RSI symptoms: May'13

Jan answered your questions on what the symptoms of RSI are, how to cope with the pain and how to prevent the condition.

Jan Vickery is the lead physiotherapist for our health services team. 

AXA PPP healthcare asked: Welcome to today's live chat with Jan Vickery on RSI symptoms, causes and treatments.

Ruth asked: Hello, can anyone get a repetitive strain injury?

Jan Vickery lead physiotherapist answered: Yes, I geuss so. Anyone who makes demands of their body that is beyond their capacity can result in having an injury.

fiona asked: Can yoga help prevent RSI?

Jan Vickery lead physiotherapist answered: Yoga has many benefits. i don't think it would be viewed as a treatment for RSI though. in general the best ways to prevent RSI is to make sure that don't use your body beyond its capabilities. One could argue that yoga may increase your capability and therefore may reduce the chances of RSI but you should also look at not overloading your body by avoiding or reducing the trigger factors. See the next question to find out more about trigger factors.

lenny asked: What are the trigger factors of RSI?

Jan Vickery lead physiotherapist answered: HI Lenny Typical trigger factors for RSI are poor or awkward posture, vibration, workload that involves high forces, repetition and work that is carried over for a long period of time.

Anonymous81 asked: im experiencing aching in my left shoulder and pins and needles down my shoulder to fingers, is this RSI or and impingement do you feel?

Jan Vickery lead physiotherapist answered: Hi RSI in itself does have specific diagnostic criteria. in general there are 2 types of RSI - those that clearly and easily diagnosed such as Carpal Tunnel Syndrome, De Quervains and others and then there are those that are non specific. its difficult to comment on your specific clinical presentation without a fuller assessment but it sounds like you may have some sort of impingement. its worth seeing a physio if you have been struggling it for more than a couple of weeks. Good luck - hope it gets sorted.

Anonymous81 commented: Thank you much appreciated.

Anonymous81 asked: ive been using a powerplate do you feel this could have caused the problem? refer to my previous question.

Jan Vickery lead physiotherapist answered: Possibly, it may be one of a number things that are contributing. If you see a physio they will give you an idea of how your symptoms are beign caused and what to do and look out for to prevent the triggers.

Anonymous81 commented: Thanks

Terisa asked: What treatments are available for tendonitis?

Jan Vickery lead physiotherapist answered: Hi Terisa Tendonitis means inflammation of the tendon so the principles of treatment are to use modalities that will reduce inflamation. The most common advice is rest (sometimes a splint or brace is used) and anti-inflammatories. In general, an important aspect of managing tendonitis is to identify what the triggers might be and to address those.


Scott1984_FP asked: Does Your Expert Have Any Knowledge Of Mid Carpal Instability (Disability) & Part Of The RSI Family?. Or Any Advice,Treatment, Physiotherapy, For Treating Mid Carpal Instability?.

Does Your Expert Have Knowledge Of RSD/CRPS 1&2 ?.

Jan Vickery lead physiotherapist answered: Hi Scott Funnily enough, I attended a conference last week where a session focused on the management of Complex Regional Pain Syndrome. There are some specific and highly effective techniques like mirror therapy and graded motor therapy and i would advise seeking treatment from someone who is competent in this specialist area. Carpal instability is another diagnosis that usually needs someone specialist to look at exactly where the instability is, what might be causing it and how it should be treated. Both these types of injuries are often overlooked and tend to present after the individual has been around the houses treatment wise. If I were struggling with either of these i would be sure to find someone who is specialised in these conditions and their management

Scott1984_FP commented: Many Thanks For Your Response :)
I Suffered From Mid Carpal Instability Which Triggered Me To Suffer From RSD/CRPS & Clinical Depression,Anxiety, After I Suffered From An Accident/Injury To My Left Hand/Wrist,Arm.

I've Been Under A Hand Specialist Through The Past 2003-2010, Had 3 Wrist Operations, Wear Wrist Splints/Wrist Braces On My Left Hand/Wrist,Arm, Use Physiotherapy & Exercises On My Left Hand/Wrist,Arm, & Upper Limb, & Saw Physiotherapists For One To One Physiotherapy In 2003 & 2010, & Started Seeing A Pain Specialist In 2009, Where I Was Put On Pain Patches, Pregabalin, & Had 7 Stellate Ganglion Block's Since 2009 Every 4-6 Months Were Possible, I Also Have A Fold Away Mirror Box Too, I Also Been On Tylex Painkillers Or The Like Since: 13-10-2002.

Jan Vickery lead physiotherapist answered: Hi Scott it sounds like you have had a real time of it. I hope things have turned a corner for you. I was really inspired by the case studies i heard about last week - how patients who had been through everything going and were at their wits end, with some good specialist treatment by physios who understood chronic pain and CRPS specifically, were able to return to full function, work and no pain. Good luck.

