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How to Avoid and Treat RSI When You Work From the Road

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Choosing to work from the road brings many benefits, including freedom, flexibility, and a much better view than most cubicles will ever have. For many such workers, though, it also provides something far less enjoyable: recurring pain, discomfort, and injury.

We recently sat down for a lengthy discussion with Dr Gregory Soltanoff, a chiropractor and musculoskeletal and workplace injury specialist, about one of the ugly secrets of life as a digital nomad.

Dr Greg, one of the aspects of working from the road that gets very little coverage is the impact of poor work environments on people’s health. As a practicing chiropractor, is this something that you’ve started to see the effect of with your patients?

I’ve been in practice for 15 years, and in the last five I’ve seen a huge shift in the kinds of injuries I treat in my office. The majority of my patients are suffering from a repetitive strain or cumulative trauma injury, developed after prolonged sedentary behavior and working at the computer, driving, and sleeping in the wrong position.

It has completely changed the way I practice, and it’s really become my mission to help people that are suffering from injuries associated with modern work.

Some of the very first patients I treated for these kinds of injuries, before “everyone” had them, were people with long commutes, those who worked on the road, and college students.

What these groups of individuals all have in common is that they work in the absolute worst conditions; using the computer on the train, driving for long hours without a break, working from their bed or the coffee shop.

In fact, I opened my second office in 2010 and built a room that had a desk, a bed, and a car wheel and seat in it, just to teach people proper positioning.

I was very sensitive to this issue, as my fiancé (now wife), was a graduate student with a two-hour commute and debilitating neck and shoulder pain. I knew that her drive, and then working for hours on her laptop from bed, was what was creating her pain, and even told her that if I could fix it for her, she had to marry me!

“With the correct diagnosis, treatment, and preventative measures, you should be able to be pain-free no matter what your job.”

Unfortunately, many physicians aren’t as familiar with exactly how dangerous poor work environments are. Many people suffering from an RSI or cumulative trauma injury will assume it’s from an old trauma like a sports injury, or they may be misdiagnosed with arthritis or bursitis.

This is particularly frustrating because, with the correct diagnosis, treatment, and preventative measures, you should be able to be pain-free no matter what your job. The good news is that companies are starting to pay attention. At the National Ergonomics Conference and Expo this year, there was a lot of talk about remote workers.

One of the driving forces is that there’s a trend now to turn even conventional offices into more collaborative “coffee shop” environments, so the people who are at the office are starting to understand the struggle of not having a set desk that the ergonomic specialist has set up for you.

Several of our clients in my software company have come to us looking for solutions for their remote workers—so hang in there, help is on the way.

While corporates spend millions on wellness programs and ergonomic workspaces, digital nomads hunch over tables in coffee shops, lie in bed, or tap away on laptops teetering on their knees for hours every day.

What are the risks of working for extended periods in environments like these?

The risks are tremendous, both on the musculoskeletal system and biochemically. You absolutely cannot work for hours a day without moving around — in a coffee shop, bed, or the wrong position anywhere — without putting your health at risk. There are three main consequences of this type of work:

1. Repetitive Strain/Cumulative Trauma: The body is an incredible machine, but it has to be used correctly in order to function. Your musculoskeletal system was designed to support the body and head, and keep you upright. Each ligament, joint, and muscle has a proper position that it needs to be in to function.

When you sit for prolonged periods with improper posture, you put undue strain on your body. The result can be pain in your head, neck, upper back, shoulders, mid or lower back, and wrists.

On my website I have an e-book titled “Sitting Can Be a Pain in the Neck” that outlines the most common injuries, their symptoms, causes, and treatments.

Let’s look at neck pain as one example. The human head is extremely heavy. When babies are born, it takes them months to be able to hold up the weight of their own heads. Your spine and all of the connective tissue associated with it are designed to hold this weight when you sit with proper “S curve” posture.

“The result is misplaced joints, strained tendons, strained or spasming muscles, pressure on the nerves, and the worst part, PAIN.”

As soon as you start to slouch or hunch forward and sit with a “C curve” posture, your head begins to jut out forward in front of your body. For every inch forward your head protrudes (what’s called anterior head translation), you’re putting an extra 10 pounds of leveraged weight on your neck and back.

