Weavers Guild of Minnesota

Abstract

Repetitive strain injuries (RSI), in particular carpal tunnel, are a common physical ailment that can have debilitating and profound consequences on the artist. With a focus on the female tapestry artist, this paper reviews RSI, discusses the history of carpal tunnel, its symptoms, a holistic treatment plan, and arrangement of the tapestry artist's studio to avoid RSI. By concentrating on a holistic lifestyle, the artist can prevent repetitive disorders from interfering in her creative path.

Section I. Introduction

Repetitive strain injury (RSI) is a cumulative injury of the soft connective tissue that develops over time. Connective tissue holds the body together. Every time we move, the connective tissue has to contract and lengthen. Through injury and repetitive movement, the connective tissue becomes stressed, and pain, numbness, and swelling can occur, eventually leading to loss of movement. Some of the more familiar RSI types are tennis elbow, carpal tunnel syndrome, tendonitis, and writer's cramp. This paper focuses on carpal tunnel because it can be a concern for tapestry artists. The carpal tunnel is a passageway through the wrist that protects nerves and tendons. The median nerve passes through this tunnel. When the tunnel becomes swollen from injury or repetitive motion such as using a computer keyboard or repetitive weaving techniques, the median nerve is pinched or compressed potentially causing pain and numbness. RSI injuries have been recorded since the 1700s but have become more common in modern times with the change in mechanization and lifestyle. Carpal tunnel is more common among women then men. Surgery and other medical procedures can improve the condition, but body maintenance and a holistic approach to one's lifestyle it the best long term solution for prevention of carpal tunnel and other RSI injuries.

Section 2. History and Occurrence of RSI and Carpal Tunnel

People have been suffering from RSI for centuries but not with the large numbers of reported injuries evident today. As early as 1717 Bernadrino Ramazinni, considered the father of occupational medicine, recorded incidences of writer's cramp (focal dystonia) in scribes. With the inundation of technology in the work place and at home, RSI has grown to epidemic proportions including artists, computer users, assembly-line workers, meat processors, cashiers, dental hygienists, construction workers, landscape caretakers, journalists, and surgeons, musicians to name only a few. In the year 1999, the U.S. Bureau of Labor Statistics reported that 8.4 million workers were stricken with RSI in the United States alone. Currently, 60% of the workers' compensation claims result from RSI.

History of Carpal Tunnel

Adapted from “The Repetitive Strain Injury Handbook” by Robert Simon & Ruth Aleskovsky
and “End Your Carpal Tunnel Pain Without Surgery” by Kate Montgomery

• 1717 Bernandino Ramazinni (father of occupational medicine) noted writer's cramp reported in scribes.
• 1850s Phsycian Sir James Paget wrote about nerve compression in the wrist
• 1920s “Butchers wrist” was reported in meatpackers hands that swelled
• 1930s Farm workers reported repetitive strain disorders
• 1950s Marine sergeants reported repetitive strain disorders
• 1970s “Space Invaders wrist” and “Nintendo thumb” reported from children using video games
• 1980s With the advent of more machines people became more stationery in their work habits. But with the variance in response to these conditions repetitive strain injuries were not always taken seriously
• 1990s With the influx of computers and their mousse, more people have developed carpal tunnel, a problem called “mouse disease” in Norway.

Section 3. What activities cause RSI and Carpal Tunnel

Repetitive strain injury is a stress-related, cumulative injury resulting from constant repetitive movements. With the influx of high-speed machines into our culture, we are constantly under stress, and can vary little in our movements for a long period of time. Often pushing ourselves physically we take insufficient breaks in our activities and maintain continued movement in awkward positions. With computers and keyboards, we type faster then the old typewriters. Using cell phones we are in constant communication adding additional stress to our lives and often holding our phones in awkward angles with our bodies

In addition to repetitive movements, other physical conditions can cause carpal tunnel syndrome, such as arthritis or fracture near the wrist, pregnancy, diabetes, and thyroid disease, particularly an under active thyroid. In each of these conditions there is either nerve injury or added pressure in the carpal tunnel.

