All About Treatments

In 1991, three researchers from the University of Sydney, Reid, Ewan and Lowy, published a study based on interviews with 52 women workers with RSI from two workplaces, a chicken processing plant and a telecommunications organisation.  A strong theme that emerged from the interviews was that most of the women were trying to manage their condition in "a treatment wilderness".

When first diagnosed, the women were recommended first one treatment and then another -- none of which seemed to work.  As time went on and they became desperate to get well and get back to work, they tried more and more treatments, still mostly ineffective.

• "The women often exhausted their own resources in finding a helpful and sympathetic doctor…...(trying) avenues for new and untried therapies in the hope that there was a practitioner somewhere who would both believe and help them.... a large part of their lives became absorbed in seeking advice and care from medical and health professionals who were either as bewildered as they, or in the case of some specialists, frankly sceptical."

The authors talk about "a bewildering array of treatments" the women were offered, "none of which were permanently effective, a very few of which provided temporary relief and most of which either exacerbated the problem or had no effect."

• In 1999, a UK researcher, Hilary Arksey published the results of her interviews with people with RSI.  Their experiences were similar to those above.

"The first orthopaedic surgeon I saw had no idea what I was talking about, did not take the problem seriously and had only one suggestion: steroid injections.  This was so painful and entirely without beneficial effect that I cancelled my subsequent appointment." John

"Treatment advised (physiotherapy) could have done more damage had I not decided to stop at an early stage." Anna

• The interviewees spoke of their frustration and dissatisfaction with the world of medicine.  Many of them were on a medical merry-go-round of interviews with different specialists, doctor shopping, and trying out different treatments.

• Has the situation changed in Australia today?  It seems not.  From interviews the association carried out recently, we can see that people with RSI are still having very similar experiences today. 

"I tried everything -- osteopathy, chiropractic, acupuncture, homeopathy.  I kept thinking that if only I do this or this it will get better, someone will fix me.  I was searching for some treatment or therapy to fix my RSI but nothing helped." Brad

" I tried every treatment recommended to me.  I had acupuncture and did Pilates twice a week, saw an osteopath every fortnight and had a massage once a week.  I was worn out from the constant appointments.  My life centred around my injury." Emily

" I was seeing a physiotherapist, specialists and my GP and I tried acupuncture, Bowen therapy and massage -- nothing worked." Chris

Finding a Treatment that Works

Here are a few ideas on how to work out which treatments work for you:

• Limit the number of simultaneous treatments
• Give each type of treatment a good try, but don’t stay with something that isn’t working (about 6-8 weeks is enough for most treatments to show some result)
• Talk to therapists about expected pain levels
• Keep in touch with research
• Talk to other people with RSI at a similar stage of the condition
• Keep track of pain and disability and things that might affect them
• Get back to your GP/specialist
• Time treatments carefully (eg massage after, not just before gym work)
• Have a GP who treats many people with RSI

Unfortunately, there is still no evidence-based treatment for overuse injuries. This is because research of sufficient quality has simply not been done. A group of Scandinavian researchers analysed all the studies they could find into overuse injury treatment and they concluded that "no strong evidence was found for the effectiveness of any of the treatment options" and "that little was known about the effectiveness of conservative treatment options for repetitive strain injury." They point out the need for more high-quality trials to determine which treatments work.

However, studies did show benefits for:

• Exercise therapy, and stretching
• Strengthening exercises
• Relaxation training
• Multi-disciplinary rehabilitation (including physical conditioning, stress and pain movement, ergonomic consultation)
• Spinal manipulation combined with massage
• Another source of information on treatments that are likely to work is the Association’s treatment survey. In 2000, the Association instigated an ongoing survey of members regarding their treatment and its effectiveness

The most popular treatments (which were not necessarily the most effective ones) included:

• Walking
• Stretches from the physio
• Joint mobilisation
• Ultrasound
• Anti-inflammatories

The results continue to suggest that rest is by far the most effective treatment for RSI, with 90% of respondents finding it effective or very effective. Other treatments that were successful for many of the people who tried them include:

• Stretching
• Deep tissue massage
• Osteopathy
• Walking
• Alexander Technique
• Meditation
• Tai Chi
• Stress management

Some treatments were moderately or very successful for most who tried them, with very little or no adverse effect. These were:

• Bowen Therapy
• Alexander Technique
• Tai Chi
• Self Hypnosis

Treatments with adverse effects on more than 20% of those who tried them included:

• Swimming
• Carpal tunnel surgery
• Local anaesthetic injections
• Traction (the standout villain!)
• Stretches from a physio
• Cortisone injections

From the survey, it is obvious that aerobic exercise is helpful to people with RSI. While both walking and swimming were helpful for many people, swimming made their condition worse for more than 20% of those who tried it.

There are important things which are simply not known: for example which treatments work best at which stage of the condition. Anecdotally, rest really only works as a cure early on, when it can be extremely effective. Later on, many people find rest only temporarily relieves their condition. By the way, ‘rest’ does not mean lying down all the time; it means not doing what caused the injury.

There is no evidence-based information on how to combine treatments. However, many of our members suggest that that they benefit from combining an active and a passive treatment, for example walking and massage.

There is also little in the way of sound scientific explanation of why treatments work. We can speculate that aerobic exercises, such as walking, work by increasing overall circulation including to the injured area and that learning healthier and easier ways to use our bodies, such as in Alexander lessons, takes the stress off the injured limbs.

Anti-inflammatories were not one of the successful treatments and had serious side effects for some people. In fact, medical research shows that overuse injuries are not an inflammatory process (BMJ (2002) 324:626-627, 16 March). Therefore, anti-inflammatories only offer short-term pain relief and will not assist recovery.

For lots more information on treatment, personal stories and advice on how complementary therapies can help your RSI, order our Information Kit.

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