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The RSI case of Sanjeev Sabhlok: description of the problem and its treatment.

Section 3. Treatment history

There were effectively two tracks I was following - one, the prescriptions of doctors and specialists. I followed only this track till July 1999. But after July 1999, on reaching India, I began to explore alternative tracks on my own. The fact that completely checked out alternative tracks on my own, and finally found the solution is probably due to some healthy contempt that I developed for the "solutions" prescribed by traditional doctors and specialists in the first eight months of my full-blown RSI.

Of course, given the hegemony of this profession, doctors have managed to enforce their presence as controllers of people's health at every stage. One also somehow tends to attribute greater knowledge to them than to others because of the impressive salaries they draw. Now that may not have been a bad idea if doctors knew anything important about this problem. Unfortunately their ignorance is rampant, and therefore it was unfortunate that they wasted more of my time and money and significantly delayed the proper cure.

Doctor 1: The very first thing I did, in late 1998, was to go to the general practitioner at the USC student health centre.  I was asked to stop writing for two weeks and given some exercises to stretch the fingers with a rubber band.  Stopping to type was clearly an impossible situation, given the nature of my work as a PhD student.

Doctor 2: The second time I went back to the general practitioner was when the entire left arm went numb at night.  At that point, I was prescribed three tablets of 800 mg of ibuprofen, i.e. 2400 mg per day for three months.  By the time I had reached my second month, my stomach was in very bad shape but the pain and numbness (of the fingers) had increased.

Doctor 3: After my contacting the sorehand e-mail list, someone suggested that I visit a hand surgeon. So I went back to the general practitioner and got a referral to the hand surgeon at the University of Southern California hospital.  After a very long wait for an appointment, I finally got to see Stephen Schnall, who cursorily looked at my hands, poked it around, and asked me to get an EMG test at the hospital. The test found "incipient carpal tunnel syndrome" and I was given a pair of splints to wear at night, and sent away, saying that this would automatically go away. Stephen Schnall did mention that physiotherapy may help, though he gave no recommendation to visit a physio (in the USA you cannot visit a physio without a referral).

Doctor 4 and Physio 1:

As the problem did not go away, and I was getting quite desperate, I went back to the general practitioner at the student health centre and suggested that maybe I should be referred to the student health centre physio. Finally therefore, six months after I had first reported the problem, I got to see the physio.

The physio, in retrospect, had absolutely no idea about the problem.  She tried to ice the wrists, used ultrasound, and very gingerly massaged the wrist, saying that the wrist is a very delicate area. I thought that ultrasound probably helped a bit, and so, two years down the road, I bought my own ultrasound machine. Of course all this was a waste.

In effect, the doctors and specialists had merely aggravated my problem.

Homoeopath 1, 2:

Back in India August 1999, since the pain continued, I first tried homoeopathy, which had absolutely no results. 

Doctor 5:

Then I got a referral from a general practitioner to a neurospecialist, got another EMG test done, etc. The results of the specialists advise and medication were equally pathetic ( I was given ....). I went back to homoeopathy, which of course did nothing.

Doctor 6:

December 2000. Migrated to Melbourne. One of the first things I did was go to the general practitioner.  This time I got to eat ...... apparently an anti-inflammatory medicine that does not damage the stomach.  Of course I did not work.

Homoeopath 3:

I also tried a local homeopath. No results.

Physio 2:

Next stop was to find a physio. In Australia one can go to physio without a referral from a doctor.  Went to the physio and described my symptoms, and also mentioned that I thought that ultrasound helped me to some extent. And so I was given some ultrasound treatments.  No results.  Then it is you suggested that I try a TENS machine.  I took it home and tried it.  I thought it gave me some relief. So I bought a TENS machine.

Physio 3:

Having to another suburb of Melbourne, I had to change the physio. This particular physio tried to apply the ultrasound to my hands in a small wash basin, twisting my hands, and actually burning them.  I stopped going for ultrasound.

Physio 4:

Later, I tried a physio close to my house, requesting for ultrasound treatment.  This physio basically said there is no problem and she would not apply ultrasound.  That was my second-last physio. I did try another physio later in 2001.

Doctor 7:

So I went to another GP and was referred by this GP to a neuro-specialist who happened to be the associate professor of neuro --- in the Melbourne University. 

Doctor 8:

This specialist tried an EMG test and said I was perfectly normal.  I was packed off, almost being treated like a fool. At that stage my distaste and abhorrence for doctors became extremely acute (this was reinforced later, by more such experiences).

These first few unsuccessful encounters with traditional doctors and specialists were not the only ones. The traditional doctors kept taking me down a blind path for much longer.

Doctor 9:

When, in September 2001 I reported that my work at the computer was aggravating my pre-existing injury, I was referred to an occupational physician. First he referred me to a specialist [....] for various tests including MRI (magnetic resonance scan) and another EMG.

Pain levels were rising enormously in mid-2001.  It became clear to me simply that following the advice of doctors (essentially nothing, that there is nothing wrong) would lead me nowhere but to more pain. I had no choice but to throw money at the problem and experiment on my own.

Chiropractor 1:

Doctor 10:

After many hundreds of dollars and time spent, he said there is nothing wrong with my spine (ie the chiropractor was taking for a ride) and since the EMG did not show nerve compression but I had this horrible pain, he did three things (a) referred me to the pain management clinic, (b) asked me to see a particular Feldenkrais therapist, and (c) suggested I use voice activated software in the office [something that effectively happened only in April 2003].