3a: The Causes of RSI

The human body is designed for movement with a lot of it repetitive, such as walking. Movement is good for the body keeping the connective tissue loose and fluid. Connective tissue holds the body together and is made of up blood, bone, tendons and ligaments. The connective tissue is all connected throughout the body and acts as a transmitter thus movement in one part of the body affects another. This connectivity is why in repetitive stress injury or carpal tunnel syndrome the injury is rarely limited to the site of the pain. For movement to happen, muscles and connective tissue on one part of the joint contract while the muscles and connective tissue on the other side release. When the connective tissue is subject to injury or stress is changes chemically trying to protect the body. For example, with a whip lash caused by a rear-ended car accident, the connective tissue immediately becomes more solid to protect the spinal cord. Even surgery motivates the connective tissue to make a chemical changing to protect and heal its parts. The scarred tissue is more solid, it now makes movement less fluid and more difficult causing stress on other parts of the body to compensate. Even gravity plays a role in straining the connective tissue. With good posture, the body is fluid and the natural body alignment is supported by gravity. When the body is out of posture, the connective tissue responds by stiffening to lend more support, which strains other parts of the body. Repetitive movements themselves are not the cause of repetitive strain injuries. They are more related to previous injury, poor posture or other traumas.

3b. The Causes of Carpal Tunnel Syndrome

Carpal tunnel syndrome is a repetitive strain injury. A major nerve, the median nerve, passes through a narrow tunnel at the wrist. The tunnel is called the carpal tunnel and is formed from carpal bones and a thick ligament. The median nerve supplies sensation to the thumb, index finger, middle finger, half of the ring finger and some thumb muscles. The tendons that pass through the carpal tunnel allow the forearm muscles to move the fingers. When the ligament in the carpal tunnel thickens, for the reasons indicated above, it puts pressure on the nerve. This pressure causes numbness and potentially pain in the first three to four fingers of the hand. The most common reasons for carpal tunnel syndrome is the thickening of the ligament however other reasons may include swelling of the tissues and the bones surrounding the carpal tunnel such as rheumatoid arthritis. Fractures can also affect the nerves causing carpal tunnel syndrome. Diseases such as diabetes, which may damage the median nerve, may also cause carpal tunnel syndrome. Pregnancy, thyroid disease, use of oral contraceptives, diabetes, rheumatoid arthritis, and Lyme disease all involve fluid retention and can contribute to carpal tunnel syndrome.

3c. Symptoms

The symptoms of carpal tunnel syndrome normally affect the palmar aspect of the hand starting in the wrist and shooting down into the hand. The forearm may experience some numbness and pain but no higher. The symptoms appear first and worse at night when the wrists are often in a bent position. Also at nighttime normal fluids will shift to the extremities. The symptoms include burning, tingling or numbness of the fingers, difficulty gripping tools or other implements, and problems making a fist. The thumb, index, and middle fingers are the areas most noticeable. If the condition is not treated the muscles of the thumb eventually can waste away and hand movement and grasping objects become extremely painful and definitely minimized.

3d. Tests for carpal tunnel syndrome (adapted from “End Your Carpal Tunnel Pain Without Surgery” by Kate Montgomery

Tinel's Test: Two common tests for carpal tunnel syndrome can be done by the patient. In the Tinel's test, hold one hand out, palm side up, and tap the carpal ligament over the median nerve. The nerve is found in the crease of the wrist, between the middle of the hand and the thumb. If you feel pain or a tingling sensation the nerve is entrapped and indicates carpal tunnel syndrome.

Phalen's Test: Hold your hands up and press the back of the hands together. Straighten your arms until they form a straight line and hold the position for thirty seconds. If you begin to experience numbness or tingling, that means pressure is being exerted on the median nerve and indicates carpal tunnel syndrome.

Numerous sources can be used from the Internet to determine the symptoms of carpal tunnel syndrome and chat rooms to ask questions.

