# Death by computer

If you're anything like me, you probably spend too much time on the computer. (The fact that you're currently reading this isn't really helping your case.) That's unfortunate because, as you already know and likely try to ignore, screen time is slowly killing us. It's a perfect storm of sedentariness and repetitive stress that all but guarantees us a miserable and arthritic old age.

As any other chronic affliction, screen time slays some victims more easily than others. I have discovered the hard way that I fall into this category of highly injury-prone computer users. In fact, I am one of the most injury-prone people I know.

Now, I don't mean this in a competitive way (though I am a bit of a hypochondriac). If you are more injury-prone than I am, then, well. . . good for me, I guess. I'm just stating an observation: between 18 and 22, my left side has suffered a runner's knee, a climber's elbow, and emac's pinky (more on that later). The right has seen a dash of carpal tunnel, then, this year, it was a serving of swimmer's shoulder, followed, a few weeks ago, by a small serving on the left.

What all this means is that I've spent a lot of time thinking about how to adjust my routines around computers to minimize injury risk while simultaneously maximizing productive recovery. And I'd like to share some of what I've taken away, so that maybe you to do a better job than I have.

A disclaimer: I have absolutely no medical or physiotherapeutic certifications, and you should definitely consult the officially knowledgeable folk before me.

I've broken down these items into two categories. Take them at your leisure:

1. At the computer
2. Away from the computer

# At the Computer

## Keyboard

I'm an emacs junkie.1 Besides the obvious perks (flying through code, never having to touch vim), there is a rather unfortunate risk that accompanies regular use: emacs pinky. Every key combination begins with either the control or meta (option) key, and emacs involves rather a lot of key combinations, so if you don't watch out, you'll end up with a repetitive stress injury (RSI) in your left pinky.

Two years ago, I found myself suddenly at the mercy of this terrible affliction. And I have to say that moving through code without my key combinations (at the speed of molasses) was almost as painful as the originating pangs in my little finger.

Fortunately, I've been able to completely resolve this issue. What makes this unique is that it's the only issue I've been able to remedy entirely at the computer.

First, I reprogrammed my keyboard. I moved my control key to my caps lock and my option key to tab. This helped some, but it couldn't keep emacs pinky at bay forever. The problem returned.

The thing that really made the difference was getting the Kinesis Advantage2, the gold standard of ergonomic keyboards. Not only is the keyboard delightfully contoured to your hands (and in a placement much more comfortable to your shoulders), but it moves your modifier keys to your thumbs. Emacs pinky be gone.

After only two days, I was up and running at a reasonable speed. After two weeks, I was faster than I'd ever been. And in the two years since, I've never again suffered emacs pinky. As for my thumbs, they are pretty confident that they can avoid a petty little finger disease.

## Mouse

It is, of course, the highest calling of any emacs user to transcend one day beyond the squalid, paltry computer mouse. The moments of transit between keyboard and mouse rack up to hours and years over one's lifetime—hours and years that go to waste.

As much as I would like to achieve that mouseless nirvana, I must admit that I still lapse into base dealings with that antiquated navigating device.

When I purchased the Advantage2, it was second-hand and included an ergonomic mouse, the Contour Unimouse, which I have used ever since.

Even though the unimouse is a feat of ergonomic perfection (and I'd consider myself a fan), there's a fundamental problem with the whole mouse thing. If you make lots of movements left-and-right and back-and-forth (as is often the case with design-related programs like Photoshop), you put your shoulder at risk of injury.

That's what happened to me earlier this year when I as spending a lot of time working with wireframes. Now, because I had to avoid using my right arm as much as possible while still accessing mouse-like functionality, I began to explore the accessibility features available on my computer.

To be honest, I'm a little disappointed. I thought that we had made more progress in computer vision and audio—that text-to-speech was a solved problem and that pupil-tracking would be a walk in the park. But no. Text-to-speech was nowhere near ready for programming and only marginally useful for conventional writing tasks (such as for these articles). Despite my ardent wishes to contrary, my pupils will remain untracked for some time yet (at least at my price point).

On the bright side, my computer did have built-in gaze tracking, and that, surprisingly, was not too bad. Even better, I could configure facial expressions to function as different kinds of mouse interactions: kissy face for click, open mouth for press-and-hold, tongue-out for double-click, etc. Now, I won't pretend that this was working more easily than the mouse. My shoulder ultimately recovered, and I fled away from these accessibility features as soon as I could. That said, I'm happy to know that these features exist for the people who need them.

## Foot Pedals

The natural next step in my ergonomic evolution—after more effectively engaging my thumbs with the Advantage2—was, of course, ergonomic foot pedals—again from kinesis, this time as a Christmas gift from a dear friend.

