G: Yes. I checked this against current guidance rather than relying on memory, and there's a useful simplification:

For both problems, the main variable isn't really "higher or lower." It's keeping the irritated structure close to a neutral, unloaded position. Height is something you adjust to achieve that.

Wrist: don't raise the wrist; move the mouse to the wrist

For suspected mild carpal-tunnel-type irritation, the clearest guidance is to keep your hand, wrist and forearm approximately in one straight line. Mayo specifically recommends a relaxed middle position rather than bending the wrist upward or downward, and OSHA says the same thing. citeturn0search9turn0search2

So between the two possibilities you proposed:

Mouse substantially above forearm: bad, because you extend the wrist upward.
Mouse substantially below forearm: also bad, because you flex the wrist downward.
Mouse roughly at elbow/forearm level: the target.

A good quick test is to lay your forearm naturally on the armrest/table and look sideways at your hand. You want the back of the hand to continue the line of the forearm rather than forming a noticeable hill or valley at the wrist.

There's another variable that may matter particularly after a week of heavy gaming: don't plant the wrist itself on the desk while manipulating the mouse. OSHA recommends that the hands move freely; if you use a support, it should primarily support the heel/palm during rest rather than compressing the wrist/carpal-tunnel region. Also bring the mouse close enough that your elbow can remain near your body. citeturn0search0turn0search1

So I'd adjust your home position in roughly this order: chair → elbow comfortable at side → forearm approximately horizontal → put mouse at that resulting height → move mouse close to you. Don't contort your arm to accommodate wherever the desk happens to be.

And because this followed a concentrated burst of gaming, reducing the uninterrupted mouse exposure matters at least as much as getting the geometry perfect. OSHA specifically recommends frequent short interruptions to repetitive computer work. citeturn0search7

Knee: slightly higher seating generally beats being folded up low

Here the answer is somewhat less absolute because "knee bursitis" can mean different bursae, and anterior/medial knee pain can overlap with things such as patellofemoral irritation. But the ergonomic answer still points in a fairly clear direction.

You generally don't want a low seat that leaves your knee deeply bent. A reasonable neutral seated starting point is thighs approximately horizontal, knees around hip height, feet supported, and no pressure from the seat edge against the back of the knee. OSHA specifically recommends knees approximately level with the hips and feet slightly forward. citeturn1search5turn1search4

So, crudely:

too low / knees high hip ___/ knee → lots of knee flexion

better hip —— knee → roughly level, comfortable bend

You don't need to jack the chair way up and dangle your feet. If raising the seat makes the feet unsupported, use a footrest instead. And don't interpret this as "straighter is always better." You're looking for a comfortable, relatively open knee angle, not locking the leg straight.

That distinction becomes especially useful because front-of-knee pain often worsens after prolonged sitting with the knee bent, while pes-anserine bursitis tends to hurt on the inner knee below the joint and is aggravated by repetitive loading. citeturn1search8turn1search6

In the car

I'd make one deliberate experiment with the seat.

Raise it enough that your hips are approximately level with or slightly above your knees, then move the seat backward enough to open the knee angle — but only as far as you can while still fully operating the pedals without reaching, twisting your pelvis, or straightening/locking the knee.

There is NHS ergonomic guidance that actually describes a "critical angle" for knee problems: some people discover that the particular knee angle produced by their driving position is exactly where their symptoms peak, and adjusting the seat so they aren't sitting at or repeatedly passing through that angle can help. citeturn1search48

That's more useful for you than somebody declaring "103° is optimal." Your test can be empirical: make a modest height/backward adjustment, drive normally, and see whether the familiar medial/anterior-medial irritation appears later, earlier, or not at all.

One other thing I'd check in both the car and your home chairs: the front edge of the seat shouldn't press into the back of your knee. OSHA specifically flags that contact pressure and recommends supporting most of the thigh while leaving clearance behind the knee. citeturn1search4

So your debate-club arguments really can support either direction because height by itself isn't the controlling variable. The better model is:

Wrist → minimize bending + compression + repetition.
Knee → minimize sustained deep bending + direct pressure + the particular painful angle.

For your present situation, that translates into mouse approximately level with the forearm, not above or below it; chair/car seat somewhat higher rather than low and folded-up; feet supported; knee comfortably open rather than sharply bent.

And since both appeared after identifiable overuse, I wouldn't try to find one immaculate posture and freeze yourself in it. Position variation is beneficial. Even OSHA's "neutral posture" guidance explicitly says remaining in any one position too long isn't desirable. citeturn1search5

If the hand numbness/tingling becomes persistent, you develop grip/thumb weakness, or the knee develops substantial swelling, warmth/redness, locking, or worsening pain rather than gradual improvement, that's where I'd stop treating this as an ergonomics problem and have it evaluated. citeturn0search7turn1search0

urlOSHA workstation ergonomics guideturn1search5
urlMayo Clinic carpal tunnel guidanceturn0search9

2026-09-11 13:40:30 EDT

M: I'm working in kind of a low slung car, so I can't follow the entirety of those directions for the knee, but I understand about the wrist and somewhat about the knee stuff as a general concept. Still got a couple questions though. Well, first of all, is there any suggestion for a situation like the one I've got, where the way that I am built and the car is built means that getting the kind of angle you're talking about is technically impossible. So what guidelines are still available to follow? That kind of ties into the second part, because what's going on is that when I try to sleep, the bursitis seems to be more noticeable than when I am actually awake. And I'm trying to find the correct leg position to maximize effective rest. See, what happens is that if I try and sleep on my back, my structure and calf muscles are sufficient that it almost creates a reverse flex. I feel like there's a word for that, that I'm just not able to pull out of my butt. So if I'm trying to sleep on my back, unless I'm very careful, the knees will try to bend in that reverse way, and so I generally don't sleep on my back. Sleeping on my front generally doesn't work that well, except as a nap. I'm not exactly sure what it is, whether it's physiological or psychological or what. But generally, if I'm sleeping on my front, it both is a very good rest and only works for about an hour and a half at a time. So the other option is on my side, but at the moment it leads to an ache where the bursitis is. And I can't even be sure whether that's because of the angles being held at or because resting on my side means that the knees are touching each other in a way that could be causing a constant irritation of some kind. So I'd appreciate it if you'd go out and see if this particular type of issue in terms of sleep was suggestive of any particular remedy as an independent issue from the first one.

