Stop worrying about your posture.
I spent 8 years teaching RehaSport classes in a large physiotherapy centre and came across countless patients who had had it drilled into them by doctors, physios, etc. that they had a 'bad' back, that certain movements were dangerous, that they always need to be careful and that spinal movement was the Devil. Unfortunately I'm seeing the same with gamers now, being told that only perfect posture is acceptable and to constantly worry about anything that deviates from it. This article is here to counter this dogma and help you relax and enjoying your gaming.
First of all I should state that of course posture plays a part of the total wellbeing puzzle, you do need to spend some time building a good gaming set-up, but it's only one part of the puzzle and I feel it's being overemphasised. I'm sure you've all heard of the placebo effect, well the opposite of that where the effect is detrimental is called nocebo. In the example above of patients being told they have a 'bad' back they language that a medic or therapist uses can have a massive influence on how the patient perceives the problem and what they will do about it. Straight away using the word 'bad' has a negative connotation and reinforces the patient's perception that something is broken which will affect the exercises/therapy they are willing to undertake. Typically a person's vertebrae and inter-vertebral disks will change with age and if you perform an MRI scan then you can always find something that's not perfect, but if you say to a patient with non-specific lower back pain (NSLBP) for which we know there is no mechanical cause, hence the non-specific term, that their vertebrae look worn out then you are reinforcing a negative perception of the problem. In contrast if you look at an MRI and say that the spine looks "normal for your age" then the word "normal" can be reassuring (of course there will be patients who can not accept that there's no visible mechanical problem, that's another issue). Those people who had negative beliefs about exercise, about their health and about the condition of their backs were a challenge in a group rehab session because they'd avoid exercises, always keep the intensity low and honestly needed their hands help as they were slowly encouraged to trust their body. I worry now that this nocebo effect is creeping into advice for gamers. YouTube is full of videos with titles such as "how to fix your posture", "why your posture sucks" or "be careful of this bad position", it's pure click-bait and hopefully now that you are aware of nocebic language you can spot how problematic these titles can be.
A lot of these video titles using words such as 'fix' or 'correct' imply that there is a siting posture that we should all be aiming for, a gold-standard correct posture, but is this true? Not according to Slater et al. (1) who concluded that natural anatomical differences mean that there is no single correct posture. Korakakis et al. (2) also point out the gender differences in habitual and perceived optimal sitting postures and that this isn't just because of anatomical differences but also cultural differences such as perception of/emphasis on the aesthetics of posture. Whilst gaming somebody who prefers a low sensitivity mouse setting and correspondingly uses a large range of motion will need a slightly different set-up to somebody who prefers high sensitivity/small movement settings, those who game on a PC will need a slightly different set-up to those on consoles. A lot of PC gamers will rotate their keyboards inwards slightly to give better wrist alignment with the movement keys (w,a,s,d) which would go against typical advice from, for example, the UK National Health Service (3) to keep your keyboard straight, but if it reduces ulnar/radial deviation of the wrist and allows the fingers to better line up with the keys then why not? Once again I'm not suggesting it's a good idea to throw all of the basic ergonomic advice out and spend the next 8 hour session doing the splits with a mouse pad balanced on one knee and the keyboard on the other, but there has to be room for flexibility and accommodation for personal preferences when advising somebody on their set-up.
Injury = load > capacity
Wong et al. (4) studied the differences between sitting straight, slouched and supported on hard and soft surfaces for 20mins and whilst they did find differences in muscle activity there was no difference in any pain scores, proprioception or tissue creep. It's possible that 20 mins was too short a time span to see significant differences, a gaming session will last significantly longer and it's theoretically possible that an accumulation of stresses over months of gaming will have an affect on your body (which adapts to the stresses played on it, that's how training works) but if you're fit and healthy then slumping down every now and again should not create a load that the body can not handle. Mood will affect posture (1) and we've all been there - having a great melee battle and finishing 2nd to somebody who has 1hp left, if you slump down in your chair don't worry about it, just pick yourself back up and win the next battle.
Don't be afraid of movement!
If there was such a thing as a perfect posture, would it be a good idea to maintain it constantly throughout a gaming session? Bontrup et al. (5) studied 64 call centre workers and found a trend that those with back pain moved and shifted sitting position less than those who were pain free. Obviously correlation ≠ causation but by combining direct measurement of movement patterns and questionnaire responses they came to a conclusion that workers with chronic back problem could be moving the least because they are afraid of pain - they don't want to do a 'bad' movement or sit in a 'bad' position and so have learnt a very static sitting behaviour. Even those with acute pain moved more than those with chronic complaints, it's a learnt behaviour. Does this sound familiar? Remember how I said that negative beliefs impacted participation in exercise classes? I have no evidence to show that these office workers were affected by previous exposure to nocebic language but I do think that with the exposure you have as a gamer to people telling you to 'fix' things if I then go on to tell you to stay sat with perfect posture at all times I'm are at risk of encouraging the fearful paralysis displayed by the office workers.
