What is Repetitive Strain Injury? – Preventing RSI Part 1

What is Repetitive Strain Injury (RSI)? It’s a question that’s important for everyone, particularly if you work in an office.

You made it! I’m so glad you’re here. This is the place to get the complete low down on the answer to the question “What is Repetitive Strain Injury (RSI)?” at your computer.

It could be a PC, a Mac, Linux desktop, laptop, or tablet: whatever it is you use to get stuff done, Repetitive Strain Injury is still an important issue.

What Is Repetitive Strain Injury (RSI)?

Repetitive Strain Injury, or RSI for short is sometimes a bit difficult to pin down. Most people have heard of RSI, but may not understand what it actually is.

You may have heard references to conditions like carpal tunnel syndrome, or “tennis elbow”. In fact, the media and medical websites are sometimes awash with such terms.

So, what is Repetitive Strain Injury?

The UK National Health Service (NHS) defines it in this way:

“Repetitive strain injury (RSI) is a general term used to describe the pain felt in muscles, nerves and tendons caused by repetitive movement and overuse.

It’s also known as “work-related upper limb disorder, or non-specific upper limb pain.”

Make sense? No?

Here’s my translation or paraphrase, as it applies to the office world:

Repetitive Strain Injury may happen when a particular movement (such as mouse movement and clicking), is performed over and over again.

In and of itself, as part of one day’s work, these movements shouldn’t be a problem…

However, over a period of time, the repetition causes ongoing symptoms of pain and discomfort. Worse, the pain continues even after these movements have stopped and affects life beyond the normal working day.

I must also extend that definition further, because RSI can also be caused by a repeated position:

When you hold yourself still for a long period of time, tension develops in the muscles of the upper body. Poor posture also plays its part in this. Whether this happens consciously or unconsciously, you may also set yourself up for the same issues, as if you performing repetitive movements.

What Is Repetitive Strain Injury And How Does Ergonomics Help?

If Repetitive Strain Injury is the problem, ergonomics is the cure.

So what is ergonomics?

According to the Collins English Dictionary, ergonomics is defined as follows:

“Ergonomics is the study of how equipment and furniture can be arranged in order that people can do work or other activities more efficiently and comfortably.”

So ergonomics looks at how your environment can be modified to prevent or reduce the effects of Repetitive Strain Injury.

But it also studies individual objects in your environment too. For example, one mouse may have much better ergonomic properties than another.

From a business management point of view, ergonomics is particularly concerned with ensuring that employees work as efficiently as possible.

In 2008, the Society of Physiotherapy reported a sharp rise in the number of cases of Repetitive Strain Injury, across all industries. In this article they note that:

“RSI costs employers almost £300 million per year in lost working time, sick pay and administration. An estimated 3.5 million working days were lost in 2006-07 due to RSI, with each person affected taking over 13 days off sick. However, RSI is usually preventable or treatable with help from an occupational physiotherapist.”

For individuals, like you and me, comfort is probably the first priority. But efficiency certainly helps you in your job too!

I tackle ergonomics in detail here on ergonomictoolbox.com, but before we get into all that, you need to know more about Repetitive Strain Injury and how it can affect you.

What Is Repetitive Strain Injury? Why is RSI important?

If you’ve never suffered with RSI before then you may be thinking, “So what? Why should I be worried?”

However, if you have experienced RSI, then you’ll be all too familiar with the issues. You’re probably desperate for any information that can help you get away from the pain and strain (but we’ll get to that).

Either way, you need to know what you’re getting into – or more likely, what you’re already up to your eyeballs in!

In short, you need to know more about RSI, because:

• the effects of RSI are more debilitating than most people think.
• some people are more susceptible than others.
• it’s more common than you might expect.
• it’s really bad for you.
• if you’re a manager or business owner, RSI is bad for your employees and ultimately bad for your business (aka a productivity sink).

If you’re still not convinced, then check out the stats in the next section: they’re quite an eye opener…

Wha is Repetitive Strain Injury? Who gets RSI?

Pretty much anyone can get Repetitive Strain Injury, but some people seem to be more vulnerable than others.

Globally, across all job types, it’s estimated that as many as 1 in 3 people will get RSI at some point in their working lives.

Certain professions and work environments are more likely to be affected, although statistics are notoriously difficult to come by:

I did manage to find this page regarding the US labour force, but could not find the original sources.

