Commonwealth Club Speech on Muscle Learning Therapy (MLT) Part 2
Using again the sports analogy, you don’t go out and buy a better tennis ball in order to become a better player (although manufacturers of tennis balls – or ergonomic keyboards – will have you think so). The solution, instead, ultimately depends upon improved performance through training. In today’s work environment, instead, the only training offered by industry involves the use of specialized tools along with some vague, inconsistent idea of where to place those tools. That’s like saying the secret to baseball is in how you hold the bat. Never mind the hours of repetitive practice and sacrifice. Never mind motivation, focus and drive.
Never mind the physical and mental pain often experienced while training. Never mind the skills resulting from trial and error under severe pressures. But especially never mind the skills, insight, and wisdom of the coaching. Just buy a better word processor and you will get better literature. Become an accurate typist by getting stronger arm muscles and a wrist rest, and finally, a better desk. Taking the analogy further, to stop having arm pain, all you need is stronger muscles, the correct keyboard and good posture. Some things don’t even pass the straight-face test.
The biomechanical and biochemical events in chronic muscle pain, of which RSI is a major pain producer at this time, are much more complex than once thought. But happily they are now becoming clearer while at the same time, are offering solutions. The solution involves more than just good posture, correct tools, and healthy muscles, however. Those have always been the basic rule but we STILL have injuries when all those are OK. It is now apparent that what we also need is professional training of the workers so that they can perform under pressure, arrive at the end of the day less exhausted, and without injury. Bear with me while I give you just a minute of what we think may be actually happening in the affected tissues I have just described and where training can make the difference between success and injury.
When you’re overwhelmed, upset, in a hurry or just having an ‘intensely’ good time, the part of your nervous system which responds is called your sympathetic nervous system and over which you have no direct control. The intensity of the event can come from within us or it can come from family, friends, co-workers, subordinates and/or superiors. Interestingly, it was only recently we discovered that sympathetic nerves actually innervate skeletal muscles in the first place. We have known about their effect on arteries for many years. For example, when you are overwhelmed, your arteries constrict as you go into a ‘fight or flight’ response. It is the body’s defence and protection against dangers.
The sympathetic nervous system is responsible for getting the chemistry of the body ready for resolution of a perceived problem. If resolution doesn’t happen, you stay in that highly vigilant, aroused state until something changes. Recent research has now proven that the sympathetic nervous system does MORE than simply shut down the arterial blood flow. It was originally discovered by a research group in Italy as well as reinforced by recent research here in California by Richard Gevirtz, PhD and David Hubbard, MD, that those nerves actually terminate directly into the same muscle spindles I mentioned earlier.
They wind up right where your muscle’s pain receptors are located! That’s why you hurt more when you are more upset, overwhelmed, intense, and driven. It also means that if you don’t resolve that intensity,
the muscle spindles get too much stimulation and you have a higher probability of injury or lingering pain. That pain is there for a reason. It is there to warn you.
OK, I know, you’re thinking here we go again, blame it all on stress. But it’s not just stress. It is the desire to do very well, it is having a high work ethic and the need to please the ones who control your future. But also I must remind you that the stress response from social pressures is triggered from a multitude of social cues and manifests itself in ways that we are only now beginning to understand.
Luckily, from this complex problem comes a unique solution. It doesn’t require mind tricks or sophisticated forms of denial in order to learn how to feel better. Instead, it comes in the form of learning to reduce physical and mental overload the same way you would learn to throw a ball or type a letter. It comes from the simple practice of muscle control, NOT mind control. That’s why MLT is easier to learn and allows everyone the chance to reduce one of the major causes of muscle pain. In other words, muscle overloading would be a lot easier to control if one could learn a muscle (motor) skill that reduces overloading for you.
And finally, it would be even better if that skill didn’t require the stoppage of your work or require having to remember to do it in the first place. That type of training already exists and is called ‘Practice makes perfect’. You do it for sports, to type, play an instrument or learn to walk. But in the field of muscle pain we must call it something else or people become confused. Therefore I have called it Muscle Learning Therapy (MLT) and it works the same way. The difference is that instead of watching a thrown ball or listening to notes played, you watch a computer screen and do what the therapist tells you. The rest happens automatically. What is more, it lasts a life-time. Even if you want to forget what you learn, it is impossible. Just like it is impossible to unlearn how to ride a bike.
To this day I don’t know why that solution seems so far out of reach to health care professionals. We use it all the time when we learn to drive, throw a ball, walk, type, dance, play an instrument and/or learn a sport. The only difference is now we must learn to develop those skills while working, at home and during sports and leisure time.
The drive to transform a generalized training concept into a specialized method for worksite training was my main focus 20 years ago and became a reality fifteen years ago. There is actually now preliminary research supporting MLT’s efficacy at changing and maintaining the behaviour of skeletal muscles while people are working. So the remaining issue is, how do we get training to actually show reduced pain or reduced injury rates at work?
