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Repetitive strain injury (RSI)

Repetitive strain injury (RSI) refers to aches and pain in your upper body caused by repetitive movements or poor posture at work. It’s also called occupational overuse injury and overuse syndrome. RSI mainly affects your arms, elbows, wrists, hands, fingers, neck and shoulder.

Upper limb exercises
Alex McKinven, Physiotherapist, shares some simple exercises to keep your upper limbs moving.


  • About What is RSI?

    You can get RSI from a wide range of occupations and activities. You may develop an RSI if you use a computer regularly or if your job involves repetitive movements. RSI may also be linked with hobbies such as painting and carpentry, and with certain sports such as tennis and golf.

    If you think you have RSI, it’s important not to ignore it. Sometimes, RSI has an underlying cause, such as carpal tunnel syndrome, which causes pain in your hand and wrist. If you don’t get it treated, you may end up with long-term (chronic) pain and find some day-to-day activities difficult.

  • Symptoms Symptoms of RSI

    RSI can cause a wide range of symptoms, including pain and tenderness in your muscles and joints. During the day, your symptoms may be most noticeable when you're doing the activity that causes them. However, conditions such as carpal tunnel syndrome can cause your symptoms to be worse at night and in the early morning.

    Your symptoms may include:

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

    You may not have any physical signs such as swelling, even though your hand or arm feels painful. The pain may get worse with time if you don’t get any treatment. Your pain may increase or start affecting you more frequently. It may get so bad that you’re not able to do routine work or household activities.

    If your symptoms ease when you rest, it’s worth thinking about whether you can change your activities or adapt your work environment. Try speaking to your employer or occupational health advisor for advice. See our FAQ on RSI at work for more information. If your numbness, tingling, pain or weakness continues despite making changes to your work or activities, make an appointment with your GP.

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  • Diagnosis Diagnosis of RSI

    RSI isn’t always easy to diagnose because there’s no specific test. If you see your GP with symptoms of RSI, they’ll ask about your symptoms and ask to examine you. They may also ask you about your medical history. Tell your GP if you’ve noticed that certain activities could be causing your symptoms or making them worse.

    RSI may be caused by a specific medical condition such as carpal tunnel syndrome or tendonitis (inflammation of your tendons). This type of RSI is called Type 1 RSI. Your GP may suggest you have some tests to see whether one of these underlying conditions could be causing your symptoms.

    Sometimes RSI symptoms don’t fit in with any recognised medical condition – there’s no swelling or the pain doesn’t stay in one area. This type of RSI is called Type 2 RSI, or non-specific or diffuse pain. It’s more difficult to diagnose than Type 1 RSI, as there are no specific tests. But your GP may still suggest you have some tests to rule out other conditions.

  • Self-help Self-help for RSI

    Reducing activity

    You may notice your RSI symptoms improve when you’re resting the affected part of your body. Try having a complete break from the activities that trigger your symptoms, and then gradually reintroduce them once your symptoms have settled down. If this isn’t practical, it may help if you limit the amount of time you spend on these activities. Try to keep moving the affected part of your body in a way that doesn’t cause pain. This will help to stretch the muscles and keep them strong.

    Changes at work

    If your symptoms are related to your work, your first step should be to speak to your manager or supervisor. Your employer may be able to refer you to an occupational therapist or occupational health advisor for help and advice. By looking at your working environment and how you work, you may discover which 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.

    If you can't stop or reduce the activity that’s causing the problem, 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 doing the same thing.

    If you use a computer, you may be able to change your mouse or keyboard to relieve pain. You can buy specially designed ones that make your movements as natural as possible. There isn’t much solid proof that they work but some people find them useful.

    Cold and heat

    You may find that applying cold packs to the affected part of your body helps to ease your symptoms. This can ease pain and reduce swelling. When your symptoms flare up, apply a cold compress, such as an ice pack or ice wrapped in a towel. Use the cold pack or ice for up to 20 minutes at a time, with a 30-minute break before you use it again. Don’t apply ice directly to your skin as this can cause damage.

