The Gamer’s Guide to Ergonomics: Your Posture, Chair, Desk, Fingers and everything Else

Learn how ergonomics and posture impact eSports health, from monitor setup to chair adjustments, to ensure gamers stay healthy.

Introduction

Ergonomic equipment is typically one of the first changes many consider when they have a little bit of wrist or hand pain with repetitive use. This can be from desk work, gaming, drawing and other activities that require repetitive hand use in a static position, but do ergonomic mice and keyboards actually help if you have some discomfort or pain at your wrist?

If you are feeling some discomfort while you are working and you want to make sure to fix it so it doesn’t get worse & prevent you from being able to continue working. You are in the right place.

WHY is it important for us to understand load

As gamers or office workers, we are repeatedly using the muscles at our wrist & hand over a typical 8 hour work day for typing & clicking. Now while it may not seem like a lot of stress for our tissues, it can really add up. In gaming and esports players perform 10-15 movements per second (500-800 actions per minute) regularly practice esports-related skills for 5 to 10 hours per day. This is nearly triple the 8000 to 11 000 keystrokes (130-180 actions per minute) of office workers, who are already at increased risk of upper extremity pain.

Over many years with lower levels of physical inactivity or exercise our endurance to tolerate our work or hobbies can diminish. When this happens, there is now a higher potential for injury which is now fairly typical of many tech workers.

The best way to understand this is through the concept of demand vs. capacity. Or the Scale of Physical Stress. This is based on what we know with our current understanding of tissues adaptation to stress (General Adaptation Syndrome)

Think of a scale with…

Left Side: How much stress your tissues can handle (muscular endurance) and on the other side of the scale..

Right Side: How much stress you are applying to it based on what you are doing on a regular basis.

We start our day with just our weight (capacity) on the left side. Let’s say it’s 100lbs. As we work we’re gradually adding physical stress. (For example, if we do intense work for 2 hours then we add 30 lbs to this imaginary scale.

Responding to emails and browsing the web for 30 minutes, add 5 lbs.

Programming for the rest of the day with no breaks, add 50 lbs). This is not a problem if we do this everyday and if we always have 100 lbs, but what happens if we do this for several years without physical activity or exercise? Our now 100 lbs capacity becomes 85 lbs, then 80 lbs…Or we happen to have a few days where the work sprint is a lot longer and it’s a few 10 hr days in a row? This can quickly add up making the right side “too heavy” and therefore cause pain and irritation!

Hopefully now you understand the “Why?” Because our tissues can only handle so much.

Role of Ergonomics

Ergonomics is the study of how to design the workplace or environment to fit the worker with the goal of reducing the risk of injury and increasing efficiency & comfort. 

Despite someone with the perfect ergonomic position, injury can still exist, but how is this? Again, going back to understanding load. Load through exercise is essential to a well rounded approach to injury prevention and management. Ergonomics and posture absolutely play a role as ergonomics can create an environment that helps us assume the most optimal postures, but exercise is necessary to still manage the duration and stress that is unavoidable even with great positioning.

Posture however is the arrangement of our body parts in relation to each other in the various positions and movements that we assume during the day. Now ergonomics can support one’s posture, but again even a perfect posture is susceptible to injury due to poor activity tolerance through decreased muscular endurance.

How Does Ergonomics Affect My Body?

It is important to remember that everyone is different, meaning that some individuals may have longer torsos, shorter legs, etc. Individuals also have their own preferences to how they sit or game and this is normal. We should be mindful of these differences when setting up our own ergonomic set up. Simply put, the more adjustability, the better. As everyone is different in size and shape this does not allow for each and every person to have the same desk height, chair height, mouse, monitor, etc. When these are able to be adjusted then we can fit them to our needs. 

 

—Monitor Height and Tilt

Recommendation: When you are sitting upright, your eyes (horizontal eye level) should meet slightly above or at the upper 1/4th of the monitor. If possible, the monitor should also be slightly tilted back.

 

 

This adjustment is to ensure that you are limiting movement of your neck to look at the various things on your monitor, but more specifically, that you’re not using your upper neck to look up. Our eyes direct neck movement and thus by setting up your monitor slightly below the horizontal eye level with a slight backwards tilt, you are limiting the need to use your neck to look up. Optimal viewing angles have been shown to be between 20-50 degrees from various studies. The placement of the monitor as suggested allows the most active areas of the monitor to be least visually straining.

 

If it is too high, we often find ourselves gaming with a slight upward tilt of our neck. Monitors set too low will often cause the dreaded forward head posture.

