Transcript Document

‘RSI in India –
de RECOUP
methode’
Dr. Deepak
Sharan,
Bangalore
Titlexx
Slide: 1
RSI in India – de RECOUP methode
Dr. Deepak Sharan, Bangalore
Vrijdag 6 november 2009 Jaarbeurs Utrecht
Spreker: Sharan, dr D. (Deepak)
MS Ortho, DNB Ortho, Dip Ortho, M Sc Orthopaedic Engineering (UK), Dip Orthopaedic
& Rehabilitation Technology (UK), Fellow, AACP&DM (USA), Fellowship in Paediatric
Orthopaedics (UK & USA), Certificate in Ergonomics (Sweden) Consultant in
Orthopaedics, Rehabilitation & Ergonomics, Medical Director, RECOUP
Neuromusculoskeletal Rehabilitation Centre, Bangalore, India
Dr. Deepak Sharan is een Indiase expert op het gebied van RSI. Dr Sharan is oprichter
en medisch directeur van een RSI centre of excellence in Bangalore, India. Hij is
consultant op het gebied van orthopedische chirurgie en RSI-klachten, met een
indrukwekkende lijst titels en diploma’s op het gebied van orthopedie en ergonomie.
Eén van zijn interessante stellingen is dat aspecifieke RSI vaak niet goed
gediagnosticeerd wordt, dat er meestal andere klachten achter zitten. Het
behandelprogramma in zijn RECOUP kliniek in Bangalore is multidisciplinair, een
combinatie van fysieke behandeling, yoga, gesprekken met een psycholoog, cognitieve
gedragstherapie, meditatie, stressmanagement en mindfulness training. Het is een
fulltime programma van 8-13 weken. Hiermee claimt hij 95% genezing te bereiken bij
RSI-klachten.
Titlexx
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RSI Treatment What Works?
Dr. Deepak
Sharan,
MS Ortho, DNB Ortho, Dip.
Ortho, M Sc. Orthopaedic
Engineering (UK), Dip.
Orthopaedic & Rehabilitation
Technology (UK), Certificate in
Ergonomics (Sweden)
Consultant in Orthopaedics,
Rehabilitation & Ergonomics
RECOUP, Bangalore, India
Titlexx
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What will be Covered?
 My Professional Background
 Overview of my Understanding of RSI
 My Treatment Protocol
 How do I judge the Prognosis in RSI?
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Medical Education
Medical Education and Postgraduation in Orthopaedics
JIPMER, Pondicherry, India (1985-1994)
“An institute of national importance” and among the top 2
Medical Institutions in India
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M Sc Orthopaedic Engineering
Cardiff School of Engineering,
Cardiff, Wales, UK 1996-1999
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PG Dip Orthopaedic &
Rehabilitation Technology
Univ. of Dundee,
Dundee, Scotland, UK
(1996-1998)
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Certificate in Ergonomics
Lulea University of Technology ,
Lulea, Sweden 2004-2005
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Professional Experience
& Licensure
 Orthopaedics & Rehabilitation: 19 Years
 5 years in UK, 3 months in USA
 Full registration in India and UK, eligible in
USA
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Advisory Role
 I am an advisor on RSI to the Govt of
India and help to frame national
guidelines for RSI prevention and
management.
 I also provide RSI and Ergonomics
Consultancy to 70 major companies,
including the Global RSI Group for
McKinsey and Company, HP, Oracle,
Texas Instruments, Monsanto & Cisco.
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My interest in RSI
 After returning to India 9
years ago after training in
Paediatric Orthopaedics
and working in UK and USA
for 5 years, I started
seeing kids as young as 6
years suffering from RSI
due to overuse or incorrect
usage of hand held gaming
devices, musical
instruments and
computers.
