpal tunnel syndrome exercises (figure 1) can be of great benefit. Performing them prior to beginning activities such as keyboarding and repeating them at each break will often prevent injury. When carpal tunnel syndrome is present the exercises should be done at hourly intervals, even if the wrist is splinted and other activities are being avoided.

Vitamin B-6 has been shown to significantly ease carpal tunnel syndrome. Since B vitamins compete with each other for absorption I recommend that a B-complex preparation containing at least 50 mg. of B-6 in balance with other B vitamins be taken three times daily.

Supplementation of systemic enzymes is perhaps the most effective means of easing carpal tunnel and other overuse syndromes. Originally developed in Germany for use by world-class athletes, systemic enzymes go to the site of injury and begin the repair process.

Systemic enzymes are different from digestive enzymes. They must be administered in an enteric-coated tablet that does not dissolve until it has passed through the stomach into the small intestine. If the enzymes are released in the stomach they will go to work there digesting food and they will not be absorbed into the system and they will not be available to repair sites of injury throughout the body.

One of the most important steps you can take to protect yourself from overuse injuries is to periodically ask yourself, “Are my arms and wrists resting comfortably on a firm surface? Am I experiencing any tenseness or tightness in the muscles of my neck or shoulders?” and taking steps to correct the problem if one is present.

Pain in the elbows, shoulders, upper back, and neck is due, in most instances, to a failure to sit in a relaxed position while working. Tennis elbow is an excellent example of this. The medical name for tennis elbow is lateral epicondylitis. It is an inflammation of the bump on the outside of the elbow, the point at which muscles attach. It’s cousin, medial epicondylitis is an inflammation of the bump on the inside of the elbow.

The term tennis elbow comes from its common association with the use of backhand swings in tennis. While I have seen a few cases of lateral epicondylitis arising in this manner over the years, the overwhelming majority of cases have been due to other factors, such as a failure to rest the elbows on a surface while sitting at a desk or workstation. It often occurs when an individual is using a computer mouse extensively.

Overuse syndromes are some of the most common musculoskeletal injuries seen today. They are, to a very great extent, preventable by paying attention to posture and arm support while working at a desk or computer station. When they occur, rest is the key element in treatment, but stretching exercises, B vitamins, and systemic enzymes are also of great benefit. Surgery is rarely necessary, and should be used only when these measures fail to bring a resolution in a reasonable period of time.

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