Repetitive Strain Injury

The acronym RSI stands for ‘repetitive strain injury’. The term does not infer a diagnosis in itself – it is an umbrella term for a hazy and frustrating group of symptoms in the upper limb. Using the term RSI is like the mechanic saying that the reason your car won’t start is because “there’s something wrong under the hood”.

In the case of RSI, the ‘mechanic’ has generally checked everything ‘under the hood’, and simply cannot find any concrete reason as to why the car won’t function properly.

RSI has repetitive overuse as its predominant causative factor, but it always has other factors associated with it, such as stress, poor positioning, lack of breaks, and depression. It is typically difficult to separate these issues from the condition, and recovery is, at best, frustrating, and at worst, negatively life impacting. RSI is an ‘over the top’ reaction to overload. Gen Y would abbreviate this reaction to ‘OTT’.

If everyone had the ability to take control of their own actions, this debilitating condition would no longer have a place. If your work is based at a desk, or you regularly perform repetitive activity with your hands, then reading through, and acting upon this chapter is crucial.


Anatomy Made Easy

Our arms basically consist of bones, muscles, ligaments, tendons, nerves and blood vessels.

When you were young, did you ever sing the song “The shin bone is connected to the…knee bone…the knee bone is connected to the…thigh bone”? (Google reveals this song is called ‘Dry Bones’).

Whether you have been enlightened with prior experience of this song or not, the principle that it conveys is quite poignant:– everything in our body is connected.

In the case of our arms, our chest bone (sternum) is connected to our collarbone (clavicle), which is connected to our shoulder blade (scapula), which is connected to our upper arm bone (humerus), which is connected to our forearm bones (radius and ulna). The wrist then connects into a myriad of small hand bones. Ligaments hold all of these bones together. Overlying this bony structure are muscles, which fuse onto the bones via tendons. The muscles activate to move our joints around. Nerves, which exit from our neck and then travel right down the arm, allow us to feel touch, temperature, and pain.

As you can gather, our arms have many moving parts, and movement is the system’s way of staying healthy, and in working order. By moving all joints in all directions everyday, and by activating all muscles and tendons in different ways everyday, the skeletal, muscular and nervous systems in our arms stay healthy.


What Goes Wrong

As we have discussed in previous chapters, we tend to move a lot less than we used to. The movements we are involved in tend to be repetitious, for example typing on a keyboard, writing a conversation of SMSs, operating a specialized piece of machinery, or driving.  This repetitive activity can often lead to overload and damage, somewhere along the ‘body line’. As all our body’s structures are connected, this can affect things further along the ‘line’.

Picture a lady who uses a computer keyboard a lot. Due to a poorly set up workstation, fatigue from a large workload, and stiffness in her upper back, she often slumps in her chair while she is working. This sets up a less-than-ideal pattern of muscle activation in her shoulder, elbow, wrist and hand. This poor positioning, combined with the sheer volume of time spent in it, leads to some muscles working harder than they should, and others becoming lazy.

Over time, something has got to give, and this is often a tendon, which develops pain. Often this occurs in the wrist area. As the lady continues to work with the tendon pain, the nerves in the area become sensitized, the lady becomes anxious about the pain. Muscle imbalances become more extreme, the lady gets upset, the boss gets annoyed at her decreased abilities, the tendon gets sorer, the nerves get more sensitive, the lady gets more stressed and…round and round and round it goes. Once this cycle has developed, it is very hard to break, and it is very hard to separate out all of the different contributing factors.

Even if the original sore tendon heals and settles down, the pain can continue. People often think this means they are still ‘broken’ or injured. In reality, they feel the pain because the nerves and muscles are sensitized, weak and tight.

Turning this spiral of pain and distress around is possible, but it is time consuming and takes diligent effort on the patient’s part.

Take the easy road, and prevent RSI from happening in the first place!


Take Action Before You Break


Naturally, you have to make sure your desk is set up well. Even with the most ergonomic desk set up money can buy, however, the bigger risk factor is still lack of variety of movement. If you are reading more than typing, go and stand, kneel or lie on your tummy. Make a cup of tea for yourself, rather than getting someone else to do it for you. Better still, volunteer to walk up the street for the coffee run to supply everyone’s caffeine hit (not that I am advocating caffeine addiction!).

Use your lunch break to walk around and use your legs, rather than your arms.

Make sure you are doing some general fitness work, and maintaining a healthy weight, to keep your tissues resilient and healthy. Manage your workload through open communication with colleagues and bosses, and try to get adequate sleep.

Prevention of RSI can therefore be summed up by two words: MOVE and BALANCE. Keep moving, and find balance in everything you do – not too much of any one thing!


Injury Proof Toolkit:

          1)  Change Your Environment

  • Make sure you have a good workstation set up:
  • Computer screen should be at eye level
  • Keyboard should be elbow height
  • Knees should be bent to 90 degrees, with feet firmly on the floor or a foot support
  • Sit with your bottom at the back of the chair, back straight, shoulders back


        2) Change Your Habits

  • Get up from your chair for a minimum of 10 minutes every hour for the first three hours, then 5 minutes every half hour after that
  • If at all possible, keep computer use to a maximum of 4 hours a day, 5 days a week
  • Take every opportunity to get into different positions instead, eg lie down to read, watching TV from the exercise bike
  • Take every opportunity to do non sitting activities – walk at lunchtime, post mail, chat at the water cooler!