Tuesday, April 26, 2016

Artists and Repetitive Strain Injury (RSI)

Too many artists suffer from repetitive strain injuries (RSI). In addition, too many artists know too little about:
  • how to avoid RSI
  • how best to deal with RSI
Too often, health and safety issues for artists relate purely to hazards associated with art materials. In my opinion, there is far too little focus on the hazards that certain working practices can have on your anatomy.

This post looks at what is RSI, why artists gets it; how to make it worse and how to make life more tolerable if you get it - and hopefully recover from it.

At the end there are some references to other websites where artists talk about the impact of RSI.

What is RSI?


RSI stands for repetitive strain injury.

RSI is an umbrella term for a range of muscular skeletal disorders rather than a condition.  It's a general term used to describe a related set of problems associated with a variety of very specific injuries or disorders affecting muscles and/or tendons and/or other soft tissue which have very specific names.
  • Type 1 RSI relates to a specific disorder which a doctor can diagnose. These have recognised treatments.
  • Type 2 RSI is a more generalised disorder where diagnosis in terms of a specific condition is more difficult.

RSI for Artists generally afflicts some part of the arm - the fingers, wrist, forearm, elbow, shoulders - and can also affect the neck and/or upper back.

RSI Symptoms include:
  • intense pain
  • dull aching or tenderness
  • stiffness
  • throbbing
  • burning
  • tingling 
  • numbness
  • swelling
  • weakness / reduced dexterity
  • cramp
  • inability to grip or lift

Dealing with the intensity of the symptoms can make people very tired.

My particular version of RSI is called tenosynovitis - see NHS page on Tendonitis and other tendon injuries. It runs from the index finger of my right (drawing) hand across the back of my hand, across my wrist, around the back of my forearm into my elbow and then up my arm. I have a semi-permanent swelling on the back of my hand below the index finger knuckle which is where the injury is particularly bad.

The practical impact is:
  • I can't grip anything in my right hand either tightly or for too long. 
  • I can only draw using certain techniques eg hatching is very easy; drawing small changes in line very precisely is not
  • I can't use my right hand continuously for too long - I need to take lots of short breaks
  • I must use a soft keyboard. I'm completely unable to use a keyboard which has any vibration as I'm in agony very quickly if I do.
  • Sometimes I have to wear a brace which maintains my palm and wrist in one position - but allows me to flex my fingers
My new wrist splint - the last one was very well used!
On the whole I need this less now as I'm much better at protecting myself
(Note: I'm not going to try and describe all the conditions in this post - however I am going to link to decent websites which do provide more authoritative information)

Other common RSI or RSI related conditions


I've referenced the relevant NHS information site which provides an introduction and information about causes, symptoms and treatment
  • Bursitis / Tennis elbow: The sac of fluid around a joint is injured due to a spain or irritated due to overuse /repetitive strain. This leads to swelling. See NHS Choices - Bursitis
  • Carpal Tunnel Syndrome:  This is where the Median Nerve which passes through the wrist becomes irritated. Symptoms include tingling, numbness and pain of the thumb and/or index finger, middle finger or third finger. Dexterity becomes reduced. See NHS Choices: Carpal Tunnel Syndrome
  • Dupuytren's contracture: This condition causes the hand to close - with fingers being towards the palm of your hand See  NHS - Dupuytren's Contracture
  • Ganglion - a fluid-filled lump or nodule can be caused by repetitive strain. They often develop on the wrist. See NHS - Ganglion cyst
  • Epicondylitis – inflammation of the area where bone and tendon join, such as the elbow. It causes pain and tenderness on the outside of your elbow and pain when twisting or lifting or bending. See NHS - Tennis Elbow (lateral epicondylitis)
  • Shoulder Pain eg Rotator Cuff disorder (which I experienced recently) - Normal movement is reduced and painful. Inability to lift or twist the arm. See NHS - Shoulder pain
Other conditions which can also be related or affected include:
  • Osteoarthritis - the most common form of arthritis which often affects the small joints of the hand. Symptoms include joint pain or tenderness. There is no cure but you can reduce its impact and treat symptoms. See NHS - Osteoarthritis
  • Rheumatoid arthritis - an auto immune disease which damages tendons, cartilage and bone. Symptoms involve throbbing, stiffness and pain. See NHS Rheumatoid arthritis

How do artists get repetitive strain injury?


