Understanding Repetitive Strain Injury (RSI)

Repetitive Strain Injury (RSI) can occur in any area of the body that is subjected to too much repetitive action but it is most commonly associated with disorders affecting the upper limbs.

Even just the phrase repetitive strain injury can be controversial depending on who you are talking to. It is an umbrella term for various overuse injuries, also known as upper limb disorder or work-related upper limb disorder (WRULD). Employers do not like the term because of its association with workplace practices that can give rise to legal liability and compensation claims. And medical doctors often do not like it because they prefer to narrow down the diagnosis to a more specific named condition.

Classifications of RSI

RSI is classified medically in two categories. Type 1 RSI is where a specific condition can be identified as the cause. In this case the diagnosis given is often not RSI at all, but the named condition instead, for example, carpal tunnel syndrome.

Type 2 RSI is also known as diffuse RSI where there is no clear diagnosis as the symptoms can change and move with no visible or measurable signs such as swelling.

In reality RSI conditions cannot really be so neatly categorised and are all overuse syndromes which may be caused by a combination of activities at work or outside work. This can include jobs that are desk based, or manual jobs such as a joiner or electrician, and leisure activities ranging widely from weight training to sewing – in fact, anything using the hands.

The symptoms may fluctuate daily and typically can include tingling, loss of grip strength, swelling, throbbing, loss of sensation/proprioception, tenderness, burning pain, numbness, cramping, aching, sharp and shooting pains, clumsiness, difficulty moving fingers or thumb.

Some of the common type 1 RSI conditions include:

Trigger finger/thumb

This is a condition affecting the fingers and thumb. In this condition one or more fingers or the thumb can become stiff and difficult to move, in some cases getting stuck in a contracted claw-like position. Sometimes it is possible for someone to temporarily straighten their own finger or thumb (often accompanied by a popping noise) or sometimes it gets permanently stuck. Often an accompanying nodule develops in the palm of the hand at the base of the affected digit. The condition is not usually painful but does affect movement.

Golfer’s elbow and tennis elbow

Also known as medial and lateral epicondylitis. It is possible to suffer from both conditions at the same time and to develop them without ever having touched a golf club or tennis racquet. In fact only about 5% of cases are due to these sports. Symptoms typically include pain on the inside or outside of the elbow, pain and weakness in the forearm, difficulty gripping things or turning your wrist – turning door knobs, for example.

Thoracic outlet syndrome

The thoracic outlet is the space between your collarbone and first rib at the top of your chest. Thoracic outlet syndrome is compression of this area which causes symptoms including numbness, pain, and a sense of weakness anywhere from your shoulder down to your fingers. Sometimes the compression of blood vessels can also cause swelling and discoloration in the arm and hand. This condition is typically caused by poor posture such as rounded shoulders caused by sitting in one position for prolonged periods of time, eg a desk job.

Carpal tunnel syndrome

The carpal tunnel is a narrow bony gap in the wrist through which the median nerve and tendons for the hand pass. Sometimes the tendons in this tunnel can become inflamed (tendonitis), which puts pressure on the nerve. This causes symptoms such as pain, numbness, pins and needles, and loss of strength in the hand and fingers, and sometimes also the forearm.

Standard approaches to treating RSI

The standard approach in treating RSI is generally to focus on the area where the symptoms are felt. Medical approaches may include physiotherapy to strengthen weak muscles, Botox or steroid injections to reduce inflammation, medication for the pain, splints to immobilise painful joints such as the wrist and, as a last resort, surgery to alleviate pressure in the wrist (in the case of carpal tunnel syndrome) or to release restricted tendons (in the case of trigger finger).

However symptoms persist for many people despite these interventions. In which cases, it means the problem is elsewhere in the body. Very commonly symptoms are due to restrictions in the brachial plexus which is the bundle of nerves that enervates the arm and hand. These nerves first exit the spinal cord in the neck and travel under the collarbone and chest muscles, then through the armpit into the arm.

All nerves are encased in fascial sheaths which are channels in the fascial tissue that allow free gliding. When fascia is restricted and compromised, this squeezes the nerves and prevents their free movement. In the case of the arm nerves, if they are restricted at any point, for example due to poor posture or overuse, this comes out as symptoms that are felt ‘downstream’ in the elbow, wrist and hand.

RSI and Myofascial Release

If you have RSI symptoms, whether or not you have been diagnosed with a specific named condition, it is a good idea to explore ways to release your fascia and help return the tissues to better movement. One way you can do this is through self-help myofascial exercises. Our Fascial Fix for Neck Pain is actually a good starting point to help release restrictions affecting the arm nerves where they start in your neck. If you want a more in-depth understanding of RSI and more exercises to help then why not consider our Living Pain Free All About Class for RSI.


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