On January 22 2013 07:13 Aerisky wrote: Wouldn't your mouse moving quickly mean you have less strain because you're not moving your wrist as much, though? Enlighten me :O
If it only takes 1cm to move your mouse across the screen, you may not be flicking your wrist as much (your fingers do all the movement) - but when you do this, you tighten all the fragile muscles and tendons inside your wrist. The little muscles in your wrist are only designed for short bursts of pressure. I'm no doctor, but I think it's a lot healthier to spread the pressure across a combination of fingers, hand, wrist, forearm and shoulder, just like you would playing piano.
Oh I see...hm that does make a lot of sense.
Now I'm tempted to do that, but I'm still afraid of messing up my hand from moving around a ton ><
i sit like a perv with a hunched back jacking it in the bushes. its awful but no problems after many many years gaming.... i played sports for most my life tho now that im done maybe ill start having issues lol
I am a kinesiology student, and I have had my share of problems, so I can probably clear up the misconception on what really is the issue and the things currently used to help with it.
There are 2 categories of pain for the wrist, though sometimes you can fall under both categories. 1. Pain from tendon damage 2. Pain from nerve compression (the median nerve) - it can be caused by (1.)
Tendons in the wrist are usually damaged by repetitive motions (repetitive strain injury), though sudden high force impacts can also damage tendon.
Repetitive strain injuries(RSI) happen over time, as you load your tendons more and more, if you look under a microscope you can start seeing micro-tears of the collagen. Your body can heal this,but it is a very slow process, and your body can't keep up if the damage that is being done is faster than it can heal it.
When the damage has become too excessive, smaller tears add up to larger tears (we are still speaking of microscopic damage, not large visible tears). This is when you get tendinitis; the inflammation of the tendon. The inflammation process takes 3-4 weeks, and after that pain should drop down significantly. Inflammation is actually a very healthy process, because tendons get very small amount of blood compared to muscles, when there is excessive damage, you need inflammation to bring more blood and nutrients to help heal. Thus taking anti-inflammatories is not really a good idea (advil, aleve, etc)
The appropriate use of anti-inflammatories is a whole different issue, so I won't cover it.
When you get tendinitis, 1. your tendon gets more blood flow, and there is also some angiogensis (the formation of new blood vessels from nearby branching blood vessels) 2. The tendon thickens and enlarges anywhere from a 1 mm to 1cm. This is done by putting down immature collagen around the tendon. This is a protective adaption, by thickening and stiffening the tendon with immature collagen, the tendon can take stress from movement while trying to heal the damage. Eventually the immature collagen will be removed and the tendon will go back to its original thickness.
Wrist pain can be pain from: 1.the tendon injury itself and/or 2.pain from the thickening of the tendon causing compression of the median nerve.
What can you do to fix it?
If this is your first time getting tendinitis --> Rest, Ice, compression, elevation --> Don't take NSAIDs (Non-steroidal anti-inflammatory drugs) - These disrupt the whole inflammation process and don't allow your tendon to heal the damage properly. It can also delay the process by which your tendons thickness goes back to normal, possibly leaving you with a damaged tendon with scar tissue and thicker than usual.
--------------------------------------------------------------------------------------------------------------------------------------------------- When tendon pain continues for longer than 3 weeks, it is no longer tendinitis in most cases. This is called tendonopathy or tendonosis; the process of degeneration of the tendon, without the presence of any inflammatory conditions.
I mentioned before that when you get inflammation, there is a formation of new blood vessels in the tendon to aid in blood flow to the tendon. It is known that nerves accompany blood vessels very closely, and it is thought that sustained pain in a tendon that has failed to heal is because of these newly formed blood vessels and nerves that have formed.
Treatment??
1. There are many studies on on eccentric training for the treatment of tendonopathy (you can google scholar this, or go on Pubmed)
2. Nitogylcerin patches. It is thought that Nitric oxide is an important regular in the health of tendons. Studies have proven that is works, but only with exercise (such as eccentric training)
3. Sclerosing injections (basically its a certain percentage of ethanol that gets injected where you have pain). These are not done yet in most hospitals, but clinical studies showed that the alcohol destroys the nerves that have formed within the tendon, and overtime the biomechanical properties of the tendon went back to normal.
