According to the US Department of Labor, musculoskeletal disorders accounted for 33 percent of all injury and illness cases requiring days away from work in 2013. Among the conditions that are particularly concerning to women are repetitive strain injuries and temporomandibular joint (TMJ) dysfunction.
In all the hoopla that has accompanied the manifestations of the computer revolution, not much attention has been paid to how the installation of computers in offices has physically affected the people using the devices. What is talked about is how jobs that were grimy, dirty, and physically grueling, such as those in steel mills and automobile plants, are being replaced by jobs in service industries, including many that involve sitting in offices at terminals processing and moving information. Those who are infatuated with the world of computers see this transition as all for the good. However, although there are undeniable benefits to workers from this exchange, they do not necessarily fall in the area of occupational health and safety. The owners and managers of plants that manufactured heavy industrial equipment were notorious for disregarding toxic chemicals and other dangers in the workplace, but it is also true that the managers of many light industries have exposed people to years of looking into computer screens and rattling out numbers on keyboards without ever taking a look at the possible health effects of this labor.
Repetitive strain injuries affect hundreds of thousands of American workers at a cost of more than $20 billion a year in worker’s compensation alone. Among the causes of repetitive strain injury are repeated movement combined with physical stress; chronic tension; faulty biomechanics; inappropriate ergonomics; and previous injuries or surgeries.
Dr. Timothy Jameson, author of Repetitive Strain Injuries: Alternative Treatments and Prevention, is a graduate of Los Angeles Chiropractic College and a certified chiropractic sports physician. He says that a number of overuse injuries can affect the neck, back, chest, shoulders, arms, and hands. He describes the symptoms that typically occur: Most people start off with simple muscle fatigue due to overexertion. Putting stress on an already fatigued muscle eventually leads to problems with the connective tissue, or fascia, that forms a sheath around the muscle. The fascia responds to repeated stress by becoming harder and thicker. It may get “sticky” and begin to bind to the muscle and other neighboring tissues. The muscles and fascia also become tight and restricted. Nerves and blood vessels get squeezed, causing tingling and numbness. Eventually, the nervous system gets involved, setting off pain signals throughout the body.
Dr. Jameson adds that repetitive strain injuries can be extremely serious. “You can become very limited in your ability to do any type of work, especially repetitive work. In severe cases, people cannot work at all, cannot even get dressed in the morning. They cannot do the things they normally would do.”
Anti-inflammatory drugs and surgery may be recommended. There are a variety of less invasive natural options as well.
If you are engaged in activities that can lead to repetitive strain injury or are already suffering from this disability, there are foods you should cut out of your diet. The number-one item to avoid, which is a major precursor of joint pain, is refined sugar, particularly high-fructose corn syrup. It increases sugar within the body, which sets off the whole process of the insulin reaction, with release of prostaglandins, which starts the inflammatory reaction.
Dr. Jameson recommends the book Enter the Zone by Barry Sears as a good source of information on proper nutrition. The book “goes into depth on how to prevent an inflammatory reaction. If you look through the aisles of the gro-cery store, you’ll see that something like 50 percent of the products sold there use high-fructose corn syrup as an ingredient. The body has a lot of trouble digesting that. I know of cases where people cut it totally out of their diet, and their repetitive injury subsided within a few days.”
Processed meats, such as corned beef, salami, and hot dogs, are very tough for the body to digest and can trigger an inflammatory reaction. Some of the more saturated oils, such as corn oil, palm oil, safflower oil, and butter, should also be avoided. Margarine, too, is bad. Many people think margarine is better than butter. However, margarine, because of its trans-fatty acids, is actually worse for the body than butter.
Dr. Jameson advocates use of supplements. “I would recommend vitamin C, which is very important for tissue healing, starting out with about 1 gram and going up to about 3 grams a day. Also very important are the B-complex vitamins. These are used for nerve regeneration and nerve healing.”
Minerals also can help in cases of repetitive strain injuries. “You should never underestimate the power of minerals to rejuvenate cellular tissue,” Dr. Jameson says. He puts his patients on a complete mineral regimen, with either colloidal or chelated minerals.
