Preventing Musculoskeletal Disorders and Repetitive Strain Injuries
- Warm up and stretch before starting activities that are repetitive, static or prolonged.
- Take frequent breaks from any sustained posture every 20-30 minutes and stretch stiff muscles.
- Respect pain. Change positions or stop whenever activities cause pain.
- Recognize early signs of the inflammatory process, and treat early.
- Only use splints and wrist supports after instruction by your physician or therapist.
- Maintain erect position of back and neck with shoulders relaxed. Minimize twisting and bending motions. Position equipment and work tasks so that your body is directly in front of and close to your major work tasks.
- Use proper positioning during all activities. Keep upper arms close to the body, elbows at 100 degrees, forearms neutral (thumb toward ceiling), and wrist straight. Keep feet flat on the floor when seated by proper adjustment of your chair, or use of a footrest.
- Keep wrists as neutral as possible. Avoid extreme motions. There is a safe zone of movement for your wrist. This zone is about 15 degrees in all directions.
- Avoid bending neck forward for prolonged periods of time. If typing from a manuscript, place the document on a holder beside or below your computer screen.
- Avoid static positions for prolonged periods. Muscles fatigue faster when they are held in one position. Keep moving to increase your blood circulation.
- Whenever possible, alternate activities frequently throughout the day. Rotate heavy and/or repetitive tasks with lighter, less repetitive tasks.
- If symptoms become worse, or a specific activity consistently causes discomfort, reassess the task setup and look for alternative methods.
- Avoid repetitive or prolonged grip/pretension activities. Avoid pinching with wrist flexion or wrist deviation (bending to side). Take frequent breaks to stretch and rest hands.
- Avoid tugging, jerking, or pounding with the hand.Tool/Environmental Modification:
- Avoid tools with finger grooves, hard plastic handles, sharp edges, small diameter, or large diameter handles.
- Use power devices when available.
- Use grips/tape to build up small diameter pens/pencils for writing. Better still, select large diameter pens with soft grip pads.
- Use the longest tool possible (screwdrivers, wrenches) for the best leverage.
- Use vises, clamps, or jigs to stabilize objects to avoid sustaining forceful gripping with the hand.
- Use a step stool or ladder when necessary to reach above shoulder level, or to lift objects overhead.
- Use carts/dollies to carry heavy loads. Avoid the need to handle heavy loads by making several trips.
- Use forearm troughs, armrests, or pillows under forearms during tasks if needed.
- Use adjustable keyboard trays large enough to support a pointing device to properly position your keyboard. Negative tilt adjustability is highly recommended if you sit in an upright position to work.
- Tilt containers or objects to avoid bending the wrist to pick up objects.
- Use the largest joints and muscles to do the job.
- Use two hands to lift rather than one, even with light objects and tasks. Avoid lifting with the forearm in full pronation (palms down) or supination (palms up).
- Slide or push and pull objects instead of lifting.
- Keep reaching to a minimum. Position objects close to the body within easy reach. Carry objects close to body at waist level.
What is Good Treatment?
Repetitive strain injury (RSI) is a common condition that encompasses many different injuries. The spectrum ranges from carpal tunnel syndrome to tendonitis.
The common denominator is that they are cause by excessive repetitive activity or overuse. There is no specific protocol for treating RSI, due to the fact that RSI can be so many things. However, getting the correct treatment is essential for recovery of the affected area. And the earlier you seek treatment, the faster the recovery.
It can be difficult to find a doctor who is experienced in diagnosing and treating RSI. Most people will start with their primary care physician. Some primary care physicians will have the skills to treat your condition, but most will refer you out to specialists. Some of the specialists you might see include orthopedic surgeons, rheumatologists, neurologists, hand specialists, and physiatrists. The correct doctor often depends on the seriousness of your injury.
Diagnosis of RSI is not simple. Sometimes it is difficult to arrive at a definite diagnosis because you may have a multitude of symptoms that can change from time to time. Your doctor may use a variety of diagnostic procedures in addition to a physical examination to evaluate your symptoms.These may include:
- Nerve conduction studies and EMG tests. These tests involve attaching electrodes to your hand and passing an electrical current through your arm. The time required for the nerve to respond is measured. Slow or delayed times can be indicative of pinched or injured nerves.
- Diagnostic imaging. X-rays and MRI scans are used to check for skeletal problems, most commonly at the wrist, elbow, back shoulders and neck. If you have the symptoms of thoracic outlet syndrome, your doctor might also want to check for extra ribs or other abnormalities.
Your doctor will use the findings from these exams and his clinical findings to refer you to another doctor or a therapist to begin the rehabilitation process. Sometimes you may see more than one specialist. The most common are:
The physical therapist should check your spine and neck and look for pinched or stretched nerves.A good assessment will include the following:
- Posture - To determine areas of the body that may be compromised due to poor posture
- Spinal range of motion - Determines how much motion there is in the neck and back to determine limitations in range.
- Joint mobility - Determines how the each individual neck and back vertebrae moves.
- Strength – Specific assessment of scapular muscles and functional assessment of arm, leg and abdominal strength.
- Neural tension - Assessment of nerve tissue integrity and mobility as it courses out from the neck and down the arm.
- Soft tissue - Assessment of restrictions of movement in the arm and hand
The occupational therapist should complete a thorough evaluation of the following:
- Strength – To determine areas of upper extremity that are weak.
- Flexibility – Determine tightness or range limitations in shoulder, elbow, forearm, hand and wrist.
- Soft tissue - Determine presence of scar tissue, swelling, and tendon and nerve integrity.
- Pain – Determine areas of discomfort and things that increase pain levels.
- Time management/Lifestyle assessment - Determination of effective stress management strategies for home and work.
- Worksite evaluation – Review of your job to determine problems in workstation design or work that can interfere with your recovery.
A certified hand therapist can also treat over-use injuries. Hand therapists can either be physical or occupational therapists and may provide a combination of the previously listed services.
Therapists have a variety of skill levels and expertise. Make sure you choose a therapist who has experience and expertise in treating over-use injuries. Your therapists should collaborate to develop a comprehensive treatment plan that addresses all of the identified problem areas. Typical treatment plans include the following:
- Range of motion and mobility exercises
- Strengthening exercises
- Postural exercises with emphasis on scapular and abdominal or “core” strengthening
- Nerve gliding activities
- Soft tissue mobilization
- Splinting PRN
- Pain management
- Work techniques
- Work pacing and time management
- Use of adaptive equipment including specially designed keyboards, pointing devices, furniture and alternative technologies such as speech recognition
There is frequent cross over between hand, occupational, and physical therapists. For example, the hand therapist might use modalities to reduce swelling. Soft tissue mobilization and stretching might be performed to increase the flexibility of the soft tissue. Treatment is very individual and this outline is general. It should give you as idea of what to expect if you need treatment.
Remember, don’t wait too long to seek treatment. RSI can become so serious that it is not curable. Your symptoms may never go completely away if you wait too long to get help.