Work Related Injuries

Repetitive Strain Injuries

Stiff Joints & Repetitive Strain Injuries

Work Related Musculoskeletal Disorders, or in other words work place injuries and accidents, account for roughly a third of all the injuries we see in clinic. The repetitive nature of some jobs and the increasing necessity to sit for long periods with limited or no movement causes the body to be stressed in ways that it is not used to. Over time this can cause muscles and joints to stiffen up creating pain and discomfort.

Medically it is important to be able to recognise the symptoms of these injuries and seek treatment where possible.
The following are some of the more common conditions associated with occupation and the work place.









Repetitive Strain Injuries


Repetitive Strain Injuries (RSI) or Overuse Injuries are just that; injuries that result from overuse of one particular area due to the continued repetition of one particular activity or exercise. As a result they usually come on gradually. It may be difficult to remember a specific onset of pain.


Your body is designed to deal with a certain amount of stress and strain. We move a lot from day to day and on the whole do not repeat one particular activity continuously. As a result there is no one area of your body that is continually doing the same thing. However, some jobs and lifestyle choices require the body to repeat certain movements over and over again. For example, data entry on a computer can demand repeated use of the wrist and fingers whilst painters and decorators man need to continually move their arms forwards and backwards.


In the same way that a spoon would break if you bent it forwards and backwards continually, muscles and tendons will tend to breakdown with repeated unrelenting activity. Overtime, tiny muscle and tendon fibers snap causing micro tearing of the tissue. This produces scar tissue that restricts normal movement and subsequently causes pain.


Repetitive Strain Injuries usually occur in the upper limb and neck, i.e. fingers, hand, wrist, elbow, shoulder, and neck joints.



Symptoms of Repetitive Strain Injuries include localised burning pains that can spread over time if left untreated. In extreme cases this pain can affect surrounding nerves causing tingling and numbness. If left untreated this can develop into muscle weakness as well. Swelling and tenderness may also be present over the effected area.


In the early stages, Repetitive Strain Injuries will cause pain during the activity responsible. When this activity is ceased the pain usually subsides. Over time you may notice that this pain takes longer and longer to settle down after these activities are stopped.



It can be helpful in the initial stages to apply ice regularly. Be careful not to give yourself an ice burn and never apply ice directly to the skin. Speak to your GP about oral anti-inflammatories as well. It is important to identify the activity responsible and where possible stopped it or reduced it significantly. If this can’t be done you should look for ways to modify the activity in some way to reduce demand on that particular area.


Starting Physiotherapy quickly can be beneficial. Treatment can include soft tissue massage, mobilisation/manipulation of the area, and reconditioning of the muscles and tendons. Acupuncture can also be effective at reducing the pain. Treatment for Repetitive Strain Injuries usually lasts between 6-8 weeks and you can expect around 6 sessions of treatment. It is important that the area is rested during treatment.


Should Physiotherapy not be effective, it may be necessary to scan with area with an MRI scanner and potentially inject the area with a steroid anti-inflammatory. In extreme cases, surgery may be required to repair the area.



Carpal Tunnel Syndrome


Carpal Tunnel Syndrome could be considered as an overuse injury. It affects the wrist and fingers and can be experienced by typists and those using computers regularly. It is more common in women and usually occurs typically between the ages of 40-60. Although, it can affect anyone given the right circumstances.


Carpal Tunnel Syndrome usually develops over time and is often caused by increased pressure within the wrist joints as a result of overuse. Scar tissue and swelling can put pressure on the underlying nerves as they go into the hand potentially causing pain and numbness.



The main symptoms of Carpal Tunnel Syndrome include pain in the wrist and numbness all the fingers except the little finger. Overtime this can cause weakness and even paralysis of certain muscles within the hand and fingers. As with other Repetitive Strain Injuries these symptoms are worse during activity and should subside when this activity is ceased.



It is important that treatment be sought quickly if you suspect you have Carpal Tunnel Syndrome. All symptoms can be reversed if caught early enough, however, if left untreated, Carpal Tunnel Syndrome can cause permanent nerve damage.


Physiotherapy treatment is often tried initially. Treatment can involve soft tissue massage, mobilisation/manipulation to the area, and rehabilitation to the surrounding muscles and tendons. Looking at the cause and modifying activity will also be important. Wrist Splints and other supports can also be helpful in the treatment of Carpal Tunnel Syndrome.


Where Physiotherapy is not effective, MRI scans may be required to give a clearer picture of what is going on in the wrist. Often steroid injections can be used to reduce the swelling and pain. In extreme cases, surgery may be required to repair the injury.


Carpal Tunnel Syndrome can take anything from 6-12 weeks to settle depending on the severity. This can require anything from 6-10 sessions of Physiotherapy treatment. It is vital to continually reassess during treatment and if there is no effect after 4 sessions, we would always look to gain a second opinion.



Postural Related Injuries


Postural Problems such as Rounded Shoulders and Poking Chin Posture can be caused by poor working conditions. Those working continuously at desks or at personal computers often remain in static positions for large lengths of time. If there is inadequate support in the chair and if the computer screen is in the wrong place the body can begin to slouch and strain in order to get into a comfortable position. Inadequate support and sustained stretching can cause the joints and muscles to become stiff and painful. Staring at a computer screen can also cause the neck joints to come out of alignment and protrude forwards. This will often cause the characteristic Pocking Chin Posture.


