I had hand surgery shortly after starting to quilt back in 1996. I found that adjusting the height of the cutting surface was a big factor in being able to hold the ruler in place. I use my ironing board that I can adjust down & I have a "Big board" on top that makes it just wide enough for the Olfa cutting mat. As others said, folding the WOF so that your cutting 4 layers at 1 time shortens the distance you have to cut & you don't have to move the ruler.