RSI – Repetitive Strain Injury

RSI - Repetitive Strain Injury


Article by H.Giebeler, J.Dobrowolski

Repetitive Strain Injury

What is RSI?

RSI (or Repetitive Strain Injury) is a descriptive term for an overuse injury. Occupational Overuse Syndrome (OOS) is another name used to describe RSI.

repetitive strain injury rsi

Repeated use of the same movements causes inflammation and damage to the soft tissues (muscles, nerves, tendons and tendon sheaths etc.) In particular, RSI attributes to upper limb and forearm pain.

Repetitive Strain Injuries (RSI) includes many localised injuries such as trigger finger, golfers, tennis elbow, and carpal tunnel. RSI may describe more diffuse pain syndromes (those spread over the body), diagnosed as cervicobrachial pain syndrome or chronic pain syndrome.

Common RSI Symptoms

Symptoms of RSI or an overuse injury can be any of the following:

  • It is burning, aching or shooting pain.
  • Tremors, clumsiness and numbness.
  • Fatigue or a lack of strength.
  • Weakness in the hands or forearms. It is often difficult to perform even simple tasks.
  • Difficulty with everyday activities, e.g. opening doors, chopping vegetables, turning on a tap.
  • Chronically cold hands, particularly the fingertips.

Early Signs of RSI

The first signs of RSI may be soreness, tingling or discomfort in the neck, arms, wrists, fingers or shoulders. These symptoms may come on when you do something or appear after a repetitive task.

Symptoms may disappear when you stop the aggravating activity. It may take only a few hours for the symptoms to settle or take as long as a couple of days. Unfortunately, over time a minor RSI can turn into a nasty chronic injury. Extra stress in your work or taking fewer breaks can make your symptoms much more severe and long term.

What Causes RSI?

Many factors can cause RSI. They include:

  • Repeated arm use for too long
  • Working with equipment that doesn’t fit your body
  • Working too fast
  • You do not have enough recovery breaks.
  • Holding your muscles in the same position for a long time
  • Lack of training in the safest way to carry out a task
  • Lack of variety in the type of work you do
  • Working in cold conditions

What’s Injured by RSI?

RSI potentially damages your muscles, tendons,  nerves and joints through repeated micro-trauma.

Muscles & Tendons

With muscles or tendons use, tiny tears can occur in the muscle tissue or tendon tissue. The local area becomes inflamed for a short time as the body attempts to repair the damage.

Thickening and scar tissue may form over the torn muscle or tendon tissue. At this stage, the area will feel painful. Typically, the body would repair the damage, and the pain would go away. However, more activity causes further damage and more inflammation, thickening, scar tissue, and pain without enough rest.

This cycle gets progressively worse if insufficient rest. Under the microscope, pathologists can observe changes in the structure of a muscle or tendon damaged by overuse. Collagen bundles that are generally tight and parallel instead look disorganised and discontinuous. Several other changes have been noted as well, including a decrease in fibre diameter and fibre loosening.

More info: Tendinopathy


RSI also damages nerves. The compression of nerves causes tingling feelings. Nerves run through muscles, and with reduced muscle health, so is nerve health. Damaged nerves can heal, but the process is prolonged.

Most persisting RSI cases have their basis in the nerves that run from the neck to the hand. These nerves pass by many other structures, most notably the discs and facet joints in the neck. If the discs or muscles become damaged or tight – often due to a poor posture – the nerves cannot move freely in the arm.

If these restricted nerves are then used repetitively, such as when typing or process working, they naturally become sore and inflamed. Repeating this process before the nerve has recovered worsens the problem. It can be challenging to perform any task before long, even lifting a coffee cup, without feeling pain. Many different nerves course through your arms.

More info: Neurodynamics

This diagram illustrates some areas covered by the main branches, any of which can produce RSI symptoms.

RSI can be complicated. Because you have so many nerve fibres that exit from your neck and travel through your arm, the symptoms of this problem can vary wildly. You may experience pain almost anywhere.

Nerve-related pain misdiagnosis can occur. It may present as a variety of conditions. These injuries include rotator cuff tendonitis, carpal tunnel syndrome, tennis elbow, golfer’s elbow, de Quervain’s Tenosynovitis (thumb) and fibromyalgia.

Nevertheless, by assessing both the nerves and the structures that they cross, your physiotherapist can usually determine the exact cause of RSI. This much-maligned problem is no longer a mystery. A cure may be close at hand.


In the long-term, your posture and movement may become abnormal and result in joint pain, stiffness and premature degenerative changes.

Please contact your physiotherapist for your specific individual assessment.

RSI Treatment

Whereas acute RSI is relatively simple to assess and treat successfully, it is difficult to cure chronic RSI. Chronic RSI is multifactorial, with some RSI sufferers eventually developing a chronic pain syndrome that affects many aspects of life.

However, the good news is that RSI is usually very receptive to treatment in its early stages. Hence, it’s vital that you get medical help early and that you proactively manage this condition.  

Early intervention is the key.

Common Wrist & Hand Pain or Injuries

Common Wrist & Hand Pain Treatments

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