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In the year 1700, Italian physician Bernardino Ramazzini observed that workers in his country had been suffering from different types of stress injuries owing to their primary occupations. He went on to document their plight in his book Diseases of Workers. In the book, he categorised the stress injuries under as many as 20 headings!

Repetitive strain injuries (RSI) are a common phenomenon all over the world. Though modern lifestyles have made us more prone to some of these injuries, Ramazzini's book is proof that medical professionals have been thinking about ways to diagnose and treat RSIs for centuries.

As the name suggests, RSIs are caused by repetitive movements. They are also known as repetitive motion disorders or repetitive stress injuries. Another common expression to describe RSI is overuse injuries. RSIs encompass several problems related to nerves, tissues, ligaments and tendons. Tendonitis (tendinopathy) and bursitis the most common forms of RSI.

While an RSI owes its origins to occupations such as manual labour, sports and harsh working environments, its more recent iterations have come from the use of modern technology. Conditions such as carpal tunnel syndrome, PlayStation thumb and Blackberry thumb, Rubik’s or raver’s wrist are some of the modern RSI conditions that have developed over the years due to the use of technology.

The most basic of movements, like jogging in the morning or even typing on a computer, can result in RSIs. Though RSIs can affects the knees and ankles, a majority of such injuries are seen in the upper body - in the elbows, wrists or anywhere in the arm, as well as the shoulders and neck.

  1. Types of repetitive strain injuries
  2. Repetitive stress injury symptoms
  3. Repetitive strain injury causes
  4. How are repetitive strain injuries diagnosed?
  5. Repetitive strain injury treatments
  6. Risk factors for repetitive stress injuries
  7. Repetitive stress injury prevention and tips

Repetitive strain injuries are broadly divided into two categories:

Type 1: Musculoskeletal disorders, which lead to inflammation of specific muscles or tendons (the tissue that connects muscles with bones).

Type 2: This kind of RSI leads to nerve damage.

As many as 20 different kinds of repetitive stress injuries were documented by the 18th century, and the list has only grown steadily in number, owing to the arrival of different occupations and lifestyles. Some of the most common types of RSI include:

  • Tennis elbow: Also called lateral epicondylitis, tennis elbow is an inflammation of the tendons that connect the elbow to the forearm muscles. This type of injury results in loss of strength in the hands and difficulty gripping things. It is a common occurrence among people who play sports such as tennis or cricket, and those who perform repeated "throwing" movements.

  • Bursitis: This is an inflammation of the fluid-filled sacs (bursae) that are found near the joints to cushion the muscles, tendons and bone. Overuse or a direct impact can cause the sacs to leak, resulting in joint pain and loss of mobility. Bursitis can occur near any of the big joints in the body, though it is more common in the shoulders, elbows and hip.

  • Achilles tendinitis: The webbing-like structure on the top of the heel is where the Achilles tendon is. Inflammation in this area, a condition that is known as Achilles tendinitis, results in pain and loss of movement.

  • Carpal tunnel syndrome: Tingling in the hand and arm as a result of overuse of the wrists, especially while working on a computer, is the main symptom of carpal tunnel syndrome. Women are three times more likely to develop this condition, primarily because the carpal tunnel in their wrists is smaller than that in men. As the name suggests, the carpal tunnel is a passageway: it protects the nerves and tendons that help us move our hands and fingers.

  • Rotator cuff injuries: Overuse of the shoulder joint due to athletic activities or weight-bearing work or exercises leads to inflammation in the tendons around the shoulder joint.

  • Cervical pain: Cervical pain has become a common condition among office-going people used to sitting in front of a computer and working long hours. It causes chronic or acute neck pain.

The pain of RSIs can vary from moderate to debilitating. While some conditions like bursitis on the Most people who develop RSI will show the following signs:

  • Pain or tenderness in the muscle or joint
  • Swelling in the affected region
  • Tingling sensation, especially in the hands
  • Throbbing or pulsating sensation in the affected area
  • Loss of strength, like the inability to grip
  • Loss of sensation in the affected region

If you experience any of these symptoms on a regular basis, it is a good idea to visit a doctor to get it checked thoroughly. Chances are making small adjustments to your posture or movements may provide you with some relief from the pain. Physiotherapy exercises, like stretching exercises, may also help you avoid pain in the future.

RSI can cause temporary or even permanent damage to your nerves, tendons or ligaments. Here are some of the foremost reasons behind these injuries:

  • Overuse of certain muscles, joints and tendons: Excess use of certain parts of the body in professions such as industrial workers in factories, professions such as carpentry and painting, and all kinds of sporting activities can lead to RSIs. One of the best-known examples of an RSI injury is something that afflicted cricketer Sachin Tendulkar, who had a long history of suffering from a tennis elbow.
  • Incorrect posture: Many of us spend hours slouching in a chair, typing or moving the mouse. Improper posture, especially while working on the computer, is one of the main reasons for digital eye strain, back pain, neck and shoulder pain, and wrist pain. Over time, RSIs linked to bad posture may lead to problems such as degenerative disc disease.
  • Work-related stress: Occupational hazards such as poor posture aren’t the only factors behind developing RSI. They also include psychological factors such as stress due to long working hours, high work rate as well as the cultures in the workplace.
  • Age, gender and lifestyle habits: RSIs also tend to affect individuals as they get older, and are more prevalent among women due to their smaller frame and lower muscle mass presence. Factors such as alcohol and smoking are also contributors to developing RSI.

