Applied Ergonomics 43 (2012) 392e399

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Applied Ergonomics
journal homepage: www.elsevier.com/locate/apergo

Characterization of posture and comfort in laptop users in non-desk settings

J.E. Gold a, *, J.B. Driban a,1, V.R. Yingling b, E. Komaroff a
a
Department of Public Health, Temple University, 1301 Cecil B. Moore Avenue 004-09, Philadelphia, PA 19122, USA
b
Department of Kinesiology, Temple University, 1800 North Broad Street, Philadelphia, PA 19122, USA

a r t i c l e i n f o a b s t r a c t

Article history: Laptop computers may be used in a variety of postures not coupled to the office workstation. Using
Received 25 October 2010 passive motion analysis, this study examined mean joint angles during a short typing/editing task in
Accepted 11 June 2011 college students (n ¼ 20), in up to seven positions. Comfort was assessed after task execution through
a body map. For three required postures, joint angles in a prone posture were different than those while
Keywords: seated at a couch with feet either on floor or on ottoman. Specifically, the prone posture was charac-
Office ergonomics
terized by comparatively non-neutral shoulders, elbows and wrists, and pronounced neck extension.
Computer workstations
Significantly greater intensity and more regions of discomfort were marked for the prone posture than
Joint angle
for the seated postures. It is recommended that the prone posture only be assumed briefly during laptop
use. Exposure to laptops outside of the office setting should be assessed in future epidemiologic studies
of musculoskeletal complaints and computer use.
Ó 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

1. Introduction a lesser extent, while using a laptop computer at a desk (Asundi

Almost one-half of American adults own a laptop computer
(Horrigan, 2009). In Australia, laptop prevalence is increasing (to
63% of all households in 2008), while desktop computer ownership
is declining (Nielsen Company, 2009). A similar trend is occurring
globally, with the volume of laptop sales recently exceeding that of
desktops (Euromonitor International, 2009). In contrast to desktop
computers, which are typically utilized in a seated position at
a desk, the portable nature of laptop computers allows for a variety
of postures during usage.
Several postural factors are thought to impart risk for muscu-
loskeletal symptoms in computer users. Generally, non-neutral
postures are regarded as detrimental. In a systematic review of
epidemiologic studies of video display terminal work, Punnett and
Bergqvist (1997) identified the following specific risk factors: wrist
ulnar deviation, wrist extension, elbow flexion, shoulder flexion, as
well as neck flexion and rotation. More recent works (Gerr et al.,
2006; Marcus et al., 2002) have pointed to study inconsistencies
with respect to some of these postures. Although the postures
assumed while at a desktop computer (Gerr et al., 2000), and to
* Corresponding author. Tel.: þ1 215 204 9661; fax: þ1 215 204 1854.
E-mail addresses: Judith.Gold@temple.edu (J.E. Gold), jdriban@
tuftsmedicalcenter.org (J.B. Driban), Yingling@temple.edu (V.R. Yingling),
komaroff@temple.edu (E. Komaroff).
1
Present address: Division of Rheumatology, Tufts Medical Center, 800 Wash-
ington Street, Box #406, Boston, MA 02111, USA.
et al., 2010; Moffet et al., 2002; Straker et al., 1997; Szeto and Lee,
2002) or on or close to the lap while seated at a chair (Asundi
et al., 2010; Moffet et al., 2002; Sommerich et al., 2002) have
been quantitatively characterized, this is not the case for postures
assumed when using laptops in other positions or locations.
Postural risk factors may be common in these non-traditional
positions, but to date, this has not been assessed in any published
study that we are aware of. Sommerich and Korkmaz (2008)
surveyed high school students and teachers who had been issued
tablet PCs and found that participants used these devices in non-
desk settings such as sitting on a bed or sitting on the floor
between “a little time” to “some time”. However, postures were not
quantitatively assessed in this study.
The objective of this study was to quantitatively determine
postural characteristics of the upper extremity, head-neck
segment, and trunk during laptop usage away from the desk and
to ascertain the level of musculoskeletal comfort following a short
(seven minute) typing/editing task in college students. Specifically,
students (n ¼ 20) were asked to assume three non-desk positions
of laptop usage. These included 1) sitting on a couch with both feet
flat on the floor, laptop on lap (couch feet down), 2) sitting on
a couch with their feet on an ottoman, laptop on lap (couch feet
up), and 3) lying prone on a bed, laptop on the bed in front of the
participant (prone). Students were also asked to choose up to four
alternative positions with which they frequently used a laptop in
order to form a more complete assessment of the positions
employed in non-desk laptop usage.