4. Low level laser therapy - This one is lacking significant data to prove that it works, but there are clinical studies that have shown that it does work especially with an eccentric training regime.
What is lacking evidence for treatment? 1. Ultrasound - it heats deeper tissues without affecting skin temperature, it is essentially a more effective version of using heat topically. In the literature there are some studies showing it helps, but most studies show that there is no significant benefit.
2. Stretching - This is commonly prescribed as a preventative measure for injuries, but there are studies that show that there are no significant positive results from stretching in injury prevention. Though stretching certainly isn't a bad thing, I do it myself all the time.
3. NSAID's (non-steroidal anti-inflammatory drugs) - For tendinitis, and tendonopathy, I would not suggest taking these. For Tenosynovitis (inflammation of the sheath of the tendon), NSAIDs can be beneficial.
4. cortisone injections (don't get these, it will lead to significant problems later on such as tendon degeneration, ligament degeneration, joint destruction and many more)
For the wrist, Tendonosis or tendonopathy is especially important to pay attention to , because it could mean the tendons have not healed properly, and it could be thicker than usual. Thicker tendon will result in compression of the median nerve and lead to carpal tunnel syndrome. The pain from Carpel tunnel syndrome will be different than tendinitis, as you might feel numbness, tingling, burning, sharp pain from your wrist into your hand and fingers. Tendonosis does not go away on its own, you have to treat it properly. Once the tendon has begun to heal properly, the size of the tendon should go back to normal and alleviate any pressure on the nerve.
I have listed the best treatments above for tendonosis, but these are not widely used for some odd reason. Here are the commonly used treatments right now if you go to a doctor.
1. Night splint - this is actually a pretty good tool, when you sleep you might twist your wrists around and it might get stuck under your body if your flipping around all night, it could cause further injury if you already have tendinitis.
2. Cortisone injection - provides temporary relief but causes catabolism (the destruction of tissues). If it is injected into a tendon, it will significantly damage the tendon and cause disorganization of the mature collagen, leaving you with a weak stiff tendon. If you are going to have this done, it be should injected near the tendon, but not into the tendon. Some say one injection isn't bad, but multiple repeated injections spread out over a couple of months is bad. But I think you should avoid these all together.
3. Surgery - Done by releasing the transverse carpal ligament. This surgery will mean that your wrist will be unstable because they have essentially cut a ligament, meaning your muscles will have to do more of the stabilization, possibly leading to future strains and injuries. This surgery does not fix tendonopathy, it merely releases the pressure on the median nerve.
If you want links to some studies, just message me, I will try to provide.
Just thought I'd say this is the third google result for 'gaming and rsi', be aware! Maybe this should be a sticky on your forums or something, I don't know, "gaming and health" or something?
I don't actually play starcraft anymore but it's quite nice to me that I found the info I needed on something going back to when I was tiny. I used to borrow my little brother's starcraft CD when I was little and ended up not giving it back til I had finished it due to loving the story in StarCraft (the voiceacting and drama being better than much of TV, really) (I did try multiplayer at one point but I liked playing co-operative better with my little brother and random internet friends i made, really The singleplayer story was the best part for me really, I wish they'd continued that in a meaningful way, I don't really have much respect for the apparently hollywood-ised sequel game)
Anyway: I was looking for info because I am getting a bad feeling after pain in my fingers after, I think, spending too much free time playing games! And well, a bit worried, even more so after reading this stuff... Especially that last post just before mine, saying doing stretches haven't been shown in research to actually make any difference??? I'd love some sources for that??? (any physiotherapists or the like on the forums, I guess?) Eep.
I have a form of RSI not mentioned here as far as I can see.
Thoracic outlet syndrome. There is a nerve/blood vessel cluster that goes from the neck to the arm. Your muscles can tense and compress this area.
Image:
I didn't even realize my muscles were so tense. It turns out, your upper body should be extremely relaxed when at the computer. I think I would subconsciously tense my shoulder/neck when I was in situations with lots of action / stress.
I also realize that I associated the tensing of certain muscles with others. If I flexed my bicepts, I would tend to flex my whole body with the effort. If I wanted to type faster, I would tend to tense my shoulders as if I was "flexing" my type speed.
