A myofascial understanding of Repetitive Strain Injury (RSI)
What is RSI?
RSI or repetitive strain injury is a condition that at best is not fully understood and at worst is denied as non-existent. However the symptoms experienced by sufferers are very real indeed and they can be debilitating.
The problem starts with the fact that RSI is not one condition but rather an umbrella term for a wide range of symptoms that can affect anywhere in the body. Breaking it down, repetitive strain injury is exactly that, an injury or strain caused to a body part through repetitive use or overuse.
RSI can therefore occur anywhere in the body and can be caused by too much exercise, craftwork such as sewing, hobby such as DIY, as well as too much work. In recent years RSI has come to be associated with the repetitive nature first of factory work and now desk work. In an attempt to distinguish the two, a new umbrella term is often used to describe work related issues and this is WRULD – work related upper limb disorder.
However any link between RSI and the workplace is not welcome in some quarters. Employers, keen to avoid litigation, are equally keen to disprove that symptoms have been caused solely by poor workplace practices or set-up. In a digital world where computer access comes in all shapes and sizes, it is increasingly difficult to distinguish whether symptoms are a result of your job or your leisure time spent gaming.
A medical understanding
Many medical consultants are equally dismissive of RSI or WRULD as a diagnosis and prefer to diagnose a condition affecting a specific body area, for example tendonitis (forearm), epicondylitis (tennis or golfers elbow), carpal tunnel syndrome (wrist) or Duputryrens contracture (thumb).
Some of these conditions are recognised as occupational diseases allowing the sufferer to claim disability benefits. However many more people suffer from diffuse RSI where the diagnosis cannot be pinned down to a specific body area mainly because the symptoms don’t conveniently match the expected pattern or stay in one body area. Instead people can experience a whole range of symptoms that come and go and move around their body.
Whatever the diagnosis, the symptoms of RSI are common to many named conditions with some being more pronounced than others depending on the individual. Typically RSI starts with mild pain and stiffness in a specific area that stops when rested. From this symptoms can intensify and include pain in the fingers, wrists, arms or shoulders; pins & needles or tingling; numbness; swelling; cramps; coldness; and loss of grip strength.
The difficulty with RSI
As the condition progresses people find rest from the activity that causes the symptoms doesn’t make them go away and instead they start to affect other daily activities and even disturb sleep. Often people are advised to completely stop the problem activity, ie to have several weeks or months off work, and find this stops the problem. But only until they go back work when the symptoms return with a vengeance.
Medically RSI conditions are difficult to treat. People with symptoms may display no outward sign of a problem and are sometimes accused of making them up. People are prescribed a variety of medications including anti-inflammatories, painkillers, opioids, and anti-depressants and anti-epileptics as a way of changing neurological reaction to pain. They may also have steroid, anaesthetic or Botox injections into problem areas and, in worst case situations, have surgery to decompress or release the area. They may be given exercises to strengthen weak muscles or splints and braces to support painful areas.
Despite all of this, many people still have symptoms which may worsen. The question is why does RSI not respond to all of this medical attention and what is wrong.
Understanding RSI from a myofascial perspective
The myofascial answer is that the attention is on the wrong body area. When viewed as a holistic whole, the body is a biotensional three-dimensional network held together and supported by fascia as the main connective tissue. If some areas are overworked, they can become irritated and inflamed which leads to the formation of micro-scar tissue and restriction. This changes overall body-wide tension and can cause other areas to work harder or differently to maintain balance. In many cases this leads to referred symptoms where a restriction in one area leads to pain and other symptoms elsewhere.
An example of this is carpal tunnel syndrome. This can be caused by pressure on the carpal tunnel (a bony structure in the wrist) which compresses the median nerve that travels through it. Typical symptoms are numbness, tingling and pain in the fingers which can lead to permanent nerve damage if left untreated. Diagnosis is by passing an electric current through the nerve and, if it doesn’t conduct, then surgery is required to release pressure on the area.
However, many people who present with these symptoms have nothing wrong with their carpal tunnel and for them the problem is actually restriction in the neck where the arm nerves originate. Despite this, they may still be advised to have the surgery which unfortunately doesn’t solve the problem.
This is just one RSI pattern and often the symptoms and the cause are far less clear. However medical treatment is usually focused on where the symptoms are felt often with no real consideration that there may be a cause somewhere else in the body.
A myofascial approach looks at the whole body to observe obvious imbalance. Hands-on therapy can help to release old fascial restrictions that may be contributing to the symptoms, but a longer-term solution is to adopt a programme of myofascial self-help exercises designed to release restrictions and prevent them from returning.
In these days when more and more people work from home and spend extended hours using digital devices, hands-on treatments will help but it is also important to take the problem into your own hands (so to speak) by proactively working with your fascia to keep it elastic and restriction free.
You can find more information about RSI and the best self-help exercises for your fascia in our online Myofascial Self-Help Guide for RSI.