Scott1984_FP commented: Its Nice To See Someone Who's Aware Of Both Mid Carpal Instability & RSD/CRPS :)

Your Right, It Often Missed, Overlooked, & The Patient/s Often Won't Be Seen By An Expert For Many Weeks/Months, After The Accident/Injury To The Effected Limb/s,Body,

I Wasn't Referred To A Hand Surgeon Until: 28-02-2003 & I Had MRI Scans, X-Rays, Physical Examinations, & Wrist Arthroscopy For Diagnose In October 2003 & To Confirm The Mid Carpal Instability,

It Was Only Years Later & After Knowing My Diagnose & Learning More About Mid Carpal Instability & RSD/CRPS, It Was Most Likely I Had CRPS/RSD Same Day I Suffered From Mid Carpal Instability & That Mid Carpal Instability Often Can't Be Detected On Plan X-Rays, MRI-Scans, & Often In The Early Stages Of Mid Carpal Instability Only Show Dynamic Changes, & Later Static Movements Show Up, But You Have To Rely On Dynamic Tests In X-Rays & MRI-Scanners,.

Sadly I Still Have A Very Painful Clear Clunk,Snap,Clicking/Popping, Left Hand/Wrist,Arm, & Giving Way/Unstable Wrist, & Even If I Manage To Get Rid &/Or Reduce The RSD/CRPS, I'll Still Have A Dull Ache Over The Carpal Bones/Ligaments & My Left Hand/Wrist,Arm, Giving Way,Unstable, & Dull Ache.

Its Nice To See Physiotherapist's Like Yourself & Other Trained NHS Physiotherapist's Whom I Have Come Across Willing & Learning About Mid Carpal Instability & RSD/CRPS.

Scott1984_FP commented: What Is Graded Motor Therapy For CRPS/RSD 1&2 ?.

Jan Vickery lead physiotherapist answered: Hi Scott, Graded motor imagery is often used alongside mirror therapy and left/right discrimination excercises. Essentially it is "imagining" movement without actually doing it. So it involves the brain work without the physical work. A lot of the work in this area has been pioneered by the Neuro Orthopaedic Institute. check it out on the web. If you are not already aware of them, their stuff will interest you I am sure.

Scott1984_FP commented: Hi Jan, in Your Opinion, What Is Your View On Mid Carpal Instability (MCI)/Palmar Midcarpal Instability (PMCI)?
Some Consultant Orthopeadic & Trauma Hand & Upper-Limb Surgeons, Think Mid Carpal Instability is just a party trick & causes no pain, disability, & any pain is in the mind. Where Do You Stand?.

Jan Vickery lead physiotherapist answered: Hi Scott I feel that is is not as simple as discerning between it being a "physical" or "in the mind" thing. Because we know that with musculoskeletal problem there is commonly both at play. I also think that to answer this in a generalist way is not really useful because each case is different and the answer may be different from one patient to another. The important thing is to make sure that we understand how that patient feels and presents and then to take it from there.


If you missed our live chat and have any further questions relating to RSI, then why not ask our panel of experts a question?

Heather asked: are there any gentle exercises to help relieve the pain caused by RSI? As in some physiotherapy?

Jan Vickery lead physiotherapist answered: Hi Heather. The treatment that you would need really depends on what your signs and symptoms are. Treatment may well involve exercise - although not necessarily.

Anonymous82 asked: I work extensively on the computer, using a keyboard for most of the day. I sometimes have a sharp pain in between the metacarpal of the 3rd and 2nd finger. Is this RSI?

Jan Vickery lead physiotherapist answered: Hi Possibly although i would encourage you not to think about your pain in terms of whether it is or isn't RSI as this isn't really helpful from a clinical management point of view. Reallys you want to think about why the pain is happening, how it is happening, what is being affected and how to address and manage these different aspects. if you can't figure this out on your own then its worth seeing someone who can like your GP or a physio.  It would probably also be worth having someone assess your workstation use to see if there are risk factors there that can be tackled. If you are employed, your employer will be able to advise you about how to go about getting one.

Anonymous82 commented: Thanks - it was more a question of, can a symptom like this be indicative of RSI, or is it just a tired hand from using it all day. I may contact my GP, and or get a workstation assessment - Ive been using a computer for years.

Jan Vickery lead physiotherapist answered: Hi yes it could be a fatigue thing or it could be a specific  joint, ligament or muscle issue. Getting a workstation assessment is a sensible first step. Good luck.

becs asked: I have bad tennis elbow. I've tried everything to heal it. HELP!

Jan Vickery lead physiotherapist answered: Hi Becs. The answer depends a little on what you have tried. Have you had physio or seen your GP?

becs commented: Both. On naproxen, having sports Physio and have tried both cold and heat application. Need to get back to the gym!

