What Causes Repetitive Strain Injury (RSI/OOS)
RSI / OOS & Overuse
Straight forward overuse is the most obvious and natural cause of RSI/OOS pain. Overuse starts to really make sense when you understand the body’s need for constant repair.
Your body can do far more repetitive work than any machine without the need for new parts, because it engages in constant repair. Consider the fact that an active person loads their entire body weight through their ankle joints more than 800 million times every 10 years without any need for replacement parts. This feat is only achievable within a system that constantly repairs itself.
Classic overuse injuries occur when the body cannot keep up with the repair that is needed to sustain life’s activities’.
Overtraining is the most easily understood cause of true overuse RSI / OOS pain. You might be incredibly strong and have perfect lifting technique but if you do the same intense crossfit workout every day for 3 years the damage you do will massively over-exceed your body’s ability to carry out growth and repair processes.
Obviously occupational overuse is a very common form of RSI / OOS. Work tasks that require a certain amount of strength, tasks performed in huge numbers of repetitions or are performed at an awkward angle can all lead to RSI/OOS type pain and injuries. Overuse is usually only part of the story with RSI & OOS however.
RSI / OOS & Sedentary Lifestyle
Our body’s muscles and soft tissues were designed for a very different life from the one most of us lead; a far more wild and active life. Imagine the amount of work your hands and arms do if you need to find your own food and water, and build your own shelter.
In the modern world tending to our needs requires us to perform very different tasks to those our body’s were designed to perform. Typing all day for example limits our tendons and muscles to a very limited range of motion, it requires a great deal of repetition but does not strengthen the tissues in any meaningful way.
A life of typing, swiping and shopping has a profoundly weakening effect on our muscles, tendons and fascia. Our soft tissues just don’t get the varied work that they need in order to stay strong and elastic. Weakening can predispose us to RSI & OOS pain in a big way. In fact we believe it is the no.1 cause of RSI & OOS bar none. Strong tendons, fascia and muscles can put up with a lot!!!
RSI / OOS & Poor Alignment
A wise woman once said ‘It ain’t what you do it’s the way that you do it’ and she was right, at least when it comes to preventing RSI & OOS pain.
Tasks performed in a smooth, relaxed and efficient way put a tiny fraction of the strain on the body’s tissues than tasks that are performed inefficiently or in a tense and awkward fashion.
Many sufferers of OOS & RSI type pains are people who have developed inefficient or tense ways of doing things. Many of our habits of posture and movement sneak up on us and it is all too easy to develop habits of working/living that cause strain without us realising. Much in the same way that we are able to slowly lose 20/20 vision without realising.
For many sufferers of RSI % OOS pain, improved ergonomics and biomechanics are major factors in the eventual elimination of their pain. Happily, any professional pain clinician who knows their stuff should be able to help you take the guesswork out of making these type of changes
RSI / OOS & Repetitive Tasks
A solid metaphor for the way repetitive strain works is the way in which water can melt an ice cube. If a classic major injury event is like pouring a large kettle of hot water over the icecube to melt it; repetitive strain is like melting an ice cube 1 tiny drip of hot water at a time. The real point of this metaphor is that the end result is exactly the same in both instances. A gradual injury is still an injury and repetitive strain can leave the body’s soft tissues just as broken as any dramatic injury.
In repetitive strain injury the work that the body does exceeds the repair and renewal of cells that it must do in order to keep a healthy tissue. When the workload exceeds the repair work in our body’s it spells trouble for the health of our muscles, tendons and fascial structures.
The body is designed for a variety of movements just as it is designed for a variety of nutrients. For many the repetitive strain mechanisms that lead to RSI & OOS type pain in their soft tissues are caused by a loss of variety in their body’s movements.
Taking all the variety out of life’s natural movement patterns and reducing our experience to the act of sitting could be compared to just living on one type of food. The body craves the stimulation that comes from different types of movement, different planes of movement, different movement intensities, different ranges of motion. When we perform the same exact task every day we leave the door wide open to developing RSI & OOS because we have created a Groundhog Day scenario for our body’s soft tissues.
The obvious problem with all this for many of us is that quitting our job is unrealistic and quitting all our favourite pastimes is unappealing. There is good news though. Combining the right pain treatments with the right exercises and the right gentle lifestyle changes has an excellent track record for success in managing the frustration and misery of RSI & OOS pain.
RSI / OOS & Stress
Increasingly science is unpacking the intense links between our psychological well being, our emotions and the stubborn health issues we suffer from. These days it is more or less common knowledge that stress can influence pain in a big way.
