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Repetitive Strain Injury

Repetitive Strain Injury

Repetitive Strain Injury (RSI)

What is an RSI?

RSI stands for Repetitive Strain Injury.   As the name suggests, this is a build up of small, often painless activities repeated day after day.   Each activity in itself is painless, but causes a small amount of damage to the tissues which increases over time until the body is triggered into an infalmmitory response in order to healit.   This is when the pain begins.

RSIs come in a variety of forms, can occur at any age and can affect most movable parts of the human body.
The term RSI covers a myriad of complaints. There are almost as many RSIs as there are movable parts of the human body. This article will focus predominantly on those that are caused by working environments, sports and modern technological devices.
RSIs are conditions associated with repetitive tasks, forceful exertions, vibrations, mechanical compression and sustained or awkward positions.
General terms applied to RSIs include repetitive stress injury, repetitive motion injuries, repetitive motion disorder (RMD), cumulative trauma disorder (CTD), occupational overuse syndrome, overuse syndrome and regional musculoskeletal disorder.
Other, more colloquial terms for modern RSIs include Blackberry thumb, iPod finger, PlayStation thumb, Rubik's wrist or cuber's thumb, stylus finger, raver's wrist and Emacs pinky.

Symptoms of RSI

Because there are so many potential causes of RSI, it follows that there are a huge number of potential symptoms. Below are some of the more general symptoms of RSI:

  • Tenderness in the affected muscle or joint
  • Pain in the affected muscle or joint
  • A throbbing (pulsating) sensation in the affected area
  • Tingling sensation in the affected area (especially the hand or arm)
  • Loss of sensation
  • Loss of strength.

Repetitive Strain Injury: Causes And Diagnosis

Due to the nature of RSIs, the specific causes are incredibly varied. The following list includes the general types of actions and behaviors that are most likely to induce RSI:

  • Overuse of a particular muscle or group of muscles
  • Vibrating equipment
  • Working in cold temperatures
  • Poor posture or a non-ergonomically designed workspae
  •  Forceful activities
  •  Holding the same posture for prolonged period
  •  Direct pressure to particular areas
  • Carrying heavy loads
  • Increased psychological stress has been shown to worsen RSI2
  • Fatigue

Diagnosis of RSI

RSIs can take many forms, including tennis elbow and rotator cuff syndrome.
Because of the nebulous array of potential symptoms and their diffuse etiologies, RSIs are generally diagnosed by asking questions.
The patient will be asked about the sort of repetitious tasks they carry out on a regular basis and the source and timing of the discomfort.
In general, RSIs are split into two groups:

Type 1 RSI
If a doctor can diagnose a recognized medical condition, such as Raynaud's phenomenon or rotator cuff syndrome (see below), it is considered a type 1 RSI.
Symptoms usually include swelling and inflammation of specific muscles or tendons.

Type 2 RSI
If a doctor cannot diagnose a known medical condition from the symptoms, it is classed as a type 2 RSI. Type 2 RSIs have no obvious symptoms, just a general feeling of pain or discomfort.
Type 2 cases are sometimes referred to as non-specific pain syndromes.

Examples of RSIs

The list of conditions that can potentially be brought on by repetitive actions is long. A few of these conditions are included in the list below. It is worth noting that many of these conditions can be caused by a number of factors, RSI being just one:

  • ? Edema: fluid build-up in cavities
  • Tendinosis: cellular degeneration of collagen within the tendons through overuse (a separate condition from tendinitis)5
  • Carpal tunnel syndrome: painful compression of a nerve as it passes across the front of the wrist
  • Raynaud's disease: the collapse of blood vessels in the extremities when cold or stressed; this condition can be brought on by work involving vibration - jackhammer operators, for instance, are prone
  • Cubital tunnel syndrome: pressure on the nerve in the "funny bone" area. This might be brought on by repeated or prolonged pressure on the area in question, or from stretching the nerve for long periods of time
  • De Quervain syndrome: a painful condition affecting the tendons on the thumb side of the wrist, often associated with overuse of the wrist
  • Thoracic outlet syndrome: blood vessels or nerves become trapped between the collar bone and first rib. Mostly affects people who have occupations involving heavy usage of the upper extremities against resistance
  • Intersection syndrome: a painful inflammation of specific muscles within the forearm caused by repeated flexion and extension of the wrist. Weightlifters, rowers, racket sport players, horseback riders and skiers are particularly prone
  • Dupuytren's contracture: a thickening of deep tissue in the palm of the hand and fingers that, if left unchecked, leads to permanently bent fingers. Users of vibrating tools can be at risk
  • Rotator cuff syndrome: damage to any of the tendons that hold the shoulder joint in place, particularly common in work where prolonged overhead activity is necessary
  • Medial epicondylitis: also known as golfer's elbow this affects the inside of the lower arm near the elbow. Overplaying certain sports or repetitive twisting motions can lead to this condition
  • Lateral epicondylitis: also known as tennis elbow, affects the outer part of the elbow
  • Stenosing tenosynovitis: otherwise known as trigger finger, a finger may become stuck in the bent position and, when straightened, does so with a snap. Also known as "texting tendonitis"
  • Radial tunnel syndrome: dull ache at the top of the forearm. Overuse of the arm to push or pull, or overuse of the hand and wrist can irritate the nerve and cause pain.


Treatment for RSI

Medicalt reatment for RSI includes mainly medication to manage the uncomfortable does not address the root cause.


A Chartered Physiotherapist can not only diagnose a RSI, but can determine how it was caused by taking a detailed history, and examining predisposing factors like posture, etc   A Physiotherapist will treat RSI by eliminating the underlying predisposing factors, and addressing the increased pain and inflammation by means of electrotherapy, mobilization and manipulation, postural advice, exercise,and acupuncture.

We alsoeducate on prevention of recurrence, and ergonomic advice fort he work place.


Preventing office-based RSIs

Although there are numerous ways in which RSIs can be generated, the most common in modern societies are using a computer or sitting at a desk.
Below are some rough guidelines that, if followed, could help prevent the most common complaints:
? Ergonomics: ensure that desk, chair and screen are aligned in an ergonomic fashion. Employers will have access to official guidelines
? Posture: do not slouch - ears and back should form a straight line with the pelvis
? Wrists: arms, wrists and fingers should be aligned when typing, rather than having bent wrists
? Typing: avoid hitting the keys too hard while typing; if possible, learn to touch type so that each finger takes its fair share of pressure and there is no need to constantly look down at the keyboard. One option to consider is voice-activated software to further minimize typing
? Shortcuts: learn keyboard shortcuts to save any additional typing and mouse movements
? Mouse: do not grip too tightly; slowing the speed can reduce muscle tension in your hand
? Temperature: ensure the office is heated to an appropriate temperature
? Telephone: if telephone usage is common, use a headset rather than clamping the receiver between the head and the shoulder while typing.