Repetitive Strain Injuries and the Feldenkrais Method

Cliff Smyth, GCFT

The way we take action in the world affects our lives in significant and profound ways. Our habits can include the ability to move with great ease and comfort. Unfortunately, our habitual patterns of movement and perception can also lead to injury and pain. Repetitive strain – also known as repititive stress – injury (RSI) can seen from this perspective: as the result of accumulated injury and pain arising from the kinds of movements required of us in our lives - along with the way we make those movements. Thinking in this way about these kinds of injuries also offers hope for successful prevention and rehabilitation. The Feldenkrais Method can help us become more aware and improve the ways we act in the world

In this paper I will review what repetitive strain injuries are, how they are described and thought to come about, and then how the Feldenkrais Method can help us to prevent and recover from these kinds of injuries.

What is RSI?
Repetitive Strain Injuries are commonly experienced as aching, pain, fatigue or heaviness, coldness, weakness, numbness and tingling and loss of propriocetion (sense of the part of the body in space) in the hands, wrists, elbows, arms, shoulders and neck. They are usually associated with activities that involve repetitive movements such as keyboarding, use of hand tools (scissors, knives, pliers, wire cutters, etc), assembly, production or processing work - including word processing. They can also occur in the feet and legs (eg. among athletes and people using equipment with foot pedals).

RSI is sometimes also referred to by generic names such as RMSs (repetitive motion syndromes), CTDs (cumulative trauma disorders) and OOS (occupational overuse syndrome). Such descriptions of work-related syndromes were common in Australia and Sweden in the 1970's and 1980's. Or they can be described in terms of specific medical diagnoses, including: soft tissue injuries (tendonitis, tenosynovitis and bursitis), neuro-vascular syndromes (carpal tunnel syndrome, thoracic outlet syndrome, cervico-brachial syndrome, cubital tunnel syndrome), muscle strain and fatigue, etc. These kinds of descriptions are more favored in the USA.

These injuries are commonly described in terms of:

• wear and tear to soft tissues such as tendons and tendon sheaths, ligaments, etc. leading to chronic inflammation of the tissues
• impingement and compression of nerves and blood vessels by tight muscles, inflamed tendon or joint spaces (e.g. the carpal tunnel), between bony structures, etc.
• disruption to the neurological control of movements, eg. focal dystonia of the hand (FDh)
• muscular fatigue (where the electrical firing of muscles quickly becomes less strong or even unavailable)
• chronic pain syndromes.

In reality several of these conditions may well be occurring at the same time in someone suffering from these kinds of injuries.

The occupational health literature sees the causes of these conditions arising from:

• Rapid repetitive movements lead to strain and fatigue in particular groups of muscles and then to recruitment of other (inappropriate) muscles to get the task done
• Vibration (from micro vibration, such as computer keyboards, to macro, such as jack hammering)
• Working in the cold (air conditioning too low in the office, working outdoors, working in freezers, eg. in the food industry)
• Awkward postures due to poor ergonomics, equipment or job design (eg. keyboard too high, working with the arms above shoulder height, playing certain musical instruments such as the violin or viola). Lack of knowledge and training in how to use equipment to maximize safety and comfort is also a factor.
• Static loading: this can arise from awkward postures and also many regular sedentary jobs. Static loading occurs when work is required without the movement of the body parts, such as lifting the arms over shoulder height or simply lifting the hands to a keyboard. The muscles produce the by-products of muscular work (eg. lactic acid) without the movement that would help 'pump' out these by products and help bring in new nutrient rich and oxygenated blood. In fact a lot of machine and production line design arising from time-and-motion studies aimed at reducing the size of movements to enhance efficiency - but put people more at risk of static loading and tendon inflammation.
• Long hours of work with insufficient breaks during shifts and insufficient time between shifts for our muscles, our bodies, and us as people to rest and recover. For example, working overtime and working for start-up companies. Or for example, working in the health and human services and some non-profits, which are often understaffed, and where the staff are very dedicated to their clients or cause. Self-employed professionals and small business owners also often work long hours. Close monitoring by supervisors - the boss looking over your shoulder - is also correlated with the incidence or RSIs, and contributes to work-related stress. Not enough variety of work activities also makes extra demands on particular parts the body.
• Work speed and work under time pressure: such as assembly line or machine speeds, 'productivity monitoring' (counting key strokes) or piece work and productivity 'bonuses'. Working to short deadlines and financial pressure are definite risk factors.
• Occupational and life stress is correlated with people getting RSIs. Poor morale in the workplace eg. poor management, restructuring and the threat of layoffs. Economic insecurity in general is stressful in itself and often leaving people feeling they have to stick to the job or risk unemployment and poverty. Meanwhile professionals and self-employed people often feel the pressure of their financial situation being solely in their own hands (pun intended!)

