Is your laptop a pain in the neck?

When Ram Viswanadha began using a laptop at work, he decided to shelve his clunky old desktop PC for good. The notebook's size, speed and memory blew the older computer away.

What the 30-year-old Silicon Valley software engineer didn't bargain for was a severe case of repetitive strain injury -- and three-months of disability leave -- from hunching over his laptop day in, day out for four years.

Viswanadha's situation is a worst-case scenario in workplace ergonomics, but stories like his are becoming more common, according to doctors and ergonomic experts across the country. As people ditch desktop computers to work full-time on laptops, doctors expect to see a lot more pains, strains and injuries among white collar workers.

"When you look at the design, laptops were never meant as a replacement for a desktop computer," said Alan Hedge, director of the Human Factors and Ergonomics Laboratory at Cornell University. "The idea was portability for occasional use. It was never intended to be a machine you would work at for eight hours a day, 52 weeks a year."

More than 9,200 US nongovernment workers reported missing a day or more of work because of typing and keyboarding-related injuries in 2003, according to figures from the US Bureau of Labor Statistics. Ninety-two percent of those cases were associated with worker motion or position, the bureau said. More than a third of those workers missed over a month of work because of their injuries.

For notebook computer use, such statistical information on injuries is scarce, but doctors report a steady stream of new patients who've overdone it on the machines. That's not surprising, given the boom in laptop sales. Nearly 49 million notebooks were sold in 2004 worldwide, almost double the number sold in 2000, according to market researcher IDC. The devices account for more than a quarter of the computer market, and are set to surpass desktop sales in the US by 2008, IDC said.

The main problem with laptops is that the screen and keyboard are so close together. Without the aid of peripherals, laptop users have two choices, neither of which would win them any points for posture. They can cramp their neck down to view the monitor or they can elevate the machine to eye level, which can wreak havoc on shoulders and arms.

And the wrists lose out regardless, because the keyboard is so small, leading to awkward hand positioning.

"These are all recipes for disaster for your body, and your musculoskeletal system especially," said Nicholas DiNubile, an orthopedic surgeon in Philadelphia.

Laptops can cause other physical woes. People have been burned by the heat the machines generate. The temperature issue can also cause fertility problems in men who place the machines on their laps for prolonged periods. Frequent travellers can put strain on backs, hands and shoulders by lugging a laptop around.

For Viswanadha, neck strain was the root of his injury. His doctors said spending so much time on the laptop had shortened his neck muscles, putting pressure on his spine and compressing the nerves that run to his hands. Eventually his hands began feeling numb and painful and he was diagnosed with repetitive strain injury -- a family of ailments caused by repetitive motion and poor posture.

But the bad news went beyond his body.

"For a couple of months, I didn't know what I was going to do; I have a single-income family," he said. "I kind of went into a depression state."

Viswanadha is back at work now, however, and learning to cope with his injury, but he wishes he had taken precautions much earlier.

An ounce of prevention...
Many laptop-related injuries can be avoided. The use of peripherals such as docking stations, separate keyboards and mice is probably the easiest way to avoid neck and shoulder trouble. These add-ons let users adjust monitors to eye level while keeping arms and shoulders in a natural position. Several companies offer laptop stands that prop machines up to the desired height.

The ideal height of the monitor is about 20 degrees below horizontal eye level, or 0.2m below eye level at a 0.5m viewing distance, said Tom Albin of the Human Factors and Ergonomics Society.

Special pads and trays -- some with fans -- can reduce risk of burns and other heat-related problems.

However, these bulky items can be unpractical for travellers. Their ergonomic benefit may be offset by the strain of hauling them around in a shoulder or handbag, Hedge said.

Lifestyle choices and work habits are also critical to warding off computer-related ailments. Taking short breaks every 20 to 30 minutes, stretching, exercise and eating healthily all reduce the risk of injury with any type of computer. Knowing when to shut off the devices and call it a day is important too, especially with portable machines.

"The portability is problematic," said Lisa Zacharewicz, a doctor of internal medicine at Saint Francis Memorial Hospital in San Francisco. "People can take a laptop home with them, so they never get off of it."

Another reason people are spending more time on laptops is that they've become mobile entertainment centres, complete with DVD players, bigger screens and more powerful processors. These feature-laden machines -- though often heavier and less portable than previous devices -- will dominate the laptop scene in the future, Hedge said.

Laptops often cause men physical problems more often than they do women because a small stature helps, Zacharewicz said. Being over 40 and having a history of orthopedic injuries, such as tennis elbow or tendonitis, are other risk factors, DiNubile said.

Yet the young are not immune. Zacharewicz estimates the average age of patients she sees with computer-related tendonitis has dropped dramatically over the past decade, from between 45 and 50 to between 28 and 34.

"People just think that's part of working hard -- that you have to hurt," she said. "But if you're 25, you shouldn't have tendonitis."