The most common RSI conditions include:

* Bursitis - inflammation and swelling of the fluid-filled sac near a joint at the knee, elbow or shoulder.
* Carpal tunnel syndrome - pressure on the median nerve passing through the wrist.
* Dupuytren’s contracture - a thickening of deep tissue which passes from the palm of the hand into the fingers.
* Epicondylitis - inflammation of an area where bone and tendon join - for example, tennis elbow.
* Ganglion - a cyst in a tendon sheath, usually occurring on the wrist.
* Rotator cuff syndrome - inflammation of muscles and tendons in the shoulder.
* Tendinitis - inflammation of a tendon.
* Tenosynovitis - inflammation of the inner lining of the tendon sheath that houses the tendons that control the fingers and thumbs.
* Trigger finger - inflammation of the tendon sheaths of fingers or thumb accompanied by swelling of the tendon.
* Diffuse RSI - nerve damage.

RSI is often caused, or aggravated, by frequently repeated movements, such as a task or leisure activity - for example playing golf or tennis regularly. Symptoms usually persist over time if left untreated.

As the number of people using computers increases, the chances of developing RSI increases. The repetitive action of typing on a computer can cause painful symptoms in fingers and hands, such as a throbbing pain. RSI caused by typing on a computer is typically referred to as ‘writer’s cramp’.

RSI is also linked to many types of repetitive manual work, such as the use of vibrating equipment in factories.

If there are any symptoms, including painful, tingling or swollen hands, elbows, wrists or shoulders, it is important to get treatment quickly. The sooner treatment is started the better the chances of recovery.

Types of RSI

RSI can be categorised into two types, Type 1 RSI and Type 2 RSI:

* Type 1 RSI - this includes conditions that are due to repetitive tasks, but can also be common in people who do not carry out repetitive tasks. The main symptoms tend to be swelling and inflammation of muscles and tendons. Typical type 1 RSI conditions include carpal tunnel syndrome (pressure in the wrist), tendonitis (inflammation of a tendon), and tenosynovitis (inflammation of tendon sheath).
* Type 2 RSI - is when a person’s symptoms do not fit into one of the above listed conditions. This is usually because there is no obvious inflammation or swelling in the affected area, merely a feeling of pain. This type is often called ‘non-specific pain syndrome’.

The symptoms of repetitive strain injury (RSI) vary, but can include: * pains or tenderness in your muscles or joints,
* a throbbing sensation in the affected area,
* tingling (pins and needles) or numbness in your hand or arm, and
* loss of strength or sensation in your hand.

Initially these symptoms may only occur when you are carrying out the repetitive motion, for example during working hours. Towards the end of the day your symptoms may improve when you have finished work and are resting. This initial stage of symptoms may last for several weeks.

If left untreated, the symptoms are likely to persist, causing pain or aching much of the time. You may also have tender swelling in the affected area, which can last for several months.

Pain could also be experienced all the time, affecting your sleep. At this stage the condition may be irreversible. Therefore, recognising the early symptoms of RSI is important to ensure that any treatment is most effective.

The actual cause of repetitive strain injury (RSI) is unknown. In some cases, there is no swelling in your muscles or tendons, and yet pain can continue to cause you discomfort.

RSI is related to overuse of muscles in your hands, wrists, arms, shoulders, back, or neck. This overuse is usually a repeated action that is often carried out on a daily basis. For example, if you use a computer at work you may experience a typical RSI condition called ‘writers cramp’. The repetitive action of typing on the computer can cause painful symptoms in your hands, such as a throbbing pain.

Cold temperatures, vibrating equipment, or forceful movements are also thought to worsen the condition.

Other things that may bring on the symptoms of RSI include:

* awkward posture,
* poorly organised workstations,
* badly designed equipment, or
* lack of rest breaks.

Stress may also be a contributing factor in RSI. However, relaxation techniques may be able to help reduce stress (see treatment section).

There are no tests to confirm a diagnosis of repetitive strain injury (RSI). Pain felt in the affected area may be common, but can often be due to a variety of factors.

RSI is often diagnosed based on the fact that symptoms develop following a repetitive task, and tend to fade, or be partially relieved, once the task is stopped. For example, if you have recently done a lot of DIY around your house, once the task has been competed, the pain may disappear.