 

Monitor Distance

Recommendation: 1-arm’s length away ± the length of your hand.  While there is an extensive amount of research and suggestions regarding how far the monitor should be placed from your eyes, I want to give you guys a practical way to set up the distance of your monitor.

 

Monitor Distance is 1-Arm’s Length ± Length of your hand

 

One thing we have to realize with regards to this is that everyone is different. Our eyes have the ability to both accommodate (changing the shape of the lens within the eye to focus on objects at various distances) and converge (looking inwards toward the nose with closer objects). It has been shown that convergence contributes more to eye strain, meaning that in GENERAL, farther is better. Obviously a distance where you can barely see characters or details on the screen is not recommended, but we should have a minimum distance that the monitor is set.

 

Keyboard

Ah our prized LED mechanical keyboards with the customized WASD keys.  Peripherals always seem to be a big topic of conversation when it comes down to ergonomics, reasonably so as they are the main tools we utilize to game! While we believe considering ergonomics for both our keyboards and the mouse is important, it truly comes down to preference and understanding the tradeoff.

 

There is a performance tradeoff that should be considered when discussing ergonomics and in the end, it is how we position ourselves with both the keyboard and the mouse. Again when considering the ergonomics of our peripherals, it is crucial to understand that it is the position the tool is placing us in. Ergonomic Keyboards place our wrists in a neutral position (the position in which there is the least amount of stress at the joints and supporting tissues) however are known to have slower response times and less durability.

 

Neutral Positioning/Palm Grip of the Wrist (Left), Extended position/Claw Grip of the Wrist (Right)

 

Modifying your own positioning to the neutral grip is ideal, however behavior should be considered more important than position. Response times are crucial in eSports performance and thus there is the preference for the straight mechanical keyboard, which typically places our wrist in extension (slightly bent towards the ceiling). Increased wrist extension leads to reduced time to fatigue (higher risk of repetitive strain injury) due to poor mechanical advantage.

 

Grip Types in order of Highest to Lowest Physical Stress on Forearm and Hand Musculature

 

What about the different types of mice out there? It is the same story. Different mice often lead to different types of grip which can also vary the amount of physical stress on your hands, wrists, forearms (listed in highest to lowest risk of injury):

1. Claw
2. Fingertip
3. Palm

 

Each of these provide different benefits in terms of performance (Koosta from CLG utilizes the claw grip from his history with playing AVA allowing him to click very quickly) however have the tradeoff of risking increased physical stress.

 

You can again modify your wrist position to minimize the tradeoff.  The difference in physical stress at your hands/wrists/forearms is minimal and more dependent on the demands of your game (500 APMs vs 100 APMs) or how long you play that is the major risk for injury.

 

The bottom line is that your wrist positioning along with your behavior (how long you are playing) is more important than the type of keyboard or mouse you choose. So just pick one you are comfortable with and take the time to understand proper posture.

 

Chair Backrest Angle

Recommendation: Angle between 90-120 degrees, with a lumbar support conforming to the NATURAL curvature of your lower back. START AT 90, modify the reclining angle up to your comfort This means that you need to be able to find your neutral spine position and then find a lumbar support or back-rest that adequately conforms to that. The height of the back-rest ideally includes a neck support, although it is not necessary.

 

 

This is one of the most common concerns when it comes to ergonomics of the chair and is often poorly understood. There is a landmark study that was performed by Wilke et. al 1999 which reported that the intradiscal pressure is the lowest in a slightly reclined position (see the image). While this is an important understanding, it does not provide a complete picture about the stresses on the other tissues surrounding the spine.

 

This study has led to the idea that reclined is better than the standard upright position, which I believe misses the point and is a misinformed recommendation.

 

Intradiscal pressure is the lowest when the muscles supporting the spine have the LEAST amount of activity. This is usually dictated by the position of the lumbopelvic complex.  This may have contributed to the reason why the reclined position demonstrated such low intradiscal pressures – as it moved the lumbopelvic complex into a position that relaxes the low back musculature, thus reducing pressure.

 

So, it is more important to first find your neutral spine position and relax your lower back musculature than it is to adjust the reclining angle of the chair. This is why I make the suggestion above to start at 90, then move toward 120 as you see fit.

 

Chair Height

 

Recommendation: Height at which the HIPS and KNEES to be roughly the same level AND for the feet to be supported (flat on the floor or on a footrest).