How can Feldenkrais lessons help? 
Movement is good for you. Feldenkrais can help you prevent and recover from these injuries through:

• promoting good self use
• discovering proportional movement and effort
• reducing habitual effort
• developing your awareness of habits and new movement possibilities
• increasing sensory and motor precision
• using awareness to help you choose improvement.

Feldenkrais Method can provide essential tools as part of an integrated program for dealing with these injuries.

Feldenkrais can be done as Awareness Through Movement lessons - which are done live in a group or at home from a recording, using verbally-directed explorations. There are also Functional Integration sessions which are done individually, using a hands-on approach. Both are ingeniously designed to help you use yourself in a more efficient way, reduce unnecessary muscular work and become aware of how you can move more comfortably. Feldenkrais lessons use both functional and novel patterns of movement, along with directed attention, to help you improve the mechanics of your movement, reduce habitual, unnecessary effort and become aware of how to improve your action.

Movement is good for you
Activity increases blood flow and uses up physical energy mobilized by our responses to stressful situations. One way to combat the effects of static loading on the muscles of the legs, back, shoulders and arms is to have enough movement in our lives. Feldenkrais Awareness Though Movement can help you become more aware of how you can move with less pain and greater comfort and awareness. It can help you work, do your everyday activities, exercise and live more easily.

Good self use
There are a number of principles underlying good bodily movement. In a well-balanced body, in an upright position (standing or sitting), it is possible for much of the force of the weight of the body to be supported by the bones of the skeleton. The muscles only need to work enough to help us balance on our skeleton with a certain amount of (tonic) contraction to support our bodies and a certain amount of (phasic) contraction to allow us to move our body parts and rebalance ourselves.

If the skeleton is well aligned and moves to support our limbs as we move, there will be less strain on the muscles. However, if we lift our arms - without a suitable response in the pelvis, spine and ribs - then there will be extra strain in the shoulders and arms.

Proportional movement and effort 
Another principle of efficient movement is that the right muscles do the right work. As people work long hours, become fatigued and work in awkward postures, they begin to call on (recruit) muscles to do work that they are not meant to (eg. using the muscles of the neck and back of the forearms to lift the hands to the keyboard).

In fact the big muscles should do the big work (say of positioning the arms) while the small muscles do the small work (say fine movements of the hands, wrists and lower arms for manipulation and expression). It is also important that the right muscles do the right work at the right time - Feldenkrais lessons can help you feel how the different parts of yourself are called into action to form a movement of your whole self. Finally, effective movement also requires that we can move freely in the joints, feeling how they can articulate well with, as well as finding the necessary support from, the other parts of the body. The freedom in your ribs, shoulders, elbows, wrists and fingers that can help you bring your finger tips to the keys on the keyboard in just the right place, with just the right rhythm and pressure to make typing easier.

Habitual effort 

Through poor self-use, inattention to how we feel and working under stress (which also creates muscular tightness) we often use much more effort than we need to. Moreover, we often retain that muscular work in our hands and arms when we are not working. I often notice my clients with RSIs initially lie on my Feldenkrais table with their hands in fists or with the hand flattened and the fingers splayed - either way it takes muscular effort to keep the hands like this - they are not really resting their arms and hands! A unique aspect of Feldenkrais work is that it makes use of the Fechner-Weber law of biomechanics. The Fechner-Weber shows that using less force allows for more sensitivity to our actual level of effort. Finding how to only use the necessary amount of force, and really rest in between activity, is essential to preventing and recovering from these kinds of injuries.

Sensory and motor precision
Feldenkrais lessons utilize the intimate and essential relationship between sensation and movement to improve our functioning. Through touch and movement in Functional Integration, and directed attention and movement in Awareness Through Movement, people can regain sensation and gain a more precise sense of position and movement of their bodies, and in this case, especially the fingers, hands and arms. In this way people can sense themselves with more precision and reduce the chance of injury - or re-injury.