Your GP can diagnosis certain RSI conditions such as carpal tunnel syndrome (pressure in the wrist) by examining your affected arm or wrist. X-rays may be used, but this is rare.

Reporting early symptoms is essential to avoid repetitive strain injury (RSI) conditions becoming disabling - that is, reducing your mobility and independence. See you GP if you experience any aches or pain in a particular area over a prolonged period of time (if it continues for more than a couple of weeks).

It is likely that your GP will initially advise that, if possible, you stop doing the task or activity that appears to be causing your symptoms. In some cases, this might not be possible if it is an activity you carry out on a daily basis for work. In this case, you may need to tell your employee about your RSI so that improvements can be made to relieve your symptoms.

Treatment for RSI usually aims to help with your pain, and to enable your strength and mobility to return. Your GP may recommend that you take a course of anti-inflammatory painkillers, such as aspirin or ibuprofen, to help relieve any pain. Children under the age of 16 should not take aspirin. You may also need to use heat or cold packs, elastic supports, and firm splints. All of these are available over-the-counter (OTC) from your local pharmacy, but they only offer temporary pain relief.

Steroid injections are usually only considered if you have defined inflammation in an affected area. For example if you have pressure on the nerves of your wrist (carpel tunnel syndrome), or inflammation on your tendon sheath (tenosynovitis).

Your GP may also suggest you take a short course of sleeping tablets if your sleep is disturbed due to your RSI-related pain.

Complementary therapies

Because there is no cure for RSI, chronic sufferers may find complementary therapies also help to relieve symptoms. For example, if your symptoms are severe, your GP can refer you to a physiotherapist, who can help you with your posture and teach you how to strengthen the muscles that are causing you particular discomfort. Your physiotherapist may also decide to perform a therapy called electrotherapy, which uses small electrical impulses placed on particular points of your body to help reduce your pain.

Other complementary therapies that may prove helpful include:

* Messages - to help relax your upper body muscles and tissues.

* Osteopathy - a treatment that focuses on your skeleton and muscles.

* Chiropractic - a method using your body structure, particularly your spine, to ease symptoms.

* Kinesiology - oriental medicines are used to help restore your body’s energy flow and balance.

* Alexander technique - is a method that works to change your movement habits in your everyday activities, helping to make you aware of balance, posture and co-ordination.

* Feldenkrais method - is similar to the Alexander technique but focuses less on specific body positions.

* Pilates - is more strenuous than the Alexander technique and the Feldenkrais method, as it involves exercise to both strengthen and improve your flexibility.

* Acupuncture - is a traditional Chinese treatment method that is often used to relieve pain and restore balance to your life force.

* Shiatsu - is a traditional Japanese technique often described as ‘finger pressure’ therapy, which is a form of massage that applies pressure to energy lines using fingers, thumbs, and elbows.

* Reflexology - is a foot message of Chinese origin that has been said to improve blood circulation and help to relax you.

Fitness techniques

You may find that there are a number of fitness techniques you can include in your lifestyle to help ease your RSI pain. These include:

* walking,
* swimming,
* yoga - the practice of poses, stretches and flexibility,
* tai chi - a mind and body discipline of choreographed movements to restore your body’s harmony, and
* relaxation techniques, such as meditation.

Symptoms for repetitive strain injury (RSI) can ease over time. To prevent the development of RSI, or relieve your symptoms, you need to review particular aspects of your lifestyle. For example, if you take part in regular sporting activities remember to warm up before you start, and cool down afterwards.

Aspects of your working environment are likely to have the most impact on your RSI. For example:

* If you work at a computer all day, make sure your seat, keyboard, mouse, and screen are positioned so that they cause you the least amount of strain to your fingers, hands, wrists, neck and back.

* Sit at your desk with a good posture. Adjust your chair so that your forearms are horizontal with the desk, and that your eyes are the same height as the top of your computer screen.

* If you do a repetitive task at work try to take plenty of regular breaks. It is better to take more frequent smaller breaks than just one long break at lunch.

