Repetitive Stress Syndrome

Repetitive stress syndrome * occurs when doing something over and over again causes pain, muscle strain, inflammation, and possible tissue damage. Repetitive motion problems, also called repetitive stress injuries, are the most common form of occupational (workplace) illness.


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Cumulative trauma disorder



Musculoskeletal disorders

Occupational health

Overuse Injuries

Repetitive motion syndromes

Repetitive strain Injuries

Tennis Star

As a member of the high school tennis team, John served with accuracy and overwhelmed his opponents with his backhand. He worked harder and practiced more than any other team member. Major college scouts were looking him over. During a major tournament, however, John felt pain and swelling where the tendons join the bones at the elbow. His repeated practice of straightening elbow and extending wrist—especially with his mean back swing—had caused small tears in the tendon and muscle. The doctor diagnosed epicondylitis (ep-i-kon-di-LY-tis), a classic case of "tennis elbow."

What Is Repetitive Stress Injury (RSI)?

Tennis elbow, runner's knee, and writer's cramp are common names for repetitive stress injuries (RSIs), which result from repeated movements that stress the tendons, ligaments, joint capsules, fascia (FASH-ee-a), and other soft tissues that surround or attach to muscles and bones. Repetitive stress injuries can cause inflammation * of the neck, shoulders, arms, wrists, hips, legs, and ankles.

* syndrome means a group or pattern of symptoms and/or signs that occur together.

* inflammation (in-fla-MAY-shun) is the body's reaction to irritation, infection, or injury that often involves swelling, pain, redness, and warmth.

Leon Fleisher: Left-Handed Concerts

In 1964, at age 36, Leon Fleisher was one of the world's great pianists. When he noticed a weakness in the little finger of his right hand, he practiced harder to overcome it. During the following 10 months, however, the other fingers in his right hand curled under until he was unable to play piano at all.

At that time, not much was known about how repetitive movements caused carpal tunnel syndrome and other overuse injuries. Fleisher tried many different medications and therapies, but finally had to switch his performance repertoire to concertos written for the left hand alone.

In 1995, Fleisher began physical therapy and deep tissue massage, which taught him how to "de-contract" the overused muscles in his right hand. In 1996, he was able to resume playing concerts with both hands.

Carpal tunnel syndrome affects people who overuse their hands on piano or computer keyboards.
Carpal tunnel syndrome affects people who overuse their hands on piano or computer keyboards.

People at highest risk include office workers using computer key-boards, factory workers using sewing machines or working on assembly lines, tennis players working with tennis rackets, football players, and dancers who damage ankles and hips. Common RSIs include:

  • Carpal tunnel syndrome, which affects the hands and wrists.
  • Tendinitis, which affects the connective tissue that attaches muscles to bones, for example, Achilles tendinitis or shoulder (rotator cuff) tendinitis.
  • Bursitis, which affects the fluid-filled sacs between muscles and bones that cushion the joints.
  • Fasciitis, which affects the connective tissue that surrounds the muscles.
  • Shin splints, which affect the front of the lower leg.

Although most RSIs occur in adults, young people who spend too much time on computer keyboards, playing sports, or practicing on musical instruments also are at risk.

What Happens When People Have Repetitive Stress Syndrome?


Warning signs of repetitive stress injuries include:

  • Electricity-like tingling in hands or fingertips
  • Soreness or weakness in hands and arms
  • Aching neck or shoulders
  • Frequent headaches
  • Pain that wakes the person up at night
  • Pain that lasts more than 24 hours.


The doctor's physical examination and medical history usually will reveal the repetitive motion that has stressed the soft tissue and caused the injury. The doctor may recommend x-rays or blood tests to rule out other causes.

Office workers who overuse computer keyboards are at risk for repetitive strain injury. © 1994 T Buck/Custom Medical Stock Photo.
Office workers who overuse computer keyboards are at risk for repetitive strain injury.
© 1994 T Buck/Custom Medical Stock Photo.


Treatment begins with rest. Temporarily, the person must give up the activity that caused the problem, or must adjust the repeated motions that caused the injury. Retraining and physical therapy may be required before the person can resume the activity. The doctor also may recommend putting a wrist or elbow in a splint to keep it from repeated bending. Other treatments include medication to relieve pain and inflammation, massage, or surgery in cases of severe injury.


Prevention always works better than treatment. Proper warm-ups and cool-downs, frequent rests, and improved ergonomic rules for the workplace are important preventive measures. Ergonomics is the science of adapting tools and equipment to the human body—for example, chairs and desks that can be adjusted to fit the body of the user may help to prevent repetitive strain injuries. The U.S. National Institute of Occupational Safety and Health (NIOSH) is creating new standards for workplace safety to reduce the number of cases of repetitive stress syndrome.



Peddie, Sandra. The Repetitive Strain Injury Guidebook. Los Angeles: Lowell House, 1997.


U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road N.E., Atlanta, GA 30333. CDC posts an Occupational Health fact sheet at its website and provides a link to NIOSH.

U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Building 31, Room 4C05, Bethesda, MD 20892-2350.
NIAMS posts information about shoulder problems at its website.
Telephone 301-496-8188

U.S. National Institute of Neurological Disorders and Stroke (NINDS) posts information about repetitive motion syndromes and carpal tunnel syndrome at its website.

American Academy of Orthopaedic Surgeons (AAOS), 6300 North River Road, Rosemont, IL 60018-4262. AAOS posts patient education fact sheets about shoulder pain and carpal tunnel syndrome at its website.
Telephone 800-346-AAOS

Arthritis Foundation, 1330 West Peachtree Street, Atlanta, GA 30309.
The Arthritis Foundation publishes brochures and posts fact sheets about many different kinds of soft tissue rheumatism at its website.
Telephone 800-283-7800

American College of Rheumatology, 60 Executive Park South, Suite 150, Atlanta, GA 30329. ACR posts a fact sheet about tendinitis/bursitis at its website.
Telephone 404-633-3777

American Physical Therapy Association (APTA), 1111 North Fairfax Street, Alexandria, VA 22314-1488.
Telephone 703-684-2782

Association for Repetitive Motion Syndromes (ARMS), PO. Box 471973, Aurora, CO 80047-1973.
Telephone 303-369-0803

See also
Carpal Tunnel Syndrome
Strains and Sprains

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