Repetitive strain injury
Encyclopedia
Repetitive strain injury (RSI) (also known as repetitive stress injury, repetitive motion injuries, repetitive motion disorder (RMD), cumulative trauma disorder (CT), occupational overuse syndrome, overuse syndrome, regional musculoskeletal disorder) is an injury of the musculoskeletal and nervous system
s that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces), or sustained or awkward positions. Different sections of this article present contrasting perspectives regarding the causes of RSI.
Types of RSIs that affect computer users may include non-specific arm pain or work related upper limb disorder (WRULD). Conditions such as RSI tend to be associated with both physical and psychosocial
stressors.
Other typical habits that some sources believe lead to RSI:
In contrast to carpal tunnel syndrome
, the symptoms tend to be diffuse and non-anatomical, crossing the distribution of nerves, tendons, etc. They tend not to be characteristic of any discrete pathological conditions.
, cubital tunnel syndrome, thoracic outlet syndrome
, DeQuervain's syndrome
, stenosing tenosynovitis
/trigger finger/thumb
, intersection syndrome
, golfer's elbow
(medial epicondylosis), tennis elbow
(lateral epicondylosis), and focal dystonia
.
Finally RSI is also used as an alternative or an umbrella term for other non-specific illnesses or general terms defined in part by unverifiable pathology such as reflex sympathetic dystrophy syndrome (RSDS), Blackberry thumb
, disputed thoracic outlet syndrome
, radial tunnel syndrome
, "gamer's thumb" (a slight swelling of the thumb caused by excessive use of a gamepad
), "Rubik's wrist" or "cuber's thumb" (tendinitis, carpal tunnel syndrome, or other ailments associated with repetitive use of a Rubik's Cube
for speedcubing
), "stylus finger" (swelling of the hand caused by repetitive use of mobile devices and mobile device testing.), "raver's wrist", caused by repeated rotation of the hands for many hours (for example while holding glow sticks during a rave
).
Although tendinitis and tenosynovitis
are discrete pathophysiological processes, one must be careful because they are also terms that doctors often use to refer to non-specific or medically unexplained pain, which they theorize may be caused by the aforementioned processes.
Doctors have also begun making a distinction between tendinitis and tendinosis
in RSI injuries. There are significant differences in treatment between the two, for instance in the use of anti-inflammatory medicines, but they often present similar symptoms at first glance and so can easily be confused.
The most often prescribed treatments for repetitive strain injuries are rest, exercise, braces and massage. A variety of medical products also are available to augment these therapies. Since the computer workstation is frequently blamed for RSIs, particularly of the hand and wrist, ergonomic adjustments of the workstation are often recommended.
) are often recommended.
software, and break timers.
Break timers software reminds the user to pause frequently and perform exercises while working behind a computer.
There is also automated mouse-clicking software that has been developed, which can automate repetitive tasks in games and applications.
or pointing stick
, which requires no gripping or tensing of the muscles in the arms may help as well. Inertial mice (which do not require a surface to operate) might offer an alternative where the user's arm is in a less stressful thumbs up position rather than rotated to thumb inward when holding a normal mouse. Also, since they do not need a surface to operate ("air mice" function by small, forceless, wrist rotations), the wrist and arm can be supported by the desktop.
, OrbiTouch, Maltron
and Kinesis
are available. Also one can use digital pen
s to avoid the strain coming from typing itself. Other solutions move the mode of input from one's hands entirely. These include the use of voice recognition software or pedal
s designed for ergonomics and gaming to supplant normal keyboard input.
are also valuable to RSI sufferers, since overall strain is much reduced by the keyless nature of the device and the minimal finger movement involved, as well as the much greater variety of body postures while using the device and the replacement of the mouse by a touch screen. Although not a complete solution, it can be a good way to do day-to-day personal computing tasks.
