About Repetitive Strain Injury (RSI)

Repetitive strain injury (RSI) describes a painful condition generally associated with doing a particular activity repeatedly or for long periods of time. It often occurs as a result of working with computers and typing or repetitive manual work, but you can also develop it if you don’t regularly carry out these sorts of tasks.

The term RSI covers a number of musculoskeletal injuries that can affect your hands, arms and upper body. It can be split into type 1 and type 2. Type 1 RSI means that the disorder can be classed as a recognised medical condition, such as:

  • tendonitis – inflammation of a tendon (the tissue that joins muscles to bones)
  • carpal tunnel syndrome
  • tennis elbow (epicondylitis)
  • rotator cuff syndrome
  • Dupuytren’s contracture
  • writer’s cramp (cramp of the hand)

A doctor will be able to recognise and diagnose type 1 RSI conditions. For example, tennis elbow is caused by repeatedly using your arm in a twisting movement. This can damage the tendons in your elbow making the outside of it painful.

Type 2 RSI means either that your symptoms don’t fit into type 1 RSI and you don’t have any inflammation or swelling, or the pain doesn’t stay in one area. This is also known as non-specific or diffuse pain. Doctors are less clear how to treat type 2 RSI and there is little scientific evidence about which treatments are effective.

There are different stages of RSI and if treated early enough, you may make a full recovery. It’s harder to treat if your symptoms have gone unchecked for a while. You may also be more likely to develop further injury as a result.

Causes of RSI

A number of factors put you at risk of developing RSI. These include:

  • repetitive activities
  • doing an activity that involves force, such as lifting or carrying heavy objects
  • carrying out an activity for a long period of time without adequate rest periods
  • poor posture or activities that require you to work in awkward or tiring positions

It’s important that your working environment (for example, your desk layout or assembly line set-up) is designed so you can work with your body upright and without having to twist or stretch. For example, working with your arm raised above your head or sitting in a fixed position for long periods of time may increase your risk.
There is a wide variety of jobs that may lead to RSI, such as data-entry or typing, working on an assembly line or doing supermarket check-out work. Therefore, it’s important for you to take steps to minimise risks. Speak to your employer about this – see Prevention of RSI for more information.

Some people find that their pain is linked to stress, often work-related.

Symptoms of RSI

There are a wide range of symptoms including pain and tenderness in your muscles and joints. You will probably notice symptoms most when you’re doing the activity that caused them. The pain may get worse so that it’s there all the time, even when you’re resting. It may get so bad that you aren’t able to do routine work or household activities.

This is why it’s important that you see a doctor as soon as you notice any pain in a particular area that lasts for more than a couple of weeks.

Symptoms include:

  • a sharp or a dull ache
  • stiffness
  • tingling
  • numbness
  • weakness
  • cramp

You may have some swelling but it’s also possible that you won’t have any physical signs, even though your hand or arm feels painful.

If you’re in constant pain, you may find it difficult to sleep. If you’re feeling stressed because you’re worrying about the possible consequences of RSI, this can make sleep problems worse.

Diagnosis of RSI

A doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history. If you have type 1 RSI symptoms, the doctor will be able to identify definite conditions, such as carpal tunnel syndrome, when you describe your symptoms and by examination.

With type 2 RSI symptoms diagnosis is more difficult. The doctor may refer you for an X-ray to rule out any other conditions that could be causing pain, such as osteoarthritis. If a recognised condition can’t be confirmed, you may be diagnosed with type 2 RSI.

Please note that availability and use of specific tests may vary from country to country.

Treatment of RSI

There is no single treatment for RSI. However, there are often specific treatments for recognised conditions, such as carpal tunnel syndrome. If you’re diagnosed with a particular condition, follow the recommended treatment. This may involve steroid injections or possibly surgery.

You may be referred to a physiotherapist (physical therapist) for exercises to build up strength in the affected muscles and for advice about ways to improve and strengthen your posture.
Although you should try to rest the affected area regularly, it’s not helpful for you to rest for long periods as it can weaken your muscles. Gently massaging and flexing the affected limb stimulates circulation and can prevent your muscles from weakening.

Self-help

You can make changes to your working environment and how you work by examining what you do and how you do it, and modifying the activity causing the problem. If you can, carry on working but reduce the amount of time you spend on the activity that causes the pain. If you can’t stop doing it completely, take regular short breaks to stretch and flex your arms and hands.

Split up when you do different tasks so that you don’t spend long periods of time doing the same thing.

Learn to touch type if you use a keyboard regularly. This will enable you to keep looking straight ahead and not down or to the side.

Exercise such as swimming, pilates or yoga may help to ease your symptoms.
There are a number of support groups for RSI. You may find it helpful to talk to other people with RSI as they may be able to offer advice and suggest things that could improve your symptoms.

Medicines

Medicines generally aren’t helpful in treating RSI, although a doctor may recommend over-the-counter painkillers or non-steroidal anti-inflammatory drugs (NSAIDs). Low doses of antidepressants are also thought to have some specific painkilling effect in chronic pain conditions such as RSI.

However, it’s not generally a good idea to take painkillers as they dull the pain and allow you to carry on doing the harmful activity, aggravating your RSI.

If you do take medicines, follow the instructions on the patient information leaflet and ask your pharmacist for advice.

If you’re having trouble sleeping, you may be prescribed sleeping tablets for only a few days because of the risk of becoming dependent on them.

Prevention of RSI

Your work area needs to be suitable and comfortable for you. The risk of an accident or injury occurring should be reduced as much as possible.

If you use a computer, make sure:

  • your chair supports your back and you sit up straight
  • your chair is the right height for you; if not use a footrest
  • your monitor is around 60cm from your eyes
  • your screen, keyboard and mouse are directly in front of you with the mouse as close to the keyboard as possible
  • when you type, your arms aren’t extended forwards, your forearms are horizontal and your fingers are at the same height as the middle row of keys
  • your legs have room to move under the desk or table
  • you only use a wrist rest when having a break from typing – don’t place your wrists on it while typing

If you have been off work because of RSI, when you return try not to do the activity that causes the pain. You may need to modify your job when the pain is severe. Take regular breaks and alternate tasks to prevent long periods of repeating the same movement.

Complementary therapy

Although there is no evidence to suggest that complementary therapies can successfully treat RSI, some people say that techniques such as massage and osteopathy ease their symptoms and help them to relax.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.