Repetitive Strain Injuries (RSIs) and How to Avoid Them

By Mary Lynn Cloghesy and Jason Schembri

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All it took was a simple up-and-down stroke of a paintbrush over a couple hours, and my shoulder screamed. Nerve pain shot down the back of my neck, and I dropped the tool. Holding my breath, I coaxed the joint to loosen by rotating my shoulder blade. After stirring the synovial fluid, I picked up the implement again, but my fingers went numb, and I instinctively dropped it. Project terminated. Had the wall suddenly outgrown my reach, or did the implement become weighted beyond what I could sustain? No. I had a Repetitive Strain Injury (RSI), where the soft tissue “recognized” the movement pattern as dangerous, years after a rotator cuff injury had healed. My fascia (connective tissue) seized to support the joint as if the trauma were new. 

Repetitive Strain Injuries (RSIs) are a common source of pain for writers, but they can be avoided or mitigated by bringing your attention to the root causes. In this series on healthy living, we’ve discussed a number of topics, including Upper and Lower Cross Syndrome. When thinking about RSIs, it’s important to familiarize yourself with these conditions and their remedies, as RSIs relate to latent disease or dysfunction in the body. They are based in existing and/or recurrent movement patterns (or the lack thereof). Once you understand what RSIs are and their classifications, you can begin to position yourself—literally—to stave off any future difficulties. Author Neil Gaiman has said, “I found myself getting tendonitis in my wrist... I started writing longhand again, with fountain pens, because it slowed me down and was gentler on my hands” (Interview with The Guardian, 2013).

Definition and Classifications of RSIs

Any injury that affects the fascial system (soft connective tissue throughout the body), as well as muscles, nerves and joints, causing persistent and/or pathological pain, mainly in the neck, shoulders, forearms, hands, wrists, elbows and lower limbs, is considered an RSI. 

There are three types of RSIs:

• Rapid movement injuries: These types of injuries relate to small or micromovements that are quick and recurrent. Think of a stylist cutting hair. The snipping action of the scissors over time could cause inflammation in the tendons of the hand and wrist, leading to Carpel Tunnel Syndrome if untreated. For writers, the constant tapping of keystrokes is a risk factor. In fact, the term “writer’s cramp,” was coined in the mid-1800s to refer to the abnormal contraction of hand muscles after holding a quill or dip pen for hours.

• Forceful movement injuries: RSIs of this nature are associated with physical labour, caused by powerful muscle movement over time. Someone working at a warehouse, who lifts heavy boxes all day, would need to be to be trained in healthy movement and be aware of their level of fatigue to avoid torsion (twisting) and overload (straining) injuries. This is not typically a problem for writers unless special conditions apply. For example, if an author is loading or unloading books at a conference.

• Static loading injuries: The most prevalent cause of RSIs is fixed positioning by unsupported limbs, which is where our previous articles on Upper and Lower Cross Syndrome come into play. When writers are penning new pieces, they often sit for long periods of time, but in order to hold a static position, certain muscle groups—like those in the lower back, neck, hips, and thighs—stay under continuous low-level contraction. Over time, this can lead to:

• Lower back pain from spinal compression and inactive core muscles

• Hip flexor dysfunction and imbalance from constant flexion

• Neck and shoulder tension from leaning forward or looking down

In addition, writers may experience more than one RSI at a time, compounding the problem. When discomfort or pain arises, a writer may compensate through movements that cause other strain injuries too. For example, pain in the wrists or hands can radiate or refer to the forearms and shoulders.

