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Repetitive strain injury (RSI)

Published by Bupa's health information team, October 2009.

This factsheet is for people with repetitive strain injury (RSI), also known as upper limb disorders (ULDs), or who would like information about it.

RSI is a general term that refers to chronic pain in any part of your upper body caused by overuse. Chronic pain lasts a long time, sometimes for the rest of the affected person's life. When describing a condition, the term chronic refers to how long the person has it, not to how serious it is. RSI commonly affects the arms, elbows, wrists, hands, fingers, neck, shoulders or upper back.

About RSI
Symptoms of RSI
Causes of RSI
Diagnosis of RSI
Treatment of RSI
Prevention of RSI
Questions and answers
Video
Related topics
Further information
Sources

About RSI

Repetitive strain injury (RSI) describes a painful condition generally associated with doing a particular activity repeatedly or for long periods of time. It often occurs as a result of working with computers and typing or repetitive manual work, but you can also develop it if you don't regularly carry out these sorts of tasks.

The term RSI covers a number of musculoskeletal injuries that can affect your hands, arms and upper body. It can be split into type 1 and type 2. Type 1 RSI means that the disorder can be classed as a recognised medical condition, such as:

tendonitis - inflammation of a tendon (the tissue that joins muscles to bones)
carpal tunnel syndrome
tennis elbow (epicondylitis)
rotator cuff syndrome
Dupuytren's contracture
writer's cramp (cramp of the hand)

Your GP will be able to recognise and diagnose type 1 RSI conditions. For example, tennis elbow is caused by repeatedly using your arm in a twisting movement. This can damage the tendons in your elbow making the outside of it painful.

Type 2 RSI means either that your symptoms don't fit into type 1 RSI and your GP can't find any inflammation or swelling, or the pain doesn't stay in one area. This is also known as non-specific or diffuse pain. Doctors are less clear how to treat type 2 RSI and there is little scientific evidence about which treatments are effective.

There are different stages of RSI and if treated early enough, you may make a full recovery. It's harder to treat if your symptoms have gone unchecked for a while. You may also be more likely to develop further injury as a result.

Symptoms of RSI

There are a wide range of symptoms including pain and tenderness in your muscles and joints. You will probably notice symptoms most when you're doing the activity that caused them. The pain may get worse so that it's there all the time, even when you're resting. It may get so bad that you aren't able to do routine work or household activities.

This is why it's important that you see your GP as soon as you notice any pain in a particular area that lasts for more than a couple of weeks.

Symptoms include:

a sharp or a dull ache
stiffness
tingling
numbness
weakness
cramp

You may have some swelling but it's also possible that you won't have any physical signs, even though your hand or arm feels painful.

If you're in constant pain, you may find it difficult to sleep. If you're feeling stressed because you're worrying about the possible consequences of RSI, this can make sleep problems worse.

Causes of RSI

A number of factors put you at risk of developing RSI. These include:

repetitive activities
doing an activity that involves force, such as lifting or carrying heavy objects
carrying out an activity for a long period of time without adequate rest periods
poor posture or activities that require you to work in awkward or tiring positions

It's important that your working environment (for example, your desk layout or assembly line set-up) is designed so you can work with your body upright and without having to twist or stretch. For example, working with your arm raised above your head or sitting in a fixed position for long periods of time may increase your risk.

There is a wide variety of jobs that may lead to RSI, such as data-entry or typing, working on an assembly line or doing supermarket check-out work. Therefore, it's important for you to take steps to minimise risks. Speak to your employer about this - see Prevention of RSI for more information.

Some people find that their pain is linked to stress, often work-related.

Diagnosis of RSI

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If you have type 1 RSI symptoms, your GP will be able to identify definite conditions, such as carpal tunnel syndrome, when you describe your symptoms and by examination.

With type 2 RSI symptoms diagnosis is more difficult. Your GP may refer you for an X-ray to rule out any other conditions that could be causing pain, such as osteoarthritis. If a recognised condition can't be confirmed, you may be diagnosed with type 2 RSI.

Treatment of RSI

There is no single treatment for RSI. However, there are often specific treatments for recognised conditions, such as carpal tunnel syndrome. If you're diagnosed with a particular condition, follow the recommended treatment. This may involve steroid injections or possibly surgery.

You may be referred to a physiotherapist for exercises to build up strength in the affected muscles and for advice about ways to improve and strengthen your posture.

Although you should try to rest the affected area regularly, it's not helpful for you to rest for long periods as it can weaken your muscles. Gently massaging and flexing the affected limb stimulates circulation and can prevent your muscles from weakening.

Self-help

You can make changes to your working environment and how you work by examining what you do and how you do it, and modifying the activity causing the problem. If you can, carry on working but reduce the amount of time you spend on the activity that causes the pain. If you can't stop doing it completely, take regular short breaks to stretch and flex your arms and hands.

Split up when you do different tasks so that you don't spend long periods of time doing the same thing.

Learn to touch type if you use a keyboard regularly. This will enable you to keep looking straight ahead and not down or to the side.

Exercise such as swimming, pilates or yoga may help to ease your symptoms.

There are a number of support groups for RSI. You may find it helpful to talk to other people with RSI as they may be able to offer advice and suggest things that could improve your symptoms.

Medicines

Medicines generally aren't helpful in treating RSI, although your GP may recommend over-the-counter painkillers or non-steroidal anti-inflammatory drugs (NSAIDs). Low doses of antidepressants are also thought to have some specific painkilling effect in chronic pain conditions such as RSI.

However, it's not generally a good idea to take painkillers as they dull the pain and allow you to carry on doing the harmful activity, aggravating your RSI.

If you do take medicines, follow the instructions on the patient information leaflet and ask your pharmacist for advice.

If you're having trouble sleeping, you may be prescribed sleeping tablets for only a few days because of the risk of becoming dependent on them.

Complementary therapy

Although there is no evidence to suggest that complementary therapies can successfully treat RSI, some people say that techniques such as massage and osteopathy ease their symptoms and help them to relax.

Prevention of RSI

Employers have a legal duty under the Health and Safety at Work etc Act 1974 and the Management of Health and Safety at Work Regulations 1999 to prevent work-related RSI and ensure that anyone who already has the condition doesn't get any worse.

Your employer needs to adjust your work area so it's suitable and comfortable for you. The risk of an accident or injury occurring should be reduced as much as possible.

If you use a computer, make sure:

your chair supports your back and you sit up straight
your chair is the right height for you; if not use a footrest
your monitor is around 60cm from your eyes
your screen, keyboard and mouse are directly in front of you with the mouse as close to the keyboard as possible
when you type, your arms aren't extended forwards, your forearms are horizontal and your fingers are at the same height as the middle row of keys
your legs have room to move under the desk or table
you only use a wrist rest when having a break from typing - don't place your wrists on it while typing

If you have been off work because of RSI, when you return try not to do the activity that causes the pain. You may need to modify your job when the pain is severe. Take regular breaks and alternate tasks to prevent long periods of repeating the same movement.