However, one thing is clear:

Increasingly, office workers are affected, particularly those who work long hours on PCs and laptops.

One 1990s UK study drew various conclusions, including:

“Responses to a questionnaire completed by 3503 keyboard users …showed that approximately 55% had experienced symptoms associated with upper limb disorders at some time and 49% stated that they had experienced such symptoms within the preceding three months.” [Bold added for emphasis]

And:

“Those who spent most time using a keyboard or who had the longest periods of keyboard use without a break were significantly more likely to be a case. This held for all syndrome groups when the influence of age, gender and medical conditions was taken into account. This association was highly significant.”

As far back as 1999 a report by the Society of Physiotherapy said:

“RSI affects many thousands of workers in a wide variety of occupations and is certainly not associated solely with those jobs traditionally involving repetitive work, such as keyboard workers, although this group certainly exhibits the greatest prevalence.”

The report also names “display screen equipment users” as part of a list of at risk industry workers.

I used to be one of them. That’s why I share my experiences here: to help people like you find ways of working that will stop RSI and prevent it coming back.

What is Repetitive Strain Injury? Where does it hurt?

Just as RSI can affect anyone, so it can also affect almost any part of the body.

It tends to cause pain in the joints and muscles, particularly in the upper limbs.

Repetitive Strain Injury is most common in:

• forearms and elbows
• wrists and hands
• neck and shoulders

It may also be found in and around the spine and back muscles, although this typically happens as an extension to pain from elsewhere.

For example, pain in the neck and shoulders often results in tension passing down through the body, and hence into the upper and lower back.

What is Repetitive Strain Injury? What are the causes of RSI?

Repetitive Strain Injury is caused by:

• repetitive activities.
• doing a high-intensity activity for a long time without rest.
• poor posture or activities that require you to work in an awkward position.

Various tasks on a computer could be classed as repetitive activities. Typing is one, and clicking with the mouse is another.

Some repetitive activities are more likely to cause problems than others.

For example, in my experience, more people seem to be negatively impacted by using the mouse, than by typing.

But Typing very quickly, making mistakes – and correcting them – for several hours in one go (perhaps due to an approaching deadline) will leave you aching.

However, poor posture will have a greater impact than either of these.

Stooping to look at your laptop screen, while performing any computing task will further compound the effects.

For most people, one day operating like this is fine. It’s what happens to the body over weeks or months that will turn a simple ache into a burden of pain.

What is Repetitive Strain Injury? What are the symptoms?

RSI symptoms include a variety of issues in the upper body, including:

• pain, aching or tenderness
• stiffness
• throbbing
• tingling or numbness
• weakness
• cramp

The specific symptoms may also vary widely between individuals:

Some may feel pain whenever they move, others experience aches with certain types of movement.

Some people get numbness, tingling, or “pins and needles” sensations. Finally, some will have combinations of some, or all, of the above.

The important thing to remember is that any of these symptoms may be the beginning of something much more serious.

It is therefore a good idea to implement better ergonomics as soon as possible, to prevent any deterioration.

What is Repetitive Strain Injury? How is it diagnosed?

When you see your doctor, they will check your symptoms and test for specific conditions.

If the condition isn’t obvious, they may send you for further tests. This could include X-Rays or blood tests to rule out other issues.

They may also ask you about your work place and whether your employer is doing anything to help.

If no specific condition is found, then you may be diagnosed with “non-specific” or “diffuse” RSI or upper limb pain syndrome.

What Is Repetitive Strain Injury? What conditions does RSI cause?

Repetitive Strain Injury manifests as a number of different medical conditions and syndromes, including bursitis, carpal tunnel syndrome and tendinitis.

It’s important to understand that some of these conditions may be caused by other issues such as trauma, not just by repeated movements. However, I list them here for your reference.

Bursitis

– A bursa is a fluid filled sac that forms a “cushion” between bones, tendons, joints and muscles, in various parts of your body.

Bursitis is when one of these bursae (plural of bursa) gets inflamed. It’s commonly found in the shoulders, elbow, knees or hips. Bursitis causes pain, inflammation and tenderness in the affected area.

Carpal tunnel syndrome

– This well known condition is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist (may also have restricted blood flow). Sufferers experience numbness and pain the hand.

Cubital tunnel syndrome

– Compression of the ulnar nerve as it passes through the cubital tunnel in the elbow causes this syndrome. In turn, it creates numbness and tingling in the little and ring fingers.

