~ “Physiological and Somatic responses in clients with Repetitive Strain Injuries”

The state of the mind and nervous system is reflected in the state of the musculature.

During stress and anxiety, the body’s endocrine, immune, and nervous system structures all get activated.  In this article, I am going to limit my focus to the physical sympathetic responses to anxiety and stress and indications for clients with Repetitive Strain Injuries.

Anxiety is a response to danger or threat.  Scientifically, immediate or short-term anxiety is termed the fight/flight response. It is so named because all of its effects are aimed toward either fighting or fleeing danger.  From an evolutionary standpoint, this physiological state was a necessary component of our survival back in the caveman days.  In today’s society, the fight or flight response is still a necessary mechanism so that when we’re walking out into the street and a car comes rushing towards us, we swiftly act accordingly to get ourselves out of the way.  Thus, the number one purpose for anxiety is to protect the organism.

The flight or flight reaction presents with a momentary freezing and contraction of the extensors and a halting of breathing followed by a succession of disturbances.  Contraction of the flexors and adductors, accelerated pulse, sweating, and a violent contraction of the abdominal musculature result in paradoxical breathing with labored and shortened breaths and a slightly increased pressure on the viscera as the diaphragm is pulled in and up.  This respiration pattern inhibits peristalsis and can affect the overall lymphatic system and circulation of fluids to one’s organs as well as to the distal extremities.

With decreased lymphatic fluid and blood flow, oxygen will not be circulated as efficiently and waste products will accumulate.  75% of lymph travels through the thoracic outlet (the area between the upper arm and neck), and if it gets backed up, the fluid gets swampy and stasis or congestion can occur.

John Sarno MD in his book “Mind Over Back Pain”, describes what happens when vasoconstriction and a diminished blood supply occur.  1. Pain occurs due to an accumulation of chemical waste products in the muscles.  These waste products are typically carried away by the blood.  2. Reduced circulation means that insufficient oxygen reaches the muscle causing it to spasm. 3. Reduced circulation results in reduced oxygen to nerves which could eventually result in numbness, tingling, burning, etc.

The nervous systems of humans are made in layers with the oldest layers (the reptilian brain) covered by more recently evolved layers.  Each more recent layer is higher functioning and more cerebral (neocortex), making motor actions more graded and differentiated.   During states of fear or panic when the sympathetic nervous system predominates, the higher functioning layers shut off and rely on more of the reliable older parts, hence making movements less differentiated and coordinated.

Repetitive stress injuries (RSIs) are conditions caused by placing too much stress on a joint, resulting in the overuse of certain muscle groups. Many RSIs are linked to the stress of repetitive motions at the computer, factory labor work, or overuse injuries in sports.

Yes, anyone could give themselves an RSI when overusing any joint in their hand for a period of time without proper rest breaks.  Even 2 hours of pushing a mouse button repeatedly with the index finger without breaks can cause problems.

However, after working with RSI clients for over fifteen years (primarily office based), the basic motor patterns I have witnessed in mild to chronic cases are distinguished.  Many of them present with sustained and habituated somatic states as mentioned above.

Specifically, what I see is more undifferentiated movements and a lack of incorporation of larger muscle groups of the shoulder, back, and pelvis and minimal incorporation of these body parts in conjunction with the movements of the hand, wrist, and arm.

Diaphragmatic breathing may be replaced with paradoxical breathing, and the scapula may not glide properly on the thorax.  As a result of this pattern, individuals are strongly relying on the smaller muscles of their distal extremities to do all or most of the work.  Functions that these muscles are not structurally supported to do over long periods of time.

Whether it is because a person is sitting slouched in their chair with a rounded seated posture (inhibiting their breathing and occluding the freedom of movement of their back and spine), using their computer while laying on their couch or bed, resting their wrist on their desk or their elbows on an armrest while typing or for any host of other reasons, the patterns I observe of underutilization of the larger muscle groups and over utilization of the smaller and more distal muscle groups remains constant.

I would even go as far as to make the more highly charged statement that in chronic RSI cases that I have observed, their upper extremities are slightly disconnected from their lower extremities in their movements, sequencing, and in their awareness.  This can be observed as they walk.

If you are curious about what it may look like with the proper mechanics of movement, watch an infant walk, reach, or crawl.  When an infant reaches his arm forward for a ball, the scapula glides and rotates as many structures around the shoulder quadrant are involved.   The ribs compress, rotate, or expand, and the vertebra twist (almost like the links of a chain) with the most rotation occurring in the mid/upper thoracic, etc. To be precise with this last statement, the position the infant is in, the distance of reach, where the weight of his pelvis is, etc. are some of the factors which would greatly affect the degree of excursion each vertebra may take.

These same principles apply when an individual reaches for a mouse while sitting at his/her office desk.

After working with over 1000 Repetitive Strain injury clients over the decade, what I continually see is a deeply habituated and ingrained somatic response (as explained above with the flexor or the extensor musculature pattern predominating) accompanied by an underutilization of the larger musculature and an overutilization of the smaller ones.

For instance, their metatarsals and meta phalanges (fingers and toes) are often held in slight extension.  Their eyes may be overused and held in an extensor pattern (wide open).  Over time, these patterns become so engrained that they persist even when one rests or sleeps.   With continual over firing of these muscles and a lack of proper rest, then perpetuates the pain cycle.

For this reason, pharmaceuticals will be only partially effective at extinguishing these conditioned reflexes and responses.  In order to actually reverse the body pattern of anxiety, fear, or stress, one must at a subcortical level learn the proper role of the flexors, how to reduce the effort in all muscles, including even the finest twitch muscles such as the eyes, the toes, and the viscera and restore a normal state of diaphragmatic breathing.

The Feldenkrais method is extremely effective at inducing the parasympathetic state and restoring one’s innate capacity to move and feel.  When I perform Feldenkrais sessions on clients who present with RSI I have the goal in mind to allow these body parts which are overworking (i.e. the neck, toes, eyes, back, etc) to “let go” and to encourage more of parasympathetic dominance.  I bring body parts that may have fallen out of their conscious awareness (such as fine twitch movements of individual phalangeal joints) into more conscious control and teach the body at a subcortical (unconscious) level how the motor connections occur through the wrist, and elbow, shoulder, truck and so forth.

Often times clients report back to me how well they slept the night after a Feldenkrais session as well as how relaxed they feel after sessions.  For many, this may be the first time in a while their extraneous muscles stopped overfiring, and that full belly breathing returned beyond conscious control.

I am also an Ergonomist, so I am a strong proponent of proper workstation ergonomics and setup.  However, more important than the actual setup, I believe is the actual way someone uses themselves while at their workstation.   I have found that just instructing someone how to sit differently or breathe differently will be ineffective unless the client learns to do it without conscious control.

While working as an Occupational Therapist in typical medical settings, I at times felt somewhat limited when only treating the hand/arm for a carpal tunnel or ulnar Nerve injury diagnosis instead of looking at the full picture of the individual is customary (although some differential diagnoses such as the upper limb nerve tension testing are often performed).  I understand that legal reasons are part of the reason why treatment is often limited to just these distal body parts.

Many physicians are at odds (so I have heard) with how to handle these more chronic RSI cases, and I’d like to be an advocate for saying there are a lot of noninvasive things we can do.  I have had tremendous success with relieving such clients of pain and instilling in them a life-long change of better health, happiness, and comfort.

“The body reflects the state of the mind.  Change the state of the body, and you will change the state of the mind.” (Moshe Feldenkrais)