Abstract
Reflex sympathetic dystrophy (RSD) may occur following any trauma to the upper extremity. Symptoms include pain; swelling; vasomotor, sudomotor and trophic disturbances; stiffness; and decreased function. Stress-loading is presented as an effective treatment of RSD. The stress-loading program consists of active exercises that require stressful use of the upper extremity with minimal joint motion. If necessary, other modalities are used to treat the residual fibrosis that occurs secondary to RSD, only after the pain and swelling subside. A theoretical rationale for the use of stress loading in RSD is presented in light of current theories of RSD and exercise physiology. Exercise, if of sufficient intensity, duration and frequency, places a demand on tissues that causes adaptive changes. Active loading of the involved tissues in RSD provides input to the central nervous system, which is hypothesized to alter the abnormal sympathetic output and break up the pain cycle.
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