Repetitive strain injury: causes, symptoms and treatment

What RSI is

RSI describes pain and other symptoms in the upper limb or neck that develop from doing the same movements over and over. It is not one condition but a group. Some cases have a specific diagnosis, such as tennis elbow, De Quervain's tenosynovitis at the thumb side of the wrist, or carpal tunnel syndrome. Others are described as non-specific arm pain, where no single structure explains the symptoms.

Either way, the underlying pattern is similar: the tissues are being asked to do more of the same thing, for longer, than they can currently tolerate, often without enough variety or recovery.

Common causes and who gets it

• Long hours of keyboard and mouse work, especially with few breaks
• Manual trades using tools repeatedly, such as plastering, joinery or assembly work
• Hairdressers, musicians, chefs and cleaners
• Gaming and heavy phone use
• Grip-heavy training blocks with lots of pulling, carrying and rowing
• New parents lifting and feeding a baby many times a day

Stress, time pressure and poor sleep also play a part. Pain is more likely when you are working to deadlines, skipping breaks and feeling tense, and it often eases on holiday even before anything else changes. That does not mean the pain is imagined; it means the whole system affects how sensitive tissues become.

In the UK, employers are required to assess display screen workstations for employees who use them regularly. If your pain is linked to work, it is reasonable to ask for a workstation assessment or an occupational health referral.

Typical symptoms

• Aching, burning or throbbing pain in the forearm, wrist, hand, elbow, shoulder or neck
• Tenderness and stiffness
• Pain that builds during the working day and eases at weekends
• Tingling or numbness in the fingers
• Weakness, cramp or reduced grip

Symptoms often start mildly and only during the aggravating task, then linger for longer if nothing changes. Acting early, when it is still mild, usually means a faster recovery.

A typical example is an office worker who takes on a big project, spends ten-hour days at a laptop on the kitchen table for a month, and notices a burning forearm by the end of each day. Nothing dramatic has happened; the tissues have simply been asked to do too much of the same thing without enough variety or recovery.

What a physio assessment looks at

A physio will ask in detail about your work, hobbies and training, including how many hours you spend on the aggravating tasks, how often you take breaks and what has changed recently. They will examine the neck, shoulder, elbow, wrist and hand, test strength and grip, and check nerve function if you have tingling or numbness.

The goal is to identify any specific condition that needs a particular approach, and to find the practical changes that will reduce the load while your tissues recover.

If you already train, bring your programme. Grip-heavy weeks, such as lots of deadlifts, rows, pull-ups and carries stacked on top of long desk days, are a common combination, and small adjustments to training often help as much as changes at work.

What usually helps

The first step is changing the load: reducing time on the aggravating task where possible, breaking it up with regular short breaks, varying your position and technique, and adjusting your workstation or tools. Small changes, such as a different mouse, keyboard shortcuts, voice typing for long documents or a thicker tool handle, can make a real difference.

The second step is building capacity. Strength training for the forearm, grip, shoulder and upper back helps tissues tolerate the demands of your day. Our guide to grip strength covers progressive forearm work. Manual therapy can ease pain and stiffness in the short term. For carpal tunnel symptoms, a wrist splint worn at night often helps, and a GP may discuss an injection or referral if symptoms persist.

What you can start with at home

1. Regular microbreaks every 30 to 45 minutes during repetitive tasks.
2. Gentle wrist and finger movements: circles, making a fist and spreading the fingers, 10 each.
3. Wrist curls and reverse wrist curls with a light weight, 3 sets of 12 to 15, three times a week.
4. Rows and shoulder blade squeezes to support the upper back, 3 sets of 12.
5. General activity such as walking, which helps overall pain sensitivity and stress.

Our guide to training around a desk job has more ideas for moving well through a long working day, and our page on wrist pain in the gym covers training-related wrist problems.

Recovery time and when to get help

Most people improve over a few weeks to a few months once the load changes and strengthening starts. Longer-standing cases may take longer, particularly if the aggravating tasks cannot be reduced. The on-site physio at Lycan Strength can assess it and build a plan, with 20% off for members; book a physio appointment online.

Keep the new habits once the pain settles. Breaks, variety and strength work are what keep RSI from returning when the next busy period arrives.

• Call 999 if arm, shoulder or neck pain comes with chest pain, breathlessness or sweating.
• Go to A&E if the arm or hand becomes cold, pale or numb, or after a significant injury with deformity.
• Call NHS 111 or see a GP urgently if a joint becomes hot, red and swollen, or you have a fever.
• See your GP if you have constant numbness or tingling, weakness, dropping things, or visible wasting of the muscles at the base of the thumb.

Questions