Ergonomics for the Hard-Working Medical Writer

We writers often talk about the mental and emotional labor of writing. But writing is physical labor as well. When we think of physical work, we might more likely think of construction workers or athletes as examples. After all, those jobs are more obviously linked to injury. But the principles of injury and its prevention apply equally to writers.

Over years of clinical practice, I've cared for people who work in a variety of sedentary jobs. Many of those patients are surprised to learn how much physical stress they are under as computer workers. Many are similarly surprised to find that ergonomic practices, by reducing those stresses, help alleviate work-related wrist, neck, or low back disorders. But if you understand one main principle behind both injury and healing, you will understand why ergonomics matters.

Most importantly, if you are a writer, your body (especially your upper body) undergoes routine "wear and tear" stress during each day of work. Overnight, your body needs to balance these stresses with recovery and repair. If you recover fully from those unnoticed "micro-injuries", you don't develop a true injury. But if those micro-injuries start to overwhelm your body's healing response, the result is sometimes called an overuse condition. Common examples are "repetitive strain" to muscles or tendons.

If you minimize the micro-injuries and fatigue, you will more likely avoid overuse injuries. This is what the "toolbox" of ergonomics helps you do. It's a big toolbox, and in fact is sometimes mischaracterized as being simply the many products marketed as "ergonomic." But my hope is not to persuade you to go on a big shopping trip for computer peripherals, but instead to prompt you to consider how, and how well, your work equipment supports you in your work.

So let's break down what this ergonomic toolbox contains. We can group them roughly as tools that 1) physically support you, 2) you interact with visually, or 3) you handle. (I'll indicate when a statement relies on my experience or opinion, rather than empirical research or broadly accepted facts. In other areas, I've hyperlinked sources for further reading.)

Tools That Shape Your Workspace and Physically Support You

One of the crucial first things you probably do in writing is either sit down in a chair, at a desk; or stand in front of a desk. And once you have yourself placed in your chair (if you use one), at your comfortable seat height, and have a desk of an appropriate height, this informs where you'll place other equipment. So let's start with chairs and desks.

Your Chair

If you're going to sit at all for your desk job, you should have a good chair. Let's talk about what that means. Here are some rough specifications.

Backrest angle: It's a good idea to have a backrest that can tilt at least 20 degrees backward. (Much more than that is generally not advised.) It's equally important for the backrest to be able to lock at any tilt angle you prefer.

Seat depth and height adjustability: If you sit all the way back in the chair, you should still be able to fit your hand between the front of the seat and the backs of your knees, and your feet should still be able to rest fully on the floor.

Seat and backrest material: the fabric or mesh you sit against can be important for comfort. Both fabric and mesh types may feel relatively firm or soft. Some seat meshes may feel too firm after just a few minutes; some meshes, on the other hand, are famous for being accommodating and comfortable. Some fabric seats trap your body heat (not usually good); others are engineered to circulate heat away from you. Some users report feeling cooler in a mesh seat. Comfort, whether with fabric or mesh seats, is very individual, and you may simply have to try a couple of different chairs to get an initial sense of what you like.

Armrest location, shape, and maneuverability: armrests increasingly are being made moveable: not just up or down (which is essential), but forward and backward, and sideways too. On the whole, I see this as good, unless it creates more options than you want to deal with, or, of course, if it puts the chair beyond your price point.

Gaming chairs have emerged more recently as an "ergonomic" option. They're cheaper than most products marketed as office chairs. Typically they feature a smooth (fake) leather surface. Their backrest and seat pan contours tend to be flatter than those of typically styled office chairs; rather than built-in lumbar support, they may come with strapped-on, movable lumbar support bolsters. I have been skeptical of them, but I've heard more than one patient describe being happy and comfortable in a home-office gaming chair.

A general observation: I prefer a chair that allows me to sit how I want. If I have 3 or 4 different habitual work postures, I want my chair to accommodate all of them, not pre-determine a single "ideal" posture. If I feel I’m being “pulled” into a particular area of the chair, or “pushed” away from a posture that’s natural for me, I move on. You might at least consider whether your chair is "friendly" toward your preferred sitting postures. Bottom line: if you feel comfortable, competent, and productive in it, you've probably found your chair.

Your Desk

The key variable I'll discuss here is how to determine your appropriate desk height. The tabletop height should roughly match your elbow height whether you're sitting or standing. This allows you to use a keyboard with your wrist in a neutral position. Many desks often, unfortunately, are manufactured at fixed heights. But if your workspace and budget allow, choose your desk according to your own height.

