Repetitive strain injuries (RSI) are a family of injuries affecting tendons, tendon sheaths, muscles, nerves and joints. They cause persistent or recurring pains most commonly in the neck, shoulders, forearms, hands, wrists, elbows and lower limbs.
The term “repetitive strain” injury is misleading. Unlike other diseases, RSIs are not easily classified because they have a variety of causes and include injuries to different parts of the body. A number of terms are applied to such injuries including: repetitive injury, repetitive motion injury, repetitive trauma, overuse injury, cumulative trauma disorder, occupational musculoskeletal disorder and cervio-brachial disorder. The different terms indicate that such injuries involve repetition, and can also be caused by force, rapid movement, overuse, static loading, excessive strain, uncomfortable positioning of limbs or holding one’s posture in an unnatural, constrained or constricted position.
Who is affected?
In the past, repetitive strain injuries were most commonly attributed to those persons involved in sports – hence the names, “tennis elbow” or “golfer’s elbow”. These injuries were generally not recognized amongst workers. However, RSIs are increasingly common among a variety of worker groups, including those of us that work in a variety of occupations at Bethesda.
Many workers are unfamiliar with repetitive strain injuries so everyday aches and pains are overlooked and no connection is made between the injury and the workplace. Aches and pains warn that a serious injury may be developing. If the causes are not eliminated or the worker moved from the job immediately, the damage can be permanent and irreversible. Sometimes the injury is crippling, leaving the worker in pain and possibly immobile for life.
Although the number of RSI injuries reported is increasing, at the present time, there are no regulations or standards covering them.
RSI: The Causes
The causes of repetitive strain injuries can be classified in the following ways:
- Rapid movement injuries, caused by repeated rapid movements;
- Forceful movement injuries, cause by exertion of muscle movement;
- Static loading injuries, caused by fixed positioning with unsupported limbs.
Such injuries can be caused by either too little movement or excessive movement while handling light as well as heavy loads.
Often, repetitive strain injuries have multiple causes. A maintenance worker using a screwdriver may get pains from repetitive use of force while working at an uncomfortable angle. VDT operators may sit in an uncomfortable position with no wrist support and use rapid finger movements on a poorly designed keyboard. These workers may develop a number of serious injuries because of effects on their musculoskeletal system.
Any work that forces a person into an “unnatural” position can lead to repetitive strain injuries. The forceful twisting of a screwdriver, repetitive finger movements without rest, sitting in an uncomfortable position, bending the wrists for long periods, working with arms above shoulder length, gripping tools forcefully, etc., strain tendons, ligaments, and muscles causing injury. In the AI department we have been having ongoing and multiple conversations regarding the poor ergonomics of the chairs we use to provide treatment therapy for the children we serve. Sitting in uncomfortable child sized chairs and child sized tables for hours on end is taxing on our bodies. ergonomics is a hot topic in Bethesda these days with our employer keeping a watchful eye on the mighty dollar. But the Employment Standards Act and the Occupational Health and Safety Act is clear that the Employer has an obligation to proved a safe workplace and that includes proper ergonomics. Addressing the issues in your job will help prevent yourself or a co-worker from suffering from a RSi.
Repetitive strain injuries are linked to type of work conducted, the tools used, and the design of the work station. For example, most tools are made for “the average man”. Sometimes grips are too wide or too slippery. Gloves may be too thick causing separation of fingers, or they may not be flexible enough. Tight gripping and squeezing with overstretched hand muscles is then required (the fact that standard hand tools are too large for many women helps explain why RSIs are more common amongst women). The workstation may be designed so that workers strain their bodies bending, stretching, reaching or twisting, etc.
Other factors contributing to repetitive strain include excessive work rates, lack of job variation, speed up, poorly maintained equipment, stress, overtime, vibration and inadequate training.
RSIs can be caused by overwork. Our bodies are simply not designed to work faster, more vigorously, endlessly or without rest. They break down, just like machines that are overworked. Rapid, repetitive motions with insufficient rest can cause RSIs. With overwork, the body is forced to work too much with not enough time to recover. This spiralling effect – coupled with stress, another contributor to RSIs – can cause injuries that might never heal without a long-term break from their causes.
What are the symptoms of Repetitive Strain Injuries?
Description of how RSIs feel range from “a sense of discomfort” to “excruciating pain”. General symptoms include:
- tingling and burning sensations
- pain, dull ache
- dry, shiny palm
- clumsiness of the hands (loss of ability to grasp items, impaired thumb and finger dexterity)
- swelling around the wrist and hand
- wasting of the muscles at the base of the thumb
- aches and pains which may be strongest at night
Pain in one area of the body may radiate to other connecting parts. Pain from the wrist can radiate to the forearm and the shoulder joint. If a worker has any one of these symptoms, it should be reported immediately.
What parts of the body are affected?
