Repetitive Stress Injury

RSI damage is typically caused by repetitive tasks performed over time. It can also be the result of forceful exertions, vibrations, mechanical compressions or sustained or awkward positions. The main thing is that RSI damage always accumulates gradually over time.

The term “RSI”  is actually an umbrella term that covers a large number of discrete conditions. These include (rotator cuff) tendinosis, carpal tunnel syndrome, golfer’s and tennis elbow and trigger finger. Some RSI injuries are sports injuries linked to repetitive motions required by a particular sport.

Many of these injuries can be addressed by the use of the P.R.I.C.E. strategy to protect, rest, ice, compress and elevate the injured structure.

An orthopedic brace or athletic tape can be used to protect muscles, ligaments or tendons that are damaged by overuse. The tape or brace restricts the movement of the injured muscle, tendon, ligament or other structure. This permits it to heal naturally.

What Is A Repetitive Strain Injury?

As explained above, these are injuries caused by gradual damage to muscles, ligaments, nerves or tendons over time. Many repetitive stress injuries are caused by everyday activities that many of us take for granted. Examples of such actions include:

• Using a computer mouse (can cause carpal tunnel syndrome, an RSI of the wrist that has been associated with the use of vibratory tools and with activities involving frequent flexion or extension of the wrist);
• Painting an overhead object (may cause RSI injuries such as rotator cuff tendonitis);
• Using a hammer (may cause tennis elbow or lateral epicondylitis – an RSI involving the outer elbow tendons);
• Playing a sport that requires plenty of running, an activity that can lead to shin splints. It can also cause stress fractures of the shin bone.

RSI Causes

Overuse injuries are typically the result of repetitive motions. Many of them occur as a result of physical work activities. Examples for such work activities leading to RSI include lateral epicondylitis in textile workers, hand-wrist tendinitis in board manufacturers, sewers, packers and assembly line workers as well as carpal tunnel syndrome in jobs requiring the use of vibratory tools.  When this happens the cumulative effect of the  movements can stress muscles, tendons or ligaments over time.

However, RSIs are sometimes caused by other types of activities such as:

• Holding the same posture for long periods;
• Holding an abnormal posture for extended periods;
• Lifting heavy objects, especially when doing so with inefficient technique. An often cited example of this is lifting a heavy object by bending the back instead of the knees. This can lead to lower back pain – one of the most widely experienced overuse injuries.

Risk Factors

Some of the factors that can increase the propensity to experience an RSI are:

• Being in poor condition, so that the muscles, tendons or ligaments are easily overworked;
• Having a job that requires repetitive movements over extended periods. Examples include dental hygienists, gardeners and people who use a computer mouse all day;
• Working in an occupation that requires extensive standing time. Examples include waitresses, air hostesses, bus conductors and teachers.
• Having a job that requires maintaining uncomfortable or unusual positions for long periods. Plumbers and heating/cooling technicians are examples.

Symptoms Of A Repetitive Strain Injury

The symptoms of an RSI usually appear at major muscle groups or joints, such as knees, ankles, forearms and shoulders. They may include:

• Pain, which can be anywhere from mild to moderate to severe;
• A “tender to the touch” feeling in the affected area;
• Swelling;
• Inflammation;
• Joint stiffness;
• Unusual sensations, such as tingling or throbbing;
• A partial or complete loss of feeling (i.e. numbness);
• Muscle weakness;
• Reduced joint range of motion;
• Joint instability; and
• Hyper sensitivity to cold or heat.

Because of the gradual and progressive nature of the damage done by an RSI, its symptoms typically begin gradually. They may also be intermittent in nature at the beginning (i.e. they may come and go).

However, as time goes on, overuse injury symptoms tend to become more persistent and severe. Eventually, if left untreated, they may start to interfere with the ability to perform everyday activities.

Treating Repetitive Stress Injuries

Doctors usually opt initially for a conservative treatment plan:

• Resting the injured muscles, tendons, ligaments or nerves;
• Protecting injured muscles, ligaments and tendons from further stress with an orthopedic brace or athletic tape;
• Icing the injury or applying a cold compress (typically 20 minutes at a time, every 2-3 hours);
• Applying compression to the injury;
• Elevating the injured body part above heart level if and when possible;
• Using pain killers like tylenol (paracetamol) or non steroidal anti inflammatory medications like advil (ibuprofen);
• Corticosteroid injections to fight inflammation;
• Physical therapy exercises (physiotherapy).

Healing times vary widely from several weeks to a few months in acute florid tenosynovitis through to 8-12 months in epicondylitis and 12-18 months in adhesive capsulitis.

In addition to the above, an occupational therapist can recommend changes to the home or work environment. These will hopefully reduce the stress on muscles, tendons, etc. caused by everyday activities. Examples may include changing the height or shape of your chair or desk at work. In general, the employer and worker should think about the design and choice of equipment at the workplace. This should then be followed by modifications to reduce the likelihood of RSIs occurring.

If these conservative steps do not work, doctors may consider surgery to directly repair the injured structures. In addition, surgical intervention sometimes involves decompression and release. However, physical therapy exercises and changes recommended by an occupational therapist may still be necessary to prevent injury recurrence.

Preventing Overuse Injuries

There are several steps that one can take to reduce the risk of experiencing an RSI. These may include:

• Strength training to prepare bones, muscles and tendons for repetitive movements;
• Modifying your work environment to reduce stress on your back, wrists, etc. These may include changing your sitting position,computer monitor position, using a phone headset, etc.
• Trying to incorporate frequent position changes in your daily routine. For example, spend 20-30 minutes working in a standing position at your desk every hour or so.
• If you normally have to spend long periods standing, consider using an anti fatigue mat;

For more tips on RSI prevention, consult the National Education Association handbook on RSI..