Forearm Extensor Muscle Overuse and RSI
March 24, 2008 | Posted by alanf RSI symptoms are very often the result of extremely tight (overused) forearm extensor muscles. These muscles are located in the upper forearm region. They are used to raise the wrist and fingers, which is the primary motion involved in unergonomic keyboard and mouse driven activities.
The symptoms have been described by a few physicians to me as tennis elbow like in nature. The tight and spasming extensor muscles and tendons end up being over used, and don’t get the chance to recover. This leaves them in a permanently fatigued state, tightly tensioning the forearm tendons to which the extensor muscles are attached, causing referred pain down the tight tendons into the hands and fingers.
You can do a check to see how fatigued your forearm extensor muscles are. Using your left hand to check your right forearm extensor muscles press down firmly with the thumb onto the upper forearm extensor muscles (see image below), move the position of the thumb slightly over these muscles and check for pain. Repeat the diagnosis with the left arm extensor muscles and your right thumb.
If you are in any doubt about what these muscles do, press your thumb on your arm as above and raise your wrist up as if you were about to type. Also raise and wiggle your fingers. With your thumb, you should be able to feel your extensor muscles tightening as your wrist and fingers raise.
If you find the extensor muscles to be in pain with the above procedure then these muscles are fatigued. It also means that ergonomically, you are not using your keyboard properly and are probably typing using the claw, which causes this type of problem. This type of condition is one of the most common mechanisms for RSI pain, but can easily be addressed by changing the way you type.
If you are experiencing pain in these muscles, it is time to try to relieve them which can be done by massage, icing and rest. Consult your doctor or a trained physiotherapist to find out the best techniques which may include ultrasound. It is also time to re-assess your typing technique otherwise you may be placing yourself at risk of an RSI type condition. This may send the forearm extensor muscles into a more permanently fatigued state, from which recovery may be difficult, and in some extreme cases may be impossible.
In my own case, forearm muscle fatigue is the primary mechanism for my RSI pain. Unfortunately for me, I learned of the prevention techniques several years after my symptoms began, when these symptoms had already become more permanent. To this day I still have not been able to understand what condition these misused muscles are in, but I suspect permanent damage. I do however still get some much needed temporary pain relief these days from massage of the forearm extensor muscles and tendons, just not very lasting , but my injury is after all a long term one.
See also my other article on forearm extensor muscle overuse and wrist positions.
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Categories: Miscellaneous, RSI, Tips | 
Tags: extensor muscles, forearms, mouse use, RSI, RSI eduction | 
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You made mention of the problems associated with lateral deviation of the wrist on November 23 last year and this post shares certain key issues whereby the muscles responsible for lateral deviation are the extensor carpi ulnaris (the one you mention here) and the flexor carpi ulnaris (just on the other side of the ulna). Typically it is the flexor group that gets too tight but it can be the extensor, as you say depending on the working positions. You did not mention the presence of the Radial nerve in the lateral elbow as a point to avoid massaging. As you promote self-administered therapies it is important to give as much detail as possible as massaging a nerve is counter-productive.
Thanks for you posts and keep it up!!
Doc Russ
Thanks for the clarifications. As you are probably aware I am not a medical professional, and don’t try to be. Hence my common references to consulting a doctor or medical professional for best advice.
In my past experience it has been extremely difficult to find anyone (OK, I’m talking last 13 years here) to diagnose or identify my problems. I think that education on RSI type conditions in the medical community over the last 15 years has been in a state of evolution hence limiting the ability to correctly recognise and diagnose these conditions. I can only hope that with the increase in numbers of RSI sufferers, these conditions will become more commonly taught in medical schools.
I was perhaps unfortunate to come through with this injury at the wrong time and hence missed out. It’s certainly been a self learning journey! It’s frustrating it’s taken me this long to figure out what I needed to know all those years ago!
I think that medical professionals that understand RSI need to have much closer ties with industry ergonomists and suffering workers so that diagnosis and worker education can happen much quicker. I believe we are still a long way away from this today, and as a result, cases of RSI type conditions will continue to dramatically increase.
If you can expand on the location of the radial nerve (a web linked diagram would be good) I would be happy to reference this. Also is there anything in your experience beyond massage that could help badly fatigued (and possibly permanently scarred) forearm muscle/ligament tissue? I’ve been through lots of ultrasound in the past, (but not much recently) which stopped helping as soon as i started using a keyboard again at work. Most of my attempted rehabs were done while still holding down the job that created the problem in the first place!
Thanks for your comments
Alan
I suffer from forearm muscle pain a little rather midwayr down the forearem . If the pain is caused by RSI.? Then I am a loss as to what might have caused it, as I don’t type!
The pain is certainly apparent in both arms! So any little computer work I do at home for pleasure, (I don’t play games, rather I might roam web pages), should confine any problem to the rh arm?