    If ice doesn’t work for you, you could try heat treatment instead. Gently hold a heat pack or hot water bottle against the affected part of your body or maybe have a warm bath.


    Over-the-counter painkillers, such as non-steroidal anti-inflammatory medicines (NSAIDs) and paracetamol may help to ease your symptoms. You can buy these painkillers from pharmacies and supermarkets, but don’t take them regularly without your GP’s advice. Taking painkillers regularly may stop the pain, but you may carry on doing the activity that’s causing your symptoms without realising it. This could make your condition worse in the long term.

  • Treatment Treatment of RSI


    If self-help measures and any changes you make at work don’t help to improve your symptoms, you may need to see a physiotherapist. A physiotherapist is a healthcare professional who specialises in maintaining and improving movement and mobility. A physiotherapist will show you how to rest the affected part of your body to ease your pain. They will also help you to stretch and strengthen any affected muscles with safe gentle exercise and to sit or work with good posture.

    If you have carpal tunnel syndrome, your physiotherapist may suggest you wear a wrist splint, especially at night.

    Steroid injections

    If other treatments haven’t worked or you have inflammation in a specific tendon, your GP may suggest you have a corticosteroid injection. This can be helpful in carpal tunnel syndrome.

    Surgery for RSI

    Most people don’t need surgery for RSI. But if your GP suspects your symptoms are caused by a specific medical condition such as carpal tunnel syndrome, they may refer you to a surgeon who specialises in this area. Surgery may be recommended for more severe carpal tunnel syndrome.

  • Physiotherapy

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

  • Causes Causes of RSI

    RSI has many possible causes. These include:

    • doing repetitive activities
    • doing an activity that involves lifting or carrying heavy objects
    • carrying out an activity for a long time without taking enough breaks
    • poor posture from working at a poorly designed work station
    • doing activities that involve working in an awkward or tiring position
    • using vibrating equipment

    If your work could increase your chances of getting RSI, you can take some steps to prevent the symptoms. Speak to your employer about this. Also see the Prevention of RSI section and the FAQ on RSI at work.

  • Prevention Prevention of RSI

    To prevent RSI, try to limit your repetitive actions, especially those involving using heavy equipment or vibration. You’ll also need to improve your working posture and environment and take regular breaks.

    Employers have a legal duty to prevent work-related RSI, or stop existing RSI from getting worse. This is under the Health and Safety at Work etc Act 1974 and the Management of Health and Safety at Work Regulations 1999. If you work on computers, you’re protected by the Health and Safety (Display Screen Equipment) Regulations 1992. See our FAQ on RSI at work.

    Your work area should be suitable and comfortable for you. If you use a computer, make sure:

    • you’ve adjusted the height of your chair and computer screen so your hips are slightly higher than your knees
    • your chair is the right height for you; if not, you may find a footrest reduces pressure on the backs of your legs
    • you adjust the backrest of your chair so you feel comfortable and your back is well supported
    • your monitor is angled to reduce glare or reflections
    • your keyboard and mouse are easy and comfortable to reach
    • you’ve enough room on your desk for all your documents
    • you’re not stretching your arms when you type; forearms should be horizontal and your fingers should be at the same height as the middle row of keys
    • your legs have room to move around under your desk or table

    You may find it helpful if you take a break from time to time. Try to have a break for a few minutes every hour. Stretch and change position and look up and away from the screen. Change your activity before you get tired, rather than waiting until you feel uncomfortable.

  • FAQ: Early symptoms What are the early symptoms of RSI?

    You may notice some early symptoms of RSI when you’re doing a particular activity. These symptoms may include tingling, aching or numbness in a particular part of your body. If you work with a computer, you may notice your wrists and shoulders ache at the end of the day. Your exact symptoms will vary, depending on what’s causing your RSI.

