Workplace Wellness
for the performing arts

Identify the causes and precise
anatomy of an individuals' repetitive strain injuries

Performance injuries affect the spine and lower limbs as well as the forearms and wrists.

Why do some people get injured from a particular activity whilst others performing the same activity are seemingly immune?

It would appear that the main factors in giving an increased likelihood for injuries fall into the following categories:

  1. Musculo-skeletal
  2. Neural encroachment and compression
  3. Amount of time spent performing activities
  4. Intensity of actions required
  5. Fast twitch/slow twitch muscle typology

Repetitive Strain Injury (RSI)

RSI is a general term used to describe a primary cause of a condition. It can also indicate an aggravating factor of a pre-existing condition. It simply refers to the repeated use of particular muscle groups as causative and/or aggravating factors.

Most often it is used to classify conditions related to computer work. It also includes most commonly writing with pen/pencil, activities involving prolonged periods of gripping, playing musical instruments, typing, mousing and dance.

Thus, any action repeated too many times, no matter how light, will produce a repetitive strain.

The injury maps

As a result of many years of observation of injury patterns of pain Paul Manley produced the ‘RSI maps’. These maps indicate the specific areas most likely to be afflicted. They enable us to interpret the areas involved and the related mechanical functions specific to those areas. This then enables us to make recommendations regarding habits and to evaluate the nature and severity of the condition.

What is RSI - Repetitive Strain Injury?

WRULD or Work Related Upper Limb Disorders is a term coined by the TUC   (the British Trades Union Council) meaning repetitive strain induced by one's occupation. This term includes conditions such as 'beat hand', 'white finger syndrome' and various other work related syndromes.

The principle is simple. For example if I were to stroke my cats' chin with my index finger once, there would be no problem, but if I were to do this one thousand times in an hour, both my index finger tendons and my cat would complain bitterly. The muscles and tendons effecting the movement would become tired and begin to ache. They should recover soon. But if I were then to perform the same activity each day for a week, I would probably find that I could only repeat it a few times before my muscles would feel tired and achy, plus, my cat, now with a bald chin would not be pleased.

Thus, any action repeated too many times, no matter how light, will produce a repetitive strain. 'Nintendo and Blackberry thumb' are classic examples. In the case of dancers, the lower back and legs are most afflicted.

Diagnosis and treatment

The experienced hand sees by touch, the shapes, densities, heat, textures, resistances of the body, the trained mind puts it all together. The trained hand stretches and softens the specific muscles, tendons and joints, the experienced mind asks questions about usage and the particular trigger area under investigation. Thus revealing additional information about any other activities that the sufferer is engaging in which might be adding an additional trigger area.

Whilst 'weakness' in the muscles' is much ballyhooed, it is more usually the best procedure to save strengthening exercises until the last, once the deep muscles and joint problems have been corrected. The action of correcting a muscle will induce muscle growth anyway. It is often wise to tone up the secondary muscles involved in a given action. Typing, for example, has the Deltoid muscles as secondary stabilisers holding the arms slightly out from the body. If you strengthen these muscles the arm will feel lighter. If the Deltoids are too underused then the deep primary stabiliser, Supraspinatus will become hypertonic and will constitute another trigger area.

When I began many years ago, I took it all for granted. Having been brought up as a boy in an Osteopathic environment I didn't realise that there were many things that people didn't know about in connection with the workings of the body and what makes them function that I took for granted. Hence, trying to take the thorny subject of performance injuries and shake some common sense into it for you.

Sure, there are other factors potentially involved. Psychological elements, metabolic factors, ergonomic, posture, hydration levels, diabetes, hypoxia, hypercalcemia, even pollution levels, but here I have restricted my talk with you to those things that seem to be least understood by sufferers. I hope it helps you to understand more deeply the whole painful subject.


Whilst a small number of performance injuries can be chronic, the majority are relatively easy to avoid and to correct using a precise diagnosis, examination and treatment of the structures involved. Thus, any physiotherapist, massager, osteopath, chiropractor, gym, trainer, GP or other specialist will find the reports from Workplace Wellness to be of tremendous use in comprehending and treating conditions.