Repetitive strain injury (RSI)

Read about repetitive strain injury (RSI), which is a general term used to describe the pain caused by repetitive movement and overuse of muscles, nerves and tendons.

Information written and reviewed by Certified Doctors.

Contents

Key Information

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What should I do?

If you think you have this condition, you may not need to see a doctor.

How is it diagnosed?

You might be able to diagnose repetitive strain injury yourself if you notice pain and stiffness in a part of your body that occurs after repetitive actions. It commonly occurs in forearms, elbows, wrists, hands, neck or shoulders. If your pain does not improve when you avoid the repetitive action – or if avoidance is not possible – then you should see a doctor. They would want to examine you and exclude any other conditions. The doctor may also want to order an X-ray or blood tests.

What is the treatment?

Treatment is based on reducing the repetitive action and modifying your tasks to relieve your symptoms.

Regular exercise and physiotherapy can help to strengthen the muscles in the affected area.

Mild pain may be controlled with non-prescription painkillers or non-steroidal anti-inflammatory drugs such as ibuprofen.

If the pain is more severe, your doctor might consider a corticosteroid injection in the affected joint. In some cases your doctor might discuss surgical options.

When to worry?

If you develop any of the following symptoms you should see a doctor immediately:

  • severe pain
  • joint pain and fever

If you develop an of the following symptoms you should see a doctor within 48 hours:

  • pain that has not improved despite modifying tasks
  • constant pain unrelated to activities.

Introduction

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Repetitive strain injury (RSI), also called work-related upper limb disorder, is a general term used to describe the pain from muscles, nerves and tendons caused by repetitive movement and overuse.

The condition mostly affects parts of the upper body, such as the forearm, elbow, wrist, hands, neck and shoulders, and may also cause stiffness and swelling.

Types of RSI

There are two types of RSI:

  • Type 1 RSI – This is when a doctor can diagnose a recognised medical condition from your symptoms (see below). It is usually characterised by swelling and inflammation of the muscles or tendons.
  • Type 2 RSI – This is when a doctor cannot diagnose a medical condition from your symptoms. This is usually because there are no obvious symptoms, apart from pain. Type 2 RSI is also referred to as non-specific pain syndrome.

There are several medical conditions and injuries that can be classed as type 1 RSI, including:

  • bursitis – inflammation and swelling of the fluid-filled sac near the joint of the knee, elbow or shoulder
  • carpal tunnel syndrome – pressure on the median nerve passing through the wrist
  • tendonitis – inflammation of a tendon

Read more about the symptoms of repetitive strain injury (RSI).

Causes of RSI

RSI is usually associated with doing a particular activity repeatedly or for a long period of time. It often occurs in people who work with computers or carry out repetitive manual work.

Certain things are thought to increase the risk of RSI, including:

  • doing an activity for a long time without rest
  • doing an activity that involves force, such as lifting heavy objects
  • poor posture or activities that require you to work in an awkward position
  • cold temperatures
  • vibrating equipment
  • stress

Read more about the causes of repetitive strain injury (RSI).

Treating RSI

The first step in treating repetitive strain injury (RSI) is often to identify and stop doing the task or activity that is causing the symptoms.

To relieve symptoms, your doctor may advise:

  • taking a course of anti-inflammatory painkillers, such as aspirin or ibuprofen
  • using a heat or cold pack, elastic support or splint
  • having steroid injections to reduce inflammation in an affected area (this is only recommended if an area has definite inflammation from a condition, such as carpal tunnel syndrome or tenosynovitis)

You may also be referred to a physiotherapist for advice on posture and how to strengthen or relax your muscles. Some people find that other types of therapy help to relieve symptoms, including massage, yoga and osteopathy.

Preventing RSI

Most employers carry out workplace assessments to ensure you are comfortable, but you may be able to help prevent RSI by ensuring your posture and typing style are not causing the symptoms. Read more information about [workplace health].

It's also good to look at other aspects of your lifestyle, including hobbies and your general stress levels. Read more information about preventing repetitive strain injury (RSI).

More information on RSI prevention can be found on the RSI Awareness website.

Symptoms

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The symptoms of repetitive strain injury (RSI) usually develop gradually. They can range from mild to severe.

Symptoms can vary, but often include:

  • pain or tenderness in your muscles or joints
  • stiffness
  • throbbing
  • tingling or numbness
  • weakness
  • cramp

At first, you might only notice symptoms when you are carrying out a particular repetitive action, for example when you are at work. When you have finished work and are resting, your symptoms may improve. This is the first stage of symptoms and may last for several weeks.

If left untreated, the symptoms of RSI are likely to get worse and cause longer periods of pain. You may also get swelling in the affected area, which can last for several months.

Without treatment, the symptoms of RSI can become constant. At this stage the condition may be irreversible.

It is important to get treatment as soon as you experience symptoms of RSI. This increases your chance of recovery and reduces your risk of long-term problems.

Read more about treatment for repetitive strain injury (RSI).

Types of RSI

RSI is often split into two categories, depending on your symptoms.

  • Type 1 RSI – This is when a doctor can diagnose a recognised medical condition, such as carpal tunnel syndrome, from your symptoms. It is usually characterised by swelling and inflammation of the muscles or tendons.
  • Type 2 RSI – This is when a doctor cannot diagnose a medical condition from your symptoms. This is usually because there are no obvious symptoms, apart from a feeling of pain. Type 2 RSI is also referred to as non-specific pain syndrome.

Causes

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Repetitive strain injury (RSI) is related to the overuse of muscles and tendons in the upper body, especially the hands, wrists, arms, shoulders, back or neck.

