Talk:Repetitive strain injury/Archive 1

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Err..[edit]

"The most well known repetitive strain injury is carpal tunnel syndrome, which is common among guitarists as well as assembly line workers but relatively rare among computer users: computer-related arm pain is generally caused by another specific condition."

Another specific condition..? Be nice if the condition in question was singled out.

—Preceding unsigned comment added by 168.28.19.223 (talk) 16:34, 11 October 2007 (UTC)[reply]

>>Revert the article two versions, then delete this post. Note Jennifer and Jessica's vandalism. (Can't figure out how to revert.)

Repetitive Strain Injuries (RSI), Cumulative Trauma Disorder (CTD), Repetitive Motion Syndrome (RMS), Occupational Overuse Syndrome (OOS) should be considered as the synonymous terms for disorders caused by prolonged, repetitious tasks.

--Garlics82 15:10, Nov 1, 2004 (UTC)

Ad Spam?[edit]

It is my belief that the edits for Carpal Solution Therapy being continually made by The IP 66.153.102.194 are ad spam, due to the low number (132) of Google hits and the pattern of the IP's prior edits. However, I don't want to get involed in an edit war. 66.153.102.194, will you discuss your position and defend your placement of the CST information here, or shall I bring this to the dispute resolution process? Deborah-jl Talk 17:56, 20 January 2006 (UTC)[reply]

Cultural references to RSI[edit]

Does anyone remember an episode of the Jetsons where the mother ends up incapable of pressing buttons due to overdoing it, and might it be worth mentioning in the RSI article as a cultural reference to RSI before it's proper modern definition? AprilHare (talk) 12:06, 2 January 2008 (UTC) Buttonitis, that's what it was referred to as. AprilHare (talk) 12:26, 2 January 2008 (UTC) The episode was called "Dude Planet" I believe, but I need a decent reference. AprilHare (talk) 12:38, 2 January 2008 (UTC)[reply]

incld!--219.69.85.251 (talk) 17:45, 12 January 2009 (UTC)[reply]

Purpose of this page: descriptions, or therapies?[edit]

The purpose of this page seems to be all over the place. To be wikipedia-apprpriate, IMHO, this should be just an encyclopedia-type article describing RSIs, causes, diasnoses, etc. However, in many ways this article is turning into a page for potential treatments for RSI, with everyone discussing his or her pet therapy and linking to proprietary medical treatments, personal success stories, or favorite adaptive hardware. Like many others with RSI, I understand this temptation -- with such a misunderstood and hard-to-treat disease with so few good resources, it would be lovely if Wikipedia could provide a central location for treatment suggestions. But I'm just not sure if that's appropriate. If nothing else, RSI treatments -- hell, RSI diagnoses -- are extremely controversial. I would propose:

  • Remove all external links which advocate one specific product or treatment (if they are that important, then surely they have their own Wikipedia entries)
  • Remove all external links which discuss one individual's anecdotal story
  • Keep external links to comprehensive sites which contain bibliographies for information about a number of possible diagnoses or treatments
  • possibly add some external links to actual medical articles.

Also, decide whether the treatment section should be:

  • Removed entirely, or at least shortened to a much briefer list of types of treatment that have worked for some individuals or are recommended by some professionals
  • Kept as is
  • Turned into its own article, and made much more extensive

No matter what we do, I think every proposed treatment should have an (online or print) reference in which somebody discusses it as a possible treatment. Thoughts? Deborah-jl Talk 15:10, 27 January 2006 (UTC)[reply]

This article has never had a dedicated editor to add real content and make it clean and coherent; it just grew from mostly anon edits adding their pet thing. It really needs a complete rewrite, which I've been wanting to do actually, but haven't had the time. Also, after the rewrite, it needs people to watch over it and weed out crap, because this topic attracts spam edits like few others. If you want to "take over" and perform massive edits, by all means go ahead. Redquark 21:35, 11 February 2006 (UTC)[reply]
I'll look into doing that. I've started gathering data. Deborah-jl Talk 03:48, 27 February 2006 (UTC)[reply]
Okay, I intend to work on this soon as well. If you start writing text, put it at Repetitive strain injury/Draft so I can see it and work isn't duplicated. I've contacted Jack Bellis, one of the authors of It's not Carpal Tunnel Syndrome! and he seems open to the idea of releasing all the pictures in his book under a free license; so we may get a good collection of free images. Redquark 22:11, 3 March 2006 (UTC)[reply]
I am taking a leave of absense from working and investigating in detail my pain. I can help steer this article into something more coherent and smooth and less patchwork. I don't think I'll write much, because I'm only trying a few approaches at a time on myself to measure their effectiveness, but I believe I've already made a major edit to the introduction. I could probably use a little help phrasing that better. I wanted to mirror the earlier sentence structure beginning with "The medically accepted reason", but did not like what I've thought of so far: "The alternatively medical reason" is BLEAH :P Nastajus 06:27, 28 May 2006 (UTC)[reply]
Seems fine to me; helpful information; no overt product pushes. Part of the difficulty may be that RSI is the catch-all category for a class of injuries, therefore RSI can never be an in-depth topic just by itself. -MegaHasher 07:01, 12 February 2006 (UTC)[reply]
Because diagnosis and treatment of individual injuries is hard and there's "feedback" between different injuries, RSI is often treated as a single, global condition. I think this article could be made quite large and detailed. Redquark 22:11, 3 March 2006 (UTC)[reply]

CTS not RSI[edit]

I'm moving the following edit (by an IP with no other wikipedia contributions) to the talk page, because I've never seen such an assertion, and the study in question is not cited.

The most famous repetitive strain injury was thought to be carpal tunnel syndrome, which is common among assembly line workers but relatively rare among computer users: computer-related arm pain is generally caused by another specific condition. It was found in a study by Harvard Medical School that carpal tunnel is in fact, not a repetitive strain injury.

