Apart from the standard ways of avoiding repetitive strain injury through having the correct posture, taking breaks and using ergonomic equipment, I thought of another important component of avoiding or rehabilitating repetitive strain injury – namely the importance of strengthening the back.
The idea to strengthen the back is based on an understanding of how the body works and how injury can be caused. My idea is based on observations from my own experiences of injury. What I have noticed is that an injury can travel through the body by either spreading upwards or sideways. I came to this conclusion because I he had an injury with my left foot and not long after this my left knee was affected and then a couple of years later my right knee and then my gluteal muscles. It was as if the injury that had begun in my left foot had moved up to my left knee and then moved sideways to my right knee and then up again to my gluteal muscles. This may have been because the stresses that weren’t being dealt with effectively by my left foot were simply moving up to my left knee and because joints work in pairs since my left knee wasn’t absorbing stress effectively my right knee was then affected and finally because my knees weren’t absorbing stress effectively my gluteal muscles were affected.
So basically stresses travel through the body and if they are not being dealt with effectively they cause injury on their journey. Applying this principle to repetitive strain injury, initially fingers and then the hands, arms shoulder and back are absorbing the stresses caused not only by the impact of typing but also by sustaining a static posture. If there is a vulnerability somewhere along the route that the stress travels along then injury can occur. When you are typing or using a keyboard your arms are outstretched so they need to be supported by your back. If they are not effectively supported by your back then more stress will be absorbed by the smaller joints and tissues within the fingers and hands.
I can feel that when I am playing on my piano keyboard that sometimes within a relatively short period of time my back starts to ache a bit because it is obviously not strong or flexible enough to support my arms within this posture. It’s only a small jump of logic to see that this may make my hands vulnerable to repetitive strain. If stresses are not been absorbed by the bigger muscles contained within the back then they will have to be absorbed by the smaller and more vulnerable muscles are contained within the hands and fingers. So my conclusion is that it is very important to have a strong and flexible back if you want to avoid or rehabilitate a repetitive strain injury of the hands.
As an aside, I think these principles about how stress can be transferred from one part of the body to another can also be applied to the psychology of groups. If stress is felt by an individual or a number of people within a group then sometimes the stress can be transferred to more vulnerable members of the group.
Just going back to the body again, it also makes me wonder whether when you are trying to rehabilitate one part of your body with some strengthening exercises, it’s worth simply focusing on strengthening one part of your body. Do you not need to strengthen the whole of your body if you wish to strengthen one part of it? Because if you don’t is there not a risk that when you do the strengthening exercises, vulnerable parts of your body might take some strain and even become injured in the process? I found that when I was doing leg exercises for my knees that my back was affected adversely. Maybe there was no point in just focusing on my legs, I need to focus on strengthening the whole of my body if I want to strengthen my knees. Obviously this makes into a bigger undertaking.
It is important to be cautious when practicing yoga, there was a piece in the New York Times a couple of years ago written by a yoga tutor who was explaining how within the yoga world there is almost a conspiracy around hiding the dangers and risks associated with yoga. I have been thinking about trying yoga again but because of the injuries I have acquired with physiotherapy I want to make sure, as for as is possible that it is safe. There are a number of yoga postures that may be harmful for people with scoliosis. These include; forward bends-be careful with this posture making sure that you do bend your knees. Avoid the Cobra and the Locust position. Be careful with twisting your torso, bending sideways and doing the shoulder stand. The warrior poses or the half lotus can be dodgy for your knees. I have just dug out a DVD by somebody called Elise Browning Miller that is specifically about Yoga for scoliosis so I’m going to give this a go. Elise Browning has scoliosis herself.
I saw a psychiatrist recently who suggested that I could take Lamotrigine to help with anxiety. He said that anxiety, migraine, depression and digestive problems are all connected due to a problem with glutamate in the brain. Glutamate is an excitatory neurotransmitter which is normally in balance with GABA which has the opposite effect. He said that he has had some success with people who have anxiety that hasn’t responded to other treatments and that have some of these other problems. You start on a very low dose and then gradually build up. It takes a few months before you notice any positive effects. The only snag is that Lamotrigine can potentially have very serious side effects, i.e. something called Stevens-Johnson syndrome which can be fatal. So I’ve been looking at other alternative ways to improve the balance between glutamate and GABA in the brain. One possibility is following the ketogenic diet.
The ketogenic diet is a low carbohydrate high-fat diet. Basically you are eating a combination of protein from meat and vegetable sources, fat from things like coconut oil or cheese, vegetables which I guess give you the recommended 50 g of carbohydrate per day. Strangely fruit is not part of the diet. This is because fruit has got a lot of sugar in it which is a big source of carbohydrate. So essentially the ketogenic diet is a low carbohydrate high-fat and zero sugar diet. Sometimes people call it a paleo diet, which implies that it is similar to the diet of hunter gatherers. I can see how the potatoes, bread and rice that we eat would not have been part of the hunter gatherer diet and may possibly be harmful to us, but the hunter gatherers would have been gathering fruit which of course is an important source of vitamins. This diet is better known as being a way to lose weight but it is also gaining popularity as a way of treating neurological conditions and mental health problems.
The ketogenic diet is a diet has been used for decades as a treatment for treatment resistant epilepsy. Lamotrigine was originally used as a treatment for epilepsy as well. However like Lamotrigine the ketogenic diet also has drawbacks. I don’t think I would feel confident trying it without being guided by an experienced dietician. In the meantime I’m trying to find ways to deal with my sensitivity to noise as an alternative way to reduce anxiety because I think this may be one of the root causes of my anxiety. Apparently there is a kind of sound therapy which uses either white or pink noise to reduce sensitivity to sound. I think I would rather try this first then try either the Lamotrigine or the ketogenic diet.
