2 Repetitive Strain Injuries and Pain ManagementReviewing tennis/golfers elbow carpal tunnel syndrome neck pain/thoracic outlet syndrome low back pain Causes DIY Treatments and Dr. Lee’s recommendations 1

3 RSI: Causes typical injury is a result of both continuous muscle overload and joint(s) stiffness muscles are constantly being overused without sufficient rest muscle stiffness/spasm leads to joint stiffness which leads to a cycle of muscle stiffness<->joint stiffness<- >pain/numbness aggravated by poor postural strength and poor workstation ergonomics which together continuously strain muscles and joints can be exacerbated by nutritional imbalances (calcium, magnesium, DHA)

4 Chronic RSI longer the injury has lasted, the longer it takes to resolve because the initial site of injury has spread to adjacent muscles and joints (compensating) chronic long lasting injuries have a definite nerve component that is impeding healing often depends on personality type of person;  individuals who have a hard time relaxing can take longer to recover the injury has become the new normal 3

5 Tennis and Golfers Elbowcharacterized by pain on the outside of the elbow (tennis elbow) or on the inside of the elbow (golfers elbow) tendonitis = inflammation of a tendon what’s a tendon? 4

6 Tendon attaches muscle to a bone.pain occurs when you transition from 1 structure to another. can be muscle to tendon or tendon to bone Text

7 Tendons run from the elbow to the finger tipsproblem is NOT the elbow problem is the WRIST!

8 Tendons cross small bones in the wrist to get to the fingerssmall wrist bones are like a bunch of marbles a half-full bag of marbles has enough space to allow the bones to glide a full bag of marbles has no space so the marbles (bones) will stick and lock tendons now have to work much harder to move the fingers because of these stiff wrist bones tendons become over used and without rest, starts to breakdown producing inflammation and pain

9 Carpal Tunnel SyndromeMost of the time, it’s due to contraction at the wrist as a result of repetitive actions muscles and tendons stiffen/shorten which leads to wrist bone contraction a band surrounding the wrist (extensor retinaculam) tightens even more leading to compression of the median nerve pain is produced by wrist bone stiffness numbness/tingling due to median nerve compression 9

10 Carpal Tunnel Syndrome

11 Band compresses the wrist structuresjoints compress tendons compress and shorten median nerve is pinched 11

12 Nerve pain, numbness and tingling

13 Treating the elbow or wrist?most health care practitioners focus on treating the elbow and sometimes this works what works most of the time is unlocking the wrist bones releasing the wrist bones allows the muscles in the forearm to move the wrist and fingers with a normal degree of resistance this means less overuse of the muscle, less pulling at the elbow attachment point and faster healing 13

15 Due Braces Work? Can be effective but often just supportive.Lacks isolation bubble Only wear this when actively using elbow/wrist Can be very effective. Look for a bubble built into the brace as this will isolate the tendons more effectively. Placement is important so make sure the bubble is moved 2” or 5 cm below the elbow crease for tennis elbow. Switch to the inside for golfer’s elbow. Only wear this when actively using elbow/wrist

16 Wrist Splints/Braces Worn primarily through the night.It is recommended that a wrist splint be worn at night while sleeping. While sleeping, people often hold their wrists in a position that allows the median nerve to become pinched. The night splint holds the nerve in a relaxed position. Negatives - atrophies muscles and contracts joints leading to longer recovery

17 Wrist Stretches and Exercises

18 Thoracic Outlet SyndromeSitting hunched over a computer all day, a long commute to work and other such activities all take their toll.After a relatively short time the muscles of the chest become contracted and stiff, resulting in chronically stooped posture. When this occurs, the collar bone and chest muscles compress the nerves and blood vessels that pass through the small "thoracic outlet" down to the arms and hands.

19 Neck pain and Thoracic Outlet Syndrome TOSpain and nerve symptoms in the: hands (carpal tunnel syndrome) or elbow (tennis/golfers elbow) can also originate from the neck if you experience: neck pain/stiffness, pain between the shoulder blades (sometimes pain down the arm) numbness/tingling in the hands consider TOS 19

20 Vice-like compression of the nerves and blood vessels in the shoulder area causes pain, tingling and numbness down the arms and hands, much like stepping on a garden hose will cause a sprinkler to shut off many feet away. pain patterns

21 TOS Treatment ProtocolsDr. Lee acupuncture trigger point therapy DIY focus on the neck muscles neck stretching (every hour - reminder on outlook) better workstation ergonomics chest stretches

22 Treating TOS

23 Low Back Pain

26 Hip flexors run from the inner aspect of the hip joint to the low backThe sitting position causes the hip flexors to contract. Add up all the time we sit during work, commutes, at home and realize how much this muscle is used.

27 The primary cause of low back pain is the combination of week hip flexors and sacroiliac joint stiffness. With tennis elbow, the arm muscles cross the wrist bones which causes wrist stiffness. With low back pain, the hip flexors cross the low back joints and the sacroiliac joint.

28 Low Back Treatment ProtocolsDr. Lee acupuncture - releases the nerves and relaxes the muscles (reboot) sacroiliac joint movement restored to release the hip flexors DIY focus on the hip flexor muscles low back stretching (every 2 hours - reminder on outlook) better workstation ergonomics

29 Back Braces Back braces can help with acute and chronic painOffers support to surrounding muscles Negatives: Leads to muscle atrophy and weakens core and low back muscles when used constantly. This leads to longer recovery times

30 When to Use Ice and Heat While ice may not be the most comfortable thing to put on your body, your injured tissue will thank you! Putting ice on the area is important as it: - slows down circulation which reduces inflammation - numbs the area to reduce pain - the above steps allow the body to heal faster While heat is much more comforting, the heating process actually can make your problem worse. Heat has the complete opposite effect on the joint, increasing blood flow and inflammation. So hot packs, hot water bottles, whirlpool baths and heating pads should all be avoided initially. If you choose to soak in a hot bath or whirlpool, follow your bath with ice treatment over the affected area. The therapeutic effects of ice are experienced within the first 10 minutes. After that, the response actually reverses as your body acts to save the frozen area by increasing circulation to the area. We do not want those side effects. You can ice hourly, just always for no longer than 10 minutes. With this in mind, do not fall asleep on the ice pack in bed as you may wake up very sore! 30

31 Ice Procedure - Always place a towel between the ice pack and your skin. - If possible, elevate the inflamed joint and place it in a 'neutral' pain free position. - Ice for ___________ minutes, every ______________.Icing is most beneficial if it is followed by controlled pain free range of motion in all directions of the joint

32 Low Back Exercises

33 Nutritional Solutions?Nutrition Works: remove cheese and dairy from your diet as high calcium levels promote muscle tension and slow healing increase magnesium levels to relax muscles (magnesium levels diminish with prolonged stress levels) Omega 3 Fatty Acids are natural anti-inflammatory substances vitamin D, C, E, beta-carotenes, niacin, niacinimide, kaprex 2_99 33

34 Questions? Contact Dr. Derek Lee at