Things that can put you at risk of RSI include:

  • repetitive activities
  • doing an activity for a long time without rest
  • doing an activity that involves force, such as lifting heavy objects
  • poor posture or activities that require you to work in an awkward position

Cold temperatures and vibrating equipment are also thought to increase the risk of getting RSI and can make the symptoms worse. Stress can also be a contributing factor.

RSI is most commonly caused by a repeated action carried out on a daily basis. A variety of jobs can lead to RSI, such as working at an assembly line, at a supermarket checkout or typing at a computer.

If you use a computer at work you may experience a typical RSI condition called writer's cramp. This is when the repetitive action of typing on the computer causes painful symptoms in your hands, such as a throbbing pain.

It is important that your working environment, for example your desk space, is laid out so that you can work comfortably. Your employer is under a legal duty to try to prevent work-related RSI and ensure that anyone who already has the condition does not get any worse.

Read more about preventing repetitive strain injury (RSI).

Diagnosis

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There are no tests to confirm repetitive strain injury (RSI), as the pain and symptoms are often caused by a variety of things.

RSI is often diagnosed when symptoms develop following a repetitive task and fade when the task is stopped.

Your doctor can examine the area where you have pain and will ask about your symptoms and medical history. If you have type 1 RSI symptoms, such as inflammation and swelling, your doctor may be able to diagnose a specific condition.

There are several medical conditions and injuries that can be classed as type 1 RSI. These include the following:

  • bursitis – inflammation and swelling of the fluid-filled sac near the joint of 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 in the palm of the hand and into the fingers
  • epicondylitis – inflammation of an area where bone and tendon join (an example of epicondylitis is tennis elbow)
  • rotator cuff syndrome – inflammation of muscles and tendons in the shoulder
  • tendonitis – inflammation of a tendon
  • tenosynovitis – inflammation of the inner lining of the tendon sheath that covers the tendons, most commonly in the hand, wrist or forearms
  • ganglion cyst – a sac of fluid that forms around a joint or tendon, usually on the wrist or fingers
  • Raynaud’s disease – a condition where the blood supply to extremities, such as the fingers, is interrupted
  • thoracic outlet syndrome – compression of the nerves or blood vessels that run between the base of the neck and the armpit
  • writer’s cramp (a type of dystonia) – a condition that occurs from overuse of the hands and arms

Many of the conditions described above, such as carpal tunnel syndrome and Dupuytren’s contracture, can develop as part of normal ageing.

If you have type 2 RSI symptoms (non-specific pain and no inflammation or swelling), you may be referred for further tests to rule out other conditions. For example, you may be given an X-ray to test for osteoarthritis or blood tests to rule out inflammatory joint diseases.

If no other condition is found after having tests, you may be diagnosed with type 2 RSI, which is also known as non-specific pain syndrome.

Treatment

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If you are diagnosed with repetitive strain injury (RSI), will probably advise you to temporarily stop doing the task or activity that is causing your symptoms.

In some cases this might not be possible, for example if it is an activity you carry out for work. You may need to tell your employer about your RSI so that arrangements can be made at work to improve your symptoms.

There are many treatment options for RSI. They all aim to relieve pain and enable your strength and mobility to return. Treatment options include:

  • taking a course of anti-inflammatory painkillers, such as aspirin or ibuprofen
  • using a heat or cold pack, elastic support or splint
  • being referred to a physiotherapist for advice on posture and how to strengthen or relax your muscles (see below)
  • having steroid injections to reduce inflammation in an affected area (this is only recommended if an area has definite inflammation from a condition, such as carpal tunnel syndrome or tenosynovitis)

Your doctor may also prescribe a short course of sleeping tablets if your RSI is preventing you from sleeping.

Self help

Often, small changes to your lifestyle and working environment can help to relieve symptoms of RSI.

Think about the activity that is causing your RSI. What is it, when do you do it and how long do you do it for? Could you spend less time doing the activity or take more regular breaks so you are doing it for shorter periods of time?

Some people with symptoms of RSI find that including exercise in their daily routine, such as walking or swimming, helps to ease their symptoms.

Physical and complementary therapies

‘Hands-on’ therapies including physiotherapy, massage and osteopathy may be available after a referral from your doctor, but in some cases there may be a long wait for an appointment. If you wish to consider private treatment make sure that your therapist is registered with a professionally recognised organisation.

Read more information about hands-on therapies for RSI on the RSI Awareness website.

Many long-term sufferers of RSI use other types of complementary therapies and relaxation techniques, such as yoga, acupuncture and reflexology, to help relieve symptoms of RSI.

However, it should be stressed that these approaches will not work for everyone. Their success varies between individuals and their symptoms of RSI.

Prevention

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Preventing RSI, or relieving your symptoms, involves understanding what causes your RSI. This includes work, hobbies, general stress and posture.

Many repetitive strain injuries (RSI) develop over a long period of time rather than suddenly.

Aspects of your working environment are likely to have the most impact on your RSI. Employers have a legal duty to prevent work-related RSI and make sure that the symptoms of anyone who already has the condition do not get worse.

Most employers will carry out something called a risk-assessment or desk-assessment when you join a company. This is to check your work area is suitable and comfortable for you and that the risk of accident and injury is as low as possible. You can request an assessment if you have not had one.

Reviewing your work activities

Use the following as a guide to review your own work situation before you talk to your employer:

  • If you work at a computer all day, make sure your seat, keyboard, mouse and screen are positioned so that they cause 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 your eyes are the same height as the top of your computer screen.
  • If you do a repetitive task at work try to take regular breaks. It is better to take smaller breaks more frequently 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. .

You can review other aspects of your lifestyle yourself, such as your hobbies or general stress levels. The most important thing is to notice the factors that are causing or aggravating your RSI and make changes accordingly.

More information on RSI and work-related upper limb disorders (WRULDs) prevention can be found on the RSI Awareness website.

Content supplied by NHS Choices