0003-6870/$ e see front matter Ó 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.
doi:10.1016/j.apergo.2011.06.014
 J.E. Gold et al. / Applied Ergonomics 43 (2012) 392e399
The objectives of this study were to:
1. determine if there was any difference in mean joint angles
during typing among the required three positions assumed.
2. determine if there was any difference in mean joint range
of motion (ROM) during typing among the three required
positions.
3. determine if participants reported any difference in comfort
after typing in the three positions.
Mean joint angles, joint ROM, and comfort after typing were also
determined for the three most frequently chosen self-selected
postures.
2. Methods
2.1. Participant recruitment and selection
Twenty asymptomatic right-hand dominant college-aged
students who identified themselves as laptop users were recruited
through electronic and paper advertisements at Temple University.
After responding to a solicitation, each potential subject was con-
tacted for a structured phone interview to determine study eligibility.
We limited our study to 18 to 25 year olds because we thought that
this age group (which represents a typical undergraduate population)
would be more likely to be accustomed to using their laptops in non-
desk settings (floor, couch, etc.) than an older age group, thereby
minimizing confounding of discomfort ratings due to using a laptop in
an unfamiliar position.
Additional exclusion criteria included left handedness, and
a history of adhesive allergy. Potential subjects reporting pain in the
upper extremity or back or numbness in the arms or hands of 4 on
a ten point scale (1 ¼ no pain or numbness, 10 ¼ most intense pain
or numbness imaginable) while typing on a computer were also
excluded as were those that reported frequent or continuous (vs.
occasional) discomfort of any intensity. These latter exclusion
criteria ensured that joint angle, range of motion, and comfort as
well as self-selected postures were not confounded by symptoms of
musculoskeletal disorders. Temple University’s Institutional Review
Board approved the study protocol and consent forms.
2.2. Equipment and data capture
A five-infrared camera motion capture system (Qualisys AB,
Gothenburg, Sweden) with a 60 Hz sampling rate was used to track
and record passive reflective markers associated with the head-
neck segment, trunk, right shoulder, and right elbow kinematics.
Due to the failure of one camera, eight of the total (n ¼ 75) trials,
representing 10.7% of the data, used a four-camera system. The
motion analysis calibration procedure passed in all trials with both
Fig. 1. Passive motion analysis markers with segments and joint angles, shown for prone position. Solid lines represent segments used to derive flexion/extension and shoulder
elevation. Arrows indicate direction of positive joint angles. Sternum, left shoulder, and right hip markers are not shown. ZeX represents the sagittal plane, XeY represents the
frontal plane.
393
four and five cameras, reflecting acceptable precision for both
conditions. The cameras (MacReflex, Qualisys AB) were on average
located 2.53 m from the participant. Coordinates of the reflective
markers were passed from the video processors to a computer with
Qualisys Track Manager version 2.0 software (Qualisys AB). Addi-
tionally, right wrist kinematics were captured using a 30 Hz Sony
high definition video camera (HDR-SR11, Sony Corporation; Tokyo,
Japan). The camera was placed parallel to the sagittal plane of the
wrist and recorded wrist flexion and extension. MaxTRAQ version
2.21 (Innovision Systems, Inc.) was utilized to digitize the wrist
markers.
To detect kinematics for all joints, eleven passive markers were
placed as indicated below. Black pre-wrap was wrapped around the
participant’s head to cover the ears in order to adhere a head
marker, which was placed over the right tragus. The other markers
were positioned at standardized locations: 1) suprasternal notch of
the sternum, 2) acromion process of the scapula (bilateral), 3) right
lateral epicondyle of the humerus, 4) right dorsum of the wrist
between the radial and ulnar styloid processes, 5) right ulnar
styloid process, 6) ulnar surface of the head of the right 5th
metacarpal, and 7) greater trochanter of the femur (bilateral)
(Fig. 1). Low pass (6 Hz) filtered data from each participant was
exported to MaxMATE version 3.6E (Innovision Systems, Inc.;
Columbiaville, MI), through which all joint kinematics, including
that of the wrist, were analyzed.
Joint angles analyzed included trunk flexion/extension, neck
flexion/extension, shoulder elevation, shoulder horizontal abduc-
tion/adduction, shoulder external/internal rotation, elbow flexion/
extension (inner elbow angle), and wrist flexion/extension. Wrist
flexion was defined as the angle between the hand (H) segment
(Fig. 1) and the forearm (FA) segment (sagittal plane). Elbow flexion
was defined as the angle between the forearm (FA) and the upper
arm segments (UA).
Shoulder (glenohumeral) elevation was calculated as the angle
between the upper arm and trunk (T) segment. Glenohumeral
elevation is the displacement of the humerus upwards away from
the trunk. Based on clinical terms, flexion is elevation parallel to the
sagittal plane and abduction is elevation in the frontal plane (Wu
et al., 2005). To determine whether the humerus was elevated
closer to the sagittal or front plane we measured horizontal
abduction (a transverse plane movement; sagittal plane ¼ 0
degrees and frontal plane ¼ 90 degrees). Shoulder horizontal
abduction was calculated as the angle between the right upper arm
segment and a sagittal reference plane (perpendicular to a line
between the two acromion process markers) (Fig. 2a). Shoulder
internal rotation was calculated as the angle between the forearm
segment (FA) and a sagittal reference plane (Fig. 2b).
Trunk and neck (N) segment angles were referenced to the
global reference vertical plane in the seated positions and a hori-
zontal plane in the prone position. Therefore, the trunk segment
394 J.E. Gold et al. / Applied Ergonomics 43 (2012) 392e399