“A lot of people—especially people in jobs that involve heat and a lot of sweating in the summer—are sweating out many of the minerals in their body. So if they are doing a lot of cumulative work and sweating, they are depleting their body’s mineral’s resources.” A list of the minerals and vitamins that Dr. Jameson finds useful for preventing and treating repetitive strain injuries follows. “I usually prescribe these substances in pill form,” he notes, “but you can also get all these things in food.”
CALCIUM—Calcium is very important for muscle activity and for bone growth; it is also a muscle relaxant. Take about 800 milligrams a day of calcium, a little more if you are pregnant or postmenopausal.
MAGNESIUM—Magnesium is important for muscle relaxation and is required for the functioning of about 80 percent of the enzymes in the body. Good sources of magnesium are vegetables and whole grains. Dr. Jameson recommends starting out with about 200–300 milligrams of magnesium a day. “That’s a small amount, considering that magnesium is not well absorbed,” he says. “However, I always like to start my patients out with small amounts to see how they react.”
ZINC—Zinc is needed for enzyme function and cellular healing. Dr. Jameson recommends about 20 or 30 milligrams a day. Zinc is found in fish, meat, and poultry.
SELENIUM—Selenium, another valuable substance, is found in fish, wheat germ, and garlic. Take 50–200 micrograms a day in the pill form.
VITAMIN E—Vitamin E is a potent antioxidant; Dr. Jameson recommends 200 to 400 IU a day.
BETA-CAROTENE—“Beta-carotene,” Dr. Jameson remarks, “is a compound found in vegetables of a yellow-orange or dark green color. Carrot juice is a great source of beta-carotene. I recommend that patients drink carrot juice to get a natural, fresh form of the compound.”
COENZYME Q10—Coenzyme Q10 is particularly important for patients with underlying heart disease. It helps to maintain cellular energy, which is vital in cases of repetitive strain injuries.
PROTEOLYTIC ENZYMES—These enzymes “scavenge around the cells and rake up any cellular debris, aiding the healing process,” Dr. Jameson explains.
CARTILAGE GROWTH FACTORS—“There is also some good research now on the cartilage growth factors glucosamine sulfate and chondroitin sulfate,” Dr. Jameson says. He recommends them for patients with joint pain or irritation of the elbow, spine, or hands and fingers.
Certain herbs help the body relax, which is important in overcoming repetitive strain injuries. “Valerian root can be used for reducing muscle spasms,” Dr. Jameson says. “It should be taken toward the end of the day, because it’s a relaxant. You wouldn’t want to take it throughout the day, because it might affect your ability to perform. Garlic is a natural antibiotic as well as antifungal. Some of these muscular problems can stem from an underlying fungal problem, something we also see in fibromyalgia. A third valuable herb is ginkgo biloba, which increases circulatory function and brain function and enhances memory. It helps the blood flow get down to the extremities. Cayenne has also been found to help increase circulation. And ginseng is great for stress relief.”
In addition to vitamins, minerals, and herbs, homeopathic remedies can be of service. Try the ones you find in health food stores that are recommended for muscle and joint injuries and for rheumatoid arthritis.
Carpal tunnel syndrome, a widely recognized type of repetitive strain injury, is a common disability affecting office workers who sit at computer terminals. It is important that people at risk for carpal tunnel syndrome not only follow the suggestions we make here but also learn to sit and type with the correct posture and to use ergonomically designed chairs and keyboards.
In 2010, an estimated 3.1 percent of employed American adults had carpal tunnel syndrome in the past year, according to the Centers for Disease Control and Prevention (CDC). Women in every age group had higher rates than men. Some cases of carpal tunnel are pregnancy-related, and resolve on their own after the woman gives birth.
The carpal tunnel is a bony canal in the wrist through which the median nerve as well as nine tendons of the hand pass. Carpal tunnel syndrome occurs when the nerve becomes compressed in this narrow space, causing numbness, tingling, and/or pain that gradually increase over time. The symptoms often appear at night because of the way people position their wrists when sleeping. Although the cause of carpal tunnel syndrome is often unknown, many people report increased hand activity or day-in, day-out use of the same muscles and nerves to perform a repetitive task.