So far recovery seems to be pretty quick. I'm doing all the listed stretches, and I'm doing a meditation-like thing to progressively relax my muscles. I find that finding each muscle in my shoulder, and then flexing / unflexing them individually is by far the best way to relax the region.
I'm also trying to type while staying perfectly relaxed. It is going to be a while until I can train myself to stay relaxed in dota 2. One moment of weakness and suddenly my entire body would be tensed and I would be stressed out.
EDIT: In addition to the stretches, resting my elbows on my desk instead of letting them hang really helps. It seems to not activate the muscle that is bothering me if my shoulders are ~3cm above fully lowered level.
Holy shit, believe it or not, I think my breathing technique is causing me to have tight scalenes and, as shown in this imagine, scalene muscle tightness can cause pain all along your arm and shoulders.
It turns out that your neck and chest muscles like to help your diaphragm out. Many of your neck muscles are attached directly to the lung. If you have healthy breathing, they should only help the diaphragm during cardio, or when you are postured in such way that the diaphragm is having a hard time.
For some people, their diaphragm barely moves at all. The diaphragm doesn't work very well at all when one is leaned forward. They get into the habit of having a LARGE burden put on their upper body to "lift" the lungs in order to create more of a vacuum below the lungs.
After investigating a bit by feeling the flesh under my clavicle, I found that I could really feel my neck muscles pulling up hard on my chest cavity every time I breathed. My diaphragm was hardly moving. After breathing properly for 5 minutes, my arm feels much better. This makes sense -- I could really feel some tightness deep within my right shoulder. I probably had one of my upper body muscles on my dominant side doing most of the work for breathing !
This might be a placebo. We'll see. It makes sense tho.
EDIT: I found a really good way to relax these scalene muscles. You sit down with your chair on low, your elbow resting on the table. Then you do diaphragmatic breathing while making circles with your head. You know you are doing the diaphragmatic breathing properly when you feel a tightness in your neck when you breath in and tilt your head back and towards your shoulder.
Edit: I actually think this info didn't help me in the slightest.
Alright guys I'm almost all healed up. Here is the summary of what treatment I found effective:
For me, I only got RSI pain when I was on the computer. All other wrist related activities were fine. What does this mean? It means that my body trained itself somehow to limit blood flow around the tendons in my arm ONLY when I was exposed to the trigger. When blood flow is limited, tendons get many times bigger than they once were, in order to expose themself to more blood. This causes nerve compression and RSI.
So, my solution was to do exercises every day to disassociate the pain and tightning of muscles with the use of my wrist. The important thing to do is pay extreme attention to how your muscles feel when you do there exercises. Try to see if you can manage to "not" feel any pain, and if it feels comfortable, pay lots of attention to that.
Two exercises I found to work EXTREMELY well were 1. Wringing a towel back and forth as hard as I can and 2. Rice bucket training
Do not underestimate the rice bucket, you can get as much or as little resistance as you want with it.
I limited my exposure to computers to make me 'forget' that typing was my trigger.
Muscle awareness and stretching. It is VERY important to exhale when you stretch. Your muscles relax when you exhale. If you don't exhale, you will be contracting your muscles and they will NOT stretch. Contraction != stretch. This was a big problem for me. I found ways to stretch my forearms (day9 stretches), my tricepts, and my rotator cuff.
The rotator cuff muscles are a big deal to stretch because nobody even knows they exist and tension can go unnoticed. This video This video lets you get an idea of how to stretch these muscles.
BIG EDIT: Also I managed to find the anterior scelene muscle in the neck. It is actually really cool. Shirtless, look in the mirror and put your arm straight out. Turn your hand from "holding a can" to "holding a mouse". You can actually see the muscle pop out and move forward in the neck. No wonder this muscle feels tense after holding it tight so long!! XD
EDIT2: Also make sure when you stretch you must NOT stretch so that you feel pain. This will reinforce your brain's idea that your wrists should be in pain and should have fucked up blood flow. If you have trouble stretching without feeling pain, try just letting your hand "fall" into the stretch position through relaxation rather than force. It can take a while to feel your way into relaxation.
Alright guys, just wanted to say that I found the TRUE source of my pain. All of the stuff I've been doing has been rehabbing everything from the top down. I was over 60% free of any pain and my hands could move properly, but I still felt something was missing. My hands felt uncomfortable and my shoulder was always tight. I felt uncomfortable overall and my arms tired very easily.