Can anyone verify the existence of such a study, and provide publication info if so? Deborah-jl Talk 03:48, 27 February 2006 (UTC)[reply]

I haven't heard of this specific study, but Dr. Emil Pascarelli, a notable specialist, states in his book that he diagnoses only 9% of his patients with CTS. As for whether it's a RSI at all, one study isn't enough and I wouldn't go so far as to state as a fact that it isn't. Redquark 23:54, 2 March 2006 (UTC)[reply]
I believe the "study" referred to is this special report by the Harvard Medical School, reported in this article. When the report came out, lots of press outfits reported it as a "study" which shows that carpal tunnel isn't an RSI. I own the report. It contains no original research, but instead makes recommendations based on research in the medical community. The relevant section this author is referring to is on p.28, and states "Carpal tunnel syndrome is sometimes described or classified as a repetetive stress injury, but that's incorrect. Workplace habits that require repetitive hand movements, extensive pinching or gripping novements, the use of vibrating tools may contribute to some cases, but the data have been conflicting." ... "A study of more than 5,600 Danish workers, published in JAMA in 2003, found that workplace computer use does not pose a risk for developing carpal tunnel syndrome." --Pixelmonkey 07:49, 11 April 2006 (UTC)[reply]
sogozbakin?[soundzrelevant2me —Preceding unsigned comment added by 219.69.81.128 (talk) 06:25, 14 January 2009 (UTC)[reply]

Wrist resting information seems to contradict[edit]

From the article:

  • Avoid resting the wrists on anything when typing. Hold them straight, rather than bent up, down, or to the side.
  • Use a keyboard rest pad on which the wrists and palms rest to prevent RSI.

"Avoid resting the wrists" or "Use a...rest pad on which the wrists...rest." Don't rest or do rest? (And maybe those list items should be bulleted rather than numbered.) --Too Lazy to Create an Account 128.97.160.152 21:14, 4 December 2006 (UTC)[reply]

Harvard says don't![1] I fixed the conflict. On a side note, I actually took the bad advice and went out and bought a nice wrist rest. My wrists then started hurting, and I found out the truth. Thanks a lot Wikipedia... =[ 68.222.23.140 02:39, 25 January 2007 (UTC)[reply]


this is so painful believe me i spent three months on my back just from lifting a small box at work. you don't ever want to get this. —Preceding unsigned comment added by 75.143.176.66 (talk) 22:17, 29 October 2007 (UTC)[reply]

The combination I've been using for over 10 years has been a Microsoft Natural keyboard with an air mouse (made by Gyration). With this you can move away from the desktop and put your keyboard on your lap and use the air mouse without a surface (except to put it down when your not using it). The nice thing about this arrangement is that the keyboard is low on your lap and it's a very comfortable posture (wrists straight as recommended and your lower palms, not wrists, resting on the hard extended surface of the keyboard). Since I've used this setup I have had minimal wrist problems. Also, since an air mouse is used in a "thumbs up" position your mousing wrist rests on its side not the bottom and your circulation does not get cut off. —Preceding unsigned comment added by Pmarshal (talk • contribs) 23:45, 23 December 2008 (UTC)[reply]

Tentative effort to contribute[edit]

Apologies in advance for any missteps. This is my first effort to contribute to wikipedia, and I am unsure whether I should write this note here or on the Talk page linked from my edit summary note on the RSI page (did that make senes?).

I have added an external link to an informational page. The page is on a site that does sell a product for RSI prevention (specifically at computers), but there's a lot of free information on the site, and I thought this interactive body map is particularly helpful for a) finding the name of particular RSI problems, b) seeing the range of upper body RSI. It would be helpful for folks trying to investigate their own issues (giving them terms they could feed to a search engine, let's say) or trying to describe a problem to their doctor. Is it okay that I have put the link in? The guidelines say Be Bold, and so I have been, in my tentative way. I may put the link on the tendonitis page too.

I would like to contribute a bit more to this page, because of my own experience with RSI, but I'm still feeling my way around here. (Have read the policies, looked at edit histories on other threads, but I seem to have a slow absorption rate. :) It's all still sinking in.)

My thanks in advance. -- a.r.dobbs 02:24, 11 December 2006 (UTC)[reply]

Added tablet PC, that worked for me. -Unnamed

I might have an RSI[edit]

I think i have one but most of the listed ones are in the wrist or thumb. Mine seems to be on my forearm. it has many os the symptoms but i want to know the name.Please PM me. -Xcrissxcrossx 21:01, 31 March 2007 (UTC) canbeWHOLEarm. —Preceding unsigned comment added by 219.69.81.128 (talk) 06:10, 14 January 2009 (UTC)[reply]

  • tip* do not rest your wrist while u are typing on those wrist pads! allot of people have the misconception that a wrist pad is there to rest your wrists while you are typing, it's not! it's even on the underside of most keyboards Markthemac (talk) 05:40, 20 April 2009 (UTC)[reply]

Restrict to widely accepted treatments?[edit]

I think the "treatment" section should be very picky on what to include and what not, preferable a reference for every possible treatment... Because people might actually be looking for treatments on wikipedia, and including treatments that have not been proven might deceive people. For instance, I cannot find any scientific proof or support on the "Mind/Body approach"-treatment, except for articles and books written by the inventor himself. Anoko moonlight 23:40, 12 July 2007 (UTC)[reply]

