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What exactly is Repetitive Strain Injury (RSI)? And what can you do about it? The RSI Association* helps explain the facts behind this much-misunderstood issue.

No agreed medical definition of Repetitive Strain Injury (RSI) exists, and although it is listed in medical dictionaries, the definition differs, from one, to another, and its nature is still much disputed, in medical circles.

RSI - What It Covers

Commonly. RSI is held to be a general term for a group of conditions affecting the muscles, tendons and nerves of the upper limbs, including the neck (although the legs may also be affected.)

They may be named after the tissues involved (e.g. tendinitis, tenosynovitis, bursitis) or the location in which they occur (e.g. carpal tunnel syndrome, rotator cuff syndrome, and bicipital tendinitis) or the occupation with which it is associated, as with tennis elbow (lateral epicondylitis) and writer's cramp.

Conditions where there is no clear-cut diagnosis, but a range of symptoms exist, may be known as diffuse RSI, or non-specific arm pain.

Other Names

Other names are work-related upper limb disorder (WRULD), regional pain disorder, cumulative trauma disorder, and occupational over-use syndrome. The last two are particularly helpful, in that they stress that RSI may consist of a group, or pattern of conditions, that occur through an accumulation of minor traumas, over a period of time, and that recovery time may vary, considerably.

Many patients make a quick recovery from the early symptoms of RSI, but unfortunately some continue to experience problems, for a protracted period.

Controversy

The controversial area in the diagnosis, and recognition of RSI type conditions, has been with diffuse conditions, where doctors could see no signs of injury, but patients experienced a variety of symptoms, often in different parts of the body. The picture on diffuse RSI has now begun to change.

New Research

Research, carried out at University College London, by physiotherapist Jane Greening, and neuro-physiologist Dr Bruce Lynn (published in 1998) indicates that the condition 'diffuse RSI', or 'non specific arm pain', may be due to nerve damage, similar to a number of painful neurological conditions.

Their study showed that patients, suffering from RSI, had an abnormal response to vibration, and they experienced pain, and other unpleasant sensations, when exposed to strong but normally pain-free sensory stimulation. A work- related exacerbation was also shown. Their control group of office workers who did not have RSI also showed a reduced sensitivity to some stimulation which could indicate the beginnings of a problem. The researchers were also surprised at the number of people who get pain from keyboard and mouse use.

In 1999 the above researchers published the results of a new study which gives further evidence of the physical nature of diffuse RSI and which it is hoped will in time lead to the development of effective diagnostic tests.

Symptoms

Among the symptoms of RSI are: pain, weakness and loss of function in the affected parts, tingling (pins and needles) of fingers, numbness, tenderness, swelling or feeling of swelling, crepitus (creaking during movement), muscle spasms, restriction or loss of movement, spontaneous flicking movements and persistent pain, even after a rest.

Causes

A number of factors may contribute to causing RSI, including:the amount of force used, repetition, day after day - and/or static load on muscles, for long periods - poor posture, and awkward movements, badly designed tools and workstations, insufficient breaks and changes in activity, unsympathetic management practices, imposing too much stress, and discouraging early reporting of RSI symptoms.

In some cases, there may be leisure time activities which increase the risk, because of the amount of hand and arm use involved in upper limb disorders, or leg use, in the case of lower limb disorders. Poor working techniques, in using tools or keyboards, may be a factor, as also may injuries or other physical conditions, not related to one's occupation.

Treatment

Early treatment is essential for overuse injuries. If allowed to become chronic, recovery may take months, or even years, and full recovery may not be possible. Common sense suggests that one should stop the activity at the root of the problem, so the first step is to rest the injured limb, or limbs, and to cut down their use generally, i.e. from domestic tasks and other activity - not merely from one's work.

Despite this, the pain may get worse, for up to a month, after starting to rest. Pain relief, with paracetamol, ibuprofen or aspirin, taken in accordance with the manufacturer's instructions on the label, may be the first line of treatment for pain. (However, painkillers should not be taken to allow you to continue with the activity which is causing the problem.)

Gentle exercises and relaxation techniques will help to keep the injured limbs, and the body generally, in good shape, and avoid loss of power in the muscles. The return to full use of effected limbs should be gradual. Treatment may include exercises, to improve posture, or to relieve pain. Recovery may have its ups and downs, in what is essentially a process of rehabilitation, to which the patient must contribute by adopting a positive attitude, and by showing patience and perseverance. A relaxation technique, acceptable to the patient, will help, as may counseling, if the need for it exists.

The immobilisation of affected limbs is sometimes recommended by the use of slings, splints, gloves or braces. Splints need to be designed, specifically for the injury, by a specialist in overuse injuries, and their use regarded as supplementary to the more important requirement for rest. Remember, however, that muscle wastage may result from prolonged immobilisation, therefore the use of splints, and supportive bandages, are normally only a short-term measure.

In fairness to members of the medical profession, it must be said that treatment of RSI is frequently difficult. It is often confused with arthritis, and this can be dangerous. Beyond a certain point, the condition may be too far gone to benefit from steroid injections, (e.g. cortisone) and anti-inflammatory or analgesic drugs. Operations for carpal tunnel syndrome may not give the expected relief, and are of doubtful value, for genuine overuse injuries. The same may be said of local infrared treatments.

Physiotherapy (possibly including ANT adverse neural tension), hydrotherapy, occupational therapy and other forms of therapy may facilitate rehabilitation but one cannot be sure unless a therapist experienced in treating overuse injuries administers the treatment. Otherwise the treatment may be counter-productive. Usually treatment of the shoulders and neck are effective, but active treatments of the forearms are less so. Relaxation is also an aid to recovery.

Concensus?

Due to the lack of consensus among members of the medical profession about the nature, diagnosis and treatment of the various RSI conditions, the Association has had difficulty in finding doctors and consultants to whom it could refer its members. The Association, therefore, is unable to recommend practitioners of any kind, but it seeks to obtain information about doctors, consultants and physiotherapists who are sympathetic, and have treated RSI so that this information can be passed on to sufferers.

Diagnosis may be established by clinical judgment of the doctor with the help of tests either to confirm the nature of the injury or to rule out other disorders. Physiotherapists with experience in this field are also able to make an assessment of patients.

All the work done on treatment and rehabilitation may be undone, if the RSI sufferer returns to work under the same conditions, as those that contributed to the injury. The work practices of the employer and the design of the workstation in ergonomic terms should be examined and modified.

A return to work should be gradual, and the pace and weight of the work carefully controlled. It will be necessary to take things more easily, than was formerly the case. RSI tends to affect over-conscientious workers!

Do remember that the majority of people who experience RSI problems make a satisfactory recovery, with the aid of good medical help, and careful evaluation and reorganisation of work practices; a few, only 3% - 4%, suffer long term difficulties.

For further information about the safest way of using your home PC - or computer at work, why not visit the Health and Saftey section of our sister site - Working Balance. More details of the HSC/E campaigns on this subject can also be found here. The Ergonomics Society website may also be useful.


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