This blog explores evidence-based physiotherapy treatment for neck pain in office workers.
Neck disorders are a significant source of pain and disability for office workers. In fact, neck pain was ranked 21st for the overall burden of disease in the past ten years in the Global Burden of Disease. Research has shown that once someone has had neck pain, there is a high chance of recurrence. Neck pain can have a myriad of changes to muscle behaviour. This blog will explain these changes and how to address them.
Risk Factors and Causes
The link between prolonged computer use and neck pain is well established. Awkward postures, repetitive work, or even stress and anxiety have been shown to contribute to neck pain. Below are other risk factors and causes of neck pain.
holding the neck in a forward-bent posture for an extended period
working in the same position for an extended period
repeated movements such as repeatedly using the mouse
sitting for an extended period
mental health
repetitive work.
Here's what actually changes anatomically when you experience neck pain.
Loss of natural curvature of the spine
The spine has three main segments, each with its corresponding natural curvatures. When one or more of the curves are lost, the body loses its healthy curves which impacts the overall biomechanics and impedes its capacity to function optimally
This happens when we adopt a poor posture, or the so-called ‘forward head posture’ where the soft reverse C-shape curvature, or medically referred to as the healthy lordosis of the cervical spine, is lost, affecting the functions of the joints.
Subsequently, because most of the muscles of the neck are attached to the vertebrae, the muscles are dragged into positions they cannot work optimally.
The same is true if the muscles are tight, resulting in pulling and stressing of these joints
Muscles imbalance between the deep cervical muscles (muscles that lie deeper within the neck) and the axio-scapular muscles (muscles that lie superficially between your spine and the shoulder blades)
The deficit in strength and endurance of the deep cervical muscles to maintain a neutral spine posture leads to the bigger axio-scapular muscles such as sternocleidomastoid, scalene, levator scapulae, and trapezius, to become overactive and overworked. As a result, we may feel the neck being “tight” or “strained”.
Best Evidence-Based Treatment for Management
When it comes to treating and preventing the recurrence of neck pain, a multi-modal physiotherapy approach is necessary. As mentioned before, even if the pain resolves, the structure and function of the muscles are altered. The best evidence-based treatment consists of retraining these muscles, as well as manual therapy techniques such as cervical spine mobilisations, trigger point therapy, myofascial release and dry needling.
At Breathe, we've found that our Roadmap to Recovery process is the most effective way to treat and prevent neck pain from happening again. The number of weeks is just a rough guide, and can differ from person to person.
Stage 1: Pain reduction
The first stage of physiotherapy management to set you up for success is to provide you with a solid understanding of your health and your body. Because in our experience, the more you understand your injury, the better it heals.
There is evidence suggesting that manual therapy, including mobilisation of the cervical and thoracic vertebrae, and trigger point therapy, is beneficial.
Gentle neck exercises can also provide pain relief. We will teach you how to perform the McKenzie exercises for neck pain, including chin tuck, neck extension, side bending slide, neck rotation and flexion, and shoulder shrugs. The goal of these exercises is to “centralise” the pain which makes it easier to treat its source, rather than simply catering to its symptoms.
Stage 2: Activation of muscles
In this stage, it is very important to start retraining the deep cervical flexors (e.g. longus colli, longus capitus muscles that lie in front of the neck) and achieving the correct pattern of muscle use. When the deep neck muscles are weak, other accessory neck muscles such as sternocleidomastoid and scalene muscles tend to take over to compensate for their weakness. Therefore, regaining the proper activation is of utmost importance before starting to build strength and endurance.
1. Craniocervical Flexion (CCF) Training or the “Chin Nod” training (see above video)
The craniocervical flexion / chin nod training involves being able to tuck your chin towards the front of your neck to activate and train your deep cervical flexors to maintain a healthy cervical spine. Below is our demonstration of how you can perform a correct chin nod. Once the correct pattern of activation of these muscles are achieved, we can start training their holding capacity. The aim is to hold 10s of 10 reps and gradually progress to the next level.
2. Craniocervical Extension Training or the “Chin Lift” training (see above video)
Similar to the CCF muscles, we also need to retrain the deep cervical extensor muscles (e.g. semispinalis, multifidus muscles) as they also provide stability and control for the neck. In fact, both work synergically to prevent a forward head posture. For this exercise, get onto your hands and knees on a mat, ensure your neck is in a neutral position with the ears in line with shoulders. Simply say ‘YES’ by nodding your head. Practice several times with good control.
Stages 3 & 4: Movement training and Strengthening
The last two stages, arguably the most important ones to prevent the recurrence of symptoms, are to build strength and endurance of these deep cervical and axio-scapular muscles. The latter is crucial in maintaining a stable posture required during extended periods of computer use. Some of these exercises include:
Training Flexor Synergy Strength (Deep Neck Rotation and Deep Neck Head Lift): This is a progression of the above exercises. Once able to perform the CCF hold, we can add a head lift or head rotation while still maintaining the CCF position.
Resisted Low Rows in Standing: This exercise is excellent at targeting the middle and lower trapezius and rhomboid muscles that are required to bring the shoulder blades together for an upright sitting posture.
In summary, neck pain is more prevalent in office workers than any other occupation. This poses a socioeconomic burden as it impacts the employer, as well as the employee’s health, performance and productivity. Physiotherapy management consists of a multi-modal approach, from considering an ergonomic workstation, to correcting posture, to manual therapy techniques to prescribing exercises for long-term effects.
References:
Blanpied, P.R. et al. (2017) ‘Neck pain: Revision 2017’, Journal of Orthopaedic & Sports Physical Therapy, 47(7). doi:10.2519/jospt.2017.0302.
Cagnie, B., Danneels, L., Van Tiggelen, D., De Loose, V., & Cambier, D. (2007). Individual and work related risk factors for neck pain among office workers: a cross sectional study. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 16(5), 679–686. https://doi.org/10.1007/s00586-006-0269-7
Chen, X. et al. (2017) ‘Workplace-based interventions for neck pain in office workers: Systematic Review and meta-analysis’, Physical Therapy, 98(1), pp. 40–62. doi:10.1093/ptj/pzx101.
Corp, N., Mansell, G., Stynes, S., Wynne-Jones, G., Morsø, L., Hill, J. C., & van der Windt, D. A. (2021). Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. European journal of pain (London, England), 25(2), 275–295. https://doi.org/10.1002/ejp.1679
Hoy D., March L., Woolf A. The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(7):1309
Kim, R. et al. (2018) ‘Identifying risk factors for first-episode Neck pain: A systematic review’, Musculoskeletal Science and Practice, 33, pp. 77–83. doi:10.1016/j.msksp.2017.11.007.
Louw, S., Makwela, S., Manas, L., Meyer, L., Terblanche, D., & Brink, Y. (2017). Effectiveness of exercise in office workers with neck pain: A systematic review and meta-analysis. The South African journal of physiotherapy, 73(1), 392. https://doi.org/10.4102/sajp.v73i1.392