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RSI-UK FAQ: Old Version

Note: For the current version of the RSI-UK FAQ, see http://www.rsi-uk.org.uk/

This is the FAQ for the RSI-UK mailing list. The initial version of the FAQ was written mostly by Douglas Hall in May 1999. Since then there have been a few additions and amendments, but at present (12/06/2000) the FAQ is not being maintained or regularly posted or updated. However, most of the information in it should still be valid.

As most people who will be reading this FAQ will have got RSI through keyboard use, the information and advice is angled towards this set of sufferers. However most of the information/advice will apply to people with RSI from other causes.

Advice given on the internet is no substitute for expert medical advice. Always consult your GP.


Subject: Table of Contents

1. Changes since last posting, marked #
2. What is RSI?
3. What are the symptoms of RSI?
4. What causes RSI?
5. What are Adverse Neural Dynamics?
6. What are trigger points?
7. How can I prevent my RSI getting worse?
8. What treatment can I get for RSI?
9. Is it psychological?
10. What support is available in the UK?
11. What is RSI-UK?
12. Where can I find information about RSI on the Web?
13. Are there any good books on RSI?
14. Further Information


Subject: 1. Changes since last posting

None.

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Subject: 2. What is RSI?

RSI is an umbrella term for a collection of conditions affecting the neck, shoulders, arms, wrists and hands. It can also affect the legs and feet. If you use your hands and arms a lot, e.g. keyboard use, you get it the in upper limbs; if you use your legs and feet, e.g. sewing machinist, you get it in the lower limbs.

RSI is also called by various other names, including:

There are two forms of RSI:

  1. 'Distinct' RSI

    This includes: Carpal Tunnel Syndrome (CTS), Tennis Elbow (Epicondylitis), Tenosynovitis, Tendinitis, Bursitis, Thoracic outlet syndrome, Cubital tunnel syndrome etc. Health care professionals who deal with RSI tend not to call these conditions RSI but by their separate names.

  2. 'Diffuse' RSI

    This is where you get multiple areas of diffuse pain in the muscles and other soft tissues. It is due to nerve compression (AND), trigger points etc. When health care professionals who deal with RSI talk about RSI this is what they are referring to.

You can have both of these types of RSI at the same time and multiple occurrences at the same time.

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Subject: 3. What are the symptoms of RSI?

RSI is a progressive condition, it starts with mild pain or tiredness of the hands, arms etc. during the working day, getting better overnight. Progressing to the pain and tiredness persisting overnight, but getting better after a few days break, to finally persistent pain which does not go away even after complete rest.

The earlier treatment is commenced, the better your chance of complete recovery. In the later stages, complete recovery is not always possible although symptoms can be reduced with treatment.

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Subject: 4. What Causes RSI?

There are several factors that predispose people to developing RSI:

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Subject: 5. What are Adverse Neural Dynamics?

Adverse Neural Dynamics (AND), sometimes called Adverse Neural Tension (ANT) or Adverse Mechanical Tension, probably occurs to some extent in all cases of RSI.

This is where the nerve (in the arm, shoulder etc.) becomes tethered. This means the nerve cannot slide in its protective sheath and so causes pain, tingling, misfiring of the muscles and spasm. The nerve can become tethered due to a pressure point on the nerve or damage to the sheath it runs in.

The original cause of the tether could be due to muscles being tight and scrunched up. This is often the case with RSI and happens because of the static posture you sit in at a keyboard. As the muscles are tight it restricts the blood supply to the them and results in them getting fatigued. Eventually the muscles stay in this fatigued state as the never get to relax and have the blood supply restored. Surrounding muscles become tight to support the fatigued muscles and the problem spreads.

Tight muscles also press on the nerves as they pass through/around the muscle group, causing a tether. It also results in restriction of the blood supply to the nerves which prevents them from functioning properly and can eventually cause the nerves to send pain signals to the brain.

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Subject: 6. What are trigger points?

There is a condition called myofascial pain which is caused by trigger points. Trigger points are small areas in a muscle which when pressed cause pain in other parts of the body. When they are active the referred pain is there all the time and gets worse when the trigger point is pressed. Trigger points can cause shortening of the muscle they are found in. They are often overlooked in the diagnosis of many pain conditions and are mis-diagnosed as other pain conditions.

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Subject: 7. How can I prevent my RSI getting worse?

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Subject: 8. What treatment can I get for RSI?

When you go to see a doctor or other healthcare professional write down the symptoms you have, consider the following questions:

Diagnosis of RSI is diagnosis by elimination. Everything else is tested for and if your doctor cannot find anything wrong then you probably have RSI. Your doctor will have to rule out things like rheumatoid arthritis and heart problems so don't be surprised if they get you to have a lot of blood tests.

There is no 'Cook Book' approach to treating RSI as each person has different problems caused in a unique way. However the person treating you should look for problems with your neck and shoulders as well as with your arms and hands.

When you are referred to a specialist or see a therapist always ask: "How much experience do they have in treating RSI?"; "How good are they at treating RSI?"; "How does this treatment work?"

Always check for the relevant qualification when seeing any therapist outside the NHS. Also ask to see a current insurance certificate, this is a good check to see if they are qualified.