 

Setting your chair up for your thigh to be parallel to the ground reduces excessive pressure under the thigh that may prevent blood flow. When they are not at the same level, the position of the lower back and pelvis are typically affected. If the knee is higher, the lower back becomes too rounded and if the hip is higher, the lower back becomes too arched.

 

Lack of foot support can also place undue pressure on the back side of the lower thigh, again cutting off blood flow. Foot rests are usually needed with tables that are too high and aren’t adjustable.

 

Arm Rests and Seat Cushion

Recommendation: Shoulders should be relaxed and elbows comfortably supported on the arm rests. It should allow your shoulders to relax. It should not prevent you from scooting forward to the front of the desk. Cushion is recommended, especially one that can reduce pressure on your butt bones.

 

Working while sitting with the arms supported reduces strain to the body – specifically the shoulder.

 

 

In some studies it has also shown to reduce keying forces during typing (affecting your elbow and wrist position). If the armrests are too high, it will push your shoulders in a shrugged position and can create a higher risk of neck stiffness along with shoulder repetitive strain.

 

Proper cushioning, especially with relief at the ischium (butt bones) has been shown to reduced spinal load. This is a much less emphasized portion of ergonomics as the backrest, lumbar support and chair-height affect the position of the lumbopelvic complex more significantly.

 

Desks

The only things one has to consider with your choice of a desk is that your choice allows for the other components of your ergonomics to be properly managed. It should provide enough space to allow you to maintain the 1-arm rule for monitor distance. The desk depth and height creates space for your knees to scoot close to the desk and allows your knees to comfortably rest on the floor/footrest, respectively. The height may not be adjustable at all times but it is again important to allow your shoulders to be relaxed so you aren’t at risk for rotator cuff overuse.

 

Remember,  ergonomics can create an environment that helps us assume the most optimal postures. This also means that improper ergonomics can put increased strain on tissue that we use often which can then lead to injury. When looking at the wrist/hand there are many muscles that assist in clicking, moving a mouse, toggling the joystick, etc.

 

These tendons are at a risk for injury due to the repetitive nature of gaming. When we experience pain at the wrist we can tell which actions are responsible for the pain because they correlate to the sides of the wrist experiencing the pain. Meaning if there is pain with wrist flicks on the pinky side of the wrist than we can tell it is likely an Extensor Carpi Ulnaris (ECU) tendinopathy as this is the muscle responsible for this action.

 

 

Where does an ergonomic mouse or keyboard come in?

Having an ergonomic mouse or keyboard will reduce the amount of weight you are applying on the “stress” side. per unit time. So think adding 1 lb at a time vs. 4 lb at time. The scale will tip over more slowly and may not exceed the left side. That number is not static and changes based on what you have done over the past quarter in terms of physical activity and conditioning. Again the left side of the scale will drop in weight.

 

Many times our conditioning gradually reduces as we sit for many hours without performing endurance exercises on our wrist & hand. Better ergonomics will place our muscles at better lengths and positions to contract. This can lead to the reduction of stress per type / click as discussed which is due to the length-tension relationship of muscles. At better positions that influence the length of our muscles, they can produce force optimally. If you’d like to learn more about ergonomics, which mouse/keyboard is right for you, or how it affects the hand/wrist click the link here.

 

 

It is important to realize that improving your environment through ergonomics does not actually change the muscles overall endurance or even flexibility. The endurance or ability to handle repeated stress over an extended period of time provides the best protection against injuries and strain. If you’d like to learn more about how to strengthen the wrist then check out this video below:

 

Importance for Exercise

Imagine you are set to run a marathon. You are in your 30s, you haven’t trained or exercised for several years. If you run the marathon tomorrow, there is a high risk of you injuring yourself which is why you seldom do this. We always train to prepare ourselves for a challenging activity to ensure that we prevent injuries. The same can be said for working up the necessary muscles to game for long hours. Most of the time using a computer does not seem like a strenuous activity as it isn’t…But with the repetitive small movements of typing, clicking and mouse movement combined with many years of low levels of physical activity and limited focus on endurance can lead to a similar risk of injury.

This is why exercising is so important! If we are engaged in long bouts of any activity, tendon irritation is possible. In order to then tolerate these longer hours than we have to strengthen these specific muscles and that is what our program focuses on. If you would like to learn more about specific exercises to help build up these muscles used in gaming check out the link here.

