Wednesday, January 16, 2008

Hand Health Resources Newsletter

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Monday, January 14, 2008

The Benefits of Pain

The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The word "pain" comes from the Latin root poena meaning punishment, a fine, a penalty (Wikipedia: Pain and Nociception). Although often associated with negative feelings, pain actually has some very important functions.There are two types of pain: acute pain and chronic pain. Acute pain occurs for specific reasons. With acute pain, an actual or potentially damaging event triggers special sensory nerve endings located in the skin, muscles and joints. These neural impulses then travel through the dorsal horns of the spinal cord and up to the higher centers of the brainstem and brain. An automatic and rapid course of action to eliminate the event and prevent further injury is decided upon.

  • Acute pain is a protective mechanism that helps us avoid damaging situations. It warns us that damage is imminent and provides information that the body uses to avoid further injury. For example, acute pain warns us to quickly remove our hand from a hot stove top.

  • Acute pain lets us know when we need to seek medical attention - such as when we have received a cut, broken a bone, or are having a heart attack. Our action may be as small putting on a band-aid or as extreme as a visit to the Emergency Room.

  • Acute pain is also a signal that we need to rest a body part to allow it to heal. For example, the pain of a broken ankle prevents us from putting weight on the leg until the bone has healed enough to withstand it.

Many RSI (Repetitive Strain Injury) sufferers experience chronic pain. Unlike acute pain, chronic pain serves no purpose. It is defined as "the disease of pain" (Wikipedia: Pain and Nociception). The initial purpose of pain is long forgotten but the pain continues and may even worsen. A stronger emotional component is associated with chronic pain including anxiety, depression and helplessness.

The benefits of acute pain are automatic body responses that prevent the body from further injury. We can some receive some of the same benefits with chronic pain; however, our actions will need to be more deliberate and thoughtful rather than the immediate and spontaneous requests demanded by our body.

Pain as a Warning Signal

  • Reduce environmental stresses on the body by making appropriate ergonomic changes to the work area.

  • Use the body smarter, not harder. Use proper body mechanics when performing tasks such as lifting, carrying, pushing and pulling. Use power tools. Pace yourself. Use the strongest and largest muscles to perform heavier jobs. Plan ahead. Use good posture.

  • Change harmful and painful work habits. Don't ignore pain. Stretch regularly and take frequent mini-breaks. Avoid static grip or positioning. Avoid awkward positioning.

Pain as the Body's Request for Healing

  • Seek medical attention. Be specific with your pain concerns so that your medical practitioners can better diagnose your injury.

  • Think outside the box with alternative treatments such as: Yoga, Pilates, movement therapies such as the Alexander Technique and the Feldenkrais Method, massage therapy, acupuncture.

  • Develop healthy habits: consult with a nutritionist, stop smoking, get a good night's rest, perform 15-20 minutes of gentle cardio activity daily.

Pain as a Signal to Rest

  • Take frequent mini breaks. If you are less painful by the end of the day, you will actually be more productive for taking these breaks than if you worked straight through.

  • Use splints and supports to rest painful joints and muscles. Your physician or therapist can help you choose the style that is most appropriate for your condition and provide instructions for wearing time.

  • Use cold packs to control inflammation.

  • Use either heat packs or cold packs to alleviate pain. Both may help to reduce pain by changing the way the pain signal is delivered to the brain. Try both and choose the one that feels the best.

For further information on injury prevention and recovery, visit Hand Health Resources.

Using cold packs can help reduce inflammation and alleviate pain. Elastogel cold packs are well made, durable, don't leak, feel nice against the skin, and fit/conform to body areas comfortably. This is my choice of cold pack in the clinic. An added bonus is that they can also be used as heat packs. The velcro strapping is a nice addition to hold the packs in place.

Elasto-Gel Hot/Cold Wrist or Elbow Wrap - #WR200 Elastogel

There are many topical pain relieving gels and creams on the market now. Biofreeze is one of the preferred choices by my clients in the clinic. It is easy to apply and does not leave a long-lasting, strong odor.

BIOFREEZE with ILEX Pain Relieving Gel - 4 oz. Tube

This book introduces trigger point therapy as a self-care tool for alleviating chronic pain caused by a variety of conditions. It has nice illustrations and consistently gets good reviews.

The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition

Friday, January 04, 2008

Trigger Finger

Mouse and keyboard use can cause finger pain. One common cause of finger pain is called trigger finger. Trigger finger is a swelling of the tendon or tendon sheath in the palm of the hand of the tendons that bend the fingers. This swelling prevents the tendon from gliding smoothly through the sheath and the "pulley" (ligament) which holds the tendon to the bone. Trigger finger occurs most frequently in the middle finger and the ring finger, but it can occur in any finger or the thumb.

SYMPTOMS
  • A locking, snapping, popping or catching sensation in the finger while making a fist.
  • This "triggering" of the finger can be quite painful at times.
  • The finger may "lock" into a bent position.
  • There will most likely be pain or tenderness in the palm of the hand over the site of the pulley which holds the tendon close to the bone.
  • There may be joint stiffness and pain in the affected finger.

OCCUPATIONAL CAUSES

  • Repetitively gripping or bending and straightening the fingers (e.g. - mouse clicking)
  • Sustained gripping
    (e.g. - squeezing the mouse forcefully or holding a pen in a "death grip")
  • Using tools that have handles with sharp or hard edges

ERGONOMICS

  • Avoid repetitive grasping and releasing of objects. Modify the activity if you are unable to avoid it. Look for ergonomic mice or larger barreled pens. Change your typing style so that your fingers are relaxed on the keyboard and mouse.
  • Avoid sustained grasp.
  • Keep the fingers relaxed over the keyboard. Do not plant your wrist down on the wrist rest while typing as this causes excessive and stressful finger movements to reach all the keys. Rather, the wrist should glide over the wrist rest, allowing the fingers to be positioned over the keys in a relaxed manner.
  • Purchase tools with padded, comfortable handles.
  • Handles should have some texture for easier holding. Slippery surfaces require more forceful grasping.
  • Minimize repetition. Periodically rest the hands during repetitive or stressful activity. Stretch frequently during repetitive activity.
  • Slow down!
  • Use the lightest grip possible (on tools, pens, the mouse, the steering wheel, etc.) that still allows you to maintain good control.
  • Use the least amount of force necessary during the activity.
  • Use the appropriate tool for the job.
  • Use ergonomically designed tools if available (modified or padded handles, larger grips with good traction, handles with modified designs).
  • Make sure that tools are in good condition and that cutting edges are sharp (reduces the force needed to use the tool).
  • Alternate work activities so the hands are not performing any one task repetitively for any length of time.

This ergonomic mouse can help relieve hand, wrist and elbow pain.

And here's an example of an ergonomically designed tool - scissors - that can help take the stress off the fingers.

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

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