By Dr. Levi Harrison

Keyboard placement, whether it is in a gaming environment, or perhaps in a general office environment is essential to long term hand, wrist and upper extremity health of computer users. As I have touched upon in previous articles, podcasts and videos, repetitive stress injury (RSI) is at its core caused by the repetition of a specific motion such as clicking, typing, joystick use or the pressing of a button.

The rate at which conditions such as carpal tunnel and tendonitis develop can be affected by a multitude of factors. These include poor posture, improper nutrition, minimal fitness, and unbalanced hand and wrist placement in accordance with keyboard/mouse positions and potentially extracurricular activities. Regardless, in this particular article, I would like to touch upon the topic of proper keyboard placement, which is undoubtedly essential in preventing career ending repetitive stress injuries. Let’s get down to business!

INITIAL STANDARD POSITIONING

First let’s begin with the standard, initial placement of the keyboard. Though some games can encourage players to hold their keyboards in diagonal, or inverse positions, I would always recommend that if possible, the user sets their keyboard up directly, and squarely in front of them. This, assuming the player is sitting properly, and is at the appropriate height, relative to their desk, which will allow for a proper 90-degree angle between the elbow and the forearm. More specifically, you don’t want to be reaching from under the table, NOR do you want to be reaching down to the keyboard from a heightened angle. Ideally, you want your forearms to be aligned with the resting keyboard.

Many ergonomic studies have demonstrated a keyboard on a tray below the desk is the best for keyboard placement. It would seem none of my gaming patients will entertain this idea after extensive discussion. This particular article will ideally provide you with a healthy alternative to the lowered desk/tray placement.

Once a proper angle/ergonomic environment is established, it is essential that the keyboard is not placed to far from the user, or to close. If this is done, then it can force the user to fall out of the proper ergonomic posture to adjust for the incorrect positioning of the keyboard. I recommend having the keyboard 6 to 9 inches in front of your center torso. TLDR – Make sure your keyboard is in a position that does NOT alter your 90-degree angle (Elbow Angle) between your elbow and forearm while in use.

On that same note, once you set up your desk and chair, and you are comfortable with their balanced position, and have established a 90-degree elbow angle, I would suggest using a tape marker on your desk to indicate the keyboard position that allows for the desired 90-degree angle. Often, in between games, especially ones with aggressive clicking or keyboard piloting, the keyboard can be moved, hence, allowing for additional extremity stress, and a tape marker can help you quickly readjust in between games.

Lastly, on the subject of keyboard alignment, if you are struggling to maintain the appropriate 90-degree angle, you could try using a keyboard gel pad to hold your forearms up, hence, maintaining a proper angle.

*This image shows the use of a gel pad support; however, the pad is to thick causing me to have my elbows below the wrist. This is not the best ergonomic position. The wrist and elbows must be in a neutral position. Also the keyboard is flat, without the appropriate 20-degree slope.*

KEYBOARD HEIGHT/ANGLE

Another pertinent subject relating to keyboard use and gaming is the slope of the keyboard. There are many keyboards out there on the market, many of which claim to provide competitive advantages, and yes, in certain circumstances, having an extra macro able button may be helpful. Regardless, at the end of the day, if you’re in perpetual pain, you cannot play, despite that button. Many studies have shown that having a keyboard, which features a 20-degree slope is ideal, and I would agree. In using a completely flat keyboard for sustained periods of time, your fingers will have to reach, then, flex downward to push buttons further up the keyboard, where as, a minor slope allows for more fluid, keystroke of the higher placed buttons.

ANGLED/ALTNERIATVE KEYBOARD PLACEMENT

Firstly, I’d like you to take a look at the following images:

These are positions I commonly see in individuals who play CSGO, and it has even appeared in other games/genres. This particular style of playing forces the elbows away from the body, and in turn, pulls the head and neck forward. Simply put, these positions, though they may benefit your play in the short term, may potentially lead to the development of:

Wrist Tendonitis – This wrist/forearm alignment can lead to the unnatural flexion of the wrist, hence, causing additional stress with each press.

Tennis Elbow – Again, being out of alignment, and RSI in general can be a compounding issue, and can cause pain in the elbow and upper forearm.

Neck & Shoulder Pain – The angling of the arm/shoulder in these particular positions can cause additional stress on the shoulder, as it forces the user’s shoulder/arm into an unbalanced, ergonomically poor position.

Again, as previously mentioned, you may not feel the harm of these play styles in the short term, however, during long hours of practice, scrimmaging, or competition prep, this may not only deteriorate your performance, but also your health.

*NOTE: If you must play this way to stay competitive, then do your best to follow the other tips mentioned in this article, and make sure to take perpetual breaks on the hour. Understandably, as a professional sport, we must make sacrifices from time to time. Remember, these are suggestions, use those that are applicable to you; even making a single change for the better can greatly impact your hand and wrist health!*

PROPER KEYBOARD PLACEMENT/ALLIGNMENT

Now that we have talked about the bad, let’s talk about the good! Please reference the following picture, as well as the excellent decorative plate in the background.

Ideally, you want to have your keyboard and mouse directly in front of you. If your mouse is slightly off to the side, as it is in the picture above, that is fine. It is ESSENTIAL to make sure your well padded chair is elevated high enough to keep the elbows flexed between 90 degrees and 105 degrees, in a neutral position. Elbow neutrality is critical here as well.

Secondly, the back should be straight against the chair, so that your lower back (Lumbar) is supported; often, I’ve seen gamers slouch, or use chairs that do not firmly support their lower backs, which can in turn lead to the development of not only lower back pain, but can inevitably cause RSI. During your next gaming session, do your best to sit up straight, and try to find a chair that firmly supports your lower back. Also, keep your feet firmly on the ground without crossing your legs while gaming.

Next, make sure that your ergonomic mouse is no more than 8 inches away from the closest keyboard side. This will assist you in maintaining the optimal ergonomic alignment, as going further away, can force your hand, wrist, elbow and shoulder into a less ergonomically balanced position.

Also, while on the subject of distance, I would suggest having your monitor 20-30 inches away from your eyes. You also want your eyes to align with the top of your monitor. This will ensure that your neck is not flexed in straining position, and that proper posture is maintained (I personally prefer a wider monitor that is slightly lower and angled).

Again, I sincerely hope that these tips and suggestions will assist you in not only extending your gaming careers, but will also improve your quality of life! Thank you all for your perpetual support! Let’s get to work people!

-Dr. Levi Harrison

The Gamers & eSports Doctor