You can work on your posture, or you can work on your game play, not both
In order to achieve a long term retraining of habitual posture it would require a period of conscious adjustment. You can make sure that you're sitting with 'decent' posture at the start of each session and when you sit back down following a movement break, but if you're conscious of your posture during gaming I believe that it will affect your performance. This is because we have limited cognitive resources and if you're concentrating on your body you are reducing the resources available for the game play (7). I'll often hear physios and trainers saying things like "activate your transverse abdominals" to an athlete and whilst they may perform training sessions focused on technique I can guarantee that when they're competing they are not focussing on differentially activating individual muscles and I don't see why it would be any different for a gamer. If you are thinking about the activity of your lower rhomboid muscles retracting the scapulae then you are not concentrating on aiming. The altered movement pattern from consciously changing a muscle firing pattern may also detract from your aiming accuracy because it's not normal for you, that's not how you are used to moving the mouse, it will be different and probably worst (to begin with). Of course I'm not saying you should never re-train your posture, if you've developed a particular habit that you (or your trainer/physio/sports therapist) are convinced will cause you problems then you may need to adjust things, but be aware that this period of retraining will initially negatively affect your game play.
The holistic approach
So I've had a good rant now about the negative aspects of focussing on posture, but what advice do I actually give to gamers? I recommend taking a more holistic approach to you health. Sitting posture and an ergonomic set-up is part of this, but as I said there has to be flexibility in the set-up to allow for individualisation. Also, if you do start to notice a problem try to work out why it is occurring, rather than just addressing the symptoms. I will often find myself leaning into a screen but this is because my eyesight isn't great. I have a hereditary eye condition (nothing to do with gaming or screen time) and my eyes get tired when wearing either contact lenses or glasses for long periods of time, so if I do notice myself struggling to aim and leaning in to the screen then a change of eye wear can help.
Studies into the incidence of lower back pain in medical students (who are of a similar age to gamers and also spent a long time sitting whilst studying) have revealed a number of risk factors (8,9) which back up my approach. One of my favourites is that coffee intake was correlated with the incidence of back pain. Does coffee cause back pain? No, probably not, but higher coffee consumption does point towards students who are tired. Stress around exam periods was also a risk factor, as was sitting time, put all of these together and you get a student studying for long periods, worried about exams, not getting enough sleep and drinking a lot of coffee through the day. Physiotherapists talk about a bio-psycho-social approach to patient treatment which is described as treating the patient rather than the injury and this is a classic example, yes a better chair might help (students who studied in bed had a higher risk than those who sat a desk) but to be truly effective we need to look at the whole picture - get enough exercise, take movement breaks, sleep well, manage stress.
You can't totally overlook gaming posture as a risk factor to gaming related aches and pains, but it's debatable that such a thing as a perfect posture exists and don't believe the 240,000,000 YouTubers trying to fix you will a simple trick. Get a decent gaming set-up then look at the whole picture - diet, exercise, mental health and movement breaks all play just as important part in your well-being, so stop worrying about your posture.
References
1. Slater, D., Korakakis, V., O'Sullivan, P., Nolan, D., & O'Sullivan, K. (2019). "Sit up straight": Time to re-evaluate. Journal of Orthopaedic and Sports Physical Therapy, 49(8), 562-564. (Link)
2. Korakakis, V., O'Sullivan, K., Whitely, R., O'Sullivan, P., Korakaki, A., Kotsifaki, A., Tsaklis, P., Tsiokanos, A. & Giakas, G.(2020). Notions of "optimal" posture are loaded with meaning. Perceptions of sitting posture among asymptomatic members of the community. Musculoskeletal Science and Practise. Advance online publication. (Link)
3. National Health Service. (2019, July 18). How to sit at your desk correctly. (Link)
4. Wong, A., Chan, T., Chau, A., Cheung, H. T., Kwan, K., Lam, A., Wong, P., & De Carvalho, D. (2019). Do different siting postures affect spinal biomechanics of asymptomatic individuals? Gait & Posture, 67, 230-235. (Link)
5. Bontrup, C., Taylor, W., Fliesser, M., Visscher, R., Green, T., Wippert, P-M., & Zemp, R. (2019). Low back pain and its relationship with sitting behaviour among sedentary office workers. Applied Ergonomics. 81, 102894. (Link)
6. Zemp, R., Fliesser, M., Wippert, P-M., Taylor, W., & Lorenzetti, S. (2016). Occupational sitting behaviour and its relationship with back pain - a pilot study. Applied Ergonomics, 56, 84-91. (Link)
7. Audiffren, M. (2009). Acute exercise and psychological functions: A cognitive-energetic approach. In McMorris, T., Tomporowski, P., & Audiffren, M. (Eds). Exercise and Cognitive Function (pp. 3-39). Wiley-Blackwell. (Link)
8. Aggarwal, N., Anand, T., Kishore, J., & Ingle, G. K. (2013). Low back pain and associated risk factors among undergraduate students of a medical college in Delhi. Education for Health, 26(2), 103-108. (Link)
9. Vujcic, I., Stojilovic, N., Dubjanin, E., Ladjevic, N., Ladjevic, I., & Sipetic-Grujicic, S. (2018). Low back pain among medical student in Belgrade (Serbia): A cross-sectional study. Pain Research and Management, 8317906. (Link)