Connective Issues — Cinderella In 2021

This year’s viral times have resulted in many more people working from home. Employers love it because employees are seemingly more available and more productive. Most people are on the computer more.

I’ve had clients tell me they could be computing up to 12 hours a day. This comes with a price. I remember a phrase whereby ‘we use our legs by default and our arms by selection’. But now we are using our upper extremities by default and we are not adapted to do this for long periods.

Henneman (1965) first revealed that muscle motor units are stereotypically recruited in order of smallest unit to larger unit, and de-recruited in reverse. Therefore the smaller fibers with smaller axons are doing more work. These smaller units are the Type 1 or red fibres, and the process is called the ‘size principle’. In the children’s story Cinderella is the first to get to work in the morning and last to go to bed, hence the Cinderella Hypothesis as postulated by Hägg (1988, 1991, 2003), so you now get the connection.

Our shoulder and arm muscles generally have more fast twitch fibers than slow. Selection / default. Fast twitch like to work, have a rest, work, have a rest. But, in our modern world of miniature, sub-maximal (almost static), repeated activities we use (overuse/misuse?) slow twitch fibers. These are in smaller than required numbers in the shoulders and arms and so they get overloaded. Even forces of 5-30% of its maximum can lead to ischemia, with the muscle fibers compressing their own blood vessels.

Ischemia and hypoxia leads to insufficient ATP synthesis, a build-up of inflammatory chemicals, an acidic environment, and lack of perfusion. This ‘stagnant swamp’ can lead to myofascial trigger point formation, nociception and pain. The medically accepted terms for this muscle damage are ‘ragged red fibers’ and ‘moth-eaten fibers’.

It seems possible that allied to the physical contribution, cognitive and mental stress may also load up muscle tension and increase trigger point development. There are further studies by Treaster (2006) and by Hoyle (2011) that confirm trigger point formation from postural and visual stressors.

Telling this Cinderella story to your clients can paint a memorable picture in their minds. Pain neuroscience education is a huge part of our efficacy. As I’ve said in the past there’s only three ways our client’s get better; spontaneous recovery, a belief that we can help them, or  that we actually can help them. Let’s make use of all three.

The solution to this computer-age malady is to regularly break into this stereotypical patterning on the keyboard, putting the ugly step-sisters (Type II, white fibers) to work. Lifting a heavy-ish weight will wake up these fast twitch fibers, maybe leading to a muscle reset. One repetition a couple of times an hour may be all that is needed. I also get people to twist in their chair, turning their head the opposite way and turning their eyes the way of the twist. Or, just stand up and lift your chair in the air.

I once told this Cinderella Hypothesis story to a burnt-out thirty-something stockbroker. He wondered if this was why at the beginning of each stressful working day on the floor, a dumbbell was given to him and his workmates and it was never allowed to be put down. Makes sense to me.

Cheerio for now,