a b H
FA

UA UA UA

Y
Z

Fig. 2. Schematic showing a) shoulder horizontal abduction/adduction, and b)

shoulder external/internal rotation. Arrows indicate direction of positive joint angles.

angle was considered flexed if the acromion process (shoulder) was

anterior to the greater trochanter (hip), and extended if the acro-
mion process was posterior to the greater trochanter. The neck
segment (ear to shoulder) was defined as flexed if the ear was
anterior to the shoulder marker, and extended if posterior. Joint
angles in the anatomical position were defined as 0 . Positive joint
angles represented flexion, shoulder forward elevation, shoulder
external rotation, shoulder horizontal abduction, and wrist radial
deviation. All participants used a 2.47 kg Lenovo 3000 N200 laptop
(Morrisville, NC) with a 15.4 inch screen and standard keyboard
with integrated standard two button touch pad with scroll feature.

2.3. Experimental protocol

2.3.1. Postures
Study participants assumed three required postures and up to
four self-selected postures. The required postures were chosen
based on preliminary surveys of laptop postures among college
students. Posture order was randomized a priori over two visits for
each subject, with no more than four conditions per visit. The three
obligatory postures included 1) seated couch feet down e the
participant sat on a couch with their back against the back pillows,
thighs on the couch and both feet on the floor with the laptop on
the participant’s lap; 2) prone e this condition was performed by
lying with the abdomen in contact with a bed with the laptop
directly in front of the participant; 3) seated couch feet up e the
participant was required to sit similarly to position 1 but both feet
were placed on an ottoman with both legs straight and parallel to
the floor with the laptop on the participant’s lap (Fig. 3). In addition
to the three primary conditions, at their first visit, participants were
asked to demonstrate up to two conditions on the couch and two
conditions on the bed that they adopted regularly while using their
laptop.

2.3.2. Laptop tasks

A 2-minute typing task followed by a 5-minute editing task was
performed in this study. The first task consisted of typing Edgar
Allen Poe’s The Raven (Dennerlein and Johnson, 2006). This two-
minute task gave the participant an opportunity to become
accustomed to the posture while using the laptop. After the typing
task, the participant switched windows and began an editing task.
Fig. 3. Required postures (top to bottom): seated feet down, prone, seated feet up.
This second task involved editing articles from a university news
service that were manipulated to include spelling and grammatical
mistakes. The participant was expected to perform three types of
edits: spelling and grammatical corrections, text selection with For each condition, the middle three minutes of the editing task
mouse pad followed by deletion, and typing new phrases into the was recorded for posture analysis.
text. All errors were highlighted for efficient editing, as were new
phrases to be inserted into the document. For the latter type of edit, 2.3.3. Procedures
after the new text was typed the participant was instructed to use At their first session, all subjects completed an informed consent
the mouse pad to select the original highlighted text and delete it. form. After instruction on assuming the required postures and
All work was performed in Word 2003 (Microsoft Corporation, participant demonstration of self-selected conditions, markers for
Redmond, WA) under the Microsoft Windows XP operating system. motion analysis were placed on the study subject. Following each
 J.E. Gold et al. / Applied Ergonomics 43 (2012) 392e399 395

Table 1
Mean joint angle (degrees) by posture assumed while using a laptop in non-desk positions (n ¼ 20).

