Understanding And Dealing With Repetitive Strain Injuries - NYDNRehab.com

Healing and Recovery from Repetitive Strain Injuries

Healing and Recovery from Repetitive Strain Injuries

They say that practice makes perfect, and repeating the same motions over and over again can help lay down neuromuscular pathways that enhance skills and promote motor precision. But unless deliberate measures are taken to offset repetitive motions, they can create muscle imbalances, tissue thickening and nerve disorders that cause pain and disability.
Learn more about repetitive strain injury (RSI), repetitive strain injury physical therapy, and the latest regenerative treatment options.

What are Repetitive Strain Injuries?

Repetitive strain injuries can occur anywhere in your body where repetitive motion begins to negatively impact structures like muscles, connective tissues, nerves, or even bones. Injuries may arise as tendonitis, nerve compression, erosion of cartilage, muscle strain or osteoarthritis. As long as the activity continues, pain and disability may persist or even worsen.

Certain circumstances and conditions are thought to underlie repetitive strain injuries:

  • Incomplete healing of muscle and connective tissue after an injury

  • The presence of scar tissue

  • Improperly rehabilitated tendon injuries

  • Damage to local nerve tissue

  • Damage to fascia

What are Repetitive Strain Injuries?

In many cases, the body adopts compensation patterns to offset tissue damage that has not been successfully repaired. Compensation strategies may bring about changes in afferent sensory information, cause dystonia, and lead to central sensitization, all of which interfere with neural control of muscles. Compensation patterns often persist long after pain disappears, causing suboptimal and uncoordinated muscle recruitment patterns that lead to repetitive strain injuries.

RSI Symptoms and Common RSI Conditions

RSI symptoms generally have a gradual onset, worsening over time. Symptoms may be alleviated or even disappear during an extended break from the activity, but if there is underlying structural damage, symptoms will return once the activity is resumed.

Symptoms of RSI include:

  • Burning, aching or throbbing pain

  • Weakness and stiffness in the affected structures

  • Numbness and tingling

  • Cramping

  • Redness and inflammation

Symptoms of RSI include

RSIs often affect the upper extremities. Common conditions arising from RSIs include:

  • Carpal tunnel syndrome

  • Tennis elbow (lateral epicondylitis)

  • Tendonitis in the wrist, hand and fingers

  • Rotator cuff tendonitis

  • Peripheral nerve entrapment

Early treatment can limit the severity of an RSI, but many people ignore their symptoms until their pain starts to interfere significantly with their performance.

Who Gets RSIs?

Anyone can incur a repetitive strain injury, but people in certain occupations or who participate in certain types of activities are more likely to develop an RSI. While it makes sense to stop the activity that is causing the pain, rest is not always a viable option for people whose livelihood depends on continuing the activity.

People who may develop RSIs include:

  • Athletes

  • Body builders

  • Fitness professionals

  • Dentists

  • Musicians

  • Construction workers

  • People who work online

  • Online gamers

  • People who drive for a living

  • People working on an assembly line

People sometimes endure RSI pain for years before finally seeking treatment. But new technologies bring hope for anyone suffering from an RSI, whether recent or longstanding.

People who may develop RSIs include

How to Heal Repetitive Strain Injuries

While repetitive strain injury physical therapy is a common solution for RSIs, there are certain things that should be considered and addressed prior to beginning treatment. Pain and dysfunction from an RSI can arise from multiple causes, so it is important to accurately identify which structures are affected, and how.

Possible structural damages underlying RSI include:

  • Neurogenic inflammation (where sensitized nerves activate an inflammatory immune response)

  • Thickening and fibrosis of fascial tissue

  • Reduced muscle elasticity

  • Development of myofascial trigger points

  • Neuromuscular instability

  • Nerve compression or impingement that hampers a nerve’s ability to glide freely

  • Hyper-excitability of nervous fibers

  • Reduced mobility and/or stability of the joints

Beginning repetitive strain injury physical therapy without first identifying and addressing the underlying issues can make the condition worse instead of better, costing the patient time and money, and prolonging their pain and dysfunction.

New Technologies for Treating RSIs

Recent advances in rehabilitative medicine have dramatically changed the way RSIs are diagnosed and treated. Sadly, most clinics that offer repetitive strain injury physical therapy do not have the equipment or training necessary to give their patients the fastest and most effective treatment available.
RSIs often occur in tissues with limited vascularity, making them slow or resistant to healing. Regenerative therapies are used to jump-start the healing process at the cellular level, stimulating the body’s own innate reparative mechanisms to accelerate rehabilitation. Regenerative therapies are mostly non-invasive, with the exception of minimally invasive injection therapies.

Technologies for Treating RSIs

Effective regenerative therapies for addressing RSIs include:

  • Extracorporeal Magnetic Transduction Therapy (EMTT) transmits high energy magnetic pulses that synchronize with the body’s own magnetic fields, triggering a regenerative response.

  • Focused Extracorporeal Shock Wave Therapy (ESWT) produces high frequency sound waves to stimulate the body’s reparative mechanisms. It is especially effective for degenerative tendon disorders and myofascial pain.

  • Extracorporeal Pulse Activation Technology (EPAT), also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues.

  • High Energy Inductive Therapy (HEIT) uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes.

  • INDIBA Radiofrequency Therapy uses electrical current to increase the exchange of ions in damaged cells.

  • NESA Neuromodulation Therapy uses a biphasic low-frequency electrical current to emit a series of intermittent and cyclical stimuli, to calm hyper-excited nerves and restore optimal neural signaling to the brain.

  • Ultrasound Guided Dry Needling targets myofascial trigger points that often contribute to RSIs.

  • Prolotherapy injects a biologically neutral solution to irritate affected tissues, stimulating the body to grow new normal ligament or tendon fibers.

  • Prolozone Therapy injects a combination of procaine, anti-inflammatory medications, vitamins, minerals, and a mixture of ozone/oxygen gas into injured or degenerated joints or tissues to jump-start the healing process.

  • Stecco Method Facial Manipulation Therapy uses deep manual friction to reduce the density of damaged tissues, freeing up tissue layers to become more fluid.

  • Dynamic Neuromuscular Stabilization (DNS) taps into your body’s inherent developmental movement patterns, to restore functional movement and promote mobility and stability.

Advanced RSI Treatment in NYC

Physical therapy clinics are a dime-a-dozen in NYC, but the vast majority of therapists lack the training or access to leverage the most effective treatment technologies. At NYDNRehab, we are continually adding to our treatment toolbox, to offer our patients the best available care.
Prior to initiating repetitive strain injury physical therapy, we use the most advanced high-resolution diagnostic ultrasonography to identify structural damage brought on by your RSI. We then treat your injury with regenerative therapies to put you on the road to healing, followed by repetitive strain injury physical therapy.
If your occupation or activity is causing you pain and limiting your mobility, contact NYDNRehab today, and jump-start the healing process so you can get back to doing the things you love.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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