DeQuervain’s syndrome

– This is a specific form of tenosynovitis (see below) affecting the tendons of the thumb. Causes pain in the base of the thumb and into the lower arm.

Dupuytren’s contracture

– Uncommon deformity of the hands, where connective tissues in the palm contract and stiffen, over time. Causes fingers to bend inward into the palm of the hand.

Epicondylitis (“Tennis Elbow”)

– Common repetitive strain of the elbow, often formed by repeated twisting motions. Involves inflammation of the tendons around the joint. Causes pain and tenderness in the elbow itself, and may also include pain in the wrist, when twisting or gripping objects.

AKA Golfer’s or Tennis Elbow (according to which part of the elbow and arm is affected). When I was a teenager, my dad got tennis elbow from doing archery with a bow that was too heavy for him.

Focal Hand Dystonia (“Writers Cramp”)

– Involuntary muscle spasms and movements, usually concentrated in the fingers and hands, but can occur elsewhere.

In the writer’s cramp form of this condition, may result in:

• wrist flexing.
• excessive grip on the pen.
• dropping of the pen due to sudden extension of a finger.

Less commonly, may also cause cramps and aches in the hands, fingers, wrists or forearms.

Ganglion cyst

– Fluid filled swellings, that tend to form on top of joints or tendons.

These are colloquially known as “a ganglion”, but this is a misnomer:

• A ganglion is simply a bundle of nerve cells: structures found throughout the nervous system.
• A ganglion cyst is where one of these ganglions becomes inflamed and fluid filled.

Harmless, but may occasionally cause pain in the affected area. Often settle down on their own.

Raynaud’s Disease

– Blood supply to the extremities (usually fingers) is interrupted, causing them to become blue or white, due to the lack of blood flow.

May be caused by vibrating machinery. Causes numbness, tingling and pain.

Rotator cuff syndrome (“Tennis Shoulder”)

– Inflammation of tendons (tendinitis/tendonitis) and muscles in the shoulder.

Causes pain, stiffness, swelling.

May also cause pain and clicking sounds when raising or lowering your arm.

Sufferers may also experience weakness, or loss of mobility in the arm.

Stenosing Tenosynovitis (“Trigger Finger”)

– Tendon and tendon sheaths of fingers or thumb get inflamed.

Causes fingers or thumb to get stuck or locked in a bent position.

Common symptoms include painful popping or snapping when bending or straightening the affected digit.

Among workers using vibrating power tools, may also be known as “white finger”.

Tendinitis/Tendonitis

– Inflammation of a tendon. Includes specific categories, such as carpal tunnel syndrome, and tennis elbow.

Commonly affects joints in shoulders, elbows, wrists and hands.

Causes pain, swelling and stiffness.

Tenosynovitis

– The sheath around a tendon gets inflamed.

DeQuervain’s syndrome and Trigger Finger are specific kinds of this condition.

Causes pain, tenderness, stiffness and swelling around the affected joints.

Thoracic Outlet Syndrome

– Compression of nerves and/or blood vessels in the thoracic outlet, between the lower neck and axilla (armpit).

Causes pain in shoulders and neck, and numbness in fingers.

Ulnar collateral injury of thumb (“Gamekeeper’s/Skier’s thumb”)

– The ulnar collateral ligament in the thumb is torn, or damaged. Commonly caused by a small fracture just behind the ligament.

Causes pain, swelling and subcutaneous (just under the skin) bleeding around the damaged area.

Symptoms include pain and weakness, when making a pinch grasp movement.

Important!

If you think you have any of these conditions, or their symptoms, then don’t waste any time: go and see a qualified medical professional asap.

The sooner you can get a diagnosis, the sooner you can start the right treatment and the sooner you can return to full health.

Some of these conditions can get progressively worse over time, so the longer you leave it, the more likely it is to delay your recovery.

What is Repetitive Strain Injury? What is Diffuse RSI?

I’ve left this one until last because it’s a biggy!

Diffuse RSI involves generic pains, strains, stiffness and aches, but where the there is no physical (medical) issue found. In other words, the diagnosis is non-specific, or there is no diagnosis.

In my experience, the majority of RSI sufferers are in this category.

