Repetitive strain injury (RSI) is a general term for conditions that affect the muscles, tendons, ligaments, nerves, other soft tissues and joints, causing pain and other symptoms.
Also called upper limb disorders (ULDs), these conditions generally affect the neck, shoulders, arms, wrists, hands and fingers (carpal tunnel syndrome, for example, is a common type of RSI that affects the wrists and hands).
By Lamberts Informa
Many people may associate RSI with overworked office staff who spend their days hunched over computer keyboards or factory workers using heavy machinery. But it can affect anyone who makes frequent, repetitive movements, either at work or at play (some sports, for instance, can lead to the development of RSI). Even children are at risk of developing RSI because of the way computer games consoles, smartphones and other digital devices are operated.
Apart from making repetitive moments such as twisting, squeezing, hammering, pushing, pulling, lifting and reaching, there are other factors that may contribute to the development of RSI, including the following:
As far as age is concerned, people who are 45 and older are more likely to develop RSI than those from younger age groups, with the most likely work-related causes including holding tools, using keyboards and heavy lifting.
As well as aches, pains and tenderness, RSI can cause stiffness, tightness, tingling, numbness, weakness, cramp and throbbing. Symptoms often develop gradually rather than suddenly, and initially you may only be affected while you’re doing whatever action is causing the problem (that is, the symptoms wear off when you’re at rest).
However, if you don’t take steps to relieve or prevent the symptoms, they may gradually become worse and you may be affected for longer periods or even all of the time.
The most common types of RSI injuries include the following:
Bursitis: Also called beat elbow or ‘frozen shoulder’, bursitis is inflammation of the soft tissue between either the skin and bone or between the bone and tendon (cords that connect the muscles to the bones), causing pain and swelling. It’s thought to be caused by pressure on the elbow and repetitive shoulder movements.
Carpal tunnel syndrome: Caused by pressure on the median nerve that passes through the wrist, carpal tunnel syndrome symptoms include pain, tingling and numbness in the fingers and thumb. Using vibrating tools as well as working with a bent wrist – such as at a computer keyboard – may cause it.
Cellulitis: Sometimes called beat hand, cellulitis affects the palm of the hand, causing pain and swelling as a result of using hand tools such as hammers and shovels.
Dupuytren’s contracture: This is a hand condition where the fingers – sometimes just the ring and little fingers – bend towards the palm and cannot be straightened, caused by the thickening of scar tissue under the skin on the palm. It may be seen alongside other RSI problems, such as bursitis or tendinitis.
Epicondylitis: Most commonly known as tennis elbow, epicondylitis is the term for inflammation of the tendons at the point where they attach to the bone, causing pain and swelling. It’s linked to strenuous jobs such as bricklaying.
Ganglion: Cysts that form under the skin, ganglions are usually found on the back of the fingers or wrist, and are caused by repetitive hand movements. The swelling may feel tender, though ganglions are often painless.
Rotator cuff syndrome: This is the term for tendinitis in the rotator cuff (the soft tissue at the top of the shoulder). It causes inflammation in the shoulder muscles and tendons, resulting in pain and restricted movement. Rotator cuff syndrome is usually seen in people who reach up a lot with their arms, such as painters, plasterers, swimmers and tennis players.
Tendinitis: Caused by inflammation of the tendons, tendinitis can affect the hands, wrists, shoulders or elbows and develops as a result of overusing of a group of tendons.
Tenosynovitis: Mostly affecting the hands, wrists and arms, tenosynovitis is caused by inflammation of the tendons as well as the protective sheaths that surround some tendons. Symptoms include aches, pain, tenderness and swelling.
Trigger finger: This is inflammation of the flexor tendons of the hand, which makes it difficult for fingers and thumbs to bend on their own. It’s thought to be caused by repetitive movements and having to grip objects for long periods of time.
Writer’s cramp: This term is often used to describe muscle cramp caused by repetitive movements such as handwriting and typing.
All of these conditions are categorised as type 1 RSI. When you have pain that cannot be diagnosed one of these or any other specific condition, it’s categorised as type 2 RSI (or non-specific upper limb pain).
The simplest way to treat RSI is to stop doing the movements that are causing it. There again, if your RSI is related to your work, that may not be possible – although some people may be able to change what they do at work or modify their working environment, either of which can help.
If you can’t stop or modify your actions at work, several things may help to relieve your symptoms on a temporary basis, including the following:
Medicines: You may be prescribed medication such as anti-inflammatory painkillers, muscle relaxants, antidepressants or – if your RSI stops you from getting a good night’s sleep – sleeping tablets.
