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Repetitive strain injury: causes, treatment and prevention

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Ann Shuttleworth, BA, is a freelance health care journalist.

Article

Repetitive strain injury is an umbrella term that describes a number of musculoskeletal conditions, most of which are occupational in origin (Box 1). The conditions often affect the limbs but can also affect the spine, causing referred pain in the limbs. This makes diagnosis difficult. Lack of accurate diagnosis and access to appropriate treatment often exacerbate the condition. Symptoms of RSI can continue for years (Tjepkema, 2003) and include numbness, tingling, sharp pain, dull ache, weakness, loss of grip, and restricted movement. People with severe RSI can find it difficult or impossible to carry out simple tasks (Tjepkema, 2003). This can result in job loss and financial difficulties as well as high levels of pain and distress.

Causes of RSI

There are many causes of RSI, but the consensus is that the common factor is chronic repetition of tasks that do not normally cause damage, possibly accompanied by exertion of force (Bongers et al, 2002). Such repetition can affect the body in various ways:

- Carpal tunnel syndrome - repeated flexion and extension of the wrist causes inflammation of tendons, which leads to pressure on the median nerve and results in numbness, burning and tingling symptoms;

- Tennis elbow - caused by muscle lesion or inflammation of tendons where they attach to the bone;

- Tenosynovitis and writer’s cramp - occur in occupations involving routine clerical or assembly-line work;

- Vibration white finger - caused by the use of pneumatic drills and hammers.

Overuse of any part of the body, compounded by poor posture, twisting, cold, vibration or stress, is a risk factor for RSI

Most RSI is probably caused by a combination of factors. While primary factors are mainly related to environment, secondary factors are also likely to play a part.

Secondary risk factors for developing RSI may include:

- Predisposition due to factors such as age, intrinsic strength, and general health;

- Stress (either physical or emotional), which makes muscles and soft tissues tense up and so become more prone to injury (Bongers et al, 2002).

Prevalence

Work-related upper-limb pain and dysfunction has been documented for 300 years in jobs such as clerical work and telegraphy. However, since the late 1970s many countries have experienced dramatic increases in musculoskeletal conditions. During this period there has been widespread replacement of typewriters with computers, and many workers now spend long periods in a fixed position, using only a limited range of movements to operate their keyboards.

The exact prevalence of RSI in the UK is unclear due to under-reporting and misdiagnosis. Estimates suggest that more than 500,000 people have a work-related neck or upper limb disorder and an estimated 36,000 workers have vibration-induced white finger (Trades Union Congress, 2003; Health and Safety Executive, 1995). A survey of occupational exposure to hand-transmitted vibration (Palmer et al, 2000) revealed that more than one million people in the UK had tingling and numbness in their hands associated with vibrating tools. Of those, 515,000 had disturbed sleep and 355,000 found it difficult to fasten buttons.

The TUC (2003) estimated that 5.4 million working days were lost as a result of RSI in 2003. On average, six people leave their jobs each day due to RSI.

The annual cost to UK industry is estimated to be between £5bn and £20bn (TUC, 2003).

Treatment

Although there is no conclusive evidence regarding the efficacy of treatments for RSI, a multidisciplinary approach is likely to be most effective (Bongers et al, 2002). Treatments fall into two broad categories: conventional and complementary.

Conventional therapies include:

- Physiotherapy - use of infrared and ultraviolet rays, heat, electric current, manipulation, and exercise;

- Medication - nonsteroidal anti-inflammatory drugs, aspirin, antidepressants, and muscle relaxants;

- Immobilisation - splints can alleviate pain in hands and arms but there is a risk of muscle atrophy;

- Steroids - cortisone injections administered into the relevant soft tissue can give short-term pain relief;

- Surgery - usually only recommended if conservative treatments are ineffective;

- Chiropractic and osteopathy - joint and muscle manipulation can help a range of conditions, especially neck and back pain;

- Massage - a wide range of massage techniques can be used to relax soft tissue;

- Pain management - cognitive support can help patients to come to terms with chronic disability.

Complementary therapies include:

- Alexander technique - postural retraining to promote ‘good’ use of the body;

- Pilates - body conditioning targeting deep abdominal muscles to build up strength and improve flexibility;

- Yoga - helps with fitness, while flexibility and stretching can help to manage symptoms of RSI;

- T’ai chi - a Chinese system of movement, meditation, and martial art that helps with posture;

- Bowen technique - hands-on therapy for muscles and tissues using the thumbs and fingers;

- Feldenkrais - a system of body work and gentle exercise aimed at improving posture and coordination;

- Shiatsu - Japanese therapy that uses pressure on the acupuncture points and meridians;

- Acupuncture - seeks to remove ‘energy blockages’ by applying gentle pressure with tiny, sterilised needles;

- Magnet therapy - magnets are placed on the body to affect charged particles in the blood, helping blood vessels to expand and thereby increase circulation and promote healing;

- Hypnosis - use of images to promote healing.

Prevention and recovery

A range of measures can be taken to prevent RSI. Most are also useful in helping people with RSI to recover or to avoid recurrence.

An understanding of lifestyle factors implicated in RSI is important, particularly for people whose occupations and activities put them at risk (Box 3). These factors include general stress, high workload, and poor overall health and posture (Bongers et al, 2002).

People whose jobs involve repetitive activities need to take extra care outside work by avoiding activities that increase the strain on joints and muscles. Other factors that may be helpful include healthy eating including plenty of fresh fruit and vegetables, drinking two litres of water a day, regular exercise, keeping alcohol intake within recommended limits, and not smoking (Repetitive Strain Injury Association (RSIA), 2004). Steps to recovery include:

- Avoiding risk of further damage;

- Obtaining a full and accurate diagnosis;

- Receiving appropriate treatment for the condition and the person’s circumstances;

- Taking part in activities to stimulate blood flow and avoiding activities that restrict circulation;

 

- A gradual return to work.

Awareness week

The RSIA is running an RSI Awareness Week on 23-29 February 2004 to raise awareness among employers and employees that a collaborative approach to RSI is essential. The association believes that employees must feel able to talk to managers about concerns regarding their workstations, and that managers should address any problems in negotiation with their staff. Employers should ensure they are following up-to-date ergonomic advice, that staff are encouraged to report symptoms, and that remedial action is quick and effective.

Local and national events have been planned and the association has created an online exhibition promoting products and services of benefit to people who live or work with RSI. An awareness pack can be downloaded from the RSIA website. This contains a range of resources, posters and activities to inform people about the condition and prevention strategies.

This article has been double-blind peer-reviewed.

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