Current Research
The following research projects are under way at RECOUP and are scheduled to be completed by the end of March 2008
No
|
Topic |
Type of Paper |
Main Resource Person
|
1
|
Thoracic Outlet Syndrome associated with Shoulder Instability: A Clinical Protocol |
Original Research |
Anu Ebenezer |
| 2 |
Outcome of Treatment of Myofascial Lumbo-Pelvic Pain |
Original Research |
Sasikala V |
| 3 |
Thoracic Outlet Syndrome associated with Temporomandibular Joint Dysfunction |
Original Research (brief report) |
Chetan Parasar |
| 4 |
Physical Therapy of Thoracic Outlet Syndrome: A Clinical Protocol |
Original Research |
Mohan Babu |
| 5 |
Prevalence of Musculoskeletal Symptoms in Indian Computer Professionals, Risk Factors, and Clinical Features |
Original Research |
Praveen TJ |
| 6 |
CRPS as a complication of SEMLARASS |
Case Report |
Pallavi Sharma |
| 7 |
Non operative Management of Cubital Tunnel Syndrome in Computer Professionals |
Original Research (brief report) |
Jaba Prabu |
| 8 |
Physical Therapy of Patello Femoral Pain Syndrome: A Clinical Protocol |
Original Research |
Anoop P |
| 9 |
RSI in Indian Musicians |
Original Research (brief report) |
Habeeb Rahman |
| 10 |
Osteoporosis in IT professionals younger than 40 years |
Original Research (brief report) |
Jeena Jose |
| 11 |
Treatment of Fibromyalgia using an integrated approach |
Original Research |
Dr. Satish VR |
| 12 |
Back pack injuries in Indian School Children |
Original Research (brief report) |
Shelza Gupta |
| 13 |
Thoracic Outlet Syndrome associated with Complex Regional Pain Syndrome Type 1 |
Original Research |
Muniyandi P |
| 14 |
Outcome of SEMLARASS for Spastic Diplegia |
Original Research |
Pallavi Sharma |
| 15 |
Outcome of SEMLARASS for Spastic Athetoid Quadriplegia |
Original Research (brief report) |
Karthikeyan M |
| 16 |
Outcome of OSSCS for Spastic Hemiplegia |
Original Research (brief report) |
Karthikeyan M |
| 17 |
Role of Psychosocial Risk Factors in Pathogenesis of Work Related Musculoskeletal Disorders |
Original Research |
Pushpalatha |
| 18 |
Management of Thoracic Outlet Syndrome associated with Cervical radiculopathy |
Original Research (brief report) |
Jeena Jose |
| 19 |
Physical Therapy of heel pain: A Clinical Protocol |
Original Research (brief report) |
Balaji G |
| 20 |
Myofascial Pain Syndrome in Children |
Original Research (brief report) |
Shanmugha Priya |
| 21 |
Lumbar Radiculopathy associated with Myofascial Pain |
Original Research (brief report) |
Sajin Dev |
| 22 |
Physical Therapy for Failed Back Surgery Syndrome : A Clinical Protocol |
Original |
Jayashree J |
| 23 |
Physical therapy for Iliotibial Band Friction Syndrome |
Original Research (brief report) |
Priyavadhana V |
| 24 |
Text Message Injuries including Blackberry thumb |
Original Research (brief report) |
Balaji G |
| 25 |
Effectiveness of stretch break software in RSI |
Original Research (brief report) |
Sasikala V |
| 26 |
Kinesio Trial for Thoracic Outlet Syndrome |
Randomised Controlled Trial |
Deepa K
|
| 27 |
Kinesio trial after SEMLARASS |
Randomised Controlled Trial |
Caroline Jothi |
| 28 |
Cost Effectiveness of Ergonomics and RSI Programme in IT Companies |
Original Research |
Nithin Suresh |
| 29 |
INTREX CRPS |
Randomised Controlled Trial |
Biju Nirmal Jacob |
| 30 |
INTREX FMS |
Randomised Controlled Trial |
Dr. Satish VR |
| 31 |
INTREX Post SEMLARASS |
Randomised Controlled Trial |
Shanmugha Priya |
| 32 |
INTREX MPS |
Randomised Controlled Trial |
Biju Nirmal Jacob |
| 33 |
Osteoarthritis of Knee: Comparison of efficacy of EFAC and Diacerin |
Randomised Controlled Trial (Sponsored by Cymbiotics) |
Biju Nirmal Jacob |
| 34 |
Physical therapy for wrist tendinitis: a clinical protocol |
Original Research (brief report) |
Jerrish A Jose |
| 35 |
Physical therapy for lateral epicondylitis: a clinical protocol |
Original Research (brief report) |
Reshmi Priya |
| 36 |
Physical therapy for adhesive capsulitis: a clinical protocol |
Original Research (brief report) |
Reshmi Priya |
| 37 |
Physical therapy for coccydynia: a clinical protocol |
Original Research (brief report) |
Bieju K Balan |
I am leading the largest prospective study in the world on Computer
Related Repetitive Strain Injury (RSI). This comprehensive, prospective
study started on February 8, 2001 and will be completed in 2008.