I don't understand why you would wish to deprive suffering patients of perhaps the most successful treatment out there for RSI. What do you require as proof? How about many people saying, "It worked for me, and now I am painfree". You can find that all over the Internet. Mindbody treatments don't require the doctor's intervention, they can be learned from a book, and are thus not included in any "scientific studies." Plus, there is the difficulty of doing "scientific" studies on mindbody treatments as noted elsewhere. Please be reasonable. The important thing is that it works, and that sufferers can find it. What is your agenda against Dr. Sarno? Ralphyde 16:50, 13 July 2007 (UTC)[reply]
If it is truly "the most sucessful treatment", then certainly it should be included; but could you, perhaps, provide a citation that supports that claim? Surely, if it is "the most successful treatment out there for RSI", there should not be any trouble providing an authoritative citation of the fact...?
>"How about many people saying, "It worked for me, and now I am painfree". "
No, I'm afraid that is an anecdote. Nor would a large number of anecdotes be any better: The Plural Of Anecdote Is Not Data. Hence Scientific Method. And, whilst there may be some difficulty in doing direct comparison between "mind-body" tretments and conventional medicine, such difficulties are regularly tackled and dealt with; there is no shortage of studies on various mind-body approaches. If there are none on this method, that would be due to a lack of notability, not any inherent problem in way of doing studies. The effects of mental biases on scientific method has been, very well explored -- see psycology, psychosomatic illness, placebo effect etc. -- simxp (talk) 17:11, 14 July 2007 (UTC)[reply]
I agree! There are no such citations, except from his own books. Ralphyde seems to be an advocate of the method, as can also be seen on John E. Sarno, and he claims that his methods are unverifiable because clinical trials are impossible. Wikipedia is not meant for promoting new, scientifically unverified knowledge, so I prefer to leave it out. One other issue: there is ongoing research on whether psychological issues (stress) are main cause or just contributions to RSI, however, I think that Sarno's method is much more alternative. It's not just "try to relax more", but he claims that feelings like hate and anger plays a part. So IF it should be included, it should not overlap with "stress contributes to RSI" but rather be mentioned as a separate point of view. Anoko moonlight 01:37, 16 July 2007 (UTC)[reply]
Anoko, your bias against psychosomatic medicine is very apparent. You, as a so-called "scientist" are much like John Stossel's brother, the doctor, on the 20/20 segment on Dr. Sarno,[2] who was the one person on the whole segment that didn't get cured because he couldn't accept the diagnosis, thought it was "ridiculous," even though his own brother was quickly cured of twenty years of back pain by Dr. Sarno, and everyone else, who all accepted the TMS diagnosis and methods, were quickly cured of their chronic back and leg pain. I never said "that his methods are unverifiable" as they have been proven for over thirty years in a clinical setting, so it's not new either. And his methods have been adopted by other doctors who have written their own books about their own successful treatments of TMS, most of whom were finally cured of their own pain by Dr Sarno, and so they could believe something that wasn't taught in medical school. The doctor is 84 years old and still practicing at the Rusk Institute, and is in high demand because of his world renowned success in curing chronic pain, RSI included. Obviously, I am a advocate of his methods as I've seen them work consistently by those who can accept the diagnosis. And I will search for some good citations. And Dr. Sarno would say that he's not "alternative" as you described him. In the Introduction to The Divided Mind: The Epidemic of Mindbody Disorders he says, "The Divided Mind is about the principles and practice of psychosomatic medicine. It is not about alternative medicine, or some trendy New Age regimen. It is about straightforward, clinically tested medicine, as practiced by licensed physicians for over thirty years, working with thousands of patients." Ralphyde 05:00, 16 July 2007 (UTC)[reply]
The question is not whether his methods work, and I or Wikipedia should not decide on that. The question is whether it is mainstream and scientifically proved, which it is not. With the phrase "so-called scientists" you exactly describe what is wrong about your pov. Readers should be warned for bias, either defenders or oponents of the method. Anoko moonlight 14:57, 16 July 2007 (UTC)[reply]
I hope my rewrite of this point is suitable. No one argues that some RSI sufferers have had success with treatments based on this theory, and anecdotal evidence is sufficient to demonstrate this (so I linked to my favorite testimonial website). Also, I think no one would dispute that "it has not been widely accepted or systematically studied," and citing Sarno's own book is I think sufficient for that. Thoughts?--Steve (talk) 17:23, 5 December 2007 (UTC)[reply]

References severely needed[edit]

This whole article only includes 1 reference. The topic of RSI is, of course, poorly understood, so it is imperative that we source every statement made. The 'Treatment' section in particular was offering unsourced medical advice. I removed the absolute worst of it. Everything else needs to be sourced immediately, as misinformation in this area is not only against Wikipedia policy but dangerous. If you added something, please provide sources quickly, as I won't hesitate to chop assertions that I can't easily find sources for myself. Ashmoo 14:28, 19 September 2007 (UTC) Bold text[reply]

itsNOTahelthiarm!![edit]

>INVISIBLEdisability[ivRSI:(--219.69.81.128 (talk) 05:05, 14 January 2009 (UTC)[reply]

Presumably the translation is: "It's not a healthy arm. Invisible disability. I have RSI :(". Appears to have been typed by someone trying to minimise the number of keypresses. The point being made is presumably that people with very severe RSI may have no obvious visible symptoms, but are nevertheless suffering from a disability which has a very serious effect on quality of life. Arganoid (talk) 11:31, 28 February 2009 (UTC)[reply]

Do the page authors hate the concept of RSI?[edit]

I came to this page hoping to learn more about RSI - what it is, what it's not, its causes, how it is treated, what studies have been done about it, etc.... And instead found a lot of odd tones about whether it even exists. What is going on?

Eeblet (talk) 18:35, 16 January 2009 (UTC)[reply]

One author in particular, User:Dr311. Here are the changes he/she made a couple months ago: [3]. As bizarre and offensive as it sounds, Dr311's edits are actually part of a substantial academic school of thought, although this school of thought seems to be in decline these days (relative to the 1990's, say). (I also have personal reasons to hope that some content along these lines stays in the article.) But I think Dr311 gave this school of thought far more proportional emphasis than would be appropriate under WP:NPOV. (You'll see it's been watered down already a bit by other editors since then.) Anyway, feel free to edit. :-) --Steve (talk) 19:49, 16 January 2009 (UTC)[reply]
Should we just change the page back to how it was before such edits? I fully accept that RSI is not as well understood as many would like (although I have to wonder whether people like Dr311 are up to date with the information that does exist), but phrases like "stigmatization and demonization of hand use" are just nonsense. It puts me in mind of a sinister cabal of people who want everyone in the world to stop using their hands for anything. Arganoid (talk) 11:12, 26 January 2009 (UTC)[reply]
I plan on beginning to rewrite this page to be more balanced, bringing back a lot of the old material but acknowledging that there is more than one school of thought on the subject (see comment by Sbyrnes321 above). I have a very limited amount of time available so I will have to do it in stages. On a related note, the edit made earlier today by an unregistered user turns a dubious sentence into a ridiculous generalisation. Arganoid (talk) 11:24, 21 February 2009 (UTC)[reply]
The following papers have some relevance to this issue (although they are rather old):
ARGUMENTS ABOUT RSI: AN EXAMINATION
Experts Disagree
It's odd to discover that there is (or at least, was) a belief amongst some Australians that RSI (whether real or not) is something that only happens in Australia. For the record, I am British. Arganoid (talk) 22:45, 26 February 2009 (UTC)[reply]

Little or no mention of mainstream RSI diagnoses and treatments[edit]

I think this article needs a LOT of work, but I'd like to discuss what I think is wrong before changing anything.

