Laptops, Extraterrestrials and Your Neck Pain

I’m sort of dating myself here, but I can remember when laptops were exotic. A computer you can take with you! And it weighs “only” seven pounds! Nowadays of course, only a few laptops are even fashionable. They’re simply part of the background, ubiquitous in computer use.

To me, this strongly reflects one more triumph of convenience over ergonomics. It’s unfortunate, but when we have to balance “I can take this with me!” to “it kind of hurts my body to use this,” the former consideration wins out surprisingly often.

The core issue is this: your head is higher off the ground than your hands, when you sit or stand. Your head does not rest directly on your hands (of course). But the screen of a laptop rests directly on the keys. That means that laptops are designed as if they were going to be used by people whose heads were attached to their hands. If you ever meet such a being, I recommend giving them a laptop as a present, to take back to their planet. They’ll love it. For us humans, however, there are problems with using a device designed for use by someone shaped like this.

There’s a standard rough rule to figure out how high a computer screen should be when you’re using it: if you stick your hand out directly in front of your shoulder, your middle finger should touch about midway up the screen. A laptop screen will always violate this rule.

Typically people adapt to this line-of-sight problem by advancing and lowering their heads. This creates substantial strain on the joint and muscles of your neck and upper back. If you use a laptop frequently, and experience neck, shoulder and/or upper back pain, consider this as a possible reason. I lost count long ago how many of my patients were able to decrease their neck pain after we’d considered their laptop ergonomics.

On the other hand, if you were to bring the laptop up to improve the line of sight—for example by propping it up on a thick book—then the keyboard would be too high. This would create a different set of problems, by forcing your arms and hands to reach forward and up. Those problems can include rotator cuff (shoulder) strain, nerve compression disorders at the elbow, and wrist tendon overuse problems.

So this is the dilemma we face when trying to improve laptop ergonomics and reduce the risk of injuries related to their use. In fact, sometimes ergonomic solutions won’t even be available to you, the laptop user. Many ergonomic solutions require some extra equipment or props, such as those I’ve described below. But quite often, people use their laptops in more than one location. Within one workday, a user might start with their laptop at their regular workstation, then scoop it up and use it in a laboratory, meeting room, on a train and then again at home at a desk or sofa. That was the point in having a laptop, after all. And all those extra props meant to improve ergonomics won’t necessarily travel along with the laptop.

This means that sometimes, the best you can do will be to keep checking your working posture, regularly shifting your body position a little, so that at least no one part of your body has to take on all the physical stress. It doesn’t sound ideal, and it isn’t. But simply drawing your spine upward, looking up and away from the screen, and letting your arms down and away to your sides will allow your body some crucial moments of rest. And this should also help your mind stay a little fresher. Elsewhere I’ll be writing more about exercises to improve sitting postures more consistently.

In other situations, ergonomic equipment might help. For those who use laptops as a primary computer, laptop stands may help by raising the entire laptop. They shouldn’t simply angle the laptop up toward you; the whole laptop has to be elevated, to comply with the height rule I described earlier. Beware of laptop stands that tilt the laptop keyboard toward you, in an apparent invitation to continue using the same keyboard in this position. I’m a little dismayed to by how many of this kind I see on the market. Typing with your hand in this orientation places your wrist in a bent-up (extended) position that overstresses your forearm tendons over time. The keyboard you use should be flat, or more exactly, lying in the same plane as your level forearm. So for this to be an effective solution, you should connect an external keyboard and mouse to the laptop when it’s on the stand.

Alternatively, you could hook up an external monitor to your laptop, and use that as your screen. But in practice, the laptop screen will often block the second screen; and using the screens in side-to-side fashion may create its own problems (more neck pain, unfortunately).  Larger workstations, with expansive desk surfaces, sometimes make this workable.

So if you use a laptop frequently, I wish you luck in avoiding the often-associated physical stress. Failing that, well… I might see you in my office someday!