Let's suppose you're buying a sit-stand desk. First, sit in your work chair (adjusted to comfort), and measure from the floor to the bottom of your bent elbow. Then do the same while standing in your typical workday footwear (and, if you use one, on an anti-fatigue mat or other soft surface (pro tip here)). Consult the product information to ensure the desk top can match both heights reasonably closely.

Contouring of desk edges deserves mention. For reasons that elude me, many modern desks are still made with sharply-angled edges and corners. This may chafe and be uncomfortable for writers who like to rest their forearms close to the near edge of the desk. It may be worth keeping in mind if you're shopping.

Tools You Look At

Once you are sitting or standing comfortably in front of a desk, it's time to attend to your computer monitor. Important considerations include size and number of monitors, positioning, and viewability. You want sufficient real estate for your screens, but without creating clutter.

Our eyes function most naturally when vision is directed just slightly downward, such as when reading a book. However, computer monitors are sometimes positioned too high, causing eye strain. The topmost line of text or interactive icon should be at about eye height. On the other hand, the monitor on a laptop is generally too low, and often induces poor work posture, as a glance around any coffee shop will show. I usually recommend raising a laptop using a stand designed for that purpose (i.e., not a pile of books), and adding a wireless keyboard and mouse, for those who use laptops extensively.

Finally, eliminate stray lighting that causes glare, either directly into your eyes or indirectly by reflecting from the screen. Additional task-specific lighting may be needed to view other materials, such as hardcopies and (non-electronic) books.

Tools you handle

When discussing ergonomics, a lot of attention goes to the tools we handle, such as keyboards and mice. Concern about conditions like carpal tunnel syndrome (CTS) is understandable, even if CTS specifically has an uncertain association with computer use. You've probably seen a colleague sporting a carpal tunnel brace on his or her wrist. This is a visible reminder of the physical burdens and risks of a writer's work. It's no surprise, then, to see keyboards and mice marketed as "ergonomic", prominently and in bewildering variety. How effectively they limit risk is still not certain. But they almost certainly have a role to play, so here are several considerations for each.

Mice

Mice are the most frequently used pointing devices in computer use. Unfortunately, the mousing arm tends to sustain relatively awkward and constrained postures and movements. For example, an awkward mouse position could be having the mouse placed too far forward or out to the side, requiring you to reach and turn your arm. Your arm is then constrained to stay in this position while using the mouse. Many people don't notice the muscular effort and awkwardness of mousing, but this might eventually surface in the form of muscle and tendon overuse problems.

If you use a conventionally shaped mouse (like the one that might come included with your desktop computer, or included with a discount package) with a more conventional shape, you may find it more comfortable when placed directly in front of your body. This positioning subtly lowers the effort and awkwardness of mousing, although this can get in the way of your keyboard.

Certain mouse designs can help lessen awkwardness and effort, as well. I have a mouse whose upper domed surface, and buttons, sit at an angle to the tabletop, such that the little-finger side of my hand rests lower than the thumb-side. I like this because it allows me to rest the mouse with my hand directly ahead of my elbow, without stressing my arm and also without colliding with the keyboard.

The mouse should also not be positioned too low. If your desktop height is correct, then your mouse should be at, or just barely above, elbow height. The size of the mouse is important too, and is underappreciated (especially for users who are children). Users often default to the same mouse regardless of hand size; but if you have relatively small hands, you may be more comfortable using a mouse that feels well sized in the palm.

Keyboards

Computer keyboards come in a wide range in styles, shapes, contours, aesthetics. Some are split, angled, or curved. The variety can be bewildering. But the main consideration is simple: You should be able to depress the keys comfortably. This comes down to a few key factors.

Width and spacing of keys should create a good fit for your finger length and hand width. Key travel (how far down you have to depress the key to produce the character onscreen) is also important. Some users like shallow keys with short travel (I do), but others prefer the feel of taller keys that sink deeper. You may find either to be quite comfortable, partly depending on the keyswitch design. Again, keep it simple: if it doesn't feel laborious to type, you've probably chosen well.

The keyboard should be parallel to the tabletop, and to your forearms while you type. I strongly advise against tilting your keyboard toward you, which extends (bends back) your wrists and probably raises the pressure inside your wrist's carpal tunnel. If the "feet" at the back of your keyboard are raising that end, I suggest folding them back in, so the keyboard will rest level with the table. You can then relax your wrists and fingers more as you type.

I hope this advice helps you develop your intuition as you navigate the physical work of writing. It can take time to get used to this kind of "ergonomic thinking." But over time, you will learn to trust those intuitions. It will start to become obvious when you need a better solution than you have at hand; and you'll be able to choose among options that will improve your workspace.