When Comics Hurt: Artists on Their Drawing Injuries

Some weeks ago, a tweet from Jamie McKelvie, artist on the tremendously popular series The Wicked + The Divine and Phonogram, caught my eye. Writing about the physical difficulties of a heavy drawing schedule, McKelvie said he felt he could keep drawing for only 15 more years. Just a few tweets away on my timeline, graphic novelist Faith Erin Hicks, author of Friends with Boys, Superhero Girl, and The Nameless City, commented that a full day of drawing had left her with sore wrists.

Being a comic book artist is a physically taxing job. Long hours sitting at the literal drawing board (whether drawing on paper or digitally) can strain muscles in the back, neck, and shoulders; repetitive motions inflame tendons in the arms. Combine this demanding work with the life of a freelancer, which, in the United States, does not come with any form of health care, and you’ll realize that many comics artists are living one injury away from economic disaster. An injury will not only cost money to treat, it will also cost time as it heals --- time that could be spent drawing --- resulting in lost income.

This is a reality I’ve heard from many comics artists of my acquaintance: Drawing hurts. From general soreness to serious repetitive stress injuries that cause permanent damage, pain always eventually accompanies art.

“Chronic muscle pains, knots, tightness, in my back, shoulders, chest and neck.” This is the catalog of pains related by Jamie McKelvie that he attributes to drawing professionally. “For years my set-up was bad and my posture poor, and drawing comics require very long hours, so even though I've been taking measures to address it, it's a very slow process to try to free myself from pain.”

Hicks described similar factors causing her lower back injury at the beginning of 2014. “It was a combination of long hours in a terrible chair and some inappropriate stretching that compounded the problem,” she said. “My lower back was very painful for about six months, so much so that I couldn't work for long periods, and had to take a lot of Advil. My back still aches, and I still do stretches and am careful with it even now. It's not 100% healed, and unfortunately maybe never will be.”

Anna-Kristina Arnold is a senior lecturer of ergonomics in the Department of Biomedical Physiology and Kinesiology at Simon Fraser University in British Columbia. She has not worked specifically with comic book artists, but spoke to us generally on the conditions that contribute to injuries in artists.

“Most visually intensive work has a number of risk factors for MSIs [musculoskeletal injuries],” she said. “A hunched posture with the neck flexed more than 20 degree and a forward angle --- less than 90 degrees --- in the hip held for more than 30 minutes is likely to produce muscular discomfort in the neck, shoulders and lower back.”

To reduce the risk of injury, Arnold has a few recommendations:  “A raised seat (sit-stand stool) and elevated work surface can help back and neck discomfort.  Additionally placing the working surface at an angle --- as much as tolerated up to 45 degrees --- will provide increased relaxation in the back neck and shoulders.”

Not only are MSIs a risk for comics artists, so are perhaps the most dreaded of injuries for artists: those that affect their drawing arms and hands, such as tendonitis and carpal tunnel syndrome, making it impossible for them to draw without pain, or even impossible to draw at all.

Sarah Neila Elkins, who has worked as a flatter (an artist who demarcates flat areas of color before the colorist does the final coloring and shading) and draws her own web series Here There Be Monsters, first sought treatment for pain in her drawing arm in early 2014. The severity of her injury affected even her ability to fill out forms at the doctor’s office.

“My arm ached so badly I couldn't hold a pen,” she said. “I had to fill out the paperwork with my non-dominant hand.”

After nearly two years of treating tendonitis with ice and heat and prescriptions for anti-inflammatory steroids, Ibuprofen, and even opioid pain relievers, without abatement of her pain, Elkins finally got a full diagnosis of her injuries in August 2015 when a doctor referred her to a specialist.

“The tendon in my arm is stiff with an apparently rare condition that causes it to not function like a tendon should,” she explained. The official diagnosis, she said, is tendonitis caused by “lateral epicondylitis” with “angiofibrodysplasia affecting my tendon.”

Arnold explained why drawing can cause tendinitis. “Wrist tendinitis is generally caused by force, repetition and awkward postures held over a duration of time,” she said. “In the case of comic book artists I suspect there is a static force in the grip of drawing tools or input device. Often the circumference on these tools are small, forcing the hand to ‘over-grip’.”

As with the case of MSIs, Arnold recommends changes in artists’ work habits and modifications to their tools to avoid repetitive stress injuries and tendinitis. “A larger circumference [on the drawing tool] will relax the hand a bit. A rubber fitting over the pencil can help. Posture is also important. The wrist should be as straight as possible. Depending on the task, an angled surface or elbow rest can help.”

In addition, Arnold stressed that rest is essential to prevent injuries. “Rest breaks with wrist massage and finger movement are helpful,” she said. “Rest breaks will also help the neck and back but must be ‘active’ --- meaning encouraging blood flow into the muscles that have been static. Slow stretches and movement will help.  Short breaks --- 30 seconds to two minutes --- every 30 minutes are recommended.”

