The Downside of Mobility: Injury

By Amy Mayer

August 20, 2008

As Wi-Fi--and laptops and mobile devices--become more ubiquitous, users from kids to adults find themselves suffering from injuries ranging from carpel tunnel syndrome to "BlackBerry thumb." The first in a series of features and reviews related to the ergonomics of Wi-Fi-induced mobility, this article offers tips on how to prevent injuries.

As Wi-Fi--and laptops and mobile devices--become more ubiquitous, users from kids to adults find themselves suffering from injuries ranging from carpel tunnel syndrome to "BlackBerry thumb." The first in a series of features and reviews on the ergonomics of Wi-Fi-induced mobility, this article offers tips on how to prevent injuries.


As publicly accessible Wi-Fi access points come to more and more coffee shops, libraries, and other venues, people are using laptops in environments that compromise comfort and often precipitate pain. That's because on a notebook computer, the monitor and keyboard can't be independently positioned.

"That insists that you crane your neck to see the screen," says Lenore Bryck, a pain-relief and massage therapist in Amherst, Massachusetts who works with clients suffering from chronic pain and repetitive strain injuries. But if you elevate your laptop so the screen is at an appropriate height for your neck, you've moved it out of the comfort zone for typing.

"And then you've got the whole gamut of injuries to your wrists and hands," Bryck says, which aren't so different from the problems a person can have with an improperly arranged desktop computer, but they tend to be worse. Carpal tunnel syndrome, in which several fingers can feel numb because the nerve leading to them gets inhibited, is a well-known problem, but pain can range from the fingertips through the arms, shoulders, neck, and back due to the combination of poor keyboard and monitor placement.

In 2006, the most recent year for which the US Bureau of Labor Statistics has data, there were 13,010 reported workplace incidences of carpal tunnel syndrome. Although the data don't track how workers got carpal tunnel syndrome, computer use is likely a significant cause. Carpal tunnel syndrome accounted for 3.6 percent of all workplace musculoskeletal injuries in 2006. That figure was 4.4 percent in 2005 and 4.6 percent in 2004. While the slight decrease might suggest improved ergonomics for some workers, Bryck and others say overall incidence of discomfort—if not, perhaps, diagnosed carpal tunnel syndrome—is on the rise. One reason the labor statistics don't reflect that is the shift in demographics. Increasingly, younger computer users are complaining of pain—college, high school, and even middle school students.

The ubiquity of laptops that extends down to some of the youngest users reflects an overall industry trend.

"Portable PCs represented 40.1 percent of all PCs sold worldwide in 2007," says Michael Shirer of the research firm IDC. That makes them hardly peripheral to the overall PC market, which is where they entered the playing field—intended for occasional use that complemented a desktop machine.

You don't have to work in pain

Importantly, pain and conditions such as carpal tunnel are not inevitable results of notebook computer use—at any age. Occupational therapist Gail Hegeman of Pioneer Ergonomics in western Massachusetts says as more people in their 20s find their way to her—often because of acute non-computer-use injuries, she's astonished at their attitude toward pain.

"They almost act as if it's normal" to experience pain from using their computers, she says. "They say to me, `oh, well, I just work in pain.'" It doesn't have to be that way.

A variety of proactive measures can help prevent pain, and are also recommended for pain relief.

First and foremost, whenever possible plug an external mouse or trackball and keyboard into your laptop. In particular, if you have a regular space where you most often work, make sure that it allows for you to elevate your laptop to a comfortable height while attaching a mouse and keyboard below.

You've heard it before but it's important: take frequent breaks. Set a timer or download some software, Hegeman says. Every 20-30 minutes you should get up and gently stretch. Hegeman also says that some of the ergonomic "rules" you may remember haven't held up over time. The 90-degree angle at the hip, for example, which got wide publicity for years, is no longer rigid.

"Leaning back a little is now considered to be fine," she says. If you're comfortable sitting ramrod straight, that's great. But if not, adjusting your chair slightly to a create a more open hip angle may be better for you. But don’t follow suit with the elbows, she cautions.

"I'm a big believer in the 90-degree elbow joint angle," she says. "I've seen so many repetitive strain injuries from people who put their elbow straight, who lean back in their chair."

Leaning back in a chair may seem minor compared to how some people compute these days. Stretched out on the bed, lounging on the couch or even lying flat on the floor all have become not unusual positions for laptop use, especially among young adults and teenagers.

Bryck says being aware of how you're positioned and what that does to your body is an important step toward improvement.

"For me, the best way to check in on the way you're standing, the way you're sitting, the way you're inhabiting your body, is to check in on your breathing," she says.  Is your rib cage free to expand and fall? Are your shoulders and neck relaxed so your head feels like it's floating? Do you have a natural lumbar curve? "To me, that's the main check-in point. If you do that, everything is going to fall in place."

Tips for on-the-go laptop use

Let's face it though, sometimes you're going to use the laptop at your favorite coffee shop or in an airport gate area—even if, strictly speaking, you don't have to. Hegeman has some recommendations for making the best of an imperfect situation.

"The neck muscles are bigger and can handle more strain," she says. "I would definitely choose to take care of your hands." That means don't put the computer up on a high table top. Rather, consider using it actually on your lap "so the wrist and hand angles can be appropriate." But still be mindful of your posture and choose straight chairs rather than couches or easy chairs. And don't forget those breaks—in addition to every 20-30 minutes, Hegeman recommends getting up for five minutes every hour or two.

"Go get that second cup of coffee—or get a glass of water or juice or something healthy for your body," she says. 

Be mindful of what you're using your computer for, though, too. If you're primarily reading rather than typing, a better head-neck position will trump the hands.

Campus casualties

Karen Jacobs, a former president of the American Occupational Therapy Association and a clinical professor of occupational therapy at Boston University's Sargent College, is studying the impact of notebook computer use on campus.

"College students are our next generation of workers and they are also a cohort of people who have had their whole lives with computers," she says. Like Bryck and Hegeman, Jacobs observed growing complaints about aches and pains associated with notebook computer use and conducted studies to understand it better.

"University students are complaining about discomfort and, in two studies, attributed it to the way they used notebook computers," she says.

She's now carried out three studies at Boston University involving some 400 students in all. She's looked at how well various interventions such as risers (to elevate the laptop), adjustable chairs, external input devices, and training worked to curb the potential problems. Research results are pending publication, but she says conceptually the students fully embraced making small, generally inexpensive changes.

"No one wants to have aches and pains," she says. "We want to encourage students to work in comfort."

For more tips and information about proper ergonomics, both the Occupational Safety and Health Administration of the federal government and Cornell University offer workplace checklists and other resources. Stretch Break, a software package that prompts you to stretch at regular intervals and provides music and animations along with the reminder, is available for purchase. You can test it with a free 10-day trial first. Jacobs has worked with the developers to offer a free kids' version of the software for K-12 students and their schools.

If laptops and carpal tunnel syndrome are the scourge of this generation, Hegeman fears that new devices will only spur users into addition preventable injuries as work migrates from laptops to even smaller keyboards and screens. Already hand therapists are talking about "BlackBerry thumb," she says. "It is a problem, absolutely."

Amy Mayer is a freelance writer and independent radio producer based in Greenfield, Massachusetts. Read and listen to her work at her website.

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