Which of the following employees is most at risk of repetitive strain injury?

Repetitive strain injury (RSI) refers to work-related injuries to the muscles, tendons, nerves, and soft tissue in the upper limbs. It usually affects the neck, shoulders, forearms, elbows, wrists and / or hands. RSI is a painful and potentially debilitating condition that, if left untreated, can lead to permanent damage.

The most significant risk factors for RSI include:

• carrying out repetitive tasks for long periods without suitable rest breaks
• poor posture or activities that require you to work in an awkward position
• poor working environment setup

RSI is most commonly caused by repeated actions that are carried out on a daily basis over a long period.

2. What are the symptoms of RSI?

RSI symptoms can vary but often include:

• Pain or tenderness
• Stiffness or joint restriction
• Tingling or numbness
• Cramping
• Swelling in the hands or forearms
• Referred pain – where the pain is felt in a different part of the body to the one that is injured

There are two main types of RSI:

• Type 1 - pain is the result of a recognised medical condition such as tendonitis, cellulitis, or carpal tunnel syndrome.
• Type 2 - no specific diagnosis can be made, and the injury is often referred to as non-specific upper limb pain or diffuse RSI.

3. Why worry about RSI?

Statistics from the Labour Force Survey suggest that in the UK alone, there are over 200,000 cases of work-related upper limb disorders (ULD) every year.

In addition to the pain and discomfort experienced by individual workers, RSI also carries significant costs for employers.

The Health and Safety Executive (HSE) estimates that 2.6 million working days were lost in 2017/18 due to ULDs – with an average of 14 days lost for each case.

4. Can RSI be treated?

If you develop any symptoms of RSI, you should speak as soon as possible to your employer or occupational health specialist about any ways that you could modify your working environment and tasks to relieve your discomfort or pain.

If your symptoms persist, then you should contact your GP.

It is important to address any possible symptoms of RSI as early as possible because, without appropriate adjustments and any necessary treatment, it may progress from mild to severe.

• Early-stage RSI (mild) – Aches and pain or tiredness occur during work but improve with rest. Performance may not be affected. This stage may last weeks or months but is reversible.
• Intermediate stage RSI (moderate) – Pain and tiredness occur early in the work shift, persist away from work, and may disturb sleep. Capacity for repetitive work may be reduced. Physical signs (e.g., swelling of the tendon areas) may be visible. This stage may last several months.
• Late-stage RSI (severe) – Pain, tiredness and weakness persist even with complete rest. Sleep is often adversely affected, and you may be unable to perform even light tasks at home or work. This stage is sometimes irreversible, and you may never get back full use of the affected part of your body.

Not everyone goes through these stages in the same way, but the first pain, numbness or tingling experienced is a clear signal that you need to act and that your affected muscles and tendons need to rest and recover.

Early intervention is key. Any member of the Chartered Association of Physiotherapists (MCAP) can provide a number of simple exercises to help alleviate early symptoms of RSI, hopefully leading to full recovery.

5. What should employers do to prevent RSI?

Employers have a legal duty to provide safe working conditions, employers also have a common law ‘duty of care’ towards their staff.

Under the Health and Safety Act, employers must carry out a risk assessment of any task or equipment that may cause injury. This includes the setup of computer equipment and workstations. For staff who regularly use computers or laptops, employers must follow the guidance given in the Display Screen Equipment (DSE) Regulations.

To reduce the risk of RSI or any other harm or injury, employers should also:

• consult employees on potential risks arising from their work
• consider changing the way work is organised
• provide clear instructions, information and training on any measures being taken to control the risks
• help sufferers when they come back to work

Employers who do not meet their statutory responsibilities for health and safety, or who fail in their duty of care, may face employment tribunal. One study by the HSE found that most of the compensation claims made against call centre operators came from RSI sufferers.

Employers could also be vulnerable to claims of discrimination under the Equality Act if they fail to make ‘reasonable adjustments’ for a disabled employee.

