Repetitive strain injury — it’s not just about the arms
Repetitive strain injury (RSI) is a blight on the working world affecting the individual’s ability to perform. Personally RSI can cause great suffering on a number of levels and financially there can be significant cost to both the individual and the business. For all of these reasons it is important that the understanding of RSI evolves. Similar to other persistent pains, when society realises that pain can change when you understand it and know what to do, there will be a vast shift. The shift will mean less suffering as people learn how to overcome their pain.
RSI often begins with mild symptoms that include pain, soreness, stiffness and altered sensation that build up over time. There is usually a point when the pain motivates the person to seek help or deterioration in performance enforces action when they are unable to do their work as needed. In the early stages, typically there is a search for an actual injury or evidence for inflammation with varying results. In other words, some people will discover that there is an injury but most will not. The reason for this is simply that pain does not accurately reflect tissue injury. So what is pain?
This is the ultimate question that needs answering and like most problems, to solve them we must ask the right question to create an opportunity for understanding. What is pain? Pain is all about protection. The amount of pain we experience in that moment (we can only experience pain in the present moment, the rest being a memory or an anticipation that something will hurt, both of which impact on what is happening now; i.e./ remembering a painful time can evoke pain now, and thinking that something will hurt causes us to experience more pain) is dependent upon the level of perception of threat. More threat predicted results in more pain experienced regardless of tissue damage. This is why a soldier can suffer great injury without experiencing pain because escape from danger is more important, hence feeling no pain allows for such escape to a safe place.
Pain that is attributed to RSI then, is all about the perception of threat to the arms and hands (sometimes as far up as shoulders, neck and upper back). In fact, it is a threat to the person that is pertinent enough for the brain (we are our brain of course, so this is just for convenient description) to predict that the self needs protecting in its entirety. I say entirety because we are a whole person, experienced moment to moment as the ‘self’, which is the brain, the mind, the body and the context (environment) blended and unified into this single experience now. It is this that takes the problem of RSI or any other pain emergent in the body beyond just where the pain is actually felt. Pain in the arm or hand is more than just the feeling, the sensation, the lived experience; it equally involves what we think about the pain (cognition), how we feel about the pain (emotion) and the meaning that we attribute. All of these dimensions create the experience we call pain. So, even from this brief insight into the modern blend of neuroscience and philosophy to help us ask the right questions to which we can discover answers.
The right questions also include posing those that allow the person to tell their story. Creating the environment for this is the vital first step in understanding the person’s lived experience, listening to their words and the way in which they express them. This picture that is drawn allows the clinician to decide how together they can form a partnership that forms the basis of the person overcoming their pain.
As the narrative emerges, the clinician is able to validate and give meaning to events and moments that have shaped the current context (many of which will not be realised). From thereon in, a comprehensive programme is created to address all dimensions of the problem in an interrelated manner. Pain being a lived experience moment to moment, the person needs to know what to think and what to do at any given moment. In effect they need to become their own coach, which is the Pain Coach concept — the Pain Coach coaches the person to become their own coach so that they successfully coach themselves to overcome their pain. We are change with every new moment that passes as our biology updates, and similar to a sports coach, we aim to optimise that change in the direction of health: the healthy vision of me.
The main areas that a comprehensive programme focuses upon are the person’s understanding of the problem (their working knowledge), addressing fears and worries to put these resources into developing the ‘healthy me’, normalising movement and body sense, and creating the conditions for a healthy existence. There are many different strategies and techniques to use alongside treatment that also creates the conditions for health (hands-on, movement and other desensitising ways). Overall though, the programme gives you the know-how to overcome pain and resume a meaningful life.
In summary, RSI similar to other persisting pain problems involves much more than the area that hurts. Pain involves the person, the whole person and hence to address pain comprehensively, the programme must also be whole person. In other words it must reflect the fact that we are thinking, feeling and moving as an expression of who we are, the self that we ‘feel’, emerging from the unification of these dimensions. The programme thereby creates a way forward.
Part 2 will look at what happens in RSI
Pain Coach Programme for persistent pain problems: t. 07518 445493