Picture this: you can hold a bowling ball close to your body for hours at a time, but as you extend your arms outward, your ability to support that ball drops dramatically. The result is misplaced joints, strained tendons, strained or spasming muscles, pressure on the nerves, and the worst part, PAIN.

2. Deconditioning Syndrome: When you picture a couch potato, you don’t picture someone in the greatest physical shape. That’s because we’ve known for some time now that a lack of leisure-time exercise leads you to become out of shape. The same thing holds true with a lack of exercise during your workday.

We’re not talking about the same kind of out of shape, however. You can actually look very strong and healthy from working out at the gym and eating healthy, but the muscles we often ignore are those used in everyday activities, like gardening or walking around.

People who are inactive for long periods of time due to their careers will have muscles that are weaker, ligaments and tendons that are stiff or stretched, and joints that are out of place. This condition makes you more likely to be injured doing even the simplest of activities, and your recovery time longer.

3. Biochemical Consequences: Motion is a necessary nutrient for the body. After not moving for even one hour, certain metabolic and circulatory systems start to dysfunction. For example, your body stops producing an enzyme called lipoprotein lipase, which is needed for breaking down fats and sugars.

Without this enzyme, the body deposits these fats in places we don’t like them like our heart, mid-section, and brain. Prolonged sitting has now been linked to heart disease, diabetes, obesity, type two diabetes, kidney disease, and even cancer.

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With limited luggage space and frequent travel, most location-independent workers hate adding extra weight and equipment. As a result, they tend to use laptops with small screens and keyboards, often without a mouse or other accessories, and things like ergonomic chairs and adjustable desks are usually just a dream.

Do you have any recommendations for equipment that can minimize the risk of injury while still fitting in a backpack or suitcase?

Instead of reviewing technological products or ergonomic devices that are going to add to your load no matter what you do, let me give you a few of the tricks I use. The number one easiest thing to buy and use is a posture brace.

You can pick one up for as little as $10 or you can spend $70-$100 on a product such as IntelliSkin, which is clothing with bracing tape built in. Wear it for a few hours every day (not all day), to help train your shoulders, back, and neck to sit with proper posture wherever you are.

Another great tool is either a rolled-up towel or an actual roll of paper towels. This can turn any chair into an ergonomically supportive one if you put it right at your lumbar spine. Also, I always drive with a neck brace on. It may get some funny looks, but it’s small, fits in my glove box, and I’m never in pain after a long drive.

Additionally, when you’re traveling and sleeping at a hotel, take the hotel pillow out of the pillow case and put in rolled-up towels from the bathroom. You’ll be amazed at how life-changing that piece of advice is.

“The hunched-over position is the number one worst thing you can do.”

Sleeping in a poor position after working in a poor position all day is the kiss of death. The best position to sleep in is with towels under your neck and under your knees, laying on your back.

If you going to pick one piece of equipment, choose something to raise the height of your laptop. The hunched-over position is the number one worst thing you can do. Everyone is different, so take your time and see exactly what height your laptop needs to be at to sit with proper posture.

If you’re a person who likes technology, I’d also recommend the new LumoLift from LumoBack. This is a little activity tracker device that monitors your posture and will vibrate when you slouch.

I recently started to pair this device with my wellness program when sitting at my computer in the evenings. I feel great even after a few hours, due to the constant reminder to sit up straight and frequent alerts to take a movement break.

Of course, it’s not just about the hardware. What thoughts do you have on other ways to stay injury-free while working on the road?

While it’s important to sit with the correct posture, it’s even better to break up those periods of sitting. Even with the best ergonomic solutions, if you’re sitting all day, you’re still putting your body at risk for both injury and disease.

I’ve done a lot of research and work on the most effective, efficient, and productive ways to get more movement into your day and prevent not just some, but ALL of the risks associated with the modern working condition.

Make sure you take a two-minute break once an hour while working at your computer, tablet, or phone. Two minutes once an hour is the exact amount of time and interval at which you need to move in order to prevent chronic disease.

