Repetitive strain injury

What is repetitive strain injury (RSI)?

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 task 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.

What causes repetitive strain injury (RSI)?

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 or inflammation and there are no 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.

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.

What are the symptoms of repetitive strain injury (RSI)?

Symptoms in the affected area can include:

Pain, Tightness, Dull ache, Throbbing, Numbness, Tingling

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 squashing (compression) of a nerve in the wrist).
• Tendinopathy (inflammation of a tendon).
• Tenosynovitis (inflammation of a tendon sheath).

(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 objectives 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 (RSI) diagnosed?

There is no test that a doctor can do 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, tendinopathy, 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 (RSI)?

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. 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 medicines have usually been recommended, although recent studies suggest that simple painkillers such as paracetamol work just as well.

A referral to a physiotherapist who can give advice to help with posture and how to strengthen or relax the muscles involved.

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?
• 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?
• If a lot of people at work are suffering from RSI your employer may consider asking an occupational therapist for advice.
• What we want the employer to do is to look at the issue of RSI with the GMB and its Reps to discuss and consider how we can tackle the problems. The outcome from the discussions with your employer will be put to the Health & Safety Committees for discussion and for me as the London Regional