Repetitive Strain Injuries (RSIs) and How to Avoid Them

By Mary Lynn Cloghesy and Jason Schembri

---

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.

Upper Cross Syndrome: What is it? Why should you care?

By Mary Lynn Cloghesy & Jason Schembri

---

One indisputable truth about writers is that we all sit for long periods of time. Whether you are putting pen to paper or punching keys on a laptop, writers spend hours at their desks. Recent research has shown that part-time writers average 10-15 hours per week, whereas full-time writers range between 21-42 hours per week, with high-output periods reaching 12 hours per day. Regardless of the level of output, the body works hard to accommodate your demands. One way in which the body responds to long periods of focused effort is to adjust to the biomechanical forces on the musculoskeletal system. Can you imagine how difficult it would be to get any work done if you had to think about holding up your head and setting your shoulders to protect your neck while writing? The body is quick to adapt to your working conditions and expectations, yet what seems to be a simple solution can have negative, long-term consequences. As such, starting this month, we are writing a series of articles on the most common conditions affecting writers and offering healthy living advice on what to do about it. We’ll start with one of the most pervasive: Upper Cross Syndrome.

What is Upper Cross Syndrome (UCS)?

UCS is a muscular imbalance in the upper back, neck, and shoulders caused by poor posture over an extended period of time, like when writers sit and slouch for hours. It results in dropped or rounded shoulders, a forward head position, and an exaggerated curvature of the spine in the neck and upper back. If you think about the body as an interconnected system, then the muscles at the top and mid section of your back and the deep flexors in your neck become weaker as the front body muscles work hard to stabilize your position as you naturally lean forward to write. The pectoral or chest muscles and anterior neck muscles shorten due to the strain, which can cause pain and dysfunction, as well as reduce your range of motion. The name “Upper Cross” comes from the pattern where the spine is pulled forward and compressed over time. See the image below: 

Why should you care?

UCS is associated with a variety of pathologies that can affect a writer, many of which cause discomfort or worse. Is there any greater distraction than pain? Here is one example of how UCS can affect you: did you know that every inch forward for your head posture adds 10-12 pounds of pressure on the spine? If you’re wondering whether your head is forward, a simple test is to put the back of your heels and buttocks against the wall and see if you head touches too. Don’t force it. If not, you can start to bring awareness to the condition to remedy it. Head forward position is linked to TMJ pain (temporomandibular or jaw pain), headaches, chronic neck conditions, weak respiratory muscles, and stability and balance issues, among other things. Here is a quick list of the reasons to care about UCS:

• Postural Strain and Discomfort:

  • Writers often adopt a slouched posture over laptops or desks for extended periods. The fascial system (connective tissue throughout the body) can lock in these dysfunctional patterns, which leads to further impairment over time.

  • This posture tightens the pectoral muscles and neck extensors while weakening the rhomboids and trapezius, causing chronic pain in the neck, shoulders, and upper back.

• Decreased Energy and Focus:

  • Poor posture reduces lung capacity and restricts airflow, leading to fatigue.

  • Chronic discomfort or pain can distract writers, reducing productivity and focus.

• Carpal Tunnel Syndrome Risk:

  • Rounded shoulders and forward head posture can compress nerves leading to the hands, exacerbating risks of carpal tunnel syndrome or other repetitive strain injuries.

  • Alternatively, numbness in the hands due to nerve impingement can make it difficult to hold a pen or type, let alone write for long periods of time.

• Headaches and Eye Strain:

  • UCS frequently causes tension headaches due to overactive neck muscles and occipitals.

  • The forward posture often results in additional strain on the eyes and headaches due to misalignment with screens or documents, decreasing working time.

• Impact on Mood:

  • Research indicates that poor posture can negatively affect mood and increase stress levels, potentially influencing creativity and writing output.

What can you do about it?

Most writers suffer from, or are at risk of developing UCS, but there are a number of readily available solutions, some of which you can do at home. First, let’s consider professional intervention, then we’ll look at other options. All physiotherapists and RMT’s (Registered Massage Therapists), will be trained in treating UCS. Costs range from $75 to $150 per consult for an initial assessment, with follow-up appointments potentially at a reduced rate. It’s important to understand any treatment won’t be a “quick fix,” as UCS is a condition associated with habitual movements (or lack thereof) which affect the fascial system or connective tissue throughout the body, which is stronger than muscle. An investment of time and financial resources will be required but ask yourself, what is your health worth? Also, most insurance companies cover this type of treatment. Chiropractic, Fascial Stretch Therapy, and other modalities can help as well. 

If you want to make a smaller investment, then home-based exercise tools and equipment can be beneficial, such as an inversion table (just to hang out), foam rollers, resistance bands, and/or any number of ergonomic aids. There are many health practitioners who offer online subscription services to support your learning with regard to regular movements that target the imbalances of UCS. There are simple protocols that can be incorporated into your workday. While posture braces and other similar tools are marketed as solutions as well, we doubt the efficacy as these devices will not be strong enough to counteract the hours you’ll be writing, when you won’t be thinking about your device or how to work with it. Lastly, here is a list of suggestions that you can try at home: 

• Ergonomic Workspace:

  • Adjust desk and chair height so the top half of the screen is at eye level and your back is fully supported. Change your desk or chair if necessary.

  • Use an ergonomic keyboard and mouse to reduce strain on the wrists and shoulders. There are also desks that raise to standing, and chairs designed for multiple seated positions. 

• Frequent Movement:

  • Take breaks every 30-60 minutes to stretch and move, helping alleviate muscle tightness. One simple trick: stretch your arms overhead and rise up on your tiptoes. This will reenergize you and lengthen your upper spine.

  • Incorporate stretches that target the chest and strengthen the upper back into your breaks from writing. You can learn simple protocols from online practitioners by searching for UCS programs.

• Postural Exercises:

  • Perform exercises like scapular squeezes, chin tucks, and wall angels to strengthen weak muscles and promote correct posture.

  • Practice yoga, Pilates, or something similar, which emphasizes alignment and flexibility.

• Mindfulness and Body Awareness:

• Writers can practice mindfulness or body scanning to become more aware of their posture while writing.

• Ask yourself if you need to make adjustments to your seated posture throughout the day or stand to write, using talk to text for a while.

Healthy Living Top Tip

While most writers will experience some version of UCS, even if it is only short-lived upper back and neck tension, one healthy living practice that will benefit all writers is to add more movements into your day as the hours at your desk increase. Also, do not pull on tight muscles. You need to coax them to flex and stretch, or you run the risk of causing tearing at the insertion points. Think of muscular movement like the flow of water. If you allow the body to respond, it will become more fluid. 

When we became full-time writers, we realized that the only way to be productive was to stay fit, so we began counter-balancing much longer periods of time writing with more time in the gym, running, building muscle, and stretching. Consider the time you spend on supporting your body similar to the investment you make in learning the craft: you need growing knowledge of and active engagement with both to cross the finish line. For UCS in particular, head and neck strain can lead to chronic inflammation and reduced energy due to restriction of lung capacity. When muscles are locked down, your vitality decreases. Writers can only keep doing what they love when they are healthy. If you love to write, learn about UCS and how to prevent it before it becomes problematic. Your writing and readers will thank you for it. 

---

 Mary Lynn Cloghesy is the founder of the Leadership Literary Lab (https://leadershipliterarylab.com), and Jason Schembri is a long-term weight loss specialist (https://jasonschembri.coach) Together, they host a luxury writing retreat in the Canadian Rockies.