Thought Bytes...
July 2003

Heal Thy Self

It starts with a burning feeling in the muscle, tendon or joint that goes away after resting for a couple of hours. That lasts for a couple of weeks. Then it starts to take longer to feel better. The discomfort only goes away after a good nights sleep. Then it takes a weekend off to feel better and starts to effect your sleep on the days between. Eventually, it takes a long holiday before it feels better. But, as soon as you go back to work it comes back. And all the time, you keep telling yourself "it will get better on it's own".

Well, I've got good news and bad news for you. The good news is that if you stop the activity that causes the strain, the inflammation and pain will go away. The bad news is that we can't, don't or won't stop using our arms, neck and backs. Our lives and jobs depend on us being able to use these parts of the body continuously.

The problem is that many people wait until the pain is incapacitating before they seek treatment. By this time, there may be permanent damage to the tissues. But there are many things you can do for yourself to control the injury, so that scar tissue isn't as much of an issue. Now, obviously, if there is blood pouring out of your body, you will want to get medical treatment. But for soft tissue injuries, we can look to the sports medicine model of treatment as a starting point. All the aspects of the sports medicine model focus on controlling inflammation.

Rest - if it hurts... stop doing it! (or pay someone else to do it...)

Ice - this is the most important tool in the sports medicine chest. Generally ice or a cold pack is applied to the sore area for a period of 20 minutes. The first 10 minutes of cooling chills the tissues resulting in constriction of the blood vessels. This pushes the accumulated fluids (swelling) out of the area. After about 10 minutes, the tissues start to react to the cold and ask for more blood to keep them warm. The resulting dilation of the blood vessels brings in blood carrying oxygen and building blocks to repair damaged tissues. Alternating heat and ice in a 20 minute cycle will further stimulate circulation through the injured tissues.

Compression - The idea of applying compression is that by restricting the distance that tissues are able to swell, there will be less pressure on the damaged areas and less peripheral tissue damage / bruising. Swollen tissues also tend to have more discomfort. Generally, tissues that have been injured rapidly, such as sprained tendons from twisting your ankle, respond well to compression. Tissues that have been injured from continuous exposure to physical demands will only see moderate improvement from the application of compression. Care needs to be used with this aspect in regard to the wrist. The wrist is a very compact and delicate area. If the tendons passing through the carpal tunnel are inflamed and putting pressure on the median nerve, applying more pressure will likely make the condition of nerve compression worse.

Elevation - elevating the affected areas also stems from rapidly induced injuries. By elevating the affected tissues, blood will flow toward the heart. Therefore there will be less pooling around the injury. Alternating elevating with light usage of the tissues will stimulate circulation to (and from) the tissues.

Using the RICE model is a good starting point. But, lets look a bit deeper at the injury process. First you have an injury to the tissues. This creates inflammation. The inflammation provides the stimulus for the pain receptors to send the message back to the brain. The brain then sends a signal to the muscles to contract to protect the area (or to gather more proprioceptive feedback to tell the brain what the muscles and tendons are doing). The extra tension on the muscles creates more strain, sometimes causing further injury. So, the downward spiral begins. So, now lets look in your own medicine chest...

NSAIDs - Over the counter Non steroidal anti-inflammatory drugs are among the most commonly used in our society. They come in many forms, under many names: Aspirin, Ibuprofen, Advil, Motrin... These drugs work to control both pain and inflammation. They can be hard on your stomach so talk to a pharmacist about what will work best for you.

Pain medications - Over the counter pain medications (i.e. acetaminophen, etc.) will control pain, but not inflammation. The problem is that inflammation is the source of the pain stimulus. Pain meds may help prevent some of the muscle tension that is known as guarding or spasm by fooling the brain into thinking that the problem isn't severe enough (painful enough) to warrant protecting it with extra tension.

Muscle relaxants - Over the counter muscle relaxants can come with either an NSAID or acetaminophen base. These will help control the muscle tension that result from pain and that can cause additional damage to the tissues. If your stomach can tolerate the NSAID version, then you are addressing inflammation, pain and muscle spasm - three for the price of one.

In the end, the only person who can prevent a repetitive strain injury from progressing from minor irritation to major pain is you. Early recognition and self treatment are the best way to keep the strain under control while changes are made to your work environment. Letting the injury progress will only prolong the healing process and require more treatment.

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