Repetitive Stress Injury (Overuse Injury)

Repetitive stress injury [RSI], or now commonly, Overused or Overload Injury is collective term used to describe physical pains caused by excessive strain on the muscles, tendons, nerves and fascia from repetitive movements. Repetitive microtrauma or repeated strain overload overtime results in structural weakening, or fatigue breakdown, of connective tissue.


In a nutshell, this is how it happens… When connective tissue is injured, it goes through a reparative process. However, in connective tissue that is repetitively stressed beyond the ability to repair itself, the inflammatory process is perpetuated. Proliferation of fibroblasts with increased collagen production and degradation of mature collagen leads to a predominance of immature collagen. This has on overall weakening effect on the tissue.

Initial signs and symptoms of inflammation such as pain, redness, swelling and limited movement may be observed. Initially, the inflammatory response from the microtrauma is subthreshold but eventually builds to the point of pain and resulting dysfunction. The type of pain may show the stage or extent of the injury. There are stages for repetitive stress injury:

  •  Phase 1 – Pain is localized and is easily relieved when rested.
  •  Phase 2 – Pain radiates out to other parts of the body. Pain appears more quickly and disappears more slowly.
  •  Phase 3 – Pain is almost always present and can limit function.

Since RSI is a progressive condition, the longer you wait for treatment, the longer the period of recovery takes.

Repetitive stress injuries can occur anywhere in the body where there are repetitive and forceful movements. It is more common in the upper body including the neck, shoulders, elbows, wrists and hands. Overuse injury can be simple muscle tensions with recurring aching pain to involvement of other soft tissues like nerves, ligaments and tendons.

The following are the more serious types of repetitive stress injuries.

Thoracic Outlet Syndrome 

thoracic outlet

Thoracic outlet syndrome [TOS] is a term used to describe symptoms of pain and discomfort in the neck, shoulders and arms which can be associated with numbness especially in the fingers. The symptoms are cause by entrapment or impingement of the nerve bundle and/or blood vessels [artery or vein] as they pass through the scalene muscles in the neck, the first rib, or the clavicle [collar bone]. For a more detailed description check out my previous blog on this topic.

Lateral Epicondylitis [Tennis elbow]

tennis elbow

Pain in the common origin wrist extensor muscles along the lateral epicondyle and radiohumeral joint on gripping activities. Activities requiring repeated wrist extension such as the backhand stroke in tennis [thus, the term “tennis elbow”], computer keyboarding, pulling weeds in the garden can stress the musculotendinous [muscle and tendon] unit and cause pain.

Carpal Tunnel Syndrome

carpal tunnel

Carpal Tunnel Syndrome is an irritation of the median nerve as it passes through the carpal tunnel. The carpal tunnel is the tight space located in the wrist formed by fibrous bands and the carpal [wrist] bones. Any condition that causes swelling or change in position of the tissues within the carpal tunnel can cause irritation of the median nerve which results in tingling and numbness in the thumb, index and middle fingers which receive innervation from the median nerve.


The best way to manage RSI is through prevention. Avoid prolonged used of your joints by talking micro breaks every 30 minutes during working hours. Take some time to loosen your neck, shoulders, elbows, wrists, and fingers by moving and stretching them. A physical therapist can teach you the right mobility and reset drills that you can do few times throughout the day while at work.

In cases where you feel any recurring pain, numbness, tingling sensation, and limited joint range of motion in the neck, shoulder, and arms, conservative physical therapy is also the ideal first line of treatment.

Remember for aching and bothersome body pains, physical therapy is your initial option. This is cost effective as many medications, injections and imaging are unnecessary.

Get PT 1st.