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RSI Knowledge in 2001
 Generalised muscle pain in Computer Users
usually indicates RSI
 On developing pain you should stop using
your hands
 Avoid Physicians if possible since they know
nothing about RSI
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RSI Knowledge in 2001
 Treatment is essentially home exercises
picked up from books or web sites or
Physiotherapy in severe cases
 Be guided by other RSI sufferers and
information on the Internet
 RSI can only be “managed” and not cured,
as long as the exposure (e.g., computer
usage) persists
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RSI Treatment
 Our search for a sequenced and an integrated RSI
Treatment Protocol started in the year 2001
 Our treatment approach in the initial days largely utilised
Physical Therapy alone
 Our therapists were trained by Suparna Damany (RSI
Therapist and author from USA)
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Results
 Our success rate with the predominantly
Physical Therapy approach was
approximately 60-70%
 Flare ups and incomplete recoveries were
common in patients with chronic pain
 Our results improved to > 95% once we
refined our treatment protocol and added
the Mind Body Approaches
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Alexander Technique
We found AT to be a valuable “body
awareness” adjunct and integrated it in our
treatment protocol.
AT teachers from UK, Australia, Finland,
Germany, France and Switzerland have
since visited us.
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Yoga
We incorporated Yoga to address the “Mind Body” connection.
We offer individualised Yoga through a Physician cum Yoga
Teacher who is knowledgeable about RSI.
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De Stressing Modalities
 Psychological counselling
 Stress management
 Cognitive Behavioural
Therapy
 Mindfulness Training
 Sleep Hygiene
 Meditation
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Ergonomics
Several of our Physiotherapists are Certified Ergonomists.
They have also received personalised and intensive training
from some of the topmost names in Ergonomics, e.g., Prof.
Daniela Colombini, Milan, Italy (inventor of OCRA and MAPO
methods of assessment) and Prof. Arun Garg, Wisconsin,
USA (inventor of Strain Index, Mod. NIOSH Lifting Equation,
etc.)
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Prevalence of RSI in India
 75% of > 35,000 computer professionals in
Bangalore, Mumbai, Hyderabad & Delhi (2001-09)
– RECOUP’s study (largest in the world on
Computer Related RSI)
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Risk Factors for RSI
 Worker: Age, Gender, Body Mass Index, Smoking,
Habitual Deep Muscle Tension, Medical Comorbidities
 Environment: Temperature, Air Quality, Humidity,
Lighting, Noise
 Task: Physical/Biomechanical, Psychosocial
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Personality
 The Type A personalities have a vulture neck
posture, while the depressed types work
slouched with drooping shoulders.
 The net result is the same: muscle strain and
compression of nerves and blood vessels in the
neck, chest or shoulders.
 In our experience, the depressed types seem to
be at greater risk for Generalised Myofascial
Pain or Fibromyalgia, while the Type A ones
mainly develop Thoracic Outlet Syndrome.
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Medical Management of RSI
The rehabilitation team must be led by a Physician
and not a Therapist or an Alternative Medicine
Practitioner because over 30% of 55,000 RSI
patients treated at RECOUP were found to have a
co-morbid condition on investigation requiring
medical management.
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Common Comorbidities
 Nutritional Deficiencies, esp. anaemia
 Hypothyroidism
 Hyperuricemia
 Inflammatory Arthritis
 Osteopenia and Osteoporosis
 Depression and other Psychiatric Disorders
If not identified before starting Physiotherapy
some of these conditions can lead to
complications during therapy, including death
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Diagnosis
 History: symptoms that get worse towards
the end of the working day or week and get
better with rest or time off work tend to be
work related, at least in the earlier stages.
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Diagnosis
 The physical assessment includes a
comprehensive and methodical
musculoskeletal examination with a focus on
range of motion, myofascial trigger points
(MTrPs), biomechanical or postural
problems, and evidence of nerve or blood
vessel entrapment, and any other pertinent
tests according to the presentation e.g.,
Finkelstein’s, Roos, Mill’s.
Titlexx
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Diagnosis
 A specific diagnosis consistent with the
current International Classification of
Diseases is necessary
 Terms such as repetitive strain injury,
occupational overuse syndrome, repetitive
motion disorders, and cumulative trauma
disorders are not ICD diagnoses
 At RECOUP, every single RSI patient has
received a specific diagnosis so far
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Chronic Widespread Pain
Earlier called Diffuse, Nonspecific RSI
1. Myofascial Pain Syndrome
2. Fibromyalgia
3. Complex Regional Pain Syndrome
4. Inflammatory Arthritis
5. Osteopenia and Osteoporosis
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Is the Disorder Work Related?
