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Repetitive strain injury (RSI)

Repetitive strain injury (RSI) is a general term. It refers to aches and pain in any part of the upper body caused by overuse or poor working posture. Other names include work-related upper limb disorders, occupational overuse injury and cumulative trauma disorder. RSI commonly affects the arms, elbows, wrists, hands, fingers, neck and shoulder.

RSI describes a painful condition generally linked to doing a particular activity repeatedly or for long periods of time. You can get RSI from a wide range of occupations and activities. You’re most likely to be affected if your job involves working mainly with your arms, e.g. computer or assembly line work. More women than men are affected, probably because of the typical range of work they do. RSI may also be linked with hobbies such as gardening, carpentry and playing a musical instrument.

The term RSI covers a number of muscle-related injuries that can affect your hands, arms and upper body. RSI can be categorised as type 1 or type 2. Type 1 RSI means the disorder is a recognised medical condition. These include:

  • tendonitis – inflammation of a tendon (the tissue that joins muscles to bones)
  • carpal tunnel syndrome (pain or weakness in your forearm or hand)
  • tennis elbow
  • rotator cuff injury (shoulder pain)
  • Dupuytren's contracture (a condition that causes your fingers to bend towards the palm of your hand)
  • writer's cramp (cramp of your hand)

Type 2 relates to when:

  • your symptoms don't fit with those of a recognised medical condition 
  • your GP can't find any inflammation or swelling
  • the pain doesn't stay in one area.

This is also known as non-specific or diffuse pain.

There are different stages of RSI. The earlier it’s treated the greater your chance of making a full recovery. The longer you leave your symptoms untreated, the harder it is to treat and can lead to long term (chronic) pain and disability.

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Details

  • Symptoms Symptoms of RSI

    RSI has 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.

    Symptoms that occur in your upper body include:

    • a sharp or a dull ache
    • stiffness
    • tingling
    • numbness
    • weakness
    • cramp

    The pain may get worse so 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.

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

    If you find that your symptoms ease when you rest it’s worth looking at adapting your activities and your work station before seeing a doctor. See our FAQs for more information.  If your pain is constant and lasts for over two weeks or you have constant pain and swelling, book an appointment to see your doctor.

    Bupa On Demand: Physiotherapy

    Would you like to see a Bupa physiotherapist? You can book an appointment to see them at a Bupa Centre.

  • Diagnosis Diagnosis of RSI

    It can be difficult to diagnose RSI and there isn’t a specific test for it. To help diagnose your condition, your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Be sure to tell your doctor if you have noticed any particular activities that you think are linked to your symptoms.

    Your GP may be able to diagnose a recognised condition such as tendonitis (inflammation of a tendon) and carpal tunnel syndrome. These fall under the type 1 category of RSI. You may have some tests that can help identify these specifically.

    If you have more general (type 2) RSI symptoms, diagnosis is more difficult. Your GP may refer you for other tests to rule out other conditions. But if a recognised condition can't be confirmed, you may be diagnosed with type 2 RSI.

  • Treatment Treatment of RSI

    There’s no single treatment for RSI. However, there are often specific treatments for recognised RSI type 1 conditions. If you're diagnosed with a particular condition, follow the recommended treatment. This may involve self-help treatments, physiotherapy, steroid injections into the affected joint, or possibly surgery.

    Doctors are less clear about how to treat type 2 RSI and it’s not known which treatments will definitely work.

    Self-help

    It’s not always practical but if you can, try to reduce the activities or tasks that you know are causing your symptoms. Take breaks regularly and try to keep your body mobile and moving to stop your muscles from weakening.

    Some people find that applying either hot or cold packs to the affected area help ease symptoms. When your symptoms flare up, try applying a cold compress, such as an ice pack or ice wrapped in a towel. Don’t apply ice directly to your skin though as it can damage your skin. If ice doesn’t work, you could also try a heat pack or hot water bottle applied to the affected area, or perhaps a warm bath.

    There isn’t much scientific proof, but some lifestyle changes might work for you. For example, some people try swimming or Pilates to help ease their symptoms.

    Changes at work

    If you feel your symptoms are related to your work, speak to your manager or supervisor. Your employer may be able to refer you to an occupational health advisor for help and advice. Look at your working environment and how you work to try to find out what activity is causing the problem. Carry on working if you can, but try to take steps to reduce how much time you spend doing this activity. Or change how you do it.

    If you can't stop doing it completely, take regular, short breaks to stretch and move your arms and hands. You could try to divide up your time by doing different tasks so that you don't spend long periods of time doing the same thing.

    You might have an option to change your mouse or keyboard for specially designed ones that aims to make your movements as natural as possible. There isn’t much solid proof that they work but some people find them useful.

    Physical therapies

    Your GP may refer you to a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility). They will show you what to do in order to both rest the affected area and also maintain or improve strength in the affected muscles. If you have carpal tunnel syndrome, your doctor or physiotherapist may advise you to wear a wrist splint.

