Since the country went into lockdown in March many of us have been working from home, often at makeshift desk spaces and enduring increased screen time due to the endless schedule of Zoom meetings.
I’ve been back in the clinic just three weeks and there’s already a common theme starting to appear, as sedentary workers seek out physical therapy for newly acquired neck pain, tension headaches and shoulder and arm discomfort. I’m going to run through a few of the common symptoms, look at the potential causes and suggest how you can maximise the ergonomics of your home workspace with a few simple changes.
The Anatomy:
The neck is made up of the seven vertebrae of the cervical spine and surrounding 26 muscles that enable mobility and stability, not to mention the tendons and ligaments. The vertebrae surround and protect the spinal cord, where the top vertebra (C1, or Atlas) connects with and supports the skull, and the lowest vertebra (C7) sits just above the level of the shoulder blades and articulates with our thoracic spine. The cervical nerves supply sensation to the skull and scalp, as well as sensation and muscular control to the arms.
Our necks permit us a large range of flexibility and motion under normal circumstances, however it also allows a vulnerability to a number of physical forces; in this case when we subject our cervical spine to unusual positions while sitting and using our phones or computers.
Neck Pain:
Neck pain is fairly obvious; it’s when we notice localised pain around the neck and it can feel stiff, resulting in a limited range of movement. Trapped nerves can sometimes become an issue and pain can also radiate into the shoulders, jaw, temples, forehead and eyes, and base of skull.
Neck pain occurs when the soft tissues–muscles, fascia and tendons–supporting the cervical spine and weight of the head, become stiff after prolonged static postures, such as hours in front of a screen. If our desk set up means we have to lean forward or look down for long periods then the force on our neck increases.
While in a neutral position, the pressure on our neck is only around 5kg, as the direction of the force comes straight down the spine. But if you tilt your head forward, as you would look at a screen or laptop, then those forces increase dramatically as a study from 2014 (1) shows; if you were to look down at your phone at around 45°, the force your head puts on your neck increases up to three times as much. This requires a lot of extra work from your neck muscles, fascial system, tendons and ligaments, and in turn can tug at the skeletal organisation of your vertebrae.
Headaches:
Headaches commonly accompany neck pain. The tightness of the neck muscles pull at their attachment to the skull and they can be more prominent and disabling for people than the neck pain, and may be the main presenting symptom.
Headaches emerging from neck dysfunction often begin at the skull base, radiate up over the scalp and produce a pressure-like sensation over the entire head. Some headaches we feel behind our eyes and across the forehead, these can radiate from the sternocleidomastoid muscle (SCM); two large neck muscles inserting to the mastoid process of the skull, just behind the ears, and coming down to your collarbones.
Shoulder Pain:
We all have a large fan-shaped muscle either side of our spine that crosses a large surface area of our upper back, from the base of the skull, down the back of the neck, over the shoulders (where it attaches to part of the collar bone), along the superior and medial edges of our shoulder blade and to the spinous processes of the mid spine. Static contractions and prolonged static loads can lead to fatigue and/or aggravation of these important shoulder muscles.
Recent research suggests that there is a link between psychosocial factors and the occurrence of trapezius muscle pain; social issues such as lack of support from colleagues, mental stress at work and low influence (2), all of which can be exacerbated when we are working in isolation, without contact time and daily support from our colleagues.
Another common aggravator for the shoulders are the levator scapulae muscles that link the upper neck to the shoulder blades, their job is to elevate the shoulders and, I’m sure many of us have noticed, the shoulders can creep up to our ears when we’re involved in focused work at our desks, especially when the work is stressful or involves deadlines!
With both of the muscles above we tend to feel aches at the top of our shoulders, along the top of, and between, our shoulder blades and at the base of the shaft of the neck.
Arm and Hand Pain & TOS:
Sometimes our sedentary and work-related postural positions can result in numbness and/or pain down the arms, in the wrists and hands. Wrist and hand pain can be a carpal tunnel issue, but often it’s a pain symptom created further up the chain by a tightening of the muscles around the shoulders and neck that impinge on the blood supply and irritate the bundle of nerves (brachial plexus) that comes from the cervical spine and innervates the muscles of the arm. This is thoracic outlet syndrome (TOS) and can feel like a heavy, aching and fatigued sensation, as well as numbness in the hand and fingers.
Hands on physical therapy can certainly offer a lot by way of reducing soft tissue tensions and encouraging the body into a more efficient alignment. However, there are also some simple things you can do to maximise your home office set up.
Home office tips:
If you’re working with your laptop on a kitchen table or home desk it may be time to invest in a laptop stand to ensure your screen is at eye height when the head is lifted.
Check in with your working posture regularly to allow your head ribs and pelvis to stack on top of one another, with your chin gently tucked so the back of your neck stays long.
Some people find it helpful to set an alarm every 20/30 mins to get up and stretch their legs, grab some water or spend a couple of minutes stretching. Posture tends to deteriorate the longer we spend sitting or standing in a static position so changing your movement pattern regularly will prevent build ups of tension
When typing it’s easier on your shoulders if you allow your arms to hang next to your body. Think less zombie-like and more T-rex.
Ideally the wrists want to be hovering above your fingers so avoid resting your wrists on the table as it can contort your wrist and create RSI issues.
Keep the keyboard close to the edge to the table, if you need to take notes on paper have a note pad to the side rather than a space for you to write on between you and the keyboard.
Ideally, having your feet flat on the floor with your hips and knees at 90 degrees, and your back against the back support of your chair, will help the pelvis and spine feel supported and balanced, which your shoulders and neck will appreciate.
1 Hansraj, K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int, 25(25), 277-9.
2 Burton AK. Back injury and work loss: biomechanical and psychosocial influences. Spine. 1997 Nov 1;22(21):2575-80.
Amy Moffat, August 2020