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Repetitive strain injury (RSI)

Key points

  • Repetitive strain injury (RSI) is an umbrella name for painful conditions generally linked to doing a particular action repeatedly or for long periods of time.
  • There are several ways you can help prevent getting RSI, including changes to how you work or do things.

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.

About RSI

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:

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 RS. 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.

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.

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.

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 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.

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.

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

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

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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