 Is the medical condition known to be
associated with work?
 Does the job involve risk factors (based on
job surveys or job analysis information)
associated with the presenting symptoms?
 Is the employee’s degree of exposure
consistent with those reported in the
literature?
 Are there other relevant considerations
(e.g., unaccustomed work, overtime, etc.)?
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Investigations
• Bloods: CBC, Arthritis and
Thyroid Profile
•X-ray (sometimes shows
cervical ribs)
• Ultrasound Scan (esp. useful
for shoulder tendinitis)
• MRI (beware false positives)
• Nerve Conduction Tests (not
fool proof)
• Bone Densitometry:
Osteoporosis is now a major
concern even in young males
Titlexx
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Commonest RSIs
1. Myofascial Pain Syndrome
2. Thoracic Outlet Syndrome
3. Tendinitis
4. Cubital Tunnel Syndrome
5. Carpal Tunnel Syndrome
MPS + TOS together account for > 95% of cases
Source: Our ongoing prospective study of Computer Related
RSI in India (2001-09) > 50,000 subjects
Titlexx
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Myofascial Pain Syndrome
 Pain of a regional nature beginning within a specific
trigger point (TrP) within muscle/fascia
 Associated autonomic abnormalities - blanching,
coldness, sweating, piloerection, erythema,
hyperesthesia, and hyperalgesia locally or within the
area of referred pain
 Responsible for 30-85% of all pain
Titlexx
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Types of Trigger Points
Active TrP and Latent TrP
Key TrP and Satellite TrP
Titlexx
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Active TrP’s
 Causes pain and tenderness at rest or with
motion that stretches or loads the muscle.
 It prevents full lengthening of the muscle, as
well as fatigue and decreased strength.
 Pressure on an active MTrP induces /
reproduces some of the patient’s pain
complaint and is recognised by the patient
as being some or all of his or her pain.
 The signs and symptoms of TrP activity long
outlast the precipitating event.
Titlexx
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Latent TrP
 Clinically quiescent with respect to
spontaneous pain, but painful when
palpated.
 Does not cause pain during normal
activities.
 It also refers pain on pressure.
 It can be associated with a weakened,
shortened, more easily fatigued muscle.
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Key TrP
 Responsible for activating one or more satellite
TrP’s
 Develops almost directly in the centre of the
muscle fibres, where the motor endplate
innervates it at the neuromuscular junction
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Satellite TrP
 Develops in the zone of the referred pain
pattern of the Key TrP
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Spinal Segmental
Sensitisation (SSS)
 If TrP is left untreated, it may become an
irritative focus and send persistent pain
impulses via a sensory neuron into the
spinal cord
 The spinal loop that is constantly
bombarded with noxious stimuli and irritated
may develop the facilitated release of
nociceptive neurotransmitters with lowered
threshold for synaptic activation,
amplification and perpetuation of pain
Titlexx
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Simons Criteria for Dx of MPS
Major criteria:
1. Localised spontaneous pain.
2. Spontaneous pain or altered sensations in
expected referred pain area for given MTrP
3. Taut, palpable band in accessible muscle.
4. Exquisite, localised tenderness in precise
point along taut band
5. Some measurable reduced movement
range.
Titlexx
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5 major and at least 1 of 3 minor criteria
Simons Criteria for Dx of MPS
Minor criteria:
1. Reproduction of spontaneously perceived
pain and altered sensations by pressure on
MTrP.
2. Elicitation of local twitch response of
muscular fibers by transverse “snapping”
palpation or by needle insertion into MTrP.
3. Pain relief obtained by muscle stretching or
injection of MTrP.