Artists get RSI for the same sorts of reasons that other people with vocational activities get RSI.

The most common reasons for RSI injuries are:
  • repetitive strain - overuse of the muscles / tendons in a way which is continued
  • poor posture and/or holding the same posture for too long without a break
  • working for too long without a break
  • poor and/or cold working working environment
  • use of tools which require force or can cause a strain
  • vibration of tools held or used
Basically if you exhibit bad posture and keep using the same muscle groups over and over again, day after day for long periods
  • sooner or later you will find that you start to get aches and pains; 
  • those aches and pains will in due course become more painful; 
  • if the tendons or tissue becomes inflamed and/or if the nerve(s) become involved you will experience intense pain;
  • if you continue and don't take appropriate action you may experience paralysis and/or a total inability to perform normal functions.
The other most common reason is that artists don't get enough education in why certain working practices make them a "sitting duck" for RSI.

You may also be predisposed (like me) to problems if you have a connective tissue disorder.

How do artists make RSI worse?


This is easy.
  • Continue to do whatever created the problem in the first place.
  • Fail to rest
  • Fail to consult a doctor
  • Fail to follow any professional advice
  • Fail to use appropriate supports or exercises

Caution!


Tendons can take some time to recover if you continually provoke them. You could experience intense pain and be out of action for months.

If an artist continues to do whatever started the RSI problem in the first place, the chances are that he or she may end up totally unable to make art.

You may also struggle with activities of daily living or any alternative way of making a living.

How do artists alleviate RSI symptoms - and make art?


It depends on:
  • what the condition is
  • what your doctor advises
  • what your physio advises

Be sure to get professional advice as to the best treatment and different ways of working.

Below are some of the common ways people find to avoid and/or address RSI.

Minimise symptoms


The best way to minimise symptoms is to eliminate the contributing factors:
  • within your working environment
  • due to your working practices

The different ways of doing this are described below.

Rest and Exercise!


Your first priority is to REST. You have to STOP doing whatever caused the problem.

In terms of returning to work and carrying on you MUST:
  • take regular short breaks
  • make sure you have lengthy breaks from time to time
Break up long periods of sitting time with short bouts of activity and exercise.  Every 30 minutes stop for just one to two minutes. You can get up and walk around and stretch your arms and hands above your head or windmill your arms.  Make the blood flow!

Regular exercise can also help. Some find swimming helps. I know an artist who always takes a walk - and swings his arms - before starting work.

Posture and Practical Habits


Make sure that you use the best posture possible for however you make your art. In very simple terms this means:
  • maintaining a straight back 
  • keeping your neck straight and your head up
  • avoiding the potential for cramping any muscle groups.
Computer Workstation Variables cleanup
Image of how to sit at a computer
- many of the principles also apply to artists
This is how to sit correctly.
  • Your chair needs to support you sitting with a straight back
  • if you are drawing or painting a still life or some other object, your subject matter should ideally be on your eye level when you have a straight back with head up and neck straight. This means raising subjects up and finding equipment which allows you to do this e.g. a clamp or plinth.
  • all the materials and equipment you need to use are in front of you and within easy reach (i.e. does not involve frequent and repetitive twisting or turning)

It also means promoting freedom of movement in your arm, elbow, wrist and hand.

You want to find ways to AVOID cramping of muscles / tendons / nerves through:
  • holding pencils / pens / brushes too tight or for too long
  • making very small movements continuously for too long
Probably the most important thing is to take regular breaks.  Stopping what you do and the way you work and giving your body a rest is the most important contribution you can make. Using your arms and hands for different activities also helps. You can do housework in 10 minutes slots!

