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.

Creating Your Personal and Business Road Map to Success as an Author: Creating Situational Awareness of Time and Events Impacting Our Journey

By Pamela Ebel

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Article One of this series explored the hurdles faced when we begin the change to writing as a full-time endeavor. We considered why and how to avoid the ‘One Right Answer’ when setting our professional goals. 

Article Two examined how new goals may require major changes in our professional and personal lives. Their impact on our families, friends, and co-workers—many of whom will become the first audience for our writings—need to be addressed. To lessen that effect we discussed the need to explain the goals to these groups, include them in the decision-making process, seek their acceptance, and bring them along on the journey.

Now we’ll work to acquire or refine skills that ensure our goals stay relevant and achievable. 

Creating Situational Awareness

Situational Awareness is something most of us do every day. We look around carefully as we head to our car in a darkened parking lot; prepare for an important meeting by studying those who will attend and the topic(s) to be covered. The list of things we believe require us to be aware of certain situations is prolific. 

Still, when it comes to personal and professional goals, we often struggle to examine them with fresh eyes because, having committed to them early on, we’ve become victims of habit. To avoid this pitfall, let’s start creating situational awareness.

There are three parts to the process:

1. Perception–   Start by examining our current writing situation to see what key elements, events and/or individuals have changed since we set the original goals. This requires refreshing memories about what our professional and personal lives were like before beginning the journey. 

Next, we look at what changes have occurred. Did we quit the other career completely or did we move to part-time? Were there any major changes in our personal lives such as marriage, births, divorce, death, illnesses, relocation, which changed our plans? The answers may have altered our initial goals and immediate environment.

2. Comprehension– This step is often the hardest for us to tackle. When we delve back into the time, place, events, and the people that existed when we announced, “I’m going to be a writer full time!” what ifs abound. 

The results of those original decisions may or may not be satisfying. They are, however, the reality we must work with when deciding if goals need to be changed. Consulting with the people that were and are still a part of our decision-making process will help in comprehending the new situation.

3. Projection– Identifying goals affected by time and events is the challenging part of this exercise. 

Looking back, we should note the goals that have been met and are still worth time and effort to pursue because…? Beware of keeping goals based on the ‘One Right Answer’ or on habits that are outdated. List the reasons that justify maintaining and supporting certain goals.

Then take a close look at the goals that don’t appear successful or relevant considering added information. Checking with those individuals who have been with us from the start and other writers on similar journeys will allow us to make predictions of what is likely to happen in the near future.

Wait! This process is asking us to recalibrate our futures based on guesses about known and unknown facts and situations? When would we find ourselves in such a predicament having been so careful at the beginning? What could possibly throw the ‘best laid plans’ into such disarray? 

One word that comes to mind – AI! 

From Federal Court decisions in search of a way to demand and determine the presence of the ‘Human Hand’ in a work seeking publication and copyright protection under the U.S. Constitution to copyright protection in general being threatened with extinction in the United States, our journeys are now filled with land mines of questions that may have answers or no answers, all of which threaten to blow up the carefully planned journeys.

All of the above information suggests that we need all the help we can get to navigate through uncharted waters. That brings us to the final discussion in this series—what are the Five Questions we need to know and answer to have a successful personal and professional writing career? Join me for the final discussion soon.

Timing is Your Time’s Best Friend: Calendar Management for the Soon-To-Be-Published Author

By Roger Johns and Kim Conrey

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If you’ve been through the book publication process, you know the demands of publication and promotion can be ferocious time eaters. If you’re a soon-to-be-published author, about to go through this process for the first time, the magnitude of these time demands can be difficult to anticipate. So, it’s important to know what this process will look like, ahead of time, so you can manage your time and your calendar more effectively. The last thing you want is for the joyous occasion of your book’s upcoming emergence into the world to be plagued by stress and anxiety because you’ve gotten stuck in the mire of constantly playing catchup, or because things aren’t happening at the pace you expected them to.

An important set of tactics to keep this from happening is to make it a priority to acquire advance knowledge of: (1) the demands the book production process will place upon you, (2) the opportunities publication will make available to you, (3) how to properly plan for what’s coming so you can stay ahead of the game, and (4) when you should begin the various tasks that contribute to your book’s success.