The explanation lies within the physiology of specific nerves and the muscles they innervate. When put under certain pressures, the body does not always respond in positive ways.
The chemical and physical response, the heightened arousal your body feels when you are overwhelmed or in a hurry, although a normal one 2 million years ago to insure your survival, is no longer a critical factor. It is called the fight or flight response. Nature gives you a built-in mechanism to avoid danger of injury or death.
In today’s intense working world, it not only has become an exaggerated response, it is completely unnecessary and can actually set you up for injury. But your body does not know that in front of you is a computer, not a saber-toothed tiger. Your chemical and physical responses scream for resolution. But you, instead, sit focused and resolute to finish your work. And as you ignore the pleas of your system to do something, the chemical response continues firing into muscle spindles and creating an extremely sensitive environment ready for pain. Injury eventually occurs when you have reached a threshold wherein your tissues can no longer take the protected abuse. Now you hurt.
That is nature’s way of trying to get your attention and get something changed. Instead, you get an ergonomic evaluation and reduce the irritants in front of you by putting everything in their proper place. You now hurt less. So you ignore future warnings because everything should be ok. Until you hurt so badly that you can’t ignore it and you go to a physician. He/she has nothing from medical training to draw upon except medication and rehab. Medications, exercise – exercise, medication. You are in a rut and soon you are lucky to get good eye contact from your doctor or therapist. Welcome to the world of chronic muscle pain and the saga of trying to find the magic potion to end your pain. Of course, you are still working very hard and trying to keep your job. Or, you are on disability and wondering what kind of future you will have.
Unfortunately, evolution is having a hard time catching up with our rapid technological changes. Eliminating that chemical overreaction may take another couple of million years and we, instead, need to go to work in the morning.
Today we are under pressure to do more work in less time and with more responsibility than ever before. We sit in a confined worksite with all our material right at our fingertips along with a computer working faster than humans are made to go and, unfortunately, with little opportunity to get up and fight the battles our pain is emphasizing.
Through our aches, pain, and soreness the worksite is actually giving us a signal that a problem exists. The confusion lies in the fact that the worksite is, in effect, only part of the problem. So it is only part of the solution. And TRAGICALLY, WE SEEM TO BE CONFUSING THE WARNING SIGNAL WITH THE PROBLEM ITSELF. For example, if speed bumps on a road were to cause you, all of a sudden, to become annoyed or even to give you pain, you would quickly want them eliminated or moved. But what of their function as a warning device that you need to be careful ahead? Removing them doesn’t eliminate their message, “slow down/take heed”. The warning itself, therefore, is only a small part of the big picture, just as your workstation is also only a small part of the problem. The keyboard is simply warning you of the existence of a bigger problem looming ahead if you continue on the same path.
In other words, the work surface and all your tools act like a trip mechanism, an early warning device, not originally intended to be such, but nevertheless functioning like one. Consequently, obsessing only over your keyboard or chair or work height or the tools you use is missing the point. You might as well be obsessing over the road bumps as you incorrectly assume they are your only problem. Especially if the ‘bumps’ cause pain. Why was it that sites were worse ten years ago and people weren’t having as many problems?
The only variables that have really changed are that you have more work, more responsibility and less time to do it all (due understandably to downsizing and cost containment strategies).
Finally, it also needs to be noted again that those people injured are the ones who accept extra work, try harder, and become very focussed and driven – in other words, the good workers. And management itself isn’t immune, either. Even your position in the company can’t insulate you from having pain. There are no sacred cows avoiding this injury. Management gets it, insurance adjusters, programmers, physicians, and CEOs get it. Surgeons, librarians, police officers, house wives, teachers and newspaper reporters get it. The only ones that don’t get it are those who deny they have it or who are so naturally relaxed they wouldn’t get anything.
Years ago we used to constantly have to get up to get our work; our computers and software moved slower, our phones were slower, in fact ALL our tools were slower. We even had time to go to the bathroom. Today, we not only don’t have time to go, we’re so overwhelmed we don’t even realize it when we need to.
NOW LET’S TALK ABOUT SOLUTIONS:
Muscles can be taught how to reduce the overload they are under and yet still allow you to continue working. The teaching or training method involves learning, through repetition and reinforcement. It trains how to reduce the muscle loading in the areas that count: the neck, shoulders, back, arms, and hands. But it is critical that it be reduced DURING work, not just during designated rests. Ten-minute breaks can’t go back in time and correct what has already been done. Taking a break is important but not as much as reducing the extra muscle loading along with reducing sympathetic activity at the time you do the work. By correcting overly responsive muscle behaviour, that is, by reducing muscle sympathetic loading during work, we have the hope for long-term change. How that occurs is difficult to teach but it is not difficult to learn.
