Repetitive strain injuries (RSI)
Repetitive strain injuries (RSI) or workplace overuse injuries are becoming increasingly prevalent in all walks of life.
G.P. practices are seeing a significant rise in patients complaining of musculoskeletal pain of an insidious nature. Prescribing analgesics or NSAID’s can be effective in the management in some of these cases, but is often a short-term fix.
Repetitive strain injuries are often complex and sometimes difficult to diagnose. Left untreated they can become harder to overcome, lead to long-term sickness and lost employment and adversely affect people’s basic activities of daily life.
Waiting times for NHS physiotherapy and 0ccupational therapy services can often be lengthy, especially for ‘chronic’ conditions. Often patients can feel frustrated with this wait and want to find a faster route to conservative and evidence based effective treatment. The private sector is a controversial option for some, but to others it is an essential resource to allow immediate and high quality intervention to help those needing advice whilst they wait for the essential treatment to get them back to normal.
The Stats
Repetitive Strain Injuries cost 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. The Health and Safety Executive’s (HSE) most recent figures (2006/7) show that both the number of new cases as well as the overall number of people affected has risen. The overall numbers of people reporting a problem with RSI has also risen from 374,000 in 2005/6 to 426,000 in 2006/7.
http://www.hse.gov.uk/statistics/swi/swi0405.pdf
Facts you know, some you may not
Repetitive Strain Injury (RSI) and Occupational Overuse Syndrome (OOS) are umbrella terms that include many localised injuries such as trigger finger, golfer’s and tennis elbow and carpal tunnel and also more diffuse pain which may be diagnosed as cervicobrachial pain syndrome or chronic pain syndrome. Repetitive strain injury (RSI), also called work-related upper limb disorder, is a general term used to describe the pain from muscles, nerves and tendons caused by repetitive movement and overuse.
Symptoms and types of RSI
The first signs of an overuse injury may be soreness, tingling or discomfort in the neck, arms, wrists, fingers or shoulders. These symptoms may come on when your patients’ do something or they may appear afterwards. They may disappear when they stop the activity that brought them on. It may take only a few hours for the symptoms to go away, or it may take as long as a couple of days.
Type 1 RSI
This includes well-defined syndromes such as carpal tunnel, tendonitis, tenosynovitis (inflammation of a tendon sheath) etc. These conditions may be caused by, or be made worse by, repetitive tasks. However, these syndromes are also common in people who have not done repetitive tasks. These syndromes may have other symptoms such as swelling, inflammation, nerve compression problems, etc.
Type 2 RSI
This is where symptoms do not fit into a well-defined syndrome. Also, there are no objective or measurable signs such as inflammation, swelling or problems with nerve function. It is sometimes called diffuse RSI or nonspecific pain syndrome.
Basic Pathophysiology
The underlying cause common to all RSI-type conditions is damage to muscles and tendons (and the nerves that run through them) through repeated micro-trauma. Whenever muscles are used, tiny tears can occur in muscle tissue. The local area becomes inflamed for a short time as the body attempts to repair the damage.
This cycle gets progressively worse if sufficient rest is not taken. Under the microscope, changes can be seen in the structure of a tendon damaged by overuse. Collagen bundles that are normally tight and parallel instead look disorganised and discontinuous under diagnostic ultrasound investigation. A number of other changes have been noted as well, including a decrease in fibre diameter and fibre loosening.
Nerves are also damaged by RSI. Tingling feeling, numbness and pain are caused by the compression of nerves. Nerves that run alongside the damaged muscle or tendon tissue can become sensitised by the inflammatory chemical produced due to the damage of overstrain myofascial tissue. This process of sensitisation only serves to make the symptoms harder to treat and slower to resolve
Unfortunately, over time a minor condition can turn into a crippling injury with little warning. Extra stress in life, pressure to work harder and longer or take fewer breaks can make the symptoms much more severe and long-term.
RSI, once it’s established, is difficult to cure and can prevent all kinds of activities, like playing a musical instrument, carrying out hobbies, or gardening. Some people with RSI may eventually get a chronic pain syndrome that affects every aspect of their life. However, RSI is curable in its early stages, so it’s vital that people get early intervention and that they take this condition seriously! Early intervention is the key.
How we can help
There is growing evidence that strengthening exercises for the specific muscle groups involved in RSI complaints are effective as a long-term answer. Here at ESPH we have the expertise and the environment to facilitate that long term beneficial outcome. All our patients get access to a 3 month free gym membership during their treatment programme. Here they can use our top of the range equipment whilst being treated by at least 7 year qualified physiotherapists who specialise in these forms of injury and dysfunction.