As with all complex endeavors that are not completely under your control, the schedules and demands of others will have to be considered and, to some extent, catered to. This means you will need to know who and what you will encounter on the road ahead, what their role is, and how they view your role in the process. Experience tells us that what you do, and when you do it—especially during the busy months preceding launch—can have an outsized impact on the success of your promotional efforts in the critical months immediately following publication. So, it pays to understand the timeframes during which certain undertakings need to be started, because when you begin can be as or more important than what you begin. In this context, timing is your time’s best friend.

Demands of the Book Production Process

If you have just signed your first contract to become a traditionally published author, you should expect your manuscript to undergo a fairly rigorous, multi-part editing process—a process in which you will play a significant part. Depending on your publisher, the condition of your manuscript, and your editor’s inclinations, this can include story edits, copy edits, and proofing edits. All of these must be done with care, and completed and returned on time. So, ask your publishing house editor what’s coming and how much time you’ll have to complete and return your responses. If your editor wants a lot of story edits, this can take quite a while to do properly because changes to one part of a manuscript often require changes to other parts. And, obviously, the longer your book, the longer all phases of the editing process can take. Knowing, ahead of time, what’s expected of you, will allow you to plan these tasks into your personal and professional life.

In addition to the editing process, you will need to provide input on cover images, gather blurbs from other authors, produce some of what’s known as front matter and back matter (i.e., dedication and acknowledgements), and provide an adequate headshot, and you may be asked to weigh in on (or craft entirely) the jacket/flap copy. All of these tasks can be loads of fun, but they all take time, and they all come with deadlines, so they need to be planned for. Missing an editing or production deadline is not a recipe for success in the publishing world. And starting late in the process of soliciting blurbs from other authors can leave you with less than you had hoped for, in terms of quality and quantity. Authors who agree to furnish a blurb will need a copy early enough to do a good job for you. This is especially true if you are self-publishing your book. Publishing houses have established timelines for prompting authors to solicit blurbs. If you’re self-publishing, you’ll need to initiate this process yourself.

If you have just made the decision to self-publish, you’ll need to plan other activities even further ahead, as well. The fantastic editor you’ve hired who took only weeks to get edits back before, may be playing catch up when your manuscript hits their inbox, and the same goes for your cover designer. A mantra for any author, especially the self-published author, is, everything takes longer than you think it will. If this is your first attempt at self-publishing, you may be shocked to find that it can take Ingram Book Company, the largest book wholesale distributor in the world, several weeks to load your book’s meta data onto Amazon and other retailers. So, if your goal was to get as many print preorders as possible, you’ll need to have your book ready to go months before your official publication date. Take it from droves of authors who’ve checked book retailer websites every morning for weeks looking for their book’s cover only to find the dreaded “No Image Available” icon. This can be heartbreaking for an author who was planning a huge preorder push, and there will be nothing you can do but wait for the data to load. No amount of begging customer service will help. You are one of thousands of authors waiting on the same thing. If eBook sales are your only goal, you will have more time, but if you do not have your eBook loaded in time for preorders to be delivered, Amazon can suspend you from selling an eBook on their site for a solid year. It is crucial to plan for the unexpected. Whatever you think your timeline is, double it at the very least.

And…while all this is going on—whichever way you choose to publish—you’ll need to do your part in the increasingly challenging process of book promotion. It’s tempting to think that, if you’ve signed with a traditional publisher, especially a big one, that all of that “promo stuff” will be taken care of by the sales and marketing and publicity folks at your publishing house. Sorry, unless you’re one of the biggest of the bigtime authors, things are unlikely to work out that way. Regardless of whether you’re about to be traditionally- or self-published, you’re going to have to do your part. And, unless you’re a celebrity author, with high brand recognition, “doing your part” means building demand for your book before it becomes available for purchase, by: (1) establishing a social media presence, (2) lining up appearances at bookstores, local author-oriented events, conferences, conventions, book clubs, and other venues, (3) developing or joining a blog or a podcast, (4) creating posts for blogs hosted by others, and (5) becoming involved in professional organizations dedicated to the type of book you’ve written. 

And…while all this is going on, you’ll need to be writing your next book.

