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Pelvic Muscle Exercise Training Manual and Cassette
889
Repetitive Strain Injury: The keyboard disease by €&ad Huskisson. Charterhouse Conference and Communications Limited, 35 Cloth Faic London €CIA 7JQ, 1993 (ISBN 0 951 9807 0 X). Illus. 98 pages. f10 including postage.
This book is one of a series produced by Charterhouse Health. The aim is to provide ‘books for doctors that patients can read . . . books for patients that doctors can read’. The title is very relevant considering t h e number of people allegedly suffering from repetitive strain injury (RSI). Edward Huskisson is a n acknowledged expert on rheumatic diseases and has a particular interest in RSI. Ten chapters offering a range of logically ordered topics are presented with two appendices. The latter gives some 11 references and the address of the RSI Association in the United Kingdom. Despite its length, the book is very readable and is suited to both patient and doctor.
I
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--
4
I
RSI is not a new disease Chapter 1 gives the points on RSI in a nutshell. It is good to see a clean distinction made between well-known clinical conditions (eg tennis elbow) and RSI. Unfortunately, it is stated that repetition causes RSI and this is not entirely true. The history of RSI is presented in chapter 2 but chartered physiotherapists will find a more detailed description in one of the references quoted in the book. ‘Why does it happen’ is the title of chapter 3. A pathological explanation has been given and to patients it is plausible. Alternative theories including abnormal mechanical tension i n nerves are suggested. However, this theory is not given full support. ‘The Australian epidemic’ is the next chapter title. Data for the epidemic are given but not the source. Once again, it is likely that a distorted view is given. The author admits completing the data with ‘a bit of imagination’. Chapter 5 highlights occupations a t risk. This could be suggestive to people reading this in the waiting mom of a GPs surgery. Greater attention to the risk factors might have been more beneficial to readers be they doctors or members of the public Symptoms and signs are listed in chapter 6.It is stated that the symptoms
are relieved by rest and that there are no objective physical findings in most cases of RSI. This highlights a major problem confronting doctors as well as other treating professions; the inability to examine a patient accurately. When there are no physical signs and no abnormal tests, the case for psychogenesis is even stronger. It is therefore appropriate that a chapter on the psychological aspects is presented. The chapter asks the vexing question whether RSI affects people of certain personalities or whether it affects their personalities. Ergonomics in chapter 8 is a series of factors to be considered. Unfortunately, it does not adequately cover all issues. This could be due to the bias of the book towards keyboard workers. Workers undertaking non-keyboard tasks are just as deserving of attention. Chapter 9 covers the legal aspects of I compensation. At last this section warns Work is painful the RSI sufferer that the quest for compensation is a long p m e s s and rarely strongly questioned. The section on is it financially worth while. The con- physiotherapy shows that the author is fusion surrounding the time available not a physiotherapist. Little detail is for VDU work stations to comply with given on other alternatives suggested for recent regulations is perpetuated by the treatment. The chapter concludes with comments of the author. A clearer the most important piece of advice: ‘Prevent it if possible, but if it happens, description should have been given. recognise it quickly and take appropriate Prevention, management and outcome action.’ are the issues covered in chapter 10. It is Who should read this book? Patients stated that rest is the first essential in the and doctors are the intended audience. management of RSI. The sooner this form Physiotherapists would find it light of advice is corrected the better. Stopping reading and the illustrationdcartoons the task that has produced the symptoms amusing but the money would be better is more appropriate and fortunately this spent on more detailed information on the is stated. prevention of RSI. Alternative occupations are suggested Jeffrey D Boyling MSc MCSP MErgS but the similarity of some of these is
Pelvic Muscle Exercise Training Manual and Cassette by ffiren Medin. HIP (Help for lncontinent People) Inc, PO Box 544, Union SC 29379, USA, 1992 (3rd edn) Manual: Illus, 16pages. Tape: 38 minutes. $7 post paid.
This manual and cassette have been produced as a self-help guide for sufferers of urinary incontinence; both for women with mild to moderate stress and urge incontinence, and for men who are anticipating prostate surgery, or who experience urinary incontinence after prostatectomy. The manual begins by giving a clear, simple account of the types and causes of urinary incontinence. Diagrams accompany explanation of the pelvic floor but there is some incorrect labelling and t h e medical terminology may be confusing to lay people. The benefits of pelvic floor exercises are emphasised and the importance of a training programme becoming a life-long habit. Useful suggestions are given as to how patients can recognise whether the correct muscles are working. At this point, it would have been better if patients had been given advice on sources of help if they were having difficulties.No reference is made to the importance of these muscles being assessed - before starting an exercise programme - so as to ensure appropriate management.
Side A of the tape ‘Beginner exercises’ is enjoyable and helps to teach patients how to isolate the correct muscles, although the exercise routines tend to be rather prescriptive. Slow and fast twitch muscle fibres are addressed and patients correctly advised in the manual to keep breathing normally while exercising. However, i n dealing with the fast contraction, patients are instructed on the tape to breathe in while tightening and out when letting go. This contradiction and the advisability of linking contraction with inspiration is questionable. Also, there is no clear starting command with the first practised pelvic floor contraction and patients appear to be encouraged to hold for 32 seconds! Excellent advice is given regarding tightening the pelvic floor muscles during daily activities. Reporting to a doctor every 6-8 weeks is recommended but patients are left to judge when to progress the exercises. Side B contains ‘Advanced exercises’, the relevance of which is open to question. There is every chance that patients would find this part of the tape very confusing. In conclusion, physiotherapists working in this field would find a tape and manual useful in reinforcing their instructions and supervision, but the combination under review cannot be recommended, in spite of its many good points. Joyce Nelson MCSP
Physiotherapy, December 1993, vol79, no 12
Repetitive Strain Injury: The keyboard disease by €&ad Huskisson. Charterhouse Conference and Communications Limited, 35 Cloth Faic London €CIA 7JQ, 1993 (ISBN 0 951 9807 0 X). Illus. 98 pages. f10 including postage.
