PhysioMonkey

RSI is a very mis-understood term.

Definition: R.S.I. : Damage to tendons, nerves, and other soft tissues that is caused by the repeated performance of a limited number of physical movements and is characterized by numbness, pain, and a wasting and weakening of muscles. (Taken from dictionary.com, definition 1 on RSI)

R.S.I. is not a diagnosis; it is a syndrome.

Definition:  Syndrome: A group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition. (Taken from dictionary.com)

 

In other words if someone says you have RSI he or she is NOT giving you a diagnosis.  He's merely telling you that your symptoms fit into the pattern.  It's rather like going to the doctor complaining of a headache and being told "You have a headache".  It doesn't get you much further in knowing what's happening to you.

To begin with it is not just about tendons (as the definition shows).  Tendons are affected but so are most of the structures around.  Nerves get damaged as they are overused, blood vessels can't deal with the amount required and the whole lot fails, slowly. 

Recovery is slow and based around rest.  Remember that the neck may be involved; often people respond best to neural mobilisations and neck physio. People often find that splints for the wrists are helpful.  There is no magic bullet though so if you end up with RSI then get yourself ready for a long haul.

The best advice is not to get it; so vary your workouts, don't stick to one skill the whole time even if you're a pro wanting to work on one aspect only.  Professional athletes do not spend their whole time on one aspect of their sport, vary your training regime to give you a good variety of stresses and practice.

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What is - Tendinopathy

Repetitive Injury and Pain

Definition: Any problems with tendons.

Definition: Tendon : inelastic cord that attaches muscle to bone.

There are a number of different problems that all tend to get lumped in as "tendinitis".

These include:

1. RSI.
2. Tendinitis.
3. Tendinosis.
4. Tenosynovitis (tenovaginitis in the US).

1 - RSI

Look under the post "Condition - RSI" under the category "What is?".  RSI tends to be lumped in with tendinopathies but isn't quite.

2 - Tendinitis

Definition: tendinitis : inflammation of a tendon

This is nearly worthy of puttng under the category of "Controversy" but not quite. 

Historically any tendon trouble less than about 2-3 weeks old was diagnosed as tendinitis.  In fact it seems likely that tendons rarely inflame; they're not vascular (not many blood vessels) enough to do so. 

The usual treatment has been steroid injections.  These are now not recommended.  The major action of steroids is as an anti-inflammatory; tendinitis rarely exists hence little inflammation to treat.  In fact the physical damage of putting a needle into a damaged tendon often makes the tendon weaker and more likely to rupture.  If you are advised to have an injection into a "tendinitis" make sure you have talked about this!

3 - Tendinosis

Definition: tendinosis : chronic deterioration of the tendon

Much more common than tendinitis.  Tendinosis happens as a gradual accumulation of tiny amounts of damage to the tendon.  Over time this damage adds up to enough to cause pain and disability.  Historically any tendon pain over about 1 month was called tendinosis.  Treatment is rest and slow building up of nomal stresses through the tissues (ie gentle exercises and stretches).  This can take months; some people never respond well.  Anti-inflammatories and injections are not helpful.  Sometimes surgery is recommended; this depends on the individual circumstances and is not a panacea.

4 - Tenosynovitis (Tenovaginitis)

Definition: tenosynovitis : inflammation of a tendon sheath

Some tendons (notably for us in the wrist) have sheaths that they move inside of.  This can be inflamed via similar over-use problems and can be as painful and debilitating as the others.  You may have heard of "de Quervain's" disease; this is an example of tenosynovitis in the wrist. 

Injections can be useful as a treatment for this.  Otherwise the same treatment regimes as for tendinosis will work.

Further Information

Further and more technical detail can be found here.

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What is - R.S.I.

Repetitive Injury and Pain

Scenario:

You've been juggling for 4 hours perfecting your 7 club Mill's.  Your wrists have been aching for the last 30 minutes. This has happened for the first time today.  What would you do? 

I have noticed that this sort of problem has been discussed on rec.juggling a few times so I took the liberty of seeing what advice has been offered for just this problem.

rec.juggling answers

1. Rest.
2. Practice other skills for a while.
3. Heat.
4. Ice.
5. Heat and ice alternately.
6. Stretch it out.
7. Go to the gym and build yourself up.
8. Use wrist-weights or power-balls to strengthen yourself.
9. Adjuncts (eg acupuncture, dietary changes etc..)
10. See a professional.
11. Warm-up before exercising.

Let's have a look at these then:

1 - Rest         and

2 - Practice other skills for a while

• Rest - meaning a total break from practice.
• A good idea.
• Practicing other skills may be acceptable as long as the pain doesn't come with the new skill as well.
• You may need to rest for a few days or even longer.
• After a break do not try and return straight to your previous level of activity - work up to it slowly.

