Tips FOR DESK WORKERS with NECK & BACK PAin (2020)
Like it or not, desk jobs are a large part of our workforce now. With the recent pandemic, people are finding themselves even more deskbound. People working at a desk also happen to make up the largest proportion of patients we see at Integrity Chiropractic. Having worked at a desk in my past career, I know firsthand the impact it can have on your body.
People are naturally curious about what they can do to self-manage their aches and pains. While our chiropractic and massage treatments are often very effective at resolving or managing many musculoskeletal issues, my treatment philosophy is that patients should take an active role in taking care of their musculoskeletal health to mitigate and hopefully even prevent problems to the greatest extent possible- much like a healthy diet.
This primer not all inclusive of the issues I treat, but speaks to a large majority of patients and issues I see.
If there's something seriously bothering you, don't put it off by self-diagnosing and wasting time. Seek help. From me, or even another practitioner.
--Dr. Frank Wen
Addressing Neck, Shoulder, and Upper Back Pain
We'll start by addressing things up top.
Office workers will often find themselves in my office making comments like "I can't turn my neck to talk", "I can't turn my neck to drive", and "something is pinching in my shoulder blade".
I've had days like this too in my tech days, and it's not fun.
Muscles in the upper shoulders and neck often get overworked from suspending your head (about the weight of a bowling ball), shrugging your shoulders to type, or both. This leads to stiff necks and shoulders. Some studies have shown that just the act of sitting in front of a computer while reading can ramp up activity levels in your traps. Yikes.
Being hunched over all day not only doesn't help your neck and shoulders, but it can tighten and irritate the extensor muscles of your back that help keep you upright. Inevitably, long hours of working in this position starts to distorts your posture and makes the journey for you to undo this much harder.
Improve Your Workstation
You have to survive an 8 hour day so your strategy needs to be how you can reduce the amount of work your body needs to exert to survive it. This can be achieved by making some simple changes to your workstation. I've seen a lot of ergonomic solutions, but many don't always address the issue completely.
You can watch the video I made below or read on below.
Raise your monitor up higher than eye level.
This may mean that you need to invest in a mounting arm that can be clamped to a desk. Many people will say they have their monitor at eye-level but are still looking downward most of the time. That's because most ergonomic advice calls for the top of the monitor to be around your eye-level. If you look at pictures of offices, most people resemble the guy I drew on the left (below).
While this may accommodate a tendency for a lower viewing arc of the eyes, the trade off is that it increases muscular effort if your neck and shoulder muscles over time. This positioning often requires two muscles (our upper traps and levator scapulae) to help suspend our head, which is not their primary job and leads to frequent complaints in desk workers.
This posture can also lead to a rounded upper back as well as rounded shoulders from your pecs being in a shortened position (not good if you like to play sports or workout).
Modern monitors have crisp views over very wide viewing angles compared to monitors of the past which helps to essentially make this a non-issue now to bring it up higher like the image on the right. Just think of what our natural positioning would be for our head and shoulders when we are walking. Most individuals I meet don't complain of neck and shoulder pain from walking too much.
I think this is one of the simplest and easiest things that can make a big difference toward improving comfort and improving posture.
If your monitor doesn't have mounting screws or you have one of those all-in-one's I like to stack printer paper packs, old text books, or use a plastic stand to bring it up to a decent level.
If you happen to still find yourself leaning into your monitor, it's probably is too far away for you to see. So either get a bigger monitor, magnify the text, or slide the monitor a bit closer.
If you've been stuck with a laptop, do yourself a big favor and get an articulating laptop mount and bluetooth keyboard.
Get your keyboard to around waist level.
I've seen a lot of setups where the monitor is at a decent height, but then the keyboard sits at the same level as the base of the monitor. Imagine if the entire table was raised up in the picture to the left so that the guy's neck can be in a neutral position. It would still not be ideal because he would ultimately end up shrugging to get the forearms and hands to be able to type at the level of the keyboard which just perpetuates the issue of upper shoulder tightness. This is why I recommend having an adjustable keyboard tray to help keep the keyboard low to keep shoulder elevation out of the picture.
An adjustable desk can help mix things up.
Lastly, if you have the ability to alternate between standing and sitting at work because you have an adjustable table, switching positions is a good way to allow some muscles to rest and some muscles to get some activity. If you've set things up above as described, you'll be able to preserve your monitor to keyboard height when you rise and stand.
