Repetitive strain injury (RSI) is one of the office blights so it may seem. Of course you do not have to work in an office to suffer on-going arm or hand pain, or as some call it: WRULD (the rather clunky ‘work related upper limb disorder). You may have tennis elbow or golfer’s elbow, of course without playing either sport — then it should be lateral or medial epicondylalgia! Words aside, this is a big and costly problem for individuals who bear the brunt of the pain, symptoms and their consequential limitations, and for businesses that have employees on light duties or off sick. So how does typing cause an injury?

Well it may not. We are not really designed to be sat, hunched over a desk (as I am now I have just realised), poking away at small buttons, getting quicker and quicker so that we don’t even have to think about where our fingers are going in order to produce a document. The ‘noise’ created by all these small, precise movements of the fingers (signals flying up from the joints and muscles about movement, pressure, touch etc) can be difficult for the brain to gather into a tangible meaning. We start to develop different sensations, perhaps a change in temperature, some tingling, numbness or a sense of size difference (my hands are now warm and a bit tingly). If you interpret this as strange or mildly worrying because you have heard of RSI and you don’t want it because your job involves typing all day…..you can perhaps see how the worry and concern and vigilance and responses begin to amplify and amplify; this without any notable injury. However, the tension that builds, the stress responses that affect tissue health, the change in blood flow and nerve function when anxious, all impact and can create a threat value that is perceived as dangerous and hence the body systems that protect kick in — this may well mean some pain. And pain is useful and normal, even without a significant injury, because pain is a need state, motivating action: maybe I should take breaks? Perhaps I should type less at the moment? Maybe I need to work at changing my thinking about a situation that is making me stressed? Maybe I should start exercising regularly? Maybe I should seek some help and advice?

On-going use without adequate recovery can lead to an imbalance between tissue breakdown and rebuild, the natural state of change that is constantly occuring to all of us. The inflammation that results can of course add to the level of sensitivity or activate it, leading to aches and pains that can begin in specific locations but with time expand up and down the limb and even be noted in the neck and shoulder. This is not the spread of a ‘disease’, but rather the volume switch being turned up, meaning that increasingly normal stimuli (touch and movement, thought of movement, particular environments) can result in pain. Associations build with stimuli, and we get better and better at certain habits of thought and action that can perpetuate the problem — e.g./ avoidance, expectation, changes in movement, extra muscle tension unbeknownst to us.

There comes a point when the symptoms can begin so quickly that it becomes difficult to type, text, hold light objects and even gesticulate. This makes work life and socialising very challenging as well as frequently occupying much of our thinking, planning and our mental resources from the emotional impact. A comprehensive approach is needed to change direction and begin recovering, from wherever your start point. Certainly if you are feeling a few aches and pains that are becoming more frequent, you would be wise to seek advice. Or if you are struggling, then the right treatment and training programme can help you to resume meaningful activities.

Due to the biology of RSI, like all persisting pains, being upstream in the main, i.e. away from where the pain is felt, any programme must address this as much as improving the health of the tissues locally with movement and use (gradually). Once you undertand your pain, you realise that pain is not an accurate indicator of tissue damage, and that there are many things you can do to take you towards a better life. Asking yourself why you want to get better gives you the answer as to where you want to be going; your direction. We need direction and then the know-how to get there, dealing with distractions on the way, so that we remain focused on the right thinking and actions.

You will have been successful before, using your strengths (e.g./ concentration, empathy, dedication, motivation) and values. Using these same strengths and values to perform the training and to think in the right way leads you to a better outcome. What are your strengths and values? The exercises, training and treatment are all straight-forward, but their effectiveness is impacted upon by the way you think about your pain and your life. There are many factors in your life that are affecting your pain: e.g. tiredness, stress, anxiety, people, places. Understanding these and your pain puts you in a position to make changes and groove healthy habits and in so doing take the focus away from pain and worrying about pain to the doing and enjoying and living. There is only so much you can attend to in a passing moment, so why not focus on the good stuff? And if you are in pain, you can learn how to create conditions for ‘pain-off’ over and over whilst you get healthier and fitter generally as well as specifically training to resume meaningful activities: common problems are typing, texting, carrying etc.

This is an insight into modern thinking about pain and how to overcome pain. We understand so much more and this knowledge is ever-expanding. Passing this knowledge to you with practical ways of using it to overcome pain is our role, and treating you with techniques that calm and ease symptoms whilst you get fitter and stronger.