RSI – THE CASE OF DEANNA MILLER
This is a section of an article, by Lisa Grainger, that appeared in the Body and Soul section of The Times on May 22 2004.
When the sensation of raindrops hitting her skin made Deanna Miller cry one summer’s day in 1999, she knew she could no longer deal with the pain in her arms. Miller, a civil servant was suffering from RSI (repetitive strain injury). “It was excruciating,” she says.” At its worst, I had stabbing pains down my arms, all the way across my shoulders and into my neck, often 24 hours a day.”
Miller had first started to feel pain after a three-week stretch of inputting computer data at work seven hours a day, five days a week. At the end of the third week her arms were aching and by Saturday she had “unbearable pains all the way up my forearms and then by Monday in my shoulders too.”
Over the next five years Miller went from being a fit, happy extrovert woman to someone obsessed with her health. “I’d never really thought about it, but RSI, which is caused by repetitive use of the same muscles, took over my life because the pain was always there. I couldn’t sleep because of the shooting spasms up my arms and I became depressed. It also affected my social life.”
From being a productive member of staff, Miller was on constant sick leave, sometimes for six months at a time. Mostly, she’d lie in bed and try to rest because any exertion was agony. Or she would read health books on “anything that might help me, from acupuncture to healthy eating.”
Her GP had prescribed anti-inflammatories, which reduced the swelling in her arms for a week. Six months later she tried physiotherapy, which inflamed her muscles further, resulting in more weeks off work. A year later she tried acupuncture, which had little effect. A visit to a chiropractor helped only a little, “mainly by advising me to put ice packs on my shoulders to reduce the swelling.”
At work, her employers provided her with an assistant three hours a day, as well as a voice-activated programme so she could speak into her computer and her telephone – the consequence of her taking them to court for not giving her regular desk and computer assessments in accordance with the 1992 Display Screen Equipment Act passed by the European Union.
However Miller’s breakthrough came when she read a book by an American helicopter pilot, Richard Rossiter, whose shoulders had been so painful he could no longer fly – until he tried Rolfing: a series of deep massage manipulations, which works on the myofascial system, the soft connective tissue between muscles. Intrigued, she contacted the Rolf Institute of Structural Integration in January 2003 and was put in touch with Alan Richardson, a Certified Rolfer.
“I was so desperate that when Alan asked me how I was I just broke down and cried”, she admits. “I couldn’t keep up the bravery any longer.”
After looking at Miller’s posture and muscle position, and finding out about painful movements, Richardson set to work. Over 10 sessions, once every fortnight, he slowly massaged the muscles and fascia on her body, starting at the feet and legs on the first session and working up to the head and arms by the seventh. The point, he stresses, is to align a different block of the body each week, “until, like building blocks, they are in one long line without any obvious unnecessary tension,”
Over-stressed points in the muscles’ fascia, he says, are like “flies in a Spider’s web pulling in opposite directions, straining the structure.” His task is to soften the fascia by friction and manipulation, then to stretch it so that the muscles can realign themselves in their natural positions. “When muscles are out of balance, they can feel pain in all sorts of places,” he says.
“The tense muscles in Deanna’s arms meant that her shoulders were out of alignment and had frozen. Rolfing was able to reduce the compression in her whole body, so that her shoulders went back and the pain was reduced there.”
In addition, he tried to teach Miller new ways of moving-for example, using her entire arm rather than just her wrist for some task-which he says freed ” a significant amount of energy previously held in overworked muscles.”
Since finishing her ten treatments, Miller has felt no pain in any part of her body. “Unlike all the other doctors, Alan treated it like a mechanical problem, rather than a chemical one, and it worked a treat,” she says happily. ” I haven’t had a day off for six months and I feel great.”
Her confidence , however is still very low after years of pain, so she is wary of activity that might affect her muscles again. She goes back to Richardson occasionally for “top-up” sessions when she feels her muscles becoming tense.
“I had begun to think I would never get better again”, she says. “But having gone from being a 95% cripple on Prozac, anti-inflammatories and sleeping tablets to being a 50% cripple on no medication at all, he has given me hope.”
LEON FLEISHER’S COMEBACK
This is adapted from an article in John’s Hopkins magazine, November 1995
Leon Fleisher has perhaps the most famous right hand in contemporary music. It is famous because for more than 30 years it did not work. During that time Fleisher continued performing concerts for the left hand, but not until he began working with Rolf Institute teacher Tessy Brungardt (see Note 1) in Baltimore, did his right hand become strong enough for him to confidently return to the concert platform with a two-hand repertoire. Music aficionados will know Leon Fleisher from his brilliant 13-year career in the 1950s and early 60s when he was hailed as the “pianistic find of the century.” About his debut with the New York Philharmonic, NewYork Times critic Olin Downs wrote “Leon Fleisher at once established himself as one of the most gifted of the younger generation of keyboard artists.” In 1960, Joy S. Harris of the New York Herald-Tribune wrote: “….came a performance by Leon Fleisher, of Mozart’s Piano Concerto in C, such as I never expect to hear bettered in my lifetime.”