The pain is most noticeable when l press down on the arms, similar to leaning over the bicycle handlebars.
Regards
Alan Y
RSI is not solely restricted to computer use. Many repetitive task or hobbies can lead to pain eg piano playing etc.
Having said all that, my father who is 85 and has minimal exposure to computers other than playing a few card games on them at home has an occasional tweak of forearm/hand pain and that is down to his style of mouse, and bad ergonomics ie desk. He doesn’t use the computer much at all.
I’d advise you to consult your Doctor or Physiotherapist though to check your arm out.
Alan
Good tip on how to check with your thumb. I found it hard to tell whether I’m healed aside from curling a heavy dumbell or playing vigorus paddleball. Starting to play paddleball again was what caused my problem. My bicep and inner forearm didn’t get sore, my tricep got sore once and healed, but my forearm extensor muscles, which I had never thought about before, seem to be a problem.
Hi like Barry I found your tip on how to check with your thumb spot on. My current episode has been brought on from windsurfing at the weekend. I do not want to give up windsurfing.
Any site you would recommend for stretching/strengthening exercises to cure/prevent recurrence.
Hi guys. I am also been suffering from tight forearms for a long time. Unfortunately I did not seek out treatment until now (I’ve had the symptoms for 4 years) Right now the therapists are doing a combination of ultrasound and massaging to try and get the tightness to go away. I hope that eventually this will work, but I am worried that I’ve had it for so long that it won’t. Do you guys have any tips on how to get rid of it? Has there been any progress or success in gettting rid of long term fatigue?
Hi Landon, 4 years of symptoms is not good, but it’s not the end either. I’d say you should look at my recommendations about dealing with symptoms
The physiotherapy you are getting is realy only symptom relief. The root cause of your problem is the tenson in your forearms as you (presumably type). Until you look at where thee tensions are coming from and make adjustments, you will continually bounce between physiotherapy and pain. Id also check out the post which for me describes the hidden tensions in the forearms when a lot of people type.
It may well be that you need to make posture as well as ergonomic equipment (eg drop down keyboard tray) adjustments before you can use a keyboard in the less forearm stress manner described. An ergonomist should eb able to provide you with this information
Of course you need to also factor into the equation the time you are spending on a computer daily. Nothing quite beats time away from comuters to help ease the pain.
I guess one thing that I have not really seen mentioned anywhere is strengthening the forearm muscles. Doing exercises with therabands and light weights to improve the strength of the muscles. Have you come across this anywhere in your research? It is one of the things the physical therapist says could improve my situation. The stronger the muscles become, the longer it takes for them to fatigue.
Hi Landon, you are probably asking the wrong guy. I have battled chronically fatigued forearm extensors for many years now. I too wish I had ‘built them up’ more before the injury. I would caution you to not overdo this because when they are in pain, the best thing for them is rest. Save exercises for when they feel better (not easy with a full time job). Go along with what your physio recommends, but keep in mind what I said earlier about cutting down exposure, and improving posture.
A good overall cardio and body workout is swimming, and I can’t recommend this highly enough. Also Yoga is very beneficial too.
There also are some excersisers out there, including grip specific ones (aimed at climbers) again I’d suggest not over using these, but getting blood flow into sore injured muscles has to be a good thing. Its the lack of blood flow (and hence oxygen) to these muscles whilst using a computer that creates the ripe environment for these types of injuries.
I used a chain saw for several hours as well as an axe last weekend and never noticed any problem at the time. This week though I have had terrible pain in my right forearm all week. The pain is a terribly sharp stabing pain that runs from my outside wrist area to about six inches down. I am in my forties and have never felt anything quite like this before.
<p>I am having a pain in the forearm similar to what is described above. However, when probed with my thumb, I don’t find an especially sensitive spot. Also, when I move the arm in a certain way, eg extending my arm fully out to my side, to shoulder level I get a pain that is a bit lower on the arm, and along the side of the arm, rather than the top as illustrated above. I am wondering if this could be caused by a nerve problem in my neck or back? Any thoughts?</p>
Hi Joe,
RSI conditions can be caused by a whole multitude of different activities, and each will have it’s own signature. Just because you have different symptoms does not mean that you do or don’t have RSI. RSI conditions are very specific to the task that caused them, and you didn’t mention what it was that has led you to experience these symptoms.
I suggest you get checked over by your GP or Physical Therapist to try to pinpoint the source of your pain.
I just finished massage school and i would recommend massaging them. You can use your thumb along the sore muscle going away from the hand. You can also knead your forearm, like you would bread. If the pain is unbearable or there is any swelling than see a doctor. But I usually massage mine and it helps, it’s easie rot massage with oil or lotion. You could go on youtube and search massaging the extensors or flexors group and there are tutorials on how ot do that effectively.
What keyboard setups (wrist pad, ergonomic or split keyboard, etc.) have been preferred by people with forearm stress?