    Working with a physiotherapist will give you the chance to see that you can keep the affected area moving and active without causing further damage. They will also show you exercises that you can carry on doing at home and at work. Your physiotherapist may also offer further treatments such as transcutaneous nerve stimulation (TENS). This uses low current electrical signals to block pain signals.

    There’s no one treatment that experts know will definitely work so discuss your options with your physiotherapist about what may be most helpful for you.

    Medicines

    Over-the-counter medicines like non-steroidal anti-inflammatory medicines (NSAIDs) may help reduce inflammation. Painkillers like paracetamol may also be helpful. If your GP prescribes or recommends these to you, take them as he or she advises. However, if you’re taking them without advice, it’s important to be careful. Painkillers will mask the pain and allow you to carry on doing the harmful activity, which may ultimately make your condition worse.

    Your GP may prescribe you muscle relaxant medicines or antidepressants (these are sometimes used to help treat other conditions than depression). More research is needed but some evidence indicates that certain antidepressants might help improve your symptoms if your arm pain is related to RSI.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    In some situations your doctor might offer you a corticosteroid injection. This might be if other treatments haven’t worked and there’s evidence of inflammation of a specific tendon in the affected area.

    Complementary therapy

    There isn’t much research that suggests complementary therapies can successfully treat RSI. Some people have found that acupuncture and yoga help. Furthermore, relaxation techniques might help you cope better with your condition. Some people also try alternative treatments like Alexander technique lessons. This aims to improve your posture. Do some research into any therapies you’re interested in. Discuss them with your doctor to make sure there’s no reason why you shouldn’t try it if you feel it’s right for you.

  • Physiotherapy

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including physiotherapy.

  • Causes Causes of RSI

    There are a number of things that can increase your 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
    • using vibrating equipment
    • working in a cold environment

    You’re more likely to be affected by RSI if you have more than one of these factors.

    Your experience of RSI may also be linked to how you feel about your work and your health. Some people find their pain is linked to stress, which may be work-related. Demanding work deadlines, fast pace and feeling unsupported by your colleagues and managers can contribute to musculoskeletal disorders like RSI.

    If your work involves one or more of the factors listed above you may want to consider taking steps to prevent getting RSI. Speak to your employer about this – see prevention of RSI for more information.

  • Prevention Prevention of RSI

    Prevention of RSI is based on minimising your repetitive actions, especially those associated with force and/or vibration, and improving your working posture and environment.

    Employers have a legal duty to prevent work-related RSI. This is under the Health and Safety at Work etc Act 1974 and the Management of Health and Safety at Work Regulations 1999. They should also ensure that anyone who already has the condition doesn't get any worse. See our FAQs for more information.

    Your work area should be 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, ensure your work station is set up in the following way by making sure:

    • your chair supports your back and you sit up straight
    • your chair is the right height for you; if not you may find a footrest reduces pressure on the backs of your legs
    • your monitor is about 50 to 90cm from your eyes and is angled to reduce glare or reflections
    • your screen, keyboard and mouse are directly in front of you with the mouse as close to the keyboard as possible
    • you have enough room on your desk to accommodate all your documents
    • when you type, your arms aren't stretching 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

    It’s also helpful to take a break from time to time. Small frequent breaks are best. Stretch and change position and look up and away from the screen every so often. Try and change your activity before you get tired, rather than waiting until you feel uncomfortable.

  • FAQs FAQs

    Are there early symptoms of RSI that I should look out for?

    Answer

    Early symptoms of RSI may include mild tingling, aching or twinges in your fingers, hands, arms or shoulders. You notice these usually during or after performing a particular activity.

    Explanation

    Early signs of RSI may often appear when you do a particular activity. For example, if you work with a computer, after a day’s work you might have aches in your fingers, hands, arm or shoulder. It can be difficult to know what‘s happening to you when you first have symptoms of RSI. But it's really important to take action to get treatment. Ignoring any pain you have and carrying on as usual can make things worse. As soon as you notice any possible RSI symptoms talk to your employer first. The symptoms of RSI can progress and may eventually lead to pain and tissue damage that stops you from doing everyday activities. Your exact symptoms will vary depending on the specific RSI condition you have.

    I think I have RSI. What help can I expect from my employer?

    Answer

    Report any possible RSI symptoms that you think are caused by the way you work to your employer as soon as possible because carrying on in the same way may make things worse. By law your employer must offer you help.

    Explanation

    Your employer has 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 try to prevent work-related RSI. They also have a duty to do what they can to stop existing RSI from worsening. You need to talk to your manager, human resources department or the occupational health department.

    Ask your employer to carry out a proper risk assessment with you. This means he or she needs to do the following.

