Many people will wait too long to start treating their repetitive strain injury. And it’s no surprise – repetitive strain injuries are often sustained from performing standard, commonplace activities and movements like typing on the keyboard, or even just lowering our head down to our shoulder to hold our mobile phone to our ear. As a result, these movements feel like they’re just a simple part of everyday life, or a normal “part of the job” at work, leaving many assuming that if most other people can perform these activities daily without pain, then they’ll get used to it too, and their pain will subside.
The reality is that without changing something like your ergonomics or the way you perform specific movements that are causing you pain or tenderness, you risk experiencing recurrent painful flares, as opposed to your body adapting to it in a painless way.
While the heavy integration of modern technology like laptops and hand-held devices into our everyday lives and workplaces has seen ergonomic issues and injuries rise in prevalence, repetitive strain injuries have been described as an “epidemic” as early as 1987, with the Australian medical journal reporting that 34.3% of telecommunications workers that used corded telephones and 28.4% of workers that used keyboards sustained a repetitive strain injury over a four-year study.
Given that approximately 60% of all occupational injuries are caused by repetitive strain and data shows that Hong Kong workers are being very much affected, today our physios have shared about what repetitive strain injuries are,how they are caused, how to spot repetitive strain injuries of the wrists early, and how our physiotherapists can help you recover so you can regain your comfort and function.
What Is A Repetitive Strain Injury?
A repetitive strain injury (RSI) is a result of slow and gradual damage to your muscles, tendons, nerves or joints, from performing repetitive motions in a suboptimal way, whether the is prolonged, forceful, or awkward from a less-than-ideal alignment.
This produces damage in the form of micro-trauma, which may be unnoticeable at first, but can build up over time and trigger pain, inflammation, numbness, weakness and affect your strength and flexibility. You may feel these symptoms in your wrists, fingers and thumbs, as well as your elbows, arms, shoulders, knees, and whichever other areas have been affected. If you’ve had previous injuries such as a rotator cuff tear or a sprain to your wrist, this can make you even more susceptible to developing an RSI.
Who Is At Risk Of A Repetitive Strain Injury?
There are three primary risk factors for repetitive strain injuries:
- Poor posture
- Poor technique
There are also additional risk factors for RSIs that may increase your risk if you already tick the box for one of the three primary factors, which include working without taking adequate breaks, having poor physical strength or flexibility, having conditions like arthritis, carrying excess weight, and having a sedentary lifestyle. Working in environments that require consistent computer use or hands-on tools (like hammers) also increase your risk when paired with one of the three risk factors above.
What Are The Early Signs Of An RSI In The Wrist?
If you’re concerned about a repetitive strain injury in your wrist, the first signs you may experience include soreness, tingling or discomfort which may only happen when you do a certain task or repetitive action. Your symptoms may disappear as soon as you stop the aggravating activity, or it may take a few hours or a couple of days for the symptoms to settle. Over time, as your RSI progresses, you may notice an increase in the frequency, duration or intensity of your symptoms, or experience more symptoms such as:
- Weakness in the hands or forearms
- Burning, aching or shooting pain ranging from mild to severe
- Numbness around the hands or wrists
- Fatigue or a lack of strength
- Swelling or stiffness
- Difficulty performing everyday activities requiring fine motor skills such as turning door handles, chopping vegetables, or turning on a tap
If you’re currently experiencing an RSI in your wrist, practical things you may notice could include:
- You use your non-dominant hand more frequently to avoid using your injured hand
- Drop things from your hand more often
- Find food preparation, such as chopping and peeling, more difficult
- Find it more difficult to use keys to open doors, or do things like brushing your teeth
What Happens When Your Wrists Are Repetitively Strained?
Repetitive strain injuries build up over time, and this slow repeated damage can also lead to other conditions, including:
- Tendinitis: This is the most common complication of RSI in the hand and wrist. Tendinitis occurs when a tendon, a cord of tissue that connects muscles to bones, becomes inflamed and triggers tenderness and pain, and the surrounding tissue tends to swell. Symptoms are often triggered during and after physical activity, and worsen over time.
- Carpal tunnel syndrome: This is one of the most common problems that affects the hand, and it can result in pain, numbness, tingling, and weakness in the hand and wrist. It is caused when the space known as the carpal tunnel in the wrist narrows from overuse and pressure, which presses down and pinches the median nerve, and makes the tendons swell, cutting off sensation in the fingers and hand.
- De Quervain’s tenosynovitis: This condition happens when repetitive movements of the thumb and wrist irritate the tendons that run from the wrist to the thumb, causing them to swell. These tendons are encased in a tunnel-like tissue called a sheath, and when they are swollen, it makes it difficult for them to move through the sheath, which can cause pain.
