Avoiding Carpal Tunnel Syndrome and Other 'terminal' Diseases

DATELINE:
Silicon Valley: home of the computer and of the computer terminal.

A large percentage of people in Silicon Valley have at least one thing in common: they spend many hours at the keyboard of a computer terminal. They have another thing in common: tight shoulders, back pain, tendinitis, and in many cases, carpal tunnel syndrome -- "repetitive use injuries".

So let me say a few words about work hygiene -- things beyond "keyboard hygiene" that you may not have heard before -- because if you're going to avoid stress or repetitive use injuries, you're going to do something different to take care of yourself. More on that, later.

Repetitive use injuries do not come from mechanical problems of the body; they, Themselves, are mechanical problems caused by habitual action patterns, ways of working. Habitual ways of working set up habitual tension patterns in your muscles and habitual states of stress. Repetitive use injuries are one physical manifestation of stress.

Your brain is an organ of learning and the master control center for your muscles and movements. If your muscles are too tight, the problem lies not in your muscles, but in your brain, which controls them. You have conditioned yourself to maintain a state of muscular tension. The mechanical problems of the body come from how you have applied yourself to your work.

HOW PEOPLE PROGRAM THEMSELVES INTO WORK-RELATED INJURIES and STRESS

You may notice that people who work at a keyboard spend long periods sitting in one position. As they do, three things happen: they enter a heightened state of concentration, they hold relatively still during those periods of concentration (except for their hands), and their breathing and circulation decrease.

Let's look at what happens with each of those aspects of self-programming.

High Concentration for Long Periods

Usually, keyboard workers enter not merely a heightened state of concentration; they enter a state of high-speed concentration -- the race to beat the deadline or to meet the quota. To work at high speed involves a heightened state of tension.

This heightened tension affects workers in two ways: their whole body gets tense, particularly in the low back, neck and shoulders; and the muscles of their forearms, which control the movements of the hands, get especially tense, possibly leading to tendinitis in the wrists or carpal tunnel syndrome. Neck tension pulls the neck vertebrae closer together and can cause pinched nerves.

Long periods of tension, like long periods of exercise, create a kind of conditioning. As someone programs themselves (i.e., learns) to meet the demands of a job -- they get used to the tensions it entails. These tensions tax the body and form the bodily basis for job stress, burnout, and medical consequences.

This kind of self-conditioning also creates carpal tunnel syndrome. Thoracic Outlet Syndrome, which involves burning sensations and numbness down the arms, has the same origins.

Lack of Movement 

Movement interrupts tension habits. Conversely, lack of movement while under tension leads to conditioning into a state of tension. Postures become set; people "set up" like jello --but without the jiggle! They get stiff on the job. Stiff jello.

The position most people adopt when working at the keyboard involves suspending their arms with bent elbows, hands over the keyboard. This position places strain on the muscles of the back and shoulders below the shoulder blades, which prevent the shoulders from rolling forward. Those muscles get tired and sore and produce mid-back pain.

The combination of intense concentration and lack of movement is a sure formula for stiffness and stagnation. It is an often unrecognized fact that muscles pump blood as they relax and contract. Muscles that stay in heightened tension produce metabolic waste products that accumulate. The effect is stagnation and fatigue.

Circulation Decreases

In addition, muscular tension blocks blood circulation (since blood must circulate through the muscles). This tension-induced blockage makes the job of the heart even harder, deprived as it already is of the pumping action of muscles in movement.

Decreased breathing leads to decreased mental clarity and decreased productivity -- not to mention decreased vitality.

Lack of good keyboard hygiene contributes to tight shoulders, to low back pain, and to Worker's Compensation costs.

WHAT TO DO TO PREVENT OR ELIMINATE WORK-RELATED INJURIES

Take "stretch breaks". A stretch break interrupts the formation of a tension habit and flushes out stagnant body fluids. There are certain movements that you can perform to prevent tension from accumulating in your back, shoulders, and forearms -- not stretches, actually, but related to yawning.

Here's a video that talks about and shows what I am talking about.

Better than a stretch break, however, is an exercise break. Five minutes of calisthenics -- windmills, side-bends, and running in place -- can make your morning break feel like a vacation (or at least highly refreshing).

Another way in which you can reverse the effects of prolonged keyboarding is with somatic exercises. These exercises reverse the conditioning that result in habitually tight muscles; they refresh your ability to relax.

So break your concentration. Interrupt your "productivity program". Take care of yourself. You'll be more productive.

WHAT HAPPENS TO MANY PEOPLE WHO DON'T PRACTICE GOOD KEYBOARD HYGIENE?

(CHRONIC PAIN, CARPAL TUNNEL SYNDROME, AND HEIGHTENED JOB STRESS)

Accumulated tension takes its toll. Once accumulated past a certain point, tension cannot sufficiently be eliminated by mere stretching and calisthenics. The person has lost too much bodily awareness to release the stored tensions; you can voluntarily release only the tension you can feel. So the "tension program" continues to run on automatic.

People at that point turn increasingly to massage therapists. Massage therapy produces healthful benefits, and it can be habit forming! On-site massage has become increasingly popular in recent years.

However, massage therapy has a big limitation: its benefits are temporary. Due to the need for repetition, massage therapy can become an ongoing expense of which people may tire -- at the expense of repetitive use injury. Often, by the time chronic tension has produced a Worker's Compensation claim, the person is generally beyond the help of a massage therapist. Their brain is too conditioned to let the muscles relax for long. Something else is needed.

That "something else" is control of your own muscular tension. One name for the training process that gives you back control of yourself is, "somatic education." Somatic education is a kind of self-preservation through grooming out accumulated tension.

Somatic education gives you back control of the brain conditioning that keeps you tight. Once done, you don't need to pay special attention to your muscles or state of tension; you're freed -- and you have sufficient bodily awareness to notice when you need a break -- basically, because you notice that you're not comfortable, any more. You take a break and take care of yourself.

Somatic Education improves or restores natural control of muscular tension by a short-term, physical learning process in which you participate actively, coached as necessary by a somatic educator. The somatic educator's job is to make it easy for you to regain control of your muscular tension. This approach differs from massage and chiropractic because it leaves you self-sufficient and able to manage conditions that might otherwise ultimately worsen until you require medical intervention, such as surgery. There are numerous forms of somatic education: the Alexander Technique, the Trager Approach, Feldenkrais Somatic Integration, Rolfing Movement, Hanna Somatic Education, and others. Some produce results faster than others, and some produce significant improvements nearly immediately.

Of course, if you let things go for too long, you do have a last resort: your doctor -- or his favorite surgeon.


RECOMMENDED:

• For keyboardists and those who must sit for long periods: The New Seated Refreshment Exercises
• Access to clinical Certified Hanna Somatic Educators, click Certified Hanna Somatic Educators

Lawrence Gold is a certified clinical somatic educator who has been in practice since 1990. His clients are typically people in pain who have not gotten help from standard therapies. Contact Lawrence Gold, here. Read about his background, here.