Long distance lorry drivers and taxi drivers may also suffer with Postural Related Injuries to the lower back.


The combined affect of this abnormal posture means that overtime the body adapts to this new position and has difficulty returning back to normal. Joints, ligaments, tendons, and muscles can all be affected by this and will often develop scar tissue in response to abnormal stresses. Ultimately this can give rise to pain and reduced function.



The main symptoms of Postural Related Injuries include aching joints, stiffness in the morning and localised pain in the muscles. In extreme cases pain can spread into the arm and legs and occasionally cause pins and needles. Postural pain will take time to come on and is often worse after periods of sustained inactivity. Conversely pain is usually better during sport and exercise but can ache the day after.


It is usually possible to see the effects of poor posture by looking in a mirror. If you slouch your back and your head pokes forwards you may have underlying postural changes. Having said that, this is common in a lot of people and may not be a cause of pain or discomfort.



The effects of poor posture can take years to correct and may never fully recover. This is down to the fact that they often take years to come on and are not usually noticed until the postural changes are well established. Having said that, treatment can be extremely effective at reducing the pain associated with Postural Related Injuries. In most cases it is the muscles and tendons that cause the majority of pain and as such Sports Massage can be extremely effective at reducing pain. With appropriate treatment it may be possible to remove up to 80% of the symptoms associated with Postural Related Injuries. Manipulation can also be helpful to regaining movement within stiff joints.


An important part of treatment is ensuring that the associated muscles and tendons are Rehabilitated in order to regain strength and movement. Often for neck and back problems this involves Core Exercises. Lumbar Supports may also be helpful to realign joints and provide support.


Working environment and Ergonomics (equipment and devices to help maintain posture) should also be looked at in order to reduce the environmental demands on the body.


Where appropriate, an initial course of Physiotherapy should be provided over a 4 – 6 week period. We would expect this produce an improvement in symptoms of around 60 – 70%. When pain has settled, it is important to Rehabilitate the area with a suitable Exercise Program. This may take an additional 6 weeks to complete and can require 3 – 4 treatment sessions. Following on from this it may be necessary to have occasional ‘top up’ treatments every 6 – 8 weeks in order to keep the muscles and joints in good condition.


For severe cases, MRI scans and Steroid Injections may be required. Surgery is an option only where everything else fails.



De Quervain’s Tenosynovitis/De Quervain’s Syndrome


De Quervain’s Tenosynovitis can also be referred to as De Quervain’s Syndrome, De Quervains Disease, Gamers’ Thumb, Washerwoman’s Sprain, Radial Styloid Tenosynovitis, and Mother’s Wrist. As some of these names suggest, De Quervains’s Tenosynovitis often arises in situations where repeated wrist and thumb movements are required.


Overtime, overuse of the thumb muscles creates friction leading to scar tissue formation between the tendons and their corresponding sheaths or paratendons.



Symptoms of De Quervains’s Tenosynovitis include pain and swelling over the wrist just below the thumb. Thumb and wrist movements can be weak and painful.



De Quervains’s Tenosynovitis can be treated effectively with Physiotherapy. Sports Massage, Mobilisation, Acupuncture, and Rehabilitation can all be beneficial. It is often necessary to rest the wrist and thumb from the activities that bring on pain. Where this is not possible, modification of activity is often necessary. The acute symptoms can be managed with PRICE. You should also consult your GP for advice with regards anti-inflammatories.


In extreme cases, injections may be used to reduce inflammation, and/or surgery may be required to Debride the area.


Physiotherapy treatment usually last between 6-8 weeks depending of severity and may require 6-8 treatment sessions.



Trigger Finger/Trigger Thumb/Stenosing Tenosynovitis


Trigger Finger, Trigger Thumb, or Stenosing Tenosynovitis, is a condition that can be associated with Overuse Injuries. It is more commonly to find Trigger Finger in females and in those over the age of 40. The reasons for this are unknown, however, it has been linked to repeated gripping or grasping of the hand. Inflammation and Scar Tissue formation within the retinaculum (Fascia like tissue that retains tendons) of the hand and fingers causes the tendons to become ‘stuck’ during movement.



The tail tail symptoms of Trigger Finger are a locking of the finger during movement followed by a sudden release. Both phases can cause localised pain within the palm of the hand. The release may cause a popping sensation and have an audible noise, hence the name Trigger Finger.



Conservative management of Trigger Finger is advisable in the early stages. This would include Physiotherapy in the form of Sports Massage, Mobilisation, Acupuncture, Stretching, Rehabilitation, and modification of activity. It this proves ineffective, Steroid Injections and surgery to Deride and release the area may be required. Physiotherapy is always advocated post-operatively to maximize the effects of surgery.


Conservative management usually continues for around 6-8 weeks and involves 6-8 Physiotherapy treatments. Post-operative Physiotherapy treatment can last anything from 2-6 months and may require up to 20 treatments.