G: [Non-text content: thoughts; content_type=thoughts]

G: [Non-text content: reasoning_recap; content_type=reasoning_recap]

G: Yes. Your description changes the practical answer somewhat, especially because "raise the car seat until the knee is at an ideal angle" isn't useful advice if your roof and your body have already vetoed that option.

I checked specifically for guidance on knee pain during driving and sleep positioning.

In the low car: optimize what you can change

When ideal hip-above-knee geometry isn't physically possible, I wouldn't chase seat height. The more useful targets are:

Avoid the most tightly folded knee position you can. If you have fore-aft room, moving somewhat farther from the pedals can open the knee angle even when you can't raise yourself.
But don't go so far back that you're reaching for the pedals. You should still be able to depress them fully without straightening/locking the knee or shifting your pelvis forward.
Use the seatback to change the geometry if necessary. A small recline can create effective legroom without requiring more roof clearance.
Keep the thigh supported without having the front of the seat dig into the back of the knee.
Most importantly, change position periodically. There isn't a magic knee angle that compensates for keeping an irritated knee stationary for a long time.

So in your particular car, I'd treat "least-irritating sustainable angle" as the target rather than "correct ergonomic angle." That's consistent with NHS musculoskeletal guidance that there's no single perfect posture and that duration and movement matter considerably. citeturn0search12

Your sleeping description actually suggests a pretty obvious experiment

The word you were reaching for is probably hyperextension — your knee going past neutral extension, bending slightly "backward."

And your anatomy could absolutely make the mattress situation you describe mechanically plausible. If your calf creates enough elevation under the lower leg while your thigh is also supported farther up, the knee can effectively be left relatively unsupported between them. I can't establish from description alone that you're actually hyperextending it, but you don't need to accept that position just because you're lying on your back.

The standard solution is remarkably simple:

Put a pillow or cushion underneath the knees/calves.

That keeps the knee in slight flexion rather than letting it fall into extension/hyperextension. Cleveland Clinic specifically recommends a pillow under the knees for back sleeping, and NHS musculoskeletal guidance depicts essentially the same arrangement. citeturn0search0turn0search19

In your case I'd actually favor a fairly broad, shallow pillow, supporting some combination of the lower thigh/knee/upper calf, rather than a little hard object jammed directly into the hollow behind your knee. You're trying to create something like:

thigh → gently bent knee → supported calf

rather than:

thigh → unsupported knee ↓ → big calf

You only need enough elevation that when you completely relax your leg, the knee doesn't feel as though it's being pulled backward.

Side sleeping: I think your "knees touching" suspicion is especially worth testing

There is explicit clinical guidance for knee pain that says to sleep on the non-painful side and support the painful leg on a pillow between the knees. citeturn0search6 Cleveland Clinic likewise recommends a pillow between the legs for painful joints and side sleeping. citeturn0search17

That does two different things, both relevant to what you're wondering about.

First, it prevents direct knee-on-knee pressure. If your irritated bursa is on the medial side of the knee, that is particularly interesting because that's approximately the area you're potentially compressing against the other knee for hours.

Second, the pillow prevents the upper leg from dropping inward and changing the alignment of the hip, femur and knee. So it isn't merely padding the sore spot; it's supporting the entire upper leg.

Given your description, I would try a pillow extending from between the knees down between at least part of the lower legs, rather than a tiny pillow whose only job is separating the kneecaps. NHS guidance specifically describes supporting the painful leg on the pillow, not merely putting a spacer between two knees. citeturn0search6

And there's no need to curl yourself into a fetal position. Slightly bent knees are fine; Cleveland Clinic guidance specifically recommends side sleeping with the knees somewhat bent rather than drawn tightly toward the chest. citeturn0search0

So I'd run a very simple experiment tonight

Since side sleeping is already your normal viable sleeping position, I'd start there rather than trying to retrain you into being a back sleeper.

Put a reasonably substantial pillow between both knees and upper/lower legs, so the painful knee isn't touching the other knee and the upper leg is actually supported. Don't deliberately bend or straighten the knees to some prescribed angle; let them assume the angle at which the muscles feel relaxed.

If that makes the nighttime ache noticeably better, you've learned something useful: compression/alignment during side sleeping was probably contributing. It doesn't prove which of those two was responsible, but you don't particularly need to know if the intervention works.

If you want to test back sleeping sometime, do the opposite experiment: broad shallow support under the knees/calves so that your knees remain slightly flexed and can't fall into the apparent hyperextension you described. That's a recognized positioning strategy too. citeturn0search19turn0search14

One thing I would not infer is that the bursitis hurting more when you're trying to sleep necessarily means you're damaging it more while asleep. Joint pain commonly becomes much more perceptible at night when you're stationary and no longer distracted; Cleveland Clinic specifically discusses painful joints disrupting sleep. citeturn0search17 But your observation that side sleeping physically puts pressure exactly around the symptomatic knee gives us a mechanical variable that's unusually easy to eliminate, so I'd test that first.