Repetitive Strain Injuries Part 1
April 05, 2022
Repetitive Strain Injuries (RSI), are common injuries that can affect both the upper and lower limbs and even the back and neck regions. Yes, even the spine, how many times have we felt back pain after a heavy bout of gardening or home DIY? This is a repetitive strain injury as a result of overdoing an activity and can affect the muscles, tendons or nerves in the affected region.
Most people have heard of RSI and would immediately think of injuries such as tennis elbow or golfer’s elbow. These are probably the most researched injuries and the literature abounds with information about these 2 injuries. It might surprise you that tennis elbow is often unrelated to playing tennis and non-golfers can be afflicted with golfer’s elbow. Interestingly injuries to the lower limb such as achilles tendonitis, plantar fasciitis and shin splints are also types of RSI – we will discuss these another time. This blog will focus on the upper limb.
What is a repetitive strain injury? Well, it is an overload injury to the soft-tissues (e.g. tendons, muscles and/or nerves). An overload injury means that a stress has been applied to the soft-tissues repeatedly or constantly and this accumulation of stress outweighs the tolerance of the soft-tissue. So, for example, typing is an activity that places some stress (albeit a very low-level stress) on soft tissues in the forearm, wrist and elbow. Whilst the soft tissue can handle a certain amount of stress, asking it to tolerate increased stress repeatedly may start to overload the tissue cells and cause microtrauma. This results in a ‘low grade’ inflammation that manifests as a slight soreness that is not too much of a bother. It is only when the stress is continued that the inflammation causes more soreness to the point when the person decides they have a real problem and seeks help.
Let’s go through the biomechanics of typing: muscles create the finger movement or wrist posture and the muscles attach to bones via tendons. By raising a digit to press on a key the muscle pulls on the tendons to lift the finger and the tendon relays that stress to the bone. All along the muscle, tendon or the tendon attachment-point into the bone, stresses are being exerted. Now pretty much all of us can type for long periods of time without issues. Let’s say that an individual has a poor technique at the keyboard and places more stress through their forearm than someone else – they have a greater chance of getting an RSI. Let’s add in another variable, workload, what if there was a surge in workload? Again, the risk is increased. Let’s keep adding stresses: the task of data entry – repeated use of only a few keys (hence reduced task variability)… Work stress, a short turnaround time for the work to be completed – all of a sudden the soft-tissues have to tolerate a higher volume of stress. What if the person has poor sleep patterns (e.g. parent to a newborn child) – less time to recover…how about a co-morbidity (e.g. diabetes or heart disease) – so the ability for that person to recover is less efficient versus a fit and healthy individual. There are hundreds of variables that might cause one person to get RSI versus another person…and vitally why some people recover faster than others. The information and answers people search for on Google are too generic for most people – the information may be ‘sort of’ correct…but does not take into account the person and the numerous variables that might be impacting on the recovery.
How does a physiotherapist at Nelson Bay Physio manage someone with a suspected RSI? This starts with making an accurate diagnosis through careful history taking, observation and testing. Occasionally a scan or investigation may be required but often this is not required. The background history to the injury is paramount in how we manage the injury. Applying therapy to the injury site is helpful in dealing with the symptoms, addressing the contributing factors to the injury is paramount in settling the condition and preventing the likelihood of relapses.
So how can you expect your physiotherapist to manage your injury? This may involve several of the following:
- Providing local treatment to the injured area.
- Splinting the joint in certain circumstances and normally only in the inflammatory phase of the injury
- Providing you with copious amounts of advice regarding how you can alter your working posture and tasks (i.e. ergonomics)
- Addressing any postural issues
- Advising on and providing ergonomic equipment
- Reviewing your workplace and workplace habits if necessary
- Analysing your daily tasks – basically everything that you do that may impact on your injury
Remember, one size does not fit all.
So when should I seek help if I am getting twinges?
Having the problem assessed early makes it easier to treat. If the episodes of discomfort are becoming more frequent and more uncomfortable…and less able to settle naturally on your non-work days or rest days…seek help. Leaving it beyond this point simply means it will take longer to recover and may mean more drastic measures need to be taken.
Written By: Austin Wiehahn