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5 major and at least 1 of 3 minor criteria
Magnetic Resonance
Elastography of Taut Band
 Chevron-shaped wave propagation was recorded on
finite element simulation of the wave fronts in taut
band
Chen, Q. et al.,Titlexx
Ability of magnetic resonance elastography to assess taut bands, J. Clin. Biomech.
Slide: 41
MR elastography of taut band
 MPS
 Normal
Chen, Q. et al.,Titlexx
Ability of magnetic resonance elastography to assess taut bands, J. Clin. Biomech.
Slide: 42
(2008), doi:10.1016/j.clinbiomech.2007.12.002
Biochemical Study of TrPs
 Subjects with active MTPs in the trapezius
muscle have a biochemical milieu of selected
inflammatory mediators, neuropeptides,
cytokines, and catecholamines different from
subjects with latent or absent MTPs in their
trapezius.
 These concentrations also differ
quantitatively from a remote, uninvolved site
in the gastrocnemius muscle.
Titlexx
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Shah JP, et al. Arch Phys Med Rehabil 2008; 89: 16-23
Features
Pain
Fibromyalgia Myofascial Pain
Diffuse
Local
Fatigue
Common
Uncommon
AM Stiffness
Common
Uncommon
Tender Points
Present
Trigger Points
Prognosis
Titlexx
Present
Chronic,
Difficult to
treat
Resolves with
treatment
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Thoracic Outlet Syndrome
“TOS is a collection of syndromes brought about
by abnormal compression of the neurovascular
bundle by bony, ligamentous or muscular
obstacles between the cervical spine and the
lower border of the axilla"
Titlexx
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Compressive Neuropathies
 Median nerve
Pronator syndrome
Anterior interosseous syndrome
Carpal tunnel syndrome
 Ulnar nerve
Cubital tunnel syndrome
Ulnar tunnel syndrome
 Radial nerve
Radial tunnel syndrome
Posterior interosseous syndrome
Superficial radial nerve syndrome
Titlexx
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Double Crush Syndrome
 Nerves are irritated and/or entrapped at a
proximal location like the neck or thoracic
outlet, as well as a distal location like the
wrist.
 Naralcas reported that the proximal
neuropathy usually preceded the distal one
Titlexx
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Double Crush Syndrome
 The relative contribution at each site may be
difficult to assess and correction of the
problem at one site alone is more likely to
result in lingering or persistent symptoms.
 Signs and symptoms out of proportion to
findings documented by electrical nerve
testing.
 Underlying constitutional tendency toward
irritative nerve symptoms.
Titlexx
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Early Intervention is the
magic word
 Prolonged rest, non usage of affected body part
and usage of wrist splints can be dangerous and
career threatening
 Symptoms will overpower you from time to time
and the situation will inevitably spiral
downwards, unless a concerted attempt is made
towards an early “cure”
Titlexx
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It is almost impossible to
“manage” severe or chronic RSI
 At least 100 IT/ITES/BPO
Professionals aged 20-35 have lost
their jobs since 2001 because of
advanced, neglected or poorly
managed RSI leading to disabling
complications like Complex Regional
Pain Syndrome (CRPS) .
 There is no published association of
the link of CRPS with poorly managed
RSI, hence its awareness in medical
circles is minimal.
Titlexx
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SHARAN'S® Protocol for RSI
 Skilled
 Hands-on
 Approach for
 Release of myofascia,
 Articular,
 Neural and
 Soft-tissue mobilisation
Titlexx
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Why A Sequenced Protocol?
 Previous authors have documented a statistically
significant relationship between the presence of
TrP in upper trapezius muscle and cervical joint
dysfunctions at C3 and C4 vertebrae.
 There is clinical evidence showing that joint
dysfunctions can induce TrP activity, and that TrP
activity can aggravate corresponding joint
dysfunction.
Fernández
de-las-Peñas C, et al. Musculoskeletal Disorders in Mechanical Neck Pain MTrPs
Titlexx
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versus Cervical Joint Dysfunction- A Clinical Study. J Musculoskeletal Pain 2005; 13 (1)
Why A Sequenced Protocol?
 Nerve tissues can contribute to the origin or
perpetuation of TrPs.
