Repetitive Strain Injury (RSI)
What are examples of Repetitive Strain Injury?
Repetitive Strain Injury (RSI) is a broad term covering various conditions and overuse injuries. Some conditions might be sports-specific such as golfers elbow or tennis elbow. However, such conditions can affect anybody, even people who have never played such a sport. Occupational Overuse Syndrome (OOS) is often used within the workplace to describe Repetitive Strain Injury (RSI) type conditions. Other conditions under the broad RSI heading include carpal tunnel syndrome, trigger finger and thoracic outlet syndrome and even chronic pain syndrome. Most of these conditions predominately involve the fingers, hand, wrist, forearms, elbows and shoulders, though the neck and back can play a part. Some of the most common types of Repetitive Strain Injury involve inflammation affecting tendons (tendonitis) and or Bursa (Bursitis). In chronic cases, tendons can exhibit microscopic changes affecting cellular structure (tendinosis). Healthy tendon fibres have a well-organised structure, whereas, in cases of tendinosis, collagen fibres have a disorganised structure at the microscopic level. Changes in structure affect appearance and how well such tissues function.
What causes Repetitive Strain Injury (RSI)?
Although overuse injuries such as Repetitive Strain Injury (RSI) classically involve some form of repetitive motion or action, there is usually a combination of factors resulting in injury. However, symptoms can occur without repetitive movements and result from sustained loading to muscles and soft tissue structures. Smart devices are often relatively heavy, primarily when held for sustained periods. Such a situation could easily result in tennis elbow-type symptoms and frequently contribute to neck pain (text neck). Bodily movements involve the application of varying degrees of force to various soft tissue within the body. Moving the body requires different structures to glide over each other, with the transfer of loads changing due to changes in angles of force (vectors) due to movement. Repetitive motions and applied forces tend to create some Amplitude (vibration) level, which can result in soft tissue injury (microtrauma). Such a situation is especially true if there is little relaxation or recovery time between motions. The human body's response to tissue trauma involves the inflammatory response, a vital part of the Tissue Repair, healing and scar tissue process. However, when tissues are repeatedly injured and unable to heal properly, one can experience Repetitive Strain Injury (RSI) conditions.
As with many types of injury, Repetitive Strain Injury (RSI) can arise from a previous, seemingly unrelated and unresolved injury. Historical injuries can change how we move at the time of injury and afterwards due to tissue adaptions. Such changes in how we move can alter the loads usually placed on tissues when performing specific activities. Hence, just because a historical injury is pain-free does not mean that it is fully resolved and can still cause a new and different overuse injury. A Repetitive Strain Injury (RSI) may arise from any activity that meets the earlier criteria, such as sports, professions (work), hobbies, and interests. People from a wide range of professions or trades may experience Repetitive Strain Injury (RSI), especially when repetitive work is highly dextrous or involves prolonged gripping actions. Examples may include office workers, carpenters, plasterers, plumbers, electricians, hairdressers, surgeons, dentists, musicians, massage therapists etc. There is also some evidence of myofascial trigger point involvement, which can result in myofascial pain symptoms.
What are the symptoms of Repetitive Strain Injury (RSI)?
Repetitive Strain Injury (RSI) can cause various symptoms depending on which tissues are affected. As mentioned, Repetitive Strain Injury (RSI) covers a range of specific conditions, and it is possible to have multiple issues simultaneously. For example, a particular activity may result in carpal tunnel syndrome and tennis elbow or vice versa. Multiple conditions can occur as we naturally adapt to avoid pain, which changes forces and the initial injury mechanism factors. Symptoms can be wide and varied with numerous conditions, which increases the probability of chronicity. Chronic conditions frequently require a multifaceted approach, especially when Persistent Pain is involved.
- Pain, tenderness and swelling
- Muscle weakness and grip strength
- Muscle Fatigue
- Neurological pain (burning, stabbing, electrical type pain)
- Vascular changes (Cold fingers or hands)
How do you treat Repetitive Strain Injury?
Treating Repetitive Strain Injury (RSI) requires a comprehensive assessment approach to identify the root cause and underlying condition(s). In cases of multiple underlying conditions, it might be necessary to address the identified root cause first or after other underlying conditions. Individual patient circumstances usually dictate the best treatment approach, as no two injuries are the same. Repetitive Strain Injury (RSI) conditions are generally easily treated with manual therapy, prescriptive exercise, behavioural modification and preventative strategies.
For example, somebody working in a profession involving significant typing may present at the MSK Therapy clinic with Repetitive Strain Injury (RSI) symptoms. After a thorough assessment, the underlying condition could be Lateral Epicondylitis - Tennis Elbow. The injury mechanism may relate to a poor computer work setup, and an effective treatment approach requires addressing such issues by creating an ergonomic computer setup. Changes in work setup or how one performs tasks are both forms of behavioural modification. Manual therapy, including myofascial release therapies, can treat soft tissue changes and musculoskeletal adaptations. Prescriptive exercises are also crucial for rehabilitating tissues after injury and relearning correct movement patterns. Aftercare advice should also include preventative strategies, including specific stretches, preventative prescriptive exercises, and changes to behaviour (taking breaks, performing tasks differently etc.).
Is Repetitive Strain Injury permanent?
Repetitive Strain Injury will often go away with early intervention and the correct treatment approach. It is possible for conditions that fit under the umbrella term Repetitive Strain Injury (RSI) to become Chronic or long-lasting over three months. However, even Chronic conditions can respond well to the proper treatment approach, though often, many tissue changes occur as time progresses, requiring more effort to resolve. Generally speaking, Repetitive Strain Injury is not permanent, provided one addresses injury mechanisms and resulting changes to soft tissue structures.
How long does it take to recover from Repetitive Strain Injury?
As with any injury, many variables affect how long it may take to recover from Repetitive Strain Injury. Recovery times can vary from weeks to months and even longer in severe chronic cases. Expecting treatment by a professional to resolve the problem without any personal effort is a bad strategy, often leading to a poor outcome. A good MSK professional educates or advises the patient about their unique circumstances and condition(s). Following advice concerning behavioural changes and performing prescriptive exercises are as crucial as any physical treatment given by an MSK professional. Effective early intervention and following any advice given can significantly reduce recovery time. Other factors can influence recovery times and how many treatments one might need.
The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
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About the Author
As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy techniques and advanced myofascial release methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.
The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.