Doing a lot of needlework can cause repetitive stress injury (RSI), especially when combined with the large amount of typing that many people do nowadays. It is caused when the same movement is done repeatedly. Sports medicine physicians categorize the levels of injuries based on the symptoms and impact on the wrist’s performance. This grading helps guide the treatment and rehabilitation process. Grade 1 is when there is no pain while stitching, but there is some discomfort afterward (either immediately or during the evening or the following days). Grade 2 is when there is some discomfort while stitching but it doesn’t interfere with performance. Grade 3 is when there’s discomfort while stitching and it does interferes with performance. And finally, grade 4 is when the discomfort is so intense that stitching cannot be performed at all. Of course, none of us want to reach this level!!!

There are various treatments for your wrist, depending on the grade of the injury. Grade 1 can be treated by stitching 25% less, and that’s all that's required. Stitching can be gradually increased as the symptoms allow, but be careful not to push it too much and cause a reinjury. Grade 2 injuries can be cared for by reducing the duration of your stitching by 50%. In addition to ice and stretches, consider using nonsteroidal anti-inflammatory agents. Physical therapy is not absolutely necessary at this point, but can be considered. When pain is gone, the therapist should teach an endurance program and strengthening exercises. Grade 3 is treated by “active" rest” where the stitcher should stop stitching completely but is allowed to move the affected part for daily activities. Physical therapy is needed to speed and end to the discomfort, as well as to strengthen, increase endurance, and restore coordination. In addition to the oral nonsteroidal anti-inflammatory agents, a corticosteroid injection may be considered at this time. Grade 4 injuries are treated with complete rest of the affected part, usually involving the use of a sling or splint (even casting is considered in severe cases). All of the above options can also be used. If there is no improvement, or the condition recurs despite adequate treatment, then surgical intervention may be required.

Of course, the best situation is to avoid injury completely, and here are some tips to keep you stitching for years to come.

1. Get an accurate diagnosis from a physician if you suspect you have a repetitive stress injury. There are many other conditions that can cause, mimic, or worsen RSI such as fibromyalgia, Lyme disease or arthritis.

2. Take frequent stretch and rest breaks while you are stitching or doing any other kind of repetitive task.

3. Try self massage tools. Self massage can actually be more effective than getting a full body massage from a masseuse. And it's cheaper, too! Some of the best tools are the theracane and the backnobber. They are great for massaging trigger points in hard to reach places.

4. Try yoga. Even mainstream medical doctors are starting to recommend yoga for conditions such as carpal tunnel syndrome. Yoga is something you can do even at your desk at work.

5. Eat a healthy diet. While it does not seem to be well known, a number of nutritional deficiencies can lead to tight muscles and joints.

6. Watch your posture. Poor posture is a major risk factor for RSI. When your bones are not properly aligned, then your muscles are forced to work harder to keep your body balanced and erect. Bad posture also causes stress in your spinal cord, which cuts nerves and signals to your arms and wrists. There have been studies that show the connection between hunching and tendinitis/repetitive stress injuries.

7. Get a good night's sleep. Muscles that are over tired may be more prone to injury. Caffeine can also interrupt sleep as well as make muscles twitch and get tight. 8. Walk or exercise as often as you can fit in (15-45 min.) This increases circulation, and keeps your body healthier, stronger, and better able to ward off problems. Include wrist exercises with weights.

9. DO NOT work through pain! Stop immediately if you feel discomfort/tightness/pain.