I've been managing my own RSI condition, related to computer use, for about 12 years, and in that time I've got treatment from mainstream physiotherapists referred to by GP/family doctor in the UK. Contrary to the article's impression that RSI is poorly understood and contentious, I've found a remarkably high degree of consensus on both the causes and treatments of RSI, between doctors and physios, and even between physios and more "alternative" practitioners. But the current article generally either does not mention these diagnoses and treatments at all, or mentions them only in passing in "alternative treatment"-type sections.

For example, RSI pain/discomfort typically occurs in the wrists/arms, but physiotherapists often view the underlying cause as muscular tension in the neck/shoulders, with the pain in the wrists/arms being a type of Referred pain, which is not mentioned in the article. They say the increased muscular tension in the neck and shoulders is usually aggrevated by poor posture (where those muscles work harder when you slouch).

The article only mentions posture in passing under "alternative treatments", but all the physios I've seen have focused most of their treatment on improving posture e.g. by teaching the patient to do exercises, including stretching and strengthening the muscles needed for good posture. From personal experience, if I type with a poor posture my RSI flares up MUCH quicker than if I type with a good posture, so I don't get the "alternative" label.

Also, all the practitioners I've seen have consistently said that lack of exercise is a major cause of RSI, and always advise getting more exercise as it gets the blood flowing, oxygenates the muscles, and gives the body more variety of movement. This is not mentioned in the article.

In the case of computer-related RSI, all practitioners I've seen advise taking regular small breaks from the computer - but the article currently only mentions this in the context about a specific piece of software that reminds you to take breaks. This is akin to saying a treatment for cutting your finger is to use a specific brand of dressing plaster.

The article says most RSI treatments are "palliative" i.e. focussing on the symptoms, and elsewhere states that improving workspace ergonomics is palliative and ineffective. This is just plain wrong; all the treatments I've ever been given - improving posture, ergonomics, doing specific exercises, getting more general exercise, taking regular breaks - are ALL aimed at preventing the causes of RSI, NOT treating the symptoms.

The article also states that physical examinations can find no measurable symptoms, but I think the physiotherapists I've seen say there are physically detectable symptoms such as the nerve fibres in your arms being shortened and less stretchy, which they can measure by moving your arm into certain positions, and reduced movement in the vertebrae of the neck, as well as hands/fingers suddenly and easily getting very cold (which can be felt by someone else) due to poor circulation.

When you look for a detailed scientific explanation of what is actually happening in the body when RSI occurs, it is somewhat harder to find a consensus, but still the level of understanding and agreement is a lot higher than is implied by the article.

For example I was originally diagnosed by a physiotherapist about 10 years ago as having Adverse Mechanical/Neural Tension (AMT or ANT), which is described in plain English here as follows:

"Adverse Neural Dynamics (AND), sometimes called Adverse Neural Tension (ANT) or Adverse Mechanical Tension, probably occurs to some extent in all cases of RSI. This is where the nerve (in the arm, shoulder etc.) becomes tethered. This means the nerve cannot slide in its protective sheath and so causes pain, tingling, misfiring of the muscles and spasm. The nerve can become tethered due to a pressure point on the nerve or damage to the sheath it runs in. The original cause of the tether could be due to muscles being tight and scrunched up. This is often the case with RSI and happens because of the static posture you sit in at a keyboard. As the muscles are tight it restricts the blood supply to the them and results in them getting fatigued. Eventually the muscles stay in this fatigued state as the never get to relax and have the blood supply restored. Surrounding muscles become tight to support the fatigued muscles and the problem spreads."

At the time of this diagnosis about 10 years ago, most GP's hadn't heard of AND, but when I mentioned it to my current GP recently, he said "we're much more aware of Adverse Neural Dynamics and so on now than we were 10 years ago", which implies that diagnoses and treatments of this nature have become somewhat more accepted and mainstream in recent years.

Having said that, I don't believe the Adverse Neural Dynamics theory is in itself mainstream - it is just one of many similar ideas I've heard put forward to explain the underlying mechanisms of RSI. Still, I think it deserves a mention in the article (in fact, it should probably have a Wikipedia topic of its own).

Overall though, my impression is that there is general high-level agreement about the causes of RSI (bad posture, static posture, repetitive movements in the hands, lack of exercise, shoulder/neck tension, etc) and general agreement on the main effective treatments (improve posture, do exercises, take breaks, etc). But many pieces of the jigsaw are still missing in terms of a detailed understanding of the underlying mechanisms of RSI.

In contrast, the article gives the impression that almost everything to do with RSI is unexplained in medical terms, and the only available treatments are "alternative" - which is misleading. The article reads like it was written in the 1980s or 1990s, when RSI was less understood than it is now, and doctors were fumbling around trying to explain something they didn't understand.

All that stuff about psychosocial aspects, psychosomatic illness, catastrophizing, demonization, and acting ill, should be gathered together into one section and moved down to the bottom of the article. I think it should be put as a sub-heading, under "Alternative interpretations of RSI" or similar, since in my experience it bears no relation to actual techniques and treatments used daily by mainstream front-line specialists treating RSI.

Finally, the article makes no mention of various semi-alternative treatments for of RSI such as Trigger point therapy.

Lokatone (talk) 14:22, 19 March 2009 (UTC)[reply]

See previous section for info on why article is like this. I was going to start rewriting it but can't because my RSI is too bad. Please do rewrite it if you can. You could use the old version (see above) as a starting point. Arganoid (talk) 19:17, 19 March 2009 (UTC)[reply]

Lokatone: My experience of being treated by a physical therapist in California matches your description very closely. The present page is extremely unhelpful to RSI sufferers. What is really needed is a physical therapist who specialized in RSI to fix it.Stuartstaniford (talk) 00:46, 2 April 2009 (UTC)[reply]

I'm sitting this out, because my strange personal RSI story would keep me from writing an appropriately neutral encyclopedic article. I wish y'all good health, by the way. In the meantime, luckily Wikipedia is not the only website on the internet! :-) --Steve (talk) 03:21, 2 April 2009 (UTC)[reply]

