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Symptoms causes and effective management of repetitive strain injuries

Pain caused by repetitive moments and over usage in nerves, muscles and tendons is described as a repetitive strain injury or RSI. It is a common condition that affects millions of people internationally and can be caused and treated in a variety of different ways. RSI can also be referred to as non-specific upper limb pain or work-related upper limb disorder.

Repetitive strain injuries generally affect the upper body, with the hands, wrists, elbows, neck and shoulders being most commonly affected.

Initial symptoms

At first, symptoms of RSI tend to only flare up while you are carrying out the specific task which is causing the problem. So if you notice cramps in your fingers while you are typing but these disappear when you stop, it is more than likely a repetitive strain injury. You might notice these symptoms coming and going over the course of several weeks.

However this is just the first stage and left unattended, these issues can gradually become worse and you will notice the symptoms lasting for longer, with a possibility of swelling. The pain may not disappear when you stop performing the task, and you may start to feel that it is constant.

Causes of RSI

There are several contributory factors that can cause RSI and lead to the emergence of the condition:

  • Repetitive actions or activities that are carried out on an ongoing basis
  • Engaging in a high intensity activity for a long period time without adequate rest breaks
  • Poor posture or the requirement to carry out work activities in a non-ergonomic work environment
  • Retaining the same posture for a length of time, especially in an unnatural pose
  • The overuse of muscles on an ongoing basis
  • Ongoing activities in extremely cold temperatures
  • Operating vibrating equipment or enduring any forceful activity for a long period of time
  • Spending a prolonged period of time working, without taking any breaks or altering your position
  • Fatigue and stress has also been proven to clearly increase the chance of RSI
  • Consistent blows to the body, the carrying of heavy loads on a regular basis and ongoing stress on a specific area

As illustrated above, RSI is most commonly caused by carrying out a repeated action on an ongoing basis, usually in a work environment. Those who work in assembly lines, at the supermarket or even spend all day typing on a computer are at risk of incurring RSI and should take regular breaks and exercise daily.

To avoid RSI it is important that your working environment is ergonomically laid out and that you can work in comfortable conditions. This applies to all types of work, whether manual labour is required or you are deskbound. Patients who suffer from RSI not only suffer physically, they also suffer mentally and the condition should not be allowed to manifest at any time.

A repetitive strain injury can be debilitating and the pain can be intense, and a sufferer’s work may be affected as they are unable to perform the day to day tasks that their job requires. The causes of RSI are broad and can be avoided if patients are aware of the risk of repetitive actions.

Close up of a forearm showing red in the wrist to denote pain

Different types of RSI

RSI is generally split into two categories which are dependent on the patient’s symptoms:

Type 1 RSI: Refers to when a doctor examines a patient and diagnoses a recognised medical condition based on the symptoms. These symptoms are usually characterised by inflammation and swelling of tendons and muscles.

Type 2 RSI: Refers to when a doctor cannot diagnose RSI or any specific medical condition, as the patient suffers from no other obvious symptoms except for pain. This condition is also often referred to as non-specific upper limb pain.

Conditions classed as Type 1 RSI

There are numerous injuries and medical conditions that are classed as Type 1:

Trigger Finger: When the swelling in a tendon that runs alongside the finger makes it hard to bend and straighten the appendage.

Raynaud’s Disease: Condition whereby the bloody supply to fingers and other extremities is interrupted, often due to exposure to cold.

Ganglion Cyst: When a sac of fluid forms around a tendon or joint, often on the fingers or wrist.

Writer’s Cramp: Also a type of Dystonia, this condition occurs from continuous use of hands and arms.

Bursitis: The inflammation or swelling of the fluid-filled sac found near a joint, usually in the shoulder or elbow.

Thoracic Outlet Syndrome: When the nerves or blood vessels running between the armpit and base of the neck are compressed.

Dupuytren's Contracture: When the deep tissue in the fingers and palm of the hand thickens.

Nerve entrapment such as that experienced by carpal tunnel sufferers, epicondylitis, which leads to golfer or tennis elbow, tendonitis and rotator cuff syndrome are also all Type 1 RSI conditions. Many of these conditions can be caused by work activity but can also develop as a result of many other factors.

Type 2 RSI

If the symptoms a patient suffers from do not suggest a Type 1 condition, further tests may be required and x-rays for osteoarthritis and blood tests checking for inflammatory blood diseases may be suggested.

If after tests no other condition is determined, you may simply be diagnosed with Type 2 repetitive strain injury or diffuse repetitive strain injury, and treatment such as wearing an arm or wrist support will be suggested in an effort to offer pain relief.