If you must sit all day, then it's important to note that your chair positioning can affect how your upper body will respond. My preference is to start with the thighs parallel to the floor with the chair at a height that allows the knees to be about 90 degrees. I then recommend arm rests to be as low as possible if you have them (again, trying to keep the shoulders from shrugging). If your seat has a pitch option, just set it to what feels most level to you. The last bit is the backrest. Some sources will say to recline slightly to take load off of the lumbar spine, but the problem I have with reclining your seat is that you'll likely end up with forward head flexion, rounded upper back posture, along with your arms reaching forward more to compensate for the distance you are displaced from your monitor, even if you do pitch your screen down. So there's another trade off there. I believe the lumbar spine is best in a neutral, lordotic position when sitting for long periods. Therefore you should lock the backrest and I recommend using a simple lumbar support cushion or rolled up towel behind the small of your back if needed.
Helpful Exercises for the Neck, Upper Back, and Shoulders
There are literally endless great exercises on the internet and YouTube to address neck, upper back, and shoulder issues. I'm of the mindset that if you do anything, it's probably better than nothing.
Simple Routine for the Upper Back, Neck, and Shoulders
To just get you going with something, this is a very simple routine to address the slumped posture if you've been working on a set up like you see here for so long now. You don't even need to get out of your seat and it requires no equipment.
Simple Resistance Band Exercise for Neck and Upper Shoulders
This is an exercise to address neck and upper trap tension from Functional Movement Systems of which I am certified in the Selective Functional Movement Assessment. This exercise is to help disassociate constant stabilization in your neck and upper shoulders that develops from working in front of the computer. Patients often find this one very effective so they keep a band at their desk.
Deep Neck Flexor Exercises
This is a very popular neck exercise that is often prescribed by all practitioners. The purpose of this set of exercises is to activate your deep neck flexor muscles to balance out activity of your neck extensors. I like to think of these are the "core" of the neck. Instead of performing reps, you can hold the neck in a flexed position for 30 seconds to a minute.
Lower Trap Activation
Another way to counter upper traps that are too overactive and tight is to tone them down by doing some activation with the lower trap. Why? Because your soreness is created by overactivity of certain muscles, we need to help to activate the muscles that are inactive to simultaneously quiet the ones that are too active (Here's some background info if you want to know why: Reciprocal Inhibition)
Diaphragmatic Breathing
If you find yourself with stiff neck muscles (scalenes in particular), it might be because you are using your neck muscles to sniff the air instead of using the primary muscle designed to help you breathe. It can be caused trying to maintain a good figure or stress. Sitting in a slumped position also isn't conducive to good breathing. This is a nice video that teaches you how to belly breathe.
Addressing Low Back Pain
Low back pain is ubiquitous. Whether studying, being at work, or even walking around town; I used to experience frequent pain in the low back myself.
I'm fortunate that I've been able to gain control of this issue through my education, but the average person usually doesn't know what to do as they haven't been required to obsess over the details of this topic.
While there are many causes of low back pain, the majority of patients I see for low back pain are uncomplicated cases of localized pain due to poor mechanics, rather than something more serious involving a disc or nerve injury.
If you're having serious back pain with symptoms into your legs or worse symptoms, I advise you to seek help immediately as these tips may not be appropriate for you. For now at least.
A Quick Digression Into Low Back Pain Causes
In a nutshell, there are two simple ways we can irritate our low back- being bent forward or arching backwards in the lumbar spine too much. There's certainly more to it than this, but this is typically true for a majority of patients.
Prolonged bending forward causes the back muscles to work in a stretched position and tires them out, leading to irritation.
They'll also become very tense and bulky from having to work hard to support your upper body.
If this continues over time, spinal ligaments and the posterior part of spinal discs may also be irritated and potentially weakened which could be a pain generator.
Slouching while sitting or bending over improperly while doing things can do that. This video illustrates the stretching of the posterior spinal disc with flexion, or bending over of the back.
With arching backwards, due to the orientation of the lumbar joints, we end up compressing the joint surfaces against each other, leading to pain.
While your lumbar spine has a natural curve (lordosis), it can be over-accentuated with poor mechanics.
This can occur from having a tight and excessively rounded upper spine as well as too much anterior pelvic tilt from tight hip flexors and weak glutes, making you have to arch your lower back more to stand up straight or walk.
Sitting too much can also cause this to happen.
The second video illustrates the approximation of lumbar joint surfaces (facet joints) during extension, or arching of the back.
That's why I believe excessive sitting is a common denominator to many low back problems in modern society.
An effect of sitting so much is we lose motor control of back, core, hips, and glutes and create muscle firing patterns in our brain that are not conducive to normal and athletic movement when we need it.
While getting your joints released and popped is very helpful for some in treating low back pain, research continues to show that incorporating exercise will produce better long term results.
Because the reality is, if you don't address the root cause of the low back pain, it will continue to return so the recourse for many people is regular treatment. That doesn't make you a bad individual or failure if such is the case, but at least you are informed.
I do believe people can break that cycle of low back pain as I have and I have been privileged to to help many patients accomplish that over the years.
