RSI symptoms, causes and treatments: May'13

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

fiona asked: I regularly get an aching in my right hip when running long distances. Could this be bursitis of the hip?

Jan Vickery - lead physiotherapist answered: Hi Fiona There could be a number of causes for your hip discomfort. Its difficult to say without doing more of an assessment. I suggest that you see a physiotherapist who will ask you more questions and then probably assess various movements. They may also palpate various structures during their assessment. They are likely to give you advice and some exercises to do as part of your treatment. Its great that you run - try to do everything you can to get things painfree so that you can keep it up! Good luck.

Heather asked: My mum suffers from RSI and I wondered if it is likely that I would suffer from it too? We are both in desk based jobs working at computers.

Jan Vickery - lead physiotherapist answered:
Hi Heather. It really depends what the exact cause of your mum's RSI is? Regardless, by ensuring that you do not overload your upper limbs you will greatly reduce the chance of you developing a problem. Its important to work in good upper limb postures, break often to reduce the effects of repetition and long periods of work and avoid working with high forces.A workstation assessment is important to address all these aspects. If you do not already touch type then learning to do so will be a good thing because it spreads the load across all your digits and allows better working posture.

Heather asked: I have played piano and flute for over 10 years and wondered if this is likely to put me at risk of developing RSI in the long term.

Jan Vickery - lead physiotherapist answered: Hi Heather. Musicians do develop RSI-type problems, there is no denying that. But the principles around avoiding problems are the same as they are for a computer user. Avoid excessive force, repetition, prolonged exposure and poor postures. Keep an eye on your technique and break often. Most importantly keep enjoying your music!

Andy_M asked: In terms of tendonitis and carpel tunnel - are these on-going RSI? I've heard that these are reoccurring problems even after treatment.

Jan Vickery - lead physiotherapist answered: Hi Andy Great question. RSI is a generic term that has very little clinical meaning. There was a push to avoid using it as a term in favour of terms like work-related upper limb disorder (WRULD) Cumulative trauma disorder (CTD) and Occupational Overuse Syndrome (OOS). But the use of RSI has endured - montly I think because it as a descriptive term that has had a lot of exposure in the media. In general, there are 2 types of problems that fit into the RSI. Firstly there is the category of specific problems like carpal tunnel syndrome, tennis elbow, De Quervains and other tendonitises. These are usually pretty easy to diagnose and there is mostly good evidence around the best way to treat these. The second category is less easy to diagnose and is sometimes referred to as "non-specific" arm pain (NSAP). Also the treatment is not as clearly defined. Whether a condition recurs depends on what the actual problem is to begin with, what the treatment has been and whether contributory factors have been addressed.

Andy_M asked: Can stress lead to RSI?

Jan Vickery - lead physiotherapist answered: Not directly, no. However, the causes of stress may well be the same factors that set off an upper limb problem such as prolonged periods of intensive work involving repetition.

Ruth asked: I sometimes get tendonitis in my left wrist, it started when I was at Uni. Will it ever go away? What can I do to stop it happening?

Jan Vickery - lead physiotherapist answered: Hi Ruth There are different types of tendonitises. They are usually linked to different actions or movements that cause a specific structure to be affected. The main causes are repetition, high forces, prolonged duration of an activity, vibration and poor posture. Apart from tackling the inflammation - anti inflammatories can be helpful (check with your pharmacist or GP) to settle the tendon it is key to prevent recurrence by identifying exactly what it is that is causing the problem. By addressing this (either reducing or avoiding it) you will lessen the probability of recurrence.

Ruth commented:
Great, thanks

Jan Vickery - lead physiotherapist answered: Hi Ruth Its not unheard of to get it both sides. If it has bothered you on both sides for some time then it would be worth getting an assessment from a physio. There are some conditions that affect both sides that have specific symptoms that they could check for and according to their findings guide you about treatment.

Ruth commented: I see. Thanks


Anonymous61 asked: How bad can repetitive strain injury get?

Jan Vickery - lead physiotherapist answered: There is no specific answer here. The main aspect that matters is how the person with the problem feels about it or how "bad" they perceive it to be. It can affect some people quite severely so that they struggle to keep up their normal function but in the main it does not get this bad.

Jesst asked: I have suffered from RSI (repetitive strain injury) in my neck, right arm and hand for years. Thanks to physiotherapy, yoga and better working practices the condition is now largely under control but I still have tingling sensations in my arm on occasion. Should I be worried?

