Repetitive Strain Injury (RSI): Symptoms, Causes and Treatment

In short

Repetitive strain injury (RSI) is pain and other symptoms caused by using the same part of the body over and over, usually the hand, wrist, forearm, elbow or shoulder. It tends to creep up gradually, with aching, stiffness, tingling or weakness that is worse during or after the activity. Many cases settle once you change how you do the task, ease off for a while and rebuild strength gradually. A physiotherapist can help when it keeps coming back or starts getting in the way of work.

If your wrist, forearm or shoulder has started to ache from work, a hobby or jobs around the house, this guide explains what repetitive strain injury is, the symptoms of RSI and why it happens. You will also find what you can try yourself, the warning signs that need a GP, and how a FlexAura physiotherapist can help. Some of our physios are occupational health physiotherapists, and work-related RSI is a large part of what they see.

What is repetitive strain injury?

The usual definition of repetitive strain injury is an umbrella one: pain in the muscles, tendons and nerves that comes from repeated movement, from holding an awkward position for a long time, or both. You may also see it called repetitive stress injury, repetitive motion injury or a repetitive muscle strain. All of these names describe a tissue that is being asked to do the same job more often than it can recover from.

Sometimes a clinician can put a more specific name on it. Carpal tunnel syndrome, tennis elbow, golfer's elbow, tendon pain at the base of the thumb and trigger finger can all start with repetitive use. In other cases no single structure is to blame, and the label stays as RSI. Some clinicians call that non-specific RSI. Either way, the way it is managed has a lot in common.

Plenty of RSI happens away from a desk. Hairdressers, decorators, assembly-line workers, warehouse pickers, chefs, cleaners, musicians and parents carrying a toddler on one hip all put the same tissues through the same movements again and again, often for hours at a time and with little chance to rest in between.

RSI symptoms: what does RSI feel like?

Symptoms of repetitive strain injury usually start gradually. At first you might only notice them during a particular task, such as a long spell of typing, and they ease when you stop. Over time they can hang around for longer afterwards and start to appear with lighter use. The NHS lists these as the common RSI symptoms:

• pain, which may feel burning, aching or throbbing
• stiffness and weakness
• tingling, pins and needles or numbness
• muscle cramps
• swelling

People describe what RSI feels like in different ways. Some talk about a dull, tired ache in the forearm by the end of the working day. Others notice that their grip is weaker, that they drop things more often, or that their fingers feel clumsy on a keyboard. Aching at night and stiffness first thing in the morning are common too. Symptoms can be on one side or both, depending on how you use your arms.

RSI wrist symptoms and repetitive strain injury in the fingers

The wrist and hand are the usual places to feel it. Typical RSI wrist symptoms include aching across the back or front of the wrist, pain when gripping or twisting (opening a jar, wringing a cloth) and a sore spot at the base of the thumb. Repetitive wrist strain from heavy mouse use often shows up along the top of the forearm as well. Tingling or numbness in the thumb, index and middle fingers, especially at night, can point to carpal tunnel syndrome.

In the fingers, repetitive strain injury may feel like stiffness, aching knuckles, or a finger that catches or clicks as you bend and straighten it. Texting, gaming, knitting, playing an instrument and tools that need a tight grip are frequent triggers. If a finger locks in a bent position, or numbness spreads through the hand, get it properly assessed by a GP or physiotherapist.

Repetitive strain injury in the shoulder and elbow

Repetitive strain injury in the shoulder usually comes from repeated reaching, lifting or working with the arms above shoulder height. Shelf stacking, painting ceilings, plastering and swimming are classic examples, but so is a mouse placed so far away that your shoulder is held forward all day. A repetitive motion injury in the shoulder tends to cause an ache at the front or side of the shoulder, pain when lifting the arm and discomfort lying on that side at night.