 Decreased extensibility of the upper quadrant
neural structures, as assessed by the median
nerve tension test, was associated with decreased
length of upper Trapezius muscle.
Edgar D, etTitlexx
al. Relationship between upper trapezius muscle length and upper quadrant neural
Slide: 53
tissue extensibility. Aust J Physiother 1994; 40: 99-103
Treatment Approach
 Before starting treatment, I make a specific
diagnosis and outline the treatment goals
for our rehabilitation team.
 I also supervise the treatment and review
patients at least once a week, occasionally
modifying treatment or stopping the
treatment for reassessment and further
investigations if necessary.
 I decide when a patient can go on to the
subsequent stage of rehabilitation.
Titlexx
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Phases of SHARAN'S® Protocol
Phase 1 - Severe discomfort (Reduce pain, Eliminate
MTrP’s and spasm, Restore muscle flexibility)
Phase 2 - Moderate discomfort (Reduce nerve
tension and establish normal blood flow, Correct
joint dysfunction)
Phase 3 - Mild discomfort (Postural correction,
Strengthen muscles so that they do not fall back on
nerves and blood vessels again, Prepare for Return
to Work)
Phase 4 - Maintenance phase (Improve strength
and endurance)
Titlexx
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Phase -1 Severe Discomfort
 Ischaemic compression, deep pressure soft tissue
massage
 Myofascial Release Technique
 Muscle Energy Technique
 Positional Release Techniques
 Relaxation techniques / breathing exercises
 Aqua Therapy in a Swimming Pool
 Taping
 Interferential Therapy (IFT), Ultrasound, Laser
 Spray & Stretch and TrP needling injections
Titlexx
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Ischaemic Compression
 The therapist applies a slow, gentle, firm
pressure to the TrP for 2 minutes.
 There is a feeling of the muscle "giving way"
beneath the fingers during the second
minute.
 Once pressure is released, the skin blanches
briefly, and a reactive hyperemia follows
that may last several hours.
 This technique has no known complications
other than local ecchymosis and soreness in
some patients.
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Spray and Stretch
Useful for Resistant MTrPs or in patients who do not tolerate
Ischaemic Compression well
Titlexx
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Ice Stroking
 Water is frozen in a plastic or paper cup with
a stirring stick, such as a tongue depressor,
placed in the cup to provide a handle to hold
the ice.
 The bottom of the cup is then torn back and
an edge of ice is applied to the skin in a
unidirectional stroke following the same
patterns as for the spray.
 Useful in patients with cold-induced asthma
or other respiratory conditions.
Titlexx
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Causes of persisting pain
after 2-3 sessions
1. The key MTrP has not been correctly
identified and treated
2. The diagnosis of MTrP pain is incorrect
3. There are factors causing persistence or
recurrence of the treated MTrP and require
a review by the Physician
Titlexx
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Causes of persistent MTrPs
 Mechanical: Structural, Postural, Ergonomic
 Medical: Infectious diseases (Lyme disease,
Candida albicans infections), Inflammatory
disorders, Immunological/allergic, Nutritional
disorders (vitamin B6, B12, D, iron
insufficiency), Hormonal disorders
(hypothyroidism, GH deficiency)
Titlexx
Slide: 61
Shifting pain during
treatment
 This is likely to be an apparent movement
rather than actual movement of a specific
MTrP and can occur as a result of treatment
of a series of satellite MTrPs.
 If the key MTrP is identified and treated in
the first instance, this apparent movement is
less likely to occur.
Titlexx
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Deep Pressure Soft Tissue
Massage / Ishaemic Compression
Myofascial Release
Evaluate
Stiffness
Muscle Energy Technique
Tenderness
Positional Release Technique
Interferential Therapy (IFT), Ultrasound, Laser
Titlexx
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Myofascial Release
 A hands-on soft tissue technique that stretches
the restricted fascia (the covering layer of
muscles) in a sustained manner and helps in
improving its flexibility.
 MFR is often done after deep soft tissue massage
to release an MTrP.