    If you think you may have RSI, ask your GP for advice. Ignoring any pain and carrying on as usual can make things worse. If you don’t get the right treatment, your symptoms may stop you doing your day-to-day activities.

    As soon as you notice the symptoms, talk to your employer too. They have a legal duty to make sure your working environment prevents RSI and stops existing symptoms getting worse.

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


    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.


    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?


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


    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.

  • FAQ: RSI at work I think I have RSI. How can my employer help?

    If you think your work is causing RSI, or making it worse, speak to your employer straight away. By law, your employer must provide whatever help you need. If you ignore your symptoms, your RSI may get so bad that you can no longer do your job properly.

    Several laws mean that your employers have to try to prevent work-related RSI. These are the Health and Safety at Work etc Act 1974 and the Management of Health and Safety at Work Regulations 1999. If you work on computers, your employer also has a legal duty under the Health and Safety (Display Screen Equipment) Regulations 1992.

    You may need to talk to your manager, human resources department or the occupational health department. Most injuries are caused by poor posture, working in an unusual or uncomfortable way or working with heavy equipment. Your employer should carry out a risk assessment by watching how you work and look for possible problems. They may then need to:

    • change your work style and work environment as much as practically possible
    • provide the right equipment so you can do your job safely
    • encourage you to take regular breaks and leave work on time
  • FAQ: Gaming and RSI Can gaming make my son more likely to have RSI?

    If your son makes repetitive hand or arm movements regularly, he may be more likely to develop RSI in the future. Using games consoles often involves repetitive movements.

    There are several things your son can do to reduce his risk of getting RSI.

    • Take regular breaks and move around for a few minutes every hour.
    • Sit in an adjustable chair that supports his back and try not to hunch over the games console.
    • Don’t keep his hands and arms rigid when he’s using the controller.
    • Give his hand and thumb a quick massage regularly, and rotate his wrists one way and then the other.

    If your child already has symptoms of RSI, such as tingling and soreness, don't ignore this. Make sure he takes regular breaks from the activity that’s causing pain and follows the above advice. If he’s still having the same symptoms after a couple of weeks, take him to see his GP.

  • Other helpful websites Other helpful websites

    Further information


    • Overuse phenomena and RSI. PatientPlus., last checked May 2014
    • Verhagen AP, Bierma-Zeinstra SMA, 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 Epicondylitis. BMJ Best Practice., last updated April 2016
    • Musculoskeletal problems. Oxford Handbook of General Practice (online). 4th ed. Oxford Medicine Online., published April 2014
    • Carpal tunnel syndrome. BMJ Best Practice., last updated August 2016
    • Rotator cuff injury/subacromial bursitis. The MSD Manuals., last full review/revision October 2014
    • FAQs: Upper limb disorders. Health and Safety Executive., accessed February 2017
    • Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol 2015; 29(3): 440–53. doi: 10.1016/j.berh.2015.04.026
    • Overuse injury. Medscape., updated August 2015
    • Superficial heat and cold. Medscape., updated August 2013
    • Approach to sports injuries. The MSD Manuals., last full review/revision October 2014
    • Hoe VCW, Urquhart DM, Kelsall HL, et al. Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults. Cochrane Database of Systematic Reviews 2012, Issue 8. doi: 10.1002/14651858.CD008570.pub2
    • Fit for Active Work leaflet. Chartered Society of Physiotherapy., accessed February 2017
    • Carpal tunnel syndrome and median nerve lesions. PatientPlus., last checked May 2014
    • Dupuytren’s contracture. PatientPlus., last checked August 2016
    • Working with display screen equipment (DSE): A brief guide. Health and Safety Executive., published May 2013
    • A guide for young people: how to avoid RSI. RSI Action., accessed February 2017
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    Reviewed by Pippa Coulter, Bupa Health Content Team, May 2017
    Expert reviewer, Mike Primett, Physiotherapist, Bupa UK
    Next review due May 2020

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