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 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.

Many different nerves course through your arms. If these restricted nerves are used repetitively, such as when typing or 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.

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 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 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.

Don’t hesitate to get in touch with 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.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.


If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  


Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.


Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.

Arm Pain Causes

Arm pain and injuries are widespread. Arm pain can occur as a result of either sudden, traumatic or repetitive overuse. The causes can be related to sports injuries, work injuries or simply everyday arm use.

Arm pain can be a local injury, musculoskeletal injury or could even be referred from nerves in your neck (cervical radiculopathy). This can result in neck-arm pain.

Causes of Arm Pain by Region

Causes of Arm Pain by Structure

Neck-Related Arm Pain

Shoulder-Related Arm Pain

Elbow-Related Arm Pain

Wrist-Related Arm Pain

Hand-Related Arm Pain

Muscle-Related Arm Pain

Other Sources of Arm Pain

Common Causes of Arm Pain

The most common sources of arm pain include shoulder painwrist pain and elbow pain.

Referred Arm Pain

As mentioned earlier, arm pain can be referred to from another source. Cervical radiculopathy is a common source of referred arm pain. Cervical radiculopathy will not respond to treatment where you feel the arm pain. However, it will respond positively to treatment at the source of the injury (e.g. your neck joints).

Professional assessment from a health practitioner skilled in diagnosing both spinal-origin and local-origin (muscle and joint) injuries (e.g. your physiotherapist) is recommended to ensure an accurate diagnosis and prompt treatment directed at the arm pain source.

Arm Pain has Diverse Causes.

The causes of your arm pain can be extensive and varied. Due to this diversity, your arm pain should be assessed by a suitably qualified health practitioner to attain an accurate diagnosis, treatment plan and implementation specific to your arm pain.

What Arm Pain is Associated with a Heart Attack?

Left-arm pain can be an early sign of a life-threatening cardiac issue. Based on this, a professional medical assessment that involves an accurate history, symptom analysis, physical examination and diagnostic tests to exclude a potential heart attack is important to exclude this potentially life-threatening source of arm pain.

For more information, please consult with your health practitioner, call an ambulance on 000, or visit a hospital emergency department to put your mind at ease.

Good News. Most Arm Pain is NOT Life-Threatening.

Luckily, life-threatening arm pain is far less likely than a local musculoskeletal injury. Arm pain caused by a localised arm muscle, tendon or joint injury should be assessed and confirmed by your health practitioner before commencing treatment.

Arm Pain Prognosis

The good news is that arm pain, and injury will normally respond very favourably to medical or physiotherapy intervention when early professional assessment and treatment is sought. Please do not delay in consulting your healthcare practitioner if you experience arm pain.

Common Arm Pain Treatments

With accurate assessment and early treatment, most arm injuries respond extremely quickly to physiotherapy or medical care, allowing you to resume pain-free and normal activities of daily living quickly.

Please ask your physiotherapist for their professional treatment advice.