Repetitive Stress Update

Time for an update.

Not a whole lot has changed except for my strategies, on the repetitive stress front. I have had, over the last month or so, a couple of very low lows – sufficiently low that I ended up calling up a friend and having a conversation that more or less went, “I am not suicidal right now, but I’m uncomfortably close and on a downward trajectory, and I don’t know how to change course”. Those lows are a couple of weeks ago now, and while I experience moments of high stress about the precariousness of my current life situation every day, I haven’t had any that bad since.

I saw a doctor a little over a week ago, who diagnosed me with tendinitis, and also determined that I show none of the symptoms of carpal tunnel, so it looks like it’s all tendinitis. I adjusted my working schedule, which is part time and very time and location-flexible, so that I am working every day of the week for three hours broken up into six thirty minute shifts. This seems to be doing a good job of keeping the tendinitis from getting any worse, but it’s unclear if it’s getting any better. I am still, naturally, writing my posts via dictation software.

I’ve been doing as much research into tendinitis as I can. Rather, I should say, I’ve been doing as much research into tendinosis or tendinopathy as I can – a lot of recent research has suggested that it’s not nearly so much about inflammation (-itis means inflammation) as most people think. As per usual, a lot of my reading has been on saveyourself.ca, which has some decent articles on tennis elbow, and repetitive stress injuries. I’ve also been googling around, looking for the latest research, and as such have been experimenting on variations of eccentric strengthening exercises.

For the moment, my plan for an average day works roughly as follows: 45 reps of eccentric strengthening (“Tyler twists”) on each arm in the morning, followed by a number of saveyourself-recommended forearm and rotator cuff mobilizations, followed by two half-hour shifts of programming with at least a half hour break in between, followed by more mobilizations, followed by another pair shifts, followed by more mobilizations, followed by another pair of shifts.

You’d think three hours of work a day would be over pretty quickly, but in keeping up with the rest of this, it tends to take (at the very least) twice that long.

In addition to reading about tendinitis, I’ve been reading and rereading a book on chronic pain called Explain Pain, by chronic pain researchers Lorimer Moseley and David Butler. It’s helped my mindset with respect to back pain enormously, and has given me some interesting thoughts on the repetitive stress as well. The driving point of the book is that pain is a product of the brain 100% of the time (see a couple of the video links under chronic pain in my links section for some amazing talks by Lorimer on the subject), and while we don’t have anything near absolute control over how the brain decides whether or not to create pain, there are certain things we can do to influence it.

Though it is helpful understanding and observing how my stress levels have an impact on pain, in the case of the repetitive stress issues it’s also confounding. In the case of my back, I can be pretty confident that the pain I experience has nothing to do with damage to the tissues in my back. This enables me to be fairly fearless in terms of what I’m comfortable experimenting with physically with regard to my back. With the repetitive stress issues, though I am sure that stress and neurology plays a significant role, it also seems likely that there is at least some real, physical damage to the tissues in my arms. This makes deciding how best to go about self treatment more complex, because the advice pertinent to neuropathic pain tends toward the idea of calling the pain’s bluff in small, but increasing increments. The advice for a purely physical issue like tendinitis is more along the lines of “don’t work for too long, and give the injured parts plenty of rest”. These two ways of approaching the problem are, at times, directly in conflict, and it’s very hard to know which one to go for. Should I be going for as much rest as possible, or is that creating an avoidant pattern of behavior that will increase my fear of doing the things I associate with pain, and correspondingly increase my potential for experiencing pain? Should I be trying to slowly ramp up my level of computer use, or is that going to be doing even more damage to already overworked tissues?

It’s easy to catastrophize when you feel like no matter what you do, there’s a risk that you’re going to be making it worse. Especially when making it worse means you might not have an income anymore.

For the time being, I’m dealing with this day-to-day, and as of this morning have started going to physical therapy appointments. I have mixed feelings about physical therapy, as I haven’t had a history of good luck with it with my back pain, and these days I’m not altogether confident that the people prescribing the exercises for me to do know any more about whether or not they work than I do. That said, I’m going to give it a shot either way and see how it goes. Here’s hoping.

One of the things I still want to try and do is find some more engaging, nonrepetitive activities to do while I’m not working. Right now when I’m not working, I’m usually either doing an errand or watching Netflix. It’s healthier than typing, but some form of healthy movement would almost certainly be better, both in the sense that it would be more engaging (and being in flow is one of the best things for the neurological side of pain, in my understanding), and that non-aggravating movement is generally healthy. Finding ways to do this is challenging, because I’m almost always nervous that any particular new thing I’m trying might make the issues worse, and that nervousness can cause enough stress to create pain where there might not have been any as a result of the actual activity itself. If I always wrote off every activity I tried in the first sign of trouble, I’d be doing nothing but lying in bed all day.

So I guess I’m setting it has a general goal to be comfortable being a little more experimental movement-wise, and to keep thinking about new things I can try doing that will involve me moving around a bit.

Ending on a slightly up note, I have resumed doing the Big Five workouts from Body by Science after almost a year of not doing them on account of my shoulders. I’ve resumed the exercises at the weight that I started doing them at the very beginning, which is a little discouraging, but the first few workouts have not resulted in any alarming shoulder pain. A little bit of shoulder pain, to be sure, but this is one of those cases where bluff calling seems to have been the right choice of action. I’m three weeks and three workouts in, and so far so good. It’s definitely helpful to have at least one thing in my life where I feel like I’m making progress that I can measure. Though, to be fair, I’m also getting very good with CSS selectors on account of my work.

One final note, mostly for myself to remember: the arm pain in general has been bouncing around a lot. I know this is typical for neuropathic pain, and I’m uncertain how typical it is for tendinitis. Early this morning, I was experiencing sufficient pain to be pretty discouraged in general. Midafternoon, I was experiencing almost no pain and feeling pretty good about things. Right now, I’m somewhere between the two. The pain has also been occurring, at different times, in places as varied as fingers, forearm, both sides of the elbow, the lower upper arm, and, rarely, shoulder. Whether this is a result of my experimentation with making my workspace more ergonomic (probably not the whole story, because the changes have not consistently directly corresponded to workplace rearrangements), a result of the pain being largely neurological (pain that bounces around like this is fairly typical of neuropathic pain, in my understanding), or just somehow the way the tissue damage works out, I am not sure, but regardless, it helps to remember that random ups are about as common as random downs when I’m in the middle of a random down, and feeling like over-extrapolating.

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