Posture Related Neck Pain

By Robert Barker – Physiotherapist

The neck or cervical spine is designed for maximal movement, and is the most mobile part of the spine. It is not designed to carry heavy loads or sustain constant pressure. There are many structures within the neck that can be a source of pain, such as facet joints, intervertebral discs, ligaments, muscles, and nerves. Pain patterns vary within the neck, with pain felt at the source of injury, but also in the upper back and head region.

Postural neck pain may occur for many reasons.  It is often characterised by a forward head or chin poke posture, rounded shoulders and upper back, scapular winging, and an increased curve of the neck (lordosis).  Postural related neck pain typically occurs when the neck, shoulders, and upper back are in an exaggerated position for long periods and excessive compressive loading and uneven strain is placed on certain muscles and structures in the neck, such as the muscles, ligaments, vertebral joints and discs.

Muscles at the front of the shoulder complex become tight and short, whilst muscles in the back become lengthened and weak. In the neck the opposite occurs, with the front neck muscles become weak, and the back of the neck muscles becoming short and tight. Also, spinal joints and discs can become irritated due to chronic postures and the loads associated with them.

Postural related neck pain is common in jobs requiring prolonged periods of looking or leaning forwards to look at computer screens, working at bench tops and driving, and looking up with our heads in extension for long periods.

Pain and/or tightness is often described as being muscular in nature, and felt across the top of the shoulders, down the scapular, and at the back of the neck. Pain can also be in the form of headaches, or from the cervical spine itself and referring across the shoulders and the upper back. Movement, or change of position often alleviates these symptoms. People often describe the pain as a diffuse ache or soreness and tender when the muscles are palpated.

Studies have shown that people with chronic neck pain demonstrate a reduced capacity to maintain an upright posture with a reduced endurance capacity of the deep stabiliser muscles of the neck. Chronic neck pain sufferers also demonstrate impaired proprioception and positional awareness of their neck and head, which can add to their lack of ability to maintain a neutral neck posture.  A comprehensive rehabilitative exercise program has shown to improve their ability to maintain a neutral cervical curve during sustained activities.  

Treatment has been shown to be most effective when a combined clinical approach is taken. This includes a combination of manual therapy and rehabilitation exercises including;

• Spinal mobilisation done to reduce pain, inflammation and associated stiffness of vertebral joints.
• Neck mobility exercises and stretches will be prescribed to regain normal range of motion of the neck and reduced stiffness.
• Muscles relaxation techniques, such myofascial release, trigger point therapy, dry needling and neuromuscular techniques to relax tight overactive muscles and repair strained muscles.
• Postural control and strengthening exercises, focusing on the deep neck muscle endurance and activation and back retractor and scapular stabiliser muscles endurance.
• Functional training can be completed to correct activation and timing of postural muscles into every day and work-related tasks.

Increased tension or stress has also been attributed to the cause bad posture and overactivity of certain muscles around the neck and shoulder girdle. This is why relaxation techniques can be implemented to help reduce tension within muscles and increase our parasympathetic nervous system activity. The use of postural cues and ergonomic aids, such as a supportive chair, elevated computer monitor, visual markers, and reminder notifications also have been shown to help with postural related neck pain.

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References:

Falla, D., Jull, G., Russell, T., Vicenzino, B., & Hodges, P. Effects of neck exercise on sitting posture in patients with chronic neck pain. Physical Therapy. 2007; 87(4); 408-416.

Brukner P., & khan k. (2017). Brukner & khan’s clinical sports medicine. 5th ed. (pp. 593-621). Sydney: McGraw-Hill.