hand burning in the fire symbolize RSI Chronic Pain Syndrome

How to Heal Repetitive Strain Injury, RSI Risk Factors, and Treatment Options

In this article, I will be compiling as much information as I can about what is repetitive strain injury, why it is important to avoid repetitive strain injury, and how to possibly treat and cure repetitive strain injury. Do note that all of the information on this page is not medical advice, and should only be used for informational purposes only. If you’ve got a medical problem and you want to try out a solution, please run it by with your doctor first.

Table of Contents

What is Repetitive Strain Injury?

So let’s start with defining what is Repetitive Strain Injury (RSI)? Is it inflammation? Is it overuse? Or something else? Well, some people may define RSI as a type of injury where pain is felt in the muscles, nerves, and tendons caused by repetitive movement or overuse of a limb. The key thing you should take away is the word “overuse”. RSI is basically any injury that is caused by the overuse.

foot in vice representing pain
Cab drivers or people who tend to drive a lot everyday end up getting RSI in their foot and leg muscles & tendons.

For example, you’ll find that taxi cab drivers or people who drive cars a lot will end up with pain in their right foot, given that they use that foot to push the acceleration and brake pedal almost continuously without sufficient break for many days or even years. Another example of repetitive strain injury is for factory plant workers who perform the same execution of movements in an assembly line, over and over again.

And another exemplar way a person can acquire tendinitis is through being exposed to constant vibrations. Like holding a vibrating motorcycle handle while racing through the streets, or slowly drudging through the grass pushing the vibrating handles of a lawnmower.

It’s important to avoid RSI because if you constantly have pain in one of your joints or limbs, then it is a lot harder to use that limb effectively. It’s also a matter of quality of life- I mean who doesn’t want to have a good life, right? Being constantly in pain can harm your enjoyment and quality of life.

For example, video gamers who have RSI in their wrist, like carpals tunnel, end up not being able to game anymore because of the pain they experience while gripping the controller or mouse. Furthermore, they may not be able to use their hands for tasks that require flexion or pressure to be placed on the wrists, due to the carpal tunnel. So as you can imagine, RSI can really negatively impact a person’s quality of life.

To re-iterate, Repetitive Strain Injury is mainly an overuse injury. A bit like arthritis, actually. In arthritis, a person suffers because their bones start deteriorating or falling apart. In other words, their body’s rate of bone regeneration is slower than how fast the bones deteriorate. RSI is basically the same phenomena with the muscles and tendons.

In RSI, the tendons and muscles can’t regenerate fast enough to heal the injury. That’s how the injury ends up seeming “permanent”. And if you have RSI for long enough, the condition can become permanent. However, most RSI can be fixed simply by giving your self substantial rest to the affected area and quit the activity that caused the RSI in the first place.

For example, typists with carpal tunnel must take a long break from typing until their wrist pain is totally gone. Taxi cab drivers who have RSI pain in their pedaling foot must stop using that food to push the car pedals. And runners who have shin splints and sore feet must simply stop running until that pain totally clears up.

So taking a break from the activity that caused the RSI in the first place, and resting that affected area is a very simple but most effective way of treating RSI. But the problem is that people tend to need or want to continue the activity that caused their RSI. Typists need to type for a living. Taxi cab drivers need to drive for a living. And runners don’t want to stop running.

If you were to ask me what to do, I would say to find an alternative so that you could actually heal your RSI. Instead of typing, use voice typing (Dragon Software Version / Google Docs Version). Switch your pedal foot for driving your car, or invest in hand pedals. Instead of running, pick up a sport that allows your feet & shins time to heal, such as swimming.

Another problem is that some people have bodies with very poor rates of regeneration, due to their poor sleep, diet, exercise, and overall health. You’ll notice that healthy people not only don’t get sick and strained often, but also recover from injuries a lot quicker. A healthy body is required for proper regeneration of the body. If you don’t take care of the health of the body, the body’s rate of regeneration lowers, and RSI not only manifests a lot more easily but also is a lot harder to heal. That’s why obese people tend to have a lot more medical problems than others.

Finally, another problem with RSI is the brain itself. Some people do take an adequate rest to heal their RSI. But they still experience chronic pain in the affected area. This is due to their increased sensitivity to pain, induced by our brain. Know that with no brain, we can’t (obviously) feel pain. You’ll notice what I mean when sometimes a small injury causes a substantial amount of pain (like stubbing your toe on something), whereas a huge injury may not even be noticed when you’ve got your adrenaline running.