The next most important thing you can do is stretch and exercise in ways that a physiotherapist says will help you.

Review working practices and environment


Work out how you can minimise or eliminate the work practices which caused your condition

Ask yourself if you can change
  • how you sit e.g.
    • get a chair which is adjustable. My Aeron Chair has adjustable arm supports which I find very helpful
    • change to working standing up - using a height adjustable desk (IKEA fans will be pleased to know they also stock height adjustable desks)
    • raise the height of your desk or table (I've got mine on blocks) so that you maintain your elbow at 90 degrees and your wrist is straight
    • buy a chair which enables you to work with a better posture
  • the angle of your working surface used for drawing and painting 
    • change the angle e.g. 45 degrees 
    • change the height of your working surface to reduce strain e.g. work vertically
  • how you hold a pencil/pen/brush
  • how you rest your arm or wrist
  • the elevation of the subject matter you are observing eg raise to eye level
    • use a clamp
    • place your subject on top of a box or anything which raises it up
  • the temperature of your environment. Avoid working in a cold environment. Warmth has a beneficial effect on muscles and tendons prior to use and is one one of the best ways of avoiding problems. Athletes warm up before taking exercise for a very good reason. Keep your hands warm!

Medication


Your doctor can provide medication to reduce inflammation - however this takes time to work. Finding the right medication and the dosage which both works effectively and is safe to take can also be problematical.  The main thing is to avoid overdosing and creating another problem.

Non-steroidal anti-inflammatories are the usual medication of choice. Some of these are available over the counter (eg Ibuprofen) and some are prescription only.

Modifiers and tools


Use specially designed tools which can help you to cope and exercise to get better.

The easiest way to make it possible for you to hold a brush or a pencil is to enlarge the dimensions of what you hold.

Foam grips for pencils and brushes
Pencil Grip Tools can be used to make a pencil or brush wider and easier to hold. These include:
  • a pencil grip - this was what my Physio recommended to me when I first got tenosynovitis and the pain was intense.  They are made of moulded soft plastic and are triangular shape - and fit around a pen or pencil or brush  The net effect is they create a much bigger gripping surface. They made a big difference to the ease of holding a slim cylinder like a pencil or brush. These are other Pen and pencil holders and grips
  • foam tubing - also achieves the same effect and can come in different sizes.  One artist has identified that foam pipe insulation achieves the same solution.
Drawing Boards on an angle help some people.

You can employ arm rests and wrist rests when you stop work to maintain a good position for your arm or wrist

Stretching bands can help with stretching exercises involving resistance - the different colours denote different levels of resistance. However if you have RSI you need professional advice as to what type of exercise is appropriate to you.

I found stretching bands to be very useful to the exercises I was given recently by my Physio for problems with intense pain and very limited movement in my shoulder.

Braces and Supports


When RSI gets very bad you you may well need additional support from a splint or brace.

A brace can help relieve pain and prevent it getting worse.  Its design depends on which part of the anatomy it is supporting and what it is required to do.

Splints are often recommended for people with carpal tunnel problems

For some people with hand problems something like tubigrip - which you can get at a chemist - may do the job. If you're wearing it a lot look for a properly designed elasticated support for whichever bit of you needs to be supported

A wrist brace with a metal palmar support is very effective at keeping your wrist in a neutral position - open rather than cramped. More artists use one than talk about it! You can see what my wrist brace looks like at the top of this post.

It is very important that you are measured properly and use a correctly sized support or splint or you may make matters worse. Reputable suppliers tend to supply anatomical braces in different sizes and ask you to measure yourself.

