The Prevention and Treatment of RSI, Part 2: Increasing the Tissue Repair Rate

This is part 2 of a a series on the Prevention and Treatment of RSI. See
The Prevention and Treatment of RSI, Part 1: Decreasing the Damage Rate for the introduction.


RSI stands for Repetitive Strain Injury. In the present discussion, I will concentrate on RSI as it occurs to computer users.

A quick primer on RSI:

• An activity that causes "strain" produces microscopic tears or damage to your tissue.
• To counteract this, your tissues are able to repair themselves at a certain rate.
• You get RSI when the rate of damage exceeds the rate of repair for extended periods of time.
• The prevention and treatment of RSI completely revolve around decreasing the damage rate and increasing the tissue repair rate.

In this post, I will be discussing the mechanics and tactics related to
increasing the repair rate.

Increasing the RSI tissue repair rate

Tissues in the body undergo routine maintenance with the help of the
blood supply. The blood carries to the region all the necessary
nutrients and other components for tissue repair and regeneration, and
carries away the waste products of such processes. Furthermore, much
of actual tissue reconstruction happens during sleep. Most of the
effort in increasing the tissue repair rates will resolve around these
two key points.

The reason that RSI is such a challenge to treat is that much of the
damage is done to the connective tissues like tendons and sheaths.
These tissues, by their very nature, have very little blood supply,
which places a natural limit of the rate of repairs to these tissues.
It is not uncommon for RSI damage to require years of recuperation,
making it that much more important to do what you can on a day-to-day
basis to help with the tissue repair process.

Tactics to increase the RSI tissue repair rate

Here are some practical tactics for increasing the repair rates of the
affected tissues:

• Keep your hands warm at all times
  
  The top reason why there is insufficient blood circulation to your
  hands is that they are cold. In part 1 of this series, I mentioned
  that you should avoid typing with cold hands due to the reduction of
  lubrication. This particular tactic extends the need to keep your
  hands warm to all hours. Tissue repairs happen around the clock, so
  to maximize the amount of repairs that can be done in single day, you
  should seek to avoid having cold extremities at all times if at all
  possible.
  


• Improve your cardiovascular conditioning
  
  Since the tissue repairs are rate-limited by the blood circulation to
  the affected areas, one way to increase the repair rate is to improve
  your systemic cardiovascular conditioning. Any training that improves
  your cardiovascular capacity will help. Personally, I prefer Tabata
  sprints due to their effectiveness and time efficiency, but if you
  like jogging, hiking, or ellipticals then they will work just as well.
  


• Weight train
  
  Weight training is a very effective way to increase the amount of
  circulation to a part of a body. In the context of RSI, we are
  primarily interested in increase the blood flow to the arms. This can
  be accomplished by weight training any of the major muscle groups in
  the arms. A caveat: DO NOT perform any weight training exercises if
  it causes you pain. Also, I am not fond of exercises like squeezing a
  squeeze ball that require your tendons go under continuous movement
  and thereby causing them to incur additional friction damage while
  performing exercise. Exercises that only apply a static load on your
  tendons are preferred, e.g. push-ups, pull-ups, curls, etc.
  
  People who naturally have cold hands often find that their hands start
  to stay warmer during the day once they start a weight training
  regime, as the blood vessel network becomes better developed in order
  to supply the now larger muscles.
  


• Get adequate, high quality sleep
  
  Even though tissue repairs happen around the clock, a substantial
  majority of it happens during sleep. It is therefore of vital
  importance that you get adequate, high quality sleep so that your
  tissues can better repair themselves.
  


• Avoid cutting off circulation to your arms and wrists during sleep
  
  Since much of the tissue repairs during sleep, it is vitally important
  that the blood circulation to your arms and hands are not hampered
  during sleep. Avoid putting your arms or hands in awkward positions
  that cause them to go numb or otherwise impede blood circulation to
  them. Also avoid crushing your limbs with either your own body or that
  of someone else.
  
  Avoid having your wrists bent in awkward angles during sleep. Some
  people with advanced RSI also find that their fists become clenched
  during sleep. You can manage these conditions by loosely wearing a
  wrist brace while sleeping in order to keep the hands and wrists in a
  neutral position. Remember not to put them on so tight that it
  impedes your blood circulation.
  

You should not wait until you have started suffering the symptoms of
RSI to start trying to increase the tissue repair rate. Recall that
RSI is caused by incurring damage at a rate in excess of the repair
rate for an extended period of time. Paying early attention to the
things that can help you increase the repair rate will substantially
increase your likelihood of avoiding RSI in the first place.

