Repetitive strain injuries (RSI)

Frequently in massage practice, we see clients who have repetitive strain injuries caused by overuse. Tennis elbow is a typical one but others include golfer’s elbow, biceps tendonitis, superspinatus tendonitis, Achilles tendinopathy, patellar tendonitis and ITB syndrome. These injuries all involve the tendon, which comprises collagen fibres that effectively anchor the muscle to the bone. Clients with these type of tendonopathies experience a burning sensation, sometimes with even light use of the affected joint, lack of strength and limited range of movement. Although these injuries can respond well to treatment especially if treated during the acute stage, frustratingly it can take many months for it to heal once the condition has become chronic (Rattray and Ludwig, 2000). However, for many clients conservative treatment is effective; very few have to resort to steroid injections or surgery.

But what actually is going on?

There have been many investigations to examine tendons that have overuse injuries. What has been identified is that in the vast majority of cases where people referred to tendonitis (‘-itis’ indicates inflammation), surgery and/or pathology of the affected area has only rarely shown signs of inflammation. Indeed the vast majority of the affected tendons exhibit tendinosis (Bass, 2012).

Studies have shown that the collagen fibres in tendinosis injuries are immature, comprise the wrong collagen mix (there are different types of collagen), with increased vascular networks that are of poor quality and have a dull, greyish surface (Heber, 2012). It is thought that the immaturity of the collagen fibres as the muscle is consistently activated is one reason why tendinosis injuries are chronic conditions.

In tendonitis, the collagen fibre mix is ‘normal’ for a tendon, the fibres are aligned neatly, there is a good vascular network and the surface appears shiny and white but there are inflammatory cells are also present . Tendonitis is more commonly associated with a particular activity that has caused the pain and reaction experienced: excessive strain caused by throwing a ball, running, jumping, etc. It can result in microscopic or partial tears of the muscle and in some cases a complete tear of the muscle that requires surgery.

How to treat tendinitis and tendinosis injuries

Bass (2012) suggests that for tendinosis

Rest
Adjusting ergonomics and biomechanics
Use of appropriate support
Apply ice
Stretch and move area conservatively
Eccentric strengthening
Massage
Nutrition

Are all aspects that should be addressed as part of the rehabilitation of the tendon. In fact for tendinitis many of the factors listed above are also relevant, however, the use of anti-inflammatories, ultrasound, physiotherapy, steroid injections or in severe cases surgery may also be required.

Research by Khan (cited in Heber) indicates that for tendinitis injuries when presented at the acute stage recovery time is ‘days to 2 weeks’ yet in the chronic stage is usually ‘4-6 weeks’. Compare this to tendinosis injuries where acute recovery is ‘6-10 weeks’ and for chronic presentation it is 6 to 10 months.

For many tendinopathies, ice and completely resting the affected area for a few days can be the most effective self-care treatment available. Massage, eccentric strengthening of muscles and movement of muscle within pain free range can help with enabling the correct balance and alignment of collagen fibres to develop. Finally, look at the factors that may have contributed to the injury in the first place and see if there are any adjustments (postural, support or techniques) that can be altered to prevent the injury happening again.