Internet resources to determine the symptoms of Carpal Tunnel Syndrome

• Aetna InteliHealth: http://www.intelihealth.com
• Chat site: http://crochet.about.com/library/weekly/
• EMedicine: http://www.emedicine.com/radio/topic135.htm
• Health World Online: http://www.healthy.net/
• John Hopkins Medicine: http://www.hopkinsmedicine.org/
• United States National Library of Medicine: http://www.nlm.nih.gov/
• Using Reiki for healing: http://reiki.7gen.com/doreiki.htm

Section 4: Women and RSI

There is a strong female predominance in carpal tunnel syndrome with a male-to-female ration of 1:3-5, typically in women over the age of 30. Physically women have smaller carpal tunnels lessening the amount of space for the median nerve. More importantly, various factors specific to the female body can influence repetitive stress injuries in women. Surgery, such as lumpectomy (removal of lumps in the breast) can retrigger symptoms. Premenstrual symptoms, perimenopause, and menopause may worsen RSI. Pregnancy may cause swelling of the wrists which increases pressure on the median nerve. Osteoporosis, although not limited to women, can make RSI worse and vice versa.

Section 5: Treatment of Carpal Tunnel

5a. Short term treatment. Several precautions can be taken to avoid carpal tunnel syndrome:

• Avoid repetitive hand motions with a bent wrist. Keep the wrist straight.
• Take frequent breaks (five minutes each hour) from repetitive hand motions. Stretch your fingers and thumb and change your grip often.
• Maintain good posture. Avoid rounding your shoulders or posture.

If the symptoms of carpal tunnel syndrome occur, don't ignore them. See a health professional for the correct diagnosis and a proper fitting of a wrist splint. Health care professionals will suggest the following measures listed under Home Treatment to relieve carpal tunnel syndrome. Often the health professional will suggest physical therapy for a period of time to accompany the Home Treatment.

Home Treatment

(revised from Medica Health Handbook by Medica Health Plans, a Healthwise publication)

• If possible, stop the activity and try to change the way it is done to avoid stress on the wrist.
• By alternating tasks with your hands spend only one to two hours on each one.
• Gently warm up the hands before starting the work by doing some wrist circles and stretching the fingers and wrists. Every hour repeat these exercises.
• By using a wrist pad with the computer keyboard a straight wrist can be maintained, but don't lean on it.
• Aspirin, ibuprofen, or acetaminophen can help relieve the pain. Ice or cold packs can be applied to the palm side of the wrist.
• A wrist splint should be used at night and when doing heavy lifting.
• Taking 50 mg of vitamin B₆ twice a day has been found to be useful.
• Often reducing the salt in the diet can help with water retention and relieve swelling in the wrist.
• The wrists often get bent during sleep so try to avoid sleeping on your hands.

Notify the health care professional if: a) the pain or numbness is severe and is not relived by rest, changing positions, ice, or a normal dose of aspirin, ibuprofen or acetaminophen; b) the hand grip becomes weak c) minor symptoms do not improve within one month of prevention and home treatment; c) if any numbness remains after one month of home treatment. Long term numbness can lead to permanent loss of some hand function.

The above home treatment is what is recommended by the health care professionals. If these treatments don't work, they may recommend surgery. Cortisone can be injected to relieve the swelling, but provides only temporary relief. Two types of surgery are now available: division of the wrist ligament (transverse carpal ligament) and endoscopic carpal tunnel release (ECTR). Health professionals say that typically 80 - 90% of the patients will have permanent relief of their symptoms with division of the wrist ligament surgery. ECTR surgery as become more widespread the past couple years. ECTR has been found to offer a faster recovery and less pain after surgery. With ECTR a small incision is made in the wrist in the palm and an endoscope is used to visualize the carpal ligament. With the division of the wrist ligament (referred to as open carpal tunnel surgery) a relatively lengthy incision is made typically between 4 and 8 cms. With ECTR it is believed that the skin and soft tissue of the palm can be preserved and therefore less pain after the operation combined with more rapid recovery.

An alternative and more holistic approach for treatment would be to address the whole life style. Several approaches can be taken in regards to exercises, life style, eating habits, etc. and is available through the internet, your local library or bookstore. This paper focuses on the approaches that apply to the tapestry artist. The following holistic approach is an adaptation of methods recommended in the books “The Repetitive Strain Injury Handbook: an 8-Step Recovery and Prevention Plan” by Robert Simon & Ruth Aleskovsky, “End Your Carpal Tunnel Pain Without Surgery” by Kate Montgomery, and “Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries” by Sharon J. Butler.

