What is RSI? The background to this industrial phenomenon is outlined, and it is suggested that the unprecedented increase in the official statistics in what is now called repetition strain injury begs an explanation. Four explanatory models are summarized: The medical model, the psychiatric model, malingering, and a pain-patient model. It is argued that the facts of this phenomenon lend support to a pain-patient model rather than the popularly extolled medical approaches. Finally, it is argued that those who promote RSI as a strategy for work reform confront a paradox—'RSI sufferers' are facing more standardized working conditions because their patient role encourages heteronomy rather than the principle of autonomy that underpins work reform theories and practices.