Paleo Cholesterol Results

The lipid panel, otherwise known as the cholesterol test, is one of several lab tests that your doctor may order for you as part of your routine physical. The results of a lipid panel typically include the following:

• Total Cholesterol (TC)
• Triglycerides (TG)
• HDL Cholesterol
• Estimated LDL Cholesterol

Computing the Estimated LDL Cholesterol

In lipid panel results, LDL cholesterol is usually "estimated" or "calculated". Whereas total cholesterol, triglycerides, and HDL cholesterol are cheap and easy to directly measure, the LDL cholesterol is expensive to directly measure. Because of this, the LDL cholesterol is usually provided as a number computed using the Friedewald equation:

Friedewald (1972) Formula: LDL = TC - HDL - TG/5.0 (mg/dL)

The issue with the Friedewald equation is that it is only generally accurate when Triglycerides are between 150 mg/dL and 400 mg/dL. For someone on a Paleo or a low-carb diet, the triglycerides are usually below 100 mg/dL, and in this range the Friedewald equation grossly over-estimates the LDL concentration. For cases where the triglycerides are below 100 mg/dL, a more accurate "Iranian" formula (so named since the research was conducted in Iran) has been developed:

"Iranian" (2008) Formula: LDL = TC/1.19 + TG/1.9 – HDL/1.1 – 38 (mg/dL)

Most lab reports still provide the estimated LDL cholesterol using the Friedwald equation, so it is important to compute your own estimated LDL if you and your doctor are relying on the LDL result to determine a course of treatment.

Interpreting the Results

Currently (as of 2010), of all the results you get from the lipid panel, the most significant indicator of your health risk is the ratio of triglycerides over HDL, the lower the better.

Triglycerides / HDL:

• 2 or less: ideal
• 4: average
• 6 or higher: high risk

In order to improve (reduce) the ratio, you should seek to reduce your triglycerides and increase your HDL cholesterol. Triglycerides is reduced by reducing your carbohydrate intake. HDL is increased by increasing your intake of healthy saturated fats. Both of these are fully satisfied by the Paleo diet.

If you are familiar with the PaleoQ score, you will notice that it only asks for the HDL and triglyceride numbers. This is precisely because the other results don't actually matter as much as what these two markers indicate.

What is your PaleoQ? Find out at Paleo for Life.

New "Success Stories" Section on Paleo for Life

Continuing our mission to defeat obesity and chronic diseases through the Paleo diet and lifestyle, we're happy to announce the soft-launch of a new "Success Stories" section on Paleo for Life. Without further ado, you can see it here:

Paleo Diet Success Stories at Paleo for Life

The concept is very simple: Having been on the Paleo diet and lifestyle for some time, each of us has observed a wide variety of differences that this lifestyle has made in our health and well-being. However, until today there has not been a good repository of this knowledge that can help us make sense as to exactly what health conditions the Paleo diet really benefits, and whether there are any health conditions that it doesn't affect on or actually exacerbates. The Paleo Diet Success Stories section is designed to help us capture and share this knowledge. Hopefully, as we share our experiences in how the Paleo diet has improved our various health conditions, we can also learn from our fellow community members on any tricks-of-the-trade that they have picked up along the way.

Check it out, and share your own experiences. Tell your friends to share their Paleo diet experiences. Together, we can defeat obesity and chronic diseases with our collective wisdom!

The Prevention and Treatment of RSI, Part 1: Decreasing the Damage Rate

Recently I promised on Quora that I would give a spiel on the tactics for the prevention and treatment of RSI. I finally found some time to type it up; this will be the first in a series of posts on this topic.

RSI stands for Repetitive Strain Injury. In the present discussion, I will concentrate on RSI as it occurs to computer users.

A quick primer on RSI:

• An activity that causes "strain" produces microscopic tears or damage to your tissue.
• To counteract this, your tissues are able to repair themselves at a certain rate.
• You get RSI when the rate of damage exceeds the rate of repair for extended periods of time.
• The prevention and treatment of RSI completely revolve around decreasing the damage rate and increasing the tissue repair rate.

In this post, I will be discussing the mechanics and tactics related to
decreasing the damage rate.

Reducing the RSI Damage Rate

For many people, RSI seems to be a mysterious illness. Some people seem to be able to type all day, every day, without suffering ill effects. Others seems to develop strain and suffer permanent damage incredibily quickly. Most people do not know what really causes RSI, and if you don't understand the causes, it makes virtually impossible to apply a good prevention or treatment plan.

The damage you get from typing depends on a variety of factors: the number of keystrokes, the force you apply for each keystroke, the angles of your joints, the pressure on your tendons during each keystroke, etc. Why is this the case?