3 - Heat

• NOT useful during this acute stage.
• Heat will actually encourage MORE swelling; it is PRO-inflammatory.
• It may feel nice - people tend to prefer the sensation to that of ice.
• There was discussion over whether "wet" or "dry" heat was best: it doesn't matter heat's no use anyway at this stage of an injury.
• If you must use it; don't burn yourself.

4 - Ice

• A good idea.
• It is anti-inflammatory.
• It also acts as an extremely effective local analgesic (pain-killer).
• It needs correct application
• Ideally use crushed ice in a thin towel.
• The old favourite is a bag of frozen peas - please DON'T take a bag of peas straight out of a modern freezer and put them straight onto your skin.  It will burn.
• DON'T use ice if you suffer from angina.
• If you get chest pain whilst using ice - stop using ice and go and see your doctor.  Don't use ice again until you've been checked out.
• Don't leave it on for too long - 10 minutes at a time is enough.

5 - Heat and ice alternately

• The theory is that heat opens up the blood vessels in the area and then the ice shuts them all down again - supposedly acting as a sort of "flush".
• There is no real evidence that this is true.
• Nor is there any evidence that shows this method to be helpful.
• It's certainly not as effective as ice alone.
• Try it if you wish but remember not to burn yourself with either ice or heat.  Follow the cautions above when using ice.

6 - Stretch it out

• Can be useful if done correctly during recovery.
• You're after gentle stretches not "tendon killers".
• Rest is better for very acute (ie recent) problems.
• Stretches should not cause pain and generally should be held for around 30s.

7- Gym work

• Generally a good idea for fitness anyway.
• Make sure you know what you are doing.
• If you don't know - find out!
• If injured - don't exercise to pain and don't expect to perform as well as if you were uninjured.
• Build up slowly - know your limits but keep nudging into them.
• Not recommended for new problems - rest is better.

8 - Wrist weights or power balls

• No non nein nyet nee!!!!!!!!  I can't emphasize this enough.  DON'T DO IT!!!
• Repetitive pain means there is over-loading going on - if you use these you will over-load even more and at a time when the tissues are weaker than normal.  NOT a good idea.
• Even if uninjured, power balls are likely to give you tendon trouble.  Certainly the heavier the ball, the more likely damage is.
• Wrist weights and power balls are more likely to give you neck, shoulder and elbow trouble too.

9 - Adjuncts

• We're in the realm of "whatever floats your boat" now.
• Acupuncture definitely works for pain relief in many folks but remember that you want the problem dealing with, not just pain relief.
• Diet is important.  If you are fit and healthy generally you are at less risk of problems and are likely to be more able to deal with problems if/when they arrive.  So eat well and keep fit.
• You might want to try reflexology, crystal healing, faith healing or whatever.  I have no real clue about their efficacy although I'd like to know. If you have any info please get in touch.  Email addy is in the "About me" bit.

10 - See a professional

• The best advice so far.
• Remember that general doctors tend not to be experts at these sorts of problems.  Make sure you find a specialist (it doesn't have to be a doctor).
• You should never accept "Take these tablets" if it is a long-standing issue.
• There are common problems that may need medical or even surgical intervention.
• Remember that each profession will tend to see their own solutions to any given presentation - so surgeons will want to operate, podiatrists will claim your feet are the cause of all your ailments, rheumatologists will want to inject everything and chiropractors will tell you that your pelvis is twisted (or one leg is longer than the other - at least that's what pretty much all my patients who have seen a chiropractor have told me).  The point is this; you don't have to agree with what they tell you. Think of what bias they have.  In my world I advise people to try the least drastic options first.
• Common musculo-skeletal problems are very commonly mis-diagnosed by general doctors.  About 80% of "tennis elbows" I see are actually neck and neurodynamic problems and NOTHING to do with tendon trouble.  Likewise about 90% of "frozen shoulders" are nothing of the sort.
• Have you had neck pain?  Arm problems are very often neck-related rather than local.
• As Brian would say; "You are ALL individuals".  Your problems are individual too; there is no such thing as a generic problem - a professional should be able to take all the signs and symptoms (often including things you hadn't noticed - unless you're especially body-aware) into account and come up with an individual treatment plan.

11 - Warm-up before exercise

• Now we're into the realm of controversy. 
• I'll leave warm-ups for the next post.

Summary

• Stop doing what causes the pain.
• Use ice as an analgesic (remember the cautions).
• Return to practice in time and start at a lower level than you were.
• If pain returns stop again.
• See a professional healthcare person at any point in this pattern.
• Use gentle stretches as part of a daily routine to help recovery.

Related Posts

What is - Tendinopathy

What is - R.S.I.

Warm-ups and Cool-downs