Repetitive Strain Injury

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Repetitive strain injuries (RSI) refer to the pain felt in muscles, nerves, and tendons caused by overuse and doing the same movements over and over again. Types of repetitive strain injuries include carpal tunnel syndrome, bursitis, and tendinitis. Repetitive strain injuries typically affect the upper body, such as the forearms, elbows, wrists, hands, neck, and shoulders. This type of injury can also affect the back, hips, and knees.

Causes & Symptoms of Repetitive Strain Injury

A repetitive strain injury is related to the overuse of muscles and tendons in the upper body. Certain things are thought to increase the risk of RSI, including:


  • Repetitive activities.


  • Doing a high-intensity activity for a long time without rest.


  • Poor posture or activities that involve working in an awkward position.


High cold temperatures and vibrating equipment are also thought to increase the risk of experiencing repetitive strain injuries and can make the symptoms worse. Stress may also be a contributing factor. Additionally, jobs that involve repetitive movements can lead to repetitive strain injuries, such as working on an assembly line or on a computer. Generally, your work environment should be as comfortable as possible. You should ideally have a workplace assessment so that any adjustments needed can be made.

The symptoms of repetitive strain injury can range from mild to severe and typically develop gradually. They commonly include:


  • Pain, aching, or tenderness


  • Stiffness


  • Throbbing


  • Tingling or numbness


  • A sudden feeling of weakness


  • Cramping


At the early courses of RSI, you might notice symptoms when you are carrying out a particular repetitive action. However, without treatment, the symptoms of a repetitive strain injury may eventually become constant and cause longer periods of pain. You may also experience swelling in the affected area, which can last for several months.

Who Gets Repetitive Strain Injury?

Repetitive strain injuries can occur when you do repetitive movements. Those movements can cause your muscles and tendons to become damaged over time. Therefore, desk jobs aren’t the only occupations whose workers are at risk for a repetitive strain injury. Other occupations that involve repetitive movements and may increase your risk include construction workers, dentists, chefs, and musicians.

How Does it Affect You? How Serious is it?

Repetitive strain injuries are divided into two separate categories; type 1 and type 2 RSI.

Type 1 RSI is where the symptoms can be categorized as a specific condition, such as carpal tunnel syndrome or tennis elbow. Type 2 RSI (or diffuse RSI) is where the symptoms are not recognized as a specific condition. Symptoms may be vague or shifting, with few or no visible or measurable signs, such as swelling or nerve damage.

Other complications that may be associated with repetitive strain injuries include:


Carpal tunnel syndrome

Carpal tunnel syndrome is a narrow passageway in the wrist made up of ligament and bone. The median nerve, which runs from the forearm into the hand, passes down through the carpal tunnel. Carpal tunnel syndrome is caused when the median nerve becomes compressed or squeezed. If the carpal tunnel or the surrounding tendons swell, it can compress the median nerve. Numbness and pain in the hand can then result. A repetitive strain injury is one cause that can lead to the development of carpal tunnel syndrome.



Tendinopathy describes when tendons, which connect muscles to bone or other body parts, become injured. In addition, there are two types of tendinopathy, which are tendonitis, and tendinosis. Tendonitis is when the tendon becomes inflamed. This can be caused by a sudden injury or by overuse. As for tendinosis, on the other hand, is when the tendon does not become inflamed. Tendinosis is typically due to a buildup of small injuries that fail to recover. Tendonitis or tendinosis can be considered by a repetitive strain injury when overuse is the exact cause. There are tendons all over the body and all are capable of developing tendinopathy. Areas of the body that are commonly associated with tendinopathy include the heel, wrist, elbow, ad thumb.



Tendons are surrounded by a protective sheath called the synovium. This sheath may become inflamed, resulting in a condition known as tenosynovitis. This condition can be caused by injury, infection, and / or overuse. When tenosynovitis is caused by overuse and strain, it can be considered a repetitive strain injury. Any tendon sheath may be affected; however, tenosynovitis commonly affects tendons in the ankles, feet, wrists, and hands.


Trigger finger and trigger thumb

Stenosing tenosynovitis, commonly called trigger finger or trigger thumb, occurs when the sheath surrounding tendons in the fingers become damaged. There are bits of fibrous tissue that function as pulleys along the tendon sheaths that help fingers to bend. Stenosing tenosynovitis occurs if the pulley at the base of the finger becomes inflamed or thicker than normal level. Certain trigger finger symptoms include pain, a popping sensation, a lump at the base of the finger, and an affected finger becoming locked in a bent position.



Bursitis is a form of repetitive strain injury that can affect the knee, elbow, wrist, or shoulder. When bursitis affects the shoulder. It can also be referred to as a rotator cuff injury. When the condition affects the area in front of the kneecap, it is sometimes known as a housemaid’s knee.


Tennis elbow and golfer’s elbow

Tennis elbow, also known as lateral epicondylitis, is a form of tendinosis that affects the tendons attached to the outside of the elbow. Overuse or trauma can result in degeneration of the tendon’s attachment, which then causes pain.


Cubital tunnel syndrome

Cubital tunnel syndrome is a form of repetitive strain injury where the ulnar nerve, which travels from the neck to the hand, becomes compressed or irritated at the elbow. Numbness and tingling in the hand and fingers, particularly in the ring and little fingers, can all result. Repeatedly stretching or bending the elbow, or keeping the elbow bent for long periods of time, can cause the ulnar nerve to become compressed. Patients who regularly sleep on their elbow, for instance, are more prone to be affected by cubital tunnel syndrome.