An up to date scientific grasp of pain and how it relates to stress hinges on one relatively simple concept. Pain does not just happen in your body’s tissues, it also happens deep in your central nervous system. When we experience stubborn pain it is happening both in the tissues but also within the ‘pain pathway’’. The pain pathway is the set of nerves and nerve clusters that manage the pain signals.
Pain can be amplified by physical stress in the body’s tissues, we all know that one. But pain can also be amplified by the effects of psychological stress on the central nervous system.
An excellent piece of research carried out on behalf of Boeing highlighted the effects work related stress can have on pain. Boeing spent a huge amount of money trying to unpack what causes so many of their staff to suffer debilitating back pain. Cutting a long story short it turned out that it wasn’t heavy lifting or repetitive work that predicted back pain in workers; the workers who experienced the worst back pain were the ones who felt chronically under-appreciated.
In practical terms: the truth is that a mild repetitive strain injury in a person suffering a huge amount of psychological stress can lead to more ‘physical pain’ than a major RSI injury in someone who is enjoying their life situation.
Happily there are effective ways of managing stress that increase our resilience in ways that lead to reductions in RSI & OOS type pain. Most people also find that healing their soft tissues reduces their pain meaningfully, which leaves them free to manage stress in their own time.
RSI / OOS & Scar Tissue
Scar tissue is a major major cause of RSI & OOS pain.
There are 2 types of scar tissue in life. Scar tissue that comes from major injury events – and scar tissue that develops slowly due to repetitive strain mechanisms. Both types of scar tissue can contribute in a big way to RSI & OOS pain.
When repetitive strain in the soft tissues plays out over long periods of time (years/decades); a type of scar tissue forms within the areas of maximum tissue stress. This type of scar tissue is the mess left by all the body’s failed attempts at repairing the situation. The outcome is a degenerative mixture of scar tissue and incomplete wound healing. These changes leave the tissue with not only pain but a loss of elasticity – both of which only add momentum to the problems in the longer term.
When we injure ourselves deep invisible tracts of scar tissue are often left behind. These deep tracts of scar tissue that injuries leave behind are a very common ‘cause’ of RSI & OOS type pain. More accurately, old tracts of scar tissue aren’t so much a cause, as a major contributing factor to RSI & OOS complaints.
There can be great value in acknowledging the role that old injuries play in RSI & OOS pain, and it can be complex. Old shoulder injuries can easily contribute to pain in the wrist, hand and forearm for example.
Happily most scar tissue is easy to break down as long as you have the right tools and the right professionals at your disposal. At Featherston St. Pain Clinic for example, relieving stubborn pains by breaking down scar tissue is our bread and butter!
RSI / OOS & Surgery
We are truly blessed to live in an age of modern surgical procedures and technologies. The right surgery at the right time can be nothing short of life saving after all. Then there are all those non-life & death procedures that can relieve nerve compression and all sorts of other nasty’s. Surgery is great.
As wonderful as it is, surgery remains the most risky and invasive of all healthcare paradigms. For your body’s soft tissues getting cut open by a surgeon is an injury like any other. And like all injuries surgery can leave the body with longer term scar tissue and longer term issues that may predispose it to pain.
Sadly very few of us are given sufficient rehab after surgery due to the pressure on our healthcare systems and the need to discharge patients in a timely fashion. A history of surgery in the vicinity of a body part that is showing up with persistent RSI or OOS type pain can be a sign that there is some residual scar tissue or muscle wasting.
The happy news is that many cases of post-surgical pain and RSI pain related to poor surgical recovery are an absolute piece of cake to treat as long as you are willing to put in the necessary work.
RSI / OOS & Injuries
Old injuries that didn’t receive the type of rehab that they needed for a return to full function are a major cause of pain; and RSI/OOS pains are no exception.
Anyone who has had their arm in plaster can tell you how much muscle wasting can occur in the relatively short period of immobilization after an injury. It’s tempting to assume that once that arm looks normal again it has definitely returned to full pre-injury strength; but they often have not. Many limb injuries leave undiagnosed muscle weaknesses in their wake.
Body parts that are deprived of full muscle strength long term are infinitely more prone to RSI & OOS pain than those with full muscle strength. Muscles prevent injuries.. Including the ones caused by repetitive movement.
