“Reasonable people adapt themselves to the world; unreasonable people persist in trying to adapt the world to themselves. Therefore all progress depends on unreasonable people.”
–Paraphrased from Bernard Shaw
Having the right equipment and work environment will reduce injury and improve performance. This is true for athletes as well as for people using computers, laptops, tablets and smartphones. We look down and curve our upper spine to read the tablet, crane our heads forward to read the screen, lift our shoulders, arms and hands up to the laptop keyboard to enter data, and we bend our heads down and squint to read the smartphone—all occurring without awareness (Straker et al, 2008; Asunda, Odell, Luce, & Dennerlein, 2010; Peper et al, 2014). We are captured by the devices and stay immobilized until we hurt. At the end of the work day, we are often exhausted and experience neck and shoulder stiffness, arm pain and eye fatigue. This stress immobility syndrome is the twenty first century reward for digital immigrants and natives.
We hurt because we fit ourselves to the environment instead of changing the environment to fit us. The predominant slouched position even affects our mood and strength (Peper and Lin, 2012). Experience how your strength decreases when you slouch and look downward as compared when you sit tall with your spine lengthened at your laptop, tablet or phone. You will need a partner to do this practice as shown in Figure 1.
Sit in your slouched position while looking down and extend your arm to the side. Have your partner stand behind you and gently press downward on your upper arm near your wrist while you attempt to resist the pressure. Now relax and let your arms hang along the side of your body. Now sit upright in a tall position with your spine lengthening while looking straight ahead. Again extend your arm and gently have your gently press downward on your upper arm near your wrist while you attempt to resist the pressure.
You probably experienced significantly more strength resisting the downward pressure when sitting erect and tall than when sitting collapsed as we discovered in our study at San Francisco State University in with students as shown in figure 2.
Figure 2. Change in perceived strength resisting a downward pressure on the extended arm while sitting. Reproduced by permission from Schwanbeck, R., Peper, E., Booiman, A., Harvey, R., and Lin, I-M. (in press).
Increase your power and take charge! Arrange your laptop, computer and tablet so it fits you. This usually means changing your home and office chairs and desks; since, they have been manufactured for the average person. Just like the average coach airplane seat – it is uncomfortable for most people. As my colleague Annette Booiman who is a Mensendiek practitioner has pointed out, “An incorrectly adjusted chair or table height will force you to work in a dysfunctional body position while an appropriately adjusted chair or table height offers you the opportunity to work in a healthy position.”
Become the unreasonable person and fit the world so that you are comfortable while using digital devices. There are solutions! Take responsibility and adjust your posture to a healthy one–it will make your life so much more energetic. Sit on your sit bones (ischial tuberosities) as if they are the feet of your pelvis and feel your spine lengthening as you sit tall. Alternatively, stand while working and adjust the desk height for your size. Regardless of whether you sit or stand while working, take many breaks to interrupt your immobilized posture. Install a software program on computer to remind you to take breaks and watch the YouTube clips on cartoon ergonomics for working at the computer.
Implement the following common sense ergonomic guidelines:
For working at a computer sit in a chair with your feet on the floor, the elbows bend at 90 degrees with the hands, wrists, and forearms are straight, in-line and roughly parallel to the floor so that the hands can be on the keyboard while the top of monitor is at eye brow level as shown in Figure 3.
Figure 3. Optimum position to sit at a computer work station. From: http://bmarthur.files.wordpress.com/2009/03/good-posture-how-to-sit-at-a-desk.png
For working with a laptop you will always compromise body position. If the screen is at eye level, you have to bring your arms and hands up to the keyboard, or, more commonly, you will look down at the screen while at the same time raising your hands to reach the keyboard. The solution is to use an external keyboard so that the keyboard can be at your waist position and the laptop screen eye level as shown in Figure 4.
Figure 4. Optimum position to sit while using a laptop. From: http://www.winwin-tech.com/uploadfile/cke/images/6.jpg
For working with tablets and smart phones you have little choice. You either look down or reach up to touch the screen. As much as possible tilt and raise the tablet so that you do not have slouch to see the screen.
