WHAT IS REPETITIVE STRESS INJURY?
The term repetitive stress injury, or repetitive strain, refers to a group of conditions associated with stresses being placed on soft tissues like tendon, muscle or joint tissues. Repetitive stress injury is called what it is called because it is felt to be associated with the same action being performed repeatedly.
When stress is placed on a joint it pulls on the tissues around it. These tissues include muscles, tendons and bursae. Tendons are the strong flexible bands of tissue that attach muscles to bones.
Bursae are small fluid-filled sacs that act as cushions between tendons and bones. This inflammation is often called bursitis.
When an action that is stressful to a joint is repeated frequently, such as when playing tennis or typing, the area does not have time to recover and it becomes irritated. This can cause the area to become painful and swollen. This process is felt to be one of the factors that is associated with repetitive strain, and there are others as well like awkward mechanics for something you might not be doing for a particularly prolonged time.
We don't always know the specific tissue that is affected – is it a tendonitis or a bursitis, but we can offer care to reduce the inflammation.
HOW COMMON IS REPETITIVE STRESS INJURY?
Repetitive stress injury generally occurs in those over the age of 30 as a result of the normal wear and tear of aging, or in any age group as a result of persistent stress on tissues (ie, running athletes or swimmers). The incidence of repetitive stress injury at work is becoming more widespread as many jobs now require people to make repetitive actions such as typing or clicking a computer mouse without a lot of variability in position through out the day.
WHAT ARE THE WARNING SIGNS OF REPETITIVE STRESS INJURY?
If you have repetitive stress injury the affected area may be tender, swollen, red and warm/hot. It may be painful for you to move the area and it may wake you up during the night if it is in your shoulder especially. The pain is usually not widespread throughout the body, but usually localized to the area around the affected tissues .
WHAT CAUSES REPETITIVE STRESS INJURY?
Repetitive Stress can come from physical stresses – too much stress being placed on a tissue. But it is also affected by emotional stress – you might find you get sorer when you are working to a deadline or under a lot of other stress.
Here are some common physical stresses to think about:
- Repetitive stress injury is caused when too much stress is placed on a joint as a result of the same action being performed over and over.
- Specific kinds of repetitive stress injury are caused by certain actions:
- Shoulder tendinitis is often caused by using the arm to make repeated overhead motions (above shoulder height).
- Tennis elbow is caused by repeatedly bending the wrist backwards with force, such as when playing tennis or painting with a brush.
- Golfer's elbow is caused by repeatedly bending the wrist forward with force, such as when pulling ropes or golfing.
- DeQuervain's tendosynovitis is caused by repeated use of the wrist /thumb on the thumb side of the hand – carrying a newborn around is an example of a repetitive motion your body is not used to or using a new keyboard at work.
- Housemaid's knee is caused by kneeling or leaning forward for a long period of time, such as when scrubbing the floor.
- Some forms of tendinitis and bursitis may also be caused by diseases such as rheumatoid (pronounced room-a-toid) arthritis, gout, psoriatic (pronounced sore-ee-at-ick) arthritis, Reiter's (pronounced rlt-urz) syndrome, thyroid disease and diabetes.
WHAT CAN YOU DO ABOUT REPETITIVE STRESS INJURY?
If your doctor thinks you have repetitive stress injury, he or she will perform a physical examination of the area. There are no laboratory tests to confirm diagnosis of tendinitis or bursitis. Blood tests and x-rays may be done to ensure that other conditions associated with tendinitis (such as rheumatoid arthritis, gout, etc.) are not the cause.
The goal of treating repetitive stress injury is to relieve pain and swelling and to prevent the problem from becoming worse. Your active involvement in developing your prescribed treatment plan is essential.
Medicine to Reduce Inflammation
NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin® , if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).
Cortisone is a steroid that reduces inflammation and swelling and that can influence regulation of the immune system. It is a hormone naturally produced by the body. Corticosteroids are man-made drugs that closely resemble cortisone.
You may find general information in Arthritis Medications: A Consumer's Guide [PDF] even if your disease is not specifically addressed.
Cold to Reduce Inflammation
Cold application can provide temporary relief of the pain of repetitive stress injury. Cold helps numb the area by constricting the blood vessels and blocking nerve impulses in the joint - this reduces the inflammation. If you have poor blood circulation as a result of a condition like Raynaud's phenomenon (pronounced ray-noze feh-naw-meh-non), you should avoid cold treatments.
Resting the Tissues
The irritated tissues need a chance to rest and heal. The vast majority will settle down quickly when rested. Resting a joint or soft tissue usually means a splint if it is a wrist or thumb. Advice can come from your physician or an occupational therapist. Tennis elbow is often managed using a strap that is carefully fitted to your upper forearm to offload all the work being done where the inflammation is (the area near where the muscle attached to the bone – where it is likely very tender to touch). Other joints like the shoulder are harder to rest, but a therapist might have some suggestions to help. Joints need to be kept moving gently during this period, to keep their motion up, but they should not be vigourously moving. Again, your therapist will help you understand how to balance rest with motion.
After the irritation and swelling of the joint has been reduced, it is important to begin exercising the muscles slowly so they do not become irritated again and to prevent loss of movement in the joint. Consult your doctor before beginning an exercise program. He or she may recommend you to a therapist who can show you the proper exercises to do. Before doing any exercise, or any other strenuous or repetitive activity, be sure to 'warm up' your muscles first so they can better handle the stress.
Protect Your Joints
Protecting your joints means using them in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. There are several techniques to protect your joints:
Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest.
Positioning joints wisely helps you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one. Also, avoid keeping the same position for a long period of time. Be aware of what is straining your body and try to fix it before it goes too far.
Many cases of repetitive stress injury are caused by using the wrong tools or equipment. Using the correct tools that keep you from having to assume awkward positions will help to prevent excess stress on your joints.
Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier. Small appliances such as microwaves, food processors and bread makers can be useful in the kitchen. Using grab bars and shower seats in the bathroom can help you to conserve energy and avoid falls. At work make sure you have a mouse that meets your needs, it is comfortable and you don't feel strain using it. If you change equipment, work your body into the new equipment gradually – like a new pair of shoes, you need to get used to thing. Have an ergonomic assessment at work if you are having some difficulty with your computer set up, or brainstorm with your therapist about how to set up your workstation if something is bothering you. There is no one answer, but the idea is to create a better match between your body and your job requirements. Remember of course to take some breaks and change the activities you are doing to stretch those tissues and give them a chance to rest.
Developing good relaxation and coping skills can give you a greater feeling of control over your arthritis and a more positive outlook.