I am trying to get closer to a diagnosis of what the problem is with my voice. I have noticed that when I speak there is a kind of creak or rough sound or croak in my voice particularly at the end of phrases. Having done a bit of googling I have found a name for this, it is called glottal fry. Glottal fry happens when your vocal folds are not vibrating properly and let through air which creates a kind of croaking sound. I didn’t realise that this has become a bit fashionable and that quite a few celebrities particularly female pop singers such as Katy Perry seem to be deliberately speaking with some vocal fry. There is a trick you can do to reduce the amount of vocal fry that you make. What you need to do is raise the tone of your voice a bit at the end of a sentence or phrase. There seems to be contradictory ideas about whether glottal fry is bad for your voice or not. Some websites claim that it is harmful whereas others say that it is simply a habit that your voice has got into. My main issue with my voice isn’t really the vocal or glottal fry, though this is a bit irritating and uncomfortable, it is more that I lose projection in my voice and find it difficult to communicate in noisy environments. Most of the environments where you are interacting with people tend to be noisy environment with a its being in a restaurant, a bar in a noisy workplace on the street where there is traffic noise so it is quite restricting if you find it difficult to speak when there is noise in the background. I guess that the problem with the glottal fry and loss of projection must be connected because in both cases the vocal folds are probably not meeting properly.
I have been given various diagnoses including muscle tension dysphonia but then other ENT specialists have said that I don’t have muscle tension dysphonia, others have said that the problem may be caused by what is known as silent reflux, i.e. reflux which you don’t really feel but which can affect the functioning of your larynx. One of the recommended treatments for this is to take proton pump inhibitors and Gaviscon. However, when I have googled there the doesn’t seem to be much evidence that proton pump inhibitors are helpful for this kind of reflux.
Singing voice specialists seek to rehabilitate vocal injuries by using singing as a therapeutic tool. There is some research that indicates that this can be effective however there is no specific qualification for people who are working as singing voice specialists. I have been doing some research online try to find a singing voice specialist, but so far have only found person who may offer service.
Alternative input devices
i) Voice recognition software
I have started using Dragon naturally speaking again and it seems to be working quite well. I’m using a more natural voice this time and it doesn’t seem to be making that many mistakes. When I say that I’m using a more natural voice I mean that I’m trying to use a bit of variation in tone whilst speaking and also I’m trying to speak in phrases and this seems to make it more accurate as well. I have found that when using the commands it is possible to sing which I think is quite a good thing because it means that your varying the way that you were using your voice therefore not putting a repetitive load onto your larynx.
ii) Handwriting recognition software
I have done a lot of research online into handwriting as an alternative input method, and what I have discovered is that handwriting recognition is not as well developed as speech recognition. Nevertheless, I have found that the handwriting recognition that comes with Windows 10 is quite good. Myscript has got quite a glossy website but there seems to be some bugs in the software and I don’t think the company is focusing on developing this product at the moment. Even so, these handwriting recognition apps aren’t that bad really. Google also has a handwriting recognition app. I think that the main difference between handwriting recognition and voice recognition is that handwriting recognition doesn’t actually learn your handwriting style so unlike voice recognition it doesn’t really improve the more that you use it though I may be wrong about this. I use a Bamboo tablet whilst using one of the handwriting apps. I thought that it was not particularly comfortable because it seemed as if you can’t comfortably rest your hand on the tablet, There I found that if you undock the Windows 10 handwriting box you can move it to a different position on the screen where it was possible to rest your hand on the tablet.There is something called Microsoft surface which uses handwriting recognition but because I’ve not tried it I can’t say whether it’s better or not than just using something like a Bamboo tablet.
So I am currently using a mixture of typing, voice recognition and handwriting recognition. I have been surprised that the handwriting recognition and the voice recognition seem to work recently well on my computer that is almost 10 years old. I am using the premium version of Dragon NaturallySpeaking. It is also comforting to know that over time these applications will just keep on improving. In addition to this I am using a split keyboard which seems to be a good idea because it means that your hands are in a more natural position.
I have also started using an Evoluent Mouse however despite the positive reviews about this product on you tube I haven’t found it particularly comfortable to use because either you support your arm on an armrest which means that typing is a bit more uncomfortable or you dispense with the armrest and your arm that is holding the mouse feels uncomfortable.
A number of years ago I saw an audiologist and explained my problem with being troubled by noise when I am trying to speak in a pub or other busy places. She said that I was phonophobic. I now think that the root of my problem of speaking in noisy environments is not primarily caused by sensitivity to noise or phonophobia but a loss of voice projection that has made me sensitive a noise. This is because I have learnt to associate the noise with finding it difficult to express myself. When I look back I was not sensitive to noise in pubs (for example) and then found it hard to speak. I found it hard to speak and then became sensitive to noise. I am still not sure why I have lost my ability to project my voice, whether it is because of reflux or over/misuse or anxiety and what I can do about this. I am taking medication for reflux now. I think the solution must lie in tackling the loss of projection and dealing with the phonophobia.
I have noticed that it is possible to learn to like certain sounds that you initially dislike. Therefore it seems likely that it is possible to learn to dislike certain sounds as well that you initially did not dislike. For example, there are some songs that I do not like but when I have played learnt them I have grown to like them, maybe because I begin to associate the song with pleasant feelings of self-expression and learning.