PT Perspective

with Jason Lau, Doctor of Physical Therapy

Question:

I have been experiencing neck pain. Two weeks ago, I had to bring some work home over the weekend; it was all desk work and sitting in front of the computer. Since then, my head feels too heavy for my neck. The more I sit in front of my computer at work, the worse it seems to get. It has been difficult finding a comfortable position when I sleep. What should I do?

Answer:

The type of cervical pain you are getting is the most common form of neck pain people get these days due to working at a desk (often in front of the computer). The central issue is posture.  Due to the fact that most everything we do is in front of us, not behind us, our arms reach to the front, and our heads tend to lean forward. The reaching arms leads to rounded shoulders and the leaning head leads to a forward head posture. In physical therapy we call this upper crossed syndrome.

When we spend too much time in one position, our bodies adapt to that position. Kind of like how clay will solidify into a fixed position over time. With upper crossed syndrome, we end up with weakness in the front of the neck, tightness in the chest, tightness in the back of the neck, and weakness in the mid and lower shoulders. 

Solving this problem calls for a strategy that is divided into short and long-term goals. In the short term, we need to decrease the acute pain and inflammation that may be present. That could mean ice packs or anti-inflammatories as needed. When the neck is feeling heavy, a soft neck brace may be appropriate in order to relieve some of the muscle strain. A neck brace is a short-term solution that allows the muscles to rest during the acute stage of pain and inflammation. Once the pain and spasms have subsided, the neck brace is no longer necessary. As soon as the initial acute phase pain is under control, we should start working on the long-term goals.

The long-term goals are geared toward improving the ability to maintain better posture. So do we just need to remind ourselves to have better posture? Yes and no. Yes we need to improve our posture, but it is not as simple as just reminding ourselves to hold our posture. Due to the upper crossed syndrome, our battle against bad posture is not only against gravity but also our own bodies. Imagine how a bowstring bends a bow. In a similar way, the muscle tightness in our neck and shoulders will curve our necks forward so our head will stick out. For that reason, over time, as we release tension and strengthen the appropriate muscles, there will be less sway toward poor posture. Eventually, with consistent effort, our battle for better posture will only be against gravity.

With proper stretches and exercises, we can reverse the effect of upper crossed syndrome. We stretch the chest and posterior neck muscles and strengthen the anterior neck muscles and mid/lower shoulder muscles. The basic exercises include:

Don’t underestimate these exercises. Though they are simple, when used consistently, they can help tip the scales in your favor. You don’t need neck pain to benefit from these exercises. I consider these “owner’s manual” exercises for the body. However, do use common sense. Do not push through pain when doing these exercises. Some level of stretching discomfort is normal, but not pain. 

Submit your questions for future PT Perspective columns to Jason Lau, Doctor of Physical Therapy at jasonlaudpt@gmail.com