Cumulative Trauma Disorders & ART®

Cumulative Trauma Disorders & ART®

Dr. Sebastian Gonzales D.C., C.S.C.S., ART, Orange California

Cumulative Trauma Disorders

How do Cumulative Trauma Disorders occur?
What are some treatment options for a Cumulative Trauma Disorder?
What is the most effective type of treatment for a Cumulative Trauma Disorder?

Interpreting for the Deaf is a very rewarding job with many benefits, but has anyone noticed a shortage? Maybe people have heard about the possible hardships that go along with the job; if they haven’t they should know what they are getting into. Surely every interpreter knows going into the profession about the chance of developing a cumulative trauma disorder (CTD), but what are the chances of that? A survey done in May 2000, published in Applied Occupational and Environment Hygiene states 82% of interpreters experienced disabling pain and discomfort following work. 33% of the pain was found to be involving the wrist and hand. Two factors that are directly associated are hours of work and time of onset¹. In fact, it has been found the problems are attributed to tendonitis more often than a peripheral nerve entrapment, such as carpal tunnel⁴. Other occupations which also develop the same problems are healthcare workers, desk clerks, and anyone else who is constantly working with their hands, with minimal periods of rest. To better understand what we are dealing with, let’s take a better look at what is occurring in these conditions.

How do Cumulative Trauma Disorders occur?

Most of these problems associated to the occupational hazards of sign language interpreting are the direct cause of a CTD, also known as a repetitive stress injury (RSI), an overuse strain (OS), and occupational overuse syndrome (OOS). A CTD is cause by overuse of a certain muscle group and in the cause of extensor tendonitis, it is the muscles of the back of your forearm. Feel the back of your forearm and wiggle your fingers at the same time. First start with your index finger and progressively work down to your pinky finger, moving them one at a time. Do you feel different parts of your forearm moving? If you haven’t done this before, try it and you will begin to understand how intricate and how small these muscles are. Now that you feel your muscles, just imagine them doing the same thing over and over again in the course of your day at work. It has been found that these small, repetitive, motions are the ones that are most harmful. Overuse causes micro-tears in the muscle, leading to inflammation, decreased circulation, edema and eventually a build up of scar tissue³. The scar tissue laid down is the body’s natural way of repairing itself, however this tissue is different from the original tissue, just like a scar on your knee. The new tissue is more fibrous than the last and it is laid down in a haphazard fashion causing adjacent structures to stick to each other. This is the beginning of the injury cycle where the muscles become progressively weak, tight, and no longer receive vital nutrients needed to repair it. This process feeds upon itself, never allowing muscle relaxation to occur which is needed to properly recover. Neurological problems such as numbness and tingling into the hand occur as nerves become trapped in this bundle of fibrous tissue. Some people experience loss of grip strength, which can be attributed to problems with the forearm extensors.

What are some treatment options for a Cumulative Trauma Disorder?

Conventional treatments for CTD are: splinting, anti-inflammatory drugs, ultrasound, cold packs, and electrical stimulation. Surgery is sometimes suggested for patients with severe inflammation of the tendon or neurological involvement. If all of these treatments fail, what else can you do?

What is the most effective type of treatment for a Cumulative Trauma Disorder?

Active Release Techniques® (ART®) is a relatively new soft tissue technique, which can be used to treat and cure a variety of conditions that would be normally treated with surgery or physical therapy, such as carpal tunnel syndrome, Dequervain’s syndrome, or extensor tendonitis of the forearm. Invented by Dr. Michael Leahy, it is technique, which can address problems involving muscles, ligaments, tendons, nerves and vasculature; in fact, it includes over 300 protocols for almost all the muscles in the body. It is also the first successful non-surgical method of treating nerve entrapments. But what can ART® do for a CTD? In September 1999, a study was published in The Journal of Occupational Rehabilitation regarding the effectiveness of ART® in CTD cases of the upper extremity. An ART® provider, with only six months experience, was asked to treat 28 patients with epicondylitis, carpal tunnel, and tendonitis. All of the patients had tried medical treatment prior to the study with limited results. Results of the study revealed a 71% improvement rate within one to three months of treatment². ART® has been found to be a very effective treatment of CTD and it is also one that is least known. The mechanism by which ART® resolves CTDs is by breaking up the reoccurring cycle and letting the muscle relax, restoring the natural length-tension relationship. In fact, it is so effective that most patients have a significant change within the first 3 to 4 visits. Most providers find that their success rate is around 80% or higher. Dr. Leahy has found that he can resolve soft tissue conditions in 90% of his patients. I have found that patients come to ART® only through word of mouth and as a last resort; these are the people that get fixed.

For more on Active Release Techniques® or to find a provider in your area: http://www.activerelease.com

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(1) Scheuerle, Jane, Guilford, Habal “Work-Related Cumulative Trauma Disorders and Interpreters for the Deaf.” Applied Occupational and Environmental Hygiene Volume 15. Issue 5. May 2000 429 – 434. 07/31/2007 <http://www.informaworld.com/smpp/content?content=10.1080/104732200301386>.

(2) Schiottz-Christensen, Berit, Mooney, Azad, Selstad, Gulick, Bracker. “The Role of Active Release Manual Therapy for Upper Extremity Overuse Syndromes—A Preliminary Report.” Journal of Occupational Rehabilitation Volume 9. Number 3September 1999 201 – 211. 07/31/2007 <http://www.springerlink.com/content/vq815728g8852226/>.

(3) Abelson, Brian. Release Your Pain. Calgary, Alberta, Canada: Rowan Tree Books Ltd, 2004.

(4) DeCaro, J.J., M. Feuerstein & T.A. Hurwitz. (1992). Cumulative trauma disorders among educational interpreters. Contributing factors and intervention. American Annals of the Deaf 137, 288-292.

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