In addition to weakness, the other obvious legacy of injuries that can contribute to RSI & OOS type pain is our old mate scar tissue. Chronic scar tissue formation can leave your tissues with a chronic lack of elasticity. Soft tissues that have lost their elasticity are far more prone to RSI & OOS pain than those that have full healthy elasticity.
Happily the body is a very forgiving piece of machinery thanks to all the millions of years of adaptation and design that have gone into manufacturing it. At Featherston St Pain Clinic it is quite normal for us to have predictable success rehabilitating injuries that are more than 30 years old. **Success being defined as the elimination of chronic pain.. rather than a return to competitive rugby at 60 years of age you understand.
RSI / OOS & Muscle Wasting
If you have chronic pain (of almost any type) it’s vital to know that muscle weakness is almost certainly part of the issue. Strong body parts seldom hurt, no matter what other complex factors are involved.
Most modern humans engage in less than 10% of the activity their hunter gathering ancestors did. As a result our bodies are extremely prone to muscle wasting. In fact, compared to our ancestors,specific patterns of muscle wasting are the norm for us due to our profoundly sedentary lifestyle patterns.
The most obviously important role of muscle is movement, muscles pull on our bones and enable important life preserving activities like Zumba afterall. The role muscles play in injury prevention is a close second in importance to their role in maintaining movement.
In moments where there is a threat of injury muscles intervene and assume their role as a highly effective suit of armour. Patterns of protective muscle contraction prevent our joints reaching extreme ranges of motion, reinforce our bones, and prevent the energy of hard impacts from reaching the vital organs. The role of the core is most well known for its supportive and protective functions – but these protective roles are assumed by muscles in day to day life also.
Strong healthy muscles play a major role in preventing RSI & OOS injuries, in much the same way as they prevent traumatic injuries. The likelihood of developing repetitive strain injury is influenced by the amount of work the body does – it is also however influenced by how strong the body is.
The good news that rides on the coattails of understanding muscle wasting as a cause of RSI/OOS pain is that by strengthening our muscles and their tendons we can greatly impact the likelihood of resolving RSI & OOS type pain in the longer term. At Featherston St. Pain Clinic we often find ourselves wondering if healthy strength is the no. factor that determines whether we get repetitive strain and overuse injuries or not.
RSI / OOS & Tendinopathy
Saying tendinopathy is a cause of RSI/OOS pain is a bit like saying that RSI is a cause of RSI. This is because tendinopathy is an integral part of almost all RSI/OOS type pains and is pretty much an inseparable part of the underlying problem.
This being said it is valuable to understand what tendinopathy is, the role it plays in repetitive strain related pain and what we can do about it.
Up until recently we used a different term for tendinopathy.. Tendinitis! Until it turned out that tendonitis is a completely inaccurate and non-scientific term for what really happens in painful tendons.
The term tendinopathy reflects what we now know scientifically about tendon pain. When you look down the microscope at chronically painful tendons (including those involved in RSI & OOS pain) you see degenerative changes. This means that in a very real sense tendinopathy is just as degenerative in nature as conditions like osteoarthritis. Happily though tendon degeneration can be reversed due to its rich blood supply.
RSI & OOS type pains are often tendinopathy by another name. Using treatments like extracorporeal shockwave therapy combined with a tailored strength exercise program for the tendons is an excellent way to manage these types of problems both in the long and short term. We now know that the body can reverse degenerative type changes when it is given a chance.
RSI / OOS & Fascial Adhesions
Fascia is the whitish/ silvery connective tissue that neatly wraps up all your body’s internal structures. We now understand that the skin is a very large and very important organ system; and we are also beginning to understand fascia as an organ. Previously it was thought of as nothing more than the boring stuff that you cut through during surgerys and autopsies.
Fascia is really important stuff. It binds interdependent sets of muscles, bones, nerves and blood vessels together in a way that enables them to work together effectively. Fascia assists movement between tissues too, muscles need to slide smoothly against other muscles and against bone, and even against the overlying skin.
‘’Fascial adhesions’ are sticky thickened sections of connective tissue that contribute to pain by preventing normal movement between neighbouring tissue structures. If you are not a lifelong vegan you have probably seen what fascia looks like on a lamb shoulder. The fascia is the silvery connective tissue between the muscles. If you can picture what it would be like if that silvery membrane thickened and caused the muscles to stick to each other you understand fascial adhesions.
Fascia adhesions are a very common part of the body’s response to physical strain, and they are a major part of the mess that needs to be tidied up in most cases of RSI & OOS pain. If you have had limited success with exercise and braces it’s quite likely that you have fascial adhesions that need to be broken up.