Choosing improvement and using awareness
All Feldenkrais lessons make use of the inherent ability of our nervous systems to sense ourselves and our environment - and directly use this information to learn how to move in new ways. Improvement comes in two ways:

• our nervous systems choosing and directly learning ways of moving that are more efficient, less effortful and less painful,
• conscious awareness of our movement habits and new options.

Awareness Through Movement lessons, such as those on my 'Easy Hands and Arms' CD series, create the possibility of becoming aware of your habits of movement - and new possibilities. The ability to know what we are doing as we do it is the basis of awareness. Moshe Feldenkrais often said, 'If you know what you are doing, you can do what you want'. It would be impossible to be consciously aware of every part of our selves at all times, but discovering the ability to shift our attention is a vital tool for discovering how we do move - and how we could move better.

In Awareness Through Movement lessons you are asked to attend to the sensations of the movements, such as: comfort, ease and smoothness, the movement in different parts of yourself and the connection between the parts, how the weight shifts in relationship to the environment. Learning to attend to yourself in Feldenkrais lessons can create new habits of being aware of yourself in your whole life. Feeling what is comfortable can help you make the best use of ergonomic equipment - to set up your workspace to suit your own needs and to change it when needed. In the lessons you practice attending to your internal, bodily sensations and making sure you are moving in a way that is comfortable for you. Again, in your daily life it is a useful to be able to more quickly sense when you are tired and fatigued - and if possible to immediately change your physical organization (posture) or activity, slow down a little, take a break.

On another level, dealing with the effects of demanding work requires adequate rest: listening to your body can help you make sure you are getting enough rest and sleep.

Part of a process, Part of a program In my experience most people benefit from a program that includes a range of activities and modalities. I think everyone can benefit from:

• Reducing physical stressors, for example: reduce repetitive work/activity; improve ergonomics and make effective use of the ergonomic equipment you have by awareness of what is safe and comfortable; improve self-organization in action (support, effort, etc.); increase rest; modify your job, or if you need to and can, leave a job that is contributing to injury.
• Increasing awareness of how you move, respond, act, including, reducing your stress response and improving your relaxation response (e.g. explore Feldenkrais Method, Tai Chi, gentle awareness-based yoga, mindfulness meditation).
• Improving circulation, for example explore: acupuncture, aerobic activity (walking, swimming, aerobics classes, etc.); or using awareness and directed attention: e.g. Feldenkrais, biofeedback.
• Avoiding chronic pain syndrome, for example by utilizing movement and awareness, breathing, appropriate medications, acupuncture, hypnosis, psychotherapy.
• Maintaining or regaining strength eg. initially in recovery, strengthen core (back, pelvis, legs, along spine first), and then when pain and sensory loss and disturbance are more under control, general exercise is beneficial - but always with awareness.

Because Feldenkrais Method can help you in all of these processes, Feldenkrais can play a vital, integrative part of prevention and rehabilitation from RSI type injuries for everyone. Awareness is the key: improving how we act, and how we interact with our environment, is the deep change that makes prevention and recovery more possible and more effective. As Moshe Feldenkrais said, "Movement is life. Life is a process. Improve the quality of movement and we improve the quality of life itself".

Self-image in action 
Moshe Feldenkrais wrote that we have a dynamic self-image that changes as we act and develops over time. For him, every action was composed of 'thinking, moving, sensing and feeling' in all their forms, and separable only in language and not in reality. A final and essential piece to preventing and recovering from RSI type injuries is to ask ourselves about our self-image. What do our hands and arms mean to us? How do we feel about what we are doing in our lives? How attached are we to our jobs - or how entrapped do we feel? What choices do we have in how we respond to our activity in life? How we could improve what we do and how we do it? It is very important to be open to reflect on the direction of your life, your occupation, and habits of attention, body and mind. Feldenkrais can contribute to this process in many ways - from noticing what you are really doing and how it actually feels, to feeling you have choices to do things differently. While awareness of movement is very useful, Awareness Through Movement and Functional Integration can change your life.

Cliff Smyth, 2007

Click on the link to find out about Cliff Smyth's Easy Hands and Arms program.