Isolation due to the COVID-19 pandemic has forced many more of us into working from home. Most of us do not have ergonomically optimized workspaces. Even those of us who do are suffering neck, back, and hip pain! Many people are working on suboptimal laptop or tablet setups for many hours. Here are some ergonomics suggestions and resources to help you rebalance your head and neck.
Read this post to find out more about major causes and symptoms of forward head posture (FHP), the most common form of head/neck imbalance. We will be splitting this post to give exercises their own space.
Forward Head Posture (FHP) causes pain
FHP, classified by pain in the neck, shoulders, and back (1) causes many people to visit their doctor’s office. There, conventional medicine is behind the times regarding posture as a trigger of musculoskeletal pain. Patients are offered pain pills, or sent to a limited course of physical therapy. Rarely do patients get information regarding their workstations’ effect on posture.
Therefore, chiropractors (see Author’s Note), osteopaths, personal trainers, and physical therapists have become the first-line practitioners who deal with postural pain. Yoga and Pilates instructors are also on the front lines of FHP assessment and correction.(2)
However, pain isn’t the only reason to correct FHP. Mitigating degenerative spine or bone problems (e.g., osteopenia or -porosis) is another. Also, autoimmune diseases that affect joints or movement (such as RA, AS, or MS) also benefit from correcting posture. Regardless of the reason, the first step towards rebalancing your head and neck is becoming aware of your problem.
NOTE: If you have chronic neck pain or headaches, do see a doctor first. There are serious conditions that produce chronic or intermittent head and neck pain. For examples: migraines, artery blockages, arthritis, chiari malformation, craniocervical instability, hypertension, spinal infections, stenosis, etc. Such serious conditions should be ruled out before you do exercises on your own.
Exercise & ergonomics for Forward Head Posture (FHP)
Most people with FHP have sedentary commutes, jobs, and entertainment. That number has shot up in recent weeks due to shelter-in-place orders. Increasing any exercise (not just exercises for the head and neck) is likely to help with pain, stiffness, and fatigue. Exercises specifically for FHP correction are cheap and easy to learn, but they are harder to make into long-term habits.
See selected illustrations, instructions, and many links to resources below. If possible, get a knowledgeable physical therapist, corrective exercise, or Yoga or Pilates instructor to assess and coach you to work the correct muscles for your posture issues. (2) Once you know how to strengthen your weak muscles, especially the deep neck flexor muscles, you can then be mindful to use them in everyday activities. (3)
Take breaks and stretch
Take frequent breaks (some people set an alarm) even if you are not doing down-looking work. Stretch, look upward, stand up, extend your upper back and neck, do a set of deep neck flexor exercises or any of the stretches shown below. (4)
Roll and release
You can also use tennis balls or foam or wood rollers to do counter FHP exercises, like neck or thoracic extension. Additionally, balls and rollers can release neck tension and trigger points. (5)
Yes, it matters how you breathe. Many people (I was one) overuse their scalenes and SCMs to assist with breathing, raising the first ribs and breathing too high in the lungs. Therefore, diaphragmatic breathing is recommended for everyone. However, unless you sing or practice Pilates or yoga, you may not even know how to do it. See (17) for some instruction.
Improve your work and play ergonomics
Often, discomfort and pain are triggered by the postural stress of work or play. In particular, computers, mobile phones and tablets put your head and neck in a narrowly focused, downward-looking position. These are bad postural situations, not postural habits, and often quite fixable. There are many resources for ergonomics. Some give you specific measurements and angles, some try to sell you products. We believe one size does not fit all, so be prepared to do a little research and experiment with your set up.
Desktop ergonomics (6)
Find the right chair for you
Find chairs that fit comfortably when you sit in a good upright posture, with upper back and lower back support. For example, I am very short-waisted and my most comfortable office chair is armless with a high, narrow back and headrest. Make sure you sit back in your chair, which may mean positioning it closer to the monitor. Or try a standing desk, but place your monitor and keyboard at the right heights to support good standing posture.
