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.
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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
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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.
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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
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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
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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
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Types of Trigger Points
Active TrP and Latent TrP
Key TrP and Satellite TrP
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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.
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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
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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.
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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.
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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”
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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.
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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.
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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)
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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
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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
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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.
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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
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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)
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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.
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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
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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.
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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
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Articular Mobilisation
In Case of Thoracic Outlet
syndrome
Glenohumeral
Clavicular
Scapulo thoracic
Rib
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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
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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
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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
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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.
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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.
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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
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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
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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
Titlexx
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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
Titlexx
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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
Titlexx
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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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Slide: 88
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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Titlexx
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