What are the treatment options for Repetitive Strain Injury (RSI)?

Treatment of Repetitive Strain Injury (RSI)

Immediately eliminate the aggravating activity causing pain, apply ice for 20-30 minutes 3-4 times daily, and start NSAIDs for pain control while implementing ergonomic modifications to prevent recurrence. 1, 2

Immediate Management: First 48-72 Hours

The cornerstone of RSI treatment is immediate cessation or significant reduction of the causative repetitive activity – this is the single most evidence-supported intervention, though poorly accepted by patients who fear interruption of work or performance. 3 Continuing the aggravating motion perpetuates microtrauma and delays healing. 1

Pain Control Protocol

• Apply ice packs (ice and water surrounded by damp cloth) for 20-30 minutes, 3-4 times daily – never place ice directly on skin to avoid cold injury. 4
• Start NSAIDs immediately (ibuprofen, naproxen, or diclofenac) for pain and inflammation control, which allows patients to engage in rehabilitation. 1, 2
• Topical NSAIDs are equally effective and eliminate gastrointestinal bleeding risk, making them preferable in many cases. 4
• Avoid opioids entirely – they carry overuse risk without superior efficacy for musculoskeletal injuries. 4

Adjunctive Pain Relief

• Massage and topical pain-relief agents can provide additional comfort. 1
• For severe pain limiting function, consider injection of local anesthetic-corticosteroid mixture for prompt temporary relief, though avoid injecting directly into muscle tissue as this impairs healing. 4, 1
• For acute muscle spasm, add cyclobenzaprine 5 mg three times daily or baclofen 10-30 mg/day for 2-4 days only – avoid muscle relaxants in elderly patients due to fall risk. 4

Ergonomic Intervention: Critical for Prevention of Recurrence

Identify and eliminate aggravating factors immediately – improper posture, inadequate workstation ergonomics, and contributory habits like jaw or hand clenching must be addressed or the injury will recur. 1, 2 Workplace modifications are often legally required to prevent reinjury after return to work. 2

Common ergonomic hazards include:

• Repetitive and forceful motions 5
• Awkward postures 5
• Inadequate workstation setup 1, 6
• Lack of rest breaks 6

Rehabilitation Protocol: Start Early

Begin gentle range-of-motion exercises within 48-72 hours, progressing to strengthening once pain allows – complete immobilization beyond the initial healing phase impairs regeneration and promotes fibrosis. 4

Exercise Progression

• Start with stretching and flexibility exercises to restore range of motion. 3, 6
• Progress to eccentric strengthening exercises as these have proven beneficial for tendon and muscle healing. 4
• Physical therapy should begin early to prevent joint contractures and restore function. 4
• Simple joint-protection measures can alleviate much discomfort during the recovery phase. 1

Timeline Expectations

Recovery takes weeks to months even with optimal conservative treatment – patients must understand this is not a quick fix. 2 The rate of recovery varies widely between individuals. 6

Common RSI Presentations and Specific Considerations

RSI encompasses multiple distinct disorders including carpal tunnel syndrome, trigger finger, shoulder impingement syndrome, tennis elbow (epicondylitis), thoracic outlet syndrome, myofascial pain disorders, and ulnar nerve entrapment. 1, 2 Each presents with local pain, tenderness, weakness, inflammation, and limited function. 1

Rule out systemic disorders (rheumatologic diseases, psychologic disorders, acute inflammation from other causes) before attributing symptoms solely to repetitive strain. 2

Critical Pitfalls to Avoid

• Do not allow continued repetitive activity – early recognition and immediate reduction of the causal activity is the most conclusive intervention, though poorly accepted by patients. 3
• Avoid ultrasound, laser therapy, and electrotherapy – these have no proven benefit for RSI recovery. 4
• Do not inject corticosteroids into muscle tissue – deleterious effects on healing are documented. 4
• Consider psychosocial factors if disability persists despite appropriate treatment, and be aware that activities outside work (sports, accidental injuries) may be contributing factors. 1

When to Escalate Care

Persistent disability after weeks of conservative treatment should prompt consideration of:

• Psychosocial factors affecting recovery 1
• Unrecognized contributing activities outside work 1
• Need for specialist referral for specific nerve entrapment syndromes or surgical evaluation 2