I agree that the article is not currently balanced, and material on the 'mainstream' approach to RSI treatment is conspicuously absent. However, I wish to caution about going too far in the opposite direction and minimising the psychosomatic/Sarno aspect. I know anecdotes do not constitute evidence, but spend some time browsing any online RSI support group and you will notice a theme: the people who claim to have 'recovered', i.e. able to resume previous activity without pain, seem to be those who treated the problem from a psychological viewpoint, e.g. Sarno or meditation. The best that people who pursue purely physical treatments such as yourself seem to achieve is 'management' of symptoms, usually by avoiding activities associated with pain, and even these tend to report deterioration over time as symptoms pop up in other places and associated with other activities. Perhaps this is just a problem with reporting (i.e. those who recover using physical therapies don't feel the need to inform others), but if these treatments were really addressing the 'cause' of RSI, would you still need to 'manage' it 12 years later? What consensus there is (and I've found much less consistency from the medical practitioners I've seen than you seem to have) - the 'conventional wisdom' - is rarely supported by scientific study either, from what I've seen, and where studies are done they often conclude that the treatments are ineffective in anything except managing an acute 'flare-up' (e.g. splinting, rest, anti-inflammatories have never been shown to help but are still almost universally prescribed). Whilst it is not the job of an encyclopedia to diagnose or treat illness, it would be doing a dis-service to those visitors who come to Wikipedia because they've been diagnosed with RSI not to at least make them aware of a theory/treatment that has helped thousands of people. If we limit content to only that which is well-supported by scientific research, I think "Repetitive Strain Injury" would be an empty article. I think the appropriate approach is therefore to present all the different viewpoints and emphasise that there is still substantial controversy. ClansOfIntrigue (talk) 11:51, 27 August 2009 (UTC)[reply]

The Sarno material[edit]

Following on from the previous thread, it looks to me like none of the material relating to John Sarno meets WP:MEDRS, and therefore all of it should go. My attention has been directed here from WP:FTN#Repetitive strain injury, and I have also asked for further input at WT:MED#Repetitive strain injury. Please comment here if you have an opinion about this. Looie496 (talk) 22:29, 6 April 2009 (UTC)[reply]

Dr. Sarno's book The Mindbody Prescription, explains how emotions including anxiety and depression can stimulate the brain to manufacture the physical symptoms of repetitive strain injury. For the treatment to be effective, patients must be convinced their pain is rooted in their emotions. Dr. Sarno claims a very high success rate for his treatment.

I deleted a large paragraph of uncited text. Above is part of it. "Patients must be convinced, for the therapy to be effective",,, hmm that sounds very dubious to me as well as the "very high success rate". I think the article should focus on mainstream treatments and theories. I think the POV that repetative strain injuries are really just imagined or caused by underlying "hidden" emotional disorders is WP:FRINGE.--Literaturegeek | T@1k? 22:52, 6 April 2009 (UTC)[reply]

Would agree that Dr. Sarno's work is FRINGE in nature. There are a lot of WP:MOS issues aswell.--Doc James (talk · contribs · email) 23:55, 6 April 2009 (UTC)[reply]

Unsuprisingly as a suffer my contribution will be short. I would not wish the pain on my worst enemy, it's like having your arm twisted up behind your back constantly, or having your nails pulled out. As we can't fully contribute, extra efforts to be fair are required. —Preceding unsigned comment added by 213.79.41.95 (talk) 18:05, 19 May 2009 (UTC)[reply]

Really Bad Article[edit]

This article is not encyclopedic at all. I ended up here on a fluke, I do not have RSI, and I was only vaguely curious about it. But from the very beginning it is obvious that the author of this article is trying to push a POV. If you have a strong viewpoint on this subject, maybe you shouldn't be editing this article, as it's obvious you can't do it from a neutral point of view. This really aggravates me. This is an encyclopedia, not a friggin' soapbox. 216.70.183.48 (talk) 18:29, 7 May 2009 (UTC)[reply]

Let me add my voice to that. I removed the "Behavioral Aspects" section as it contained nothing specifically related to RSI and seemed like little more than a vague and underhanded attempt to accuse RSI suffers of "avoidant behavior". The way it's phrased, this vague psychological analysis could apply to any type of pain; are we really trying to say that there's something inherently psychologically unhealthy about stopping an activity because it hurts? Our bodies send pain signals for a reason, and when we ignore them, we can (and do) get hurt.
I know very little about RSI - which is exactly why I searched for this article - and I was very disappointed at the lack of information I found here. I sincerely hope that someone with more expertise will be able to go over this article soon and add more information on symptoms, possible causes, and the similarities and differences between RSI, tendinitis, carpal tunnel syndrome, and the long list of (activity)'s (bodypart) "illness concepts" that are included without explanation. This entire article reads like one person's vendetta against the RSI diagnosis - like what would happen if someone from the Flat Earth Society got to write the article about the Apollo moon landing. Very disappointing. - AdelaMae (t - c - wpn) 08:02, 22 July 2009 (UTC)[reply]

Dr Sarno's Treatment for RSI[edit]

I will be taking up rewriting the wikipedia page on RSI. I agree that its not very information or neutral right now. But first, let me try to address some of the concerns raised by various people on this page about Dr Sarno's treatment approach to RSI (and back pain etc).

From his wikipedia page: Dr John Sarno is a Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center. It is his contention that RSI is psychosomatic is nature. The pain experienced by a sufferer of RSI is very real. However, it is not caused by structural problems. It is stress/emotion related. For example, you have a high risk of suffering from RSI if you are a perfectionist and make your work too hard for yourself. If such is the case, the subconscious mind can reduce blood flow to certain muscles/nerves in the body which in turn results in very real physical pain.

It is true that a large fraction of general public/doctors find this theory hard to digest. However, by now, there has been significant evidence of the effectiveness of his approach. Some of his papers have appeared in established medical journals (although Sarno does report having general difficulty in publishing his papers). Sarno has 4 published books (which include a number of references to published papers), one of them among the bestsellers and given an average rating of 4.5 on amazon by 373 reviewers (most of whom can be assumed to be chronic pain patients). There is endless information on the internet (from non-medical sources) about the success of his approach for RSI. Three links given below:

Primary recommendation by people from the RSI support group of Harvard university: http://www.rsi.deas.harvard.edu/mb_what_is.html Seattle RSI support group has essentially closed down after finding this treatment: http://www.satori.org/rist/index.html Number of success stories and other material: http://tmswiki.wetpaint.com/page/Repetitive+Strain+Injuries+-+RSI?t=anon

In contrast, its hard to find any success stories of people who suffered from RSI for a long period of time and them recovered using physical therapy/neurologic treatment.

