Repetitive Strain Injury

Today we are hearing a lot from Occupational Health and Safety (OH&S) professionals about ailments such as Repetitive Strain Injury (RSI) and how it is that our behavior, posture and working practices that are among the leading causes of these types of medical conditions. Let us look into this a little deeper and see if there is anything that we can do or change to reduce our own chances of ever succumbing to them.

So what is RSI?

Repetitive Strain Injury (RSI) is also known as Cumulative Trauma Disorder (CTD), occupational overuse syndrome, non-specific arm pain or work related upper limb disorder (WRULD) and is broadly speaking a class of illness concepts that link use of the arm to injury or disease.

The basic premise of this illness concept holds that one can excessively incorrectly overuse a tool, such as a computer keyboard or musical instrument in such a way that tissue damage leading to pain can result. Prior to the advent of typewriters and computers this incorrect overuse of an implement illness concept was embodied in the concept of “writer’s cramp”. It is important to note that conditions such as RSI tend to be associated with both physical and psychosocial stressors.

In short the main causative of Repetitive Strain Injury (RSI) today is primarily accepted to be as a direct or indirect result of repeated or excessive movement of the shoulders and arms. The underlying pathological process that classes of illness concepts such as RSI claim as being causative of the patient’s symptoms is that in order for the shoulder, arms, and hands to move, the muscles of the upper body must contract. Repetitive strain injury occurs when certain movements are made repeatedly thereby resulting in:

• A diminished blood flow and oxygen supply to the muscles
• Tightening of the structures of the upper body, which makes them more susceptible to injury
• Rubbing of tendons against ligaments or bones, which causes inflammation of the tendons
• Pinched nerves, if tissues are inflamed or if repetitive movements rub the nerve

Causes of RSI

Repetitive activities commonly believed to contribute to the development of RSI include:

• Activities such as persistent, continual, excessive and prolonged periods without respite (without a regular break) of typing, sewing, heavy lifting, playing tennis, sawing wood, and using a cash register
• Poor posture when carrying out the same activities
• Poorly designed work conditions and work stations
• Pregnancy

The Symptoms

Symptoms of repetitive strain injury may occur anywhere in the shoulders or arms. Usually they first occur during the repetitive movement. These first symptoms may include tired muscles, aches, and pain. Later, if repetitive movement continues, the symptoms worsen and may include:

• Muscles aches and muscle fatigue during both activity and at rest
• Numbness or a tingling sensation in the affected area especially the fingers
• Pain radiating up the arm
• Disability because of chronic pain or weakness
• Difficulty sleeping, frustration and even episodes of clinical depression due to the pain, sleep deprivation, fatigue and persistence of the other symptoms without relief or may even be compounded by depressions arising out of a lack of an initial definitive diagnosis. People do get really over-worried when they perceive that there is something “wrong” with them and they and their doctor’s don’t know what it is.

RSI Related Conditions

Medical conditions typically associated with RSI include:

• Carpal Tunnel Syndrome – Causes considerable pain, numbness and other symptoms in the hand and wrist and often requires corrective surgery
• Tendinitis – Inflammation of the tendons in any part of the body
• Bursitis – Inflammation of the sac that cushions a joint
• Ganglion formation – Cysts that may occur on a tendon

Treatment

Minor pain or injury may require RICE therapy, drug therapies, physiotherapy, exercise regimes, ultrasound therapies and even surgery in persistent debilitating cases.

RICE Treatment – RICE is an acronym for Rest, Ice, Compression and Elevation. This means:

• Rest – Can be in the form of either total or dramatically reduced activity particularly a reduction in those activities believed to be contributing to or aggravating the condition
• Ice – Application of ice or cold packs to the affected area
• Compression – Compression of the affected area by using ace bandages or wrist splints
• Elevation – Raising the affected body part to be level or slightly above the same vertical level as the heart

Drug Therapies – Drug regimes may be employed. For example Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen and naproxen, may be used to reduce inflammation and discomfort. In some cases anti-inflammatory steroid therapies are called for. This often means a corticosteroid may be injected into the affected area.

Physiotherapy and Exercise Regimes – Physiotherapy or strength training exercises may help increase the strength of the tendons and muscles.

Ultrasound Therapy – Ultrasound may be used to warm the muscles and improve blood flow.

Surgery – If conservative treatment is not successful, surgery may be necessary.

Preventing RSI Related Conditions

Avoidance – Avoid excessive overexertion of the arms and shoulders. This can diminish and in some cases even totally prevent many cases of RSI.

Warm Up First – Warming up and stretching the muscles before activity may decrease the risk. Using proper body mechanics may also lessen the risk of injury.

Ergonomics – Ergonomics is the practice and study of arranging work equipment to allow for more comfort and less strain on the body. There are many ergonomic products, such as wrist pads, height adjusters on keyboard holders, and wrist support braces. The use of these types of products has been shown to be effective in reducing the strain on muscles, tendons, tissues, and nerves of the arms.

Regular Breaks – Taking regular breaks during repetitive activities helps to reduce the likelihood of RSI related conditions developing.

Exercise – Performing strengthening exercises may also help.

Postural Correction – Learning proper methods of sitting, positioning the feet, lifting, and bending may also decrease the risk of RSI.

Computer Software – For those using computers there are a number of specialty RSI software products that can be of great value. Most work on the premise of reminding you to take a break by causing a reminder to popup on your computer’s display informing you of the need for you to take a break. This can occur at set intervals or as a result of you entering a certain number of keystrokes.

The basic idea is to get you to move your limbs in a manner different to that which you have been doing for the past 50 minutes or so. Windows and Linux users might want to take a look at Workrave while AntiRSI is a similar product for the Mac.

Unfortunately there are a number of causes and predispositions that cannot be prevented.