The late Dr. Ray Wunderlich, author of many books including The Natural Treatment for Carpal Tunnel Syndrome, said that when treating a patient, he started by looking for contributing factors. For women, he asked immediately, “Is she taking birth control pills?” The Pill, in essence, “puts you in a simulated state of pregnancy, and we know that pregnancy is one of the risk factors for carpal tunnel syndrome. Birth control pills also diminish the nutrients in the body, some of the water-soluble vitamins. Moreover, many women who take them become bloated. They develop minor degrees of fluid retention.” Women who are taking birth control pills and who perform tasks likely to lead to carpal tunnel syndrome should consider some other form of birth control.
Two other contributing factors, said Dr. Wunderlich, are hormone replacement therapy (HRT) and thyroid deficiencies. With regard to HRT, Dr. Wunderlich said, “If the estrogen preparations are not in balance with the progesterones, this can cause problems.”
Dr. Wunderlich found that 75 to 80 percent of his patients had some kind of thyroid disorder. He said, “On top of the repetitive movement of their jobs, many people have thyroid disorders, which contribute to the syndrome and may be hard to diagnose. To pin this down, look for a pale, puffy person, edematous, which is to say retaining fluid. When there is swelling, especially in connective tissue and in the nine tendons that run through that carpal tunnel, that medial nerve in the tunnel is often screaming for more room.”
Low adrenal states, which may occur for a variety of reasons, may contribute to carpal tunnel syndrome. People who overwork themselves, who consume a lot of caffeine and/or sugar, and who are now faced with repetitive tasks and sedentary living, may wind up with low-functioning adrenals. In the workplace, they develop various allergies, sometimes combined with low blood pressure. These people often have swollen tissues, which contributes to the problem.
Type 2 diabetes is often accompanied by edematous conditions. This may not be readily observed, Dr. Wunderlich cautioned. “It may be microedema rather than pure edema. The ankles may not be swollen, for example, or the lungs congested, but the tissues may be slightly swollen.
“When the blood sugar is too high, osmotic pressure rises. As we know from high school, osmosis is what controls the body’s fluid pressure. The fluid should be in the blood vessels and in the lymph tissues. When it’s outside in the body tissues, as happens in high blood sugar states or after we eat a lot of candy or, sometimes, fruits or juices in excessive quantities, the tissue may become water-logged. This, too, can cause problems in that narrow carpal tunnel. The medial nerve is numb and irritable, and we have pain every time we move our fingers.”
Food allergies are another potential factor in the development of carpal tunnel syndrome. The monotonous diets that so many people consume, especially with high-protein antigens—such as milk, cheese, and sometimes eggs—often produce food allergies. And a hallmark of the allergic response is swelling. Although the swelling is on the microlevel, the cramped carpal tunnel reacts, causing pain.
Even if you are not allergic to what you’re eating, if you’re on a typical American diet, you may have problems. “The 140 pounds of sugar per person, per year, that the average American still eats is one problem,” Dr. Wunderlich said. “We’re not talking about a long time ago. It’s still happening. And there are also the salt-laden diets, which could be improving as people are counseled by alternative nutritionists to take high-potassium foods over high-sodium foods. There are animal foods, which are high on the inflammatory scale—they tend to accentuate the inflammatory cascade, or series of chemical reactions through which inflammation develops. Animals are on top of the food chain, and that is where all the refuse accumulates, all the toxic chemicals that get into the animals’ fat. This is especially true if the animals are domesticated and not wild, which is the case with most of our animal food sources.”
Finally, Dr. Wunderlich said, there are “the chemicals in the workplace. When you are sitting at your computer, you may be bombarded with pesticides they have sprayed around your place—every month they come in and do that, or every two weeks if they see a lot of roaches. All of this adds to the toxic load as background factors.”
