Repetitive Strain Injury


i) What is Repetitive Strain Injury (RSI) and do you have it?

In my experience almost everyone is vulnerable to RSI. If you do too much, too quickly and with poor form (the posture used when moving) you will probably get an RSI.

If you think you may have an RSI you need to be sure that this is what you really have by seeing a specialist who can confirm or refute your own self-diagnosis. My definition of RSI is something like ‘non-specific pain’ in the wrists and hands, though this can spread to the back and shoulders. There are other conditions such as Carpel Tunnel Syndrome that are related but different and may need a separate approach. Some people prefer to call RSI ‘Cumulative Trauma Disorder (CTD) of the upper limbs’, which is a more accurate term because it better describes the genesis of the disorder and because the name ‘RSI’ implies that you can only experience a repetitive strain injury in your hands, which is not true. I have reluctantly kept the term ‘RSI’ because most people know what it refers to.

ii) What cause RSI/ CTD?

I think there are two main factors, i) overuse and ii) misuse. Overuse is not just doing too much but suddenly increasing the amount (the load) that one is doing. ‘Misuse’ refers to incorrect posture, not only of the back but also the shoulders and the hands.

iii) How does healing take place?

I think it is primarily through rest followed by ‘correct use’, i.e. not overusing or misusing one’s body. After you have rested from RSI you can gradually build up your use by, for example, using a computer initially for a 5 minute slot once an hour 5 times a day for 5 days a week in the first week and then increasing the slot time by 5 minutes each week till you build up to, say 45 minutes an hour. There is more general advice about how to rest here.  If you have a smart phone you can use the clock app stopwatch function to time your activity and break periods. The stopwatch function includes an audible alarm that alerts you to when to stop or start your break or period of activity.

Once you have built up your computer use again, you need to maintain safe use by avoiding misuse and overuse.

iv) Maintaining safe use

i) Avoiding overuse – a key concept here is allowing yourself adequate ‘recovery time’.  In the same way that when people train their muscles in the gym you need to give your body adequate recovery time to repair the damage that is caused through use.

To avoid overuse you may benefit from having a ‘rest and use schedule’. This means:

– having mini-breaks so that whilst typing and inputting you have a short break every 5 minutes where you simply rest your hands for half a minute and check your posture – are your feet flat on the floor? Are you shoulders unhunched? Are you wrists parallel to the desk?

– I find it useful to use the timer function on my phone to time how long I am on the keyboard for and to time my breaks.

– take a longer break every hour for about 10 minutes

– on a given day do not exceed more than 5 hours of use.

– every week take one day off

– every twelve weeks take a complete week off.

When you take breaks you don’t need to sit and do nothing. I often do a bit of tidying. An alternative approach is to use varying your activities as a way of ensuring enough rest. You can do this by varying an hour of inputting with an hour of another activity e.g. having a meeting or making some phone calls, sitting and thinking/planning – maybe by using pen and paper.

– it is crucial to avoid sudden increases in load – either in terms of speed of movements or volume of work. It may be necessary to do this for a day or so if you have deadlines, but I think anymore than a short period can be dangerous.

– having the right attitude

I think part of avoiding overuse is about having the right attitude. By this I mean that doing more is sometimes not that productive and it may be better to assume the attitude of not being so competitive or perfectionist.  The other day I could feel some pain coming on so I simply said to myself ‘stop’ and left the piano.  I then began doing some tidying and other tasks and actually felt better doing this.  I think that it is about not becoming obsessive with an activity and realising that you achieve more overall if you do ‘a bit of everything’ rather than focusing on just one activity. I think that sometimes there is a law of diminished returns with an activity where an increase in activity eventually brings negative returns. Sometimes maybe less is more.

  • ii) Avoiding misuse

The key concept here is ‘posture’. I won’t go into all the details of this here because there is loads of information from organisations such as the Health and Safety Executive that gives guidance about correct alignment of the hands, back, feet, shoulders and neck whilst using a computer or playing a musical instrument.

The Alexander Technique is a systematic approach to incorporating good posture into every aspect of your life, whether it is walking, talking, sleeping or whatever.  I think that the idea is that by reducing the small traumas that occur whilst performing everyday activities with poor posture, over a period of time one is removing a significant accumulation of these traumas that can manifest itself in bodily dysfunction.

One of the ways that I find helps me to maintain good posture is by having two desks – one for writing and one for typing. The writing desk has adjustable legs so I can have it at the correct height for writing, which is higher than for typing.  I also find that writing helps with resting by varying the way that I am using my hands.  The desk that I use is collapsible which enables me to have enough space in the room that I am using. Using the writing desk also helps me to type less, because it circumvents the stage of making lots of amendments and edits you create by ‘thinking by typing’.

I use a cordless mouse on a decent sized mat.  I find that this helps to reduce strain from mouse use.

  • I find that using cutlery and pens that are thicker helps by enabling you to hold the item with less effort.

 Alternative input devices

When I first developed this problem I thought that the answer was voice recognition software. However, this simply caused problems with my voice which I am still dealing with.  The mistake here was that transferring ‘the load’ from one part of your body to another will simply just create more problems elsewhere.  Saying that, voice recognition technology is improving all the time and I have met people who have said that they found it very useful. However, if you have had an RSI I personally think that either you learn how to use a keyboard properly, or you can combine this with using a variety of input media, which I think currently consist of using some combination of keyboard, mouse, voice recognition, a graphics tablet and touch-screen technology.

Books to read

Help My Computer is Killing Me by Dr Sheik. N. Imrhan.