Biofeedback Associates of California has been doing that kind of muscle training for over 20 years and with excellent results. It is called Muscle Learning Therapy® or MLT®. Its limiting factor has been that not all doctors and insurance companies know of its existence. MLT forces the muscles to become more efficient while at the same time helping to reduce the major contributor to the problem, i.e. the sympathetic response or the causes from being rushed, overwhelmed and overtaxed. MLT should not be confused with traditional biofeedback, however. Traditional biofeedback tends to use more imagery, insight, cognition, and understanding.
Typically it doesn’t rely on a structured, finite and predictable training model. Even those therapists using EMG instruments to point out what people are doing wrong are engaging in education, not training. MLT is, instead, a set of unique training interventions, supported by research, with over 20 years of development, which just happens to use muscle biofeedback because it alone affords the fastest way to learn. MLT uses sEMG (surface electromyographic) biofeedback to promote learning and to document successful training as it happens.
The technique is based solely upon a training model. It forces learning by completing rapid, accurate and complex tasks while the person watches his/her own muscle graphs on a computer screen. In so doing, it forces the brain to connect the feeling in the muscles to the behaviour on the screen. Finally, and most importantly, it becomes an automatic response through the process of repetition and reinforcement.
It is essential that it become automatic because no matter how intense the real world becomes, long term change in symptoms will occur only through permanent changes in behaviour of muscles under duress. Any coach would have to do the same in order to teach tennis, throw a ball or type. Interestingly, no one, to my knowledge, has taken the training concept to the world of soft tissue injuries for chronic muscle pain and the reduction of muscle loading. At least not to such a structured, finite and successful training strategy or algorithm along with research to support its specific interventions.
Another factor resulting in increased workload has been continuous downsizing of companies. Everyone winds up doing more work in less time and with more responsibility. Eventually, the ones that accept that responsibility are the ones getting injured. Those who get injured, therefore, are the ones with a high work ethic, those who are focused, challenged, willing to accept increasing workloads, those who become very involved, and are willing to sacrifice. The best workers are getting this injury. And it has become a worldwide problem.
The problem stems from the fact that our tools, computers, software and support systems are so much faster than they used to be, that, as a result, we humans are now the weakest link amongst our tools. We are playing catch-up to them and it has started to take its toll on our ability to withstand increased workloads. We have reached a threshold that is being expressed by increased injury rates.
A recent pain study found that of all the patients entering a primary care facility with chronic muscle pain, only about ten per cent were treatable and diagnosable using standard medical procedures. In other words 90% of the problems were found to be from other than medical origins. That was the result of a study done at the University of Washington pain clinic and reported by a Professor Loesser. He pointed out that 90 percent of those presenting with chronic muscle pain to his clinic had an origin to their pain that MDs were ill equipped to recognize and treat and that had probably originated from increased social and work pressures.
It was in response to that need for many years that BAC has worked hard to reduce the sympathetic and mechanical effects from the increasing pressures we face, while still keeping people at work.
A final cautionary note and a prediction:
Biofeedback Associates of California has noted that many of its more recently injured patients have presented with ergonomic changes already implemented at their work site within the previous 6 to 12 months of their arrival at our door. Apparently, as work sites become more ergonomically correct, there results an initial honeymoon of seemingly reduced symptoms as well as fewer claims reported. We have, at BAC, in fact noticed such a tendency. But we are also seeing an increase of the severity of patients injured after ergonomic changes were made.
They present with more intense symptoms than those sent to us immediately upon feeling the first signs of discomfort. Apparently, the temporarily reduced symptoms due to ergonomic improvements have inadvertently given workers permission to work even harder to make up for lost time and/or to show their appreciation for feeling a little better. But those patients are now showing up anyway. Unfortunately, they seem more injured than the ones referred to us as soon as the first symptoms appeared when, as yet, no ergonomic changes had been made. In other words, the injury occurs anyway, it just takes a little longer when corrected workstations temporarily reduce symptoms.
Evidently something is still missing. In the end, it winds up costing everyone much more – professionally, economically, as well as emotionally. We hypothesize that it may be due to the fact that the ‘early warning system’, the cluttered and bad worksite, was the trigger mechanism pointing out only a part of the problem. After the work site was corrected, nothing was done to reduce the bigger problem of the load on the workers’ shoulders—figuratively as well as literally.
So, what is the solution and prediction? Well, since we can’t reduce the workload and still remain marketable in today’s world, the logical solution would be to teach people how to reduce the muscle loading that occurs during work. Industry spends time and money training people to do their jobs, why not spend a few pennies more and train people how to reduce the mechanism responsible for most of these injuries before they happen? Or at least let’s allow them MLT training as soon as symptoms occur. It will wind up being less expensive for everyone in the long run.
And finally, what is my prediction? My prediction is that unless the external world (ergonomics) is combined with a program to teach workers how to take care of the internal environment (muscle loading and sympathetic activity) there will never be a long term change in repetitive strain injury rates or chronic muscle pain. Until ergonomics is taught along with the reduction of skeletal muscle loading, the symptom plateau observed recently from broad ergonomic improvements, is, in retrospect, going to become just the quiet before the storm.