Research for Exercise

For many years research has supported this idea that ergonomic training on its own has been shown to have limited effectiveness in managing symptoms . In fact meta analyses have shown that the combination of ergonomic training and strengthening exercises provides the best overall outcomes for preventing and managing injuries in the workplace . These studies have been repeated across multiple body regions, always supporting the idea that the best outcomes can be achieved when you combine exercises & ergonomic changes.

This is EXACTLY what we have seen over the past decade when focusing on treating wrist & hand injuries of desk workers, gamers and musicians. In the review of our case data we have found that posture & ergonomics plays between a 10-20 % role in a majority of injuries. While changes were helpful in extending duration of activity and temporarily reducing discomfort it was always the exercises targeting the key muscles utilized that led to long-term relief.

This is why our team of Physical Therapists at 1HP have focused on creating content & resources that are aimed to help more desk workers implement basic wrist & hand programs to stay healthy. We also created an app that provides you a personalized exercise program to help you target the key areas of weakness that might be leading to your issue based on where you feel your discomfort.

It takes where you feel your pain AND takes your specific level of endurance (left side of the scale), flexibility and nerve tension to customize the recommendations. As a bonus we have included a posture & ergonomics mini-course so you can learn how to best setup at your desk while also performing the key exercises you need.

Check out our app TROUBLESHOOTER, our posture & ergonomics minicourse, and also check out this video to learn more about why exercise is so important in treating repetitive strain injuries for the wrist & hand below.

References:

• McGee C, Hwu M, Nicholson LL, Ho KKN. More Than a Game: Musculoskeletal Injuries and a Key Role for the Physical Therapist in Esports. J Orthop Sports Phys Ther. 2021 Sep;51(9):415-417. doi: 10.2519/jospt.2021.0109. PMID: 34465141.
• Cunanan AJ, DeWeese BH, Wagle JP, Carroll KM, Sausaman R, Hornsby WG 3rd, Haff GG, Triplett NT, Pierce KC, Stone MH. The General Adaptation Syndrome: A Foundation for the Concept of Periodization. Sports Med. 2018 Apr;48(4):787-797. doi: 10.1007/s40279-017-0855-3. PMID: 29307100.
• SELYE H. Stress and the general adaptation syndrome. Br Med J. 1950 Jun 17;1(4667):1383-92. doi: 10.1136/bmj.1.4667.1383. PMID: 15426759; PMCID: PMC2038162.
• Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in tendinopathy management. Best Pract Res Clin Rheumatol. 2019 Feb;33(1):122-140. doi: 10.1016/j.berh.2019.02.001. Epub 2019 Mar 8. PMID: 31431267.
• Effect of office ergonomics intervention on reducing musculoskeletal symptoms. Amick BC 3rd, Robertson MM, DeRango K, Bazzani L, Moore A, Rooney T, Harrist R. Spine (Phila Pa 1976) 2003;28:2706–2711. doi: 10.1097/01.BRS.0000099740.87791.F7.
• Chen X, Coombes BK, Sjøgaard G, Jun D, O’Leary S, Johnston V. Workplace-based interventions for neck pain in office workers: systematic review and meta-analysis. Phys Ther. 2018;98:40–62. doi: 10.1093/ptj/pzx101.
• Prall J, Ross M. The management of work-related musculoskeletal injuries in an occupational health setting: the role of the physical therapist. J Exerc Rehabil. 2019 Apr 26;15(2):193-199. doi: 10.12965/jer.1836636.318. PMID: 31111000; PMCID: PMC6509454.
• Dandale C, Telang PA, Kasatwar P. The Effectiveness of Ergonomic Training and Therapeutic Exercise in Chronic Neck Pain in Accountants in the Healthcare System: A Review. Cureus. 2023 Mar 4;15(3):e35762. doi: 10.7759/cureus.35762. PMID: 37025734; PMCID: PMC10072180.
• Bonnar, Daniel & Hwu, Matt & Lee, Sangha & Gradisar, Michael & Suh, Aly & Kahn, Michal. (2023). The Influence of Coaches and Support Staff on the Sleep Habits of Esports Athletes Competing at Professional and Semiprofessional Level. Journal of Electronic Gaming and Esports. 1. 10.1123/jege.2022-0023.
• Smithson EV, Reed Smith E, McIlvain G, Timmons MK. Effect of Arm Position on Width of the Subacromial Space of Upper String Musicians. Med Probl Perform Art. 2017 Sep;32(3):159-164. doi: 10.21091/mppa.2017.3026. PMID: 28988266. Stackhouse, M., & Hankins, B. (2021). Conditioning for esports. Human Kinetics.