By the time a person with carpal tunnel syndrome consults a physician, the condition is often quite advanced. According to Dr. Wunderlich, “The person often has atrophy of the muscles and irreversible or nearly irreversible nerve damage. The doctors operate, often with excellent results. So it’s very appealing.” However, this is a drastic therapy and will result in a life with further impaired function.
For less severe cases, conventional medicine’s procedure is less felicitous. “What ordinary medicine does is give pain relievers—aspirin, Tylenol, ibuprofen, and other nonsteroidal anti-inflammatory drugs—which in the long term are all counterproductive, damaging the gastrointestinal system, producing leaky gut, as well as actually destroying cartilage. But those are the standard therapies that are offered.”
Dr. Wunderlich’s program was short, sweet, and sensible. “The number-one approach in treating this problem,” he stated, “is detoxification. We do a vitamin C bowel flush. That’s the first step for bowel tolerance.” The vitamin C flush gets accumulated toxins out of the body. Follow this up with the second step, taking your favorite bulking agent, rice powder or psyllium, for example. “Number three,” he mentioned, “is to support the liver. I like artichoke and thistle compounds. Maybe 100 milligrams of thistle, three times a day, and 500 milligrams of artichoke leaf three times a day. Those are basics, plus water.
“I also use infrared heat to have people sweat, carefully monitored, of course, so there is exchange of body fluids. Also, exercise is important. I do running.”
In his program, then, he emphasized detoxification of the body, shifting to a sensible vegetarian diet, exercising, and improving stress management.
It is a question of priorities, Dr. Wunderlich concluded. “Many people have kids, two jobs, and so forth, so they think they do not have time. But you have to sort out the priorities, which we are not doing. You have to have good air and an appropriate amount of sleep. You need to avoid toxic foods. It is also important to have regular bowel movements, and you have to use your body appropriately for you.”
The advice that Dr. Wunderlich gave about carpal tunnel syndrome also applies to people who have any type of repetitive stress syndrome. Ultimately, we need to make our workplaces more livable. This will involve the improvement of human interaction and of the machines we surround ourselves with. If we upgraded our environments as obsessively as we upgrade our computers, we might have very few occupational disorders with which to cope.
The temporomandibular joint (TMJ) is a hinged joint that opens and closes the jaw. There are two such joints at either side of the head. The jaw is part of a wider system, the craniosacral system, which extends from the skull to the lowest segment of the spine. Disruption at any level of the craniosacral system can result in TMJ dysfunction.
According to 2014 data from the National Institutes of Health, more than 10 mil-lion Americans have TMJ dysfunction. Women are affected more often than men.
The two most common causes of TMJ problems are poor bite and stress. Poor bite may be the result of new dental work that affects tooth alignment. Sometimes braces shift the palate, which affects the jaw.
TMJ dysfunction affects larger numbers of women than men due to stresses brought on by hormonal changes. Dr. Deborah Kleinman, a chiropractor who works with TMJ patients, explains. “There are various stress factors we can talk about that are specific to women. First, we have premenstrual tension. This further weakens an already weakened system. I know women who only have a problem with their jaw three days before their period. As soon as their period comes, their pain goes away. This tells me that there is a weakness in the system and that hormones push the body past the point of being able to compensate for it.”
Hormonal changes also occur during pregnancy. “Hormones loosen the pelvis so that the woman is more flexible during delivery. And pregnancy creates structural changes through weight gain and the loosening of ligaments. These changes can further aggravate TMJ dysfunction.
“With nursing, postural changes can play a big role. Nursing places stress on the upper back muscles, especially if the woman doesn’t use the proper pillows or if she gets lazy and slumps over while feeding her baby. These upper back muscles insert into the occiput, which is part of this craniosacral system. The occiput is the bone at the bottom of the skull. Tightening or pulling on the occiput can affect the head, neck, and TMJ.”
The hormonal changes that occur during menopause also play a role in TMJ dysfunction.
Pain can be isolated in the joint itself or it can radiate to the face, neck, ear, and shoulder. Headaches may be a part of the picture. There may be a nagging toothache, even though the tooth is healthy. A person with TMJ problems may find it difficult to open the mouth all the way. Inflammation of the muscles around the joint may cause a spasm in those muscles, locking them open. Clicking, grinding, or popping noises may accompany chewing or movement of the joint.