If you observe that you slouch and collapse while working, invest in an adjustable desk that you can raise or lower for your optimum height. An adjustable height desk such as the unDesk offers the opportunity to change work position from sitting to standing as shown in Figure 5.
Figure 5. Example of a height adjustable desk (the unDesk) that can be used for sitting and standing.
Although office chairs can give support, we often slouch in them. While at home we use any chair that is available—again encouraging slouching. Reduce the slouching by sitting on a seat insert such as a BackJoy® which tends to let you sit more erect and in a more powerful and energizing position see Figure 6.
Finally, whether or not you can change your environment, take many, many short movement breaks– wiggle, stretch, get up and walk–to interrupt the muscle tension and allow yourself to regenerate. To remind yourself to take breaks while being captured by your work, install a reminder program on your computer such as Stretchbreak that pops up on the screen and guides you through short stretches to regenerate.
Cartoon videos on ergonomics: https://peperperspective.com/2014/09/30/cartoon-ergonomics-for-working-at-the-computer-and-laptop/
Healthy computing tips: http://biofeedbackhealth.files.wordpress.com/2013/01/health-computing-email-tips.pdf
Seat insert such as BackJoy®: http://www.backjoy.com/sit/
Height adjustable desk such as The unDesk: http://www.theundesk.com/
Interrupt computer program such as Stretchbreak: http://www.paratec.com
Asundi, K., Odell, D., Luce, A., & Dennerlein, J. T. (2010). Notebook computer use on a desk, lap and lap support: Effects on posture, performance and comfort. Ergonomics, 53(1), 74-82.
Peper, E., & Lin, I. M. (2012). Increase or decrease depression-How body postures influence your energy level. Biofeedback, 40 (3), 126-130.
Peper, E., Booiman, A., Lin, I-M., & Shaffer, F. Making the Unaware Aware-Surface Electromyography to Unmask Tension and Teach Awareness. Biofeedback, 2(1), 16-23.
Schwanbeck, R., Peper, E., Booiman, A., Harvey, R., and Lin, I-M. Posture changes with a seat insert: Changes in strength and implications for breathing and HRV. Poster submitted for the 46th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback.
Straker, L. M., Coleman, J., Skoss, R., Maslen, B. A., Burgess-Limerick, R., & Pollock, C. M. (2008). A comparison of posture and muscle activity during tablet computer, desktop computer and paper use by young children. Ergonomics, 51(4), 540-555.
* Adapted from: Peper, E. (in press). Become the unreasonable person: Adjust your world to fit you! Western Edition and Schwanbeck, R., Peper, E., Booiman, A., Harvey, R., and Lin, I-M. (in press). Posture changes with a seat insert: Changes in strength and implications for breathing and HRV.
I finally bought a separate keyboard and a small stand for my laptop so that the screen is at eye level and my shoulders are relaxed while typing at the keyboard. To my surprise, my neck and shoulder tightness and pain disappeared and I am much less exhausted.
How we sit and work at the computer significantly affects our health and productivity. Ergonomics is the science that offers guidelines on how to adjust your workspace and equipment to suit your individual needs. It is just like choosing appropriate shoes–Ever try jogging in high heels? The same process applies to the furniture and equipment you use when computing.
When people arrange their work setting according to good ergonomic principles and incorporate a healthy computing work style numerous disorders (e.g., fatigue, vision discomfort, head, neck, back, shoulder, arm or hand pain) may be prevented (Peper et al, 2004). For pragmatic tips to stay health at the computer see Erik Peper’s Health Computer Email Tips. Enjoy the following superb video cartoons uploaded by Stephen Walker on YouTube that summarize the basic guidelines for computer, laptop and cell phones use at work, home, or while traveling.
Adult or Child Laptop Use at Home, Work or Classroom
Healthy use of laptops anywhere.
Mobile or Smart Phone Use while Driving, Traveling or on the Move.
