What is Repetitive Strain Injury?

Most massage therapists have seen clients who claim to suffer from repetitive strain (or stress) injuries—but do they, really?

According to researchers in the Netherlands, high quality trials and evidence of effective treatments for repetitive strain injury (RSI) are needed to define this controversial condition which affects millions of people worldwide.

The researchers looked at the prevalence, causes, symptoms and treatments of RSI using a number of medical databases. The findings were reported in a recent edition of The Lancet.

"Repetitive strain injury is not one diagnosis, but is an umbrella term for disorders that develop as a result of repetitive movements, awkward postures, sustained force, and other risk factors," the authors noted.

Conventional definitions of RSI include specific disorders such as carpal tunnel syndrome (a twisting of the median nerve at the wrist causing pain in the wrist and hand), tendonitis of the wrist and hand, and various upper limb problems.

RSI arises frequently in adults of working age, with many people reporting strains of the hands, wrists, arms, shoulders or neck. Several countries report RSI incidence of 5 percent to 10 percent, although this could be as high as 40 percent in specific working populations.

Several hypotheses exist for how RSI occurs, but none have been supported by strong scientific evidence. One theory is that continuous contraction of muscles from long-term static load with insufficient breaks could result in reduced local blood circulation and muscle fatigue. Consequently, pain sensors in the muscles could become over-sensitive, leading to a feeling of pain at lower-than-normal thresholds. Another theory is that overuse of tendons by repetitive loading causes RSI.

Doctors can also find it difficult to suggest appropriate treatment for RSI, although several studies have shown exercise to be beneficial both for providing symptom relief and improving the activities of daily living. Other treatments such as massage or use of ergonomic keyboards at workstations are also regularly prescribed.

"Strong recommendations for any therapeutic intervention cannot be made at present because many trials have small sample sizes and methodological flaws that could have led to biased results," the authors noted. "This disorder will remain controversial until high-quality trials provide clear definition of repetitive strain injury and evidence of effective treatments."