Cranio means “skull” and sacral refers to the sacrum, which consists of the lowest five vertebrae of the spine. Craniosacral therapy is founded on an understanding of the relationship between these structures and several points in between, including the TMJ. Dr. Kleinman, who uses a specific form of craniosacral therapy called the sacro-occipital technique, explains: “A chiropractor like myself who uses this technique understands that there is a balance between the nervous system and the musculoskeletal system, and a relationship between the pelvis and the sacrum and then the head and the cranium. Between both structures rests the spine, the shoulders, the neck. All of these structures react to shifts in the pelvis and the cranium. The TMJ is part of that.” She adds that a stable pelvis balances the body and works in harmony with the cranium. This allows information to flow to the brain smoothly.
Dr. Kleinman says that with TMJ the first step is to have a doctor perform a series of tests to determine whether structural stresses exist, and, if so, where. Once the structural stresses are identified, treatment can begin. Dr. Kleinman explains: “We place wedges or blocks under the pelvis. The muscles will relax and contract around these levers in an unforced way, based upon what these levers tell the brain. Then we incorporate breathing techniques to assist the brain in making musculoskeletal changes. This reestablishes the proper craniosacral flow.” Sometimes secondary manipulations are necessary to readjust parts of the spine that lie between the pelvis and cranium that get knotted up as a result of compensating for the pelvis and the cranium. Cranial adjustments, made specifically to the temporomandibular joint, also help to reestablish proper balance.
Isotonic exercise, done regularly, can help in some cases of TMJ dysfunction. In addition to jaw exercise, self-treatment for TMJ problems may include jaw awareness, in which the patient tries to notice and avoid clenching and grinding the teeth, as well as biting on gum, ice, or fingernails. Eating soft foods and avoiding resting or sleeping on the stomach can also help, as can learning to rest the jaw and to adopt proper jaw posture. Other potentially helpful techniques include self-massage; relaxed rhythmic opening and closing of the jaw; alternating moist heat (fif-teen minutes) with ice (two to three minutes) to increase circulation; cool sprays and cryotherapy; bite guards; and splints. Surgery should be a last resort when dealing with TMJ problems.
Another physical therapy that can help relieve TMJ problems is body rolling, a technique developed by bodyworker Yamuna Zake, author of Body Rolling: An Experiential Approach to Complete Muscle Release. “Many of the muscles that run up the back and insert in the skull, as well as the muscles in the front of the neck, have attachments between the head and the chest. Thus the amount of tension in the muscles of the back, front, and sides of the neck can affect the level of contraction of the sutures (joints) and muscles of the cranium, and specifically the TMJ,” she explains.
In body rolling, a six-inch-diameter ball is used to apply traction that lengthens and releases muscles. “The degree of tension in the TMJ is controlled by the tension maintained in the neck,” Zake explains. “By working the neck muscles with the ball to keep them at maximum length and minimum tension level, you can help reduce the buildup of tension in the TMJ.” Zake has designed specific routines that use the ball to release the front and back of the neck, as well as an aroundthe-neck routine that helps break the holding pattern of tension that distorts head and neck alignment.
Nutritional supplements may help in treating TMJ problems. Some of the most useful are listed here:
CALCIUM AND MAGNESIUM—These minerals are essential for proper muscular function and have a sedative effect.
B-COMPLEX VITAMINS—Take 100 milligrams of B-complex vitamins three times a day. B-complex vitamins are essential for combating stress.
PANTOTHENIC ACID—The appropriate amount of pantothenic acid to take is 100 milligrams, twice daily. B-complex vitamins, such pantothenic acid, are for combating stress.
COENZYME Q10—Coenzyme Q10 is another stress fighter.
OTHER SUPPLEMENTS—L-tyrosine and vitamins B6 and C will improve sleep quality and alleviate anxiety and depression. It is also important to take a multivitamin and mineral complex.