Repetitive Strain Injury (RSI). Rarely has there been more confusion and fear about something which is just a simplistic label for a set of fairly standard physiotherapy conditions. What is it? Does it really exist? And can RSI treatment actually work? In this article we look to dis-spell some myths and give you the benefit of our experience in how to treat RSI if you have it and how to prevent it if you don’t.
Does Repetitive Strain Injury (RSI) Exist?
According to the famous 1993 court case Judge Proseer ruled that RSI does not exist in the UK. If you’re really keen you can read this report on the case. I would tend to agree. As with many things from the world of physiotherapy it is just a grouping of conditions into a convenient label. Let’s consider the words. Repetitive – you’ve done a lot of something. Strain – it asked something of your body. Injury – it caused some damage. The one I would disagree with the most here is injury. In most cases it is not an injury. As in nothing went twang, snap or pop. Indeed on MRI scans there is often nothing to see.
What you’ve done too much of could be anything. Computer work is often a large part of the problem. The term was first coined in the 80s as computer use was on in the increase. Other common causes include painting, bricklaying, golf and tennis. But it really can be anything that requires you to use a lot of muscles over and over again. But how is that some people get it and others don’t?
To over simplify I would consider two options. How much are you overusing your muscles? How sensitised is your nervous system?
Muscles can be overused through repetitive load. That is you’re asking them to do more than they’re adapted to do. This can lead to muscle degeneration rather than the increases in strength that you might expect. But, muscles may be overworking because they are compensating for weakness elsewhere. To give a common example the muscles in your forearm may be overworking because the stability around your shoulder is not as good as it could be.
The sensitisation of your nervous system aspect is even more complicated. Simply put the more stressed you are the more pain your feel. So in ‘normal’ operating conditions you’d be fine doing what you’re asking of your body. But with increased stress levels all of a sudden you start feeling problems. This is how a bricklayer who’s been in the job for years may suddenly start to have problems. Or a computer user starts to have problems out of the blue after years of working at a computer. We talk more about this concept in our previous article Do You Think Stress Causes More Pain? If you’re short of time the answer is yes!
What Is Repetitive Strain Injury (RSI)?
As I mentioned previously RSI is a generic term used by the media and some health professionals to group together a set of conditions. As a group it’s one of the more feared conditions we treat. Many people fear that it will never go away. Others fear that their life will be permanently affected. This can be true. But only if you allow these fearful thoughts to dominate and you don’t take action to change your life appropriately. With the right RSI treatment it is my view that all but a small minority of RSI conditions can be treated successfully. That is without the need for operation.
The most common forms wrist RSI, elbow RSI and shoudler RSI. But you can have RSI really anywhere in the body. Achilles tendon problems are technically and RSI.
Some of RSI conditions have very scary physiotherapy labels. They include: Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, Tennis Elbow, Golfers Elbow, Lateral Epicondylitis, Medial Epicondylitis, De Quervain’s Syndrome, Ulna Nerve Compression, Guyon Canal Syndrome, Tendinosis, Tendonitis, Thoracic Outlet Syndrome, Radial Tunnel Syndrome and Focal Dystonia.
For me this scary list are all just labels to describe where you feel pain rather than any consideration as to why you feel pain. They all fit into that combination of using a group of muscles more than they’re ready for and an increased sensitisation in your nervous system. Whether that is sensitisation through your whole body or localised to where you feel the pain.
To explain more the concept of localised sensitisation I often use an example from some research that was done on knees using video MRI imaging on people’s brains. As the non-injured knee was touched an area roughly the size of a golf ball lit up in the person’s brain. On the injured side the bit in the brain lighting up was two and a half times bigger. That is you have a larger than normal representation of that part of your body in your brain. No wonder it hurts! This was of course on knees but the principle applies throughout the body.
This is a neuroscience example of the way pain works. It is more often the fear of what you have done or the fear of what the ‘injury’ may stop you from doing that increases the pain.
What Are The Symptoms Of Repetitive Stain Injury (RSI)?
