Repetitive Strain Injuries

What’s actually going on

Repetitive strain injuries are tissue overload problems. A tendon, muscle, or fascial structure is loaded the same way over and over — at work, in sport, or in daily life — and the load eventually outpaces the tissue’s ability to adapt. The result is the slow build of pain, stiffness, and reduced function we group under terms like “tendinopathy,” “tendinosis,” “tennis elbow,” “plantar fasciitis,” and so on.

Common examples we see clinically:

• Tennis elbow (lateral epicondylopathy) — pain on the outside of the elbow, often from repeated gripping, computer work, or racquet sports
• Golfer’s elbow (medial epicondylopathy) — pain on the inside of the elbow
• Plantar fasciitis — heel and arch pain, classically worse with the first steps of the day
• Achilles and patellar tendinopathy — the tendons of the back of the heel and front of the knee
• De Quervain’s tenosynovitis — wrist and thumb pain from repetitive thumb use
• Rotator cuff tendinopathy — shoulder pain with overhead or repeated arm use
• Iliotibial band (ITB) syndrome — outer-knee pain in runners and cyclists

The traditional framing of these as “inflammatory” conditions has shifted in recent years. The current understanding is that these injuries involve a degenerative or failed-healing change in the tendon or tissue, with limited active inflammation in chronic cases. That shift matters because the right treatment isn’t anti-inflammatory rest — it’s progressive, controlled loading that stimulates the tissue to remodel.

When to see someone

It’s worth coming in for a repetitive strain injury when:

• Pain has been present for more than two to three weeks
• It’s interfering with work, sport, or daily activity
• Rest alone isn’t resolving it
• It’s gradually getting worse despite trying to back off

Reasons for medical referral first:

• Significant numbness, tingling, or weakness (suggests nerve involvement that needs proper screening)
• Sudden severe pain after a specific event (more likely an acute injury)
• Symptoms with systemic signs (fever, joint swelling beyond the affected area)

How we treat them

The shape of treatment is consistent across most repetitive strain injuries:

• Assessment — confirming which tissue is involved, identifying the specific load pattern that’s feeding it, and screening for anything that needs different attention.
• Reduce the irritation — hands-on care to settle the acute symptoms. ART and Graston Technique® are particularly well-suited to chronic tendinopathies and fascial restrictions. Massage therapy and joint mobilization or chiropractic adjustments where indicated.
• Progressive loading — the core of the long-term fix. A structured exercise rehabilitation program that progressively loads the affected tissue with the right type of stimulus (eccentric, heavy slow resistance, isometric) for that tissue and stage.
• Address the load pattern — the work setup, the training volume, the technique, the equipment. If the pattern that caused the injury isn’t changed, the injury comes back.
• Custom orthotics or supportive devices where biomechanics are clearly contributing (plantar fasciitis, certain knee pain presentations).

Most repetitive strain injuries respond meaningfully within four to eight weeks of a structured plan. Some — particularly long-standing tendinopathies — take longer. Patience plus consistent loading is what wins, not aggressive rest.

What about prevention

The best prevention for repetitive strain injuries is gradual progression — increasing training volume, workload, or new activities at a pace the tissue can adapt to. The often-cited “10% rule” (don’t increase weekly running volume by more than 10%) is a rough rule of thumb that captures the principle, even if the exact number isn’t magic.

For office and trades work, movement variety matters more than any single ergonomic intervention. A great chair won’t save you if you sit in the same position for nine hours; a mediocre setup with regular movement breaks holds up better than you’d expect.

Related reading

• What I tell golfers in the first month of the Okanagan season — early-season golfer’s elbow and the back-and-hip patterns that come from too much, too fast.
• What we tell our pickleball patients (you know who you are) — pickleball elbow and Achilles patterns from high-volume play.