Repetitive strain injury (RSI): symptoms, causes and treatment

The NHS says repetitive strain injury (RSI) is a term sometimes used for pain caused by repeated movement of part of the body. It is not one single disease. The Health and Safety Executive (HSE) uses the broader term upper limb disorders, which include aches and pains in the shoulders, arms, wrists, hands and fingers, and the neck, and which can be caused or made worse by work.

HSE says a number of disorders can affect the upper limbs, including carpal tunnel syndrome, tendonitis or tenosynovitis, osteoarthritis, cramp of the hand or forearm from prolonged repetitive movement, and hand-arm vibration syndrome.

The NHS says symptoms usually start gradually and can include the following. HSE adds tenderness, redness and reduced movement in joints.

• Pain, which may feel like burning, aching or throbbing.

• Stiffness and weakness.

• Tingling, pins and needles or numbness.

• Muscle cramps.

• Swelling.

The NHS lists several things that can help ease symptoms and speed recovery. You may need to limit your activity to start with before gradually increasing it.

• Keep active, but do not rest the affected area for more than a few days.

• Take paracetamol or anti-inflammatory painkillers such as ibuprofen, or use gels rubbed on the painful area. A pharmacist can advise.

• Use a cold pack (or a bag of frozen peas) wrapped in a towel for up to 20 minutes every 2 to 3 hours.

• Speak to your employer about changing the way you work or reducing your hours.

The NHS says RSI is caused by repeated use of a body part such as the shoulder, elbow, forearm, wrist or hand. It gives these examples of when you might get it.

The NHS also stresses that repetitive or strenuous work does not always cause RSI, and many people do the same job for years without a problem. Pain in the arm is often caused by a combination of things, including ageing.

• Doing repetitive activities such as hairdressing, decorating, typing or assembly line work.

• Playing sports such as golf or tennis that involve lots of repetitive movements.

• Poor posture when sitting or standing at work.

• Regular use of hand-held power tools.

The NHS says most people with RSI are able to manage their symptoms and get better without further treatment. If your symptoms do not improve, you may need physiotherapy, where as well as massage a physiotherapist can show you exercises to strengthen your muscles and improve your posture.

An occupational therapist can help work out what is causing the problem and suggest exercises, equipment, or changes to your workspace. The NHS says that sometimes steroid injections may be recommended to help reduce pain and swelling, and that rarely surgery may be needed if RSI is very severe.

HSE says employers must protect workers from the risks of developing upper limb disorders caused by work, by doing a risk assessment, protecting workers from injury from repetitive work, and protecting them from health risks of working with display screen equipment and from vibration from hand-held tools.

HSE says these disorders are more common in tasks involving prolonged repetitive work, awkward working postures, sustained or excessive force, work without suitable rest breaks and long periods with hand-held power tools. Poor working environment, poor work organisation and individual vulnerability can also play a part.

HSE says people with upper limb disorders usually completely recover if the problem is recognised early and treated appropriately, and encourages workers to report symptoms at an early stage. It suggests employers consider advice from an occupational health provider on fitness for work and any adaptations.

RSI is a general term, while carpal tunnel syndrome and tennis elbow are specific problems that can follow repeated use. Only a clinician can tell them apart.

The NHS says to see a GP if you have symptoms of RSI and they are not going away or are getting worse. In many areas you may be able to get help such as physiotherapy from NHS community musculoskeletal (MSK) services without a GP referral.

Tingling, numbness or weakness that is spreading, or pain after an injury or with other symptoms, also needs medical assessment rather than self-care alone.

The NHS says physiotherapy is free on the NHS throughout the UK but waiting times can be long, and that you can also pay to see a physiotherapist or occupational therapist privately. A GP may be able to refer you for occupational therapy. Workplace occupational health services, where available, can assess your workstation and tasks.