Repetitive Strain Injuries (RSI)

Repetitive strain injury has become a generalised term for conditions derived from repetitive actions. So the category ‘RSI’ suggests the cause or maintaining factor of the presenting symptoms, but due to its lack of accuracy is not a complete diagnosis.

An Osteopath or other good diagnostician may for example, gleen from the patient’s history of prolonged periods of typing and an examination with positive signs of pain and swelling over the tendon the RSI appears to be tendonitis or tendinopathy. Other musculoskeletal, neurological or vascular dysfunction such as muscular adhesions, muscular tension, nerve entrapment and vascular disorders may be at the root of many of these RSIs.

The rise of RSI is generally attributed to the small repetitive motions such as the action of typing on a computer keyboard and clicking a mouse. Common areas affected are the hands, thumb and finger joints, wrist, elbow, knee, shoulder and neck.

The most likely occupations and activities which predispose to RSI are computer work (excessive keyboard and mouse use), carpenters, Cell phone smsing (Blackberrys, iPhones etc…), chefs, desk work/studying (writing with pen/pencil, Decorating, driving, activities involving prolonged periods of gripping), mechanics, Work with microscopes, musicians, excessive pruning or Shearing and sportsmen (Tennis and Golfers elbow are examples of repetitive strain caused by over-play and poor practice). and anyone who performs a repetitive task are the most likely candidates. When looking at the cause of RSI it is also necessary to look at the strain on muscles of sitting for long periods in a fixed position as well as the stresses of repeated arm, hand and finger action.

The muscles of the arms are not biomechanically made to deal with short and fast motions for long periods of time. Prolonged contraction of these muscles reduces blood supply. Glycogen which is stored in the muscles and used as energy is quickly used up. When the glycogen is depleted, arm muscles work very inefficiently. This fatigue with forced repetitive movement not only stresses the muscles but causes tiny tears in some of the small muscle fibers called fibrils. When the muscles and tendons continue to be used without appropriate management to ensure healing, the process of fatigue and strain is accelerated.

If the body does not recover from this, more muscle fibres will get shorter and tighter, but the opposing muscle groups are unchanged in length. For example when typing, the muscles used to tap the keys (flexor muscles on the inside of the forearm) would shorten more than the opposing extensor muscles. This muscle imbalance will create a musculoskeletal imbalance and further problems. The natural position of the wrist joint will be shifted due to the shortened muscles which will in turn put stress on the wrist and the associated carpal tunnel. The stability of the joint may be compromised leaving the person more susceptible to other injuries from pulling or twisting motions.

Abnormal joint position or istability could predispose the joint surface to wear prematurely. Wear and tear of the articular surface of bones is called osteoarthritis. Prolonged muscular imbalance accelerates the development of osteoarthritis.

Muscle tone and balance is crucial for joint health and flexibilty.. Too much muscle tension will limit the range of jont motion and keep the joint under excessive compressive forces, potentially leading to early wear and tear of the joint surface. Poor muscle tone will allow the joint to be hyper mobile and not be properly stabilised. This can create undue stress have negative long term effects on the ligaments of the joint.

In a normal functioning muscle the fibers that make up a muscle glide over one another during contractions, however with muscle tension and repetitive strain this gliding action becomes limited and often small painful bumps are palpable in the muscle. These are call adehisions. Adhesions are a sign of a chronically contracted muscle. They can be treated effectively through Osteopathic treatment which includes deep massage, myofascial release, postural management.

A tendon is the tapered end of a muscle which attaches to the bone..The muscles that control the fingers are in the forearm and the tendons have to pass through a small tunnel (called the ‘carpal tunnel’) with arteries and nerves. These tendons can be subjected to friction especially with certain positions of the wrist. Repeated friction can cause micro tears and which will eventually cause the tendons to become irritated and start an inflammatory response (tendonitis). Osteopathy is one effective therapy which helps support recovery of the slow healing tendons. Tendon damage is often a later consequence of poor ergonomics and consistent overuse. Your osteopath will be able to advise you on correct sitting posture and ergonomic setup.

Ligaments are fibrous bands of non elastic tissue that hold two or more bones together at a joint.and are the barrier at the end of joint motion. Ligaments are damaged by a joint moving beyond its normal range of motion such as the excessive motion associated with whiplash. Ligaments also heal very slowly and are often left weaker post-injury. Muscles and ligaments work in unison to maintain joint health and stability and when component fails to work efficiently, it shifts the load to the other. Poor muscle tone and/or muscle imbalance will shift more of the joint stability load to the ligaments which will lead to ligamentous sprains or even tearing of the ligaments.

As a nerve or blood vessel passes through a space between tense muscles and/or gaps between bones which are misaligned it may become irritated as a result of build up of inflammatory fluid building up in the space therefore creating pressure or chemical irritation on the nerve or even direct pressure from the actual structure.. Chronic pressure or irritation often produces the classic numbness, tingling and weakness . When the structural imbalance can be identified it can then be treated appropriately.

Ways to avoid RSI
Awareness is the first and most important step on the path to a safe and healthy work practice
Correct sitting posture. Proper seating is important for proper posture. The best kind of chair is firm and provides support up and down the entire spine, but allows a space for the bottom to fit through at the back. Good sitting posture is as follows. Sit on the chair. Bend forwards, then wriggle your bottom back as far as possible until your spine meets the back of the chair. Then sit up. You will find that your lower back is concave and the remainder of the curves of your spine are well supported and automatically relaxed. Most importantly, you will find it difficult to slouch. If you find this uncomfortable, it’s because you aren’t used to it. It is important to assume this posture no matter where you sit. Avoid sitting on stools, as they offer no back support, and the softer a chair is, the more important it is to sit in the correct position. Ideally the chair you sit on should have a space at the back for your bottom to fit through.

Mouse close to keyboard

Elbows by your side

Top of monitor at eye level or just below

Stretches. Many forearm, shoulder, hand and wrist stretches can be performed without leaving the desk.

Avoid awkward and rigid positions. You will make your work harder for yourself by putting objects further away from your body than necessary, using inappropriate equipment for the job at handl and over contracting muscles to complete a simple task.
Warning signs of RSI
• Pain – usually increasing by the end of the day
• Cramping – especially in the forearm and hands
• Slight weakness
Advanced signs of RSI
• Pain – at rest and any activity using the affected joints/muscles even if it’s not the repetitive task
• Profound weakness – for example inability to pick up pencil or coffee mug
• Loss of fine motor skills
• Pins and needles
• Numbness

If anyone is experiencing any of these symptoms osteopathic consultation should be sought. Osteopathic treatment can really help with this difficult syndrome. This can be done by appropriately easing joint movement, muscle tension and stretching tissue to allow much better function. This is where a long term return to work strategy can be achieved.

Once advanced symptoms have occurred intervention must be performed to avoid long term pain and disability. As with most musculo-skeletal conditions the sooner something is addressed the better