Is poor posture the source of your pain?

Neck pain is an important public health issue that affects a large portion of our population, resulting in disability for individuals and increased health care costs for the general public.  It is currently a widespread belief among health professionals that some nontraumatic neck pain can be related to posture. As we spend more time sitting at a desk in front of a computer screen at work, we start to see changes in our bodies. In recent years, forward head posture with rounded shoulders has become more prevalent as periods of prolonged sitting increase.  This causes changes in the soft tissues of our neck and shoulders, creating injury to those structures and ultimately leading to increased pain, decreased range of motion, and potentially more serious nerve related problems.  The spinal column is made up of small bones stacked on top of each other and separated by discs that help cushion the forces that movement can place on the spine. When viewed from the side, a healthy spine should naturally curve forward and backward slightly to help absorb the forces of gravity and everyday activities. Your cervical spine, at your neck, gently curves forward to support the weight of your head. Next the thoracic spine, which starts right above your shoulders blades, curves slightly backward. Then the lumbar spine, which is considered the “low back”, curves forward again. This curve tends to be the biggest because it supports the most amount of body weight. It is often greater in women due to structural differences and how they carry their weight. Lastly, the sacral curve begins at the back of pelvis and curves backward to help support our body weight in sitting.

The poor posture that comes from prolonged periods of sitting hunched over a computer leads to an increase in both the cervical and thoracic curves and a decreased lumbar curve. Imagine bringing your shoulders and chin forward, spreading your shoulder blades apart and bending over from your mid back, flattening the arch of your lower back. This is the common position referred to as forward head with rounded shoulders, leading to kyphosis (increased thoracic curve).

This position puts more wear and tear on the spinal structures, including the bones, discs, ligaments, and surrounding muscles, and can lead to permanent changes in spinal curves. In this position, the muscles that run down the back of your neck to your shoulders and also connect the shoulder blades to the spine are stretched out and become weak. They are no longer properly able to control movements at the shoulder or neck so you start using different muscles to compensate for this weakness. This often leads to increased pain or possible injury to the neck and shoulder due to the altered body mechanics. Conversely, the muscles in the front of your neck, chest, and shoulders become shortened and may even get compressed from the altered body position. Over time, you may lose range of motion of these structures as a side effect of the changes in the spinal curve. This also changes how your body is able to perform certain movements, like reaching over head.

How to prevent these changes

An important aspect in preventing these changes is to utilize proper sitting posture. The ideal sitting posture is with your feet firmly planted on the ground with your knees and hips bent at 90 degrees. When at a computer, your keyboard should be set up so your elbows are also bent at 90 degrees at your side, not leaning forward, with your wrists in a neutral and relaxed position. For head and neck alignment, imagine your ears directly over your shoulders, with your shoulders back and directly over your hips.  When you have been sitting too long, pain is your body’s way of warning you that it is working improperly and should be used as a signal to modify your body mechanics. It is important to avoid staying in any position too long. If you sit at a desk all day, set an alarm for yourself to get up every 15-20 minutes to avoid the neck stiffness that can come from prolonged sitting. Also, there are multiple exercises you can do right at your desk to prevent this pain or stiffness from worsening. For example, you can raise your shoulders up toward your ears and slowly roll them back, squeeze your shoulder blades together slowly then release, tuck your chin in by nodding your head down and back, or roll your head around in a full circle in both directions. These can all be repeated about 10 times and should be performed multiple times throughout the day to keep your muscles moving and prevent those static postures.

Aside from sitting all day, certain sleep positions can also aggravate this neck and shoulder pain.  Sleeping on your back is the best for your spine, as it allows you to maintain the most neutral position possible. However, using too big of a pillow puts you in that forward head posture which may contribute to your neck pain. When sleeping on your side it is important to use an appropriately sized pillow to prevent your neck from bending too much to one side or the other. It is also a good idea to place a pillow between your knees to keep your hips and low back aligned. Sleeping on your stomach is the worst position for your neck because it forces you to fully rotate you head to one side. This position should be avoided if possible.

How will physical therapy help?

A major goal of physical therapy for posture related neck pain is education for proper postural habits, including sitting, standing, and sleeping posture as well as proper lifting mechanics. PT also focuses on pain relief strategies, utilizing ice, heat, ultrasound, and electrical stimulation when it is appropriate. Ice is used to help fight the inflammation process, while heat, ultrasound, and electrical stimulation are used to promote blood flow and relieve tissue tension to aid in healing the damaged tissues.

Manual therapy techniques such as deep tissue massage (DTM) can also be applied to help relieve the tissue tension and trigger points that can form in the muscles. Trigger points are small knots that develop in a muscle when it becomes injured or overworked. These areas are highly irritable and sensitive to pain when pressure is applied and can often send referred pain to other areas. DTM can help decrease the pain caused by trigger points and should be used in combination with exercise.

Neck and shoulder strengthening and stabilization exercises are the final piece of the puzzle that should be introduced and progressed as pain and tension calm down. As stated above, the muscles that help stabilize your shoulder blades, which are crucial postural muscles, become weak after being placed on constant stretch from the rounded shoulder position. This position also leads to a shortening of the muscles in the front of the shoulder and chest, like pectoral muscles. Physical therapy will focus on strengthening the muscles that are weak and stretching the muscles that have then become short. To schedule an appointment with a physical therapist please contact Total Performance Physical Therapy.