Finally, I could cast the emacs modifiers wholly away from my hands to play the control and alt keys like a bass and hi-hat of a drumkit. Finally, I could entirely free my pinky from the shift key as an extra precaution against its emacs-induced adversary.

This took a bit longer to learn to coordinate, and, unlike the Advantage2, I'm not sure that it has yet conferred a speed boost. It's also a little harder to transport. Nowadays, I take the Advantage2 with me whererever I go (yes, even when it occupies like 50% of my handbag allowance), but the foot pedals are just a tad too heavy. They're also just a tad too inconvenient to set up at a mobile work station.

That said, they definitely help add to my intimidation factor at the keyboard. And in the long-term, I'm sure I'll master them yet.

## Screen Height

Fortunately, my back has not yet been a serious victim of the chronic injury demon inside of me. Part of that is probably because I usually sit, as my brother would say, "as if [I] have a stick up my ass." In more polite words: my posture is usually okay.

If you're often working on a laptop as I do, then the number one item I would recommend (the thing that has most helped me maintain my stick-in-ass posture) is a portable laptop stand. These are cheap—you can get them for less than \$20.

## Chairs

Full discloser: in this area, I have even less experience than I do in the other areas. The only "high-end" chair I've ever had was a used HÅG Calisco. I chose it because (1) I liked the idea of a saddle seat, (2) I wanted the increased height (I would be able to use the chair with a standing desk at its full height), and (3) I was taken in by the idea of using the chair in multiple directions (see gif below). In practice, I found it to be rather uncomfortable and inconvenient 1, and the multiple positions thing was a rather poor substitute for getting up and moving around.

I decided that this was one of those "ergonomic" chairs that is more statement piece than really ergonomic. Unfortunate.

What's more unfortunate is that fake ergonomicity seems to be endemic among "non-traditional" office chairs. Consider the kneeling chair variety (pictured below). Vendors claim that these chairs decrease lower-back pain (LBP), but researchers can just as easily find evidence to the contrary [1]. Optimal sitting posture (for reducing LBP) remains controversial [2].2

So the jury is still out. All I can say is snoop around and try a bit of everything before deciding. As for me, I'll be going back to a more traditional kind until I can afford to sample the full zoo.

## Standing Desks

Just as these non-traditional office chairs, standing desks have gone viral. Every hip-looking office space is full of them, and even schools are starting to recruit standing desks, usually under the banner of obesity-prevention [3] [4]. For what it's worth, you really do seem to burn more calories while standing [5]. In the vein of this article, standing desks may also reduce risk of upper back/neck pain while increasing productivity [6].

From my own personal experience, standing desks are not all they're hyped up to be. I find them useful as an add-on—as an alternative for some of my day's sitting hours—but not as a full-time replacement. To me, the problem seems to be not so much not standing as not moving. Long-term, the only difference between not moving while sitting and not moving while standing is where—not whether—the injuries will occur. It's just that, short-term, it's easier to move while already standing.

Just make sure that if you are standing, you're standing correctly. And no, I don't mean this facetiously. Many of us have shitty posture when either sitting or standing.

# Away From the Computer

Except for the example of emacs pinky, the most effective intervention I've encountered has always been away from the computer.

Before you go to empty your wallet on an ergonomic keyboard, go out and get some exercise—more than anything else work on the mobility stuff. You have a lot of catching up to do when you spend your whole day not moving.

Unfortunately, spending less time at the computer isn't really an option for most of us. We need to make a living in this information economy, and it doesn't help that our main conduit to many of our relationships is online. A minimum of eight hours a day online seems to be a hard fact of life—so be it.

Probably my number one recommendation is to set a Pomodoro timer, or something similar, to ensure that you get out of your chair (or out of your standing position) every half hour, so you remember to jump around and just move. There's nothing quite so invigorating and healing.

The other thing that has worked for me is that when I sense an oncoming injury, I change my exercise routine. Most chronic injuries seem to result from muscle imbalance, and all the ergonomic gear in the world won't fix that if you won't first fix your movement patterns. As long as I'm slow and careful, a change in exercise doesn't aggravate my injuries but speeds up my recovery.

That said, remember that I'm no doctor and my advice is completely anecdotal and highly doubtful. You should not listen to any of this.

We're stuck in a shitty interim period—between the conception of desk work and the invention of reliable brain-computer interfaces. All I can say is that it sucks. It really fucking sucks. That and I wish you all the best in your own injury-prevention journey. I'd love to hear what kinds of fixes you've worked on, or if any of my experiences end up working for you. This certainly won't be the last I have to write on the subject, so until next time. . .

## Footnotes

1. For the uninitiated, emacs is a code editor, usually to be contrasted against its inferior rival, vim. 2

2. It doesn't help that these studies have dismally small test groups ($N~20$) with short seating windows ($~30$ minutes) and often concern people who don't even have LBP to begin with [1] [7].