"RSI and What We Can Do About It"

[Yon Lee] by:
Yon Lee
Tai Chi Instructor
Department of Athletics
Harvard University

Delivered at the Harvard Tai Chi Conference on Tai Chi and Health
Science Center April 17, 1999

RSI Repetitive Strain Injury in the American workplace is so prevalent today that the Occupational Safety and Health Administration (OSHA) last month targeted it as the number one priority (Slide 1). Last year Harvard University Health Services (UHS) found themselves with over a dozen cases a day during midterms and finals weeks (Slide 2). The major problem is that not only is there no cure for this injury, medical and health professionals have no idea what it really is. Harvard University is not alone in this. A graduating senior last year had so many problems with her typing and the pain in her wrist was so severe that UHS had to pay for a typist to finished her typing for her. This semester, an undergraduate could not use his hands to type and had to resort to dictating his papers. Now, he is losing his voice to another RSI.

In my presentation today, I will describe 3 methods of intervention on RSI based on tai chi and tai chi related modality. The first one is a group of selected tai chi movements for the hands. The second is a routine using beans in a box. The third is a procedure by which I employ the use of an herbal compound and manipulation of the injured area using chi kung techniques.

I am going to start with a little background on tai chi. Back in 1984, a primary school in East Boston invited me to teach tai chi to the 3rd, 4th & 5th graders in the hope that tai chi would help with obesity (Slide 3).

To avoid embarrassing the school children who were obese, we had the school nurse check for a number of parameters, including heart rate, blood pressure, height, and respiratory rate. To our surprise, we found that doing tai chi for 30 minutes once a week help lowered the children's blood pressure by about 10% average.

I use this example because I feel that you can never be too young to learn or do tai chi. Also, teaching children tai chi taught a very valuable lesson. You don't have to understand the philosophy of tai chi to do tai chi. Plus, children are not that picky if they were doing tai chi correctly or not. They don't even worry if they remember which move follows which. They simply enjoy tai chi by doing.

That's the same philosophy I apply in teaching tai chi here at Harvard since 1986. For over 10 years, tai chi classes attracted people young and old: undergraduates, graduate students, staff members and family including faculty. Some semesters enrollment exceeded 100. Last year the Harvard Crimson newspaper listed tai chi as one of the 100 things a student must do before graduating from Harvard (Slide 4).

The greatest reward from teaching tai chi is the number of students who went on to study medicine because of their study of tai chi. One graduate was awarded the Rhodes Scholarship using tai chi as his choice of sports. In the past 2 years, a higher number of students are taking up tai chi because of RSI.

Among the many movements of tai chi, the Chen and Yang being the most popular (Slide 5), there are only a few that yield results for repetitive strain injury (RSI). I will outline a few of the techniques that I have worked with.

Part of the problem is that the hand, particularly the wrist part, doesn't move very much. The movements are very limited. You will note that in this photo of my hand on a keyboard (Slide 6), even when I hit the keys on different rows (up and down plane), my hand did not move very much on the plane parallel to the arm. On the other plane, across the keyboard, the fingers do not move very much either when you hit a key. I would say on the average the movement is less than an inch. This is not very scientific but the point I want to convey is that today's keyboards allow very limited movement and motion in the hands. Plus the keyboards are extremely pressure sensitive, requiring very little force on part of the fingers. All these, in my opinion, confine the wrist and fingers to only a very narrow range of movement and motion. These repetitious movements cause a grove or groves to be developed.

In my opinion, once the wrist and fingers get accustomed to this limited use and narrow range of movements, attempts to leave or deviate from this narrow range will not only causes pain but also be very difficult. In November last year, a study was published in the Journal American Medical Association (JAMA) on Yoga based intervention on Carpal Tunnel Syndrome (Slide 7).

Which tai chi moves to use for RSI? I normally recommend Grasping Sparrow's Tail (Slide 8), Old Man Moving the Mountains (Slide 9), and Crane's Wings (Slide 10) as the most effective.

According to the tai chi the combination of these movements exercises the entire hand, every joint and every combination of joints. Let see if we can try these out?

The second set is a routine of using beans. This method is derived from the training of Iron Palm.

Here, I need to explain what Iron Palm training is. Iron Palm technique is the conditioning of the hand to strike a brick or cinder block with an open palm and break it. The brick. Not the hand (Slide 11).

  1. Beans
  2. Sand
  3. Pebbles & rocks
  4. Iron beads
  5. Cinder blocks & bricks
This is a training in Chinese martial arts. The fighting part uses the unarmed open hand against opponents. The objectives are simply strike your attackers and crush their bones. The secret behind this madness, I mean, methodology is that the hand (your hand) looks normal in appearance and functions regularly.

What do you do? It is very simple. Run your hands through the beans.

There are a number of routines: Stabbing (Slide 12), Twisting (Slide 13), Squeezing (Slide 14), Turning (Slide 15), and Raking (Slide 16) (Slide 17).

Now, why are we using this methodology for RSI? The reason is that if this modality works for conditioning your hand to withstand intense pressure within a very short time, then your hand can handle the pressure of repetitive strain. Of course, you really don't need to go through all 5 steps, just the beans step is sufficient.

The final method is what I called cooking with Ginger & Scallion and manipulation of chi as a final intervention.

I crush a portion of fresh ginger roots. Add in the white portion of green scallion of equal part. Boil them in rice wine (15% alcohol). Squeeze out the fluid and use the compress on the injured area, making sure to move it around to avoid burning the skin. When the heat is gone, I would manipulate the area using "chi" developed through tai chi (Slide 18).

I reheat the compress and repeat this process 2 more times.

This procedure is used for extreme cases where the first 2 methods would not work, either because of the severity or you cannot use beans on your knee.

The analogy for this procedure would be similar to the heating of metal to high temperatures to remold or reshape the molecular structure (same as the Tobin Bridge accident 4 years ago). The compress heating is the same as the high temperature heating and the remolding of the steel beam is the same as "chi" manipulation.

I find that this procedure works for:
Hands/wrists
Back
Knees

Final note:

Traditional Chinese Medicine is based on the concept of "chi": the energy or life force that flows through the body. Health of the body is regulated by the balance of "chi". Excess or lack of chi in any area causes diseases and ailments. Balancing the chi or circulating it in proper order heals the body and keeps the it healthy. Thus the many modalities in developing and in cultivating chi. Tai chi, acupuncture, and chi kung are just 3 of the most common forms that westerners are exposed to. But these modalities have been around and use by Chinese for 5,000 years. Americans are just beginning to appreciate them (Slide 19). However, just because they have been around and use for generations does not make them effective in the scientific sense. Controlled studies and research in the laboratory and in clinics must be conducted to document their effectiveness. What I have outlined today hopefully will initiate others to take up the task. You can help with that task. I hope that this conference is only the beginning of a long association with tai chi.

Thank you.