Bones and muscles make up what is known as the “musculoskeletal system”. This provides support and strength, keeps the body moving and protects internal organs. The bones, connected by joints, serve as levers for the muscles to act upon. The muscles are anchored to the bones by tendons, and ligaments connect two or more bones, cartilages or other structures. Any activity that wears away at this system may cause a repetitive strain injury.
Tendons are a common site of overuse injuries. They are tough tissues with very few nerve endings and little in the way of blood supply. Often found where there are a large number of joints to move in a relatively small space (e.g., hands or wrists), tendons connect the body of the muscle to the bone which it is intended to move.
Certain repetitive movements or forceful exertions such as twisting a screwdriver can cause the tendons to rub against adjacent bones and ligaments. This can cause friction which damages the tendons and lead to the constriction of the muscles they were designed to move. The various names for repetitive strain injuries reflect the fact that different tendons, joints or muscles may become damaged depending on which movements are overdone.
- trigger finger
- de Quervain’s disease
- Carpal Tunnel Syndrome
- Dupuytren’s Contracture
- rotator cuff strain
- tension neck syndrome
- thoracic outlet syndrome
- digital neuritis
- radial nerve entrapment
The danger of multiple problems
Workers with a repetitive strain injury in one part of the body may develop problems in other areas at the same time. When feeling discomfort or pain from doing work in one particular way, they may try and compensate through movements that cause other strain injuries. Thus, pain in wrists or hands can be followed by pains in forearms and shoulders.
An additional problem is that workers may try to “work through the pain”. Since they do not relate their pain to the workplace they try to keep up productivity and don’t stop their work. As a result, inflammation continues and worsens leading to even greater injury. YOu must report your injury. If you need help filling out an incident report please feel free to contact an executive member or reach out to your Health and Safety Committee. Health and safety isn’t just the Employers responsibility. Its both the Employers and the Workers. We all play a role and have responsibilities for our own Health and Safety.
Getting RSIs diagnosed is a major concern. The pain can be persistent, but because there are no open signs of injury or damage aside from occasional swelling, workers are accused of being neurotic or malingerers. Often the victim is blamed and told that the pain is “all in the mind”. Ensure that if and when you do get a potential RSi checked, that you have the proper documentation filled out- including WSIB forms.
While the worker finds that doing the job may lead to a painful condition, the pain usually goes away with rest. When returning to work the pain reappears. Other workers may see this person as a chronic complainer because they fail to make the connection between the unseen injury and work.
Some physicians have called such problems “women’s complaints” saying that women are more prone to RSIs. However, it’s more likely that many women receive such injuries because they are employed in large numbers where such injuries are common (e.g. typing, keyboard work) or because the tools they must use are designed for the “average male”, not for the smaller grip many women have. Again, because the injury is not plainly visible, women workers are accused of “hysteria”.
What can be done about RSI?
Because repetitive strain injuries have numerous causes affecting a variety of areas, eliminating them demands a comprehensive prevention program. The cornerstone of such a program must be to make the job fit the person rather than make the person fit the job.
- An education program outlining the source and prevention of repetitive strain injuries. Workers should be informed of the symptoms of such injuries so that they can be identified before any serious injury occurs.
- A reporting system to ensure early symptoms are dealt with seriously and immediately. Workers should not put up with the pain.
- A provision for rest and time-off work. If the cause of the repetitive motion, trauma, etc. is eliminated a healing process can begin. Too often the worker will return to work as soon as pain disappears. This furthers the problem possibly causing a worsening of the condition. Surgery to deal with serious injury is always the last resort especially in the case of repetitive strain injuries. Job rotation, job enlargement, and repeated rest breaks should be used to break up the series of repetitive motion that can lead to injury. Jobs can be redesigned to eliminate de-skilling, and monotonous and repetitive tasks. Job rotation can be used to vary the muscles used in the work process.
- A program to investigate and document all complaints of pain related to the workplace. A careful analysis of the workplace should be conducted to detect potential causes of RSIs. A full scale ergonomics study can look at the force, speed and direction of movements, frequency of movements, work posture, rate of worker and stress.
- Redesign of tools to fit the individual or specific task. For example, some tools can be designed with smaller grips that require less power to manipulate, squeeze or press, so that hands and wrists are in the same posture as when they are hanging relaxed at one’s side. Badly fitting components should be eliminated and machinery well maintained. Sometimes tools may be redesigned, but the effect is offset by a resultant increase in the work rate. A mix of both tool or workplace redesign and rest breaks would be the most effective. this also includes the type of work with clients- restraining takes its toll of your body. Do you think there is a tool or a assistive device that could help you in your job duties?
- Recognition of repetitive strain injuries as serious occupational injuries is yet to be fully recognized. Each province has different coverage under the Workers’ Compensation Board. Some jurisdictions do not even consider repetitive strain injuries while others will deal with the problem case by case. Workers must demand legislation that covers all repetitive strain injuries and which recognizes the direct relationship between their injuries and the workplace.
- Proper training for new workers if their jobs involve repetitive motion.
Stay Safe. Work Safe….. Please let an executive member know if we can help you in anyway regarding a RSI.