Gaming Ergonomics

Away from the formal constraints of the work environment, we may find ourselves relaxing at home in front of the computer or television or on the couch in positions that are not necessarily healthy for our bodies.  Does anyone run through the checklist of proper ergonomic positioning and practices prior to beginning a leisure activity?  It just doesn’t seem right that activities we enjoy should increase our risk of developing carpal tunnel syndrome (CTS) or a tendonitis.  But, as many gaming enthusiasts have discovered, repetitive strain injuries (RSIs) do not occur only during work hours.

The gaming industry is currently in a period of explosive growth.  According to a Global Entertainment and Media Outlook 2004 – 2008 study by PricewaterhouseCoopers, the video game business was accurately projected to outsell both the movie and the music industries by 2006.  A compound growth rate of 20% annually projects 55 billion USD in video game revenue by the end of 2008.  It is estimated that 50% of the population plays video games

 

Gamers are at increased risk of developing RSIs.  Games are most often enjoyed after work or school activity when muscles may already be fatigued or when tendons and nerves may already be stressed or inflamed.  The gaming environment may be spontaneously chosen and is not likely to be set up for ergonomic comfort.  Players may unwittingly end-up in awkward and unhealthy positions (for example, lying on the stomach with the neck craned up to see the television screen).  The practice of playing is repetitive.  Achieving game tasks and goals may promote nervous and muscular tension.  The controllers may cause mechanical pressures with sustained holding and with additional features such as force feedback (for example, vibrating to enhance the game in relation to the activity on the playing screen).  And pain signals may be ignored because the enjoyment of the game overshadows them.

In 1978, Space Invaders was released, and it became the first game to receive the distinction of having a medical condition named after it – Space Invader’s Wrist, a tendonitis caused by wrist and forearm movements required to maneuver the spaceship.  Pac Man’s Elbow followed closely behind along with Slot Machine Tendinitis.  In 1989, Gameboy introduced a whole new era in gaming with handheld gaming.  Currently popular maladies are Nintendinitis, Nintendo Thumb, Atari Thumb and Blackberry Thumb.  Although the names of these repetitive strain injuries do not necessarily invoke the seriousness of the condition, symptoms can be quite debilitating and range from pain and aching to tingling, numbness, and muscle spasms and cramps.  Symptoms can be severe enough to cause a loss of function in self-care, leisure and work activities.  Many gaming guides, such as Microsoft’s X-Box Healthy Gaming Guide, now offer information and suggestions on avoiding gaming pain.

Here are some ergonomic tips for remaining pain-free while playing the game:

First and foremost, if you are having pain while playing, you need to rest from the activity.

If painful, use cold packs for 10-15 minutes after play to control inflammation and spasms.

• Take 10-15 minute breaks for every hour of play.


• Stretch often.


• Perform 15-20 minutes of cardio activity daily to improve circulation and increase oxygen flow to the arms.
  
  


• Use pillows to support the arms when playing.
  
  


• Use the lightest touch possible when activating the controller.
  
  


• Try to keep the arms relaxed and the controller positioned close to your lap rather than having your arms fly up towards your chest.
  
  


• Try to alternate more intense games or play sequences with those that are less intense.
  
  


• The room should have adequate lighting.  There should be no glare on the screen.
  
  


• Prevent eye strain by following the 20-20-20 rule.  For every 20 minutes of play, focus for 20 seconds on an object 20 feet away.

When setting up to play, be aware of your positioning and environment.

• If playing on a PC, check out Ergonomic ABCs for computer ergonomic tips.  The same principles apply when setting up for leisure activities as well as work activities.  If not sitting formally in a chair, use pillows and lapboards to help achieve neutral positioning.


• If playing on a smaller handheld device such as a Blackberry or SmartPhone, check out SmartPhone & PDA Ergonomics.


• If playing on a console game system using the television as your screen, avoid twisting or crimping the neck by positioning the couch or chair so that the screen is at eye-level and directly in front of you.  Support your arms with pillows.  Have good back support.  Turn off the vibration feedback from the controller or limit the time it is used.  Use pillows and lapboards to help achieve neutral positioning.

Special Considerations for Children

• The content of games should be appropriate for the child’s age.


• The controllers or keyboard should be appropriately sized for the child’s developmental age – small enough to fit comfortable in petite hands but with buttons large to be manipulated by those who are less coordinated.


• Check out ergonomic tips specifically for children at Kids & Computers - Ergonomic Guidelines


• Encourage physical activity daily.


• Promote healthy habits.

If you are experiencing pain, these are the best cold packs on the market.  We use them all the time in the clinic.  They are durable, do not leak, will not puncture, are comfortable, and conform well to bony areas.  The Velcro strap is a nice addition to hold them in place when you are on the move.

Using a lap desk can help position your arms comfortable while gaming on the couch.