What Makes you Susceptible to RSI?

So there are a couple of factors that affect how easily you get Repetitive Strain Injury and how fast you heal from RSI. They include, but are not limited to:

  • Health
  • Fitness Level
  • Age
  • Amount of Repetition
  • Rest
  • Poor posture
close up nike sports shoes ready to run white blue profile
Keeping yourself healthy with good sleep, diet, and exercise insures that you don’t get sick easily and recover faster- even for RSI

Another observation that I have is that a person’s general health play a role in acquiring RSI. Generally, healthier people can get away with repetitive motions. Whereas more sicklier individuals may end up injuring themselves quite sooner. This circles back to the fact that an injury is more likely to manifest & stay in people who have lower rates of healing and regeneration. And generally speaking, healthier people heal and regenerate themselves a lot faster.

A factor that improves your general health and the healing of RSI is your level of physical fitness. So if I go back to the example of the motorcyclist, you should know a lot of vibrations stresses his wrists. But if the motor cyclist has heavily built-muscular arms, then he is less likely to sustain an RSI injury to his wrist than a very delicately built motorcyclist. In other words, your level of fitness, or the amount of exercise you perform everyday, helps you heal from injuries a lot faster and makes your musculoskeletal system (bones, muscles, tendons, etc.) a lot stronger, and therefore better able to handle stress.

I would say that repetitive strain injury becomes a lot more apparent in the elderly, given that older people tend to have lower rates of healing & regeneration in the body. So that basically means that although the younger people would be able to endure repetitive motions a lot better, older people need to be careful how they stress the body.

Repetitive Strain Injury is quite true to its name- injuries occur due to an overuse of a part of our organ without rest. And even runners can get Repetitive Strain Injury if they over train and don’t rest adequately. Injuries pile on injuries, making it harder for that injury to heal. That’s why (I figure) that some runners get arthritis in their knees, toes, and lower body joints; also tendinitis & tendinosis in their Achilles tendon if they don’t take care of their recuperation. Note that tendinitis is inflammation of the tendon, whereas tendinosis is the existence of microtears in the tendon.

perfect is straight wrists, bad is bent wrists in hill shape, bad is bent wrists in valley shape
Having a proper posture while you type can prevent and perhaps relieve RSI pain like carpal tunnel

RSI can also come as a result of poor posture. I’ll take keyboard typing as an example. For good typing posture, its important to keep your wrists generally parallel to your keyboard. Bending your hand up or down at an unnatural angle at the wrists puts unnecessary strain on the wrist. It’s not ergonomic or not biomechanically compatible with the way that our hand & arm is designed to be used. So typing with a poor posture would result in extra strain and later on RSI of the wrists, also commonly known as carpal tunnel.

How Do you Treat or Cure RSI?

So other than totally taking a complete break from what caused you RSI in the first place (this is the most effective option, by the way), there are a couple of treatment options that may enhance the healing of RSI or perform a bang up job at fixing RSI (surgery). Here’s a list of treatments for RSI in general:

  • Exercise
  • Taking breaks
  • Stretching
  • Anti-Inflammatory
  • Reducing use of strained limb
    • Switching limb being used
  • Make the task more ergonomic
  • Make the equipment more ergonomic
  • Make work environment more ergonomic
  • Surgery (a last resort)

Treating RSI with Exercise

The problem is that in our modern time, many of us lead a sedentary lifestyle bereft of exercise and movement of our limbs. Being sedentary, or sitting in one place for long periods of time every day, has negative affects on our muscles, tendons, bones, and ligaments. Without the stimulation of movement, our body physically becomes weaker, more delicate, and more prone to injury. With a weak body, straining a part of it is much more likely to happen and serious than with a healthy body.

black pants white shirt cool black guy with black hair in running position with bright white-blue skyExercise and movement has positive effects on our body. Our body becomes more resilient to physical stressors, and heals much faster from strain and injury. But the same is not true for a sedentary person who sits on his butt all day. Without the stimuli of exercise and movement, the body releases less hormones that promote rejuvenation or healing. You’ll even notice this fact when you start to exercise regularly, if you’ve had the experience. For example, people who exercise regularly sleep deep than people who don’t exercise as much, or don’t exercise at all. Deep sleep is one of the body’s mechanisms for rejuvenation and healing.