Our aim is to study over 35,000 computer professionals to determine
the prevalence, predisposing factors, presenting
features and outcome of treatment of RSI.
The following material is a part of my paper titled "Computer
Related Injuries: The Indian Experience", presented on November
15, 2002, during the AA Mehta Gold Medal Session of the 47th Annual
Conference of the Indian Orthopaedic Association. The number of
computer users studied has since extended to over 30,000 and over
75 IT/ITES Professionals have now lost their jobs.
Study Population
- 650 subjects in computer-dependent careers
- Recreational users were excluded from this particular study,
though our youngest RSI patient was aged 5.
Presenting Symptoms
Back pain (47%), Neck pain (35%), Shoulder pain (34%), Hand/wrist
pain (26%), Arm pain (22%), Visual strain (20%), Anterior knee
pain (20%), Tingling/numbness of hand (16%), Weakness of hand
(10%), Pilot Seat Syndrome (10%)
- 76%
of those surveyed reported having at least one musculoskeletal
symptom
- Median age 27
years (range: 18 to 52). In most studies reported
from the west the commonest age group is 40-50 years.
- 55%
developed symptoms within 1 year of starting computer
dependent careers, clearly demonstrating that most Indian
Computer Users are unaware of safe computing techniques.
- 60%
of those with severe disorders (neurovascular compression
or tendinitis) recalled having chronic neck and shoulder
pain or stiffness that they had considered "normal"
for computer users and ignored
|
Predisposing Ergonomic Factors
Lack of appropriate breaks (86%), Improper monitor height (60%),
Mouse too high (54%), Resting the arm or wrist on a hard surface
while typing (42%), Keyboard too high (40%), Bizarre leg positioning
(25%)
Predisposing Postural Factors
Head forward (92%), Rounded back (75%), Protracted shoulders
(55%)
Specific Physical Findings
- Scalenus anterior MTrP's (70%)
- Thoracic Outlet Syndrome (68%)
- Pectoralis major/minor MTrP's (66%)
- Trapezius MTrP's (66%)
- Rhomboids/Levator Scapulae MTrP's (66%)
- Forearm MTrP's (62%)
- Erector Spinae MTrP's (40%)
- Psoas major MTrP's (40%)
- Supraspinatus tendinitis (35%)
|
- Acromioclavicular degeneration (33%)
- Cubital Tunnel Syndrome (32%)
- Short hamstrings (32%)
- Patellofemoral pain syndrome (18%)
- Hand weakness (15%)
- Lateral Epicondylitis (12%)
- Medial Epicondylitis (8%)
- Reflex Sympathetic Dystrophy (5%)
- Hyperlaxity of elbow/fingers (5%)
|
MTrP's = Myofascial Trigger Points
Past Treatment (n = 353)
- 65% (mis)diagnosed as "spondylitis", "arthritis",
"slipped disc", "tennis elbow", "muscle
sprain" or "Carpal Tunnel Syndrome"
- 20% diagnosed as RSI but told "RSI is incurable"
or given steroids (cortisone), Vitamin B12 injections or Antidepressants
- 30% had x-rays/bloods (useless in establishing diagnosis)
- 15% had MRI's (all essentially normal!)
- 10% had Nerve Conduction Studies (all abnormal!, but non-contributory
in management)
- 0% had an on-site workstation evaluation
- 100% had failed conventional Physiotherapy (e.g., traction,
short-wave diathermy, infra-red, ultrasound, IFT, isometric
exercises)
Predisposing Medical Disorders
- 10 (0.02%) had a pre-existing medical condition or surgical
history.