Doctor 11, Psychiatrist 1, Physio 5:

The St Vincent's pain management clinic was another wasted effort. The first asked me to fill nearly 40 pages of questions, and then took months to give an appointment. This is reputed to be the best pain management clinic in Australia. I was seen by a doctor, a psychiatrist and a physiotherapist. I had to see the doctor twice. The doctor had absolutely no idea about this problem and gave me some of his favourite hypothesis on pain.  He did prescribe 'Tramel' -- a painkiller.  The physiotherapist had absolutely no idea too, but gave me some irrelevant advice. The psychiatrist was the best among the three. She gave me some concepts to incorporate into my work, particularly the concept of 'pacing'.  This means that I should try to get work done in stages rather than all at once. I also bought a book recommended by the doctor, ie. "Manage your pain".  The only learning of the pain management clinic was - this is an incurable problem - just live with it. As if I needed such advice! That too from such "experts"!

Manipulation therapist 1:

The only help I was getting was from my own experiments with different therapists.  When the chiropractor failed so miserably, I tried a manipulation therapist in November 2001. This young man had absolutely no knowledge of the problem, but he applied a strong pulling pressure on a few points near my shoulder for a few minutes and said the problem was solved! What happened was that there was indeed a small relief as he effectively loosened a few muscles.  But because there was no underlying hypothesis, or understanding of the problem, and this young man was extremely overconfident, he basically did not offer any solution. After four sessions I wrote him off.

I did remember though, from his treatment, that for some reason, strong pulling of a few muscles seemed to somewhat eased the problem temporarily.

Physio 6:

My manager (a good friend now), at the office recommended that I see a friend of his, a well-known physiotherapist.  I went to him probably in December 2001.  The physiotherapist checked the muscles of my back! This was similar to the chiropractor who worked a little bit on my back muscles apart from doing his silly things with the backbone.  The physiotherapist said that my muscles seemed to be extremely tight. He recommended a few exercises, and sent me packing.

It appeared to me that if the muscles were really tight, then the underlying (marginal) benefit I was getting from the chiropractor and the manipulation therapist must have been the elements of massage in their repertoire.

Clinical masseur 1:

I searched for a massage therapist in the telephone directory and found Lance Dixon.  I started with Lance Dixon, the clinical masseur (later I found he followed a shiatsu school of thought). Lance told me during the first few sessions that if there was an Olympic competition for people's tight muscles, I would get the gold medal.

Lance's treatment was quite useful.  His methods were to work fairly hard on muscles of the neck and back.  He also applied relatively hard pressure on some alleged meridians based on a Japanese hypothesis. Many of these pressure points of the meridians lie along the major muscles.  Such pressure definitely brought some relief.  Unfortunately, though there was a clear indication that some parts of this method were helping, there was no real cure, nor any prevention of further deterioration of the problem.  While the searing pain  in the upper back was partially relieved, the pain in the forearms and hands continued.  This method of massage does not apply significant pressure on the arms and hands.  In fact, the thumb may be applied in an extremely mild manner on parts of the arm on the mistaken assumption that there are some meridians below it. Because this massage method does not understand the underlying causes, but enforces a hypothesis of meridians, it got me nowhere in the end.  There were a few robust stretches or nerve glides that Lance carried out on my upper limbs.  Each time he did this, there was an improvement in the numbness for a short while.  However, Lance did not make a significant connection between my reports to him of what worked, and repeatedly went back to non-effective massage.

Acupuncturist 1, Traditional Chinese Medicine 1:

Since nothing really significant was happening with Lance's work, and he mentioned that at accupressure and acupuncture were similar in concept to his methods, I decided to look for an acupuncturist. One of my colleagues in the office mentioned that her mother had achieved significant relief in her back pain by visiting a particular acupuncturist.  Now, first visiting an acupuncturist is very brave decision, particularly for a needle shy person like me. But I made an appointment with this South Korean acupuncturist and started off a series of 22 sessions with him, coterminous with other ongoing treatment with Lance.

The acupuncturist had an extremely big ego. In his opinion, Western medical science had very little understanding of the human body. There were allegedly enormous learnings of the Chinese medicine that the Western scientists had no idea about.  He started me off with a few sessions of needles applied at various points of my arm, shoulder, and calf.  When nothing was improving after nearly 10 sessions, he suggested that I needed a particularly potent Chinese medicine.  And so I paid $500 for an assortment of leaves and bark and mushrooms and tubers that had to be boiled and drunk several times a day for a month. When this did not work, he said I needed to do it again.  So I tried another month of this obnoxious concoction for another $500. .

When nothing worked, he tried a few sessions with needles connected to an electric source which gave a tiny vibratory sensation when inserted in the skin.

That did not work either.  Consequently, after 22 sessions and nearly $2000, I decided to let go of acupuncture.

During this period of time, I was continuously purchasing books on musculoskeletal disorders, pain management, etc.

In one of the books, "The Pain Cure" by Dharma Singh Khalsa, an MD trained at Harvard Medical School and UCLA School of Medicine, among an assortment of practically tens of solutions, it was mentioned that there is a particular kind of deep tissue massage called myotherapy that helps some people.

I look for a myotherapist in the directory and found Peter. I started visiting Peter in August 2002.

Doctor 12: cortisone shot

Myotherapist 1:

Kineseologist 1:

Clinical Pilates instructor 1:

Diet supplements:

How long will this cure last?

Muscles seem to have an enormous memory -they revert back to the tightness that was last found in them. This seems to be natural, with probably some evolutionary benefits. Probably requires the minimum use of energy.  Whatever the reason, it is absolutely certain that the muscles will tend to tighten again unless there is a very strong effort expended on constant stretching and retraining.

On speech recognition