Jan Vickery - lead physiotherapist answered: Hi Jesst. It sounds like you are doing a great job of managing things proactively - keep it up. If you have been getting tingling for some time then it would be worth going back to your physio to have them check it out.

fiona asked: What can be used at a desk to prevent RSI in the wrists?

Jan Vickery - lead physiotherapist answered: Hi Fiona A workstation assessment is really useful to identify any issues and to help you work out how to tackle them. Its not complicated though - you should aim to work in good neutral postures and break often. As previously suggested, touch typing goes a long way to help with posture, spread the workload and avoid repetition. Beware of any strange gadgets - they may well introduce more risk than help!

fiona commented: Thank you I will look into this. Another quick question, how should I be sitting at my computer? Looking straight on it or slightly up/down? We have stands so we can adjust our comps at work but I'm not sure where exactly it should be sitting?

Jan Vickery - lead physiotherapist answered: Hi Fiona you should aim to have the top of the active screen at eye level. Rather err towards having it a little low. Avoid having it to high as this really loads the neck. Make sure your mouse and keyboard are within easy reach.

Amanda asked: Hi, Im suffering from repetitive strain injury in my wrist. It makes working on my computer and even holding my phone and texting very difficult. I’m wearing a wrist support and taking pain killers but wonder if there is anything else I can do?

Jan Vickery - lead physiotherapist answered: Hi Amanda. I have a bunch of questions for you. How long have you had this trouble? Have you seen your GP or a physio? What type of support is it? is it elasticated or is it a splint. If it's a splint, do you wear it when you are using your PC and if so does it help? Have you taken advice about the pain killers that you are taking from a GP or pharmacist? How much do you use a phone and how much do you text?

Anonymous62 asked: I had cartillage removed in my knee two years ago after intense pain, it got better for a while but now the pain is back and my knee often creaks and groans. I'm on my feet all day for work. How can I help get rid of the aching?

Jan Vickery - lead physiotherapist answered: Hi Don't let the creaking and groaning bother you - it happens to all of us! However if you have been struggling with pain for a while then it's worth having it checked out again by a physio. They will do a full assessment and give you an idea of what might be causing the problem and how to address it.

Anonymous62 commented: ok will look into this, thanks.  

Anonymous63 asked: I get RSI in my right hand that spreads up to my neck and causes headaches, and also into my shoulder, down to my back and even my right hip and leg when it is at its worst (I type for a living). Often it feels like I have a hot knot under my right shoulder blade. I use pain-killing cream on it when it's at its worst, but I am concerned because I have heard a theory that constant inflammation of an area can predispose one to cancer of that area. Is that right?

Jan Vickery - lead physiotherapist answered: Hi. It sounds like you are struggling so I would recommend seeing your GP or a physio for an assessment. The physio will give you an idea of what is wrong and how to tackle it. If you type for a living there may be ways of reducing your workload for example it may be suitable for you to use voice activated software. This will depend on a number of factors and therefore a workstation assessment would also be useful to identify ways in which to avoid or reduce loading of the structures involved.  I am not aware of inflammation leading to cancer.

Ruth asked: Sorry, another question about my tendonitis. I'm right-handed but I get it in my left. Is that odd or fairly normal?

Jan Vickery - lead physiotherapist answered: Hi Ruth Its not unheard of to get it both sides. If it has bothered you on both sides for some time then it would be worth getting an assessment from a physio. There are some conditions that affect both sides that have specific symptoms that they could check for and according to their findings guide you about treatment.

Karen asked: I've had wrist pain for over four months now, and have already had already physio treatments and ultrasound heat. I use Deep Heat from time to time as well to relieve the pain. I am doing different exercises for 10 minutes, twice a day, and have reduced my mouse use already, but the pain is still there. What else can I do?

Jan Vickery - lead physiotherapist answered: HI Karen. Have you had an explanation about what is causing the pain? have you had a workstation assessment - it might be that some other aspect of your workstation use is not helping.

Karen commented: I believe it's from my computer use at work

Jan Vickery - lead physiotherapist answered: Hi Karen Has the physio told you which structures are affected and how? Its important that you organise a workstation assessment at work. It will help if the assessor understands what is happening clinically in your wrist.


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

Kenny asked: I have a knee problem and was diagnosed with arthritis in one knee. It was particularly bad when I used to operate a pedal at work. I always assumed this began as RSI. 
I have had physio, then last year my GP suggested I try to lose weight to prevent a future operation. I took his advice to heart and I have lost four stone. My knee is much improved and I just wanted to ask, can losing weight really help that much? Or is it just a coincidence?