To understand the damage rate, we need to understand how the damage is incurred in the first place. Once you know how damage is incurred, it becomes easy to identify things that can increase or decrease the damage rate through logical reasoning without having to memorize a
list of "dos and don'ts".

The Mechanics of RSI Damage

To really understand RSI, it helps to think about the hand like a
mechanical engineer. Do an image search for the internal structures of
the hand. You'll see that the finger tips are connected to the
forearm with many individual tendons. The muscles that pull on these
tendons are located in the forearm, which means that the myriad of
tendons have to wind their way through tunnels and pathways in the
wrist in order to connect to the muscles in the forearm. When you
curl a finger, a certain tendon is being pulled by its forearm muscle.
Likewise, when you extend that finger, a different tendon on the
opposing side is pulled by its forearm muscle. The combination of all
the tendons and their muscles provide us with all the intricate
movements of our hands.

You can think of the finger tendons like thick nylon ropes. The
rope, by design (actually by evolution) can withstand tremendous
amounts of tension without sustaining damage. For most people, your
forearm muscles will give out much sooner than the tendons will snap.
However, in most causes of RSI it is precisely the tendons that cause
the problems in the first place. So what causes the tendons damage
when they are so strong?

Recall that tendons are like a thick nylon rope being pulled through
the tunnels and pathways in the wrist. The damage to the tendons do
not occur due to the tension on the rope itself; they occur due to
the friction between the tendon and its surrounding tissues.

Imagine pulling a nylon rope back-and-forth repeatedly through a cable
guide (such as a pipe). If the cable guide is perfectly straight, you
can keep pulling the cable back-and-forth without the rope sustaining
much friction damage.

Imagine, however, that the cable guide makes a sharp, 90 degree bend
in the middle, and the same rope is being pulled through this guide
back-and-forth repeatedly. The nylon rope will quickly fray around
the bend and will eventually snap. Alternatively, the cable guide itself could be worn down and become damaged.

In the case of the carpel tunnel, you can think of it as a whole bunch
of independent ropes sharing one cable guide, each being pulled
back-and-forth repeatedly, while the amount of "bend" in the cable
guide depends on the degree to which your wrists are bent or twisted.
As you can imagine, with many tendons gliding back-and-forth in a
tight tunnel, it's hard to predict exactly which tendons or which
tissue areas get damaged by any particular motion.

Tactics to Reduce RSI Damage Rate

Now that we understand the mechanics of RSI damage, here are some
practical tactics for minimizing the damage rate as well as the
rationale behind them:

• Most important rule: DON'T DO ANYTHING THAT HURTS
  
  If doing any particular movement causes pain, STOP. The pain indicates that you are past the point of "strain" and are actually causing acute trauma. If you persist on activities that cause pain, you can rapidly push yourself into severe injury and disability. IT'S NOT WORTH IT.
  
• Don't type or mouse unless necessary
  
  Don't be an idiot and play computer games all night after working all day on the keyboard. If you derive your livelihood from using a keyboard and mouse, you should think carefully about whether you can afford to keep tearing up your tissues for non-productive tasks.
  
  Anything you can do to reduce the number of keystrokes would help. For example, reduce keystrokes with macros or a better editor.
  
• While typing or mousing, keep your wrist posture as neutral as possible
  
  Avoid any flexion, extension, or deviation in any direction: palmar, dorsal, ulnar, radial, etc., and avoid twisting your wrists. It should be clear by now that having your wrist bent drastically increases the amount of friction damage as your tendons glide through the bends.
  
• Do not rest your wrists on the "wrist-rest" while typing
  
  Besides often inducing dorsiflection, resting on the wrist-rest compresses the "cable guides" and causes each tendon movement to generate more friction damage.
  
• Do not wear wrist-braces or "ergonomic gloves" while typing
  
  Most wrist-braces and "ergonomic gloves" end up applying more pressure on your "cable guides" and actually cause more friction damage if you are actively using your hands at the time. Wear wrist-braces only when you're not actively using your hands (such as while sleeping).
  
  An extension to this is that if you wear heavy or constrictive watches or jewelery, take them off when you are typing or mousing. You want to allow your tendons to glide as freely and as frictionlessly as possible.
  
• Minimize finger movements; use arm movements instead
  
  Since much of the damage is caused by the friction on the tendons, you can minimize the damage by minimizing the movement of the fingers. So, instead of moving your mouse with your finger tips, move your whole forearm instead. Likewise, don't stretch for keys by making exaggerated motions with your fingers; instead, move your entire hand towards the key, and only use the fingers to press down on the key.
  