Ulnar tunnel syndrome

Ulnar tunnel syndrome is a form of repetitive strain injury whereas the ulnar nerve becomes compressed at the wrist. The ulnar tunnel is a canal in the wrist in which the ulnar nerve passes through. Therefore, if the ulnar nerve is compressed at the wrist, numbness, and tingling in the ring and little fingers can result. Ulnar tunnel syndrome is less common than cubital tunnel syndrome. It is most often caused by a benign cyst, but can also be caused by repetitive movement or pressure to the hand.

Recommended Treatment & Rehabilitation

Overall, there is no specific test to help diagnose repetitive strain injury as the condition takes many forms. A complicating factor is that some conditions, such as carpal tunnel syndrome, can have several causes. Repetitive strain injuries are diagnosed by taking a medical history and performing a physical examination. Symptoms may be the result of other conditions, and diagnostic tests may be ordered, such as the following below:


  • Blood tests – to check for diabetes or inflammatory joint disease.


  • X- rays – to help check for arthritis or fractures.


  • Nerve studies – This diagnostic test checks the function of nerves by applying small electrical currents and recording how well the nerve conducts electricity. The test causes a mild tingling and is not painful.


  • Electromyography – This test checks the function of muscles by inserting small needles into them to measure electrical signals. There may be a small amount of pain or discomfort during this test.


Some conservative physiotherapy management includes the following:


  • Strengthening the limbs and joints


  • Postural retraining


  • Bracing


  • Rehabilitation


The ultimate goal of physiotherapy in repetitive strain injury is to reduce pain, improve motion, and restore strength. Since RSI is a chronic injury and develops over time, a physiotherapy rehabilitation program is highly essential.

Repetitive strain injury can be treated in a number of ways. The treatment will typically help to relieve the pain and help prevent symptoms from worsening. The doctor will first assess the severity of your symptoms and base your treatment on your personal circumstances. This will make sure it is most effective and help you recover as quickly as possible.

Firstly, your doctor will identify what activity in your daily routine has led to the injury. When you know what has caused the problem, you will be able to modify how you carry out the activity or stop altogether. If it is work-related you may need to speak to your employer about making changes to how you work. If the problem is from a sporting activity, you can make sure you get coaching on improving your technique.

Some treatments may be helpful to reduce further symptoms for repetitive strain injuries, including the following:



Painkillers can be very helpful in the short term for repetitive strain injuries. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help manage pain from RSI. NSAIDs are available over-the-counter or can be prescribed by a doctor, but will carry risks when used in the long term. Additionally, NSAIDs may be helpful for bursitis, which is caused by inflammation of a bursa.


Corticosteroid injections

These are injected into the site of the repetitive strain injury can provide short-term pain relief. Injections are administered by a medical professional and can provide relief for up to 48 hours. Although steroid injections have few side effects, this may briefly worsen the pain. They work by directly reducing inflammation at the injured location. Steroids should not be taken for long periods of time as they can damage tissues and lead to other complications.


Brace / splint 

Wearing a brace or splint can prevent further pressure on the affected body part and allow it time to heal. A brace may be helpful for repetitive strain injuries, such as cubital tunnel syndrome, carpal tunnel syndrome, and ulnar tunnel syndrome.



This is an option for repetitive strain injuries which do not respond to non-surgical treatment or cause particular pain and disruption. Surgery may be helpful for severe cases of carpal tunnel syndrome, tennis elbow, and cubital tunnel syndrome. Surgery for tennis elbow removes the damaged part of the tendon. For cubital tunnel surgery, the roof of the tunnel may be opened or widened, or the nerve may be moved to a new position at the front of the elbow.

Generally, giving your hands a break and even a good stretch can be done in only a few minutes and can have a huge impact on their health. Therefore, here are some exercise examples you can try to lessen the pain from a repetitive strain injury:


  • Prayer stretch – Start with your hands folded together with the palms against one another, just below your chin. Slowly lower your hands to your waist until you feel a light stretch in your wrists. Try to hold this position for 15-20 seconds, 2-3 times a day.


  • Wrist flexor stretch – Extend one arm out in front of you with the palm facing up. Use your other hand to gently bend the extended wrist downward, pointing your hand toward the floor. Hold this position for 15-20 seconds before taking a break and repeating with your opposite arm, 2-3 times a day.


  • Elbow stretch – Raise one arm straight above your head, and then bend your elbow. Place the opposite hand on the bent elbow, and gently push it back further. Hold this position for a few seconds, then repeat with the other side 2-3 times a day.


Alternative & Homeopathic Treatment

A few homeopathic treatments include common methods to simply reduce pain linked to RSI, such as:


  • Rest – Stopping the activity that caused the repetitive strain injury gives the body tissue time to heal itself. If this isn’t possible, discussions should be held with the employer about changing work patterns or modifying your equipment.


  • Ice / heat application – Applying an ice or hot compress can help reduce swelling and pain in the affected area. You can place a bag of frozen peas in a towel and hold it to the joint or wrap a hot water bottle in a towel.


  • Take breaks from repetitive activities – Whether you are typing, playing guitar, or using a hand drill, try setting a timer beforehand for 15 minutes. When it goes off, stop what you’re doing and wiggle your fingers. Stretch your hands and move your wrists to help improve blood flow to these areas.

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