Wrist Braces and Cumulative Trauma
Essentially an icon for computer injury, one sees people wearing wrist braces quite commonly. Sometimes at work - at the keyboard or grocery clerks - or just out in public. The image is used in articles and product literature to evoke the fearfulness of cumulative trauma.
Since tendonitis, nerve compression, and other chronic pain injuries are not visible, the wrist brace is what gives it form for the world. Many injured people have used braces exactly to confirm that they actually have an injury, afraid that colleagues will discount the validity of their problem. It is also a convenient way to avoid having to explain why they don't want to shake someone's hand.
What's The Problem?
The problem is that bracing is more often than not abused, and there are some serious ramifications.
But our tissues need to be used or they become weak. I have seen in my consulting work people who wore a brace all of the time, and the muscles in one hand were visibly smaller than the other. The skin was actually sagging at the thumb. Use it or lose it is a fact in this case.
When I instruct them to take them off and ask them to do some work, they will commonly react with fear. This is the very proof that they have become psychologically dependent on the braces, a situation that should never have been allowed to occur.
The healing process needs us to use our tissues, because the body uses that information to know how to lay down the new tissue. Regular use defines the grain of our muscles and tendons. When the tissues are braced, not only do they become weakened, but the new cells being formed take shape with no grain, forming hard scar tissue which is more prone to reinjury for lack of flexibility.
The Wearer And The Doctor
This abuse is partly the fault of the wearer who becomes dependent on the relief from pain braces sometimes afford, and partly of the general physician who irresponsibly gives people braces and tells them to wear them all of the time.
It is certainly understandable that we want to be relieved of pain. With cumulative trauma problems - the symptoms of which tend to continue to come and go for months, sometimes at low levels - even small twinges of pain can have immense psychological impact. One might go a few days feeling better, risk cutting some vegetables, and there it is again. Along with a deep depression. The pain is the source of our woes, so we want to turn it off with bracing. And drugs. And the conclusion that we must give up important activities like cooking, music, sports - or work.
This is often an overreaction. Low levels of pain don't especially mean one is aggravating their injury. Pain is actually an important message, and by turning it off we can't know anymore if we are truly healing. There certainly is a level of activity that is dangerous and will aggravate the injury or prevent recovery, but a gentle amount of use at the early stage, carefully working back to normal is an important part of the strategy that should be discussed with one's physician or therapist. One mustn't use braces for constant pain relief, or they will actually be perpetuating the problem. And the pain.
Too often a general practitioner or internist will give a person braces, maybe shoot them up with cortisone, tell them to use ice packs, and send them on their way. In truth, few people with cumulative trauma problems have found this to be an effective solution. The instruction to wear the braces at all times, as we've seen, is not responsible.
Ergonomics research has found that using braces at the keyboard is unwise. Often there will be as much muscular strain exerted against the brace as would be placed on the tissues anyway. Besides, the body is a truly miraculous, integral design. All of the various muscles of the hand, wrist, forearm, and elbow are meant to work together. When any part is restricted, the others must make up the difference, leading to the risk of overloading other tissues to the point of injury. This also retrain the body in a Pavlovian sense to "forget" how to incorporate the braced tissues into the integrated movement.
What's The Appropriate Use Of Braces?
Bracing is valuable at the early acute stage of injury. In order to begin the process of recovery, tissues need some rest. For the first few days braces can be worn much of the time, but again, they should be taken off regularly to keep those tissues from getting weak and short. Then gradually wean yourself from them altogether.
Another appropriate use is overnight. Many people sleep with the wrists bent, placing continues strain on tissues that are trying to heal, and limiting the flow of important metabolic fluids trying to pass through the hand and wrist. There are softer styles of bracing that can be worn comfortably overnight.
Don't buy them at the drugstore. Don't borrow them from friends. Always brace only on the professional advice of medical folk who have specific experience with cumulative trauma. Your family doctor's standard approach does not always work, and in many cases aggravates an injury from which one might otherwise recover.
Additional ergonomics articles from Onsight