Massage Therapy and Repetitive Strain Injuries

Sometimes I get asked what looks like a strange question. Do I treat repetitive strain injuries ? - (RSI ’s)  Then I realise that among the general public there are many misconceptions out there about the very nature of massage therapy.

Yes, massage is relaxing and consists of general ‘Swedish’ techniques such as effleurage and petrissage. However, these are usually just the opening moves within the repertoire of the skill-set used by a well trained massage therapist to treat more serious physical complaints.  So, yes I do treat repetitive strain injuries. Think of massage as a first resort before it becomes a problem restricting your quality of life.

What is a repetitive strain injury? It’s an injury to a part of the body caused by overuse or possibly a repeated action. The word ‘strain’ suggests that the injury is to the tendon - that thick cord of tissue that attaches bone to muscle. Conditions that are RSI’s include tendinosis, tendinitis, carpal tunnel syndrome, golfer’s elbow, tennis elbow, thoracic outlet syndrome and focal dystonia. These are just a few of the names.

Overuse is not the only cause of RSI’s. It can also be caused by an abnormality in the structure of joints of the body, a reaction to a medication, or the result of an infection. These latter causes can make one more susceptible to an RSI but the condition is still treated in a similar fashion.

The most usual RSI injuries that I treat are repetitive actions that are work, sports or recreational activity related. So I see many people whose job involves computer work, lots of typing, or using a mouse. That includes especially the use of laptops, a tablet or ‘smart’ phone. I sometimes wonder whether the name smartphone is a misnomer. Invariably poor posture is involved in any sort of RSI. I also see the sports enthusiast where continual action has resulted in pain in arms legs, shoulder or other areas of the body. The ‘weekend warrior’ is particularly susceptible to RSI's because their body is not always conditioned to the rigours of overexertion and exercise. Then I see a lot of musicians for treatment of repetitive strain injuries. 

Repetitive Strain injuries can include Tendonitis and Carpal Tunnel Syndrome

You might assume that a top musician would have learned techniques to avoid such injuries. Not necessarily so. The difference between someone experiencing or not experiencing pain can be a fraction of a millimetre in posture. Professionals of top rate caliber, even those on the international concert circuit, might have practiced eight or more hours a day and learned ergonomically untenable positions that have become ingrained - therefore difficult to unlearn.  Other more lucky musicians seem to experience no symptoms of repetitive strain injury. 

In my own case, even as an abject amateur on the piano limiting my practice time to 30 minutes, I would experience wrist pain that would exclude me from being the next Glenn Gould or Jan Lisiecki.  Well, perhaps that’s not the only reason.

Symptoms of RSI’s can include pain at the site of the tendon and the surrounding area - with or without swelling and a feeling of heat. With a tendonitis in the forearm, for example, there could be tingling in the fingers.  There might be a pain when moving or where the joint doesn’t move with any fluidity. The tendon itself might feel like over-tense piano wire or highly strung guitar string. 

Usually one does not wake up with an RSI but there is a gradual build-up of symptoms. There is a condition where there is a loss of motion called frozen shoulder or ‘adhesive capsulitis’ which can appear to start from no known cause but which is probably caused by repetitive motion.

If one can come up with ways to avoid tendonitis and other RSI’s, it would be to take it slow at first and build up to that activity gradually. Limit the amount of force you use and reduce the number of repetitions. Stop if pain occurs and do something else for an hour. If you go back to the activity and the pain reoccurs, give it a break for the rest of the day. In other words, and I use this as a guiding principle for life, moderation in all things. 

Golfer’s Elbow (Medial Epicondylitis) is not the only possible RSI suffered by golfers. Back, neck, wrists, knees and shoulders can be affected

Some recommendations on how to treat repetitive strain injuries are to rest the injured area and avoid activities that aggravate the problem. That’s not always practical advice especially if one’s job depends on the action. Perhaps modify how you do an action. Sitting on the couch while using a tablet or laptop may not be the best. Put an ice pack on the injured area, especially if it feels that there is a heat or inflammation present.  

Take over-the-counter anti-inflammatory drugs or topical anti-inflammatory gels if you have to. Try not to make this part of your regular pattern of treatment because this is doing nothing to solve the underlying cause of pain. More advanced treatments might be to receive a corticosteroid injection from your doctor to decrease inflammation and reduce pain, but be careful of these because they can compromise the immune system. Surgery is also a possibility for a severe case that is not responding to more moderate treatments.

However, before looking at medications and surgery, consider some massage therapy at the first symptom before it becomes a more serious problem. My object of treatment will be to increase your range of motion without pain. Anyway, massage is an important therapy to help ease you gently into any activity and, as such, should be part of your self-care for staying in tip-top physical condition.