Opportunities Publication Will Make Available to You

Being a published author is a big deal. It’s true that millions of books are published in this country every year, but it’s also true that hundreds of millions of people live here. By publishing a book you have accomplished an amazingly rare feat. And a fascinating one, as well. The reading public shows a strong interest in knowing about the writers of the books they read. Because of this, there are dozens of regularly scheduled (and undoubtedly thousands of individually arranged) events around the country, every year, at which authors and their readers gather for the purposes of getting to know each other and finding new authors to read. This means published authors will have opportunities to get in front of the reading public in ways that are generally unavailable to others—including appearances at conventions, conferences, bookstores, local author events, blogs, podcasts, libraries, and book clubs.

Availing yourself of these opportunities takes time, research, and determination and can require special knowledge. For instance, if you’re interested in lining up bookstore or local author event appearances on, or shortly after, your launch date, you’ll need to know how far in advance their schedule is booked, and approach them early enough to be considered for a spot. The most desirable venues often have crowded event calendars that are fully booked long into the future, so you’ll need to give them plenty of lead time. The same goes for blogs and podcasts hosted by others. And conferences, conventions, and book and literary fairs and festivals have specified registration periods that must be adhered to. And because not all venues will be receptive to your pitch, it’s possible you’ll need to over-develop your list of target opportunities, and make contact with enough of them early on to have a useful understanding of what’s going to work out and what’s not.

If you intend to create your own blog or podcast, you will need to start long before launch day, so you can establish your presence and build a readership or listenership. These activities can be difficult and time-consuming, and the more tech-challenged you are, the more difficult and time-consuming they become. However, there are lots of good books and web resources that can advise you on how to set these projects in motion.

Planning (to Stay Ahead of the Game), and Knowing When to Begin

It bears repeating that all of these tasks take time—sometimes lots of it. Many of them will need to be in process or fully in place well before launch day, so that a steady stream of promotional efforts is bearing fruit in the critical weeks and months immediately following publication. To make this work, it’s helpful to view your publication day as the midpoint on a timeline that begins the day you either sign your publication contract or decide to self-publish and continues for several months after your book becomes available.

The critical take-away is to develop a list of the obligations you will need to fulfill and the dates by which you will need to fulfill them, as well as a list of the opportunities you wish to pursue, along with the dates you’d like to avail yourself of them, and then place all of these on a timeline so you can literally see what the future will look like.

So you can have a clear understanding of when to begin each of the obligations and opportunities on your timeline, think of them in terms of lead time—the period between when you begin a process and when its purpose is achieved, and mark the start dates on your timeline as well. Then develop checklists for the specific tasks associated with each item on your calendar, indicating what needs to be done, by when, and by whom. This will allow you to measure your progress and to avoid getting blindsided by matters you should have or could have known about. In other words, give your book and your writing career every chance for success by creating a detailed map of the road ahead, so you can handle things like a pro.

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ROGER JOHNS is the author of Dark River Rising and River of Secrets, from St. Martin’s Press, as well as numerous short stories published by, among others, Saturday Evening Post, Alfred Hitchcock’s Mystery Magazine, Mystery Weekly Magazine, and Black Beacon Books. He is the 2018 Georgia Author of the Year for mystery, and a two-time finalist for the Killer Nashville Silver Falchion Award. Since 2016, Roger has made over 140 live appearances across the country, at conferences, conventions, bookstores, libraries, book clubs, corporate events, writing clubs, continuing education classes and other writing-oriented venues, as well as on podcasts, web radio, and broadcast radio. He has also made, and continues to make, frequent invited presentations on writing and career management for new authors, and his articles and essays on these topics have appeared in, among other publications, Southern Writers Magazine, Career Authors, and Southern Literary Review. 

KIM CONREY is the Georgia Author of the Year recipient in the romance category for Stealing Ares, traditionally published by Black Rose Writing and Losing Ares, the follow up. Her urban fantasy Nicholas Eternal was published in June 2023, and her memoir You’re Not a Murderer: You Just Have Harm OCD, which she co-wrote with her adult child, was released in October of 2023. Her work has also been published by numerous magazines and literary journals and received awards. She serves as VP of Operations for the Atlanta Writers Club and podcasts about writing with the Wild Women Who Write. She gives book marketing talks and speaks on various topics relating to writing at local and regional writing conferences and literary festivals.

TOGETHER, Kim and Roger co-author “If You Only Have An Hour: Time-Saving Tips & Tricks For Managing Your Writing Career” the quarterly advice column in "Page Turner", the magazine of the Georgia Writers Museum and the Atlanta Writers Club.