What I found good for treating my AND and associated RSI problems was:

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Subject: 9. Is it psychological?

Q9.1.
My doctor says it is all in my head. What do I do?

If it is your GP then:
If you are in a group practice try seeing one of the other doctors in the practice. Doctors' sympathy/interest varies greatly within a practice. If you have no luck, then transfer to another practice in your area. You are entitled to do this. Before you join, interview the doctors at the new practice to find out their attitude to RSI.

If it is the consultant:
You are entitled to a second opinion, so ask for one, but not from one of your consultant's best mates!

Q9.2.
I feel that my doctor thinks it's all in my head — or else that I'm just inventing it — even though he doesn't actually say so.
I get the same feeling from my boss and from my work colleagues and even from some of my friends/family. Am I going crazy?

No.
If you get the feeling that people are sceptical, they probably are. This is upsetting and hurtful, but think twice before exploding -- it might just be seen as proof that you've lost the plot. Concentrate instead on showing that you're determined to get better and get back to work.

Keep pressing the doctor about treatment possibilities, ask informed questions, and try to describe the pain as accurately as you can, erring on the side of understatement rather than overstatement. Get the PACT team in to talk to your employers about how you can be helped to return to work -- the PACT team will assume you are telling the truth, and that may help convince your employer. In the meantime, try not to take the scepticism personally, and remember that if the positions were reversed, you too might be feeling some doubt. Everyone who suffers from an "invisible" ailment has to cope with this to some extent.

Q9.3.
I can't sleep, I can't eat, I don't feel like seeing anyone or doing anything. Even when the pain goes away, I don't feel any better. Am I going crazy?

You may be suffering from depression. RSI can bring a lot of problems with it: physical pain; short-term and long-term financial anxieties; anger about being treated unfairly by employers and healthcare professionals and colleagues; loss of independence; isolation; loneliness; and fear. This is a lot to deal with all at one time, and the strain can lead to depression.

If you have any of the symptoms of clinical depression, it's essential to talk about it with your GP. It will be much harder for you to recover from RSI as long as you're depressed. Anti-depressants can help, though you may have to experiment (under medical supervision) to find the right one. Support groups (whether for RSI or for depression) can also help.

It may be suggested to you, by your GP or by others, that the RSI is caused by the depression. While this is not impossible, it's important to remember that for most people it's the other way around: the depression comes about as a response to the many practical, financial, and social difficulties that can follow in the wake of a diagnosis of RSI. If your doctor wants to treat the depression but not the RSI, you may have to find another doctor; both problems have to be treated together.

Even if you're not clinically depressed, remember that it's perfectly normal to feel scared or lonely or angry when you're trying to recover from RSI. You're not the only one who feels this way; as you learn to cope with the physical problems, the emotional turmoil will calm down.

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Subject: 10. What support is available in the UK?

Q10.1.
What benefits are available in the UK?

As a disabled person you may be entitled to several benefits:

Q10.2.
What other support is available in the UK?

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Subject: 11. What is RSI-UK

RSI-UK is a mailing list for the discussion of RSI from a UK perspective. The list is primarily intended for use by people living in the UK who either have RSI problems themselves, or are caring for someone with RSI, or are concerned that they may be developing RSI.

Q11.1.
What topics are discussed on RSI-UK?

Treatment; pain relief; social security benefits; legal aspects; coping techniques; adaptive equipment (such as ergonomic keyboards, pointing devices, voice recognition packages, break-reminder software, and workstation furniture); pacing techniques; and other RSI-related subjects. The list is non-commercial, and advertising is not allowed.

Q11.2.
Who subscribes to RSI-UK?

Mostly, people who suffer from RSI. Others with an interest in the subject, such as healthcare professionals, ergonomists, safety officers, lawyers, etc., are also welcome to subscribe; however, the primary focus of the list is the exchange of practical information and sharing of support between people who suffer from RSI.

Most RSI-UK subscribers have RSI as a result of keyboard use, but the list is for everyone who suffers from RSI, from whatever cause.

Q11.3.
How do I join RSI-UK?

To join, send an empty email to rsi-uk-join@rsi-uk.org.uk.

You should soon receive a confirmation request. If you reply confirming that you do wish to join the list, your address will then be added to the list of members; you will begin to receive the messages that other subscribers post to the list, and will be able to post to the list yourself.

A few tips about posting:

The RSI-UK mailing list is kindly hosted by Loud-n-Clear Ltd.

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Subject: 12. Where can I find information about RSI on the Web?

Both RSI-UK and the TIFAQ include links to many other RSI-related websites. Bear in mind, though, that much of the information will be duplicated from site to site, and clicking can be painful. A targeted search (e.g., for information about trigger points) is likely to be more productive than random surfing.

There is no site which has the definitive answer to RSI.

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Subject: 13. Are there any good books on RSI?

Get the following books through your local lending library or from one of the internet bookshops (the latter often sell the books at a discount).

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Subject: 14. Further Information

For more information on any of the subjects covered by this FAQ look in the RSI-UK Website (http://www.rsi-uk.org.uk), post a question to the RSI-UK mailing list or check out the RSI-UK mailing list archive (http://www.rsi-uk.org.uk/archive/).

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Last updated: 28 December 2002