Pain medications, particularly non-steroidal anti-inflammatory drug
s (NSAIDs), are most often used to eliminate pain. The major problem with such drug use with RSIs is that the pain can be masked, and therefore the patient returns to the activities which strained the tissues in the first place before the tissues have had time to heal. So a balance must be struck where pain is reduced, yet not so much that the tissues will be reinjured with continued over-use.
Medical devices are available which help the strained tissues to heal faster. Several types of devices are available, and are classified as either passive or active devices. Passive devices generally immobilize the limb allowing the body to heal itself, while active devices enhance the body's healing capacity.
Braces, particularly wrist braces, are by far the most often used products for RSIs. They stabilize the hand and allow healing to occur without further stressing the joint. Braces are available in two basic varieties; soft (i.e., nylon fabric) and hard shell.
They claim greater success from teaching patients psychological strategies for accepting the pain as an ongoing fact of life, enabling them to cautiously resume many day-to-day activities and focus on aspects of life other than RSI.
For example, the association of Carpal tunnel syndrome
with arm use is commonly assumed but not well-established. Typing has long been thought to be the cause of carpal tunnel syndrome, but recent evidence suggests that, if anything, typing may be protective. Another study claimed that the primary risk factors for Carpal tunnel syndrome were "being a woman of menopausal age, obesity or lack of fitness, diabetes or having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the thumb, smoking, and lifetime alcohol intake."
, Professor of Rehabilitation Medicine at the New York University Medical School considers that RSI, back pain, and other pain syndromes, although they sometimes have a physical cause, are more often a manifestation of tension myositis syndrome
, a psychogenic disorder in which stress causes the autonomic nervous system to reduce blood flow to muscles, causing pain and weakness.
RSI shares many characteristics with known psychosomatic disorders:
Nervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...
s that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces), or sustained or awkward positions. Different sections of this article present contrasting perspectives regarding the causes of RSI.
Types of RSIs that affect computer users may include non-specific arm pain or work related upper limb disorder (WRULD). Conditions such as RSI tend to be associated with both physical and psychosocial
Psychosocial
For a concept to be psychosocial means it relates to one's psychological development in, and interaction with, a social environment. The individual needs not be fully aware of this relationship with his or her environment. It was first commonly used by psychologist Erik Erikson in his stages of...
stressors.
Causes
RSI is believed by many to be caused due to lifestyle without ergonomic care , E.g. While working in front of computers, driving, traveling etc. Simple reasons like 'Using a blunt knife for everyday chopping of vegetables', may cause RSI.Other typical habits that some sources believe lead to RSI:
- Reading or doing tasks for extended periods of time while looking down.
- Sleeping on an inadequate bed/mattress or sitting in a bad armchair and/or in an uncomfortable position.
- Carrying heavy items.
- Holding one's phone between neck and shoulder.
- Watching TV in incorrect position e.g. Too much to the left/right.
- Sleeping with head forward, while traveling.
- Prolonged use of the hands, wrists, back, neck, etc.
- sitting in the same position for a long period of time.
Symptoms
The following complaints are typical in patients who might receive a diagnosis of RSI:- Short bursts of excruciating pain in the arm, back, shoulders, wrists, hands, or thumbs (typically diffuse – i.e. spread over many areas).
- The pain is worse with activity.
- Weakness, lack of endurance.
In contrast to carpal tunnel syndrome
Carpal tunnel syndrome
Carpal Tunnel Syndrome is an entrapment idiopathic median neuropathy, causing paresthesia, pain, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression...
, the symptoms tend to be diffuse and non-anatomical, crossing the distribution of nerves, tendons, etc. They tend not to be characteristic of any discrete pathological conditions.
Frequency
A 2008 study showed that 68% of UK workers suffered from some sort of RSI, with the most common problem areas being the back, shoulders, wrists, and hands.Physical examination and diagnostic testing
The physical examination discloses only tenderness and diminished performance on effort-based tests such as grip and pinch strength—no other objective abnormalities are present. Diagnostic tests (radiological, electrophysiological, etc.) are normal. In short, RSI is best understood as an apparently healthy arm that hurts. Whether there is currently undetectable damage remains to be established.Definition
The term "repetitive strain injury" is most commonly used to refer to patients in whom there is no discrete, objective, pathophysiology that corresponds with the pain complaints. It may also be used as an umbrella term incorporating other discrete diagnoses that have (intuitively but often without proof) been associated with activity-related arm pain such as carpal tunnel syndromeCarpal tunnel syndrome
Carpal Tunnel Syndrome is an entrapment idiopathic median neuropathy, causing paresthesia, pain, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression...
