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Understanding Overuse And Repetitive Strain Injuries


We all know of people who have suffered from an overuse or repetitive strain injury (RSI). Tennis elbow, carpal tunnel, shoulder impingement and runner’s knee are conditions affecting different parts of the body, they can all be considered RSIs.


Despite the knowledge accumulated, common therapeutic approaches such as anti-inflammatory drugs, exercises and manual therapy can fall short in their management. The reality is that the widely-held belief that the tendons (or muscles) are permanently inflamed may not be entirely accurate.


As the name ‘repetitive strain injury’ suggests, our body tissues (ie. tendons, ligament etc.) can get injured when we repeatedly perform the same task over and over again. Unsurprisingly, RSIs are among the most common injuries affecting people at their workplaces, from computer-based workers to builders. The NHS website refers to them as ‘work-related upper limb disorders’, although any activity such as sports, playing musical instruments or computer-games can lead to overuse.


RSIs are commonly associated with a problem in the muscles or tendons, People often say they have ‘tendinitis’. However, tendons are not the only affected tissues, fluid filled sacs in-and-around our joints called bursae (‘bursitis’) or fat pads can also be the ‘victim’ of an RSI. But this is only the half of it. These injuries often involve an intricate play between the nervous and immune systems making RSIs pretty difficult to study.


Tendinopathy, tendinitis, tendinosis...

How often have you heard of these terms being used interchangeably? Terminology can be confusing. Tendinopathy comes from the Latin disease (‘-pathos’) of the tendon and is the most general term to indicate tendon issues. The suffix ‘-itis’ refers to the presence of inflammation whereas ‘-osis’ to degeneration (tissue breakdown) taking place in the tendon. Each term may be appropriate for a certain stage of the RSI. But for long lasting RSIs, ‘tendonalgia’ is now commonly used, as we now know there is often very little inflammation or tissue degeneration going on in the actual tendons.


Is it inflamed or not?

Aside from the initial stage of the injury, by the time patients present to healthcare professionals with an unresolving RSI, we do not find the classical signs of inflammation. Even at the microscopic level, the typical white blood cells seen in acute inflammation (immune cells) are not really there. Instead, it may be more of a combination of slow tissue breakdown (without inflammation) and, most importantly, changes in our nervous system activity that makes us more likely to feel pain.


Yet still applying ice on the skin will probably numb the area and make it feel better temporarily, because that’s what cold does, but it’s unlikely to have further benefits as once thought. Moreover, anti-inflammatory drugs can have negative side-effects and may actually slow down the tissue healing process not what we want!


What to do at the start of an RSI

Ideally, if we recognise early-on that the pain is being caused by the repetition of a certain task or movement, a healthy dosage of resting from that particular activity may do the trick. If it is not possible to take a break, then it is useful trying to find alternative ways of using our body, so that different muscles can be engaged instead of the painful ones. It is here where seeking a manual therapist in those early stages may be most helpful to let them assess how you can use your body more efficiently.


Generally, limiting the use of painkillers can be good, but if necessary, short term use of analgesics like paracetamol or topical anti-inflammatories like volteran or ibuprofen cream can be helpful.


A graded return to activity is also important so that we do not further sensitise the area and indeed our nervous system. Tissues need enough time to recover and if we do not do this our nervous system grows more sensitive to this movement as time goes on, making us feel pain more frequently and intensely.


There are lots of things your osteopath / physio or sports therapist can do to show you exercise strategies aiming to achieve this. Safe and pain-free movements will override the feared painful ones and gradually reduce the sensitivity especially those people who have had many months of their RSI.


When in pain and confused about it, health professionals, such as osteopaths, physios or sports therapists are able to place some order in the ‘chaos’ we may feel within our body and map out a plan for a complete and long lasting recovery. Manual therapy techniques such as massage, manipulations and more!) as a way of soothing pain and improving the function of joints and muscles.


Similarly a manual therapist can guide as to which exercises to help, how to change your movement pattern and improve your body pattern to further prevent and enhance your efficiency / performance. This is done with a person-centred approach, understanding our patient’s unique bodies, lifestyles and needs, so that we can address all the elements playing a role in the pain.


Moreover, as you suffer from long lasting RSIs, it is likely that other related parts of your body have been compensating for the injury, compromising on their ideal function. Manual Therapy can help you identify compensations and address them in the view of a fast return to ideal function.


So don’t suffer unnecessarily... give us a call.



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