What are RSI’s, and how do I solve them?
Esports has taken off in the past few years with Fortnite, DOTA, CS:GO, League of Legends, and other competitions awarding millions of dollars in prize money. For competitive players or Esports gamers, they build muscle memory by playing 8-16 hours a day! That’s one crazy day job. Unfortunately, one of the most common reasons for pros to stop competing is due to wrist pain, forearm, and shoulder pain.
It seems Singaporeans can’t escape gaming either. It’s on our phones, at home when we relax, even sometimes on our work computers (shh, sorry boss). I myself am an avid gamer, with my time being spent on games like CIVILIZATION VI and Slay the Spire. But when Call of Duty sessions grow long, forearm stiffness can start to settle in. Without proper rest and ergonomics, gaming can create more chronic problems, other than wrist pain. All of our gaming and general computer hours can start to translate into something very real, and very bad for our health, RSI’s.
Repetitive Strain Injury
RSI’s, or Repetitive Strain Injury, occurs when tissue (a muscle or tendon) undergoes frequent and continuous repetitive movements so much that the tissue can’t heal properly. Ever heard of Golfer’s Elbow, or Tennis Elbow? These are the well known RSI’s, caused by repetitive stress and overloading of tissue tolerance. These injuries seem to ‘make more sense’ to us because the repetitions are high, and the force and amplitude of each hit is significant.
So what about gaming? While there isn’t a large force each time the button or keyboard is hit, the repetitions and duration can be very high. The tension put through the fingers is also unique to gaming. For keyboard gamers, the slightly curled and tensed fingers reaching for the 1-2-3 keys and holding shift can add up quickly. For console players, it’s often the extended and twisted thumb that drives the wrist dysfunction. This repetition is often the cause for chronic wrist pain.
Games that require repeated clicking (League of Legends, DOTA, CS:GO or even common mobile games) are notorious for creating arm problems. Even if you are not an Esport pro, playing for hours on end, hunched in one position, can eventually create a RSI.
What Are The Most Common Gaming RSI’s?
Gamer’s Thumb: What used to be called Nintendo Thumb, WASD Wrist, and Playstation Thumb has now become many peoples aggravation. You can often have pain and swelling at the base of the thumb, difficulty grasping or pinching, and pain with making a fist or turning it. While the thumb is strong, it can be overloaded with repetitive phone scrolling and quick tapping games.
Gamer’s Wrist: Ever felt like cracking and rolling your wrist around after typing for 30 minutes. That’s a beginning sign that the stress tolerance level of your tissues is maxed out (and not in the good, gaming way). The source of the wrist pain is often further up the kinetic chain though.
Forearm Pain: Many of your forearm muscles end their attachment near the wrist, and is often the root cause of wrist problems. Stiff forearms can be very hard to get rid of, since most office workers and gamers don’t take enough breaks.
Neck and Shoulder Pain: Poor posture and slouching will project the head forwards, causing significant stress to your cervical spine and muscles. You’re probably slouching right now! Your posture gaming (and reading) will directly affect how much soreness and stiffness you’ll get in your daily life.
Do I Have a RSI?
Remember, this doesn’t happen to only gamers, but also to office and desk job workers who spend most of the day behind the computer. Even excessive hand phone holding and typing use can create RSI’s. It’s good to note the wrist position should also be close to neutral (straight) when holding a phone for a long period of time (over 10 minutes) or for typing. The keyboards that have fold out elevation pieces in the back should generally NOT be used, as this causes wrist extension and compression of the carpal tunnel.
If you’re having any of these symptoms, and they keep coming on and off (or worse, constant aggravation), with activity, then you need to get it checked out.
Carpal Tunnel Syndrome
Unhealed RSI’s of the wrist will often turn into the more serious and debilitating Carpal Tunnel Syndrome (C.T.S) after continued damage over months.
Your median nerve runs down the forearm, through your wrist and into your hand via the carpal tunnel. Carpal tunnel syndrome occurs when too much inflammation and damage occurs at the wrist that the median nerve becomes injured and impinged. This can create numbness, tingling, and weakness of the muscles in the hand, notable the middle finger to thumb.
If you’ve only been having pain in the wrist for 1 week or so, C.T.S. is thankfully unlikely.
What often occurs with carpal tunnel syndrome is called a “double crush injury”, where the origin of the median nerve (in your neck) is damaged from poor posture, old injuries, or Subluxation in your spine. If you have nerves compressed at the neck, AND at the wrist, that is more likely to create C.T.S
RSI Stretches and Bracing
Many physios and even medical doctors recommend stretching and bracing for these problems. While this may help very mild cases, they are often ineffective as they won’t treat the root cause of the problem.
As these muscles, tendons, and fascia continue to get strained, they start laying down scar tissue and adhesions, which is thick fibrotic tissue. This makes the tissue harder, stiffer, and unfortunately less flexible and functional.
The body's short term answer for all this tension is to make those tendons tighter and stiffer to deal with the loads. Because of this, stretching only provides minor relief, and bracing only provides some rest for inflammation to dissipate … but what about the fibrotic tissue?
The gold standard for treating RSI’s in our clinic is manual Muscle Release Technique (M.R.T.). In order to break away the fibrotic tissue, specific manual pressure is applied along the joints, muscles, tendons, and ligaments while shortening and lengthening the tissue.
This is very different from a normal massage, as the gliding motions do not break up adhesions effectively. We often find great flexibility and function improvements within 2-3 treatments of M.R.T. especially with our patients with Office Worker Syndrome.