Our guide to Repetitive Strain Injuries is designed to provide you with everything you need to prevent, define, diagnose and treat RSIs. We discuss what they are, how they are caused and what you can do in day-to-day life to make sure you don’t suffer from them. You can skip to any of the sections here:
What Is A Repetitive Strain Injury?
Repetitive Strain Injuries are a symptom of modern life and were all but unheard of before people spent their days sat at desks for hours on end. Caused by physically repeating the same actions regularly and over an extended period of time, RSIs can have a profoundly negative effect on the lives of those who are unfortunate enough to suffer from them. What's worse is that RSIs are by no means the 'end result' and if they are ignored or not properly addressed in a timely fashion they can develop into long-term ailments which will impact on every aspect of an individual's life.
As it stands currently, around 15,807,500 people in the UK work in an office orientated environment, which is roughly a quarter of the population. What's worrying is that of that near 16 million people, very few will be informed about the risks that RSIs pose, and the majority will not even be aware that such things exist or are even remotely prevalent. It should therefore come as no surprise to learn that of those UK-based office workers, over 65% will suffer from an RSI at some point; which equates to a number greater than the populations of Birmingham and London combined.
RSIs are cumulative trauma disorders which means so long as you are in a situation where repetitive actions are regularly being performed you are susceptible; even if you have been doing the action for years and have never had a problem. In fact as time goes on you will become increasingly more susceptible, as the years sat hunched at a desk will have a detrimental effect on your posture; and it is more than likely that your physical health will take a hit as your work and family commitments grow, and going to the gym regularly starts to become less and less feasible.
What Causes A Repetitive Strain Injury?
One of the things which make RSIs so irritating is the knowledge that with the right equipment and a little bit of training they are quite easily prevented; the issue lies in the fact that their underlying causes are seemingly small and insignificant. This mind set leads to a lot of people ignoring their symptoms, thinking that they will go away on their own, or that by making a fuss they will appear petty; what they forget is that anything, even a good thing, can become destructive if taken to excess.
An RSI is nothing if not an injury of excess, as spending one day typing for 8 hours will not cause you any hassle, but spending 5 days a week for 11 months straight most certainly will. This is because the movements your body performs, even the small, innocuous ones, will cause wear to the muscles that control and are around it; though it is a very minor thing. It's similar in many regards to weight training, in which muscles are purposefully damaged and torn so they will become stronger once they've repaired; if they are pushed too far or too soon however they will become inflamed and painful; an RSI can basically be this, but on a smaller scale.
Another cause of repetitive strain injuries is that the tissue which covers your muscle tendons dry out and no longer have the ample supply of lubricant that is required to keep them chafing. Of course given time the fluid that acts as lubricant will replenish, but it will be quickly spent if sufficient time is not allowed for it to recover and it can diminish again just as easily. Even if a full recovery is allowed, if the repetitive action starts up again the damage sustained before will quickly make itself apparent, and the symptoms will worsen as new ones develop, culminating in long-term damage and chronic pain.
Why Do Repetitive Strain Injuries Occur?
When sat at a desk for prolonged periods your muscular and skeletal structure experience fatigue and sustain damage caused by the constant muscle tension in your back, legs and torso, which are constantly put under load in an effort to keep your upper body upright. This will inevitably lead to soreness and discomfort which will instinctually cause you to shift in an attempt to gain a respite; resulting in the body assuming unnatural, contorted seating positions that will only serve to further the development of a chronic RSI.
In truth there are a myriad of reasons why RSIs affect the human body and whilst there are too many to count, they all basically come down to a lack of balance. The human body operates on synergy, with one area acting optimally until another area is required, allowing it to rest. Humans were not designed to spend hours on end sat down and even with ergonomic aids, which will alleviate or delay the onset of RSIs, nothing can match the benefits of a wide range of bodily motion.
