How To Rebalance Your Head and Neck
Updated for COVID-19 lockdowners

Rebalancing your head and neck continues to be important since they are likely out of balance now. Lockdowns during the COVID-19 pandemic forced many more of us into working from home. Those of us who have worked from home for decades found out years ago how our workspaces and habits impact our posture. Even in the office, most of us do not have ergonomically optimized workspaces. Too many people work at suboptimal laptop or tablet setups for many hours, and then spend their non-work hours driving or peering at phones. So, here are some ergonomics suggestions and resources to help you rebalance your head and neck. Read Part 1: A Pandemic of Forward Head Posture (FHP) for more about causes and symptoms of forward head posture (FHP), the most common head/neck imbalance. Part 3: Exercises to Strengthen Deep Neck Muscles describes specific exercises to correct FHP.

Unbalanced posture (FHP) causes pain & fatigue

FHP-triggered pain in the neck, shoulders, and back (1) drives many people to healthcare visits. Unfortunately, conventional medicine is behind regarding posture as a trigger of musculoskeletal pain. Patients get pain pills, or a limited course of physical therapy. Rarely do we get information about bad workstation ergonomics and its effect on posture. Therefore, chiropractors (see Author’s Note), osteopaths, personal trainers, and physical therapists are 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 better posture. Regardless of the reason, the first step towards rebalancing your head and neck is becoming aware of the 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.

Ergonomics to help rebalance your head & neck

Most people with FHP have sedentary commutes, jobs, and entertainment. That number shot up during the Covid-19 pandemic shelter-in-place orders. While the telemedicine and work-from-home (WFH) movements have been great advances, they have also exacerbated FHP with remote meetings & suboptimal home office ergonomics. Getting up and doing any exercise (not just exercises for the head and neck) will 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, 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 (even a rolling pin) to do counter FHP exercises, like neck or thoracic extension. Additionally, balls and rollers can release neck tension and trigger points. (5)

Breathe better

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, game controllers, 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. Your head, neck, back & arms will thank you.

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 (try dark mode). 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. Ask your optometrist.

Phone positioning

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. One nice thing about telepresence is no phone cradling. However, watch out for how your camera and microphone set-up influence your carriage.

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 videos. 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 or beanbag and fiddle with it, add small pillows until it comfortably supports your head and neck. Move your TV or gaming monitor and adjust 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

Sleeping ergonomics

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 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.

Consider devices

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

Author’s note:

I 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, back pain and stress headaches. A chiropractor diagnosed “forward head” and “twisted butt syndrome.” He suggested headphones, changing chairs and elevating my monitor. So, I bought a headset, swapped the executive chair for the side chair and borrowed a 6” thick science book 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 21 years [link to PhisIQa]. Over the decades, 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.

References

1. 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/
2. Castaldo, A. (n.d.). About PhysIQa. Retrieved July 23, 2019, http://physiqa.com/about/
3. Wong, M. (2016). FORWARD HEAD POSTURE CORRECTION. Retrieved July 23, 2019, http://posturedirect.com/forward-head-posture-correction/
4. 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/
5. Ingraham, P. (2018). Tennis Ball Massage for Myofascial Trigger Points. Retrieved July 23, 2019, https://www.painscience.com/articles/tennis-ball.php
6. 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
7. 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/
8. Posture Corrector. (n.d.). Improving Your Posture With a Posture Corrector. Retrieved July 23, 2019, http://posturecorrector.net/
9. Dave. (2016). Head Weights for Posture – Do They Work? Retrieved July 23, 2019, http://www.posturesorted.com/head-weights-for-posture-do-they-work/
10. Ornstein, S. (n.d.). Correcting Neck Posture: A Key To Pain Relief. Retrieved July 23, 2019, https://www.necksolutions.com/neck-posture/
11. 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/
12. 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
13. Asher, A. (2019). Forward Head Posture Exercises. Retrieved July 23, 2019, https://www.verywellhealth.com/neck-exercise-for-forward-head-posture-296838
14. McQuilkie, S. (2019). How To Fix Forward Head Posture – 5 Exercises. Retrieved July 23, 2019, https://backintelligence.com/how-to-fix-forward-head-posture
15. 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/
16. 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/
17. 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.
18. Lefkowith, S. (2015). Thoracic Extension Exercises – The Thoracic Bridge And More! Retrieved July 23, 2019, https://redefiningstrength.com/thoracic-extension-exercises-thoracic-bridge/
19. 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