So how does exercise relate to RSI? Well, I already mentioned that exercise is a stimuli for the body to heal. Without exercise, the body heals slower so that strains from repeatedly performing a task is a lot more substantial. Meaning that you are both more likely to acquire RSI and less easily heal from RSI if you don’t stay fit. That is why chronic muscle pain, tendonitis, tendinosis, carpal tunnel, etc. is prevalent in modern society.

But let me caution you- Don’t exercise on the limb that is afflicted with RSI. This should be obvious.

Treating RSI with Stretching

So stretching can help negate some of the negative affects of a sedentary lifestyle that contribute to RSI. But how does stretching help?

You should know that being sedentary shortens the muscles, tendons, and ligaments that are the parts of our body that flex for movement. Of course there is a reason for the shortening- less movement means less need for these flexible body parts to flex and therefore they stay in a shortened position and become less flexible.

But the shortening and increased inflexibility of muscles, tendons, and ligaments may negatively impact or contribute to RSI. Reduced flexibility means a reduced range of motion, and therefore certain positions that we are in put more strain on the body.

Stretching reduces muscle tension, thereby reducing the strain on the affected area. Stretching could also reduce the amount of pressure placed on the nerves, thereby reducing RSI pain.

Stretching for those afflicted with RSI shouldn’t be overdone, but performed gradually.

No additional pain should appear during the stretch.

One thing to keep in mind for the stretching is that both mirror opposite limbs should be stretched. For example, if you are stretching your right hand, you should also stretch our your left hand. This is simply to keep your body balanced out biomechanically.

So some questions that can be asked are: “How long should I hold the stretch?”, and “how many times a day should I stretch?”.

Well, for RSI you have the choice of holding the stretch about 15 to 20 seconds. And repeating the stretch once daily for mild cases, or 3 times a day for acute/serious cases of Repetitive Strain Injury.

It will take a long time to see improvements, up to a week, especially if the limb was left immobile, like in a wrist splint or brace. But the week after you should start to see beneficial results, a reduction of RSI pain, with stretching.

One thing to beware of is using a brace. In some cases, wearing a brace to reduce movement in a particular hand can have detrimental effects. You can be familiar a particular phrase, “Use it, or Lose it”. Well, the same is true with the musculoskeletal part of our body. In the same way that a weight lifter who stops exercising loss muscle mass, you may experience atrophy of the muscles on the limb that you wear a brace on.

As for carpal tunnel, you may experience some numbness or tingling in the hands or arms. But sometimes it can be something else- always check it out with a doctor, because occasionally this feeling can be due to something else, like spinal disc herniation.

Treating RSI with an Anti-Inflammatory

man standing in front of fire
Many people like to think of inflammation as a fire, and anti-inflammatories as the cool water that puts out the fire. But you have to understand, RSI is mostly not an inflammatory issue. Like arthritis, RSI is an issue of inadequate healing and regeneration.

So you might be wondering, what is an anti-inflammatory? Well, anti-inflammatories refer to substances that reduces inflammation and swelling, and inflammation is the body’s way of dealing with pathogens, damaged cells, and irritants. The purpose of inflammation is to remove the reason why cells got injured in the first place, and to allow tissue repair to begin.

So you’d think that inflammation is a good thing from my description, right? Well, inflammation is good in the beginning and in the right context. And too little inflammation can lead to progressive tissue destruction by the harmful stimuli (i.e. pathogens). However inflammation that persists for a long time, also known as chronic inflammation, keeps damaging and healing the affected part of the body overtime. But this isn’t good, and can lead to diseases such as rheumatoid arthritis, other autoimmune diseases, and even cancer,

So at this point, you might be thinking, “what does inflammation got to do with Repetitive Strain Injury?”. Well, as with any injury, the body responds to it with inflammation. But inflammation is part of the body’s natural healing system. At least with normal injuries. But interestingly enough, overuse injuries (a.k.a. RSI) isn’t usually an inflammatory condition. After a lot of time passes the incident of the injury, the RSI may persist. The inflammation goes away, but the body failed to heal the affected tissue. This is RSI.