Artists must be diligent in following preventative measures for them be fully effective, however.

“At times of deadline it's very easy to let that stuff fall to the side, so as you might imagine that exacerbates thing. I'm also very bad at taking breaks, something I'm working on,” McKelvie admitted. “Holding a drawing position without breaks for an hour or more at a time can be really bad for the muscles.”

For freelance artists, getting medical treatment can create additional stress. McKelvie is British and Hicks is Canadian, so they both have the advantage of government-funded healthcare. Still, the specialist care required for artists’ injuries can be costly even in those countries.

“I did a lot of physiotherapy when I injured my back. It helped a lot, but was expensive, and I had to pay for it out of pocket,” said Hicks.

McKelvie has also sought specialist treatment to alleviate his injuries. “Osteopathy, massage, yoga --- in recent months I've been doing Alexander Technique, which has also helped,” he said.

Artists in the United States, like Elkins, may put off treatment because the cost is prohibitive. And without paid sick days, taking time off means losing money.

“I couldn't afford to take more than a couple weeks off,” Elkins said, “so I got back to work and just ‘played through the pain’ for a year before I had a breakdown and had to get help from family.

“I don't have any disposable income,” Elkins continued. “When I had to see a doctor regularly and still pay our bills I had to start borrowing money from family.”

Teen Titans Go artist Lea Hernandez had to put off treatment for her carpal tunnel syndrome (CTS) because she had limited income and no insurance, and had to prioritize care for her young children.

“I did my best with stretching exercises, and ibuprofen when the CTS went from ‘annoying numbness’ to ‘annoying numbness and arm and shoulder aches,’” she said. “Now that I have insurance, I'm going to see what can be done.”

A gruelling freelance schedule was a constant with every artist I spoke to. When artists are successful, they’re in demand, and that means longer hours at the drawing table --- and, unfortunately, that often also means more severe injuries.

“The more work I have, the worse my symptoms are,” said Hernandez. “For example, when I wake up during a period when I'm keeping longer hours, I literally have to use my left hand to close my right into a fist.”

The effects of her CTS have kept Hernandez from participating in some of the leisure activities she enjoys, like embroidery and knitting. “I'm trying to conserve my hands for drawing,” she said.

McKelvie points to the rigorous monthly schedule of comic book series as a contributing factor to artist injuries. “I'm a slower artist than I'd like, and the monthly schedule was set at a time when comics art wasn't necessarily required to be as complex,” he said. “That changed over the years, but the monthly schedule didn't. So what it means for a lot of us is long hours.”

With his current, creator-owned Image Comics series The Wicked + The Divine, with writer Kieron Gillen, McKelvie has the ability to modify the monthly schedule to give himself a break. “Every six months I get to reset a little and catch up before the issues start coming out again.” Still, because of his concerns about injuries, he says, “I don't think I'll do another monthly book after WicDiv.”

“If I ever end up with a major wrist injury, or if I re-injure my back, I'll definitely have to slow down," said Hicks. "It's scary. I need to be healthy to make my work.”

Elkins described her schedule as a flatter, one of the unsung jobs of the comic book industry. "Middle of the week or so you get 22 pages that must be flatted quickly enough for the colorist to get them done before the end of the month. This usually meant doing at least two pages a day. ... In the time between flatting gigs I was working on commission work and drawing a comic project on the side. The side gigs ate up all the time between flatting so there was very little down time to properly rest.”

Falling behind on her work for her graphic novel The Nameless City at the beginning of 2015, Hicks had to ramp up the rate of her work. “I had to kill myself for about three months. No exercise, no going out, I couldn't cook at home as often because I needed that time for drawing. ... I had three days off over that three-month period, and my body completely deteriorated. I gained weight, and by the time I was finished the book, I remember my wrist and arm were so overtaxed they wouldn't stop shaking. I've recovered a bit since then, but it'll be months before I undo the damage I did to my body.”

For many comic book artists, an intense schedule and physical injuries that have long recovery processes can also mean stress, anxiety, and depression.

“When I was working through the pain the idea of not working was more terrifying than the thought of ‘oh hey, a part of my body is seriously injured!’” said Elkins. “The idea that I may never draw again made me freak out, cry, scream, and feel like I was the most useless human on the planet.”

Now that she has a new diagnosis and treatment plan Elkins has hope that she will draw again, although the treatment --- cross-friction massage --- is painful. “I have to massage the tendon, [which] hurts like hell, and break up the tendon a little by little so scar tissue forms,” Elkins described.

In the meantime, she has been concentrating on writing to get her through the difficult time.  “After I was forced to stop working, writing became a life preserver,” she said.

Full disclosure: The Wicked + The Divine is published by Image Comics, where the author was an employee from 2012-2015, during which time the series began publication. The author was also Faith Erin Hicks' editor on Zombies Calling and The War at Ellsmere, both published by SLG Publishing.