Symptoms of Repetitive Strain Injuries
There are a number of symptoms that are general to RSIs, and some that are more specific to the individual types. Moreover the symptoms are so numerous and varied that it is unlikely that you will suffer from all or even a small number of them; your only recourse is to be aware of what the causes are, and remember the following symptoms, which are amongst the most common:
- General lethargy and fatigue
- Muscular weakness in the forearm, hand and digits
- Loss of physical endurance
- Tingling or numbness
- Clumsiness or lack of dexterity & articulation in the fingers
- Decreased co-ordination
- Constantly cold hands (caused by impaired blood circulation)
- Increased awareness of a specific limb or general area, resulting from increased sensitivity & nerve stimulation
- Automated massage reflex response engaged in an attempt to subdue & relieve discomfort
- Empathetic pains brought on by seeing or hearing about others with finger or hand pain
- Difficulty dressing yourself & others, such as children
These are by no means the only symptoms but so long as you are aware of them and remain vigilant, it is more than likely that you will be able to catch an RSI early in their development and can swiftly take steps toward remedying yourself.
As stated previously, many people see RSIs, initially at least, as a petty qualm, and will try to power through it in the hopes that it will just pass on its own. For this reason it may be necessary for you to keep an eye out at home or around the work place as, if someone you know is silently suffering through a repetitive strain injury, you will be able to help them by recognising the behavioural indicators that denote the physical symptoms:
- Avoidance of utilising a targeted limb or appendage
- Regular use of non-dominant limb or appendage
- Use of connective limbs to accomplish tasks e.g. using forearms to pick up cups or hold doors, using teeth to hold paper when one hand is free
- Using two hands for a task that ought to only require one (using the non-dominant hand to compensate for the loss in strength)
- Extreme change in dressing habits or dressing inappropriately for the weather, because putting on a coat or holding an umbrella would result in too much pain or discomfort
- Change in established behaviour, such as carrying in less shopping per trip, no longer playing sports or going to the gym
- Eating takes considerably longer (due to loss of articulatory agility)
- Eating with hands, rather than cutlery
- Avoidance of tasks that require dexterity or acute articulation e.g. using jewellery clasps, bra hooks, writing, drawing, etc.
- Tender wrists & fingers may result in the removal of rings, bracelets and other jewellery
- TV remotes, video game controls and the like will feel cumbersome & difficult to use
- Difficulty turning pages, opening bottles, using keys, pens, pencils, toothbrush, phones, keyboards and other similar items
Treatment For Repetitive Strain Injuries
The first step in treating any affliction is to get a definitive diagnosis, and as usual, the sooner you do so the better off you will be. There is no benefit to putting off a visit to the doctor and hoping that your symptoms will just go away by themselves, as unless you undergo a radical change of lifestyle on a whim, your condition will only deteriorate and worsen.
Getting a diagnosis for an RSI can be challenging as it affects the body in different areas and does not have a singular symptom that is unique to itself, nor a physical manifestation that can be seen and witnessed; the only symptom is your pain and discomfort. Because of this your doctor may not necessarily jump to the conclusion that your pain is the result of an RSI, and unless you have one of the more common types, such as tendinitis or Carpal Tunnel Syndrome, the pain may get confused as a symptom of another condition, such as the bruising of a muscle or some other acute affliction that will clear up on its own.
This is not ideal as your pain will only worsen until a diagnosis is found and treatment is provided. It is frustrating but on the upside as your discomfort becomes more pronounced so too will the cause, allowing your physician to diagnose it more accurately and possibly refer you to a specialist who is more adept at treating your particular injury; most commonly an orthopaedist, rheumatologist, physiatrist or chiropractor.
How your doctor may suggest going about the treatment of an RSI will depend greatly on at which stage of development you have caught the injury. If you have caught it early on your doctor may simply prescribe that you rest the affected area, allowing it to heal, and also inform you of methods that will allow you to avoid future recurrences. On the other hand, if the injury goes untreated and has been allowed to worsen you will be at an ever increasing risk of developing a permanent impairment or disability; one that can only be corrected, or possibly only lessened, by surgery and physical therapy.