, cubital tunnel syndrome, thoracic outlet syndrome
Thoracic outlet syndrome
Thoracic outlet syndrome is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene...
, DeQuervain's syndrome
DeQuervain's syndrome
De Quervain syndrome , is a tendinosis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.-Eponym:It is named after the Swiss surgeon Fritz de Quervain who first identified it in 1895...
, stenosing tenosynovitis
Stenosing tenosynovitis
Stenosing tenosynovitis is the progressive restriction of the sheath surrounding a tendon, causing inflammation .Two common diagnoses fall into this category:* DeQuervain's Syndrome...
/trigger finger/thumb
Trigger finger
Trigger finger, trigger thumb, or trigger digit, is a common disorder of later adulthood characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain...
, intersection syndrome
Intersection syndrome
Intersection syndrome is a painful condition that affects the thumb side of the forearm when inflammation occurs at the intersection of the muscle bellies of the abductor pollicis longus and extensor pollicis brevis cross over the extensor carpi radialis longus and the extensor carpi radialis brevis...
, golfer's elbow
Golfer's elbow
Golfer's elbow, or medial epicondylitis, is an inflammatory condition of the medial epicondyle of the elbow. It is in some ways similar to tennis elbow....
(medial epicondylosis), tennis elbow
Tennis elbow
Lateral epicondylitis or lateral epicondylalgia, also known as tennis elbow, shooter's elbow and archer's elbow, is a condition where the outer part of the elbow becomes sore and tender...
(lateral epicondylosis), and focal dystonia
Focal dystonia
Focal dystonia is a neurological condition that affects a muscle or group of muscles in a part of the body and causes an involuntary muscular contraction or twisting...
.
Finally RSI is also used as an alternative or an umbrella term for other non-specific illnesses or general terms defined in part by unverifiable pathology such as reflex sympathetic dystrophy syndrome (RSDS), Blackberry thumb
BlackBerry thumb
BlackBerry thumb is a neologism that refers to a form of repetitive strain injury caused by the frequent use of the thumbs to press buttons on PDAs, smartphones, or other mobile devices...
, disputed thoracic outlet syndrome
Thoracic outlet syndrome
Thoracic outlet syndrome is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene...
, radial tunnel syndrome
Radial tunnel syndrome
Radial Tunnel Syndrome is a condition proposed to explain lateral elbow pain more distal than typical for enthesopathy of the extensor carpi radialis brevis .-Etiology:...
, "gamer's thumb" (a slight swelling of the thumb caused by excessive use of a gamepad
Gamepad
A gamepad , is a type of game controller held in two hands, where the digits are used to provide input. Gamepads generally feature a set of action buttons handled with the right thumb and a direction controller handled with the left...
), "Rubik's wrist" or "cuber's thumb" (tendinitis, carpal tunnel syndrome, or other ailments associated with repetitive use of a Rubik's Cube
Rubik's Cube
Rubik's Cube is a 3-D mechanical puzzle invented in 1974 by Hungarian sculptor and professor of architecture Ernő Rubik.Originally called the "Magic Cube", the puzzle was licensed by Rubik to be sold by Ideal Toy Corp. in 1980 and won the German Game of the Year special award for Best Puzzle that...
for speedcubing
Speedcubing
Speedcubing is the activity of solving a Rubik's Cube or related puzzle as quickly as possible...