Posture Trunk flexion/ p-Value Neck flexion/extensiona p-Value Shoulder elevationa p-Value
extension

Mean SD Mean SD Mean SD

1 24.37 8.65 0.06 23.83 12.80 <0.0001 8.24 3.76 <0.0001
2 25.31 5.73 18.10 11.63 71.51 9.28
3 30.57 5.59 20.75 12.70 8.20 5.96

Posture Shoulder p-Value Shoulder external/ p-Value Elbow flexiona p-Value Wrist flexion/ p-Value
horizontal internal rotation extensiona
abduction/
adductiona

Mean SD Mean SD Mean SD Mean SD

1 39.52 16.46 0.0004 40.40 7.40 0.39 95.41 9.47 <0.0001 4.11 11.73 <0.0001
2 22.89 12.93 43.23 10.60 67.93 9.99 12.79 16.63
3 39.46 14.74 40.81 6.27 94.39 9.72 6.27 9.59

Post-hoc pairwise contrast e posture 2 different from others, except wrist flexion/extension e posture 1 different from others, p < 0.0167.
First listed joint direction is positive, second is negative.
Posture: 1 e laptop on lap, sitting on couch, feet flat on the floor; 2 e laptop on bed, lying on stomach; 3 e laptop on lap, sitting on couch, feet on ottoman.
a
Repeated measures ANOVA with Bonferroni adjustment: alpha ¼ 0.0071.

7-minute period of laptop use, participants were provided a body
map and asked to mark any regions of discomfort on a scale of 1e10
where 10 indicated the greatest imaginable symptoms. A fifteen
minute break was taken between trials.
Several metrics for discomfort were determined including
dichotomized discomfort (yes/no), number of anatomical regions
marked, and average intensity of marked regions, and average
overall intensity (including 0’s). If subjects noted no regions of
discomfort, the discomfort intensity was regarded as 0. The distal
upper extremity was defined as the elbow, forearm or hand.
Proximal upper extremity was defined as shoulder or upper arm.
The lower extremity was defined as any region below the waist.
2.4. Data analysis
mean joint angle and 8 repeated measures ANOVAs for each mean
joint range of motion. Each of the 15 ANOVA models compared
differences in mean joint angle or range of motion over the same 3
posture positions (within subject factor). Significant overall F tests
were followed by Bonferroni pairwise post-hoc contrast tests.
Similar tests were also used to determine mean differences in
discomfort (number of regions of discomfort and discomfort
intensity) between the three required postures. Differences in
prevalence of discomfort between each of the three required
conditions was determined with generalized estimating equations
(GEE) for repeated measures followed by post-hoc contrast tests. A
p-value of <0.05 was regarded as statistically significant. SAS (SAS
Institute Inc., Cary, NC) and Microsoft Excel (Microsoft Corporation,
Redmond, WA) software were used for statistical analysis.

MaxMATE motion analysis data was exported to Excel (Micro-

soft Corporation, Redmond, WA) for further processing where the 3. Results
mean joint angle and mean range of motion (maximumeminimum
joint angle) for each joint was calculated. A repeated measures 3.1. Participants
ANOVA with Bonferroni adjustment for alpha to account for
multiple comparisons was used to determine mean differences in Study participants (n ¼ 20) included 11 females and 9 males.
joint angles and joint ROM for the three required postures. There They ranged in age from 18 to 24 years (mean ¼ 20.2  1.9 years)
were 7 repeated measures ANOVA models performed for each with a mean height of 172.5  9.7 cm.

Table 2
Mean joint range of motion (degrees) by posture assumed while using a laptop in non-desk positions (n ¼ 20).