Has anyone here heard of or tried prolotherapy treatments or trigger point therapy? I went to physical therapy as mentioned above for about three months and it didn’t work, so I am looking towards more “alternative” types of treatment and medicine…
Hi Guy,
there is no universal solution that fits everyone. Everyone is built differently. Advice from a professional ergonomist is required to find out what will suit you. In my case (before I gave up my full time job anyway) I was using a drop down (fully adjustable) keyboard platform by Humanscale, a straight keyboard but with my wrists trained to neutral and a Contour roller mouse. If you check through my other posts on the site you will get more info. Try ergo equipment out before buying and please get some advice from an ergonomist. There are a lot of factors that can cause RSI, and everyone is different, so there will be different answers to your question from everyone who has gone through this. You also need to look at exposure and workload as well as other factors. Remember you can be sat in the most ergonomic chair at the most ergonomic desk with the most ergonomic mouse and keyboard and still be at risk of RSI if you don’t use them properly. Especially if you don’t ensure your posture is good. Sorry for the vague answer, but it happens to be the truth.
Alan
I was wondering if anyone has tried acupuncture to help treat RSI. This has been suggested to me from several massage therapists and people who have had the treatment, but I don’t want to spring a check for something that costly if others have tried with no success?
Hi Landon,
I havn’t tried acupuncture for this condition. I was offered it a few years back, but didn’t like the thought of it more than anything.
Recently I have had some for other ailments, with some success. I may get around to trying it for my RSI at some stage.
Alan
My condition has gotten better! I’ve been using an innexpensive Microsoft keyboard that is split and the keys are angled. I also pull the keyboard closer to my body whenever possible to minimize my reach. I take purposeful breaks from typing during the day, try to be “kinder” to the keys instead of banging on them, and I occasionally massage my forearm. All these efforts seem to be working for me.
Hi Guy,
I’m glad to hear this works for you. You are fortunate that you caught it in time and made those adjustments required to your working practice.
RSI need not be a career destroyer if it’s recognised at an early enough stage.
There are many more of us out there that took too long to discover those adjustments, and are now in a more permanent state of RSI pain.
The education of the small adjustments need to take place at an early stage of our lives ie. in schools.
Alan
Hi – I have as recently as 8 weeks ago been suffering chronic pain in my upper forearm, wrist and fingers, it came on after a really extensive period of typing as I cleared my desk to go on holiday. I thought the three week reest would do it good – but it returned as soon as I started typing again. So, after reading these comments I realise I have an rsi injury. If I completelyrest this arm and like do NOTHING for a couple of months – willmy arm recover? I would really appreciate your comments/observations. I have found all t he commentson this site to be themost helpful so far – thanks
Hi Shirley,
Rest (from computers, high tech gadgets , phones, in fact anything that involves small clicks – hard these days I know) would be beneficial.
I’d also see your doctor and get advice on taking some anti inflammatories. I’d also see a physio (you may have to hunt around for a good one) get some ultrasound
and massage on the forearm extensor muscles (most likely to be causing your finger pain). You should also try not to panic, stress is a trigger for tension which is a trigger
for RSI pain. You also need to get an ergonomic assessment done. Your employer has a responsibility to provide you with a safe ergonomic setup. It is most likely that
your injury happened because of a combination of bad ergonomics with an extended period of typing in a stressful environment with minimal breaks. From an ergonomic point of view, I expect ‘the claw‘ may have come into play too, so its important when you go back to work not to use any un-ergonomic practices that led you to this injury.
You also need to religiously take breaks when working, introduce stretches and small micro breaks from typing, get up and move around more. There are break reminders available for free download.
If your job involves text input (rather than say programming commands) then consider a voice recognition system. Also consider a physical pastime that gets your arms moving better like swimming , kayaking or yoga.
Also read over my FAQ section and ‘breaking the RSI pain cycle‘ sections here (if you havn’t already).
Keep in mind that you have caught it early, and hence you have the best chance of doing something about it.
Best wishes.
Alan
Fatigued extensor muscles can be symptom of tight flexor muscles. When you type or play the piano, you use the flexor muscles repetitively, which for some reason causes the body to adjust the flexors by shorting them (the same thing can happen for runners who repetitively use the calf muscles). So the weaker extensor works hard to maintain the balance and becomes fatigued. The solution is to the lengthen the flexor muscles by deep massage and stretching (stretching is probably not enough). You have to be careful to avoid messing with the median nerve running down center of the flexor, although some tingling is probably unavoidable. You can also sleep in a position where the flexors are slightly stretched, by putting your hand up against a pillow or wall. For some reason, long-term half-way stretching seems to work better than 30 second full stretches, at least for this muscle. The extensors should also be stretched and massaged, but if you do the flexors regularly, then extensors will probably end up taking care of themselves.