Initial treatment

Treatment for RSI will depend upon your symptoms and whether there has been a specific diagnosis.

If your repetitive strain injury is caused by an activity in the workplace, first speak to your occupational health representative if you have one and your employer to see if there are ways in which you could alter your working practices to relieve your symptoms. Small changes to your working environment or your lifestyle can often be sufficient. Wearing a thumb, hand or wrist support can sometimes be helpful too.

Work out what is causing the problem in your working day. Change the way you do this activity if possible or reduce the time spent on it. If you are unable to stop the activity altogether, make sure that you take regular, short breaks to stretch and to walk about. Consider using a software programme that reminds you to stop at regular intervals. These can be very useful.

It is also helpful to discuss how to set up your workstation for optimal health with your occupational health representative.

Many people with an RSI find that swimming, walking or practicing yoga regularly can ease their symptoms considerably.

Speak to your doctor

If your symptoms have not improved following changes to your workstation and increased breaks from the activity, contact your GP. There is no single treatment for repetitive strain injury but a range of options is available. Self-help, medication or even surgery may be recommended if your GP has been able to diagnosis a specific condition. Even if he or she is unable to do this, these treatments may still help although evidence of this is limited.

3 doctors in a hospital

Possible treatment options

Medication: This might include anti-inflammatory painkillers, muscle relaxants, antidepressants or sleeping tablets if the pain is preventing you from sleeping.

Heat / Cold Packs: These can be used to help manage the condition as well as offering pain relieving qualities.

Wrist Support: There are varying styles and options available but in general they can offer stability, compression or both. From an RSI perspective a wrist support with compression would help to counteract any inflammation whilst also offering pain relieving qualities, whilst the stability helps to offer an additional level of support when active.


Physiotherapy: Advice on posture, stretches and exercises to relax or strengthen your muscles Steroid injections: to reduce inflammation although this is only recommended in cases where the patient has received a specific diagnosis such as carpal tunnel syndrome.

Surgery: This is only considered if other options have failed. Surgery can correct difficulties with nerves and tendons in specific conditions such as carpal tunnel syndrome and Dupuytren’s contracture.

Complementary therapies

Therapies such as massage, physiotherapy and osteotherapy may be available on the NHS following a referral from your GP.

Private therapy is another option but you should always check that the therapist is fully qualified and registered with a professionally recognised organisation.

Many sufferers of repetitive strain injury have found acupuncture, yoga, the Alexander Technique and other forms of complementary therapies very helpful. However, there is little scientific evidence to suggest that they will help in every case.

Undertaking a risk assessment

The development of repetitive strain injury, or RSI, is frequently related to working environments, and most employers are legally required to carry out risk assessments on work practices and areas to ensure that they expose employees to the lowest possible risk of injury or accident. If your employer has not carried out a risk assessment you can request that they do, but you can also review your work situation yourself. If you suspect you may be developing repetitive strain injury, a wrist support may help to reduce discomfort and further damage by controlling movement and allowing the wrist to rest.

Preventing RSI at your desk

If you use a computer, check that all your desk equipment is set up appropriately for you so that strain on your upper limbs, neck and back is minimised. If you find using your mouse uncomfortable you could try a different design, reduce tension in your wrist and hand by slowing it down or use an alternative such as keyboard shortcuts or voice recognition software. Some people find clicking the mouse painful, and this can be avoided by installing 'mouse tool' software which automatically clicks for you when you pause the mouse.

Posture is also important, and the height of your chair should allow your forearms to be horizontal with your work surface and your elbows at right angles. Keep your wrists straight while typing and your keyboard directly in front of you to avoid unnecessary strain. The screen should be at eye level so you do not have to strain your neck, and should be positioned to avoid glare.

Lady sat at her desk at work holding of lower back in pain

Take regular breaks

It is important to take short breaks regularly throughout your working day. Sitting in a static position for a long period can cause you to become tense and stiff, so get up from your desk and move around to allow the muscles in your hands and arms to relax. This can help to prevent repetitive strain injury from developing. If you tend to forget to take breaks, you can use software that will remind you to take a break at regular intervals.

Stress as a contributor

Work is not the only thing that can aggravate the condition and if you are experiencing high levels of stress in your life it can make your symptoms worse. Learning some relaxation techniques that incorporate deep breathing with muscle relaxation can be really worthwhile to reduce uncomfortable or painful symptoms. Some hobbies can also contribute to the development of upper limb disorders, and musicians can be at high risk of RSI, but it is often possible to make changes to how you carry out different tasks to reduce the risk.

Repetitive strain injury affects many people but the situation can often be improved by ensuring that your work area is well set out and using aids such as software programs to make your work easier.