Repetitive strain injury (RSI) is a condition where pain and other symptoms occur in an area of the body which has done repetitive tasks (often arms or hands). Treatment includes stopping the task (if possible), improving the work environment, and other measures such as painkillers and physiotherapy.
What is repetitive strain injury?
The term repetitive strain injury (RSI) is used to describe a range of painful conditions of the muscles, tendons and other soft tissues. It is mainly caused by repetitive use of part of the body. It is usually related to a job or occupation, but leisure activities can also be a cause. Unlike a normal strain following a sudden injury, symptoms of RSI can persist well beyond the time it would take symptoms of a normal strain to ease.
You may also see the term overuse injury. This is a general name for conditions in which the muscles, tendons or soft tissues are used excessively but, unlike RSI, do not necessarily involve repetition of the same movement.
What causes repetitive strain injury?
The main cause is frequent and repetitive movements of a part of the body. For example, typing, using a computer mouse a lot, etc. Other factors may contribute, such as poor posture whilst doing the movement, using excessive force whilst doing the movement and not having enough breaks from the task.
However, the precise reason why RSI develops is not clear. In many cases there is no swelling, inflammation or other obvious problems which develop in the muscles or tendons and yet symptoms develop. Also, it is not clear why some people develop RSI and not others who do the same repetitive tasks.
Research suggests that psychosocial workplace factors (which usually means stress at work) can also contribute to RSI. It may be that stress increases muscle tension and/or affects how the body feels pain in general.
Which areas of the body are affected with repetitive strain injury?
Symptoms depend on what the repetitive actions are. In most cases the symptoms develop in an arm, wrist or hand, as these parts of the body most commonly do repetitive tasks. In recent years it is computer operators, typists, musicians and people doing repetitive tasks in factories who most commonly develop RSI. People who do a lot of DIY around the house may develop RSI, or people who do certain sports which involve repetitive movements.
What are the symptoms of repetitive strain injury?
Symptoms can include: pain, tightness, dull ache, throbbing, numbness, or tingling in the affected area. The symptoms tend to develop gradually. At first the symptoms may only occur whilst you do the repetitive task and ease off when you rest. In time the symptoms can be present all the time, but tend to be made worse by doing the repetitive task. Symptoms can range from mild to severe.
Some people divide RSI into two main categories: type 1 RSI and type 2 RSI.
Type 1 RSI
This includes well-defined syndromes such as carpal tunnel syndrome (pain and compression in the wrist), tendonitis (inflammation of a tendon), tenosynovitis (inflammation of a tendon sheath) etc. (See separate leaflets called 'Carpal Tunnel Syndrome' and 'Tendonitis and Tenosynovitis' for details on these.) These conditions may be due to, or be made worse by, repetitive tasks. However, these syndromes are also common in people who have not done repetitive tasks. These syndromes may have other symptoms such as swelling, inflammation, nerve compression problems, etc.
Type 2 RSI
This is where symptoms do not fit into a well-defined syndrome. Also, there are no objective or measurable signs such as inflammation, swelling or problems with nerve function. It is sometimes called diffuse RSI or nonspecific pain syndrome.
How is repetitive strain injury diagnosed?
There is no test or objective way to diagnose RSI. This is where difficulties may arise. Pains in the areas affected by RSI are common and can be due to various causes.
If you develop a well-defined condition such as carpal tunnel syndrome, frozen shoulder, tendonitis, etc, it may or may not be related to repetitive tasks.
Blood tests are sometimes done to rule out inflammatory joint disease. X-rays, scans or nerve conduction tests may be needed if surgical treatment of a type 1 condition is being considered. Otherwise, the diagnosis is usually made on the basis that the condition developed only following a repetitive task and is relieved or partially relieved by rest from that task.
What is the treatment for repetitive strain injury?
See your doctor as soon as you feel that a problem may be due to RSI. It is thought that the earlier the problem is recognised and dealt with, the better the outcome. A doctor may advise various things such as:
- If at all possible, stop or reduce the tasks or activities which seem to be causing the symptoms. This may be easier said than done if your job or livelihood depends on the task. If possible, discuss the problem with your employer. A change of task, or changes to your work environment, may be possible.
- Look into practical ways of adjusting your work set-up so as to reduce strain.
- Anti-inflammatory drugs have usually been recommend although recent studies suggest that simple painkillers such as paracetamol work just as well.
- Other medication you may be offered includes muscle relaxant tablets and a low dose of a certain type of antidepressant (tricyclic).
- A referral to a physiotherapist who can give advice to help with posture and how to strengthen or relax the muscles involved. Physiotherapists can also offer other treatments such as transcutaneous electrical nerve stimulation (TENS) which uses a mild electrical current to block pain signals, ultrasound therapy and infrared wave treatment.
- Some people find relaxation techniques, and regular general exercise (such as swimming) to be useful in easing the symptoms.
- An injection of steroid, sometimes combined with a local anaesthetic, may be considered into an area which has definite inflammation, such as a tenosynovitis or carpal tunnel syndrome.
Symptoms often ease with the above measures. It is then wise to review your work or other activities to prevent further bouts of RSI. For example:
- If you work with a computer: is your seat, keyboard, mouse, etc, positioned in the correct way with the least strain likely on your hands and fingers?
- The RSI Awareness website (see below) has practical suggestions on how to reduce strain from repetitive tasks - for example, how to set up your computer and workstation to reduce RSI.
- Do you work with a good posture? Do you sit correctly if you have a desk job?
- If you do a repetitive task at work, do you get enough breaks?
- Is there anything your employer could do to improve your working environment?
- If you are under stress at work, is there anything you or your employer could do to improve this?
What is the outlook?
Most people get better in three to six months. Prevention and treatment measures speed up recovery. However, some people develop symptoms that persist long-term, which can be debilitating. Sometimes a change of job is the only answer.
Further help and information
RSI Action, PO Box 173, Royston, Hertfordshire SG8 0WT
A national charity promoting prevention and relief of RSI.
Further reading & references
- van Tulder M, Malmivaara A, Koes B; Repetitive strain injury. Lancet. 2007 May 26;369(9575):1815-22.
- Verhagen AP, Karels C, Bierma-Zeinstra SM, et al; Exercise proves effective in a systematic review of work-related complaints of the arm, neck, or shoulder. J Clin Epidemiol. 2007 Feb;60(2):110-7. Epub 2006 Sep 7.
- Verhagen AP, Karels C, Bierma-Zeinstra SM, et al; Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults. Cochrane Database Syst Rev. 2006 Jul 19;3:CD003471.
- Devereux JJ, Vlachonikolis IG, Buckle PW; Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb. Occup Environ Med. 2002 Apr;59(4):269-77.
- Waersted M, Hanvold TN, Veiersted KB; Computer work and musculoskeletal disorders of the neck and upper extremity: a BMC Musculoskelet Disord. 2010 Apr 29;11:79.
- Fabrizio P; Ergonomic intervention in the treatment of a patient with upper extremity and Phys Ther. 2009 Apr;89(4):351-60. Epub 2009 Feb 26.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Laurence Knott