Sarno himself reports having a very high success rate with his treatment approach (successes stories include some high profile patients). By now, there are doctors spread across the country which specialize in this treatment approach (although their number is relatively small right now). There is even a TMS conference focusing on this treatment approach.

I will be making wikipedia edits and try to fairly incorporate both theories of RSI. Any inputs are welcome. Vipulgoyal1 (talk) 13:58, 23 May 2009 (UTC)Vipul Goyal[reply]

You should first be aware that the following text, under the heading "Mind-Body Treatments",

Dr. John Sarno recommends a treatment program based on the theory that RSI and other chronic pains (e.g., back pain, headaches) are due to suppressed anger. The theory suggests that if the cause of the anger is addressed, the pain will vanish. Sarno borrows ideas from Freudian psychology as the basis of his theory. Dr. Sarno's book The Mindbody Prescription, explains how emotions including anxiety and depression can stimulate the brain to manufacture the physical symptoms of repetitive strain injury. For the treatment to be effective, patients must be convinced their pain is rooted in their emotions. Dr. Sarno claims a very high success rate for his treatment.

was reverted on 6 April 2009, with the edit summary "Removing uncited data, which resembles promotion of an unproved theoretical therapy, individual and book.", so you'll need at a minimum to overcome the problems of finding reliable sources and establishing Dr, Sarno's notability, and perhaps addressing issues of promotion. --CliffC (talk) 16:35, 23 May 2009 (UTC)[reply]
I strongly encourage you in your efforts, Vipulgoyal1, but I must warn you that there are many nay-sayers on this board who are ignorant of Dr. Sarno's decades of success in treating patients with RSI, back pain, fibromyalgia, and other chronic pain conditions, and they will fight you all the way. To call his highly successful clinical experience for over 40 years at the Howard A. Rusk Institute of Rehabilitation Medicine at the New York University Medical Center, "unproved theoretical therapy" simply exposes their ignorance and closed-mindedness, and deprives sufferers of chronic pain of finding a successful cure. These nay-sayers think that only surgery and drugs constitute real medicine, when they only deal with symptoms, and not the deeper cause. So I wish you success. Ralphyde (talk) 21:36, 23 May 2009 (UTC)[reply]
I think many people here need to refamiliarise themselves with WP:UNDUE. In particular:
"If a viewpoint is held by an extremely small (or vastly limited) minority, it does not belong in Wikipedia regardless of whether it is true or not and regardless of whether you can prove it or not, except perhaps in some ancillary article."
For the purposes of this articler, it doesn't matter that, in your opinion, Dr. Sarno's opinion is fact and the rest of the medical community is wrong. There are places to advoate your view. Wikipedia is not one of them. We are here to present views neutrally, their presentation in the article in proportion to the prominence of each. -- simxp (talk) 13:09, 25 May 2009 (UTC)[reply]
I encourage the new user as well, but was pointing out to him as a new user what hurdles he faces. I now see that we already have an article on Dr. Sarno, so the notability issue is solved. The bar is higher here, as this is an encyclopedia, not a 'board'. --CliffC (talk) 22:33, 23 May 2009 (UTC)[reply]


CliffC: the claim that Dr Sarno's treatment approach is "unproved and theoretical" while physical therapy/posture correction/surgery for RSI is a "proven treatment approach" is not true. One of the major advocates of the PT/posture related treatments for RSI was Dr Pascarelli at the Miller Healthcare Institute for Performing Artists in New York. The institute was started primarily to treat RSI in musicians in the 80's and then shifted focus to treat RSI in computer users treating thousands of patients per year by late 90's.
There is no medical specialty devoted to RSI and this was the largest center doing research and treating RSI patients in 90's in the country. Dr Pascarelli made efforts to raise public awareness about RSI and the treatment approaches that he followed in his center. However, the effectiveness of such approaches has remained controversial even though it is true that by now, most doctors in the country (who rarely specialize in RSI) would recommend this approach when they "have to deal" with a RSI patient. For example, see publication http://www.ncbi.nlm.nih.gov/pubmed/17531890.
A noticeable percentage of RSI patients also report pain in parts of the body other than neck/shoulders/fingers (like upper/lower back or legs). This cannot be explained by the theory that RSI pain is usually a result of compression of some brachial plexus nerve. In the PT/posture related theories of RSI, this is then attributed to what is called reflex sympathetic dystrophy or Complex Regional Pain Syndrome. This is a poorly understood condition but interestingly, the general agreement in the medical community is that it is psychosomatic in nature. A description of reflex sympathetic dystrophy and its psychosomatic nature can be found in almost all books following the PT/posture related theories (includes the ones by Dr Pascarelli). Also see http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/reflex_sympathetic_dystrophy.htm
Recently, subsequent to the retirement of Dr Pascarelli, the Miller Healthcare Institute for Performing Artists has stopped accepting RSI patients. Originally, treating RSI patients was the mission statement of this institute and at some point, it had dozens of doctors specializing in RSI. I don't know the exact reason for this recent change in focus (of the largest medical center focused on RSI in the country) but I wonder if this is because of poor success rate.
In the past few years, I have read close to 10 books on RSI and numerous articles. It is a controversial and poorly understood topic and if we only limit ourselves to write what is clinically proven about it, I doubt that we will be able to have any useful information on the wikipedia page. Per wikipedia policies encourage boldness, common sense and occasional exceptions. I think we should have a fair and informative page about the various theories while disclosing of course what is clinically proven and what is not. Vipul Goyal. Vipulgoyal1 (talk) 10:05, 25 May 2009 (UTC)[reply]
'CliffC:' isn't the editor who made the claim that Dr Sarno's treatment approach is "unproved and theoretical", so I would prefer that your arguments did not address me directly. Thanks. CliffC (talk) 14:51, 25 May 2009 (UTC)[reply]

Getting some perspective...[edit]

Reading the comments above gives the impression of a debate between those who believe RSI is a "psychosomatic" condition vs. a "physical" condition.

However, I don't think this is a fair characterisation of the debate. Most mainstream doctors and therapists (certainly the ones I've seen) are quite open to the idea that psychological and emotional factors, such as "stress", may be a contributory factor to getting RSI. If you include the many so-called alternative/complementary therapies, the emphasis on the emotional well-being of the patient is usually even higher.