If you pursue any of the above professions. and have been experiencing any of the symptoms mentioned above, it is best to visit a doctor and have the problem assessed at the earliest.

  • Your doctor may ask you some questions to determine if the source of your pain or condition may be traced back to your profession or work life.
  • Next, he/she may do a physical exam to check your range of movement and locate the problem area that is causing pain.
  • In the case of carpal tunnel syndrome, your doctor may ask you to get an X-ray to check the extent of nerve compression in the wrist.
  • In the case of tendonitis, the doctor may perform imaging tests such as an MRI scan or ultrasound to locate the inflammation and the extent of tissue damage.
  • Tests such as an electromyogram (EMG) may be performed to ascertain nerve damage.

RSI’s are completely treatable and the individual can make a full recovery in most cases, especially when the diagnosis is made early. Treatment methods depend on the nature and severity of the condition.

  • The RICE method: A combination of rest, ice, compression and elevation, is the first line of defence against RSIs. Rest allows the affected area to not be aggravated by the same repetitive movements.
  • Over-the-counter drugs: Pain medication is another conservative method to relieve the pain caused by the injury.
  • Occupational therapy: Correctional measures can be applied at workplaces such as correcting one's posture or raising the height of the computer or the desk to avoid looking down at the screen.
  • Wearing braces or tapes for additional support in the affected area.
  • Steroid injections in the case of acute pain.
  • Physical therapy to restore full range of motion.
  • Stretching and strengthening exercises to relieve the tension in the muscles and joints.
  • Surgery to fix the injured tendon or nerves in more severe cases.
  • Psychiatric counselling may also be needed when the causes are stress or work-related.

RSIs are the result of repetitive movements we make almost daily, while we are at work, driving, running and generally going about our day-to-day life.

It is important to investigate the risk factors of RSI in our lives - failing this, we may continue to perform the same actions in the same manner, and cause ourselves more pain and harm!

Here are some of the risk factors of RSIs we should all be more mindful about:

  • Sedentary lifestyle: People who don't exercise and don't take breaks in-between work are also more prone to RSIs. Anyone who uses a computer, tablet or mobile device for over four hours a day is at greater risk, too.
  • Underlying medical condition: People living with arthritis or diabetes are more susceptible to RSI-linked pain.
  • Being overweight: People with a weight-to-height ratio or body mass index over 24.9 experience more physical strain while performing day-to-day tasks, whether these involve standing or running or simply sitting at a desk.
  • Smoking: Habits such as smoking or drinking can lead to chronic RSI.

In addition, RSIs are more common in some professions. These include:

  • Sportspersons
  • Construction or factory workers
  • Surgeons, dentists, nurses
  • Massage therapists
  • Musicians
  • Accountants
  • Cleaners
  • Cooks
  • Drivers
  • Housewives
  • Teachers
  • IT professionals

Along with certain professions, the use of particular equipment or having settled into an unhealthy routine can also lead to developing RSI:

  • Use of vibrating equipment such as power drills.
  • Lifting heavy objects.
  • Repetitive use of muscles and adopting certain postures.

Not only are repetitive strain injuries treatable, employing certain changes and adopting a healthier lifestyle can help prevent such conditions in the future as well. Some of the things we can do include:

  • Exercise regularly; there is nothing that can keep you healthier than maintaining keeping all muscles and joints flexible and strong.
  • Avoid activities that can elevate your discomfort or pain.
  • Use support braces or splints that support the affected area.
  • Warm-up and stretch before performing any rigorous activity, or while working.
  • Stand up from your desk and walk around frequently, if you have a desk job.

Repetitive strain injuries vary in nature and type, but early identification is important to treat the injury and reverse its effects. Unfortunately, RSIs are often misdiagnosed or discovered rather late. Early diagnosis, correct therapy as well as a general improvement in lifestyle as well as physical exercise can all lead to improved health outcomes and enable more people to make a full recovery from repetitive strain injuries.

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References

  1. Choudhary SB et al. Awkward posture and development of RSI (repetitive strain injury) in Computer professionals. Indian Journal of Occupational and Environmental Medicine. Hyderabad, India. 2002 Jan-Mar; 6(1): 10-2.
  2. Glass B et al. Diseases of Workers by Bernardino Ramazzini. A Tribute in the Year 2000. American Journal of Public Health. Wellington, NZ. 2001 Sep; 91(9): 1380–1382.
  3. Emil F. Pascarelli et al. Repetitive strain injury: a computer user's guide. Adapted from Repetitive Strain Injury by Dr. Emil Pascarelli and Deborah Quilter. J. Wiley, 1994; 218 pages
  4. National institute of neurological disorders and stroke [internet]. US Department of Health and Human Services; Repetitive Motion Disorders Information Page
  5. Stanford Health Care [Internet]. Stanford Medicine, Stanford University; Overuse and repetitive motion injuries: Overview
  6. National Health Service [Internet]. UK; Repetitive strain injury (RSI)
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