), "stylus finger" (swelling of the hand caused by repetitive use of mobile devices and mobile device testing.), "raver's wrist", caused by repeated rotation of the hands for many hours (for example while holding glow sticks during a rave
Rave
Rave, rave dance, and rave party are parties that originated mostly from acid house parties, which featured fast-paced electronic music and light shows. At these parties people dance and socialize to dance music played by disc jockeys and occasionally live performers...
).
Although tendinitis and tenosynovitis
Tenosynovitis
Tenosynovitis is the inflammation of the fluid-filled sheath that surrounds a tendon. Symptoms of tenosynovitis include pain, swelling and difficulty moving the particular joint where the inflammation occurs. When the condition causes the finger to "stick" in a flexed position, this is called...
are discrete pathophysiological processes, one must be careful because they are also terms that doctors often use to refer to non-specific or medically unexplained pain, which they theorize may be caused by the aforementioned processes.
Doctors have also begun making a distinction between tendinitis and tendinosis
Tendinosis
Tendinosis, sometimes called chronic tendinitis, tendinosus, chronic tendinopathy or chronic tendon injury, is damage to a tendon at a cellular level . It is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells...
in RSI injuries. There are significant differences in treatment between the two, for instance in the use of anti-inflammatory medicines, but they often present similar symptoms at first glance and so can easily be confused.
Treatment
On their own, most RSIs will resolve spontaneously provided the area is first given enough rest when the RSI first begins. However, without such care, some RSIs have been known to persist for years, or have needed to be cured with surgery.The most often prescribed treatments for repetitive strain injuries are rest, exercise, braces and massage. A variety of medical products also are available to augment these therapies. Since the computer workstation is frequently blamed for RSIs, particularly of the hand and wrist, ergonomic adjustments of the workstation are often recommended.
Ergonomics
Modifications of posture and arm use (ergonomicsErgonomics
Ergonomics is the study of designing equipment and devices that fit the human body, its movements, and its cognitive abilities.The International Ergonomics Association defines ergonomics as follows:...
) are often recommended.
Adaptive software
There are several kinds of software designed to help in repetitive strain injury. Among them, there are speech recognitionSpeech recognition
Speech recognition converts spoken words to text. The term "voice recognition" is sometimes used to refer to recognition systems that must be trained to a particular speaker—as is the case for most desktop recognition software...
software, and break timers.
Break timers software reminds the user to pause frequently and perform exercises while working behind a computer.
There is also automated mouse-clicking software that has been developed, which can automate repetitive tasks in games and applications.
Adaptive hardware
Adaptive technology ranging from special keyboards, mouse replacements to pen tablet interfaces might help improve comfort.Mouse
Switching to a much more ergonomic mouse, such as a roller mouse, vertical mouse or joystick, or switching from using a mouse to a stylus pen with graphic tablet may provide relief, but in chronic RSI they may result only in moving the problem to another area. Using a graphic tablet for general pointing, clicking, and dragging (i.e. not drawing) may take some time to get used to as well. Switching to a trackpadTouchpad
A touchpad is a pointing device featuring a tactile sensor, a specialized surface that can translate the motion and position of a user's fingers to a relative position on screen. Touch pads are a common feature of laptop computers, and they are also used as a substitute for a mouse where desk...
or pointing stick
Pointing stick
The pointing stick is an isometric joystick used as a pointing device . It was invented by research scientist Ted Selker...
, which requires no gripping or tensing of the muscles in the arms may help as well. Inertial mice (which do not require a surface to operate) might offer an alternative where the user's arm is in a less stressful thumbs up position rather than rotated to thumb inward when holding a normal mouse. Also, since they do not need a surface to operate ("air mice" function by small, forceless, wrist rotations), the wrist and arm can be supported by the desktop.
Keyboards and keyboard alternatives
Exotic keyboards by manufacturers such as DatahandDatahand
The DataHand keyboard was introduced in 1995 by DataHand Systems, Inc. Before that it was produced by Industrial Innovations as early as 1992. The keyboard consists of two completely separate "keyboards", one for the left hand and one for the right, that are molded to rest your hands in. This...