Ten years later, Fleisher could barely write his name, a victim of what has since become known as repetitive strain injury (RSI) resulting from his obsessive hours of practice. Fleisher consulted doctor after doctor for a diagnosis of his mysteriously deteriorating hand, but they didn’t seem interested, he says, when they were unable to find something specific in medical or surgical repair. Fleisher’s debilitation began in 1962 starting with the little finger feeling weak. He responded by practicing harder and longer. “The finger seemed to refuse to respond,” says Fleisher. “In fact it seemed to defend itself involuntarily by curling under.” To the pianist’s horror, the fourth finger soon followed, and over the next 10 months, the rest of his right hand. Fleisher has described it as feeling as if his arm were a rope becoming unbraided. Next he felt numbness in his fingers. “When my body, through the mechanism of pain, told me to stop, I didn’t listen,” he says “I tried to bull my way through it. That is utter nonsense, and dangerous, dangerous advice.” He was 37 years old when he was forced to retire from the concert platform and for one of the greatest pianists of all time, his whole life seemed to disintegrate. His family fell apart and he considered suicide, before he realised that it was the music in life that he truly loved, more than playing the piano, and the music was still there. So Fleisher dedicated himself to his students at the Peabody Conservatory in Baltimore and the Tanglewood Music Centre near Boston, where he is artistic director. “Teaching is where he found his real happiness,” says his son Julian. “He has this kind of weird adoration from students. Someone once called him the Obi-Wan Kenobi of piano teachers.”
Fleisher learned how to conduct and he learned the left-handed pieces, a slim but rewarding repertoire greatly augmented by compositions by Ravel, Prokofiev and Britten that were commissioned by a wealthy Austrian pianist who had lost his right arm in World War 1, and he never gave up on the idea of playing again with both hands. Over the 30 years since he left the concert platform in 1965 he tried seemingly every medical and psychiatric treatment that held a glimmer of hope: acupuncture, hypnosis myotherapy, est, L-dopa, steroid injections, bio feed back, Tiger Balm, and many others. In 1981 he had surgery to alleviate carpel tunnel syndrome after which he attempted a two-handed comeback only to be disappointed that his hand had not regained the strength to handle Beethoven. After the first concert with the Baltimore Symphony Orchestra which was broadcast live on PBS to much fanfare, Fleisher devoted himself again to his teaching and conducting and shied away from the word “comeback.” He issued two new recordings of works for the left hand in 1994, both of which received Grammy nominations.
In March 1995 his wife introduced him to a Rolfer in Baltimore named Tessy Brungardt. Rolfing is a form of therapy that structurally changes connective tissues restoring their pliability and range of motion. From injury and habitual patterns of use, tendons, ligaments and the sheaths known as fascia can become misaligned, fibrous and rigid and thus interfere with the functions of muscles. A Rolfer works out patterns of strain by applying pressure with finger, knuckles or elbows and calling for movement in order to soften connective tissue and realign the injured areas. The technique also seems to reprogram affected parts of the nervous system.
Under Brungardt’s care, Fleisher’s hand responded. Within a few weeks he found he could play some of the pieces in the two-handed repertoire well enough to think about performing them again. “Leon is a highly motivated person,” says Brungardt. “Anything I show him, he takes and goes on”. Brungardt worked not just on Fleisher’s fingers, hand and forearm, but also his upper arm, shoulder and neck, and Fleisher applied himself to a series of stretches. The results were remarkable. “When he began,” Brungardt says, “his arm felt like petrified rock. It’s really changed. His arm is much softer, and he has much more rotation and flexion. I can see his hand changing and the muscles developing in his fingers as he practices.”
After 30 years of trying everything and anything that might allow him to perform again two-handed, mere weeks after beginning to work with Brungardt, he performed a two-handed concert with the Cleveland Orchestra. Unlike the 1982 concert, the 1995 concert was not billed as a “comeback”. There was no PBS broadcast, no special press, no hype as he tested his stamina. Fleisher was pleased at his performance and later in the summer he played two-handed at the Tanglewood Music Centre. Richard Dyer wrote in the Boston Globe: “Fleisher played with extraordinary suppleness, imagination, finesse and style.” Long time friend Andre Previn heard Fleisher playing two-handed at Tanglewood and the conductor invited him to play at Carnegie Hall which he did on January 13 1996 to triumphant reviews.
Note 1: Tessy Brungardt was my tutor for the second unit of my Rolfing training in 1998 in Brazil