Posture Trunk flexion/ p-Value Neck flexion/ p-Value Shoulder p-Value Shoulder p-Value
extension extensiona elevation horizontal
abduction/
adduction

Mean SD Mean SD Mean SD Mean SD

1 5.19 4.55 0.16 16.11 7.02 <0.0001 17.38 6.21 0.20 32.95 14.19 0.56
2 7.41 5.61 42.85 20.34 22.95 19.86 29.13 17.82
3 4.33 3.57 16.49 8.62 16.37 6.68 28.32 9.74

Posture Shoulder p-Value Elbow flexion p-Value Wrist flexion/ p-Value Wrist deviation p-Value
external/internal extension radial/ulnara
rotation

Mean SD Mean SD Mean SD Mean SD

1 29.56 6.16 0.17 30.11 11.95 0.07 70.98 21.72 0.05 37.55 9.05 0.002
2 35.36 12.97 31.84 12.31 77.59 24.07 59.52 13.93
3 28.98 9.58 23.58 7.72 64.42 16.45 39.39 10.07

Post-hoc pairwise contrast e posture 2 different from others, p < 0.0167.

Posture: 1 e laptop on lap, sitting on couch, feet flat on the floor; 2 e laptop on bed, lying on stomach; 3 e laptop on lap, sitting on couch, feet on ottoman.
a
Repeated measures ANOVA with Bonferroni adjustment: alpha ¼ 0.0063.
396 J.E. Gold et al. / Applied Ergonomics 43 (2012) 392e399

Table 3
Discomfort by laptop posture in non-desk setting (n ¼ 20).

Posture Any discomforta Number of regionsb Intensity of regions Overall intensityb

markedb

n % Mean SD Mean SD Mean SD

1 10 50 1.30 1.84 0.93 1.10 0.05 0.09
2 19 95 4.50 3.40 3.47 1.47 0.40 0.3
3 9 45 0.80 1.01 0.90 1.12 0.03 0.04

Posture: 1 e laptop on lap, sitting on couch, feet flat on the floor; 2 e laptop on bed, lying on stomach; 3 e laptop on lap, sitting on couch, feet on ottoman.
a
Repeated measures for proportions (GEE), p ¼ 0.0005, contrast p < 0.0167.
b
Repeated measures ANOVA with Bonferroni adjustment: alpha ¼ 0.0167; post-hoc pairwise contrast e posture 2 different from others, p < 0.0167.