At the elbow, repeated gripping and wrist movement can irritate the tendons on the outer side (tennis elbow) or the inner side (golfer's elbow). Our guide to tennis elbow physiotherapy at home covers that in more depth. Shoulder and neck symptoms often go together in people who work at a screen, which is why a physio will usually check your neck as well as the sore arm.

What causes repetitive strain injury?

Repetitive strain injury is caused by repeated use of a body part without enough rest or variety for the tissues to recover. The load in any single movement is small. What matters is how many times you repeat it, how long you hold a position and how little recovery time you get in between. Several things tend to add up:

• repetitive tasks at work, such as typing, data entry, scanning at a till, assembly-line work, hairdressing or decorating
• holding an awkward posture for long periods, for example a laptop on the sofa or a screen set too low
• gripping hard, or regularly using vibrating tools such as drills, sanders and strimmers
• a sudden jump in workload: a new job, a deadline, overtime or a busy season
• sports and hobbies with lots of repeated movement, such as golf, tennis, padel, rowing, climbing or playing an instrument
• jobs at home, including long sessions on a phone or games controller, gardening, DIY, or lifting and carrying a small child

Work is not always the cause, and plenty of people do the same job for years without a problem. Tiredness, poor sleep, stress, too few breaks and general fitness all affect how well tissues cope. RSI also often appears when someone's routine changes quickly, such as swapping an office desk for the kitchen table, or going back to a physical job after a long spell off.

How to treat repetitive strain injury at home

Treatment for RSI starts with the activity that set it off. You rarely need to stop completely, but you may need to do less of it for a while, change how you do it and then build back up. The NHS advises against resting the affected area for more than a few days, because resting too long can leave it weaker and less flexible. Things that often help include:

• shorter spells of the task that brings it on, with regular breaks to move or change position
• a cold pack or a bag of frozen peas wrapped in a towel on the sore area for short spells
• asking a pharmacist about painkillers, including anti-inflammatory gels you rub on the area, and whether they suit you
• gentle movement through the day so the area does not stiffen up
• talking to your manager about changing tasks, your workstation or your hours while it settles

Once the pain has calmed down, gradual strengthening tends to matter more than stretching, because stronger forearm, shoulder and upper back muscles cope better with a full day's work. Start with light exercises that feel comfortable, such as squeezing a soft ball, wrist curls holding a tin of beans or squeezing your shoulder blades together, and increase the effort slowly. Mild discomfort that settles quickly is usually fine. If it flares for the rest of the day, you did too much.

UK Physio Tip: Set a timer to break up long spells of typing or mousing. When it goes off, drop your hands into your lap, roll your shoulders, open and close your fists a few times and look away from the screen. It takes less than a minute, and these short, frequent breaks often make more difference to wrist and forearm RSI than one long break at lunchtime.

Desk and lifting changes that help

Small changes to how you sit and handle loads can take a lot of strain off the same tissues, and you rarely need expensive kit to make them. The aim is to keep joints away from the ends of their range, keep your arms close to your body and move between different positions through the day.

At a desk or laptop

• Sit with your back supported and your feet flat on the floor or on a footrest.
• Set the top of the screen at roughly eye level and about an arm's length away. A laptop on its own is too low for long use, so raise it on a stand and use a separate keyboard and mouse.
• Keep the keyboard and mouse close, so your elbows rest by your sides and your wrists stay fairly straight.
• Type with a light touch and hold the mouse loosely. Hammering keys and gripping hard add up over a day.
• Use keyboard shortcuts, switch the mouse to your other hand for some tasks, or try dictation to cut down on repeated clicks.
• Get up often. Stand for phone calls, walk over to speak to a colleague and change position regularly.

Lifting, reaching and manual work

• Bring the load close to your body before you lift, and keep it there.
• Bend your knees and hips, and turn with your feet rather than twisting your back.
• Split heavy or awkward loads, use trolleys, and ask for help when you need it.
• Store things you use often between waist and shoulder height, so you are not reaching overhead all day.
• Swap hands and rotate tasks where you can, and take regular breaks from vibrating tools.