The symptoms of RSI can be far ranging. The pain can feel very nerve related i.e. pins and needles, bone ache, tingly and / or numb. Or it can be more muscular in sensation, usually worse when moving or doing things. Most commonly symptoms are a combination of both of these. Muscle affects nerve and vice versa.
They can be very localised to a specific spot you can point to with one finger. Or they can spread through various points in your arm and beyond.
What Isn’t Repetitive Strain Injury (RSI)?
It’s not something to fear. As we mentioned that fear will add to your pain. Of course that fear is perfectly understandable. It’s important to recognise your fear. But take action to help you move through that fear which we talk more about in our previous article on What Is Pain?
The emotional aspect of RSI type conditions is mentioned in this article here. Specifically relating to depression. It does question whether depression comes first then injury. Or injury comes first which leads to depression. Clinically I’ve seen both feed into each other.
Surgery is very rarely required for such cases and most RSI treatment is successful when combined with a few habitual posture and lifestyle tweaks. So before you go under the knife please explore all other possible options.
Remember: unless you have had a serious incident in which you’ve damaged the tissues involved, nothing has actually happened. There is technically nothing to heal. There is very rarely a specific point when something suddenly went twang. When you’re in pain this can be difficult to believe. Trusting you can get through this is half the battle.
What Causes RSI Pain?
The main source of the pain are the 3 main nerves which run down the arm. Ultimately these are the structures that report the pain sensation back to the brain. They are the Radial, Median and Ulna nerves.
There can be tension or sensitisation on any or all of these nerves which means the muscles they serve will tire out quicker than they should. If we can identify where that tightening on the nerve is coming from then we can make the muscles last longer and so remove your pain. Sounds simple!
Obviously every case is very different and each case should be assessed and treated by a qualified professional. However, there are certain repeated mistakes people make and certain common factors that we discuss below which can help prevent shoulder RSI , wrist RSI and elbow RSI.
One very common contributing factor is stiffness and tightness in and around the neck. This can cause an increase in tension on the main trunk nerve from which the others originate. This is known as the brachial plexus. Other than the neck anything in the clavipectoral fascia can affect the tension on the brachial plexus. To translate – any structure from your collar bone down to the bottom of your pecs can affect this trunk nerve.
This is looking at the structures just in and around the neck and the shoulder. Off course to do this properly we need to consider why these structures are affected. This naturally takes us to looking at the whole body. This is beyond the scope of this article and one of the many reasons we recommend you seek professional help. For many people we find that looking at the global picture is actually more effective than treating the localised condition. In fact I’d go as far to say this is more often the case than not.
RSI Treatment – Considerations To Aid Recovery
Chill out! The calmer your nervous system the less pain you feel. What can you do to reduce stress levels? Lower your own expectations on yourself? Have that difficult conversation you’ve been meaning to have with your boss, partner, family? This may not be easy but it will help with that overall sensitisation level. Equally how busy have you been? Have you been too busy for too long? This is kind of thing that can creep up on you and catch you by surprise. The importance of breaks in your day and in your life cannot be understated. We talk about how to do this in our previous article Peak Performance.
Your posture reflects your mood and sometimes that can be hard to break out of. Check out his video which talks about how do sit to give yourself a stable base so less things can go wrong elsewhere:
Getting a decent chair can help. It doesn’t need to be Starship Enterprise top of the range expensive number. Just something that is comfortable and doesn’t encourage you to slouch. If you haven’t got any spare cash I find a good old fashioned wooden chair is best. Try not to use the back of a chair. Try instead to hold yourself in the pelvic neutral we describe in the video above by using your core muscles. If you’re using the back of the chair it suggests you’re getting tired. Take a break!
DISCLAIMER: The following exercises are great for prevnting RSI. They can also be useful as part of RSI treatment. If however you are in significant pain, please go see a professional before attempting these. If it’s not us, someone else. But just go and get it looked at. Trust me you’ll have much greater clarity on what you need to do to get yourself out of pain.
Try the following stretches in the order they are given here. If you get pain on any of the stretches or you don’t feel them stretching in the right place then that stretch isn’t for you just yet. All stretches should be held for at least a minute and you should use your out breath to help you let go of the tension. Never stretch to pain, or even intense stretch. This will be counterproductive due to a principle called the stretch reflex.