Drug-free relief: Items used to relieve strains, sprains and other injuries may also be helpful, such as heat and cold packs, splints and elastic sports supports that help relieve the pressure on your joints.
Steroid injections: If you have a type of RSI that’s causing a well-defined area of inflammation – such as carpal tunnel – you may be advised to have one or more steroid injections to reduce the inflammation.
Physiotherapy: Your GP may refer you to a physiotherapist (or you could see a physiotherapist privately). He or she may show you exercises to help stretch and strengthen particular muscles or offer ultrasound or infrared wave therapy. A physiotherapist may also be help you improve your posture.
Surgery: In certain cases that involve problems with nerves or tendons – such as carpal tunnel syndrome or Dupuytren’s contracture – surgery may be recommended.
Many people also turn to complementary therapies to treat the symptoms of RSI, including chiropractic, osteopathy, acupuncture, reflexology, the Alexander technique and massage therapy. Exercise such as swimming may also be useful in easing some of the symptoms such as muscle stiffness.
There are steps you can take to help protect yourself against RSI, especially if your job is putting you at risk.
Take a break: Regular, short breaks instead of one long break during your working day can help if you do have to perform frequent, repetitive movements. Taking a few minutes every now and then to do some simple stretching movements using your arms, hands, shoulders and neck can also help your circulation and relieve the effects of bad or static postures.
Adjust your workstation: If you work at a computer, you’re sitting position at your desk is highly important. Ideally you should adjust your chair so that your upper arms and forearms form 90-degree angles while you type, and your feet are comfortably flat on the floor (you may need a foot rest, depending on how high you have to adjust your chair so that your arms fall in the correct position). Your eyes should be level with the top of your computer screen and your lower back should be supported by the back of your chair.
Learn to type: If you use a computer keyboard for long periods of time, either at work or at home, using the correct typing technique can also help as typing with two fingers can put a strain on your finger joints. If you can touch type, you can also look straight ahead while you type instead of constantly looking down at the keyboard and up again, which may put a strain on your neck.
You may also want to look into different types of non-standard keyboards, which may help by improving the positioning of your hands. If you find using your mouse uncomfortable, there are also alternative types available that are operated using a different hand position.
Use a headset: Gripping a phone between your ear and shoulder can put a big strain your neck muscles. So if you spend a lot of your day on the phone, try switching your handset for a headset.
Meanwhile if you want to avoid developing a sports-related RSI, sensible precautions such as warming up and cooling down properly may help protect against muscle strain.
As well as conventional treatments, there are some natural supplements and treatments that may help to relieve symptoms such as inflammation and swelling, as well as support nerve and muscle health.
Turmeric: A herb widely used in Indian cooking, turmeric adds colour and flavour to curry dishes and has long been used in the traditional Indian system of herbal medicine called Ayurveda. It contains an antioxidant substance called curcumin, which is widely thought to have anti-inflammatory properties.
Fish oils: The omega-3 fatty acids found in fish oils are also believed to have an anti-inflammatory action. In one study, people with acute and chronic non-specific neck and back pain were given omega-3 fatty acid supplements alongside prescription anti-inflammatory painkillers. After 75 days, 59 per cent had stopped taking painkillers while 88 per cent said they wanted to carry on taking the supplements (i).
Magnesium: A mineral that may be useful for general muscle health, magnesium is found naturally in the body (the average adult has about 25g), with just over half found in the bones and the rest in soft tissues. It’s needed for more than 300 different biochemical reactions, including muscle and nerve function. If you don’t have a sufficient level of magnesium in your body, one of the symptoms may be muscle cramps or twitches.
B Vitamins: The group of B vitamins – and especially vitamin B6 – is believed to help maintain healthy nerves. There is even some evidence that those with a specific type of RSI – namely carpel tunnel syndrome – may be deficient in vitamin B6 (ii).
Meanwhile, therapies you could try include acupuncture and magnet therapy (there is some evidence to suggest that magnets may offer relief of carpal tunnel symptoms) (iii).
(i) Maroon JC, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31.
(ii) Ellis JM, Kishi T, Azuma J, et al. Vitamin B6 deficiency in patients with a clinical syndrome including the carpal tunnel defect. Biochemical and clinical response to therapy with pyridoxine. Res CommunChemPatholPharmacol. 1976;13:743-757.
(iii) Colbert AP, Markov MS, Carlson N, Gregory WL, Carlson H, Elmer PJ. Static magnetic field therapy for carpal tunnel syndrome: a feasibility study. Arch Phys Med Rehabil. 2010;91(7):1098-1104. Carter R, Aspy CB, Mold J. The effectiveness of magnet therapy for treatment of wrist pain attributed to carpal tunnel syndrome. J FamPract. 2002;51(1):38-40.