Monitor positions matter
Position your monitor at eye level (use a stand, or prop it up on a shelf or a few books) to ensure you’re looking straight ahead. Then, put your keyboard and mouse at elbow level to keep your shoulders down. If you don’t have a separate keyboard, see Laptops are evil below.
I’ve been using a lap desk for my keyboard and mouse. However, I found during long writing days (plus COVID-19 isolation-reduced activity) that it was giving me hip and lower back pain. So I found a low table to lift the weight off my lap. My story has a moral: change up your ergonomics frequently, especially whenever you experience new discomfort or pain.
So does screen usage
Place document windows on the monitor at eye level, adjust font sizes so you don’t have to lean into the monitor to read, adjust your colors and brightness to reduce eyestrain. If you use paper documents or books, place them on a stand at eye level. Use a side or lap desk for writing.
Don’t forget vision correction
Make sure you have appropriate vision correction for your arms-length screen distance. It’s not universally known, but many people need prescription glasses specifically adjusted for their workspace screens.
Only headbanging and whiplash are worse for your neck than holding a phone cradled to one ear with your shoulder! If your job means you spend more than a few minutes a day on the phone, get a headset or earbuds and use them on every long call. Or, use speaker mode.
Laptops are evil
Laptops are notorious for enabling hunched-over posture. If you must use a laptop, buy a lap desk or a kickstand to raise the screen to eye level and use a separate keyboard and mouse at elbow level. Remember to take frequent stretch breaks. Most of all, don’t sit cross-legged and hunch over your laptop in bed—get a bedside stand or over-the-lap tray instead.
Driving and car ergonomics
If you have a long commute or a job that requires frequent driving, take the time to adjust your seat to provide the best ergonomics. First, adjust the steering wheel and seat to keep you comfortably sitting against the back of the seat with your arms relaxed. Then, implement neck and lumbar support. You may have to add your own lumbar pillow, wedge support or neck cushion to customize the car seat for your comfort. Hold the wheel at the 3 & 9 position. Take frequent breaks and stretch. (7)
We’re constantly staring at screens: reading on our computers, playing computer games, and watching TV. So whenever possible, support your head and neck. Read books propped at an angle on a stand in front of you, or use an e-reader or laptop on a hands-free upright stand. In bed, get a reading wedge and fiddle with it, add small pillows until it comfortably supports your head. Move your TV or gaming monitor and seating to minimize eyestrain and leaning forward. Adjust your game keyboard or input device. Change the brightness and sound volume for comfort. Rebalance your head and neck while you play!
Ergonomics at play
Make sure your mattress and pillow(s) provide comfortable support for your back, head, and neck. Check if your sleeping positions stress your neck overnight (neck, head, arm pain, numbness or snoring are signs of this) and adjust accordingly. Many specialty cervical pillows are for sale, or you can engineer your own combination of pillows, shims, and extra padding to support your head and neck.
Seek hands-on therapy
Chiropractic, massage, osteopathy, physical therapy (especially ART and trigger-point work), Pilates and Yoga can all help. Seek out practitioners who are knowledgeable about FHP and can help you assess and rebalance your head and neck to correct it and provide hands-on relief. In these homebound days, look for many videos teaching posture help.
Treat your pain
Don’t hesitate to use pain relief while you work to correct the problems. Ice packs can help, but they are best early in the pain cycle. Later, relieve pain with hot packs or a shower massage. Take aspirin or ibuprofen, or use local pain relief such as capsaicin, camphor, menthol or methyl salicylate liniment or patches.
There are a huge variety of devices and gadgets sold to correct FHP and slumping. These include bras and braces (8) traction slings & collars, support collars, cervical pillows, head weights (9), inversion tables, biofeedback units and more (10). Work with your care team to find the right devices for you and use them carefully and mindfully. They are retraining aids, not crutches.
Written by: Ellen M Martin, Annie Rooker
I first learned about head and neck pain in 1994 when I was director of investor and public relations for a genetically engineered tomato company. I was on the phone for hours every day and developed neck and back pain and stress headaches. A chiropractor diagnosed “forward head” and “twisted butt syndrome.” I could see it on the X-rays. He recommended headphones, a change of chairs and raising my monitor.
