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.

Healthy Living Practices for Writers #3: Lower Cross Syndrome

By Mary Lynn Cloghesy and Jason Schembri

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It creeps behind you and lays in wait while you work, unnoticed. By the time you sense it, it’s too late. Your knees will go weak, nerves will fire down your back, and legs will crumple, making it hard to stand, once it has you in its grip. If it hasn’t crippled you, it will make escape difficult, if not impossible. Make no mistake: it’s coming for you. Is this a villain in my latest thriller, or an anti-hero targeting the writing community? No, it’s Lower Cross Syndrome (LCS), and it’s on the rise. A recent study revealed that Americans now sit for about 9.5 hours per day, a significant increase over the past fifty years. This condition is associated with accelerated aging and higher incidents of heart disease.

As if that weren’t bad enough, a whopping 80% of adults will suffer low back pain at some point in their lives, and scientific evidence suggests the condition will become chronic in 50-80% of confirmed cases. Worse yet, LCS is associated with a band of thugs that can do a lot of damage: knee injuries increase by 20-30%, sciatic nerve irritation affects 40% of people with LCS, and overall movement is reduced by 30-40%. So, how are we, as writers, supposed to combat such a formidable foe—especially since our primary occupational hazard is the amount of time we sit to write?

First, we need to shine a light on the issue, to understand what it is and how to prevent it; next, we need to make a plan, because if it’s not a problem now, it’s only a matter of time.

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

Lower Cross Syndrome is a postural pathology caused by muscular imbalances in the lower body, particularly the pelvis and lumbar (or lower) spine. It occurs when certain muscle groups become tight and overactive, while others become weak and underactive to compensate, leading to a characteristic pattern of dysfunction. Because the sacrum, or the triangular bone at the base of the spine, sits inside the pelvis and connects to the hips, its attachment points are negatively impacted as well. Here are the common causes:

• Prolonged sitting or poor posture

• Sedentary lifestyle

• Weak core muscles

• Overuse of certain muscle groups (e.g., tight hip flexors in athletes )

Why should you care? 

There are many reasons to care about LCS that not only relate to the troubling statistics regarding the number of individuals affected by it, but also to its harmful secondary conditions that can be multi-faceted and hard to diagnose. For example, Drop Toe (or Foot Drop) is a result of SI (sacroiliac) joint dysfunction, which is rooted in LCS. It isn’t just a posture problem—it’s a silent disruptor of daily life. 

If left unchecked, LCS can lead to chronic lower back pain, tight hips, poor mobility, and other preventable ailments. For anyone who spends long hours sitting—especially writers—LCS can gradually weaken core muscles and overwork the lower back, increasing the risk of injury and discomfort. Beyond the physical strain, it also affects energy levels, focus, and overall well-being. 

Here are the symptoms of LCS:

• A throbbing or stiff lower back

• Nerve pain that shoots down the leg

• Anterior pelvic tilt (excessive forward tilt)

• Weak core stability

• Dysfunction of the L5/S1 joint (where the flexible part of the spine meets the fused part)

• Tightness in the hip flexors and hamstrings

• Restricted or poor movement patterns in activities like squatting or running

For those scientists among us, here are the specific muscles involved in LCS:

• Tight/Overactive Muscles:

• Hip flexors (e.g., iliopsoas, rectus femoris)

• Lower back muscles (e.g., erector spinae)

• Weak/Inhibited Muscles:

• Abdominal muscles (e.g., transverse abdominis, rectus abdominis)

• Gluteal muscles (e.g., gluteus maximus, gluteus medius)

What can you do about it?

The good news? With proper awareness, movement, and targeted exercises, LCS can be managed, allowing you to move freely and live pain-free. Most, if not all, of us will face this culprit at some point in our lives, but don’t despair, taking proactive steps to address the muscle imbalances in LCS can make a significant difference. Whether you are suffering from LCS, or taking preventative action, the key lies in strengthening weakened muscles, particularly in the core and glutes, while loosening tight muscles, such as the hip flexors and lower back. 

It’s important to incorporate exercises into your routine that target these areas, take movement breaks, and increase your awareness of what’s happening to your body as you write. Depending on the extent of the condition, meaning how your joints, ligaments, and muscles have been transformed by LCS, various treatment modalities may be necessary to relieve tension and disrupt pain cycles. 

Some individuals may require medical intervention in the form of surgery, or other treatment programs, so if you have advanced LCS, please consult a physician. For the majority of writers, who are not afflicted by advanced LCS, whether you opt for self-care techniques or professional support, consistency is crucial. Here are some solutions to consider:

• Physical Therapy or Chiropractic Care

• A physical therapist or chiropractor can design a program tailored to your specific needs, focusing on alignment and muscle strength.

• Massage or Fascial Therapy

• Deep tissue and/or trigger point massage can help release tension in the lower back and hips. Fascial therapy is a manual modality that targets tight or scarred connective tissue.

• Yoga or Pilates

• These movement systems focus on both flexibility and strength, helping to balance the muscles that are overactive and underactive in LCS.

• Tool Facilitated Stretching and Foam Rolling

• A variety of tools are available to help reset the muscles, focusing on lengthening tight hip flexors, quads, and lower back muscles. For example, Gaiam Restore Back Stretch.

• Use a foam roller to release tension in the glutes and hamstrings. A tennis ball works too.

• Personal Training and/or Strengthening Exercises

• Personal trainers will identify movement patterns and areas of concern that you might not be aware of. 

• Glute bridges, squats, and deadlifts can help activate and strengthen the glutes and core. Planks and pelvic tilts strengthen the abdominal muscles and lower back. There are many online videos that can help you create a home-based practice.

• Postural and Ergonomic Awareness

• Maintain a neutral spine while sitting or standing to avoid exacerbating muscle imbalances. Also, consider a standing desk or a chair designed to accommodate different sitting positions, such as the Pipersong Meditation Chair.

• Consider ergonomic adjustments to your workspace to promote better posture.

Healthy Living Top Tip

Our top healthy living tip for this edition: support equals release. 

As mentioned in our previous article on Upper Cross Syndrome, do not to pull on tight muscles. You’ll likely do more damage than good as “stuck” muscles need to be coaxed to move, or they can tear at the attachment points. Your body will begin to let go when you give it the support it needs to feel safe enough to do so — not a bad metaphor for life. 

For example, if you have been sitting to write for three hours or more, stop and put your legs up the wall (ONLY if you DON’T have a heart condition, high blood pressure, a lower body hernia, or Glaucoma, of course). Slide your pelvis back at least twelve inches, so that your hamstrings are soft. (note: only those who stretch often will benefit from keeping their pelvis next to the wall, as the angle is too steep for most folks.) Allow the blood flow to reverse by keeping your feet above your head, then start to pump the calves, as they are the “heart” of the lower body, returning blood to the heart. 

By using the floor to support your entire torso, then positioning your legs so they lean into the hip sockets, you’re providing maximum support. The muscles in the pelvis will start to release, and the spine will lengthen too.  

LCS is a scary condition but do not fear, tireless writers. Arm yourself with knowledge and a strategy, and you’ll be slaying that scoundrel in no time.

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Authors: Mary Lynn Cloghesy & Jason Schembri. Mary Lynn formerly co-owned a therapeutic clinic, and Jason is a long-term weight loss and healthy living coach. Together, they host a writing and hiking retreat in the Canadian Rockies.