Pec Stretching For Shoulder RSI
These muscles apart from looking good on body builders give us a round shouldered look and can contrubute to shoudler RSI conditions. Not only that they can affect tension on that trunk nerve (brachial plexus) we spoke about earlier and so contribute to wrist RSI and elbow RSI too. Release these off, improve your posture and you’ll have one happier brachial plexus. In a half surrender position walk up to a wall face first and get close enough to be able to kiss the wall. From there rotate your torso away from the arm that is against the wall and you should feel a stretch at the front of your chest.
Lat Stretches For Shoulder RSI
Another muscle group that causes the round shouldered issues and again can contrubute to shoulder RSI conditions as well as wrist RSI and elbow RSI conditions. Find the corner of a wall or door frame. Grab the door frame just above the level of your shoulder and stick your backside out behind you. You may start to feel a stretch already at this point. From here put your head down and rotate your torso towards the wall. This should increase the stretch from your shoulder, across your back and all the way down to the crest of your hip. You may feel the stretch in any or all of these areas.
Neck Stretches For RSI
Simply place the hand on the side you are going to stretch behind your back. Take your other hand around your back and clasp the wrist to stop the hand moving. This is to stop your shoulder blade moving too much as you move neck. Now take your head to opposite side to bring the stretch on. As a variation you can release the wrist and increase the stretch by gently pulling on your head with the opposite hand. If you’re feeling crazy you can hold onto a door handle and then use your hand to pull your head to create the ultimate stretch. Whatever you do don’t stretch to pain. Either in your shoulder or down your arm.
Forearm Stretches For Wrist RSI
Stand with your arm out stretched in front of you with the palm of your hand facing the floor. With your other hand bend the hand back towards the forearm. Pull until you feel a nice stretch. As always not to pain. Make sure it is a stretch and you don’t feel a compression in the wrist. To do the reverse start with your palm facing the floor and then pull the hand downwards towards the floor. Hold each stretch for 30 seconds and then stretch in a little further and hold for an additional 30 seconds.
To stop a lot of these muscles from getting tight in the first place for office workers we strongly recommend reviewing your desk set up. You can find all of our best advice on how to do this here: How To Set Up Your Desk.
Should I Get RSI Treatment?
No matter what kind of RSI you have we recommend getting professional treatment. Whether you need shoulder RSI treatment, wrist RSI treatment or elbow RSI treatment doesn’t matter. If you have any means of getting treatment then please do. The true causes of RSI are so complex and everyone has an unique set of conditions that lead to their RSI.
Above we have given you the stretches and exercises that are most likely to help the majority of people with RSI based on what we have seen over many years of clinical work.
Possibly more important than these stretches and exercises is to just keep using the area that causes you pain. Don’t be afraid of it. As we’ve spoken about in previous articles pain is not damage. When you start fearing making something worse you change your movement patterns. This increases your pain and means there’s more work for us to do! Of course there is a balance to be struck. Generally we recommend using it for light work and things that don’t annoy your symptoms.
Equally stay relaxed. Of course we all need a bit of stress from time to time to challenge ourselves. But when you have been a bit stressed for a while. Or when you’ve been stressed a lot for a bit. Acknowledge that and allow yourself sometime to unwind. And if you haven’t got time, do the best you can. It’s easy to say, harder to do.
Stress always makes us adopt our worst postures and increases our sensitivity to pain. Manage those stress levels as best you can. Most people know what they should do to manage their own stress levels, but how many people actually do what they know they should? I certainly don’t do all the things I know I should all the time. But I know I feel a whole lot better when I do. In short, do what you can.
If you fear for your job or you are frustrated by it you will feel more pain. Don’t just sit there getting stressed about what might happen give us, or anyone else, a shout and make that change now. To contact us click the Get In Touch button below
There is more information on how our whole body approach can help you with your RSI or any other condition on our Brighton Physiotherapy & Sports Therapy homepage.
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