This book is one of a series produced by Charterhouse Health. The aim is to provide ‘books for doctors that patients can read . . . books for patients that doctors can read’. The title is very relevant considering t h e number of people allegedly suffering from repetitive strain injury (RSI). Edward Huskisson is a n acknowledged expert on rheumatic diseases and has a particular interest in RSI. Ten chapters offering a range of logically ordered topics are presented with two appendices. The latter gives some 11 references and the address of the RSI Association in the United Kingdom. Despite its length, the book is very readable and is suited to both patient and doctor.
I
. ,
--
4
I
RSI is not a new disease Chapter 1 gives the points on RSI in a nutshell. It is good to see a clean distinction made between well-known clinical conditions (eg tennis elbow) and RSI. Unfortunately, it is stated that repetition causes RSI and this is not entirely true. The history of RSI is presented in chapter 2 but chartered physiotherapists will find a more detailed description in one of the references quoted in the book. ‘Why does it happen’ is the title of chapter 3. A pathological explanation has been given and to patients it is plausible. Alternative theories including abnormal mechanical tension i n nerves are suggested. However, this theory is not given full support. ‘The Australian epidemic’ is the next chapter title. Data for the epidemic are given but not the source. Once again, it is likely that a distorted view is given. The author admits completing the data with ‘a bit of imagination’. Chapter 5 highlights occupations a t risk. This could be suggestive to people reading this in the waiting mom of a GPs surgery. Greater attention to the risk factors might have been more beneficial to readers be they doctors or members of the public Symptoms and signs are listed in chapter 6.It is stated that the symptoms
are relieved by rest and that there are no objective physical findings in most cases of RSI. This highlights a major problem confronting doctors as well as other treating professions; the inability to examine a patient accurately. When there are no physical signs and no abnormal tests, the case for psychogenesis is even stronger. It is therefore appropriate that a chapter on the psychological aspects is presented. The chapter asks the vexing question whether RSI affects people of certain personalities or whether it affects their personalities. Ergonomics in chapter 8 is a series of factors to be considered. Unfortunately, it does not adequately cover all issues. This could be due to the bias of the book towards keyboard workers. Workers undertaking non-keyboard tasks are just as deserving of attention. Chapter 9 covers the legal aspects of I compensation. At last this section warns Work is painful the RSI sufferer that the quest for compensation is a long p m e s s and rarely strongly questioned. The section on is it financially worth while. The con- physiotherapy shows that the author is fusion surrounding the time available not a physiotherapist. Little detail is for VDU work stations to comply with given on other alternatives suggested for recent regulations is perpetuated by the treatment. The chapter concludes with comments of the author. A clearer the most important piece of advice: ‘Prevent it if possible, but if it happens, description should have been given. recognise it quickly and take appropriate Prevention, management and outcome action.’ are the issues covered in chapter 10. It is Who should read this book? Patients stated that rest is the first essential in the and doctors are the intended audience. management of RSI. The sooner this form Physiotherapists would find it light of advice is corrected the better. Stopping reading and the illustrationdcartoons the task that has produced the symptoms amusing but the money would be better is more appropriate and fortunately this spent on more detailed information on the is stated. prevention of RSI. Alternative occupations are suggested Jeffrey D Boyling MSc MCSP MErgS but the similarity of some of these is
Pelvic Muscle Exercise Training Manual and Cassette by ffiren Medin. HIP (Help for lncontinent People) Inc, PO Box 544, Union SC 29379, USA, 1992 (3rd edn) Manual: Illus, 16pages. Tape: 38 minutes. $7 post paid.
This manual and cassette have been produced as a self-help guide for sufferers of urinary incontinence; both for women with mild to moderate stress and urge incontinence, and for men who are anticipating prostate surgery, or who experience urinary incontinence after prostatectomy. The manual begins by giving a clear, simple account of the types and causes of urinary incontinence. Diagrams accompany explanation of the pelvic floor but there is some incorrect labelling and t h e medical terminology may be confusing to lay people. The benefits of pelvic floor exercises are emphasised and the importance of a training programme becoming a life-long habit. Useful suggestions are given as to how patients can recognise whether the correct muscles are working. At this point, it would have been better if patients had been given advice on sources of help if they were having difficulties.No reference is made to the importance of these muscles being assessed - before starting an exercise programme - so as to ensure appropriate management.
Side A of the tape ‘Beginner exercises’ is enjoyable and helps to teach patients how to isolate the correct muscles, although the exercise routines tend to be rather prescriptive. Slow and fast twitch muscle fibres are addressed and patients correctly advised in the manual to keep breathing normally while exercising. However, i n dealing with the fast contraction, patients are instructed on the tape to breathe in while tightening and out when letting go. This contradiction and the advisability of linking contraction with inspiration is questionable. Also, there is no clear starting command with the first practised pelvic floor contraction and patients appear to be encouraged to hold for 32 seconds! Excellent advice is given regarding tightening the pelvic floor muscles during daily activities. Reporting to a doctor every 6-8 weeks is recommended but patients are left to judge when to progress the exercises. Side B contains ‘Advanced exercises’, the relevance of which is open to question. There is every chance that patients would find this part of the tape very confusing. In conclusion, physiotherapists working in this field would find a tape and manual useful in reinforcing their instructions and supervision, but the combination under review cannot be recommended, in spite of its many good points. Joyce Nelson MCSP
Physiotherapy, December 1993, vol79, no 12