 MFR is performed for a period of 90 – 120
seconds
Titlexx
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Muscle Energy Technique (MET)
 MET are soft tissue manipulative
methods in which the patient, on
request, actively uses his/ her
muscles from a controlled
position, in a specific direction,
with a mild effort against a
precise counterforce.
 Used to stretch chronic or
subacute restricted, fibrotic,
contracted soft tissue (fascia and
muscle) or tissue hosting active
MTrPs.
Titlexx
Slide: 65
Positional Release Technique
(PRT)
 PRT is accomplished by placing the involved tissue
in an ideal position of comfort (POC)
 The purpose of POC is to reduce the irritability of
the tender point
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Taping
Postural Taping
Titlexx
Taping for
Temporomandibular
Disorders
Taping for
Multidirectional Instability
of Shoulder
Slide: 67
Phase -2 Moderate Discomfort
 Soft tissue, neural, articular (rib / clavicular /
scapulo-thoracic) and/or spinal (Maitland, Mulligan)
mobilisation
 Nerve & tendon glides
 Self-stretching exercises
 Yoga
 Alexander technique
 Feldenkrais
 EMG Biofeedback
Titlexx
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Articular Mobilisation
In Case of Thoracic Outlet
syndrome
 Glenohumeral
 Clavicular
 Scapulo thoracic
 Rib
Titlexx
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EMG Biofeedback
 The electromyography (EMG) measures
muscle tension by sensors placed on the
skin over appropriate muscles.
 EMG feedback is used for general relaxation
training and is useful for the treatment of
tension headaches, pain reduction, and
muscle spasms, and to strengthen muscles.
Titlexx
Slide: 70
Tendon and Nerve Glides
 In several types of RSI there is
stickiness and adhesions
(scarring) between the affected
tendons and nerve and
surrounding fascia and other
tissues.
 Glides produce pressure changes
and a relative displacement of the
tendon or nerve in regard to its
surrounding tissues due to
controlled movement in the
neighbouring joint.
Titlexx
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Phase – 3 Mild Discomfort
 Progressive strengthening exercises
 Further self-stretching exercises
 Postural retraining using EMG
Biofeedback, body mechanics and
ergonomics training on a model computer
workstation
 Ergonomic furniture and accessory
recommendation
Titlexx
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Strengthening
 Strengthening builds endurance, helps
people maintain proper posture and relieve
pressure on nerves and blood vessels.
 However, strengthening is absolutely the
last step of rehabilitation and when done in
the presence of active MTrP’s, worsens the
situation.
 We start supervised strengthening usually a
fortnight after the pain has subsided, and
only when the MTrP’s have been treated,
and adequate flexibility achieved.
Titlexx
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Progressive Strengthening
Exercises
 Free Hand
 Thera Band
 Weight Cuffs
 Avoid Dumbbells
Titlexx
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Phase – 4 Maintenance Phase
 Further strength training
 Aerobic conditioning
 Yoga
 Alexander Technique
 Feldenkrais
 Tai Chi
Titlexx
Slide: 75
TOS Treatment
 Surgery not usually
required
 Our research study of
100 consecutive TOS
patients treated with a
sequenced rehabilitation
protocol reported almost
a 100% success rate.
Titlexx
Slide: 76
The Role of Mind Body
Methods in RSI Management
 In isolation, these methods help
somewhat but are not usually
curative, except in the milder
cases.
 When used in a holistic,
multidisciplinary manner, these
methods are a powerful adjunct
to the overall treatment.
Titlexx
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Sarno’s Mind Body Concept
 We agree partly with the explanation but
strongly caution patients against ignoring the
pain or stopping physical therapy and medical
management to “buy into the method.”
 The total number of individuals who have ever
reported a “cure” from this method is perhaps
less that the number of patients who recover
by our version of Mind Body approach in a
single day.
 Of about 100 of our RSI patients who tried
the Sarno’s method, none reported any
benefit.