* Speak to your employer if there is anything relating to your working environment that you feel could be improved. It is in their interest to ensure they do everything possible to help prevent or ease your RSI. You may also find it beneficial to speak to your employer’s occupational health advisers for further assistance and advice.

1. Workstation Ergonomics

A well designed workstation is essential to maintaining good posture and reduce the risk of lower back pain and other computer related injuries.

2. Ergonomic Keyboards and Mice

There are quite a few ergonomically designed keyboards and mice available. The Microsoft Natural Keyboard is one example. This keyboard splits the keys into two panels - one for each hand, and angles each panel so that the hands sit naturally on the keyboard, rather than requiring them to be twisted into an unnatural position which is the case with normal keyboards. Many mice are now designed to fit neatly into either hand, and can often have a scrolling wheel, which can make scrolling through documents easier and less stressful than using scroll bars.

These ergonomic devices are generally more expensive than standard designs, but can be well worth the investment.

The computer mouse was originally designed to make using a computer easier - it is much easier to point at a picture and click than to learn a relatively complicated series of keystrokes. However, research has shown that using a mouse is a significant cause of repetitive strain injury. Especially if the mouse is located at the same level and to the side of the keyboard - it’s usual location. This requires extending your arm which introduces significant tensions and stresses in your arm, shoulder and neck.

The best position for your mouse is on a raised platform slightly above the numeric keypad on your computer. Also, if you reduce the speed of the mouse and the number of clicks you have to make you can greatly reduce the muscle tension in your arm and hand. Additionally, you can swap the primary and secondary mouse buttons (the left and right buttons), to change the mouse from being right handed to left handed. Using your left hand - or right hand if you are left handed - can take some getting used to, but can be very helpful if you are suffering from any aches and pains in one hand. Regularly alternating between left and right hands can also give your arms and hands a rest, thus minimizing the risk of developing any RSI condition. You can swap the mouse buttons using the Mouse applet in the Windows Control Panel - or directly from the Stress Buster context menu - with fewer mouse clicks and/or key strokes.

To reduce the mouse speed, open the Mouse applet in the Windows Control Panel, select the tab Pointer Options and move the pointer speed slider to the left to slow. Click OK.

To reduce the number of clicks you have to make, open the My Computer icon, then select Tools, Folder Options, and then under Click Items As Follows, choose Single-click to open an item.

If you can you should avoid using the mouse as much as possible. Most actions and commands can be carried out using keyboard shortcuts instead of the mouse. For example, to reduce the number of clicks you have to make with your mouse - as described above, you could use the following keyboard shortcuts:

1. Press the button on your keyboard to open the Windows Start Menu.

2. Use the arrow keys to select My Computer (or the alternative name you may have given to your computer), and then press Enter or Return. This will open an explorer window for your computer.

3. Hold down the Alt key and press “T” to open the Tools menu, then press “O” to open Folder Options.

4. In Folder Options, hold down the Alt key, and press “S”. This will select the option Single-click to open an item.

5. Press Enter or Return to close the Folder Options dialog.

Windows Help provides extensive help on using keyboard shortcuts with Windows. Individual applications such as Microsoft Office also have their own keyboard shortcuts - with the appropriate help. Learning keyboard shortcuts can take some time, but once learnt, using them tends to be faster than using the mouse, and avoids much of the discomfort associated with the mouse.

All ergonomic experts agree that taking frequent rest breaks is essential to avoid the risk of computer related injuries.

You should take frequent “eye breaks” - staring at a computer monitor for long periods causes you to blink less often - resulting in dryer eyes. Every 10 to 15 minutes you should look away from your monitor and blink your eyes rapidly for a few seconds. This will refresh the tear film and clear any dust from the surface of the eyes. Additionally you should focus on something at a distance - preferably 20 feet or more away - look out of the window if you can - this will relax the muscles inside the eye.

You should take frequent short pauses or “micro pauses” - for 10 seconds or so up to a minute - every 10 minutes or thereabouts. You should take regular short breaks - for 5 minutes or more - every hour or so - maybe go for a coffee or a short walk around the office, and you should take a long break every two or three hours - for at least 15 minutes, or preferably 30 minutes to an hour. Exactly how long and how frequent your breaks are depends on your own personal preferences and working environment.