  A corollary to this is to avoid making compound-keystrokes with one hand (especially far-off combinations like Ctrl-G). Doing so requires you to twist and stretch your fingers and wrist into unnatural postures. This causes unnatural movements that require the tendons to glide through convoluted pathways and incurring more friction damage. Always use both hands to make compound-keystrokes, ideally pressing only one key per hand.
  
• Keep your hands warm while typing
  
  The natural fluids that provide lubrication between the tendons, joints, and their surrounding tissues are drastically reduced if your extremities are cold. You should be able to feel clearly that your hands are "stiff" when they are cold. Do not type or mouse under such conditions.
  
  Do whatever it takes to warm up your hands before and during computer use. Stretches, rinsing with warm water, hot beverages, push-ups, ski jacket, space-heater, whatever. The only exception to this is that you should not wear gloves while typing (see above). Instead, warm up your core sufficiently so that your extremities are naturally warm with good circulation.
  
• Use a keyboard that requires minimal key travel and minimal required force for registering a keypress; likewise for a mouse
  
  Sometimes these two goals oppose each other. For example, typing on a solid plate of glass (like a touch screen) requires minimal key travel but imparts massive shocks on your fingers for each key and would not be ideal. I personally prefer keyboards whose keys are "light and crisp"; the crispness makes it clear exactly how much force is required to register a keypress, and avoids the problem of having to press with extra force just to ensure the keypress. You should definitely try out a few keyboards to find one that best suits you.
  
  A corollary to this it to use as little force as possible in registering keypresses and mouse clicks.

That's all I can think of for now, but hopefully once you understand
the mechanics of RSI damage, you will be able to assess for yourself
whether a particular action, posture, or device is conducive to the
reduction of the tissue damage rate.

I will get into the mechanics and tactics related to increasing the
tissue repair rate in an upcoming post, The Prevention and Treatment of RSI, Part 2: Increasing the Tissue Repair Rate.

"Most cavemen never lived past 35!"

One of the most common objections to the Paleo diet resolved around the life expectancy of Paleolithic humans. It is not infrequent to hear comments like "but most cavemen never lived past 35!"

I recently responded to such an assertion on a forum. My response was as follows:

The assertion that "most paleolithic humans never lived beyond 35 years old" is misleading; it would be more accurate to say that the median life expectancy of Paleolithic humans is about 35 years.

A slightly better way to frame the question is "How does the health and longevity of Paleolithic hunter-gatherers compare with that of the Neolithic farmers who succeeded them?" This question is very well addressed here: Longevity & health in ancient Paleolithic vs. Neolithic peoples

The short summary of the article is that:

• Paleolithic humans have a median lifespan of 30 to 35 years depending on gender, with a certain stature (body height) and frame size (a loose indicator of strength).


• As agriculture is developed (i.e. the diet becomes no longer Paleo), the life expectancy became shorter, and people became shorter with smaller frames.


• The life expectancy did not recover until close to 1500 B.C., when it went back up to about 35 to 40 years depending on the gender. However, people continue to remain short with smaller frames.


• The life expectancy hovered at around 40 years all the way to some time in the middle of the 20th century. However, people were never again as tall or strong as they were in the Paleolithic times.

Basically, as people transitioned away from a Paleo diet toward a grain-based Neolithic diet, they became weaker and shorter, and died sooner. Some other non-dietary factors that came along much later were able to gradually recover the life expectancy, but not the height and strength.

For those who insist on comparing the life expectancy of Paleolithic hunter-gatherers with that of modern 21st century humans, realize that the differences are due mostly to technology and societal change, not to diet. These include:

• Clean and reliable sources of drinking water


• Vaccinations, antibiotics, surgeries


• Reduced rates of trauma (no longer need to run from predators or to hunt)


• Reduced rates of violence (homicides, warfare)

But even with all the benefits of technology and societal change, babies born today are expected to have a lower life expectancy than their parents. Reason? The diet.

Welcome to the Paleo for Life Blog

Hi everyone. I am Gary Wu, a student and aficionado of the Paleo diet and lifestyle, and the creator of the site Paleo for Life. I originally created Paleo for Life as a way for me to keep track of all the Paleo-related research that was happening. Later, after I observed the health benefits that my family and I have experienced from the Paleo diet and lifestyle, I hoped that Paleo for Life can become a useful tool to help promote the Paleo diet as a way to defeat obesity and the chronic diseases that plague our society today.

What about you? What brings you here? If you have found Paleo for Life useful, please leave a comment. I would love to hear any suggestions on how we can make Paleo for Life even more useful as an information source.

Wishing you the best of health,
-Gary