It really is amazing how just moving a little more throughout the day can affect your health — you’ll notice positive changes almost immediately.

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What are some of the warning signs that digital nomads should be on the lookout for, that tell them they’re developing an overuse injury?

The greatest warning sign that you’re developing an overuse injury is that you consider yourself a digital nomad! It’s next to impossible to be on the road, not using ergonomic devices, not taking frequent stretch and strengthening breaks to stabilize muscles, and NOT at some point develop some type of injury. The body just wasn’t made to function this way.

As far as symptoms of these injuries go, it’s going to be pain. Everyone experiences pain a little bit differently, and an injury can really occur just about anywhere on the body and be related to overuse, cumulative trauma, or repetitive strain.

If you are in pain, you should keep a journal of what seems to trigger it the most. Is it a long car ride? Hours in front of the computer? Sleeping? That will give you a good idea of where to start.

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For those already suffering from an overuse injury, do you have any general advice on how best to treat it?

In my second office, which is devoted to cumulative trauma, I use the “Straighten Up, Strengthen Up, Keep it Up” program. If you are suffering from an injury, the first step is to visit your doctor, chiropractor, or physical therapist and see if you have some sort of functional problem such as a joint misalignment or muscle strain.

Once that issue has been identified and corrected, you need to work first on your posture and Straighten Up. This can be with the help of ergonomic devices or braces, or with just pure dedication.

Next, to Strengthen Up, find some exercises that work the small stabilizer muscles of the neck and back. Look for someone in your area using a medX machine, which is a great tool to help in the strengthening process.

And finally, Keep it Up. Remember that keeping you healthy is not only your doctor’s job, but yours also. You have to figure out what you can do on your own time to keep yourself healthy and pain-free.

My number one recommendations are to use some sort of posture corrector like a brace or LumoLift, and to get a good mattress and pillows.

If you’re suffering from acute back pain, the best thing to do is to use ice, not heat, for 20 minutes on, 1 hour off, take an anti-inflammatory like Advil, and lie in a rest position on your back with two pillows under your knees.

Lastly, do you have any other tips or advice to help those who work from the road stay happy, healthy and injury-free?

First, there’s really good news. All of the things we’ve discussed so far—the pain, injuries, chronic diseases—are 100% preventable.

The first step is to recognize how important it is that you take care of your body while you’re on the road, and not just by eating right and visiting the hotel fitness center. Remember that health and physical fitness need to be a part of your day ALL day.

If you try to incorporate a little more motion into your entire day, instead of slating an hour for it at the end of the day, you can reduce your risk of chronic diseases like heart disease more dramatically than if you started training for a marathon. It’ll keep your spirits up as well.

Movement triggers the release of happy-making neuro-chemicals and makes you more alert and focused. You’ll also avoid injury, and we all know that chronic pain and injury can hinder every other part of your life.

“Trying to make a 100% overhaul on your life is the surest way to fail at anything”

If you have an employer, don’t be afraid to speak to them. Upper management isn’t going to start shelling out money for your health until you ask them to.

Many companies have policies where they’ll pay for or reimburse you for health and fitness programs, or products like FitBit which will encourage you to log more activity throughout the day.

Finally, don’t try to do too much. Trying to make a 100% overhaul on your life is the surest way to fail at anything. Set four or five goals and space them out over a few months. Try to change 20-25% of your behavior at one time, and once that has become a habit, move on to the next thing.

For example, first work on taking breaks once an hour when sitting, then tackle your posture, then correct your sleeping position, etc. Once you’re able to get a handle on how to best work and live pain- and injury-free, being happy and healthy will naturally follow suit.

Images via illustir

Gregory Soltanoff, D.C. is a third-generation chiropractor and musculoskeletal and workplace injury specialist. An active doctor, he has two practices, Soltanoff Chiropractic and Soltanoff Spinal Strengthening and Rehabilitation, both located in upstate New York.

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  1. Really informative article! Thanks for posting. Hopefully I can start implementing some of these ideas into my nomad schedule 🙂

  2. Avatar Matthew Karsten says:

    I caught myself slouching while reading this. Good tips!

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