Jan Vickery lead physiotherapist answered: Becs, by way of comfort, tennis elbow is usually self limiting i.e. it will eventually go away, with or without treatment. Of course the idea of treatment is that it will go away sooner! If you are not significantly improved after 4 physio treatments you should discuss this with your physio and decide what the alternative options are. Good luck.

AXA PPP healthcare asked: Hi Jan, we have had a question sent to us. It is not specifically about RSI - please can you answer it.

"I was just wondering should my grandma of had the opportunity to have physiotherapy after falling and breaking her hip and having to have a operation. she has had metal plates in her hip, she cant walk she was given a potty thing to use as a toilet as she cant walk up the stairs. She hasn't been out of the house in about 4 year's when it happened."

Jan Vickery lead physiotherapist answered: Hi I'm sorry to hear that your grandma has had a difficult time. I would advise you to see her GP in the first instance so that they can discuss her needs and refer her to the appropriate services. They will be concerned if she is not able to manage activities of daily living (ADLs) and will talk to you/her about what help could be offered.

AXA PPP healthcare commented: Thanks Jan - will pass the information on

fiona asked: What kind of exercises/treatments would you recommend for RSI in the knee or hip?

Jan Vickery lead physiotherapist answered: Hi Fiona Sorry to sound unhelpful but this really depends on what the specific problem is in the knee or hip. under some circumstances, the advice may be to rest and not excercise. Equally some excersises might exacerbate certain conditions but ease others so it really depends on how the individual presents. Regardless of what is happening clinically, it would be important to identify what the possible triggers are for the problem and to address these.

fiona commented: No problem, the knee problem is more of a question for my friend, whenever she walks for more than 15 minutes her knee starts to ache. The hip is a question of my own, it often gets sore when I run on the pavement as opposed to the treadmill

Jan Vickery lead physiotherapist answered: Hi Fiona i would suggest you both start with your footwear. Good footwear will keep your joints in a good position to excercise. It may be worth seeing a podiatrist if you think there is a problem. Some sports footwear shops also offer advice for this sort of thing. Secondly there may be an issue with weakness, muscle imbalance, joint biomechanics that needs to be looked at by a physio to give you specific guidance following a clinical assessment. Good luck.

Mrs Donnelly asked: Are there alternatives to keyboards and mice?

Jan Vickery lead physiotherapist answered: Hi Mrs Donnelly. yes there are alternatives. Firstly, as i am sure you know, there are many different designs of keyboards and mice which may help to address people's problems with inputting. It usually needs someone who is able to assess and understand the clinical problem as well as the workplace to give guidance on what would be suitable for a specific set of circumstances. People who struggle to use keyboards and mice can instead look at using their voice  - there are various voice activated software packages and some that are designed especially for people who are blind or partially sighted. One can also use touchscreens, pointing devices mounted on a hat/cap or foot controls. In fact you now even get a face mouse which uses facial "twitches" to guide the pointer.

Ruth asked: How can I avoid RSI?

Jan Vickery lead physiotherapist answered: Hi,  firstly I would encourage you not to worry about the possibility of getting RSI because it would be a negative thing if it made you worry about normal activities, work and excercise. In general the best way to prevent RSI is to make sure that don't use your body beyond its capabilities. A good sensible approach is generally all that is needed. So, don't overload your body. Think about the things that you do a lot of and try to ensure that you do these in good postures, that you break often and keep forces within your capacity.  If you should happen to struggle with aches and pains that don't go away or are happening a lot then think about getting clinical help.

Asha asked: Do people with RSI tested for nerve damage in their arms and do they have it?

Jan Vickery lead physiotherapist answered: Hi Asha Yes, some conditions that may be described as RSI can involve nerve compromise that would show up on tests - but not all.

Roz asked: Does RSI eventually turn into carpal tunnel?

Jan Vickery lead physiotherapist answered: Hi Roz. no this is not the case. Carpal tunnel syndrome is one of a number of conditions that may be referred to as RSI but the one does not equal the other. RSI in itself is not a specific diagnosis.

Norman asked: Can you recommend where I can buy a suitable wrist support

Jan Vickery lead physiotherapist answered: Hi Norman it depends what you want the wrist support for. Can you explain a little more?

Norman commented: for tendonitus in my wrists

Jan Vickery lead physiotherapist answered: Hi Norman There are different types of wrist supports for different types of tendonitises. For severe tendonitis a splint is likely to be more effective than a wrist support. Boots is as good a place as any to buy a fairly general wrist support but it may not be that effective for a specific tendonitis - perhaps worth a try though. If you are really struggling with this, chat to your GP as he can refer you appropriately.


If you missed our live chat and have any further questions relating to RSI, then why not ask our panel of experts a question?


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