Image courtesy of David Castillo Dominici at

Image courtesy of David Castillo Dominici at

Sit/Stand Desks, Treadmill Desks and the 7 Commandments of Ergonomics
~ November 21, 2013 ~

I receive daily questions about sit stand desks and or whether a treadmill desk is something that should be put into this years’ budget. I am an Occupational Therapist specializing in office ergonomics.

Regardless of whether you stand at work or sit at work, there are always 7 things you need to do to keep healthy and happy while using a computer.  I call these things “commandments” because they are more important than rules – they are absolutely non-negotiable demands if you want to reduce risks to computer related injury.

It doesn’t matter whether you use a sit/stand desk, a treadmill desk or a regular work station, your posture must be anatomically correct.


Here’s how the Seven Commandments of Ergonomics apply to all computer work stations. 

  1. You need to “Secure your Spine” by making sure your ears are directly over your shoulders and shoulders aligned over your hips.
  2. Secondly, you need to make sure you are at the correct height to your keyboard, mouse and monitor.  This means that these pieces of equipment must be positioned so that when your elbow is bent to 90 degrees, they are at your fingertips.
  3. Thirdly, your arms must be beside your trunk when you are using the keyboard or mouse.  I regularly see people at the work place reaching forward to use their keyboard or mouse and this is absolutely wrong!
  4. Fourth, the position of your wrist matters.  Repetitive wrist and finger actions on a frequent basis can result in carpal tunnel syndrome, and it doesn’t make a difference if you are standing, walking or sitting.  You need to make sure your wrist is not bent when you are using the keyboard or the mouse.
  5. Monitor height and distance are the fifth and sixth commandments you need to attend to; use your chin and nose as landmarks.
  6. The chin must be parallel with the ground, the monitor an arm reach away and the nose centered over g & h of the keyboard.
  7. Lastly, and the 7th step, your body needs breaks.  If you use a standing desk, you still need breaks from long periods of standing.  You also need breaks from long periods of walking and breaks from long periods of sitting.

One important thing with sit/stand desks or treadmill desks is that you need to train yourself to stand or walk during the work day.  You need to work up to standing for 20 minutes every hour.  Do you think we are cycling?  Ever wonder why people decided to stand while working?  During the industrial revolution people fought long periods of standing so they could sit while working!!  Very interesting.

ESC Computer Pain





For a full description of all of the Seven Commandments, please see
ESC Computer Pain:  Seven Commandments of Ergonomics.








What is the best position of the wrist when using the mouse and keyboard?

Be patient with me as I answer this question by giving you some background information.  I participated in a webinar “Designing More Comfortable PC Accessories:  The Research and Principles Behind Ergonomic Keyboards and Mice, which was presented by Dan Odell, Ph.D., CPE, Founder of Comfortable Creation LLC and sponsored by Microsoft (September 11, 2013).

I don’t think the average computer user would have enjoyed the presentation as much as I did, but I love research and listening to anatomical and physiological information. Computer users, in my experience, are too busy using the computer to pay attention to these types of things.  Dr. Odell confirms my experience; he quoted a large study conducted by Microsoft which found the average computer user spends 7 hours a day on the computer.  Considering the computer users I work with, the large majority of these people would not get up once an hour to take a break from sitting!!

Basically, I learned new information about the mechanisms for injury to the wrist and hand.  Did you know for instance that 30 mmHg of pressure to the carpal tunnel can actually cause damage to the nerve that travels through the wrist?  Interesting?  Do you know how much pressure is involved when your wrist uses your mouse or your keyboard?  I think what is important for you to know is that there is more than 30 mmHg of pressure to the carpal tunnel when you use your mouse or your keyboard incorrectly.

How do you ensure a correct wrist position?  The lowest carpal tunnel pressure is when your MCP’s are flexed to 45 degrees, your wrist is in neutral (no flexion or extension) and no ulnar deviation.  To the lay person, this doesn’t mean much – that’s why I designed the Seven Commandments of Ergonomics.

Wrist in Neutral while Mousing

Wrist in Neutral while Mousing

Commandment 4, Watch the Wrist, will ensure your wrist is in a position that is correct and your carpal tunnel is not compromised.  When applied correctly, Watch the Wrist will provide the lay person with actual landmarks they can look at while using their mouse or their keyboard to ensure there is no wrist deviation.  For example, the thumb must be aligned with the forearm when the hand is on the mouse?

Another interesting thing I learned was that applying pressure to the entire palmar surface of the hand, regardless of whether you are using a mouse, increases the pressure in the carpal tunnel to the danger zone.  It is best to have contact pressure only to the hypothenar eminence, i.e. the palm surface under the fourth and fifth fingers, when using the mouse or the keyboard.  The best keyboard posture however, is holding your wrists like you are playing the piano!!.

If you would like more information that is straightforward and friendly to use, please consider the purchase of my newly released book:  
ESC Computer Pain:  Seven Commandments of Ergonomics.


Does posture really matter when you use the computer – I mean all you are doing is sitting all day?

Posture is the most important thing, whether you are sitting or doing a high level sport. You wouldn’t expect a tennis player to hit the ball with the wrong wrist position would you? If they did, the painful effects would be immediate.

I have found that computer users pay the least amount of attention to their posture. Some computer users remind me of the shape of a pretzel, or look like they are in advanced positions of yoga.

You can compare your body to a puzzle. When the puzzle is complete, the pieces fit together perfectly. Your body is the same, when you have good posture the bones in your back (vertebrae) are stacked on top of each other perfectly and your muscles work optimally to move your joints. When your posture is perfect, your ears sit directly over the shoulders and the shoulders directly over the hips, ensuring the vertebrae (the puzzle pieces) fit perfectly. When you have poor posture, or slouch for example, the puzzle pieces don’t fit. Your muscles then work really hard to try to pull the pieces together. This pull is slight at first, barely noticeable, but the harder the muscles have to work to try to pull the bones into their proper alignment, the more energy they use.  Eventually, discomfort will make you more aware of one part of your body than another. You experience an ache and this ache, over time, turns into pain. I have heard this story frequently over my 25+ years of ergonomics.

The most important thing you can do to prevent pain when using a computer is to sit with good posture. Sit so your ears are directly over your shoulders and your shoulders are directly over your hips.  Move your equipment so this good posture can be maintained all day. Posture is the first commandment in the Seven Commandments of Ergonomics: Secure the Spine.

You can read more details about how your body works and how to adjust your chair to Secure the Spine in the book called: 
ESC Computer Pain:  Seven Commandments of Ergonomics.

ESC Computer Pain



How much does it cost to address ergonomics in the workplace?

The real answer is that it can vary tremendously! Consider the following points.

  1. When incorporated during the planning or decision stage of building, buying or modifying something in the workplace (proactive), ergonomics benefits often come for free! The ‘cost’ is in the form of taking the time to plan properly. Conversely, when ergonomics is applied to correct existing problems (reactive), there will be financial costs to varying degrees.
  2. Depending on the type of business you are in and the extent of problem that exists, ergonomic improvements can range from inexpensive to very expensive. Note that many workplace improvements can be made for minor costs.
  3. Different types of ergonomics interventions can be made, such as engineering design changes and organizational design changes. It is typically easier to determine outlay costs for outright purchases, or engineering type modification projects. However, changes to the organization of work, such as implementing a work rotation scheme, also are associated with financial costs – they are just much harder to measure!
  4. Similarly, ergonomics problems can be addressed to varying degrees. Eliminating the root causes completely may cost more than making a change that reduces the risk. Your budget and resources will help to dictate the extent to which to adopt ergonomic changes.