From: marko@IMD.Sterling.COM (Mark Olson)
Subject: Re: Juggling and RSI (Repetitive Strain Injury)
Organization: Sterling Software, IMD
Date: Wed, 6 Jan 1993 19:09:37 GMT
X-Md4-Signature: 4a67500ef99581de5c6f329b138b2178

In article <1993Jan3.135346.2555@ohm.york.ac.uk> jkn@ohm.york.ac.uk (John Nicoll) writes:
>
>Hello all
>	I've been juggling 3-ball (& trying clubs) for a
>while now, and have been wondering if there is any possibility
>of injury from the repetitive catching that necessarily goes on.
>One hears a lot about such problems from keyboarding these days, 
>and since I have a malformed & mechanically awkward right hand
>I pay attention to this!
>
>I've just had a fortnights break from keyboarding (Christmas/New
>year), and have been doing a fair bit of juggling. I notice that I
>still have (occasionally) the slight soreness & tingling in my
>palms and fingers that I associate with too much/bad typing. Has
>anyone else had experience of this? Am I catching badly? What will
>happen when I try clubs for real? (I know my hands may well get
>_sore_ from  this, but that's not what I mean).
>
>Comments welcome
>
Hit 'n' now if you don't want to read copious amounts of information about
Carpal Tunnel Syndrome,,,

Disclaimer: I am not a doctor, and watching reruns of Marcus Welby, M*A*S*H,
and Trapper John M.D. did not qualify me to sit for the Medical Boards, but I
do have carpal tunnel syndrome and have managed to pick up some tidbits of
information here and there.  You should consult with your doctor to determine
the extent of any injury you have and what course of treatment you should
follow (oh, these litiginous times).

The repetitive motions of juggling can, most certainly, contribute to carpal 
tunnel syndrome (CTS).  CTS used to be rampant amongst meatpackers, at least in
the U.S., but is now endemic amongst computer operators (doctors use this term
as a catch all for anybody who types all day at a computer). 

CTS is a nerve entrapment syndrome and occurs when the median nerve, the nerve
that supplies power and sensation to your hand, wrist, and forearm, is
compressed in the sheath at your wrist.  CTS causes a pins and needles feeling
in your hand, wrist, and sometimes your forearm.  Typically the thumb, index
and middle finger are affected, but your ring finger and pinkie can be affected
as well but they are usually spared.  It is repetitive motions that cause the 
tendons in your wrist to become inflammed and/or build up fluid.  The tendons
then squeeze your median nerve. (CTS can also be caused by water retention)

Typically, treatment for CTS follows three phases depending on the severity of
the injury.  Firstly, it can be treated with anti-inflammatory medications.
Although prescription medication, such as Ancid, are available and can be quite
effective, ibuprofen works very well and does not wreak as much havoc on your
stomach and is available over the counter (in the U.S.).  Secondly, steriods
can be injected into your wrist to relieve some of the compression.  The
effacacy of this treatment varies,  some people gain total relief, others
don't.  The third option is surgery, carpal release surgery, in which part or
all of the tendon at the base of the wrist is separated.  Lately, I have heard
of people having arthroscopic surgery for CTS (as an aside, there are several 
players for our local college's football team who have had arthroscopic 
surgery on their knees and have retured to action in less than two weeks, 
amazing).  The effacacy of surgery is similar to that of steroid injections,
highly variable, some people are totally relieved of the symptoms, others are
not.

In addition to treating CTS medically or surgically, one can alter one's
behavior and receive a great deal of relief.  Here are some items to consider:

	1) If you type, use correct posture for the legs, back, neck, arms, and
	wrists.  Sit up straight, in a relaxed position, adjust your chair so that
	your back is supported and your arms are bent at 90 degrees.  Keep your
	wrists flat (use a wrist support, you can buy them, but I have found that 
	old towels work quite well).  Also, use good posture for juggling, stand up
	straight, relax, balance youself on both feet.

	2) Take breaks.  If you are typing, stop every twenty minutes or so and
	massage your forearms, get up and walk around, or meditate.  If you are
	exersizing or juggling, stop and relax, stretch, shake your muscles.

	3) Exersizes.  See a physical therapist and have him or her show you some
	exersizes that you can do to relieve the symptoms and build the the strength
	in your wrists and forearms.  My PT gave me some exersizes and suggested
	that I do them everytime I save my work.   It is important to consult with a
	PT or doctor to so that your exersizes are indeed beneficial and are not
	hurting the injury.  I also use my exersizes to warm up for juggling.

	4) Aerobic Exersize.  Walking, biking, Cross Country Skiing.  These get the
	muscles warmed up and in shape (it also prepares you for juggling festivals
	by building your endurance).

	6) Warm up before any exersize (including juggling) and cool down
	afterwards.

	7) Use less wrist and more forearm when juggling clubs.  My PT suggested
	this.  This is one that I don't follow very well, it just seems as though
	you can't get those crisp spins by minimizing the wrist action...

	8) Wear gloves when juggling clubs.  Bicycling gloves work quite well for
	this.

	9) Use lighter props (but not too light).  Catching an exerball causes
	considerably more stress on the wrists and hands than a lacrosse ball.

	10) Wear wrist braces when you sleep.  My orthopod and my PT prescribed 
	these.  This is one that I have followed religiously.

	11) Vitamins.  I have heard of studies that have indicated that individuals
	who have CTS are lacking in in vitamin B6 and that dosages, 50mg per day,
	can relieve some symptoms.  I have been taking B6 for about a year and have
	noticed considerable improvement.  Of course, you should consult with your
	health professional before taking any medication.

	12) If the doctor prescribes rest, do it.  This is a tough one, especially
	when your trying to improve and practice. If you can't juggle, ask the
	doctor or PT if there are exersizes that you can to to keep in shape, it
	will be easier to get back to juggling if you are in shape.  You could also
	practice mental juggling, visualize yourself doing a trick that you've been
	working on, mentally run through your practice session.  Watch an IJA tape.
	You don't necessarily have to juggle to improve your juggling.

The most important thing to do, if you think you might have CTS, or any injury,
is to see a doctor and find out what to do in your particular case.  I have done
most of these things for about two years and can happily report that I rarely
suffer from the pins and needles symptoms any more.  It took about six months
before the symptoms subsided, but now my wrists feel great.  My goal is to
avoid surgery, and so far, the odds look pretty good.

John, good luck.

Mark Olson
-- 
Mark Olson  || marko@IMD.Sterling.COM -or- uunet!sparky!marko