Digital devices connect us to each other, provide information from the outside world, allow us to work anywhere as long as there is Wi-Fi, and foster a 24/7 live style. It is almost impossible to remember driving without a smartphone that guides us to where we are going, or using it to find a restaurant or a place to stay. Being captured by the screen and the useful information, we may not be aware of the possible deleterious effects. Depending how the devices are used, they may contribute to disturbed sleep, increased attention deficit disorder in children, increased pedestrian death rates when the person is captured by the screen and not attending to the environment surrounding them, and increased cancer risks through antenna radiation. Some of the dangers have been integrated in a new poster, Mobile Phones: Ringing up the Danger, reprinted below from the website, http://www.cheapnursedegrees.com/mobile-phones-danger/
At the bottom of this poster are my suggestions to optimize technohealth while working with digital devices.
Poster reprinted with permission from: http://www.cheapnursedegrees.com/mobile-phones-danger/
Suggestions to improve technohealth
- Interrupt your computer work every few minutes to wiggle and move
- Breathe diaphragmatically
- Get up and do large movements (stretch or walk) for a few minutes.
- Take a short walk or do other movements instead of snacking when feeling tense or tired.
- Smile and realize that work stress it is not worth dying over
- Install a computer reminder program to signal you to take a short stress break such as StressBreak™.
- Eat lunch away from your computer workstation.
- Stand or walk during meetings or when talking on the phone.
- Turn off LED, TV or computer screens an hour before bedtime to promote restful sleep.
- Keep your phone, tablet or laptop in your purse, backpack or attaché case. Do not keep it on or close to your body.
- Use the speaker phone or plug in earphones with microphone while talking. Do not hold it against the side of your head, close to your breast or on your lap.
- Text while the phone or tablet is on a book or on a table away from your body.
“You only have to think to lift the hand and the muscles react.”
“I did not realize that muscle tension occurred without visible movement.”
“I was shocked that I was unaware of my muscle activity—The EMG went up before I felt anything.”
“Just anticipating the thought of the lifting of my hand increased the EMG numbers.”
“After training I could feel the muscle tension and it was one third lower than before I started.”
-Workshop participants after working with SEMG feedback
Many people are totally unaware that they are tightening their muscles and continuously holding slight tension until they experience stiffness or pain. This covert low-level muscle tension can occur in any muscle and has been labeled dysponesis, namely, misplaced and misdirected efforts (from the Greek: dys = bad; ponos = effort, work, or energy) (Whatmore & Kohli, 1974; Harvey & Peper, 2012). This chronic covert tension is a significant contributor to numerous disorders that range from neck, shoulder, and back pain to headaches and exhaustion and can easily be observed in people working at the computer.
While mousing and during data entry, most people are unaware that they are slightly tightening their shoulder muscles. One can often see this low level chronic tension when a person continuously lifts an index finger in anticipation of clicking the mouse or bends the wrist and lifts the fingers away from the keyboard while mousing with the other hand as shown in Figure 1.
Figure 1. Lifting the hand without any awareness while mousing with the other hand (from Peper et al, 2014)
People may hold a position for a long time without being aware that they are contracting their muscles. They are focusing on their task performance. They are “captured by the screen” – until discomfort and pain occur. Only after they experience discomfort or pain, do they change position. Factors that contribute to this apparent lack of somatic awareness include:
- Being captured by the task. People are so focused upon performing a task that they are unaware of their dysfunctional body position, which eventually will cause discomfort.
- Institutionalized powerlessness. People accept the external environment as unchangeable. They cannot conceive new options and do not attempt to adjust the environment to fit it to themselves.
- Lack of somatic awareness and training. People are unaware of their own low levels of somatic and muscle tension.
Being Captured By the Task
People often want to perform a task well and they focus their attention upon correctly performing the task. They forget to check whether their body position is optimized for the task. Only after the body position becomes uncomfortable and interferes with task performance, do they become aware. At this point, the discomfort has often transformed into pain or illness.
This process of immediately focusing on task performance is easily observed when people are assigned to perform a new task. For example, you can ask people who are sitting in chairs arranged by row to form discussion groups to share information with the individuals in front or behind them. Some will physically lift and rotate their chair to be comfortable, while others will rotate their body without awareness that this twisted position increases physical discomfort. As instructors, we often photograph the participants as they are performing their tasks as shown in Figure 2.