Titlexx
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Speed of Recovery
 Related to the stage at
presentation
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DEEPAK SHARAN’S
Severity Score
 Duration of symptoms
 Effect on activities of daily living
 Exertion (use of physical energy/hard work)
rate during work
 Pain intensity
 Ability to control the speed of work and take
breaks
 Known medical conditions or lifestyle issues
Titlexx
Slide: 80
6 statements
in each of 13 sections. Total score can range from 0 to 100
DEEPAK SHARAN’S
Severity Score
 Stress and psychological factors
 Hours of work
 Area affected (out of neck, shoulder, elbow,
wrist/hand, upper back, lower back,
hip/thigh/buttock, knee, ankle/feet)
 Restricted movements of affected area
 Activity Restriction
 Neuropathic Pain
 Sleep Disturbance
Titlexx
Slide: 81
Severity Grading
Severity
Score
Intervention (Add Duration of
Incrementally)
Recovery
Stage 1: Mild
21- 40
Ergo modifications + < 1 month
Stretches
Stage 2: Moderate
41- 60
Physical Therapy
1-2 months
(SHARAN’S Protocol)
Stage 3: Severe
60- 80
Mind Body Methods,
EMG Biofeedback,
Aquatic Therapy
3 months
Stage 4:
Complicated
> 80
Medication (for
Neuropathic Pain)
3-6 months,
sometimes more
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Poor Prognostic Factors
 Neuropathic pain
 Terrible triad (Fibromyalgia, Multidirectional Instability
of Shoulders, Thoracic Outlet Syndrome), often
associated with Osteopenia or Osteoporosis and CRPS
 Depression, poor social and economic support
 Insomnia
 Pain avoidance behaviour
 Poor treatment compliance: refusal to take medicines,
excessive reliance on google
 Passive treatment seekers
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Ergonomics
 Goal: free, effortless movement of body
 Everyone is different
 The injurious positions: pronation, ulnar
deviation, dorsiflexion
 Tense, constrained movements are never
good, no matter how “correct”
 Once recovered from RSI, ergonomics has a
role in prevention of further injury
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Research Projects @ RECOUP
 The Effect of Cetylated Fatty Esters and
Physical Therapy on Myofascial Pain
Syndrome of the Neck (Randomised
Controlled Trial, 108 patients)
Status: Presented at ICMD, Edinburgh on Oct
31, 2009, and awaiting publication
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Research Projects @ RECOUP
 Risk Factors, Clinical Features and Outcome
of Treatment of Work Related
Musculoskeletal Disorders in On-Site Clinics
in Indian IT Companies
 Musculoskeletal Disorders in Caregivers of
Children with Cerebral Palsy Following
Multilevel Surgery
Status: Presented at World Ergonomics
Congress at Beijing, China in August 2009
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35 Other Research Projects nearing completion
Courses Run by RECOUP
 Online Back School Course for Patients
(already available on www.recoup.in)
 Online M Sc and PG Diploma in Ergonomics
(with Indian University affiliation) likely to
start in Jan 2010
 Online courses on Ergonomics, Stress
Management and Yoga for patients – likely
to start in 2010
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88
What does it
take to
recover from
RSI?
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All of the following
1. Expert medical assessment by a Physician with a
sound track record with RSI
2. Protocol based rehabilitation including intensive,
skilled manual therapy and body awareness
approaches
3. Identification and correction of all predisposing
factors, e.g., posture, stress, habitual deep
muscle tension, medical co-morbidities
4. Individuals take responsibility for making
changes in their approach to work and other
activities
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RSI Knowledge in 2009
 Generalised muscle pain in Computer Users
often does not indicate RSI
 On developing symptoms avoid prolonged
disuse and rest
 Proactively seek early, physician-led
multidisciplinary treatment and avoid self
treatment alone. Get expert hands to work
on you.
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RSI Knowledge in 2009
 Physiotherapy is just one piece of the jigsaw
 Be wary of opinions expressed by other
laypersons and google judiciously
 Complete recovery from RSI (i.e., return to
full time work or activity) is the rule rather
than the exception, if all the pieces of the
jigsaw fall into place
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Further Information
Thank
You
 [email protected]
 www.recoup.in
Bangalore, India
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