Repetitive Strain Injury

Causes, Signs, Symptoms,
Treatment and Prevention.

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Repetitive strain injury (RSI) is not a specific injury, but instead a loose grouping of similar injuries. These injuries are also often called repetitive stress injuries, cumulative trauma disorder (CTD), repetitive motion disorders, and overuse syndromes. These are soft tissue injuries associated with long-term stress on an area of the body. These are usually caused by a prolonged activity in a poor posture or misalignment of the joints involved. Repeating the same activity over an extended period of time can lead to an RSI. Musicians are often quite susceptible to these types of injuries.

RSI is a common injury in manufacturing work and with computer work, although it is also found in many sport activities. Sports requiring the same movements, in similar planes and range of motion, can quickly lead to repetitive strain injuries. Tennis, pitching (baseball and softball), golf, and distance running are a few of the sports associated with repetitive stress injuries.

Anatomy involved
An RSI can occur in any muscle, tendon or joint that is impacted by a repetitive stress, although it is most commonly found in the shoulder, elbow or wrist. Below is a list of some of the more common repetitive strain injuries for each body area.

Hand and Wrist:
• Carpal Tunnel Syndrome (Pinching of one of the nerves that passes through the wrist)
• Tendonitis of the Wrist (Irritation and inflammation of the tendons around the wrist)

Elbow:
• Golfer's Elbow (Irritation of the tendon attaching to the medial epicondyle)
• Tennis Elbow (Irritation of the tendon attaching to the lateral epicondyle)

Shoulder:
• Impingement Syndrome (Inflammation in the shoulder causing the rotator cuff tendons and the bursa to become impinged)

Hip:
• Snapping Hip Syndrome (Tendons that catch on bony prominences and cause a "snapping" sensation on movement.)
• Bursitis of the Hip (The bursal sac becomes inflamed causing pain when the tendon moves over it.)

Knee and Leg:
• Stress Fractures (A fracture of the bone due to prolonged stress placed on the bone without adequate rest)
• Shin Splints (The name given to symptoms of pain over the anterior portion of the lower leg)
• Chondromalacia (Irritation to the cartilage on the undersurface of the knee cap)

Ankle and Foot:
• Tendonitis of the Achilles Tendon (Irritation and inflammation of the Achilles Tendon)
• Tarsal Tunnel Syndrome (Similar in mechanism to Carpal Tunnel Syndrome, except in the foot)
• Posterior Tibial Tendonitis (Pain in the inside of the foot and ankle caused by inflammation of the posterior tibial tendon)

What causes RSI?
Repetitive stress injuries are usually a result of prolonged repetitions of a movement without adequate rest or movements done in an incorrect or poor posture. An overload of stress on muscles, tendons or joints over a period of time without adequate rest might also lead to RSI. Going beyond muscle fatigue in any activity may cause extra stress on tendons and bones causing a repetitive stress injury. Any movement done in an awkward or unnatural manner for multiple repetitions or long duration can cause an injury as well.

Signs and Symptoms
Initially pain may be felt only during an activity and stopping the movement may bring relief. Over time this discomfort carries into rest time as well. With prolonged use and lack of treatment the pain may become severe, even crippling.

Tingling and numbness, along with swelling and loss of strength and / or flexibility in the affected area may also occur. The tingling and numbness will usually occur distally (away from the body) from the actual injury site.

Compression of the nerves and or blood vessels passing through the injury site is the common causes of the pain, tingling and numbness. The pain usually starts out localized to the site of the injury but over time may radiate away from the site along the extremity.

The affected muscles may cramp at times and sensation may be lost or impaired to the affected part of the body.

Treatment
The first step in treating an RSI is to stop the offending activity. Resting from the activity will stop the repetitive stress applied to that area. Ice and anti-inflammatory medications may help the swelling and inflammation in the affect area. Stretching and relaxation exercises for the affected area will help relieve some of the muscle tension. Massage may also help alleviate the pain and muscular tension.

Splints and physical therapy may be needed in some cases to alleviate the stress on the muscles and tendons. Surgery is rarely needed, but may become necessary in extreme cases to alleviate the symptoms and prevent additional damage.

Prevention
Prevention of repetitive stress injuries is much more important, and less costly, than treating them. Addressing the issues that can cause this type of injury helps to avoid it from happening.

• Warming up before an activity gets the muscles, tendons, ligaments and bones ready for the activity at hand. A general warm-up to get the whole body ready for increased activity is important, but specific warm-ups for those areas that will be used extensively in the sport or activity are just as important. This prepares the muscles and tendons for the stresses they will be facing.
• Certain activities may cause pain or discomfort while doing them: Avoid these. There is a reason why they cause pain. Your body may not be suited for the activity or your posture or alignment during the activity may be incorrect. Stop doing those activities that cause pain, especially if it is a repetitive activity.
• To make sure the muscles and tendons are ready for the stresses that may be placed on them keep them flexible and strong. Work the muscles through a full range of motion and gradually add resistance. Stronger, more flexible muscles can handle those stresses applied to them during an activity better. They are more resilient and bounce back easier.

Stretching is one of the most under-utilized techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don't make the mistake of thinking that something as simple as stretching won't be effective.

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• Allow adequate rest time between the activities. The muscles, tendons and joints need time to recover from the stresses they were placed under. They will need good nutrition as well. The proper nutrients must be in place to make repairs to muscles, tendons, and bones as needed. Rest during an activity is often overlooked as well. If you are involved in a repetitive activity it is important to have adequate breaks to allow the area to rest between bouts of stress.
• It is important to pay attention to your body. When you start to notice muscle fatigue or tension you must back off. Get to know your body, and how it feels when in proper alignment. This will make it easier for you to notice when fatigue or other factors pull you out of alignment and you can make corrections immediately. Reading your body for cues that may lead to RSI is an important step in prevention.

If you enjoyed this issue of The Stretching & Sports Injury Report, please feel free to forward it to others, make it available for download from your site or post it on forums for others to read. Please make sure the following paragraph and URL are included.

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Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institute.
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Special Internet-Only Bonus! If yours is one of the next 200 orders placed through this website, we'll throw in a complete athletic preparation package, including a Special Bonus Stretching, Flexibility and Sports Injury Package worth over $300.00 for free when you order today!
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