I found the last remaining thing that needed to be fixed. It was muscle knots (myofascial trigger points) on my upper back and shoulder. These caused everything else to mess up in a chain reaction. They were the base of the pyramid.
I did foam rolling and lacrosse ball therapy to solve the issues. I couldn't actually feel pain in my back -- it felt like it was in my shoulder all the way down into my arm. But when I lied down onto that roller, I was in agony. Certain spots on my back would give needle like pain if I pressed too hard. After an hour of crushing my back muscles with that roller, all the sharp pains were gone. The next day, I did it again. I felt only 20% of the pain I initially did. My entire upper body felt 100% more comfortable and powerful compared to before.
Then today I found the worst point. It was right below the shoulder blade on my right side. I couldn't get to this with the foam roller, but I got a dense foam-rubber ball and lied right on it. It was the worse pain I ever felt. Took like 30 mins on that one spot for it to go away. But the pain felt exactly the same as the pain from my RSI. This spot was always in this pain, but my body was covering it up and bringing it back as other symptoms. The ball brought it to the front.
I recommend EVERYONE just grab a piece of pipe, log, balls, and just lie on them. It takes no money and can literally change your life. Just look up the therapies and try them out. You can buy products like foam rollers etc and they do the same thing.
Thank you very much for the replies, I forgot to check back on this
I went to the hospital a few weeks ago because I had really severe pain in my back and a tingling painful sensation in fingers, I was worried they might be linked and that maybe I had spine damage somehow (I was told that's usually only from severe force though) since I was getting that numbness in my hands, which can also be a precursor for carpal tunnel syndrome, I've read also. What they said was that it could be a compression of the nerves caused by muscle sprain in the upper back which can be triggered bad posture when sitting, chair that isn't ergonomic, etc - I didn't know you could have that "serious" a feeling from something less serious, so it's a big relief, but it goes back to the kind of issues here.
What I was recommended to by the NHS (which unlike in America healthcare is not for profit, so can be trusted to be unbiased) doctor and nurse I talked to at A&E was to go on ibuprofen 400mg(2x200mg pills) and paracetamol 1000mg(2x500mg pills) for a few days (both of which are very common and cheap, I looked up the names to check they'd work for America and they have a few different brand names there, but those are the actual proper scientific names so you don't get scammed by companies branding stuff with different names to sell it for more) - The point of that was that ibuprofen isn't just a painkiller but anti-inflammatory which means it can help swollen muscles relax.
However though my back's fine now, I still have pain in my fingers that comes back worse when playing games sometimes, though at other times it feels completely fine - and even sometimes hurts when I'm in bed at night with hands completely flat, it really worries me a bit, but I don't really know what to do in the long term to make things better, this seems to be a real weakness in getting medical advice that when stuff is more long term you're pretty much left to try work things out yourself until something major and possibly irreversible happens it seems like, I'm just worried that something worse might happen now.
If any of you pro gamer types (or anyone who has contact info to ask them to weigh in) have have any guru advice to dish out for this thread, I'm sure it could help a lot of people
I've been dealing with finger pain for the last 6 years, and outer forearm pain (close to the elbow) for the last 2.5 years.
The one thing that's been effective for me, and along the same lines as DeltruS, has been self massage of trigger points in my arm muscles. Rolling a lacrosse ball down the culprits has been an enormous relief for my arms, and has also largely eliminated my finger pain. In my case, the extensor digitorum and extensor indicis muscles were setting my fingers on fire. The ultimate plan is to calm down both my arms, then strengthen the muscles with plenty of targeted exercise and posture improvement.
As for what to massage, this book told me where to look and how to do it. Those with arm problems, note the section on scalenes (neck muscles), and how they can affect your arms. Make sure you read the introductory sections as well, especially the parts on how to properly self massage and not mash areas with a pulse (i.e. arteries) and/or lymph nodes.
After years of physical therapists and on/off ibuprofen, I'm pretty pissed nobody's applied what's in this thing.
Anyway, hope it helps somebody out. Took me 6 years to find it after all.
EPT
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![[image loading]](http://saveyourself.ca/imgs/scalene-referral-m.jpg)