So, I bought a headset, swapped my executive chair for the side chair and borrowed a 6” thick science publication from the library to prop up my monitor! Since then, I’ve received body work and education from chiropractors, massage and physical therapists, and my Pilates coach of 15 years [link to PhisIQa]. Since then, I’ve modified my work ergonomics, my reading habits and my exercise regimen to prevent and mitigate forward head and neck pain. My posture is visibly improved, with my neck looking less old.
- Larsen, K. (2017). The multifactorial causes and solutions to chronic neck pain. Retrieved July 23, 2019, https://trainingandrehabilitation.com/multifactorial-causes-solutions-chronic-neck-pain/
- Castaldo, A. (n.d.). About PhysIQa. Retrieved July 23, 2019, http://physiqa.com/about/
- Wong, M. (2016). FORWARD HEAD POSTURE CORRECTION. Retrieved July 23, 2019, http://posturedirect.com/forward-head-posture-correction/
- Gouthro, J. (n.d.). 9 Seated Stretches to Release Neck + Back Pain. Retrieved July 23, 2019, https://blog.paleohacks.com/seated-stretches-neck-back-pain/
- Ingraham, P. (2018). Tennis Ball Massage for Myofascial Trigger Points. Retrieved July 23, 2019, https://www.painscience.com/articles/tennis-ball.php
- Sheth, U. (2012). Neck Pain: Forward Head Posture VII: Posture Awareness. Retrieved July 23, 2019, http://repetitive-stress-injury.blogspot.com/2012/07/neck-pain-forward-head-posture-posture.html
- Auto Loan Solutions. (n.d.). Your Posture Does Matters While Driving. Retrieved July 23, 2019, https://www.autoloansolutions.ca/blog/your-posture-does-matters-while-driving/
- Posture Corrector. (n.d.). Improving Your Posture With a Posture Corrector. Retrieved July 23, 2019, http://posturecorrector.net/
- Dave. (2016). Head Weights for Posture – Do They Work? Retrieved July 23, 2019, http://www.posturesorted.com/head-weights-for-posture-do-they-work/
- Ornstein, S. (n.d.). Correcting Neck Posture: A Key To Pain Relief. Retrieved July 23, 2019, https://www.necksolutions.com/neck-posture/
- Larsen, K. (2016). The true cause and solution for temporomandibular dysfunction (TMD). Retrieved July 23, 2019, https://trainingandrehabilitation.com/true-cause-solution-temporomandibular-dysfunction-tmd/
- North American Spine Society. (2012). Cervical Exercise: The Backbone of Spine Treatment. Retrieved July 23, 2019, https://www.spine.org/KnowYourBack/Prevention/Exercise/Cervical-Exercise
- Asher, A. (2019). Forward Head Posture Exercises. Retrieved July 23, 2019, https://www.verywellhealth.com/neck-exercise-for-forward-head-posture-296838
- McQuilkie, S. (2019). How To Fix Forward Head Posture – 5 Exercises. Retrieved July 23, 2019, https://backintelligence.com/how-to-fix-forward-head-posture
- Happeny, D. (2015). Get your Head on Straight – Correcting Forward Head Posture. Retrieved July 23, 2019, https://csspt.com/2015/12/01/get-your-head-on-straight-correcting-forward-head-posture/
- Lackowski, R. (2017). Stretch of the Week: Self Neck Traction. Retrieved July 24, 2019, https://www.athletico.com/2017/06/07/stretch-week-self-neck-traction/
- Wong, M. (2017) Forward Head Posture Correction. Retrieved July 14, 2019, http://posturedirect.com/forward-head-posture-correction/ This post, by a practicing physiotherapist, has a wealth of information in one place.
- Lefkowith, S. (2015). Thoracic Extension Exercises – The Thoracic Bridge And More! Retrieved July 23, 2019, https://redefiningstrength.com/thoracic-extension-exercises-thoracic-bridge/
- Match Less. (2016, September 6th). How to Do a Head Slide Belly Dancing [Video file]. Retrieved July 23, 2019, https://www.youtube.com/watch?v=61alCXBLf-Y