5. Stretching Exercises

Regular stretching is an essential part of RSI prevention and recovery, remember that your body is not designed to be sat at a desk for 8 hours a day clicking a mouse. Respect your body and give it the movement and range of motion it normally expects.

6. Posture

Good posture is essential to avoid repetitive strain injury and other computer related injuries. Well designed workstation ergonomics can help in maintaining a good posture.

* Make sure that you can reach the keyboard with your wrists as flat as possible (not twisted up or down) and straight (not twisted left or right). An ergonomic keyboard can help to keep your wrists straight.

* Make sure that your elbow angle is 90 degrees or more to avoid nerve compression at the elbow.

* Make sure that your upper arm and elbow are as close to the body and as relaxed as possible for mouse use - avoid overreaching. Also make sure that your wrist is as straight as possible when the mouse is being used.

* Make sure that you sit back in the chair and that you have good back support - especially lumber support.

* Make sure that your feet are flat on the floor. Use a foot rest if necessary.

* Make sure that your head and neck are as straight as possible .

* Make sure that you are relaxed. Forcing yourself to sit up straight can sometimes introduce unhealthy tensions in the back muscles.

7. Alternative Input Devices

There are a number of alternative input devices you can use, instead of the mouse and keyboard, which you might find helpful. Examples are the trackball, a graphics table and pen, a touchpad, and even voice control.

RSI is a very serious health risk, especially with the young people who are coming to any industry sector that has continuous use of a PC. You need to take all the actions and preventions necessary to help minimize that risk.

Gerard Bulger is a part of the company http://www.threadbuilder.co.uk/ which creates Stress Buster the automated background program that monitors peoples computer usage and indicates when breaks should be taken to help alleviate RSI.

The definition of RSI:

Repetitive strain injury is a medical term used to describe a pain or discomfort of the upper limb. Although a ‘repetitive strain’ can occur in any area of the body, physicians typically apply the term to a pain of the arm unit including the neck, shoulder upper back, arm, forearm and hand, that is related to repetitive tasks. RSI is really an umbrella term used to catch any and all pains of the arm, but the most common forms include tennis and golfer’s elbow, carpal tunnel syndrome, ulnar neuritis, metacarpalgia, rotator cuff of the shoulder, chronic neck and upper back pain and limb numbness.

The signs and symptoms of RSI:

The signs and symptoms of RSI vary depending on the exact areas of the arm and neck involved in the pain syndrome; however, the most common RSI complaints include the following:

Numbness and tingling of the arm and / or hand Pain and / or weakness of the upper arm and / or forearm, and / or wrist, and / or hand Reduced range of motion and / or stiffness of the shoulder, elbow, wrist or fingers Difficulty lifting of objects and / or tendency to drop objects (dropsy) The tendency of pain and / or numbness to increase with repetitive activity and at rest Background of RSI:

RSI is considered a soft tissue pain syndrome whereby the pain is derived from a disorder of the muscles and tendons of the neck and limb. To fully understand how muscles can cause disease, it is important to understand the current principles of myofascial pain (MFP) and myofascial dysfunction (MFD).

Muscles shorten and can potentially scar in a shortened position as a result of injury or exercise. This process of shortening is often exaggerated at rest. Therefore, muscles that work repeatedly in a particular action eventually shorten and over time, will develop some form of scar formation in areas of the muscle. These scars can be described as microinfarcts, or more popularly, as trigger points. In traumatic cases, muscles will shorten and scar in a much more accelerated period of time and often more severely.

Muscles shorten persistently if nerve conduction to that muscle is interrupted. This is known as Cannon’s Law, and is very important in understanding how we can develop repetitive strain injury. Walter Cannon was able to clearly demonstrate that muscles become super-sensitive and ultimately persistently shortened with eventual scarring when their nerve conduction is partially interrupted. For example, if the nerve supply to the forearm extensors is interrupted by a disk compressing the C4 or C5 nerve root, the forearm extensors will persistently shorten and cause chronic tennis elbow.

Shortened muscles around a joint will often change the static position of normal movement of the joint.