There is of course a middle ground, in which the condition has developed to the point that rest alone will not suffice, but surgery is not yet necessary. If your RSI is diagnosed as damage sustained to an area of soft tissue for instance, then your doctor may recommend the use of a splint to restrict the movement of the damaged tissue without fully immobilising it; which is the ideal method of healing such an injury.
Other, less invasive treatment that may be prescribed to you are anti-inflammatory medications or cortisone (steroid) injections and cream. You may also be prescribed medication to help manage the pain of the injury, such as Aspirin or Ibuprofen, but these should be taken sparingly and with caution, as while they're preventing you from feeling the pain of the RSI, you may perform actions that will further exacerbate your condition, bringing you a step closer to the necessity of a surgical solution.
Preventing Repetitive Strain Injuries & Relapses
It seems pointless treating an RSI if, once it is healed, you continue performing the actions that gave you it in the first place; especially as many of the symptoms will simply pick up where they left off, not start again from scratch. All of the following information will help prevent an RSI from recurring, but will also work as a means of preventing them from developing in the first place, so please take note.
Preventing an RSI from developing is not as simple as buying ergonomic office accessories and furniture, such as monitor risers, angled laptop stands, mouse mats with wrist rests, etc. This is not to say that they are not incredibly useful tools, but without making other lifestyle changes, these ergonomic devices will do you as much good as wearing a nicotine patch whilst smoking a cigarette. This is where most people will flounder, as the prospect of having to make small changes to the way we conduct our lives often puts people off. What you need to bear in mind is that it takes 21 days for a habit to form, so altering your daily routine slightly will cause you much less hassle in the long-term than an incredibly painful, potentially debilitating chronic injury.
Repetitive Strain Injuries are often preceded by muscle soreness and aches which act as something of a warning sign. Treating these will work to alleviate an RSI before it has the chance to manifest itself and fortunately they are easy to treat. Muscle aches are often caused by a tightening of a muscle due to strain being placed on it for an uncomfortably long duration and can be treated using simple remedies; usually involving hot, cold or mentholated sensations, coming in the form of a spray, pack or rub-on cream. Hot baths and massages also help as they have a calming effect on the body and help relax tight muscles.
Changing your lifestyle is all about changing your mind set and shifting your perceptions, so it helps to reason things through, understand why you are doing them and know exactly how they help. It will come as no surprise that one of the best ways to ward away an RSI is to engage in regular exercise, but not necessarily the kind that will require you to spend an hour every evening at the gym.
In fact one of the best things you can do for your body is perform simple stretches, as doing so provides your muscles with oxygen-rich blood, which helps to repair any damage and will also prepare them for work. Remember, a good deal of Repetitive Strain Injuries are caused by muscles remaining tense and engaged for long periods of time, which is what occurs during exercise; so stretching (warming up) before you sit down at your computer will at the very least make your muscles aware that they are about to be put under stress, putting them on their guard.
Preparing your body is a very important step, the usefulness of which should not be underestimated. Letting your body know that hardship is imminent by stretching does this, but it is like being told you have to do a presentation two hours before you need to do it; there is only so much preparation that can be done. To truly protect your body advanced warning is needed, as is adequate time to prepare, both of which can be accomplished by strengthening your body and making it more resilient by partaking in daily exercise.
Stretches & Exercises
Once again, these exercises do not need to be as rigorous as the kind that Usain Bolt undertook when training for the Olympics, but by performing a variety of different exercises you will be able to strengthen more areas of the body, which will bring about greater benefits and more apparent results. At the very least, the following simple exercises should be performed regularly to help your body cope with the difficulties that it is put through on a day-to-day basis.
