Now there is proof that dark chocolate is the food of the gods. Medscape just published an article on a study of the effects of eating dark chocolate on cardiovascular health. Guess what? Results are “indicative of improved vascular health and a lower risk for heart disease.” I’m taking an informal poll – what is the best chocolate dessert in Nashville? Email me and let me know!

This month, I’m tackling Repetitive Stress Injuries (of which Carpal Tunnel Syndrome is one example), and describing self-massage for the hands and fingers. I’m also including information on Watsu – a type of massage performed in a pool.

Enjoy! --- Heather Wibbels (615.294-6672)

Humans are creatures of habit. We brush our teeth in the same way each day. We carry backpacks, bags and purses over the same shoulder every day. We perform our work physically the same each day. Over time, using the muscles in the same way again and again puts strain on the musculoskeletal system, causing injuries referred to as Repetitive Stress Injuries (RSI) (also known as Cumulative Trauma Disorder).

What is a Repetitive Stress Injury?
When a muscle is used repeatedly, especially when it is placed under some sort of physical stress, damage occurs to the muscle itself, the nerves that flow through the muscle, and the tendon and the fascia surrounding the tissue. This damage is known as RSI, is a category of injuries, but individual diagnoses, such as Carpal Tunnel Syndrome, Thoracic Outlet Syndrome, Golfers or Tennis Elbow can be determined by a physician familiar with these types of injuries.

Although most RSIs are primarily muscular in nature, as the muscles tighten, circulation flow is restricted to the area, the nerves may become impinged and trigger points form in the muscles themselves. Because muscles under physical stress and muscles being used repeatedly are constantly in contraction, the loss of adequate circulation to the area is a serious problem. Not only does the muscle tension reduce circulation and cause a loss of needed nutrients and oxygen flowing to the area, it also restricts the removal of the waste products produced by muscle contraction (lactic acid and CO2).

RSIs are injuries that occur over time, and can occur from work-related activities, hobbies, sports or from a habitual posture. At their worst, they can be extremely painful and debilitating, causing a loss of range of motion and activity in the sufferer.

Carpal Tunnel Syndrome (CTS) as RSI
A small tunnel exists in the wrist that is lined by bone on three sides, and covered by the carpal tunnel ligament on the fourth. Within that tunnel run all the tendons that flex the fingers. Constant typing, using computer or cashier workstations, or other finger-intensive activities tighten the muscles connecting to the tendons. As the muscles are contracted over and over again, the tendons become inflamed and the carpal tunnel begins to restrict blood flow and nerve communication. This causes the pain and tingling that is associated with Carpal Tunnel Syndrome. The median nerve (which uses the tunnel to exit into the hand) may also be impinged in the muscles of the forearm itself, or by the elbow joint. All of these factors may lead to symptoms that are diagnosed as CTS. Sometimes surgeons recommend cutting the Carpal Tunnel Ligament to release pressure on the tendons and nerves. However, in many cases, that surgery is not a long-term fix for the problem, and the original symptoms reappear.

Massage and Treatment for RSIs
There are many ways to treat RSIs. First, it is important to find a physician familiar with RSI category injuries, and make sure that you have the correct diagnosis. Massage therapy and physical therapy are two means to treat RSIs. Massage, by lengthening, loosening, and stretching the muscles, restores circulation to the area. This also reduces the nerve impingement resulting from tightened muscles when they are loosened and released. While increasing the circulation to the area, massage increases nutrients and oxygen flowing to the muscle, and removes the by-products of muscle contraction.

Even more important than treatment of diagnosed RSIs is the prevention of them in the first place. Correctly modifying the setup of your office or workspace, maintaining balanced, neutral positions and stretching all reduce the chance of these injuries.

This article is just a short introduction to the category of RSIs, and much useful information exists on the web. I’ve listed some of sites I’ve used in preparing this article below. Some statistics follow at the end of the newsletter.

RSI Information

• Self Care for RSI
• Computer Related Repetitive Strain Injury
• RSI Program
• Amara's RSI Page

CTS Information

• Carpal Tunnel Syndrome Research
• Treating Carpal Tunnel Article from Massage Magazine

More on Massage: Watsu
Aquatic Bodywork

How would you like to a get a massage in a pool? Watsu (WATer shiatSU), a form of aquatic bodywork, combines Swedish massage, Zen shiatsu and other movement therapies to treat the body in a weightless environment. Because it takes place in warm, body-temperature water, and the therapist is supporting the body and moving the body, an element of trust and connection forms between the client and the therapist.

Invented by Harold Dull in Middletown California in the early eighties, Dull sought to combine Zen shiatsu with water work. He developed the technique and began to train therapists at the School of Shiatsu and Massage in Harbin Hot Springs.

During a session, the therapist cradles the client in his/her arms to support the head and the legs. Though the support and buoyancy of being in the water, a deep sense of relaxation ensues. As the therapist rocks and moves through the water with the client, the therapist stretches, massages and applies acupressure to his/her body. In many cases, the client reaches a very deep state of relaxation and tranquility. Sometimes, therapies like Cranio-Sacral Therapy or other Myofascial modalities are included during the water work.

For more information, see the Worldwide Aquatic Bodywork Association website:
WABA

RSI and CTS Statistics
From SportsTouch

Statistics about RSIs

• In 1992, ergonomic disorders accounted for 56% of the illnesses reported to the Occupational Safety and Health Administration (OSHA). This is double 1984 levels.
• In 1992, the Bureau of Labor Statistics recorded 280,000 cases out of one million injuries were CTD's of the upper extremities, wrists, shoulders and elbows.
• The American Academy of Orthopedic Surgeons estimates cumulative trauma disorders (CTD) cost $27 billion annually in medical treatment and lost income.

Carpal Tunnel as an RSI - STATISTICS FROM 1997 TO 2000

The following sources are compiled from the Bureau of Labor and Statistics and the National Institute for Occupational Safety and Health-NIOSH.

• Carpal tunnel syndrome results in the highest number of days lost among all work related injuries. Almost half of the carpal tunnel cases result in 31 days or more of work loss.-National Center for Health Statistics.
• The U.S. Department of Labor has concluded that Carpal Tunnel Syndrome is the “chief occupational hazard of the 90’s”-disabling workers in epidemic proportions.
• Currently, Carpal Tunnel Syndrome affects over 8-million Americans.
• Carpal Tunnel Syndrome is the #1 reported medical problem, accounting for about 50% of all work-related injuries
• Presently, 25% of all computer operators have Carpal Tunnel Syndrome, with estimates that by the year 2000, 50% of the entire workforce may be affected.
• Only 23% of all Carpal Tunnel Syndrome patients were able to return to their previous professions following surgery.
• Up to 36% of all Carpal Tunnel Syndrome patients require unlimited medical treatment.
• Women are twice as likely to develop Carpal Tunnel Syndrome as opposed to their male counterparts.
• While women account for about 45% of all workers, they experience nearly 2/3’s of all work-related Repetitive Strain Injuries.
• Surgery for Carpal Tunnel Syndrome is the second most common type of surgery, with well over 230,000 procedures performed annually.