Figure 2. Workshop participants rotating their bodies or chairs to perform the group exercise (from Peper et al, 2014).
Although there are many strategies to teach participants awareness of covert tension, our recent published article, Making the Unaware Aware-Surface Electromyography to Unmask Tension and Teach Awareness,describes a simple biofeedback approach to teach awareness and control of residual muscle contraction. Almost all the subjects can rapidly learn to increase their recognition of minimal muscle tension as shown in figure 3.
Figure 3. Measurement of forearm extensor muscle awareness of minimum muscle tension before and after feedback training (from Peper et al, 2014).
This study showed that participants were initially unaware of covert tension and that they could quickly learn to increase their sensitivity of muscle tension and reduce this tension within a short time period. Surface electromyograpy (SEMG) provides an objective (third person) perspective of what is actually occurring inside the body and is more accurate than a person’s own perception (first person perspective). The SEMG feedback (numbers and graphs) learning experience was a powerful tool to shift participants’ illness beliefs and encourage them to actively participate in their own self-improvement. It demonstrated that: 1) they were unaware of low tension levels, and 2) they could learn to increase their awareness with SEMG feedback.
The participants became aware that covert tension could contribute to their discomfort and would inhibit regeneration. In some cases, they observed that merely anticipating the task caused an increase in muscle tension. Finally, they realized that if they could be aware during the day of the covert tension, they could identify the situation that triggered the response and also lower the muscle tension.
For detailed methodology and clinical application, see the published article, Peper,E., Booiman, A., Lin, I-M., & Shaffer, F. (2014). Making the Unaware Aware-Surface Electromyography to Unmask Tension and Teach Awareness. Biofeedback, 42(1), 16-23.
Harvey, E. & Peper, E. (2012). I thought I was relaxed: The use of SEMG biofeedback for training awareness and control. In W. A. Edmonds, & G. Tenenbaum (Eds.),Case studiesin applied psychophysiology: Neurofeedback and biofeedback treatments foradvances inhuman performance. West Sussex, UK: Wiley-Blackwell, 144-159.
Having the right equipment doesn’t mean we use it correctly. It turns out that usage patterns matter just as much as fancy new office furniture. This post was inspired by a wonderful article that David Kadavy generously interviewed me for. His article explores split keyboards and working wellness. In this post, I go in-depth on some complimentary workplace tools and techniques.
After working on a laptop, smartphone or computer, many people experience discomfort and exhaustion. Back and neck pain and vision problems are very common. Although there are many components that contribute to maintaining health and productivity with digital devices, two factors stand out:
- Ergonomic arrangement: the way the physical environment forces the person to adapt, such as bending over to read and perform data entry with a tablet.
- Work style: the way the person manages themselves to perform the tasks.
Many problems that are aggravated or caused by inappropriate ergonomics can be compensated by changing workstyle. For example, if you bend forward to read the tablet or squint to see the text on the monitor, you can take many movement and stress reduction breaks to compensate for the challenging ergonomics. Having the right equipment, appropriately adjusted, is the focus of ergonomics. Working so that health is maintained regardless of equipment is the focus of work style.
Shoes are a great example. Healthy shoes would look like duck feet–wider at the ball of the feet and toes and narrower at the heel. However, most shoes have pointy or narrow toe boxes. Over time, incorrect footwear becomes a major cause of bunions, foot, hip and back pain for older adults. It causes physical deformity just as the 19th century Chinese practice of foot-binding crippled many women. If you want to run a 100 meter race or a marathon—running shoes are better than high heels. Adapting the environment to you instead of the other way around is the underlying theme of ergonomics.
But even with correctly fitting shoes many people still experience discomfort. Often this is because of misaligned movement patterns. such as their feet point outward while walking instead of pointing ahead. Or they unknowingly favor one leg over the other because many years earlier they broke that leg and adapted their walking pattern to reduce the pain. After walking to avoid pain for a month, this new dysfunctional pattern became habitual and their gait never returned to normal. Changing how you walk or work is the focus of optimum work style. For useful suggestions about workstyle see Healthy Computer Email Tips by Erik Peper.