I don't think there is anything particularly controversial about this - the idea that mental or psychological factors make people more likely to become ill is, I would have thought, well established - and where muscular tension is thought to play a role, even more so, since the link between stress and muscular tension is strong.

What appears to mark out the ideas of Dr Sarno, (based on the info/links provided above), is that whereas the mainstream view is that RSI is a complex condition caused by multiple factors including repetitive activity, ergonomics, posture, lack of exercise, and other causes, in addition to possible psychological and emotional factors, Sarno's view appears to be that the psychological/emotional factors are the SOLE cause of RSI to the TOTAL EXCLUSION of all others. This is an interesting view, but it is also an extreme view only held by a tiny minority.

Even if Dr Sarno gets successful results treating the emotional/psychological factors, this does not constitute proof that these factors are the only ones causing RSI, or that his methods are the only means of treating those conditions, or that his proposed mechanisms (about anger affecting blood flow and so on) are correct.

What does NOT uniquely mark out the ideas of Dr Sarno is his claim to have good success rates for treating things like chronic back pain - I expect the same was said by (or of) F. Matthias Alexander (Alexander Technique), Moshé Feldenkrais (Feldenkrais Method), Ida Pauline Rolf (Rolfing), Janet G. Travell (Myotherapy) and Joseph Pilates (Pilates) back in their day, and most of their ideas have become highly successful with hundreds of thousands of teachers and practitioners worldwide, even more students/patients, and hundreds of books published. And that's just the ones I know off the top of my head, I'm sure there are others.

If Sarno's ideas are not well accepted by the mainstream medical establishment, then I see no reason why this article should give them any more weight then any of the other myriad of alternative/complementary therapies which RSI sufferers turn to on a regular basis, often with successful results.

A holistic view of RSI holds that there are MANY factors causing it, of which the psychological/emotional factors are just one. And of the psychological/emotional factors, there are MANY ways to treat them, of which Dr Sarno's methods are just one. He does not have a monopoly on the idea that psychological/emotional conditions may be a factor in causing RSI: therapies with this belief are a penny-a-dozen. I do not agree with the notion that I am being narrow minded when confronted with the idea that psychological/emotional conditions may be a factor in causing RSI: quite the opposite. Rather, it is a question of balance and emphasis.

When you look at all the stuff going on globally with RSI treatment - and I mean globally, not just in the US or New York - Dr Sarno is a drop in the ocean. He is not that well known. I have done a lot of reading and research about RSI over the last 12 years, and I've never even heard of Dr Sarno apart from on this Wikipedia discussion page.

I bet most of the therapists and teachers working in more well-known disciplines like Physiotherapy, Pilates, Alexander Technique, Feldenkrais and so on spend a good proportion of their time helping people with conditions like chronic back pain and RSI. Between them, they have a good understanding of how the body works and how it goes wrong with conditions like RSI, and they are all in general agreement that such things like repetition, posture, ergonomics, lack of movement and exercise are critically important contributory factors, alongside psychological and emotional factors.

Sarno would seem to stand pretty much alone in focusing solely on the psychological/emotional factors, to the TOTAL exclusion of all other factors. As with all good ideas, you usually find there are people who will take an idea to its logical (and possibly unbalanced) extreme.

Ralphyde - you wrote above "These nay-sayers think that only surgery and drugs constitute real medicine, when they only deal with symptoms, and not the deeper cause."

I think this statement shows how out of touch you are with what mainstream RSI treatments actually are. All the doctors and therapists I've ever seen here in the UK and Europe have advised AGAINST surgery and drugs, and IN FAVOUR of a more holistic programme including posture work, ergonomics, exercise, regular breaks, stretching, relaxation and physical therapy. And I haven't even mentioned non-mainstream alternative therapies like Yoga, Tai Chi and meditation which RSI sufferers have got relief from, which clearly work on both mental and physical aspects of the sufferer.

Vipul Goyal - you have offered to rewrite the article to be more neutral, and this is welcome. But in your opening statement, you spent 2 sentences saying you'll make the article more balanced, with the next 50 sentences expounding the views of Dr Sarno. And you apparently put this proposal in a new section with the heading "Dr Sarno's Treatment for RSI". If your intention is to reassure that you will be capable of rewriting the article in a more neutral and unbalanced manner, then I have to say you haven't got off to a very good start.

Back to my original point - framing the debate as if it's a 2-sided debate between "psychosomatic" vs. "physical" is rather misleading, as it makes out as if it's a 50/50 thing, between one side and another. The real issue from my point of view is not about who is right in some debate, but rather it is that far too much emphasis is being placed on the views of one relatively obscure individual with rather unorthodox, extreme and contentious views, at the expense of ALL other more widely-accepted (and generally concurring) views. Lokatone (talk) 09:54, 4 July 2009 (UTC)[reply]

I've been messing with the "psychosocial" section[edit]

Specifically, I:

  • Added more non-Sarno background and citations
  • Tried to make it less rude/offensive
  • Moved some existing pro-psychosomatic statements into this section, and out of other sections where they fit less well.
  • Moved it to the bottom of the page as-per earlier suggestions

Someone else should add detail to the non-psych sections. Styoung (talk) 04:33, 27 August 2009 (UTC)[reply]

POV: patients, insurance companies, doctors, or scientists?[edit]

Lokatone - I agree that the majority of patients (as well as their support groups and the doctors they seek out) believe RSI is at least partially organic. Workers' comp companies, their doctors, and their allies who wrote (for instance) the California Worker's Comp code clearly disagree.

As discussed in Chapters 9-11 of From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era, the explanation you most commonly hear for a controversial illness is not necessarily the same as the consensus among medical researchers. I suggest we look at what the scientists are saying. http://scholar.google.com/scholar?hl=en&q=repetitive+strain+injury&btnG=Search

This looks like a reasonably balanced controversy to me.

We should also consider the possibility that some RSI cases may be 90% mental, while others may be 90% physical. The important thing is finding someone who can determine whether your specific case might be psychosomatic, and, if so, how to treat it. It's Not All in Your Head: How Worrying about Your Health Could Be Making You Sick has a list of psychotherapists specializing in mind-body disorders in an appendix. I advise calling one up and asking if they can refer you to a nearby expert.