Elastic support brace with a metal splint
You can review different options for wrist braces and supports:
  • Ossurwebshop - Thumb and Wrist Supports (a reputable supplier who retails quality products which work well). I can certainly recommend their speedy processing and delivery of an order.
  • Amazon - Hand and wrist braces - tends to involve braces and supports of variable quality. I recommend you read the user reviews.
  • This is a wrist brace like mine - it's made of neoprene which provides compression (which reduces swelling) and includes an anatomically designed metal brace which crosses your wrist from the underside of your forearm to the palm of your hand. The brace keeps your wrist and hand in a fixed and open position.
Compression gloves
You can also get gloves which compress and keep hands warm which help with arthritis

If things get really bad you may find you need an immobiliser for your whole arm.

[Note: you may have a device recommended to you. However sometimes it takes a bit of time to get to see somebody who can provide that professional advice. In the meantime reading up on what is available and ordering online can mean you can reduce your pain and/or swelling to something more tolerable - as I had to do with my knee 10 days ago!]

More about RSI and Artists


8 comments:

njart73 said...

I was wondering why being right handed that when I paint after a while my left shoulder starts to "lock up". I have to sit while painting and I find that a portable stool provides the better seating option given the size of my painting area. I am going to taken into consideration your suggestions about dealing with RSI.

Katherine Tyrrell said...

If you regularly suffer any pain while drawing or painting for a long time
1) Don't ignore it - it might get worse
2) Get professional advice - you might regret it otherwise

theartistsday said...

Thank you Katherine. Nobody ever talks about this. The best advice is to stop doing what hurts but you feel a wimp for not working through the pain. I had to completely change the way I worked because of a frozen shoulder.

Katherine Tyrrell said...

It's so much better to feel like a wimp then to feel like a complete fool for subsequently suffering the very severe consequences of ignoring the pain.

Don't let anybody ever tell you that it's 'normal' to experience pain when this is something that can be eliminated by changing working practices or using mechanical supports - or just taking a regular break!

Unknown said...

My hand and arm problems are related to something that isn't RSI, however I'm sure my experiences are very similar; I can't use touch screen devices for example, and any precise drawing / painting work is out of the question, too painful. IN fact my right hand and wrist are in carrying degrees of pain quite a lot.

As computer mice are impossible for me to use, I use a tracker ball, which, for me, helps a lot.

I'm currently learning to use my left hand more to 'spread the load'. For example, to use my tracker ball mouse left handed. And to do some drawing / shading / smudging left handed. Hard to adjust, but if I set myself simple and short objectives, over time it starts to make sense.

And routine jobs such as holding a cup of tea with my left hand. All these things give my right hand a bit of a rest, and it helps.

Wish you all the best as you continue to sort it out; great post by the way too.

David J Teter said...

Thanks Katherine,
You did a good job covering an issue that most might not think about until some sort of pain sets in. Really important are the preventative measures to maximize the chances you never develop problems. I had my wake up call a few years back with a pinched nerve in my upper back and was out for 2-3 weeks as I could not raise my painting arm.
Too many hours at the easel swinging and lifting my arm in the same way for years.

I went and saw a sports doctor, one familiar with repetitive motion disorders and injuries. He recommended the same advice. Take breaks often whether you think you need it or not, don't wait to do it when you start feeling the pain.
He also recommended various stretching and exercises which I do as well.
Preventative measures should be taken seriously.

And on the pencil brush grips. YES. I do a lot of small intricate work and thin handles on brushes especially are a problem with fatigue. Take fatigue seriously too. It serves as a warning.
Incidentally the triangle ones I have used on my exacto knives for years since they prevent them from rolling.

Here is another similar post on this issue:
http://muddycolors.blogspot.com/2015/07/sit-stand-desk.html

MindMyMind said...

I had really bad pain, but found the most amazing gloves from Canada (I'm UK). They look like black wooly gloves but have made a hige difference. I wear them for driving, artwork, and even overnight in bed when necessary. The pain disappears really quickly. I'd tried everthing - splints included.

L.S. King said...

Thanks, Katherine. Your words are really helpful and come at a great time. I'm taking a drawing class and have noticed some minor pain in my wrist. Your words serve as a powerful tool to change my habits now.

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