Many experts have worked for decades on defining optimal ergonomics for using digital devices. The results are always compromises because human beings did not evolve to sit in a chair for hours without movement or read from a small screen in front of them. Nevertheless, the ergonomic setup while using laptops and tablets can be significantly improved. It is impossible to achieve a healthy ergonomic setup while using a laptop or tablet. If the screen is placed so that is easily readable, then the fingers and hands need to be lifted (which often involves lifting the shoulders) to perform data entry. On the other hand if the keyboard is at the appropriate height then you have to look down on the screen. If you regularly use a laptop or tablet, consider purchasing a separate monitor and/or keyboard to improve your setup.
And if you’re replacing your keyboard, make sure to check out David Kadavy’s excellent blog: This weird keyboard may be the biggest thing since your standing desk.
Physical fitness promotes health. For one person it may be walking, for another jogging, bicycling or dancing. Increase the joy and pleasure of movement. In most cases about 20 minutes of continued activity is enough to keep in shape and regenerate. When the urge to watch TV or just to crash occurs, do some of the movement—you will gain energy. The exercises this article are are developed to reduce discomfort, increase flexibility and improve health. Practice them throughout the day, especially before the signals of pain or discomfort occur. First read over the General Concepts Underlying the Exercises and then explore the various practices.
General Concepts Underlying the Exercises
While practicing the strength and stretch exercises, always remember to breathe. Exercises should be performed slowly, gently and playfully. If pain or discomfort occurs, STOP. Please consult your health care provider if you have any medical condition which could be affected by exercise.
Perform the practices in a playful, exploratory manner. Ask yourself: “What is happening?” and “How do I feel different during and after the practice?” Practice with awareness and passive attention. Remember, Pain, No gain — Pain discourages practice. Pain and the anticipation of pain usually induce bracing which is the opposite of relaxation and letting go. In addition, many of our movements are conditioned and without knowing we hold our breath and tighten our shoulders when we perform an exercise. Explore ways to keep breathing and thereby inhibit the startle/orienting/flight response embedded and conditioned with the movements. For example, continue to breathe and relax instead of holding your breath and tightening your shoulders when you initially look at something or perform a task.
Learn to reduce the automatic and unnecessary tightening of muscles not needed for the performance of the task. As you do an exercise, continuously, check your body and explore how to relax muscles that are not needed for the actual exercise. Become your own instructor in the same way that a yoga teacher reminds you to exhale when you are doing an asana (yoga pose). If you are unsure whether you are tightening, initially look another person doing the exercise to observe their bracing and breath holding patterns. Ask them to observe you and give feedback. In many cases, the more others are involved the easier it is to do a practice.
It is often helpful to perform the practice in a group. Encourage your whole work unit to take breaks and exercise together. Usually it is much easier to do something together, especially when you are not motivated—use social support to help you do your practices.
Problems with neck, back and shoulders
The number one overall work-related complaint is the back pain and this is also true for many people who work at the computer. In many cases there are correlations between backache and stress, immobility, and lack of regeneration. Back pain is often blamed on disk problems which may be aggravated by chronic tension that may have some psychological factors. When you experience discomfort, explore some of the following questions:
- Is there something for which I am spineless?
- Who or what is the pain in my neck or back?
- What is the weight I am carrying?
- Am I rigid and not willing to be flexible?
- What negative emotion, such as anger or resentment, needs to resolved?
Be willing to act on whatever answers you observe. Back and neck pain is often significantly reduced after emotional conflicts are resolved (see the book by John Sarno, MD., Healing Back Pain: The Mind-Body Connection). The best treatment is prevention, emotional resolution, and physical movement. Allow your back to relax and move episodically. Allow tensions to dissipate and explore the physical, psychological and social burdens you carry. To loosen your neck practice the following exercise.
Free your neck and shoulders
This is a slightly complicated, but very effective process. You may want to ask a friend or co-worker to read the following instructions to you.
Pretest: Push away from the keyboard. Sit at the edge of the chair with your knees bent at approximately 90 degrees and your feet flat on the floor about shoulder width apart. Do the movements slowly. Do NOT push yourself if you feel discomfort. Be gentle with yourself.