Jan Vickery - lead physiotherapist answered: Hi Kenny. Firstly well done - that's a fantastic effort with a great outcome! When it comes to knees - yes, there is evidence that loosing weight makes a difference. It makes sense when you think that the knee is a load bearing joint, by lessening that load you are reducing one of the factors (force) that may cause a problem. I expect that along with loosing weight you also exercise more - this can also help.

Zara asked: can you give me some ideas about how to deal with my rather sudden onset of elbow tendonitis?

Jan Vickery - lead physiotherapist answered: Hi Zara to begin with you might find icing helpful. if you know what has brought it on then try to avoid that activity.  try painkillers if pain is bothering you. If it doesn't ease up after a couple of weeks, then it would be worth having a physio assessment. Be comforted that tennis elbow is usually self limiting

Andi asked: Are there any alternative therapies for CTS?

Jan Vickery - lead physiotherapist answered: Hi Andi. There are alternative therapies for everything! And they may make people feel better regardless of their clinical effect. Carpal Tunnel Syndrome is essentially a nerve being compressed in the wrist area for a number of possible reasons so unless the alternative therapy is able to address this then it is unlikely to have a significant longstanding clinical effect.

Andi commented: What types are there?

Jan Vickery - lead physiotherapist answered: Acupuncture is a well known one and may be incorporated as part of physiotherapy treatment. There is also accupressure, yoga, nutrition, hypnotherapy and others I am sure.

Mrs Rabbit asked: I spend many hours each day working at the computer.  From time to time I suffer from a pain in my left shoulder which runs up through my neck.  My neck is permanently stiff, and I find it difficult to fully rotate my neck.  Could this all be related to my posture at the computer?  I sometimes use pain killers to alleviate the pain, but it seems to persist .. any tips?

Jan Vickery - lead physiotherapist answered: Hi Mrs Rabbit. your neck stiffness may be related to your working posture -  is your screen positioned centrally to you? do you refer to documents and are they to one side? do you cradle a telephone handset to one side? Look for anything asymmetrical like resting one elbow up and not the other.
Regardless, if you haven't been able to rotate your neck for some time and it remains painful then its worth seeing a physio so that they can advise you about how to improve your neck movement.

ShazzerP commented: I've experienced the same and physio really helped. There is also a great book called 'treat your own neck' by Robin McKenzie. Some really simple exercises you can easily do.

Mrs Rabbit commented: Thank you Jan and Shazzer

Joel asked: What are the best exercises to do to help prevent rsi?

Jan Vickery - lead physiotherapist answered: Hi Joel One can't really advise about specific exercises because RSI is not a single specific condition. in principle i would say, avoid doing too much of any one excercise and make sure you keep good range of movement in all your joints and balanced, good strength of your muscles.

AXA PPP healthcare commented: Have you seen our interactive body? Find out about common conditions that affect specific areas of the body and how to treat them.

Ruth asked: How does tennis elbow differ from golfer's elbow?

Jan Vickery - lead physiotherapist answered: Hi Ruth Tennis elbow affects the outside of the elbow and is usually related to actions that involved lifting the wrist upwards when the hand is face down. Golfers elbow affects the inside of the elbow and   involves actions related to bending the hand up when it is palm up.

McG asked: I often get stiff shoulders, they get a bit painful too and it hurts to touch my shoulder blades when this happens. Could it be rotator cuff syndrome?

Jan Vickery - lead physiotherapist answered: Hi McG. this does not sound like a typical rotator cuff problem. if you are worried and your shoulders have been stiff and painful for a while and are affecting your everyday function then see your GP or a physio.

McG commented: Ok thanks.

ShazzerP asked: Hello Jan. Is it better to sleep without a pillow if you suffer from a stiff neck?

Jan Vickery - lead physiotherapist answered: Hi Shazzer. Not necessarily - it depends on your type of mattress, the position that you sleep in and the type of pillow. You should aim to keep you spine supported in its neutral posture - this will vary depending on whether you sleep on your side or back and how soft your mattress is. In general, if you sleep on you side you will have a better posture with a pillow. On your back you are likely to need a much thinner pillow.

Joolie asked: I play a lot of Wii sports and my wrists hurt. Is this a coincidence?

Jan Vickery - lead physiotherapist answered: Hard to say Joolie. Depends on what else you do - do you use a keyboard for example? If you use a lot of wrist movement with your Wii games then it may be linked. it sounds like you think it may be! In which case, it might be a good idea to try other games that involve less wrist action, reduce the time on the wii or break up your wii sessions!

AXA PPP healthcare asked: Thank you to everyone who joined our live chat today. We look forward to welcoming you to our next one. Thank you Jan for hosting this.


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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