Indeed, its quite misleading that doctors say that patients have tendinitis and the like, when in fact there is little to no presence of inflammation in the affected area. Remember, I said that RSI is a problem of overuse, like arthritis. Arthritis isn’t necessarily an inflammatory issue, but a issue of bone regeneration. And anti-inflammatories don’t necessarily help with tissue, bone, and ligament regeneration. That’s why many patients find NSAID anti-inflammatories to mostly do nothing for their RSI. Sure, there may be some inflammation as a result of a tendon being ruptured, or muscles being ripped apart. But inflammation is mostly an immune response that is suppose to deal with outside invaders, pathogens, etc.

However, Inflammation can become an issue usually if it is chronic. Chronic inflammation may be a factor that slows down healing in the body, thereby slowing down or preventing the Repetitive Strain Injury from healing. So in this case, my theory is that anti-inflammatories could be used to allow the body to heal the RSI, if it is the chronic inflammation that is preventing the healing.

But just treating the symptoms of inflammation won’t fix chronic inflammation. It is better to fix the root cause of the chronic inflammation. For obese people, they have to loose weight. For people who consume a bad diet, they must change their diet to include a lot of fruits and vegetables to promote the right kind of bacteria (probiotics). Bad bacteria release toxins into the body, causing inflammation (and if this condition exists overtime, it can be called “chronic inflammation”). For people with heavy metal exposure, they must see a specialized doctor to help them remove the heavy metals from within their body. I feel particularly bad for people who have mercury amalgams; they literally have the heavy metal mercury stuck to their teeth.

And taking pharmaceutical anti-inflammatories are not safe, or even may backfire. For example, orally taking Ibuprofin can negatively affect the gut and heart health (increases the risk for heart attacks). However, applying an anti-inflammatory cream exposes your body a lot less to of the destructive pharmaceutical anti-inflammatory chemicals.

Additionally, you should be especially careful of corticosteroids injections. Super strong anti-inflammatories like this one has a property of weakening connective tissue. That’s especially bad for RSI, given that RSI by definition is the weakening and deterioration of ligaments, muscles, & tendons. So corticosteroids may actually just add to the problem.

So the helpfulness of anti-inflammatories for RSI is questionable at least. But I suspect (read “conjecture”) that there are some “anti-inflammatories” that may actually improve the healing of Repetitive Strain Injuries. Like ginger and turmeric. But this is purely a speculation that I need to investigate further.

But for sure, there is one thing that does improve body regeneration. Those are sleep, a good diet, and moderate exercise. Note that you don’t want to exercise on the afflicted area with the RSI.

Treating Carpal Tunnel RSI

A form of RSI that happens in the wrists of the human being is called, “Carpal Tunnel Syndrome“. In this injury, the median nerve that travels from the wrists into the hand is compressed at the carpal tunnel. People with carpal tunnel syndrome may experience pain, numbness, and tingling in the thumb, index finger, middle finger, and the thumb side of the ring fingers.

In order to treat Carpal Tunnel Syndrome, you have to look at fixing carpal tunnel risk factors as a way to treat the wrist pain. Risk factors that increase the likelihood that you acquire carpal tunnel syndrome includes obesity, repetitive wrist work, pregnancy, taking supplementary growth hormone, and rheumatoid arthritis. So if you have any of these risk factors, you can eliminate them in order to improve your RSI.

So that means losing weight if you are obese, doing less repetitive wrist work and/or performing it more ergonomically, and having a doctor treat your rheumatoid arthritis, if you have it. As for pregnancy, you’ll have to wait until the baby is born. Of course, there are still many options for dealing with carpal tunnel syndrome whether or not you are pregnant.

So, lets take a look at the subject of “repetitive wrist work” and how it contributes to carpal tunnel RSI. A few common examples of work that involves a lot of strain being applied to the wrist includes typing on a keyboard, using a mouse, writing, pottery, assembly line work, and playing the piano for extended periods of time. Carpals tunnel usually develops when the wrist is overused or over strained; getting worse the less rest time you give it for recovery.

So to reduce the strain that comes from repetitive wrist work, you can use better ergonomic equipment and perform the activity in a more ergonomic fashion. Or simply find an alternative method for performing the task. For example, Voice typing method that eliminates a lot of typing on the keyboard.

Is Carpal Tunnel Release Surgery a Good Solution for RSI?

showing site of carpal tunnel syndrome
Carpal tunnel is when the transverse carpal ligament presses down on the median nerves of the hand, causing pain.