Furthermore, persistent compression of the joint may occur and contribute to an abnormal and accelerated wear pattern of cartilage and eventually the joint. Joint pain, stiffness and decreased range of motion are common side effects. Over time, destruction of the joint and osteoarthritis are predictable complications. The spine is also affected by these principles of persistent compression when the deep intrinsic spinal muscles are injured and develop shortening and contractures. The vertebral compression will cause disk herniation and spinal stenosis. The vertebrae, disks, nerve roots and the spinal cord can be affected by herniated disks and swollen facet joints.

To explain, these deep spinal muscles change the spinal positioning, cause mal-rotation of the vertebrae and non-movement of the spinal segments. This will lead to premature or accelerated disk wear, disk herniation, arthritis of the facet joints, and increase the risk of compression fractures of the vertebrae. This is true at all locations of the spine, but is more prevalent at the levels of C1 to C2, C4 to C6, T11 to L1 and L4 to S1. In the case of RSI, we are typically seeing compression of the segments of C4 to C7.

Application of these principles:

Let’s look at the typical assembly worker. He or she will often perform the same group of tasks and use the same muscle groups of the neck and arm as much as six hundred times per day. The basic effect is to overwork / exercise the muscles of the neck and arm. The first changes that occur are of typical shortening of the deep spinal muscles of the base of the neck (multifidus and deep rotators) and of the shoulder outlet and forearm muscles. Specifically I see shortening and scarring at the levels of C4 to C7 and of the back of the shoulder (latissimus dorsi and subscapularis) and of the front of the shoulder (pectoral minor and major), shortening and scarring of the forearm and hand muscles (forearm flexors, extensors and hand metacarpals) are all generally affected to some degree.

Early on, the exam will show mild trigger point or tenderness along the muscle groups mentioned above. Some weakness is often present as the muscles are working below their maximum of their efficiency as a result of being shortened. The individual will often have only slightly reduced range of motion of the neck and arm unit. However, over time the range of motion becomes obviously reduced and the pain symptoms increase as the condition progresses. X-ray and CAT scan imaging will show loss of normal curvature of the neck, and examination will show forward rolling of the shoulders, winging of the scapula, decreased pulse with elevation of the limb, and even acute joint swelling of the affected joints.

The loss of normal curvature in the neck indicates prolonged and persistent shortening of the deep spinal muscles of the neck; a so-called tenting effect. As the muscles tighten, they ratchet the neck straight like a tent pole under tension. The effect on the spine is to create a persistent compression on one or more disk and vertebrae. As well, the natural or normal positioning of the vertebrae and disks is altered. The range of motion of the spinal segments becomes obviously reduced as several vertebrae actually fail to move. Disks come under pressure and start to wear at their sidewalls, much like a deflated car tire supporting an over-weighted car. The affected vertebrae will have a slight rotation to the affected side caused by the pull of the intrinsic muscles. Disk bulging and herniation can occur and can also oscillate between bulge and herniation in the early phase of disease. This explains reduced diagnostics of disk herniation during MRI in the supine position as compared to the Standing MRI. Eventually, frank herniation is seen on supine MRI.

With increasing neck compression the nerve conduction in the neck supplying the arm becomes more and more affected. Initially the nerve is temporarily and only partially interrupted. Over time, as the spinal compression and rotation deepens, the nerve interruption becomes more constant and severe. Muscles down the affected arm will shorten following a supply pattern according to nerve roots affected (Cannon’s Law). As well, repeated local muscle injury from continued repetitive work will contribute to further limb muscle shortening.

Certain Muscle groups will contribute to different symptoms of numbness, tingling, pain and weakness of the arm. In carpal tunnel, the pectoral (chest muscle) shortening will cause a traction injury to the median nerve at the front of the shoulder. This in turn, causes a pulling effect on the nerve which translates to the nerve being lifted and then caught at the undersurface of the carpal tunnel. Entrapment and swelling of the nerve will then cause numbness, tingling and pain of the thumb, index, middle and half of the ring finger recreating the ever popular pattern of carpal tunnel syndrome.

