Repetitive Strain Injury

Overview

Repetitive strain injury (RSI) — also referred to as overuse injury — encompasses a range of conditions caused by cumulative micro-damage to muscles, tendons and surrounding tissues from repeated movement patterns or sustained postures. Unlike acute injuries, RSI develops gradually and may initially present only as mild discomfort that worsens over time if not addressed.

Common examples in sport include tennis elbow (lateral epicondylitis), golfer's elbow (medial epicondylitis), Achilles tendinopathy, patellar tendinopathy, rotator cuff tendinopathy and shin splints. Early recognition and management are essential to prevent progression to chronic or debilitating injury.

Common Causes

• Repetitive movements involving the same muscle groups over extended periods
• Sudden increases in training volume, intensity or frequency
• Poor technique placing abnormal load on specific structures
• Inadequate rest and recovery between training sessions
• Muscle imbalances or biomechanical abnormalities
• Training on hard surfaces without adequate footwear or shock absorption
• Grip-intensive racquet sports, rowing, cycling and throwing activities
• Returning to training too quickly after a period of rest

Signs and Symptoms

• Gradual onset pain at a specific site, initially only during or after activity
• Stiffness, aching or burning sensation in the affected area
• Pain that worsens with continued activity and is relieved by rest
• Tenderness on palpation of the affected tendon or muscle
• Swelling or thickening of a tendon
• Reduced performance or altered movement patterns to avoid pain
• In later stages, pain may be present at rest or during normal daily activities

Immediate Actions

• Reduce or modify the training activity causing symptoms
• Apply cooling to the affected area following exercise to reduce local inflammation
• Avoid complete rest — relative rest and load management is more effective than stopping entirely
• Address technique or equipment issues that may be contributing
• Seek physiotherapy assessment to guide a structured rehabilitation programme
• Avoid returning to full training until symptoms have resolved and loading has been progressively re-introduced

When to Seek Medical Attention

Prevention Advice

• Increase training loads gradually — no more than a 10% increase in volume or intensity per week
• Incorporate adequate rest days and recovery time into training schedules
• Address biomechanical issues early with professional physiotherapy or podiatric assessment
• Vary training activities to avoid constant repetitive loading on specific structures
• Strengthen supporting muscle groups to reduce load on vulnerable tendons
• Use appropriate equipment, including well-fitting footwear and ergonomic grips
• Include warm-up and cool-down routines in every training session

Event Environment Considerations

• Athletes with known RSI conditions should declare them to the event medical team
• Pitchside clinicians may apply taping or bracing to support affected structures during competition
• Anti-inflammatory analgesia may be appropriate for short-term symptom management but should not mask pain that indicates a need to stop
• Athletes pushing through significant tendon pain during events risk progression to a partial or complete rupture
• Post-event assessment and documentation should be provided for athletes with significant RSI symptoms