Warning Signs of RSIs

There are many medical conditions related to RSIs, but rather than overwhelm you with complicated names and jargon, we believe it’s more beneficial for you to recognize the warning signs applicable to writers. Sensations can range from “a sense of discomfort” to “excruciating pain.” Of course, we recommend cultivating an awareness of what’s happening long before your tolerance is exceeded:

• Pain that worsens with repetition (e.g. typing, gripping, writing)

• Pain that improves with rest but returns when you resume the task

• Tingling or numbness, especially in the fingers or wrists

• Stiffness, cramping, or loss of flexibility (with possible swelling)

• Burning sensations in tendons or muscles

• Sensitivity to cold or touch

• Wasting of the muscles at the base of the thumb

How to Avoid or Overcome RSIs

As with most medical conditions, early intervention is critical. By recognizing an RSI before it becomes unmanageable, you’ll not only protect your health, but also maximize your creative output and avoid interruptions to your work. Writers dealing with RSIs can still maintain a productive and even pain-free life by integrating several strategies, often simultaneously. Here are some proven tools and techniques to try:

Ergonomic Practices:

• Adjust Your Chair and/or Desk Height: Elbows should be at a 90° angle with wrists soft and neutral. When sitting, your feet should rest fully flat without reaching. Alternatively, write standing up as Ernest Hemingway famously did. He used a bookshelf with a typewriter on top, but there are adjustable desks now. 

• Use a Split or Ergonomic Keyboard: A curved keyboard reduces wrist deviation and tension. If you prefer, you could choose a lower-force or mechanical keyboard that reduces the force required for each stroke, a tilted keyboard (negative tilt away from you is best for wrists), or touch-typing aids.

• Consider a Vertical Mouse or Trackpad: These innovations prevent forearm twisting and strain. Variations include a trackball mouse, and external touchpad, plus keyboard shortcuts. 

 Alternative Writing Methods:

• Voice Recognition Software: Dictation allows you to write hands-free and can be surprisingly fast. (i.e. Dragon NaturallySpeaking, Windows Speech Recognition, or Google Docs Voice Typing.) 

• Writing Longhand: Some writers, like Neil Gaiman and Donna Tartt, find relief writing by hand with fountain pens, which require less pressure. Pen tablets for stylus typing  is an alternative that avoids or reduces the key strike motion. 

• Typing Breaks & Intervals: Follow the Pomodoro Technique (25 mins work, 5 mins rest) or the 20-20-20 Rule for eyes and posture, meaning every twenty minutes, look twenty feet away for 20 seconds. 

Physical Therapies:

• Stretching & Strengthening: Take full movement breaks at least every three hours. Start with major muscle groups (arms, legs), then add fine-motor movements in the wrists, shoulders, and forearms. Do not pull on tight or sore muscles, instead coax them to soften by using nonlinear movements such as rotations or even a shaking motion. If you are experienced in certain modalities (i.e. yoga or Pilates) add a session into your workday if possible. 

• Chiropractic, Massage or other Manual Modalities: You can reduce inflammation and realign tension points by seeing a qualified practitioner. They usually develop a custom movement protocol that you can integrate into your schedule. Also, cold and heat therapy can be helpful as the combination will alleviate swelling, relax muscles, and decrease recovery time. 

• Mindfulness Practices: One of the most powerful interventions is awareness. Try mindfulness practices while you work such as a body scanning exercise, where you tune into the different parts of your body and consciously release any tension in the area as you breath out. Diaphragmatic (belly) breathing can be particularly beneficial as the dome of the diaphragm intersects the muscles involved in both upper cross and lower cross syndrome. To learn the technique, search for apps like Breathwrk, Calm or Insight Timer, or Prana Breath. 

Top Tip for Healthy Living

Our top tip for healthy living is to avoid working through the pain. While we’ve all heard the expression, “no pain, no gain,” that doesn’t apply to RSIs because any sustained action after a clear warning sign will lead to greater injury. When you feel the symptoms associated with RSIs, stop and evaluate, like I did with the paintbrush. Did I push it to try and finish the task at hand? Only for a moment. Where did it get me? A visit to the chiropractor and an acupuncturist more than once over the course of two weeks. The good news is the task, and my paintbrush were waiting for me when I recovered. Job done. Pain free.