If you have a form of RSI in your wrists called “carpal tunnel”, one option to treat it is to have an open carpal tunnel release surgery. During the surgery, what they do is cut the transverse carpal ligament in order to release the pressure on the median nerve. By releasing the pressure, patients who undergo this surgery may experience a relief from their carpal tunnel.

carpal bones shown in x ray
Left hand, anterior view. Carpus shown in red.

But there are consequences to cutting the Transverse Carpal Ligament (TCL). I mean, our body has a logical structure. If you look carefully, you’ll notice that the TCL holds together the small bones (carpals) in our wrists. By cutting the TCL, the carpal bones are no longer held together in a sturdy fashion, are no longer stable in place, and reduces the amount of weight or force you can safely load onto your wrists. I bet performing a handstand would become a lot riskier with carpal tunnel surgery.

So with this surgery, if you think about it, you are trading away functionality of your wrists in return for possible carpal tunnel pain relief. For sure, you can perform tasks with your hand that doesn’t put a huge load on the wrists, like typing, pottery, or sowing. But you end up with a weaker, less stabilized wrist that cannot hand the amount of force that it used to.

Let’s outline the the functions of the Transverse Carpal Ligament (TCL). I already mentioned that the TCL stabilizes the all of the small carpal bones in the wrist. The TCL also serves to anchor key muscles inside the hand, including the one beneath the thumb. The TCl also functions as a type of “pulley” that aids the tendons in your hand to flex your fingers.

Additionally, scientific studies show that cutting the TCL both shortened and weakened the hand muscles anchored to the TCL[1]. And that the tendons in the fingers became “bow stringed”, leading to wrist weakness and trigger finger[2][3]. So there definitely are significant biomechanical disadvantages to carpal tunnel surgery.

Let’s take a step back and look at the overall picture. The problem is that people’s develop RSI in their wrist, specifically their median nerve becomes pinched or “squished” by the Transverse Carpal Ligament. Before the RSI, the TCL doesn’t pinch the median nerve. So wouldn’t reversing what causes the pinched nerve be the solution?

The TCL has a purpose in our body, in our hand. Cutting it is our rough way with dealing with the median nerve being pinched. Perhaps we need to investigate what causes the pinched nerve in the first place, and how to reverse it?

Well, there is actually something that may help, called “nerve hydro-dissection with platelet lysate”. Basically, they free up the median nerve without having to the cut the TCL. This procedure has the doctor inject growth factor, from the patient’s own blood platelets, around the median nerve. After the procedure, the scare tissue around the median nerve is broken up, and inflammation around the median nerve is reduced. Note that one side effect of inflammation is vasoconstriction, and therefore reduced blood flow- so by lifting inflammation of the median nerve, blood circulation to the median nerve becomes improved.

Is Fascia Relevant to RSI?

So an interesting question is whether Fascia is relevant to RSI or not? Well, let’s start by understanding what Fascia is.

Fascia is a form of connective tissue that supports and gives form to he muscles.

The Fascia wraps the muscles fibers. While the muscles fibers end at one point, the fascia continues until it joins with other fascia to become a tendon. Then the tendon continues until at one point it joins the bone. Interesting how our body is joined together, yes?

You’ll also notice this gradual change between muscle, tendon, then bone by simply looking at your own body. Look at your calf. Right behind and below the knees, your calf is at its thickest with muscles. Then as you go down to your feet, the muscles taper off into the Achilles tendon. And then the Achilles tendon continues down until it joins with the Calcaneus, or Heel Bone.

So how is Fascia related to RSI? Well, like the muscles, tendon, and ligaments in our body, fascia too can become strained out. But really, knowing about the fascia still doesn’t change the main treatment option I mentioned: let the body heal by stopping what causes the RSI in the first place. And improve body’s latent healing ability to recover from the RSI faster.

Related Links

Resources for Treating & Curing RSI

Related Articles

Sources

  1. Biomechanical alterations in the carpal arch and hand muscles after carpal tunnel release: a further approach toward understanding the function of the flexor retinaculum and the cause of postoperative grip weakness. [NCBI]
  2. Biomechanical changes after carpal tunnel release: a cadaveric model for comparing open, endoscopic, and step-cut lengthening techniques. [J Hand Surg Am.]
  3. The relationship of trigger finger and flexor tendon volar migration after carpal tunnel release. [J Hand Surg Eur Vol.]

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