3.2. Mean joint angle in three non-desk laptop postures
The mean joint angles in both seated positions were charac-
terized by neck flexion, shoulder horizontal abduction of approxi-
mately 40 , minimal elevation (“shoulder extension”), elbow
flexion of slightly more than 90 , and a relatively neutral wrist
posture (Table 1). In contrast, the prone posture was typified by
neck extension, pronounced shoulder elevation (“shoulder
flexion”), 68 of elbow flexion, and pronounced wrist flexion. The
trunk was extended in all conditions. The shoulder was internally
rotated to a similar angle in all positions.
A statistically significant difference between the three laptop
postures was found for all mean joint angles examined except for
shoulder external/internal rotation and trunk flexion/extension
(repeated measures ANOVA with Bonferroni adjustment, F-test
p-values ranged from <0.0001e0.0004). In post-hoc pairwise
comparisons, the prone posture was different than the seated
positions for neck flexion/extension, shoulder elevation, shoulder
horizontal abduction/adduction, and elbow flexion/extension
(p < 0.05). For wrist flexion/extension, the seated with feet down
condition was different from the other two postures (p < 0.05).
3.3. Joint ROM in three non-desk laptop postures
Minimal joint ROM was observed in the trunk sagittal plane,
while the greatest joint excursions occurred in the wrist (Table 2). A
significantly different joint ROM between laptop postures was
found for neck flexion/extension (repeated measures ANOVA,
p < 0.0001). Post-hoc comparisons revealed that the prone posture
was different than the 2 seated postures (p  0.05).
3.4. Discomfort in three non-desk laptop postures
All but one of the subjects reported discomfort after the typing/
editing task in the prone position, while approximately half of the
participants reported any discomfort in the seated postures
(Table 3). Participants marked 3e5 times as many regions of
discomfort for the prone position as for the seated postures
Table 4
Body regions of discomfort, by laptop posture (n ¼ 20).
Posture Neck Back Proximal Distal
UE UE
n % n % n % n %
1 5 25 6 30 1 5 2 10
2 10 50 11 55 14 70 10 50
3 8 40 3 15 0 0 0 0
Posture: 1 e laptop on lap, sitting on couch, feet flat on the floor; 2 e laptop on bed,
lying on stomach; 3 e laptop on lap, sitting on couch, feet on ottoman.
Proximal UE ¼ shoulder or upper arm.
Distal UE ¼ elbow or forearm or hand.
Lower ext ¼ any region below the waist.
(repeated measures ANOVA, p < 0.0001). Intensity of discomfort in
the regions marked was approximately 3.5 times greater in the
prone position (repeated measures ANOVA, p < 0.0001, post-hoc
pairwise contrast test p < 0.05). In the prone position, seventy
percent of the subjects reported shoulder/upper arm discomfort
(average intensity ¼ 3.6) after seven minutes of laptop use, while
approximately half noted back or neck or distal upper extremity
discomfort (Table 4). Average neck discomfort intensity in the
prone position, of those reporting neck discomfort, was 4.3, and the
corresponding mean discomfort for couch feet down and couch feet
up positions was 2.4 and 1.8, respectively. Similarly, back discom-
fort intensity in the prone position was more than two times
greater than in the seated postures (3.9 vs. 1.7).
3.5. Self-selected postures
A total of 22 different postures were self-selected by the 20
subjects. Three frequently selected postures (n ¼ 5), included cross
legged (Indian style, while seated with or without back support),
lying down with legs out (knees at 180 ), and seated with knees
flexed at 90 or greater (Fig. 4).
The mean joint angles in the cross-legged position were char-
acterized by pronounced neck flexion, shoulder horizontal abduc-
tion and internal rotation, and wrist extension (Table 5). The seated
with knees flexed position was typified by shoulder horizontal
abduction and internal rotation, and elbow flexion. The lying down
with legs out appeared to be a rather neutral posture for the
shoulders, elbows, and wrists. The trunk was extended in all
conditions.
As with the required postures, minimal joint ROM was observed
in the trunk sagittal plane, while the greatest joint excursions
occurred in the wrist (data not shown). Subjects assuming the cross
legged position reported discomfort in more regions and a greater
mean intensity of discomfort in the regions marked after a typing/
editing task than either the lying down legs out or seated with
knees flexed positions (Table 6).
4. Discussion
The goal of this study was to characterize postures and comfort
in non-desk usage of laptop computers. Differences in mean joint
Lower
angles were found for a prone condition in contrast to two seated
ext
positions (one with feet flat on the floor, and one with feet on an
n % ottoman). The prone condition was typified by several non-neutral
1 5 postures including neck extension, shoulder flexion (defined by
0 0
shoulder elevation near the sagittal plane), less than 90 degrees of
2 10
elbow flexion, and pronounced wrist flexion. The seated postures
were characterized by neck flexion, relatively neutral shoulders,
elbows, and wrists (in the flexion/extension plane). Subjects
reported greater intensity of discomfort in the prone position than
in the seated postures, particularly in the back and neck.
 J.E. Gold et al. / Applied Ergonomics 43 (2012) 392e399 397

Table 5
Mean joint angle (degrees) by posture assumed while using a laptop in self-selected
non-desk positions (n ¼ 5).

Posture Trunk flexion/ Neck flexion/ Shoulder

extension extension elevation

Mean SD Mean SD Mean SD

Cross-legged 18.28 6.03 26.60 17.35 4.32 1.96
Lying, legs out 33.87 8.70 22.62 16.56 9.62 7.54
Seated, knees flexed 35.19 8.30 11.13 13.39 10.27 9.41

Posture Shoulder Shoulder Elbow Wrist flexion/

horizontal external/ flexion extension
abduction/ internal
adduction rotation

Mean SD Mean SD Mean SD Mean SD

Cross-legged 59.11 12.54 50.02 10.66 89.83 12.43 13.27 21.05
Lying, legs out 29.11 21.99 31.37 8.42 102.92 11.87 2.02 13.03
Seated, knees flexed 45.38 9.59 54.74 7.01 77.32 5.03 6.76 9.71

First listed joint direction is positive, second is negative.

