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  1. #1
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    Brief Medical History Overview

    Age: 51, Female, Presenting Problem Since: 2 years, Symptom Behaviour: Remaining constant, with flare ups, Symptoms Worse (24hr Behaviour): NA, Aggravating Factors:: Browsing/typing/using tablet, Easing Factors:: Rest and stretches, No Investigations, No Diabetes, No history of High Blood Pressure, Medications: Lexapro, No Osteoporosis, No Hx of Cancer, No Unexplained Weight Loss, No Bowel/Bladder issues, Other Info: Problems left

    Pain/Stiffness Neck/Upper Arms. RSI?

    Physical Agents In Rehabilitation
    I hope this isnít too much; its symptoms that Iím pretty sure ultimately stem from long-standing bad posture from sitting and using my iPad too much. What Iím looking for is clues as to what is going on, so I can do further research, as I am delaying returning to my physio due to a cold Iím having difficulty getting over. Any clues or feedback welcomed



    • I have head forward posture, have started doing neck/shoulder stretches and strengthening, and upper back strengthening, and have just purchased an iPad stand
    • The problem flares up when Iíve been browsing/using my iPad/PC for any length of time, and especially when I play games I mostly use my iPad, only using my PC when Iím playing Skyrim
    • It does improve with rest (which I have dropped the ball on a lot: my main stress relievers (as someone with anxiety) and hobbies have stuff I need to do online)
    • I mentioned this to a previous physio a few months ago (at the end of a session about my lower back), and he, I think, did a trigger point release on a spot (joint?) on the right side of my neck. Very painful. And then I was able to straighten arm again. He also gave me stretches to do, ďwalkingĒ arm up wall and stretching it out, which does help (I do both arms). Mentioned something about a part of my neck being fatigued)
    • I have been mostly focussing on lower body problems with my physio sessions (have been dealing with lower back/piriformis/flat feet problems, so I havenít had a session focussed just on this yet



    Symptoms



    • Pain upper right arm; itís the upper side of arm, but more situated the left of that, and up into my shoulder
    • Tightness and pain under right armpit
    • Pain side and back of right shoulder
    • Inability to completely straighten right arm overhead
    • mild nerve pain side/little finger of right hand
    • Soreness neck (right side of back of neck, sort of the corner between side and back of neck, if this makes sense)
    • Left arm/shoulder has similar (but a bit less) pain/stiffness shoulder/armpit/upper arm (same areas), pain above left elbow, pain/twinges left wrist
    • Similar soreness on left side of neck (equivalent areas), but less so
    • I definitely have a feeling that both my arms/shoulders are (easily) fatigued, or maybe this referred from my neck


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  2. #2
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    Re: Pain/Stiffness Neck/Upper Arms. RSI?

    Hi rainbowdragon008 (nice handler) and thanks for your post. Firstly I'd like to let you know that your symptoms seem totally normal and very common in relation to people who do a lot of seated activity, with or without a computer screen. Gaming and tablet use perhaps contribute to the development of symptoms even more so in those beyond their teenage years. As you have pointed out you perhaps have a slightly bent over posture in your upper back, which means your neck has to extend more to compensate so your head remains balanced. The more kyphotic (bent over) your thoracic spine, the more the neck compensates, hence more muscle activity and thus more compression of the joints of the cervical spine. This positional change in the spine essentially locks off the bottom of the neck, upper part of the thoracic spine, from contributing to movement. So the rest of the cervical vertebra need to compensate for that too. I hope this is OK to follow.

    Now if your thoracic spine remains bent over there is no way for your shoulder blades to drop into a more natural position. So without good thoracic (and lumbothoracic) extension they end up staying elevated and the compression on the bottom of the neck remains (this could be contributing to the pain in the little finger). So how to you approach this holistically? You need to do two things to gain mobility in your thoracic spine: firstly have your therapist/s do some releasing of those vertebrae and combine it with some releasing of the overactive/tight musculature on the front side of the body that will be resisting the opening of the thoracic movement. And then secondly, as you have mentioned, strengthen the back to provide support for that new position. Now this will take a long time as it takes years to develop the hunched position and we normally only notice it once we have discomfort. So longterm reversal take a long time and needs to be part of a lifestyle change to maintain it for the next 50 years.

    One important point to make in relation to changing and maintaining spinal movement. The spine likes to move in a combination of directions. Rotation is often a combination of extension or flexion and rotation (e.g. in combination to create a side bending movement). The exercises you end up doing for maintenance should therefore include rotational movements so although you may being thinking about flexion and extension in a more passive way, ensure your therapist progresses your plan to add in rotational elements as movement becomes available.

    I hope this gives you a little more insight into possible cause/effect and how to work towards a good long term goal.

    regards
    PB

    Aussie trained Physiotherapist living and working in London, UK.
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  3. #3
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    Re: Pain/Stiffness Neck/Upper Arms. RSI?

    Thank you for giving me something to go on!

    I understand it takes time; Iíve taken six years to get to the point where my sacroiliac joint isnít being constantly thrown out, so I am prepared for this also to take to take a long while.


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    Re: Pain/Stiffness Neck/Upper Arms. RSI?

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