As a physical therapist with over 25 years of experience, including 10 years of experience treating patients with repetitive strain injuries (RSIs), I'd like to share some valuable information about symptoms and treatment of this problem.

I'm often asked by computer users, "How do I know when I should seek medical attention?" This question cannot be answered easily, but there are some classic symptoms that should not be ignored and that require prompt medical intervention:

• any pain that persists for more than 24 hours after stopping the activity that brought on the pain
• pain that awakens you during the night
• persistent numbness or tingling in the arms, hands, or fingers
• any perceivable weakness (for example, dropping objects, or difficulty with handwriting)
• problems with balance
• difficulties in bladder or bowel function

The sooner these symptoms are recognized and proper medical intervention takes place, the more successful the rehabilitation process will be.

Once you've determined that you need medical care, who do you see and how do you know if you're getting the appropriate treatment?

Many medical disciplines are well-versed in repetitive strain injuries, including physiatrists (physical medical specialists), orthopedists, neurologists, hand surgeons, physical therapists, occupational therapists, acupuncturists, chiropractors, and massage therapists. Just remember, as with any profession, there are good practitioners and bad ones. Any qualified professional will be the first to tell you that if his or her particular method is not making a significant change within a reasonable period of time, you should seek further advice.

At your first visit the practitioner should take a complete history and perform an extensive postural and functional evaluation. RSI is not an isolated condition. (The diagnosis of RSI is actually a "catch-all" term that incorporates many diagnoses, such as carpal tunnel syndrome, cubital tunnel syndrome, tendinitis, tenosynovitis, and thoracic outlet syndrome.) Problems can arise from dysfunction in your neck or shoulders. Measurements should be taken to determine range of movement and strength at individual joints. Changes in sensation should be evaluated and muscles should be palpated to determine very tender areas (trigger points).

The practitioner should discuss activities of daily living with you, as leisure activities and hobbies can be an important contributing factor in both the cause and the treatment of the injury. Another valuable component of the evaluation is an assessment of your work environment. Many medical professionals have some training in ergonomics or, if not, they should be able to refer you to someone who has.

Physical therapy includes numerous methods of treating RSI. Modalities are available that can help to reduce inflammation, improve circulation, decrease pain, and reeducate muscles. The areas where physical therapists excel and should concentrate their treatment are manual, "hands-on" techniques and exercise instruction. Manual techniques are the most effective for releasing tight muscles and other soft tissues. Exercises can increase muscular flexibility, joint range of movement, muscular strength, and endurance; they need to be monitored closely and progressed slowly, and must be individualized to your needs rather than recommended as a "cookie-cutter" cure used on all patients.