- Trigger finger and trigger thumb: This happens when your fingers or thumb get stuck in a bent position, as if squeezing a “trigger.” In your hand, tendons and muscles work together to flex and straighten your fingers and thumb. Usually, the tendons slide easily through a tunnel of tissue called a sheath, but in trigger finger or thumb, the tendons become inflamed and can no longer easily slide through their sheaths.
- Ganglion cysts: A ganglion cyst is a small, fluid-filled lump just below the skin, usually close to a joint. They are benign (non-cancerous) masses that develop in your soft tissue. It’s believed that they can develop after repetitive micro-injuries to different ligaments in your joint, which produce acids that eventually form into a jelly-like cyst.
Getting Other Pains? It Could Be Related To Your RSI
One problem we see with RSIs is that when you have a painful injury, you start performing movements in a different way – we call this ‘compensating’. This can then strain other areas of the body, as these areas are not used to being loaded in this way. If you’re experiencing pain in your shoulders following an RSI, your physio should explore the possible connection between the two.
Treating Repetitive Strain Injuries Of The Wrist
Effectively treating RSIs involves understanding exactly which movements are causing your symptoms and what structures in the wrist are being irritated or damaged. If significant damage has occurred and a specific condition has developed, the severity of this will also need to be assessed and diagnosed.
This is where it’s crucial to have a management plan that is individualised and considers every aspect of your care – from understanding the movements required for your job and your specific techniques – to how previous injuries you may have had earlier may be affecting your technique and posture. Ultimately, our goal is not simply to change you so you’re able to perform your role without pain, but to look at all the aspects of your job too so that it also works safely for you.
Once our physiotherapists have all of the information following our comprehensive assessment (which in some cases may require medical imaging like ultrasound), we’ll create a proactive management plan. It’s important to cover all our bases:
- Addressing your current symptoms and discomfort
- Creating the right conditions for injuries to heal
- Revising your unique circumstances to give you strategies and techniques to continue to move your wrists safely and efficiently at work
- Prevent the RSI and any related problems from recurring in the future
The best way to approach this will depend entirely on you. This may include:
- Having our team review your posture. It’s important that you’re positioned in a way that minimises strain on your body, and this can look different for everyone. Some office chairs that are marketed as being incredibly safe and ergonomic may not feel good to you, and it’s important to listen to that.
- Addressing imbalances. When our body is imbalanced, we may have muscle tightness or weakness that throws us off. It could be our hips, glutes, back, or shoulder – and it can have reverberating effects on our bodies that many people don’t realise. By identifying and addressing these imbalances through fascial releases, strengthening, stretching, mobilisation and other methods, our physios are best able to set you up for success.
- In certain circumstances, using a wrist splint or other aid. Depending on your symptoms and circumstances, wearing a splint or other aid for a period of time may help kickstart your healing and repair process. We understand that it’s less than ideal for some, but this is something we will discuss with you in situations where we identify that it may have significant benefits.
- Recommending specific equipment, like a certain computer mouse that places different demands on your wrists than your current one. This can look like moving from a standard mouse where all of the work is done by one finger to a trackball mouse, where you don’t have to continually move your hand and forearm, which reduces strain on the arm, shoulder, back and neck.
All of our treatment plans for your specific RSI and evidence-based and carried out by our experienced, knowledgeable physiotherapists. We will also fill you in on everything you need to know about RSIs, so you can make the best choices for your wrists and help prevent injury amidst a range of new circumstances and environments.
Once you’re back to living pain-free, remember to take regular breaks when performing activities using your wrists – even during hobbies like knitting. Consider making changes to regular, monotonous routines to engage your wrists in slightly different ways, and try to manage stress levels, as higher stress levels are linked to increased symptoms of repetitive strain injuries. A simple way to help with this is by practising diaphragmatic breathing.
- Repetitive strain injuries are likely to get worse over time if you don’t make any changes to your regular routine
- Repetitive strain injuries can cause damage to a wide range of structures – muscle, tendons, ligaments, joints and tissues – which is why it’s crucial to get formally diagnosed by a physiotherapist so you know which structures have been damaged, which actions triggered it, and the best way forward for treatment
- There may be a lot more than meets the eye with RSIs, and you may have noticed other pains that have started as compensations
- If you start experiencing pain, tingling, weakness or discomfort in your wrists, it may be a sign of an early repetitive strain injury. This is the best time to intervene so that it doesn’t get any worse and cause you significant pain and disruptions to your everyday life
- PhysioCentral’s team of physiotherapists are highly experienced in managing a wide range of repetitive strain injuries across the body, including in the hands and wrists. If you’re concerned about a RSI, our team is here to help.