With that said, below are helpful exercises to help establish good muscle balance in the low back and hips.
Helpful Exercises for Low Back Pain
Stretch Your Hip Flexors
This is an easy place to start because it requires the least effort and is easy to do. The iliopsoas is your primary hip flexor and it is often short and tight in many of my patients because they sit a lot.
Below on the left is an illustration I created to demonstrate the attachment points of the muscle in a standing and seated position from a sideways view. It's actually two (technically three) muscles that emanate from your lumbar spine and inner pelvis and fuse before attaching to your true hips.
The contraction and shortening of the muscle is what allows you to sit. While my illustration is more linear, these muscles can produce a force on the low back that's compressive in nature.
And if you're sitting a lot, the brain will get used to keeping the muscle short and tight, so when you stand up it will put additional stress on the low back by limiting hip extension, requiring you to make up for it with lumbar extension, which can potentially be irritating to the joints.
Many patients can often get relief from their back pain with a combination of soft tissue work to this muscle along with home stretches.
Core Exercises
It's good to get control of your core to help protect your spine and keep it stable and so you can create movement through your hips instead of your low back. The first video contains frequently prescribed exercises.
During the pandemic I have also created a simple 8-minute core routine you can follow and had my personal trainer on Mercer Island graciously put together some simple but tough core routines.
Work Your Booty
The glute max is a primary hip extensor and helps you advance forward when walking, running or hiking. It's also important if you want to do some weight lifting.
Often though, it is weak because of inactivation from sitting or our hamstrings are too dominant. The hamstrings are limited by design in the amount of hip extension they can generate, so if your glute isn't doing the job, your low back extensors may jump into the picture to try to help generate extension, which introduces additional stress to the low back.
These exercises in combination with the iliopsoas stretching and core strengthening can help to restore the balance of movement across your hip.
There's also a few more muscles in your butt that also get weak from sitting a lot.
If you happen to have some resistance bands laying around you can follow along a 7-minute glute workout routine I created during the pandemic. You don't even need to change clothes!
Other Helpful Tips for Addressing Neck and Back Pain
Take Breaks
As someone who has worked for large companies and as a small business owner- you're never going to run out of work to do. Your good work only begets more work. So take a break for your well being and career. 5-10 minutes every hour to get up and walk around isn't going to kill your productivity.
Our bodies weren’t meant to sit around all day. I'm sure you've seen the reports in the news in the recent years how sitting is killing us.
While taking a break you should try to keep yourself upright- your head and neck included because you want to give those muscles a break from all the looking down and shrugging you’ve been doing. That means you might want to put the phone away too if you want to really rest those muscles.
Go for a brisk walk around your neighborhood to loosen up your hips and let your glutes work a little. Look around and let your neck move.
You might actually get to enjoy where you chose to live as a result!
Get an Exercise Routine
One of the most popular questions patients often ask is what do you do to take care of yourself?
I happen to do many of the exercises above to help keep me in good shape and pain-free.
I've found that once you are able to get to a point where you aren't living in constant pain, it takes less focused work to stay that way. But the initial journey can tough.
I enjoy the challenge of being pushed by a trainer 1-on-1, and with most training these days being functional, it's easy to get variations of corrective exercises baked into your challenging workout.
However, my goals as I approach my 40 are quite different than when I was 21. I seek to find a decent balance between mobility, strength, speed, and cardio as I like to play badminton, run, hike, and treat patients!
Massage and chiropractic treatment can be very effective in reducing tension and restoring movement, but you'll really capitalize on your treatment and get better long term results if you incorporate simple changes and some homework to give you good muscle balance.
Having a good exercise routine is not just helpful to keep your body balanced and limber- it's also a lot more fun.
What Has Also Worked for My Patients
Having met so many patients over the years, the following are things I have also learned to be effective for many patients in addition to chiropractic and massage treatment:
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Yoga or Stretching. In addition to studies that have shown yoga to be effective at managing low back pain, patients often report to me that being able to maintain a consistent yoga program can mitigate or reduce levels low back pain they experience while working. YouTube has endless Yoga and mobility routines by various instructors for your consumption.
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Anti-Inflammatory supplements. One frequent natural supplement that many patients have reported to me being successful in reducing aches and pains is turmeric. Its active ingredient is curcumin which has some evidence in being effective at reducing back pain.
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Epsom salt baths. While the evidence is not strong regarding the use of epsom salts, many patients still find it effective. It is possible that the application of heat may provide benefit in helping tight and aching muscles relax.
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CBD topicals have been more popular in the recent years and many patients have reported them to be very helpful in alleviating neck and low back pain.
Thanks for Reading! As always, if you're looking for an expert chiropractor in Kirkland, I'm here to help.