into the couch to take advantage of the back support. Although

Fig. 4. Self-selected postures (top to bottom): seated cross-legged, seated with knees
flexed at 90 or greater, lying down with legs out (knees at 180 ).
overall the trunk appeared to be extended, participants often had
a decreased lordotic curve leading to a rounded posture (lumbar
spine flexion). This characteristic rounded posture was more
pronounced in the feet up position. The prone position demon-
strated overall trunk extension because the participants were lift-
ing their upper body off of the bed and hence forcing their lumbar
spine into extension.
In the prone condition, the position with the greatest discom-
fort, the neck was in extension. Although muscle activation was not
measured in the current study, presumably the neck extensor and
scapular stabilizer musculature was active during the task and
resisting the flexion moment caused by the head. In addition,
the prone posture may have resulted in scapular retraction and
elevation (shrugging) with increased levels of muscle activity in the
thoracic erector spinae and rhomboids (Schüldt and Harms-
Ringdahl, 1988), offering another explanation of an increase in
proximal upper extremity discomfort. The neck extension posture
may place the active muscles in a length that is suboptimal for
muscle force production, which could lead to early fatigue.
In the seated positions, the neck was flexed resulting in the
center of gravity of the head to be further away from the joint
center of rotation in the cervical spine, thus increasing the flexor
moment. Passive structures (e.g., ligaments and joint capsules) in
the cervical spine may be under increased loading in a flexed
posture; studies have verified a flexion-relaxation phenomenon in
the cervical spine (Meyer et al., 1993; Pialasse et al., 2009). Under
normal conditions, muscles provide joints with dynamic stability
and prevent excessive or prolonged loading to passive structures.
During the flexion-relaxation phenomenon, the neck extensors are
less active and therefore the passive structures are exposed to
adverse loads which can lead to an increased risk for injury, creep,
and/or impaired neuromuscular control. Pialasse et al. (2009)
report the appearance of the flexion relaxation at a mean value of
23.2 (SD ¼ 4.5 ). Neck flexion in both of the required seated
postures are close to that angle.

Table 6
Discomfort by self-selected laptop posture in non-desk setting (n ¼ 5).

Our back flexion/extension measurement did not separate the Posture Number of Intensity of Overall
regions regions intensity
thoracic and lumbar portions of the spine, as we measured
marked
the trunk as a single segment from the greater trochanter to the
acromion process. In all of the conditions, trunk extension was Mean SD Mean SD Mean SD

