All About Repetitive Strain Injury

repetitive strain injury

Repetitive strain injury, or RSI, is a general term for pain in the muscles, tendons, and nerves from repetitive overuse. RSI typically affects the upper limbs, but can also appear in areas such as the lower back. Commonly affected areas include arms, hands, neck, and shoulders. The injury affects humans as well as animals.

Assistive technology is a programmer or computer addict’s best friend when severe RSI limits the ability to use regular computer input devices like a keyboard or mouse.  Digital pen scanners didn’t even exist until recently, and many tech breakthroughs like these make RSI far easier to treat today.

RSI was first document in 1700 by the Italian physician Bernardino Ramazzini, but prevalence has increased with more people using computers and phones. Thomas Jefferson and famous architects of the past may well have had more healthy hands a wrists than their contemporaries, as they were not connected at the waist to CAD software.

Good luck finding an architect or designer today that would throw away repetitive motions used with digital devices, return to handwriting on a drafting board, all for a more healthy life.

As RSI gained wide notoriety in the ‘90s. Back then it was feared that it would become an epidemic in the western world because of the increase in office workers. This radical increase never happened, however, and it can be attributed to several causes. Possible factors include improved ergonomic work conditions, labor relations, and managerial strategies. [1]


There are broadly defined two types of RSI. Type 1 RSI is a musculoskeletal disorder with clearly visible symptoms. It includes swelling and inflammation of affected muscles and/or tendons. There are also indications it might relate to complex regional pain syndrome and fibromyalgia.[2] Type 1 is easy to diagnose since it is characterized by a range of symptoms (see Symptoms).

Type 2 RSI is also known as diffuse RSI or non-specific pain syndrome. It is likely attributed to certain work activities and possibly to related nerve damage. Unlike type 1 RSI, type 2 RSI usually doesn’t demonstrate physical signs of injury. Thus, it can be difficult to diagnose.


RSI has a wide range of potential symptoms. Commonly one or more of the following symptoms are experienced in the affected area:

  • Pain
  • Throbbing sensation
  • Tenderness
  • Tingling
  • Loss of sensation
  • Loss of strength

Examples or RSI

There are several conditions that are often classed as RSI. Though it should be noted that these conditions may also have other causes.

Examples of RSI Type 1 include:
  • Carpal tunnel syndrome: When blood cannot flow properly through the hand and fingers.
  • Tendinitis: Inflammation in the tendon.
  • Tenosynovitis: Inflammation in the sheath around the tendon.
  • Bursitis: Inflamed bursa. Bursa are fluid-filled sacs that act as cushions between bones, tendons, joints, and muscles.
  • Dupuytren’s contracture: Contracted connective tissue under the skin of the palm. This causes one or more of the fingers to bend into the palm. Dupuytren’s contracture is quite uncommon.
  • Epicondylitis: Inflamed tendons and muscles in the forearm. This is due to overuse, and is sometimes referred to as tennis elbow.
  • Rotator cuff syndrome: Inflamed tendons and muscles in the shoulder.
  • Ganglion cyst: Fluid-filled swellings that form on top of joints and tendons in the joints of wrists, hands and feet. They have the appearance of firm or spongy sacks of fluid.

Type 2 RSI often lacks visible conditions, but may possess one or more of the symptoms.


RSI type 1 can be diagnosed via a recognized medical condition (see Examples of RSI). Often, RSI type 1 is characterized by a swelling in the tendons or muscles.

When testing for RSI, common clinical tests include grip and pinch tests or other diagnostic measures. If the symptoms don’t correspond to any of the common medical conditions, the patient may be referred to further tests. These include X-rays, spectroscopy or blood tests.[3] If the cause is still undefined, the patient may be diagnosed with RSI type 2.


RSI is related to overuse of muscles, mainly in the upper body. Workers in certain areas or positions are more at risk; even though occupations might vary greatly. Miners, for example, are prone to repeated motions that may cause musculoskeletal damage. But so are office-workers that work in similar positions for several hours per day. Another example is pianists that regularly perform similar movements several times per day.

musculoskeletal damage


The first step in treating RSI is often identifying the cause. Many times the cause is a certain task or activity that is executed frequently over long periods of time. Then the recommendation is either to modify the activity or stop doing it altogether.

Anti-inflammatory painkillers, such as aspirin or ibuprofen, may help ease the symptoms of RSI. Other prescribed treatments include corticosteroid injections, ultrasound therapy (sending a sound pulse into the affected area), physical therapy, and exercise. In some cases, surgery might be required.

Typically, RSI sufferers can improve in as little as two weeks. But sometimes RSI can last a year or more in severe cases.


It has been shown that general exercise helps prevent RSI, especially strengthening affected key areas in the upper body.[4] Other important measures include maintaining a good work posture, taking regular breaks from repetitive tasks, and adopting relaxation techniques like those built into many modern fitness trackers if feeling stressed.[5]


[1] S. Rietveld, I. van Beest & J. H. Kamphuis, J. H. Kamphuis (2007) “Stress-induced muscle effort as a cause of repetitive strain injury?” Ergonomics. Vol. 50. 

[2] Marinus, Johan, van Hilten, Jacobus J, (2009) “Clinical expression profiles of complex regional pain syndrome, fibromyalgia and a-specific repetitive strain injury: More common denominators than pain?” Disability & Rehabilitation. Volume 28.

[3] Jaap J. Brunnekreef, Jan Oosterhof, Dick H. J. Thijssen, Willy N. J. M. Colier, Caro J. T. Van Uden, (2006) “Forearm blood flow and oxygen consumption in patients with bilateral repetitive strain injury measured by near-infrared spectroscopy.” Clinical Physiology and Functional Imaging. Volume 26.

[4] C. R. Ratzlaff, J. H. Gillies, M. W. Koehoorn, (2007) “Work-related repetitive strain injury and leisure-time physical activity.” Arthritis Care & Research. Vol. 57.

[5] Nieuwenhuijsen, Els R., (2004) “Health behavior change among office workers: An exploratory study to prevent repetitive strain injuries.” Work. Vol. 23.