This page describes some techniques that have been used in some cases for coping with Simple Writer’s Cramp. They have been provided by Rosemary Sassoon.
These techniques are not an alternative to seeking treatment from a qualified neurologist. It is essential that, before trying any course of action to help cope with your dystonia, you discuss it with your neurologist and confirm it is appropriate for your condition and that there is no risk that it will cause aggravation. Please click here for our full disclaimer.
Handwriting is a motor skill - this means that early in life motions that result in writing letters are learned and then stored in the brain’s motor memory. Once automated, the writer can then forget about how they are writing and concentrate on the content of the written work. With Simple Writer’s Cramp this automation is disrupted for reasons that are not fully understood. As with other forms of dystonia, this disruption can often be worse when the writer is under stress or anxiety – and handwriting often takes place in stressful situations such as examinations or demanding jobs. However, some people find that by relaxing and/or changing the way they write they can cope better with this problem.
Below are some descriptions that have helped in some cases. However, each individual is different and it is important to understand that what helps one person will not necessarily help another.
Reflecting on the origins of the Simple Writer’s Cramp and so reducing worry
Some people have found that thinking about how the writer’s cramp originated reduces the level of worry and makes it easier to relax when writing. Ideas how Writer’s Cramp started might include one or more of:
- Troubles learning to write at school perhaps combined with difficulties with criticism from a teacher
- Using painful, unconventional penholds. One example is that those with extra long fingers sometimes have difficulty finding a comfortable way of holding a pen.
- Holding the pen too tightly, or pressing too hard downward on the paper.
- Bad writing posture. For instance, those who are very tall or short can end up in an uncomfortable and eventually painful posture.
- Too high an expectation of handwriting. For instance someone who has won prizes for beautiful writing and may then find it hard to accommodate to the changes needed to speed up writing in examinations or later life.
- Tension and worries at examination time, not necessarily about handwriting. These may have affected handwriting and the body posture nonetheless.
- A time of intense personal problems such as bereavement or divorce.
- Worries about losing a job, particularly one involving a certain amount of writing.
- An injury to hand or arm.
For some, reflecting on how a relatively insignificant, perhaps long-forgotten happening could have escalated into a significant problem has enabled them to approach handwriting with less worry.
Reducing pressure on the body through improved posture or penhold
There are a number of things that might be a problem with current writing position for example:
- Problems with writing posture - for instance a twisted or bent body
- A painful penhold or twisted wrist
- An unnatural arm position such as a raised elbow
- Pressing too hard on fingers or paper
- An incorrect paper position leading to uncomfortable twisted wrists and poor posture. Many people find the best position to paper to be slightly to their right if right handed, or the left if left handed.
These problems can sometimes be seen better if another person photographs or videos the writer. Some people find that identifying and correcting such problems may make it more comfortable and pain-free to write and this may reduce the effect of the dystonia. In some cases, it has also been helpful to try writing on a slanting surface as it can take the pressure off their wrist and help to still any tremor – this can be achieved using a small board or something similar, raised one end on a couple of books.
Most people find that it is not a good idea to switch hands to try and evade the problem. Often, the same problems will affect the other hand in time.
Increased relaxation through distraction techniques
Being unable to write can induce anxiety and it can be difficult to make the body relax. Some people have fond using distraction techniques can help if used cautiously and without overdoing it:
- Rather than rushing straight into putting words or sentences, or even a signature down on paper, some people have found it helpful to motion something in the air several times or write something on paper with their eyes shut and then try some squiggly patterns, starting with just a scribble.
- If this works, they then try a pattern or single letters with both hands at the same time. This can be fun because one hand will usually mirror write.
- If this works they can then try some repetitive letter patterns like “hnhnhn” or “lululu”
Some have also found it helps to:
- Try to relax before starting writing
- Before writing, shrugging the shoulders, shaking the wrists and taking a couple of deep breaths.
Changes to the method of writing
Simple writer’s cramp is usually caused by caused by overuse and misuse of certain muscles.
Hughes and McLellan put it this way in 1985: ‘We suggest that writing is prone to induce dystonia because of concurrent requirements. The first is to hold the pen securely in the fingers and to keep it applied evenly to the paper.The second is to permit rapid and very fine modulation of activity in all the co-activating muscles. Muscles that oppose each other (flexors and extensors) must be tensed within a conventional tripod grip, and at the same time, delicately controlled to form the letters’. This conflict of muscles may be made worse by the use of modern pens which often need to be gripped more tightly in order to work properly.
Callewaert, a Belgian neurologist, suggested an alternative penhold which makes use of different muscles which work together rather than opposing. It consists of placing the writing implement between the index and middle fingers. When trying out changing writing method, the writer always starts slowly and does not to overdo it. When writers feel comfortable, perhaps after a few exploratory scribbles, they often find this a considerable relief. However, some people reject it, feeling that it looks odd. But it is not uncommon and, if you watch the world’s leaders signing documents on the television, you will sometimes spot one using this alternative penhold.
These suggestions have been helpful in some cases but do not constitute a permanent solution in the conventional sense. At times of stress, symptoms can often recur even where improvement has occurred. However, in most cases the improvements have returned when things have calmed down.
The Dystonia Society provides the information on this page as general information only. It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor.
The Dystonia Society is not responsible for the consequences of your decisions resulting from the use of this information, including, but not limited to, your choosing to seek or not to seek professional medical care, or from choosing or not choosing specific treatment based on the information. You should not disregard the advice of your physician or other qualified health care provider because of any information you receive from us. If you have any health care questions, please consult the relevant medical practitioner.