6. How can RSI be prevented?

Prevention of RSI is far easier than cure. Even if you do not have any symptoms, you should adapt your work to reduce risk:

• adjusting your workstation to ensure it is set up properly for you to work comfortably
• using your computer equipment correctly to reduce potential strain
• taking short, regular breaks (every 20-30 minutes) from protracted keyboard / screen work
• varying your tasks as much as possible

7. How should workstations be set up?

Maintaining a good posture (with a supported back and relaxed shoulders) and adjusting your chair to the correct height that enables you to use the keyboard with your forearms and wrists in a neutral position, parallel with the floor.

Simple measures using standard equipment that help to prevent RSI are:

• resting your feet flat on the floor, or on a footrest
• sitting central to the curve on any curved desk
• placing your screen at eye level and directly in front of you
• having your keyboard directly in front of you, with a space at the front of the desk to rest your wrists when you are not typing
• positioning your mouse as close to you as possible so you can use it with your wrist in a neutral position, avoiding awkward bending
• using a ‘compact’ keyboard without a number pad (if you do not do much number work) so that the mouse can be brought in closer still
• avoiding reflections from overhead lighting and sunlight
• using a document holder, to avoid bending or twisting your neck 
• touch typing, to spread the load
• using predictive text and auto-correct features, to reduce keystrokes
• learning common keyboard shortcuts, to reduce the use of the mouse
• slowing your mouse down, to reduce muscle tension

See the AbilityNet factsheet on Workstation ergonomics for more detailed advice on how best to achieve a safe, comfortable, and productive workstation.

8. What other aids can help prevent RSI?

Apart from the adjustments you can make to standard input devices, various non-standard keyboards and mice are available that can improve the positioning of your hands and wrist – thereby reducing strain.

Possible options include:

• ergonomic keyboard, to aid touch typing (with a split between the keys operated by each hand)
• separate numeric keypad
• palm and wrist support
• ergonomic mouse (which requires less gripping between your thumb and little finger)
• vertical mouse (which avoids having to twist your wrist to move the mouse on a horizontal surface)
• bar mouse (which avoids any gripping and overstretching)
• trackball mouse (which also avoids any gripping)

The AbilityNet information sheet on Keyboard and mouse alternatives provide more detailed information on a wide range of alternative devices and options.

Alternatively, voice recognition software can be used for dictating text and for starting and controlling programs through spoken commands. Further information is available in the AbilityNet factsheet on Controlling the computer with your voice.

If you are getting symptoms in your dominant hand, it is not advisable to switch mouse use to your other hand. It is not so strong and could well soon display similar difficulties. Learning keystroke alternatives to limit mouse use is a preferable strategy, combined with early assistance from a good physiotherapist.

9. What about laptops, tablets and smartphones?

The main problem with laptops is that the keyboard is attached to the screen, this tends to create a poor posture. To reduce such risks when working with a laptop for sustained periods, a good practice is to:

• use a separate keyboard, screen, and mouse
• place your laptop on a raiser (so the screen can be raised as close to eye-level as possible)
• if using neither an external keyboard or mouse (not recommended for long periods of work), make sure that the laptop is on a stable base and not your lap
• take regular short breaks to relieve upper body tension
• sit up straight with your back supported

10. Useful contacts

Health and Safety Executive (HSE)

The Health and Safety Executive (HSE) is the national independent watchdog for work-related health, safety, and illness. Its main aim is to secure the health, safety, and welfare of people at work and protect others from risks to health and safety from work activity.

The HSE also plays a major role in producing advice on health and safety issues, and guidance on relevant legislation. The role of enforcement is split between HSE and local authorities depending on the business sector.

The following publications most relevant to managing RSI can be downloaded from the HSE website - Upper Limb Disorders.

The institution of Occupational Safety and Health (IOSH)

IOSH is the chartered body for health and safety professionals and a world leader in health and safety training. The IOSH OH Toolkit provides information, guidance, and training materials on a wide range of conditions, including upper limb disorders, to help you tackle occupational health problems.

NHS Choices

NHS Choices is a reliable source of medical information on the symptoms, causes, diagnosis, treatment, and prevention of repetitive strain injury.

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