Common Sense Repetition 1

Patient: Doctor, it hurts when I do (….insert work, home, or leisure task…). Doctor: Well, don’t do that.
I’ve had many clients who are frustrated, having heard this, knowing that they cannot stop working or performing the activity that is painful. Although it is helpful to work with an ergonomic specialist who can show you specific ways in which to make your work less stressful on the body, a common-sense approach to activities can also make a difference.
This multi-part series will offer some common-sense tips - based on the ergonomic principles of avoiding repetition, force and awkward postures - that can help you avoid pain while working.
REPETITION
I worked recently with a graphic designer who was having pain in both arms. Working long days to complete a complicated project, a mouse-click counter showed that he was clicking the mouse between 10,000 to 15,000 times per day. The graphic designer researched available software and was able to purchase a new program that reduced his mouse clicks to 3000 to 4000 clicks per day. By the time he attended his first appointment with me, this client was already well on his way to recovery because he had intuitively related his pain to mouse use, confirmed this with the mouse-click counter, and taken steps to reduce the repetition by researching alternative software packages and changing to a program that demanded many fewer clicks.
Methods of Reducing Repetition

Look for ways to break up the repetitive components of a job. For example, after an hour of so of typing, make a few phone calls, walk down the hall to consult with a co-worker (rather than e-mailing), stretch or get a drink of water.

If your job requires a variety of duties, switch frequently between tasks rather than completing each one before moving on.

Do some research and find a different tool that makes the job easier (such as the different graphic design program in the example above).

Let the tool do the work instead of the body. Use power tools (for example, an electric screwdriver or tools with special ratchet devices) or automation when possible.

During the work week, be open to discovering leisure activities that have different physical demands than work activities. Enjoy leisure activities with similar physical demands on the days that you do not work.



Definitions
Job Enlargement is the process by which a worker is provided with a greater number of tasks to perform so that repetition of any one particular movement in reduced.

Job Rotation is the process by which employees are rotated through different jobs. This works well when the demands of the job itself can not be changed (for example, assembly line work). The key is to rotate employees every few hours between jobs that require different physical demands.



Next Week – Methods for Reducing Force & Awkward Postures
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Typing Styles

The goal of ergonomics is to reduce the force, repetitiveness or awkwardness of activities so that the body performs tasks most efficiently and with the least amount of stress.  Many excellent resources are available that describe ergonomic modifications for the office environment.  Because of this information, most people now have some general knowledge of the healthiest location for the keyboard and monitor.  Less commonly known is that typing style can be the cause of injuries.

Typing Style

In their book Repetitive Strain Injury: A Computer User’s Guide, Dr. Emil Pascarelli and Deborah Quilter describe a variety of typing techniques that can lead to painful symptoms and repetitive injuries (see book review).  Even the best and most expensive ergonomic keyboard will not eliminate pain caused by the following typing methods.

Resters – Resters lean the base of the hand upon the desk or the wrist rest.  This can be harmful for the following reasons: 1) It places point pressure against the carpal tunnel; 2) It isolates the small muscles of the hands and forces them to do the work of the larger shoulder and elbow muscles; and 3) It can promote wrist postures that are not neutral.

Leaners – Leaners type by placing their elbows on the desk or chair arms.  This puts pressure on the ulnar nerve, the superficial nerve at the elbow.

Loungers – loungers slump in their chairs leading to compression of the spine and low back pain.  Lounging also promotes forward head and rounded shoulder posture.

Clackers or Pounders – Pounders hit the keys with excessive force potentially leading to pain and tingling in the finger tips and finger joints.

Pressers – Pressers hold down keys (for example, while scrolling) with excessive force placing pressure on the small joints in the fingers.

Pointers – Pointers are hunt-and-peckers who hold their arms poised in midair.  Pointers are at risk from awkward positioning if they hold their fingers stiffly rather than in a relaxed position or if the keyboard is not positioned correctly.

Thumb or Pinkie Extenders – Extenders hold one finger stiffly out while the others perform the work.  This separation causes excessive strain on the tendons of the fingers.

Grippers – Grippers hold tightly to the mouse or use too much force when clicking. 

Typing Style Ergonomics

The following typing tips describe work-style modifications that will help prevent injuries and maximize the benefit of that ergonomic keyboard.

• When typing, keep the fingers relaxed and slightly curled as if they are resting over a large ball. 
  
• Tap lightly with the finger tips rather than with the pulp of the finger. 
  
• Keep fingernails short – longer nails require that the fingers be tensely extended so that the key can be tapped with the pulp of the finger.
  
• Keep the thumb relaxed – not held stiffly over the space bar. 
  
• Use the lightest touch possible on the keys.  
  
• Don’t stretch the fingers to reach keys that are far from the home row.  Move fingers closer to the key by moving the whole arm.
  
• Don’t stretch the fingers wide to activate a two-key command with one hand.  Use one finger from each hand to activate these commands.
  
• Maintain a neutral wrist position.
  
• The mouse should be held loosely.  Control of the mouse should come from the larger muscles of the elbow and shoulder, not from wrist motion.
  
• Don’t rest the wrist on the table or wrist rest.  Use the wrist rest as a guide that the wrist slides over.
  
• Don’t lean on the elbow when typing, talking, contemplating, or holding the phone.
  
  Pad any sharp edges that the forearm rests against.
  
• The keyboard and mouse should be positioned so that the arms are at the sides (do not reach forward or out to the sides to activate either), shoulders relaxed, elbows opened up slightly more than 90 degrees. 

Repetitive Strain Injury: A Computer User’s Guide offers more tips and exercises to help correct typing styles.  Find it at Amazon.com. 

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.