Having a doctor look for a underlying physical cause is also important, but keep in mind that doctor-shopping (and/or asking other RSI sufferers for the names of sympathetic doctors) is cheating. Don't hunt around until you find a doctor who'll agree with you. Go see the first available physiatrist at your nearest hospital. Ask them if they think it could be psychosomatic or not.

Styoung (talk) 09:21, 25 August 2009 (UTC)[reply]

In response to your first point, I have dealt with GPs (chosen by my employer), a specialist (chosen by my GP), insurance companies (chosen by my employer), another GP (chosen by the NHS), and physiotherapists (referred by my NHS GP). I didn't "seek out" any of these people, yet they all worked on the basis that RSI is physical/musculoskeletal. You are stretching things a lot, by claiming the bias towards treating it as a physical condition exists only because patients seek out experts who are sympathetic to their view, when evidently the entire front-line medical services show this bias, prior to any doctor-seeking by patients.
Looking at the scientific research, I think we need to be a bit more careful in assessing these papers in terms of their relevance, quality and age, rather than just categorize them as yes/no/maybe. There does seem to be a fair amount of psychosocial research and speculation going on, but much of it seems to conclude that this is merely one possible factor, rather than the entire cause of RSI, which is how the Wikipedia article currently presents it. If it's merely one factor then this can surely complement a physical/musculoskeletal explanation, rather than oppose it.
For example this paper looks like a piece of meta-research pulling together many other studies http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.124.7199&rep=rep1&type=pdf . There is one small section discussing psychosocial factors, but it is mostly about the physical causes and preventions.
It's also worth searching scholar.google.com for "WRULD", as well as "RSI". But remember both these terms are umbrella terms for a variety of underlying conditions - researches doing real studies into those specific conditions would likely use more specific terms for those conditions, instead of or in addition to umbrella or vernacular terms like "RSI".
So far, I don't think I've seen evidence that this is a "reasonably balanced controversy" within the scientific community, but even if there was, we are nevertheless left with the problem that the Wikipedia RSI article is still far from reasonably balanced. The few parts of the article that explain RSI as a physical condition are sketchy and presented in a "straw man" style, i.e. made tentatively and then pushed aside, then followed with detailed psychosocial explanations, which are much more carefully referenced, and presented as fact. Lokatone (talk) 18:54, 28 August 2009 (UTC)[reply]

I did move the Psychosocial section to the end. I agree someone should add more cited content to the other sections to balance it out, including expert counter-rebuttals to the psychosomatic theory and more support for the middle-ground. Literature reviews are good.

Scientists arguing that RSI can be caused by physical disease is not the same as arguing that it cannot be caused by the mind as well. Psychosomatic symptoms are perfectly capable of imitating real diseases. Since RSI is frightening and invisible, it should be an especially easy disease to mimic.

Learning the information in the psychosocial section will make a huge difference to people to whom it applies. (Perhaps you are not one of them.) It's a very counterintuitive theory, so it's hard to keep it short if you want people to "get" it. Hence, I would rather not trim it. Styoung (talk) 02:45, 29 August 2009 (UTC)[reply]

Reread "Psychosocial", decided it was a mess. Sorted it out into three subsections. Seems more coherent now. (See below) Let me know what you think. Styoung (talk) 08:35, 29 August 2009 (UTC)[reply]


Continue consolidating the psychosocial stuff at the bottom?[edit]

I could merge these into the psychosocial section, to make more room for physical explanations in the sections they're currently in:

(Freud believed that diffuse, non-anatomical symptoms likely indicated a psychosomatic root cause for an illness, especially if they moved around the body.[4] However, this is only a rule of thumb and there are exceptions.)

This lack of objective tests is often seen in psychosomatic illnesses...

For example, the association of Carpal tunnel syndrome with arm use is commonplace but not well-established....[10] —Preceding unsigned comment added by Styoung (talk • contribs) 03:53, 29 August 2009 (UTC)[reply]

Styoung (talk) 03:56, 29 August 2009 (UTC)[reply]

Yes, I think that would help. Lokatone (talk) 11:21, 29 August 2009 (UTC)[reply]

Proposed New Version of "Psychosocial Factors"[edit]

This includes the text I mentioned moving in above. Let me know if you don't think this is an improvement. Note that, since the controversial material is now mostly in this section, I propose moving the POV marker from the top of the page down to here. Note also the suggested new name, since this section does not discuss e.g. social consequences of RSI.

Test removed now that it's on the main page. Styoung (talk) 08:36, 29 August 2009 (UTC)[reply]

I wouldn't move the POV marker from the top of the page until the physical sections are at least as strong as the psychosocial sections.

Are you sure it wouldn't be more appropriate to mark the whole page as low quality/in need of more research and move the POV down?

The carpal tunnel page is twice as long, even though RSI is just as popular of a search term. —Preceding unsigned comment added by Styoung (talk • contribs) 18:15, 29 August 2009 (UTC)[reply]

Also I'm not sure about "Only later was it diagnosed in the US and Britain." Surely this should say, only later did the term "RSI" become popular in the US and Britain. No doubt specific underlying conditions now commonly referred to as "RSI" were diagnosed under their specific names before (and continue to be after) the term became popular in the public eye.

I suspect the main point of "Constructing RSI" and some ofthe other sources in "References that are cautious about the use of the physical illness concept of RSI" is that they disagree with you on this. Need to finish reading them. To the extent the the psychosomatic theory is correct, one would expect that, before RSI became popular, psychosomatic patients got stomach pain instead or something.

In a similar vein, looking at the introduction paragraph of the whole article, I think it over-politicizes the choice of term "RSI". Remember, most people use this term simply because other people have heard of it, it's become established, and people know what they mean. Not because they believe in a distinct "illness concept" that is part of a wave of pyschosocial hysteria. Sometimes popular language evolves in a less than logical fashion, and you have to just go with the flow and use the terminology that other people know and understand, even if it's less than ideal and less precise than the actual diagnosis you have. I'm not saying doctors/researchers should use it in this way, but Wikipedia isn't just an encyclopaedia of precise medical terms is it?

Changed

I think the politicisation of the choice of term "RSI" (i.e. calling it an "illness concept" rather than a vernacular umbrella term for a variety of conditions) really belongs in the "psychosocial" seciton, not in the intro and elsewhere. Lokatone (talk) 11:44, 29 August 2009 (UTC)[reply]
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