, OrbiTouch, Maltron
Maltron keyboard
PCD Maltron Ltd., d.b.a. Maltron, is a manufacturer of ergonomic special-needs keyboards, founded by South African-born inventor Lilian Malt, the namesake of the company, and manufacturer Stephen Hobday...
and Kinesis
Kinesis (keyboard)
The Kinesis line of ergonomic computer keyboards is an alternative to the traditional keyboard design. Most widely known among these are the contoured Advantage line, which feature recessed keys in two bucket-like hollows which allow the fingers to reach keys with less effort as well as a central...
are available. Also one can use digital pen
Digital pen
A digital pen is an input device which captures the handwriting or brush strokes of a user, converts handwritten analog information created using "pen and paper" into digital data, enabling the data to be utilized in various applications. For example, the writing data can be digitized and uploaded...
s to avoid the strain coming from typing itself. Other solutions move the mode of input from one's hands entirely. These include the use of voice recognition software or pedal
Pedal
The word pedal comes from the Latin and relates to the foot.A pedal is a lever activated by one's foot. The term "foot pedal" is redundant, and should be avoided...
s designed for ergonomics and gaming to supplant normal keyboard input.
Tablet computers
Tablet computers such as the iPadIPad
The iPad is a line of tablet computers designed, developed and marketed by Apple Inc., primarily as a platform for audio-visual media including books, periodicals, movies, music, games, and web content. The iPad was introduced on January 27, 2010 by Apple's then-CEO Steve Jobs. Its size and...
are also valuable to RSI sufferers, since overall strain is much reduced by the keyless nature of the device and the minimal finger movement involved, as well as the much greater variety of body postures while using the device and the replacement of the mouse by a touch screen. Although not a complete solution, it can be a good way to do day-to-day personal computing tasks.
Medical products
A number of medical treatments, including non-narcotic pain medications, braces, and therapy. Although some professionals consider these to be palliative, others consider them to be effective.Pain medications, particularly non-steroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
s (NSAIDs), are most often used to eliminate pain. The major problem with such drug use with RSIs is that the pain can be masked, and therefore the patient returns to the activities which strained the tissues in the first place before the tissues have had time to heal. So a balance must be struck where pain is reduced, yet not so much that the tissues will be reinjured with continued over-use.
Medical devices are available which help the strained tissues to heal faster. Several types of devices are available, and are classified as either passive or active devices. Passive devices generally immobilize the limb allowing the body to heal itself, while active devices enhance the body's healing capacity.
Braces, particularly wrist braces, are by far the most often used products for RSIs. They stabilize the hand and allow healing to occur without further stressing the joint. Braces are available in two basic varieties; soft (i.e., nylon fabric) and hard shell.
Exercise
Exercise decreases the risk of developing RSI.- Doctors sometimes recommend that RSI sufferers engage in specific strengthening exercises, for example to improve posture.
- In light of the fact that a lifestyle that involves sitting at a computer for extended periods of time increases the probability that an individual will develop excessive kyphosisKyphosisKyphosis , also called roundback or Kelso's hunchback, is a condition of over-curvature of the thoracic vertebrae...
, theoretically the same exercises that are prescribed for thoracic outlet syndromeThoracic outlet syndromeThoracic outlet syndrome is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene...
or kyphotic postural correction would benefit an RSI sufferer. - Some sources recommend motoric exercises and ergo-aerobics to decrease chances of strain injury. Ergo-aerobics target touch typists and people who often use computer keyboard.
Resuming normal activities despite the pain
Psychologists Tobias Lundgren and Joanne Dahl have asserted that, for the most difficult chronic RSI cases, the pain itself becomes less of a problem than the disruption to the patient's life caused by- avoidance of pain-causing activities
- the amount of time spent on treatment
They claim greater success from teaching patients psychological strategies for accepting the pain as an ongoing fact of life, enabling them to cautiously resume many day-to-day activities and focus on aspects of life other than RSI.