- 5 (0.01%) had an anatomical predisposition (e.g., Cervical
Ribs)
- 32% admitted significant stress at home/work
- 80% led sedentary lifestyles
Speed of Recovery
- Related to the stage at presentation, with little correlation
to duration of symptoms
- Stages of RSI (Damany & Bellis, 2001): Patients who presented
at an earlier stage (stage 1: pain during work,
that eased off as soon as you stopped working) almost always
got better within a few days or weeks. Stage 2 (pain
that went home with you, and interfered with your regular activities,
but disappeared by morning) usually took a few months to improve.
Stage 3 (pain that woke you up, and stayed with you
all day and night) was much more difficult to treat and took
several months.
The bad news
- 6 Software Engineers (25-35 year old) had to give up Computer-dependent
careers due to advanced RSI symptoms
- 85% of the respondents were from the so-called blue-chip IT
Companies. One shudders to think what would be the situation
in lesser equipped IT Companies, banks, newspaper offices, and
colleges/training institutes.
Message
- The high incidence of RSI in India is remarkable because
no financial gain is involved, unlike in the west. Only
"genuine" patients* would report symptoms here.
In fact, there are huge disincentives to report symptoms
(lack of support from management, possibility of retrenchment,
etc.)
- RSI is a diffuse neuromuscular disorder: a physical
problem, not a psychosomatic one (though stress may aggravate
symptoms)
- There are significant proximal upper body findings
that affect distal function. In other words, pain or numbness
in the hand may signify a neuro-vascular compression in
the neck.
- The best-known RSI, Carpal Tunnel Syndrome, is actually
very rare in India
- Splints, Conventional Physiotherapy, Medicines of all
systems, and Surgery frequently made matters worse
- All affected individuals had significant postural and/or
ergonomic abnormailities that needed correction
|
* This is not to say that RSI patients in other
countries are malingerers!
Causes of RSI?
RSI arises due to the following factors:
- Prolonged repetitive, forceful, or awkward hand movements
- Poor posture
- "Static loading" or holding a posture which promotes
muscle tension for a long period
- Poor conditioning of the heart and lungs, and poor muscle
endurance
- Direct mechanical pressure on tissues
- Cold work environment
- Poorly fitting furniture
- Basic inadequacies of keyboard, monitor and workstation design
- Work organisational and psychosocial issues
| Our findings are identical to that
of similar research being carried out by Dr. Emil Pascarelli
at Columbia University in USA, who is considered one of the
foremost expert in the world on RSI. Double Crush Syndrome
is common in RSI: there may be compression or injury at multiple
points during the course of a nerve, from the neck down to
the hand. What was earlier passed off as Carpal Tunnel Syndrome
(nerve compression in the wrist) is now increasingly recognised
as being due to neurovascular compression in the neck. This
finding has far-reaching consequences on the treatment of
RSI. Nerve surgery at wrist or elbow would be a disaster in
such cases and no amount of physiotherapy at the wrist/hand
would help because the problem usually lies higher up. |
|
Recommendations
- Awareness programmes for employees, employers, school
and college teachers, and medical professionals
- Mandatory practical training and certification on safe
computing techniques, body awareness and posture for all
computer users
- Early Intervention for RSI symptoms. Neck and shoulder
discomfort should never be ignored.
- Reporting, referral (for treatment) and workplace accomodation
procedures in organisations
|
Food for thought
| What will be the prevalence of RSI
in India when the present lot of children who have been ab(using)
computers and suffering backpack and postural injuries since
the age of 3 grow up to be IT Professionals? |
Who'll bell the cat?
NASSCOM?, IT Companies?, Individual Computer Users?, Doctors?,
Parents?, Teachers?, Government?
Significant effort needs to be made by each group, in a coordinated
manner. A reasonable start would be for NASSCOM to fund a comprehensive
multi-centre study to estimate the magnitude of the problem, predisposing
factors, with an eye on the steps necessary for prevention. I
have emailed Mr. Kiran Karnik, President, NASSCOM, in 2003 about
the seriousness of the problem, without eliciting as much as an
acknowledgement from him.
| The pattern and nature of RSI in India
is significantly different from that in the western countries.
There are significant anthropological differences in the body
shape and dimensions, work practices, and furniture design.
These problems are unique to our country and so should be
the solutions. |
|
