Subject: Re: RSI article Non-medical approaches for treatment of Repetitive Strain Injuries by Timothy J. Jameson, D.C., C.C.S.P. Over the past 10 years there has been an increased interest in the diagnosis and treatment of repetitive strain injuries (RSI) suffered by musicians. Repetitive strain injuries can lead to neck and lower back pain, shoulder pain, arm and forearm pain, wrist/hand pain, and/or carpal tunnel syndrome. Almost all of the recent publications, journal articles, and books have dealt with the medical approach for treatment of these conditions. The purpose of this article is to provide an overview of repetitive strain injuries, then offer effective alternatives to the traditional allopathic (medical) treatments. It addresses the growing segment of the population who prefer to use alternative therapies, which are drugless, and noninvasive. Many people are investigating methods for natural healing which includes treatment for both body and mind. It is important to recognize that this paper is not meant to condemn the traditional medical approach for treatment of these conditions. Many people have done remarkably well by seeking care via M.D.s who specialize in treatment of RSI's. Your alternative health care provider should be willing to work with the medical profession in cases where severe nerve and tissue damage may be present. In these cases, it is important for diagnostic testing to rule in or out injuries that may need medical attention. Their are many causes of RSI's. The most common cause seen in this clinic is due to musicians who have undergone one or more of the following: a dramatic increase of playing time, play their instrument for many hours without breaks, or have recently changed instruments or instructors. String players and pianists are more susceptible to injury. Poor posture will aggravate these symptoms, as well as poor overall conditioning. Obese people, for example, tend to have increased incidence of carpal tunnel syndrome, due to the deposition of fatty tissue in the wrist. Women tend to have a higher incidence of these injuries compared to men. Underlying systemic disease can also be a causative factor for repetitive strain injuries. Psycho-social factors may play a part, such as anxiety or stage fright, poor self esteem, and depression. All of these factors must be considered when contemplating a treatment program for the musician suffering from an RSI. If you are experiencing an RSI complaint, first consider the type of doctor you will see for an examination. Be careful in your choice of physician or health care provider. Not all doctors or health care providers are proficient in the treatment and diagnosis of RSI conditions. The doctor that singles out the symptom as your main problem, and only works at reducing your symptom is doing a disservice to you - and is wasting your time and money. The prime example is the musician who is experiencing wrist pain and abnormal finger sensations. The substandard doctor is one that only investigates the wrist and hand, and fails to investigate the forearm, elbow, shoulder, neck, posture, playing technique and style, and the other factors mentioned. The doctor who sees the functioning of your body as a whole is more effective in treating RSI's. (This is where the term "holistic" stems from.) Utilization of chiropractic care, massage therapy, somatic therapy, and acupuncture in various combinations is an excellent start to your alternative/holistic treatment program. Chiropractic care is vitally important for RSI conditions, and is the primary form of treatment at our center. If you decide to seek chiropractic care, seek a chiropractor who has previous experience with the treatment of musicians and/or athletes. You may want to seek a "Certified Chiropractic Sports Physician" (CCSP) or one who specializes in rehabilitation. Be sure to inquire if the doctor has on-site rehabilitation services and on-site physiotherapy services. There are chiropractors who limit their practices to spinal manipulation only, and although effective in some conditions, I do not recommend it for the complex nature of repetitive strain injuries. The doctor of chiropractic undergoes extensive training to diagnose disorders stemming from malfunctions of spinal and extremity joints, nerves, tendons, ligaments, and muscles. In repetitive strain injuries all of these structures tend to be affected. Treatments for these conditions are relieved by a combination of spinal and extremity manipulation (adjustments), physiotherapy, rehabilitative exercises to the spine and extremities which include stretching and strengthening. My clinic offers a unique service termed "musician performance reeducation". Performance reeducation is an analysis of the playing style of the musician through videotape analysis. Videotaping a practice session is important for both the doctor and patient. It allows the doctor to examine muscle movement patterns that may be harmful to the patient. It allows the musician to visualize his/her posture and technique. After analysis of this videotaping, proper biomechanics should be taught to encourage more fluid, stress free motions. Posture and stance should analyzed as well, and exercises should be prescribed to strengthen imbalanced muscle groups. An excellent complement to chiropractic care is massage therapy. You will find that many chiropractors (in the U.S.) offer massage therapy in their office. Certified massage therapists who specialize in "somatic therapy" are helpful in teaching the musician about proper movement patterns. Massage therapy also enhances healing of injured muscles and tendons. The Feldenkrais Method and the Alexander Technique are forms of somatic therapy that have shown effectiveness in instructing the musician to change muscle movement patterns. The musician learns in these sessions to retrain their movements from harsh, strenuous, and harmful to more flowing, relaxed less stressing movements. Acupuncture and Traditional Chinese Medicine is another form of alternative treatment that enhances healing. It allows for improved microcirculation of the injured tissues. It has been shown to increase the immune response. It also enhances nerve and energy flow. Acupuncture allows for changes in the biochemical reactions within the body, and stimulates the release of endorphins for pain relief and cortisol for an anti-inflammatory effect. Use of Chinese herbs adds in strengthening the body's defenses and stimulating the healing response. For those who prefer herbal or homeopathic relief, I would recommend a naturopathic doctor. Naturopathic doctors do not receive licensing in all states. In those states where there is no licensing board, you may find them listed under "specialized kinesiologist". They can determine which herbs and/or homeopathic remedies will aid in your body's healing. I recommend you seek this treatment in conjunction with chiropractic care and/or acupuncture, because of their beneficial effects previously mentioned. One last alternative method that is peaking in interest is "Guided Imagery". This method is helpful due to the importance of the brains control over healing the body. The person certified in providing guided imagery sessions will talk you through visualization techniques. This aids you in mindfully controlling not only your healing, but also controlling your brain's conception of the pain itself. Treatment of RSI's should be multi-faceted and should incorporate health care disciplines which allow your body to heal quickly and safely. The health care provider needs to investigate not only of the symptoms of an RSI condition, but all the aspects of the musician's life and performing style. The disciplines mentioned in this article are only a few of the many alternative therapies available to you. Those mentioned are considered mainstream and effective. There exists many others that are more controversial, and should be investigated closely before undergoing treatment. Please look into all of the options before making your final decision regarding your health care program. Finally, it is important to mention that prevention is the key to a lifetime of instrument playing without pain. Your doctor or health care professional should advise you on stretching and exercise regimens that will aid you in leading an overall health lifestyle. __________________________________________________________________________ Dr. Jameson is the owner and director of Bayshore Chiropractic Holistic Health Center located in Castro Valley, CA, USA. This center incorporates all of the health care disciplines mentioned above and specializes in the treatment of injuries suffered by musicians. You can reach Dr. Jameson by