In the UK, employers are expected to assess the risks of screen work and manual handling, so it is reasonable to ask for a workstation assessment. Our occupational health physiotherapists can look at how you actually work, at home or by video, and suggest practical changes that fit the job you do.

When to see a GP about RSI symptoms

See a GP if your repetitive strain injury symptoms are not going away, or are getting worse, despite changes at home and at work. Also get checked if you have numbness or tingling that is constant rather than coming and going, weakness such as dropping things or struggling with buttons, pain that wakes you at night, or swelling, heat or redness around a joint. There is often a simple explanation, but these symptoms should be assessed properly.

A few symptoms in the arms or hands need urgent help instead of a routine appointment:

• Sudden numbness or weakness on one side of the body, a drooping face, or slurred or confused speech: call 999, as these can be signs of a stroke.
• Pins and needles, numbness or weakness after a head or neck injury, such as a fall or a car accident: go to A&E or call 999.
• A hand or arm that turns cold, pale or blue, especially if the change is spreading: call 999 or go to A&E.
• Numbness or weakness that keeps getting worse: see a GP urgently.

This platform facilitates booking only. It does not provide medical advice. If you are not sure how urgent your symptoms are, NHS 111 can help you decide where to go. The NHS guide to repetitive strain injury and the NHS page on carpal tunnel syndrome are both worth reading.

How a physiotherapist helps with repetitive strain injury

A physiotherapy assessment starts with what you do all day: your job, your hobbies, how long the symptoms have been building and what makes them better or worse. Your physio will screen for the warning signs above, then check movement, strength and sensation in your neck, shoulders, elbows, wrists and hands. Forearm pain can come from the neck, so expect them to look beyond the sore spot. If anything points to a problem that needs a doctor, they will tell you.

Treatment is built around what the assessment shows and what you need to get back to. It usually includes some of the following:

• a graded exercise plan to strengthen the hand, forearm, shoulder and upper back
• a plan to reduce, then gradually rebuild, the activity that set it off
• hands-on treatment, such as massage or joint mobilisation, for comfort where it suits you
• advice on your desk set-up, tools, lifting and pacing your day
• a plan for staying at work, or getting back to it after time off

Some of our physios are occupational health physiotherapists. Their focus is work injuries and how your job affects your body, so they can look at your workstation or the physical tasks you do, suggest changes to your working day and draw up a return-to-work plan if you have been off, which you can share with your manager if that helps. Progress varies by person, and your physio will review and adjust the plan as you go.

If your symptoms are mainly in the neck or shoulder, our pages on neck pain physio at home and shoulder pain physio at home explain how those sessions work. Both apply to repetitive strain in the upper body, and the same physio can look at your neck, shoulder and arm together in one visit.

Physiotherapy for RSI at home or online

With FlexAura, an HCPC-registered, DBS-checked physiotherapist comes to you anywhere in England, Scotland and Wales. That suits people who cannot take time off for clinic appointments, or whose arm is too sore to drive. A home visit also means the physio can see the desk, chair or laptop you actually use. Read more about home visit physiotherapy and how it works.

An online video consultation is available anywhere in the UK and works well for desk set-up and exercise advice, because you can show the physio your workstation on camera. Our comparison of home and online physiotherapy may help you choose. You can start online and move to home visits later if you need hands-on treatment.

An online consultation is £45. A home visit is £110 for the first visit and £99 for follow-ups, and a 5-session home package is £450. Prices are the same across the UK and include the physio's travel. You pay after the visit, there are no cancellation fees and you do not need a GP referral. Full details are on our physiotherapy prices page.

We match a physiotherapist to every booking and confirm who is coming and when before the visit. If nobody can come, you pay nothing. If you have private health insurance, check your policy before you book. To get started, book a physiotherapist online, call 07782 610 633 or WhatsApp us.