- Placing a pillow on the floor, lie down on your front with your torso resting on the pillow
- Rest your forehead against the floor to allow the muscles in your neck and upper back to disengage; avoiding any unnecessary strain from being placed on them
- With your palms facing down, place your arms so that your elbow is at a right angle and in-line with your shoulder
- Imagine your shoulder blades being pulled together and let it slowly lift your arms off the ground, keeping your arm in-line with your shoulder and holding your elbows at a right angle
- Once they have reached the highest point you should feel a little bit of tension along your back and in your shoulders, but nothing painful. Hold this for several seconds
- Let your arms slowly float back down to the ground as your shoulder blades are slowly released and allowed to sit in their usual positions
- Repeat 9 more times
- Lie on your side, bringing your arm out in front of you and in-line with your shoulder
- Palms facing the floor, raise your arm up as though you are reaching for the ceiling
- Hold for 5 seconds and lower your arm slowly
- Repeat 4 more times
- Change sides and perform the exercise 5 times with the opposite arm
- Return to the original side you were lying on
- Pull your elbow to your side so that it is touching your waist
- Bend your arm at the elbow so your forearm and hand are out in front of you
- Bring your forearm up so that only it and your hand are pointed toward the ceiling
- Hold for 5 seconds and slowly release until your forearm is out in front of you again
- Repeat 4 more times
- Change sides and perform the exercise 5 times with the opposite arm
- Lie on your side or stand up straight
- Keep your arm straight and rigid at the shoulder and elbow
- Bring your arm out slowly, as though you're reaching out for something in front of you
- Continue bringing your arm up, reaching up as high as you can toward the ceiling
- Bring your arm back down behind you until it has once again regained its initial starting position
- Repeat 9 more times
- Perform 10 more arm circles with the other arm
- Start with an open hand, your fingers and thumb together and all facing straight ahead
- Leaving your thumb facing straight ahead, pull all your fingers up toward your wrist
- Hold for ten seconds
- Pull your fingertips in and wrap your thumb around, locking them in place and making a fist
- Hold for ten seconds
- Straighten out your knuckles so the lower segments of your fingers are pointed out.
- Hold for ten seconds
- Straighten out your fingers so you once again have an open palm
- Perform the exercise 9 more times
Performing these exercises should not take more than 10 or 15 minutes, and considering the level of pain and discomfort they will go toward sparing you, there is really no good reason why they cannot be carried out daily.
Working With A Repetitive Strain Injury
Rest and relaxation are paramount! Your body will not be able to heal if it is not given sufficient opportunity to do so and it is the inability of small injuries to heal properly that will go on to cause an RSI. Having said that you still need to earn a living, and whilst your doctor may be able to supply you with a note allowing you to take some time off, you will have to go back to work eventually and it is imperative that this is planned for.
When you first start back at work make sure you take it easy and be alert to the old routines and activities that initially caused your injury. The last thing you want to do is reinitialise these old habits, so take note of them and find new ways of going about them or think of something, like an accessory, that will help improve the situation.
When sitting at your desk, for example, your forearms could be resting on the edge of your desk, allowing it to dig into your arms. If this is the case you could raise your chair to a height that would keep your elbows off the table, effectively solving the issue; alternatively you could buy a cushioned pad that attaches onto the desk's edge, providing a comfortable resting place that does not dig into your forearms. There are many small situations like this that can be solved by the use of an ergonomic accessory or by simply altering how you go about it, and so long as you constantly alert and conceive effective ways of working around them, you should be able to avoid new injuries.
There are many more ways in which you can adapt the workplace, especially your particular workstation, to be more RSI conscious, and whilst most are particular to a specific workplace, there are a few hints and tips that can be applied across the board:
- Keep your head directly above your shoulders, not straining forward or backwards
- Remain seated at least an arm’s length from your screen
- Relax your shoulders, don't allow them to become raised or hunched
- Your back should be upright or at a mild incline, placed ever so slightly ahead of the hips
- Elbows ought to be relaxed
- Knees should be kept lower than the hips, not straight ahead of them
- The top of the computer screen should be at eye level or only a little bit lower, never higher
- Plant your feet into the floor or use an ergonomic foot rest
- Consider changing from a QWERTY keyboard to one with a more ergonomic key layout, e.g. DVORAK
There are many types of RSI, but because of the similarities in how many of us work and live our lives there are some which are more prominent than others, such as lateral & medial Epicondylitis, Tendinitis, DeQuervain's Disease and Carpal Tunnel Syndrome. We shall be touching on these repetitive strain injuries in future posts, so be sure to keep an eye on the Desktop Innovations blog page.