- by Dr. Robert C. Martin

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Repetitive strain injuries (RSIs) account for about 50 to 60% of sports-related injuries and a comparable 56% of work related injuries. RSIs have been shown to limit physical performance, decrease productivity in the workplace, and substantially impact health care expenditure. Societal costs for work-related injuries exceeded $1 trillion in 1996 alone. The physical and economic costs of RSIs will likely grow given that the incidence of RSIs continues to increase at an alarming rate.

Repetitive movements put tendons and ligaments as well as nervous and muscle tissue at risk for injury. Women account for a large number of RSIs, in part due to their increased participation in sports and the workforce. From 1975 to 1996, the proportion of American women working outside the home tripled, from about 24% to 77%. During a similar period, 1972 to 1998, female participation in high school sports increased from about 4% to 33%.

Many of the RSIs women develop at work are related to the work environment. A 1997 population survey conducted by the US Bureau of Labor Statistics revealed that about 83% of administrative support workers and 82% of communication equipment operators are women; both types of jobs involve repetition of tasks and are associated with musculoskeletal injury. Although the ergonomic design of work environments is more common that it once was, many current workstations are not adjustable and therefore require workers to perform repetitive movements using poor mechanics and awkward postures – and, in the process, increase the likelihood of injury.

Inherited risk factors also predispose women to RSIs. In fact many experts now believe that whether or not an RSI develops is predicted as much by biology or your genetic disposition as by the magnitude of repetitive action.

In the workplace, RSIs are prevalent in the upper extremities including the wrists, elbows, and shoulders. One of the most common work-related injuries is carpal tunnel syndrome (CTS). According to estimates it affects 11% of women but only 3.5% of men. Proposed risk factors for CTS include sex, pregnancy, menopause, oral contraceptive use, hysterectomy, repetitive movement, gripping, vibration, obesity and physical inactivity.

Sports-related RSIs also arise as a result of repeated submaximal stresses on the body; however these injuries most often affect the lower extremities. Overuse of the Achilles tendon, patellar tendon, and iliotibial band – a fascial band on the outside of the thigh – account for a large number of sports-related RSIs. Injuries of the elbow and shoulder have been noted in swimmers, golfers, and tennis players.

Treatment of RSIs should begin as early a possible since persistent duration of symptoms results in poor long-term outcome. Due to the recurring nature of RSIs, both the injury itself and the underlying cause must be addressed.

A successful treatment program encompasses three steps. During the initial inflammatory stage rest, ice therapy, NSAIDs – ibuprofen or Naprosyn – and cortisone can be used along with splinting or bracing. As inflammation subsides, tissue repair and restoration of function becomes the focus with flexibility and strengthening programs. Finally long-term equipment and activity modification as well as ergonomic changes must be considered to eliminate the potential for reinjury. For athletes, updated and properly fitting equipment is essential, and alterations in training patterns may be necessary.