In ulnar neuritis, the lattissimus dorsi and the subscapularis muscles will shorten from reduced nerve supply of C6 to T1. This shortening will then cause a similar traction phenomenon of the ulnar nerve at the back of the shoulder. This traction will then cause the ulnar nerve to catch at the elbow causing golfers-like elbow pain and pain over the nerve when leaning on the elbow. As this progresses, the ulnar nerve actually rolls over the inner elbow or medial epicondyle and can be felt by examination by palpating the medial epicondyle and while flexing the elbow. This indicates very significant traction of the ulnar nerve coming from the back of the shoulder – otherwise known as posterior thoracic outlet syndrome. The classical symptoms will be of numbness and tingling of the little fingers and eventually pain in the fingers and ulnar side of the hand.

In tennis elbow, the outer elbow (extensors) can shorten and scar as a result of compression of C4 to C6 in the neck (due to contractures within deep intrinsic muscles of the neck at these levels) . The forearm shortening will cause persistent tension of the extensor tendon which causes inflammation of the tendon. The persistent shortening of the extensor group will apply traction to the lateral epicondyle of the affected arm causing pain, swelling and bony changes over the elbow. This mechanism helps to explain the difficult nature in treating tennis elbow, as well as the high failure rate with local elbow therapy.

Golfer’s elbow has a similar mechanism to tennis elbow, only the spinal segments involved are typically C6 to T1. Often golfer elbow is associated with ulnar neuritis as the same spinal segments are involved. Other conditions can be recreated by similar spinal and limb muscle patterns.

Computer-related RSI often proves to be more ominous than assembly work. The problem is that keyboarding is a static injury. It is evident that static repetitive work is possibly the worst case scenario, as static muscles not only shorten after injury, but also at the time of injury. In this case the weakness of the muscles can be more exaggerated as the static repetitive action does not allow for increase in muscle strength as compared with standard active repetitive work.

Furthermore, the computer-related RSI often affects the upper back area (thoracic spine); an area which has secondary nerve supply to the arm. The thoracic spine can be extraordinary to treat particularly in the presence of kyphosis. The end result of computer-related RSI is a person with a hump back, forward neck, forward shoulders, compressed disks, suffering diffuse muscle shortening and multiple entrapped nerves, and typically affecting both arms.

The Treatment of RSI:

*The treatment of a complicated/chronic RSI begins with a detailed history and examination often indicating far more disease than initially thought.

*Detailed patient education of the mechanism and exercise physiology is important such that they ca be aware of aggravating factors and to succeed with personal exercises.

*Physicians and nurses need be more aware of the various patterns of RSI for their early recognition and proper treatment.

*The key part of actual therapy must include the implementation of spine and limb “neuropathic” stretching and resistance training (the Lamb Program) that allows for all muscle groups affected to be treated, and for spinal and limb segments to be properly repositioned.

*It is important to recognize the limitations of imaging technology, i.e. MRI fails to detect an estimated 40% of disk disease.

*The Implementation of injury avoidance and education of RSI-injury factors for the patient helps to reduce re-injury and progression of disease.

*The use of specialized injection technologies-surgical dry needling, the Patented Lamb Method of Spinal Botox, injectable NSAIDS can drastically reverse the compressive effect within the spinal anatomy and help most RSI’s and other pain syndromes.

*Specialized relaxation training systems help to reduce RSI-related muscle tension (i.e. ASeRT Systems).

*Positional education for sitting, standing and sleeping, as well as proper sleep education help to reduce the progressive pattern of bad sleep and bad pain.

*The implementation of laser/magnetic combination therapy and MET has demonstrated effectiveness as an adjunct to various pain syndromes including RSI.

*MET or micro-current therapy is the latest in electronic or electro-medicine that properly addresses the abnormal electrical potential concerns in chronic pain and RSI versus TENS or EMS which are demonstrating oxidizing potential of soft tissue with repeated use.

*Obviously the addition of medications can be a major adjunct to RSI and other chronic pains, and I will quickly comment on two medications.

*Anti-inflammatories have a beneficial effect in RSI, but must be tapered when stopping, otherwise reactive inflammation and spasm can occur. Lyrica, a new “anti-neuropathic” agent has been helpful in chronic pain. I have found improvement in deep spinal muscle pathology in many patients indicating that cessation of transmission of pain information has a relaxing effect upon spinal and skeletal muscles.