Repetitive strain injury (RSI)

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

RSI is a general term that refers to pain in any part of the upper body caused by overuse or poor posture. RSI commonly affects the arms, elbows, wrists, hands, fingers, neck, shoulders or upper back.

About RSI

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 muscle-related injuries that can affect your hands, arms and upper body. RSI can be categorised as type 1 and type 2. Type 1 RSI means the disorder is a recognised medical condition, such as:

• 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 syndrome (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)
  

With type 2 RSI, either your symptoms don't fit with those of a recognised medical condition 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.

There are different stages of RSI and 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 RSI. It can develop into a chronic pain condition. When describing a condition, the term ‘chronic’ refers to how long a person has it, not to how serious a condition is.

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. If you're in constant pain, you may find it difficult to sleep.

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

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

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 

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. See our video for more information about organising your workstation. Working with your arm raised above your head or sitting in a fixed position for long periods of time may increase your risk of developing RSI.

A wide variety of jobs may lead to RSI, such as data entry or typing, working on an assembly line or on a supermarket checkout. Therefore, it's important for you to take steps to prevent getting RSI. Speak to your employer about this – see Prevention of RSI for more information.

Some people find their pain is linked to stress, which may be 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 specific recognised conditions, such as carpal tunnel syndrome, when you describe your symptoms and by examining you.

If you have 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 your 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 RSI type 1 conditions. If you're diagnosed with a particular condition, follow the recommended treatment. This may involve self-help treatments, physiotherapy, steroid joint injections into the affected joint, or possibly surgery.

Doctors are less clear about how to treat type 2 RSI and there is little scientific evidence about which treatments are effective.

You may be referred to a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) to teach you exercises to help build up strength in the affected muscles and for advice about ways to improve and strengthen your posture.

Self-help

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

Look at your working environment and how you work to try to find out what activity if 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.

Divide up your time by doing different tasks so that you don't spend long periods of time doing the same thing.

You may find it helpful to 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 if you have 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 medicines. These could be gels or creams that you rub into the painful area, or tablets that you swallow.

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

However, it may not be a good idea to take painkillers regularly. This is because they dull the pain and allow you to carry on doing the harmful activity, aggravating your RSI.

If you're having trouble sleeping, you may be prescribed sleeping tablets. This will only be for a few days because there is a risk of you 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 (see our common questions 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, 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 about 50 to 90cm 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 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 

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

Video

See our videos related to repetitive strain injury (RSI):

• Organising your workstation
• Posture

Produced by Louise Abbott, Bupa Health Information Team, August 2011.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.