Exercises to relieve and prevent repetitive stress injuries

1. Neck message: Massage gently and firmly along both sides of the neck using a circular motion with your finger pads. Then place your hands at the base of the skull, and gently push up with your fingers.
2. Forward arm extension: With the opposite hand, palm upward, support your elbow with the palm of your hand. Then gently but firmly flick your forearm from the elbow outwards. Do this exercise on both arms.
3. Lateral arm extension: With your arm extended in front of you, palm down, support your elbow joint with your opposite hand. Bend your forearm to a right angel in front of your body. Then gently but firmly flick your forearm outward as you firmly support and stabilize your elbow joint. Do not go past the shoulder line.
4. Wrist press: Place your left thumb on top on your rights wrist, pointing toward the elbow, and curl your fingers around the outer part of the right hand on the little finger side. Move the supported hand, flexing and extending it up and down as your press your left thumb gently but firmly into the wrist. Move your thumb slowly across the wrist, pressing into the tendons of you wrist as you continue to flex and extend it.
5. Wrist pull: Grasp one hand with your other hand. Gently pull the hand away from the wrist and hold for five seconds. Repeat on the other hand.
6. Wrist squeeze: Use the opposite hand to gently but firmly squeeze your wrist bones together on one hand. Repeat on the other hand.
7. Finger pull: Gently grasp each finer at the base of the finger joint closest to your palm and slowly pull. Pull each finger once then repeat on the other hand.
• Thumbs: Extend your arm straight in front of you on a table. Turn your wrist and tuck your thumb under your hand. Keeping your thumb tucked under, and with the shoulders level, begin to draw the back of your wrist towards the center of your body.
8. Upper back stretch: Clasp your hands together in front of you and inhale. Exhale as you extend your arms out in front of you at chest level, stretching forward. Drop your head, sink your chest inward, and round your shoulders forward. Hold for five seconds, the exhale as you release your hands and draw your shoulders back and down.
9. Shoulder, chest, and elbow stretch: Clasp your hands and interlace your fingers together behind your back, with your palms toward the back, and inhale. Exhale as you straighten your arms and elbows, and gently stretch your arms backwards, away from your back. Stretch slowly, and hold the stretch for five seconds.
• An alternative to this exercise is to clasp your hands behind your back at the hip level. With your shoulders down and relaxed, pull your clasped hands to the left. Tile your head to the left, bringing your left ear and your left shoulder closer.
10. Follow the above exercises with a series of muscle massages in the arms, hands, and elbows.
11. Tendon stretch for computer users: Sit comfortably in an armless chair with your feet planted on the floor. Extend your right arm out horizontally in front of your with your palm facing the floor. Bend your wrist down so your fingertips are pointed toward the floor. With your other hand, gently press your down turned right hand toward your body. Press until you feel a pull. Hold for about ten seconds. Repeat step two times. Then switch and press back the left hand.

Once structural and muscular balance is achieved from the above exercises, a maintenance program is needed to stay pain free and aligned (see Montgomery, pages 77 - 96).

Alternative medical practices: There is no quick fix for RSI and carpal tunnel syndrome. Acceptance is a first and necessary step. Accepting that a change in lifestyle will be needed to continue your activities is necessary to a long term cure. Drugs can be viewed as a cure, but not a long term solution and side effects can develop as well as build up of tolerance and resistance. Adjustments need to be made as to how your approach your job and activities and your attitude. Focusing on how your feel, not being afraid of the fact that you have / can incur RSI , and patience will go a long way towards healing yourself. Listen to your body; take breaks regularly. When you feel pain view it as a signal to rest and stretch. Vary your activities to avoid repetition. Analyze the techniques you are using to see if you are doing them properly to avoid stress on your body. Make sure there are not other physical ailments causing the RSI or carpal tunnel syndrome. Incorporate healthy eating habits and stretching exercises such as yoga. Look into alternative treatment methods such as, acupressure. Get plenty of rest, exercise and adopt healthy eating patterns.