recorded. Nonetheless, it was observed qualitatively that spine Cross-legged 2.2 2.28 1.36 1.32 0.1 0.09
Lying, legs out 0.50 1.00 0.88 1.75 0.04 0.08
posture differed in the prone position in contrast to the two seated
Seated, knees flexed 0.80 1.79 0.40 0.89 0.03 0.08
positions. In the seated positions, the participants often leaned back
398 J.E. Gold et al. / Applied Ergonomics 43 (2012) 392e399
Our study’s measurement of mean elbow flexion angle while in
a seated posture is comparable to that measured in studies of
posture during desktop (see Gerr et al., 2000 for review) and laptop
near the lap (Sommerich et al., 2002) use, and our measurement of
slight shoulder extension while using a laptop on the lap is
comparable to Moffet et al. (2002) which examined joint angles in
laptop users in a similar posture. In contrast, Sommerich et al.
(2002) reported shoulder flexion (22 e27 ) during laptop use,
which is likely due to the fact that the keyboard in that study was
placed at elbow height.
In the seated postures, we observed a mean wrist extension
angle that was close to neutral in comparison to the 20e30 degree
corresponding mean angle detected in other studies (Asundi et al.,
2010; Dennerlein and Johnson, 2006; Gerr et al., 2000; Hales et al.,
1992; Moffet et al., 2002). Since the laptop used in the current study
provided a place to rest the wrists in front of the keyboard, it is
possible that subjects took advantage of the opportunity to assume
a comparatively more neutral wrist posture. Dissimilar measure-
ment methods may also account for differences.
Shoulder abduction has previously been measured in laptop
users in only one study (Asundi et al., 2010). They estimated
a median shoulder abduction angle of 15 with the laptop on the
lap. We can infer from our shoulder elevation and horizontal
shoulder abduction that our measures are close to the sagittal
plane. Thus, this can be interpreted as minimal shoulder abduction.
According to the Rapid Upper Limb Assessment (RULA) system
(McAtamney and Corlett, 1993), neck flexion of greater than 20 is
especially problematic, as is any neck extension. All mean neck joint
angles observed in the study required positions are in these less
desirable ranges. In contrast, the mean elbow joint angle in each of
the required positions is regarded favorably in the RULA system and
in a systematic study of computer users’ postures (Gerr et al., 2000).
A non-neutral wrist is regarded as problematic in several job anal-
ysis schema (McAtamney and Corlett, 1993; Moore and Garg, 1995).
We observed a non-neutral wrist in each of our required positions.
Neck and wrist deviation ROM in the prone posture was greater
than in the seated positions. This greater neck ROM may be a result
of participants aiming to reduce their discomfort by moving their
neck as their muscle fatigued.
4.1. Workstation design (furniture, laptop position)
Postures are determined through workstation design interact-
ing with individual anthropometry. In the current study, we
suspect that both the laptop computer and furniture dimensions
influenced participants’ postures. For instance, in the prone posi-
tion, a participant needed to extend their neck to adequately view
the laptop display. Under all positions, the laptop keyboard width
may have influenced shoulder abduction, and shoulder internal
rotation, while the furniture likely affected the trunk angle. In the
seated feet up position, the back was fully supported by the couch
for most participants. That is, the angle of the back support built
into the furniture determined the back flexion/extension in this
posture. In contrast, in the feet down position, many participants
did not take advantage of the back support provided by the couch. If
the couch had bulkier cushions or a reduced seat pan depth, it is
possible that any difference in back postures between the two
seated positions would have been removed.
4.2. Strengths and weaknesses
This is the first study to our knowledge to quantitatively assess
postures and comfort in laptop users away from a conventional
office setting. A single laptop was used for all trials to eliminate the
variability in postures and comfort that have would have ensued
due to specific characteristics of students’ personal laptops (e.g.,
overall laptop and screen dimensions, keyboard activation force,
key travel distance). However, because the students may have been
unfamiliar with this particular laptop, they may have reported
a greater intensity of discomfort than if they had been typing on the
laptops that they owned. It is unknown how many of the students
were familiar with the laptop that was used in this study. The
process of randomizing positions may have limited a potential
learning effect of subjects becoming familiar with the study laptop
across trials.
A limitation of the study is that we are uncertain how the results
would be applicable to a longer-term laptop usage period. However,
after a short 7-minute task in laboratory conditions we found that
the prone position elicited discomfort. Discomfort may be associ-
ated with musculoskeletal disorders (MSDs) in the longer term
(Hamberg-van Reenen et al., 2008; Werner et al., 2005). Addition-
ally, the perception of pain is an important mechanism alerting us of
potential harm being imposed to our body that requires corrective
action (Calliet, 1996). Based on this logic, the perception of
discomfort after 7-minutes of a laptop task suggests that this may be
a harmful position requiring corrective action (e.g., changing posi-
tions). We are not suggesting that there is no risk of MSDs given
a seated position. We are suggesting that MSD risk is greater for the
lying down position given that greater discomfort is initiated after
such an extremely short usage period. This experiment was per-
formed with a small sample of college students aged 18e25.
Although the results are likely not generalizable to children and
much older adults, we suspect that they are likely to be applicable to
most able-bodied individuals of working age. However, further
experiments would be necessary to verify this assumption.
The laboratory setting of the study could not capture the natural
working conditions of the subjects. That is, we required that subjects
typed for seven minutes in each position even though it is likely that
they would have changed to a different position prior to that time if
they became uncomfortable in a real-world setting. Future studies
should examine the habits of non-desk laptop users during a more
extended period of time and in varying settings to assess how often
these subjects change their overall working positions and to deter-
mine how this influences their discomfort. It is possible that
particular positions are assumed for specific tasks (e.g., web-surfing,
reading email, writing a paper). Further research should explore
task preferences in conjunction with non-desk setting positions.
4.3. Conclusions
Using a laptop in a prone posture, typified by neck extension as
well as non-neutral angles in the shoulders, elbows, and wrists, was
associated with a greater intensity of discomfort after a brief
typing/editing task than performance of the same task in two
positions while seated on a couch. More regions of discomfort were
also indicated in the prone posture. In contrast, the seated postures
on a couch were characterized by relatively neutral shoulders,
elbow flexion angle, and wrist (in the flexion/extension plane). This
suggests that non-neutral postures throughout the upper extremity
contributed to the discomfort in the prone position, and it is rec-
ommended that this position should only be assumed for brief
periods while using a laptop. Any exposure to laptops in non-desk
settings, including identification of specific postures assumed by
individuals, should be assessed in future epidemiologic studies of
musculoskeletal complaints and computer use.
Acknowledgements
Funding for this study was provided by the Office Ergonomics
Research Committee (OERC). Special thanks to Michael Bartha for
 J.E. Gold et al. / Applied Ergonomics 43 (2012) 392e399
his helpful suggestions. The authors would also like to thank
Swetang Shah for his assistance with the video data processing.
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