    • Observe you doing your job, whether it's sitting at a computer, on a factory production line or at a supermarket checkout.
    • Look at your posture, how you use any equipment and the amount of work you do.
    • Ask about your problems in detail.

    You may need to take time off work, but once you begin to feel better it can help to get back into work, gradually building up your hours. Following your risk assessment, your employer should give you specific advice. This may involve changing your duties or the way you work.

    My son spends hours on his games console and texting. Is he at risk of developing RSI?

    Answer

    Potentially, but there are things you can advise him to do to reduce his risk of getting RSI.

    Explanation

    Any movement of your hand or arm that is repeated over a long period of time can put you at risk of developing RSI. Using games consoles and texting on mobile phones all involve repetitive movements, so it's important to follow advice about preventing RSI. The following suggestions might help.

    • Take regular breaks every half an hour to give your muscles and tendons a rest. Move your fingers and stretch out your arms, and try to keep your back straight.
    • Try not to hunch over the console with your head tilted back to look at the screen. Instead sit in an adjustable chair that supports your back.
    • Don’t keep your hands and arms rigid when your fingers and thumbs are moving quickly.
    • Be aware of how you hold your mobile phone. For example, holding it in one hand and in a claw position with your thumb moving over the keys quickly can strain your arm tendons.
    • Give your hand and thumb a quick massage when texting, and rotate your wrists one way and then the other.

    If your child already has symptoms of RSI, such as tingling and soreness, don't ignore this. Ensure that he takes regular breaks from the activity that’s causing pain. Encourage your child to follow the advice above. If he is still having the same symptoms after a couple of weeks, take him to see his GP. Keep some notes on times when your child has the pain or other symptoms. Also note down how long he spends on the games console, computer or mobile phone.

  • Resources Resources

    Further information

    Sources

    • What are ULDs? Health and Safety Executive. www.hse.gov.uk, accessed 27 May 2014
    • Overuse Phenomena and RSI. PatientPlus. www.patient.co.uk/patientplus.asp, published 12 May 2014
    • RSI – what is it? RSI Action. www.rsiaction.org.uk, accessed 4 June 2014
    • NINDS repetitive motion disorders information page. National Institute of Neurological Disorders. www.ninds.nih.gov, published 11 July 2013
    • Overuse injury treatment & management. Medscape. www.emedicine.medscape.com, published 11 November 2013
    • Overview of occupational overuse syndromes. BMJ Best practice. www.bestpractice.bmj.com, published 4 July 2013
    • Managing upper limb disorders in the workplace – a brief guide. Health and Safety Executive. www.hse.gov.uk, published August 2013
    • Upper limb disorders. Health and Safety Executive. www.hse.gov.uk, accessed 27 May 2014
    • Musculoskeletal disorders – key facts. European Agency for Health and Safety at Work. osha.europa.eu, accessed 28 May 2014
    • Upper limb disorders: an overview. RSI Awareness. www.rsi.org.uk, accessed 28 May 2014
    • Kumar P, Clark M. Clinical medicine. 8th ed. Edinburgh: Saunders; 2012:510
    • What causes RSI? Worksmart. www.worksmart.org.uk, accessed 3 June 2014
    • Carpal tunnel syndrome. BMJ Best Practice. www.bestpractice.bmj.com, published 5 April 2013
    • Tendinopathy. BMJ Best Practice. www.bestpractice.bmj.com, published 31 October 2013
    • Upper limb disorders: occupational aspects of management, a national guideline. Royal College of Physicians 2009. www.rcplondon.ac.uk
    • Verhagen A, Bierma-Zeinstra S, Burdorf A, et al. Conservative interventions for treating work-related complaints of the arm, neck or shoulder in adults. Cochrane Database of Systematic Reviews 2013, Issue 12. doi:10.1002/14651858.CD008742.pub2
    • Information for workers. Health and Safety Executive. www.hse.gov.uk, accessed 29 May 2014
    • Carpal tunnel syndrome. Map of Medicine. www.mapofmedicine.com, published 19 March 2014
    • Rehabilitative measures for treatment of pain and inflammation. The Merck Manuals. www.merckmanuals.com, published August 2013
    • O’Connor D, Marshall SC, Massy-Westropp N, et al. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2003, Issue 1. doi:10.1002/14651858.CD003219
    • Sim H, Shin B, Lee M, et al. Acupuncture for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Pain. 2011;12(3):307–14. doi:10.1016/j.jpain.20. Reviewed by the University of York Centre for Reviews and Dissemination. www.crd.york.ac.uk
    • Working with display screen equipment (DSE) - a brief guide. Health and Safety Executive. www.hse.gov.uk, published May 2103
    • Guide for young people: how to avoid RSI. RSI Action. www.rsiaction.org.uk, accessed 29 May 2014
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  • Author information Author information

    Reviewed by Natalie Heaton, Bupa Health Information Team, July 2014.

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