Section 6: A Holistic Studio for the Tapestry Artist

6a: Causes of repetitive stress injuries to the tapestry artist

As a tapestry artist, several related activities can lead to carpal tunnel syndrome:

• Keyboard and mouse use with the computer
• Continued weight pressure on the wrist when dyeing or spinning yarn for long periods of time
• Improper movement of heavy equipment or other materials
• Extended periods of weaving without a break stressing the tendons in the wrist
• Improper position at the loom causing awkward positions of the body and wrist
• General, long term stress on the body to make deadlines or the inability to take a break from the creative path

6b. Preventing repetitive stress injury and carpal syndrome

Desk and computer workstation: Creating an effective work space and work habits can protect your body from RSI and carpal tunnel. Starting first with the computer, establish an effective work station. The height of the desk should be a waist level. Make sure the chair is the appropriate size to allow the feet to rest on the floor, back straight and body aligned. When using the keyboard, make sure the wrists can be kept straight while typing. Adjust the monitor to prevent straining the neck and eyes. The mouse should fit your hand comfortably and not have to be grasped by the fingers. Use a document holder to allow the head to remain upright while typing. Keep the items that are needed at the desk within easy reach or rise to go get them to avoid stretching and twisting.

Tapestry loom: Various looms are recommended for tapestry weaving and every weaver has a preference. Upright looms can prevent the neck strain that comes from bending over a horizontal floor loom but upright looms add to arm and wrist strain from constantly raising and lowering the arm and shoulders. Ergonomically it is helpful to weave on the upright loom at waist level and adjust as the weaving moves upward. Since no one loom works best for everyone, it is best to find the loom that works for the technique and body size of the individual weaver. Take regular breaks complete with stretching exercises. Instead of long hours at the loom, it is best to break up the weaving with other tasks. When warping the loom, use chairs or stools that fit the activity. Avoid stretching across areas, in particular for long periods of time and repetitively. Sit comfortably at the loom with the appropriate chair or bench. Take frequent breaks and stretch. Plan other tasks that can be completed during warping breaks to allow for a variety of motions.

Dyeing or spinning yarn: When bending over, or carrying large quantities of yarn, make sure the body weight is evenly distributed, avoid twisting, and work with as small of quantities as possible. Avoid extended periods of the same motion and vary the activities. Frequent breaks are important to avoid additional stress on the body.

Studio: Bye rearranging the tapestry studio, the weaver can create a healthier environment. Arrange those items that are used the most in a convenient location and at shoulder level. Avoid having to move heavy objects to find items that are needed. Keep the work area clear to avoid twisting and reaching. When moving and carrying objects, take smaller bundles and request help for larger items. Use wheeled carry cases when traveling.

By focusing on the health, physically and mentally, of the weaver, a tapestry weaver can lead a productive and pain-free life.

Bibliography

InteliHealth: http://www.intelihealth.com May 29, 2004

Butler, Sharon J. 1996. Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries. New Harbinger Publications, 5674 Shattuck Avenue, Oakland, California, 94609, USA. ISBN 1-57224-039-3.

Chat site: http://crochet.about.com/library/weekly/. June 2, 2004.

EMedicine: http://www.emedicine.com/radio/topic135.htm. May 29, 2004

Health World Online: http://www.healthy.net/. May 29, 2004.

John Hopkins Medicine: http://www.hopkinsmedicine.org/. May 30, 2004.

Kemper, Donald W. 1995. Healthwise Handbook. Healthwise, Inc., P.O. Box 1989, Boise, Idaho, 83701, USA. ISBN 1-877930-09-1.

Montgomery, Kate. 1998. End Your Carpal Tunnel Pain Without Surgery. Rutledge Hill Press, 211 Seventh Avenue North, Nashville, Tennessee, 37219, USA. ISBN 1-55853-591-8.

Simon, Robert M, Ruch Aleskovsky. 2000. The Repetitive Strain Injury Handbook: An 8-Step Recover and Prevention Plan. Henry Holt and Company, 115 West 18^th Street, New York, New York, 10011, USA. ISBN 0-8050-5930-X.

The Patient Education Institute, Inc. www.X-Plain.com. June 2, 2004.

Using Reiki for healing: http://reiki.7gen.com/doreiki.htm. June 3, 2004.

United States National Library of Medicine: http://www.nlm.nih.gov/ June 3, 2004.