I believe there are a number of reasons for this:

1. Some people are unaware of the connection between computer use and their aches and pains.
2. People may feel embarrassed about “little pains” and/or play them down, not realising that they can quickly become a much bigger issue.
3. Doctors may be unwilling to pronounce a diagnosis, because that makes it their problem to fix: the employer should deal with it in the first instance. (After all, simple changes to the work environment are often all that’s required)

But it doesn’t have to stay like that. Armed with just a little knowledge, everyone can make a difference, not only for themselves, but for others.

What is Repetitive Strain Injury? How is RSI treated?

Each of the above diagnoses has its own related treatments and therapies, but they usually fall into one of several categories:

• simple exercises
• adjustments to your workspace
• new or different equipment
• physical therapies
• physical aids (such as splints or bandages)
• surgery

Obviously, we want to avoid the ones further down the list as much as possible. And for the majority of folk, a few simple adjustments will suffice to keep Repetitive Strain Injury at bay.

Exercises may be as simple as gripping a squishy ball, or doing some gentle stretches every half hour, or so.

Adjustments to your workspace, and related equipment, is typically where you’ll see the biggest gains. It’s also where you’ll find the best methods of prevention. It’s the main focus of this website, and of my training course, the Ergonomic Toolbox.

To get a head start, try some of the links in the section at the end of this article.

But first, let’s have a look at how your employer can help you.

What is Repetitive Strain Injury? What should I expect from my employer?

Whatever country you live in, you’ll find that there are laws and regulations pertaining to the use of computers and office spaces.

In the UK, these are known as the Display Screen Equipment (DSE) regulations, and in the USA, the Occupational Safety and Health Act.

Your local regulations should cover things like:

• The general environment (heat, cold, light levels)
• How workstation assessments are carried out
• What to do if you have issues with your work space
• Your employer’s responsibilities regarding all of the above

Workstation assessments vary from one employer to another. At their simplest, they consist of a simple form to fill out. You may, or may not, receive guidance on how to do this.

More sophisticated assessments involve online multiple choice exercises. And in the best cases, you’ll get an individual appointment with an HR manager.

However, employer’s attitudes towards workstation assessments vary a lot: some view it simply as a check box exercise, so they can prove they comply.

Bottom line: if you’re unhappy with how comfortable you are at your desk, raise it with your line manager or HR department. – You’re worth it!

What is Repetitive Strain Injury? Helpful websites

Here’s some other websites with general information, you may find helpful:

NHS: Repetitive Strain Injury

BUPA: Information on Repetitive Strain Injury

Health and Safety Executive: Ergonomics at work paper

What is Repetitive Strain Injury? How do you stop RSI?

There are a number of things you can do to prevent Repetitive Strain Injury. The main advice is to look at the following areas, in more or less this order:

1. Alter your work environment

We’ve established that Repetitive Strain Injury is caused by repetitive movements, or repeatedly held positions.

These movements and positions are largely dictated by your work environment: how it’s setup, and the type of equipment you use.

It therefore follows that changing that environment can help to prevent RSI.

2. Spend less time in that environment

Similarly, it also follows that spending less time at your workstation will help prevent RSI.

While you probably can’t change the hours you work very easily, most roles allow for time away from your desk.

Whether you make sure you take breaks, or go to those dreaded meetings, there are ways and means to change up how you work.

3. Strengthen your body

If you’re a couch potato at home, and spend your workday sitting down, then you can’t expect your body to cooperate for very long.

Light strength training can be helpful to prevent the kind of upper body disorders we’ve been discussing.

However, any level of increased fitness will help. Even the simple action of taking a regular lunchtime walk gets your muscles moving again, removes stiffness, and improves your overall wellbeing.

4. Strengthen your mind

Getting away from your desk has another benefit: rest and restored perspective.

When you’re in the middle of a busy day, stress and tension tends to build up, without you realising. But a change of scenery helps to dissipate that stress.

Less stress means you’re more relaxed, which means less RSI and hence, increased productivity.

Of course, that’s all well and good, but what are the specifics of how you do these things?

I’m out of space for this article, but here are some others you may find useful:

• Reduce And Manage Your Time
• The Evils Of Mice
• The Ergonomic Keyboard
• Mouse Alternatives (Trackballs)
• Mouse Alternatives (Tablets)
• Mouse Alternatives (Ergonomic Mouse)
• The Importance Of Posture
• Gripmaster Hand Exerciser
• 5 Free Software Tools To Prevent RSI
• How High Should Your Chair Be?