Population studies
Studies have related RSI and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the reported pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in pain, even after short term exposure.For example, the association of Carpal tunnel syndrome
Carpal tunnel syndrome
Carpal Tunnel Syndrome is an entrapment idiopathic median neuropathy, causing paresthesia, pain, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression...
with arm use is commonly assumed but not well-established. Typing has long been thought to be the cause of carpal tunnel syndrome, but recent evidence suggests that, if anything, typing may be protective. Another study claimed that the primary risk factors for Carpal tunnel syndrome were "being a woman of menopausal age, obesity or lack of fitness, diabetes or having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the thumb, smoking, and lifetime alcohol intake."
Psychological exacerbation of symptoms
There are three common mechanisms by which a normally functioning human mind increases pain and pain-related disability.- Psychological distress (depression and anxiety) make pain seem worse. Chronic pain, regardless of its source, leads to a cycle of increasing depression and reduced physical activity. Reduced physical activity reduces pain in the short term but increases it in the long term.
- Misinterpretation or over-interpretation of pain signals. Psychologists refer to this as pain catastrophizing (the tendency to think the worst when one feels pain), and it is worsened by reliance on patient support groups and internet sites for diagnosis. Gate Control Theory, part of the most accepted medical theory of pain, states that, when we are worried about a particular body part, the brain can actually signal to the spinal cord (via outgoing neurons) that it should be more apt to interpret nerve impulses from that body part as pain and pass them on to the brain. In patients with chronic arm pain, the brain may even learn to automatically trigger pain whenever the limb is moved, as a defense mechanism to prevent further movement
- A sense that something is seriously wrong that does not lessen with normal test results and reassurance from health professionals. Psychologists call this heightened illness concern or health anxiety. (This is commonly seen in psychosomatic illnesses.) The typical RSI patient presents with a strong intuition that their pain indicates existing and ongoing tissue damage. One explanation is that they have a strong "pain alarm"—pain tends to be accepted as a sign of danger and they have difficulty modulating this intuitive uneasiness with pain.
Psychosomatic cases
Some doctors and medical researchers believe that stress is the main cause, rather than a contributing factor, of a large fraction of pain symptoms usually attributed to RSI. The most famous advocate of this point of view, Dr. John E. SarnoJohn E. Sarno
John E. Sarno is Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center. He graduated from The Columbia University College of Physicians and...
, Professor of Rehabilitation Medicine at the New York University Medical School considers that RSI, back pain, and other pain syndromes, although they sometimes have a physical cause, are more often a manifestation of tension myositis syndrome
Tension myositis syndrome
Tension myositis syndrome , also known as tension myoneural syndrome, is a name given by John E. Sarno to a condition he describes as characterized by psychosomatic musculoskeletal and nerve symptoms, most notably back pain...
, a psychogenic disorder in which stress causes the autonomic nervous system to reduce blood flow to muscles, causing pain and weakness.
RSI shares many characteristics with known psychosomatic disorders:
- Freud and other psychiatrists believe that diffuse, difficult to describe symptoms likely indicated a psychosomatic root cause for an illness, especially if they moved around the body. (Only some RSI cases fit this description.)
- Psychosomatic illnesses typically display symptoms whose origins are unverifiable but which seem consistent with the time period's understanding of physical (non-psychosomatic) disease processes. When an objective test invented which is able to prove the psychosomatic origins of a specific illness, that illness typically disappears and is replaced by new, undiagnosable sets of symptoms.
- Patients and their advocates usually reject the suggestion that their disease may be non-physical in origin. Doctors frequently avoid giving psychosomatic diagnosis, for fear of angering patients or prompting them to switch doctors. "Psychosomatic" is often misunderstood to mean "faking it" or "imaginary". Other psychosomatic diseases have been known to cause severe pain, paralysis, seizures.
External links
- Musculoskeletal disorders from the European Agency for Safety and Health at Work (EU-OSHA)
- Workrave application for prevention of RSI
- Harvard RSI Action
- Prevention and Management of Repetitive Strain Injury
- My work, my sorrow, a documentary on RSI in France today