Away from the formal constraints of the work environment, we may find ourselves relaxing at home in front of the computer or television or on the couch in positions that are not necessarily healthy for our bodies. Does anyone run through the checklist of proper ergonomic positioning and practices prior to beginning a leisure activity? It just doesn’t seem right that activities we enjoy should increase our risk of developing carpal tunnel syndrome (CTS) or a tendonitis. But, as many gaming enthusiasts have discovered, repetitive strain injuries (RSIs) do not occur only during work hours.

The gaming industry is currently in a period of explosive growth. According to a Global Entertainment and Media Outlook 2004 – 2008 study by PricewaterhouseCoopers, the video game business was accurately projected to outsell both the movie and the music industries by 2006. A compound growth rate of 20% annually projects 55 billion USD in video game revenue by the end of 2008. It is estimated that 50% of the population plays video games

Gamers are at increased risk of developing RSIs. Games are most often enjoyed after work or school activity when muscles may already be fatigued or when tendons and nerves may already be stressed or inflamed. The gaming environment may be spontaneously chosen and is not likely to be set up for ergonomic comfort. Players may unwittingly end-up in awkward and unhealthy positions (for example, lying on the stomach with the neck craned up to see the television screen). The practice of playing is repetitive. Achieving game tasks and goals may promote nervous and muscular tension. The controllers may cause mechanical pressures with sustained holding and with additional features such as force feedback (for example, vibrating to enhance the game in relation to the activity on the playing screen). And pain signals may be ignored because the enjoyment of the game overshadows them.

In 1978, Space Invaders was released, and it became the first game to receive the distinction of having a medical condition named after it – Space Invader’s Wrist, a tendonitis caused by wrist and forearm movements required to maneuver the spaceship. Pac Man’s Elbow followed closely behind along with Slot Machine Tendinitis. In 1989, Gameboy introduced a whole new era in gaming with handheld gaming. Currently popular maladies are Nintendinitis, Nintendo Thumb, Atari Thumb and Blackberry Thumb. Although the names of these repetitive strain injuries do not necessarily invoke the seriousness of the condition, symptoms can be quite debilitating and range from pain and aching to tingling, numbness, and muscle spasms and cramps. Symptoms can be severe enough to cause a loss of function in self-care, leisure and work activities. Many gaming guides, such as Microsoft’s X-Box Healthy Gaming Guide, now offer information and suggestions on avoiding gaming pain.

Here are some ergonomic tips for remaining pain-free while playing the game:

First and foremost, if you are having pain while playing, you need to rest from the activity.
If painful, use cold packs for 10-15 minutes after play to control inflammation and spasms.

• Take 10-15 minute breaks for every hour of play.
  
• Stretch often.
  
• Perform 15-20 minutes of cardio activity daily to improve circulation and increase oxygen flow to the arms.
  
• Use pillows to support the arms when playing.
  
• Use the lightest touch possible when activating the controller.
  
• Try to keep the arms relaxed and the controller positioned close to your lap rather than having your arms fly up towards your chest.
  
• Try to alternate more intense games or play sequences with those that are less intense.
  
• The room should have adequate lighting. There should be no glare on the screen.
  
• Prevent eye strain by following the 20-20-20 rule. For every 20 minutes of play, focus for 20 seconds on an object 20 feet away.
  

When setting up to play, be aware of your positioning and environment.

• If playing on a PC, check out Ergonomic ABCs for computer ergonomic tips. The same principles apply when setting up for leisure activities as well as work activities. If not sitting formally in a chair, use pillows and lapboards to help achieve neutral positioning.


• If playing on a smaller handheld device such as a Blackberry or SmartPhone, check out SmartPhone & PDA Ergonomics.


• If playing on a console game system using the television as your screen, avoid twisting or crimping the neck by positioning the couch or chair so that the screen is at eye-level and directly in front of you. Support your arms with pillows. Have good back support. Turn off the vibration feedback from the controller or limit the time it is used. Use pillows and lapboards to help achieve neutral positioning.
  

Special Considerations for Children

• The content of games should be appropriate for the child’s age.
  
• The controllers or keyboard should be appropriately sized for the child’s developmental age – small enough to fit comfortable in petite hands but with buttons large to be manipulated by those who are less coordinated.
  
• Check out ergonomic tips specifically for children at Kids & Computers - Ergonomic Guidelines
  
• Encourage physical activity daily.
  
• Promote healthy habits.
  

For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

If you are experiencing pain, these are the best cold packs on the market. We use them all the time in the clinic. They are durable, do not leak, will not puncture, are comfortable, and conform well to bony areas. The Velcro strap is a nice addition to hold them in place when you are on the move.

Using a lap desk can help position your arms comfortable while gaming on the couch.