Look to the right and gently turn your head and body as far as you can go to the right. When you have gone as far as you can comfortably, look at the furthest spot on the wall and remember that spot. Gently rotate your head and body back to center. Close your eyes and relax.
Movement practice: Reach up with your right hand; pass it over the top of your head and hold on to your left ear. Then gently bend to the right lowering the elbow towards the floor. Slowly straighten up. Repeat a few times, feeling as if you are a sapling flexing in the breeze as shown in Figure 1.
Figure 1. Illustration of side ways bending with hand holding ear.
Observe what your body is doing as it bends and comes back up to center. Notice the movements in your ribs, back and neck. Then drop your arm to your lap and relax. Make sure you continue to breathe diaphragmatically throughout the exercise.
Reach up with your left hand, pass it over the top of your head and hold on to your right ear. Repeat as above, this time bending to the right.
Reach up with your right hand and pass it over the top of your head, now holding onto your left ear. Then look to the right with your eyes and rotate your head to the right as if you are looking behind you. Return to center and repeat the movement a few times. Then drop your arm to your lap and relax for a few breaths as shown in Figure 2. Figure 2. Illustration of rotational movement with hand holding ear.
Repeat the same rotating motion of your head to the right, except that now your eyes look to the left. Repeat this a few times, then drop your arm to your lap and relax for a few breaths.
Repeat the exercise except reach up with your left hand and pass it over the top of your head, and hold on to your right ear. Then look to the left with your eyes and rotate your head to the left as if you are looking behind you. Return to center and repeat a few times. Then drop your arms to your lap and relax for a few breaths.
Repeat the same rotating motion of your head to the left, except that your eyes look to the right. Repeat this a few times, then drop your arm to your lap and relax for a few breaths.
Post test: look to the right and gently turn your head and body as far as you can go. When you cannot go any further, look at that point on the wall. Gently rotate your head back to center, close your eyes, relax and notice the relaxing feelings in your neck, shoulders and back.
Did you rotate further than at the beginning of the exercise? More than 95% of participants report rotating significantly further as compared to the pretest.
For additional exercises on how to loosen your neck, shoulders, back, arms, hands, and legs, click on the link for the article, Improve health with movement: There is life after five or look at the somatic relaxation practices in part 3 of our book, Fighting Cancer-A Nontoxic Approach to Treatment.
 Adapted from a demonstration by Sharon Keane and developed by Ilana Rubenfeld
Working at the computer, tablet or smartphone is often a pain in the neck. Young adults who are digital natives and work with computers and mobile phones experienced frequent pain, numbness or aches in their neck and more than 30% reported aches in their hip and lower back. In addition, women experienced almost twice as much aches in their necks than men (Korinen and Pääkkönen, 2011). Similarly findings have been reported previously when Peper and Gibney observed that most students at San Francisco State University, experienced some symptoms when working at their computer near the end of the semester. At work, many employees also experience exhaustion, neck, back and shoulder pains when working at the computer. Although many factors contribute to this discomfort such as ergonomics, work and personal stress, a common cause is immobility. To prevent stress immobility syndrome, implement some of the following practice.
- Every hour take a 5-minute break (studies at the Internal Revenue Service show that employees report significant reduction in symptoms without loss in productivity when they take a 5 minute break each hour).
- Take a short walk or do other movements instead of snacking when feeling tense or tired.
- Perform a stretch, strengthening, relaxation, or mobilization movement every 30 minutes.
- Install a computer reminder program to signal you to take a short stress break such as StressBreak™.
- Perform 1-2 second wiggle movements (micro-breaks) every 30 to 60 seconds such as dropping your hands to your lap as you exhale.
- Leave your computer station for the 15-minute mid-morning and mid-afternoon breaks.
- Eat lunch away from your computer workstation.
- Stand or walk during meetings.
- Drink lots of water (then, you’ll have to walk to the restroom).
- Change work tasks frequently during the day.
- Move your printer to another room so that you have to walk to retrieve your documents.
- Stand up when talking on the phone or when a co-worker stops by to speak with you.