LEARNING OBJECTIVE: To present an exercise protocol for office workers who complain of neck pains or those with chronic neck pain. This protocol can be applied in the workplace during working hours. It requires no special outfit or equipment, and its effectiveness is related to how frequent it is used by the employee.
Anastasia Beneka, Ph.D., is an Associate Professor of Therapeutic Exercise and Rehabilitation at Democritus University of Thrace in Greece, Department of Physical Education and Sports. Her research focuses on the role that exercise protocols play in preventing and treating acute and chronic muscle skeletal injuries.
Paraskevi Malliou, Ph.D., P.T., is an Associate Professor of Therapeutic Exercise and Rehabilitation at Democritus University of Thrace in Greece, Department of Physical Education and Sports. Her research focuses on the role that exercise protocols play in preventing and treating acute and chronic muscle skeletal injuries.
Asimenia Gioftsidou, Ph.D., is an Assistant Professor of Therapeutic Exercise and Rehabilitation at Democritus University of Thrace in Greece, Department of Physical Education and Sports. Her research focuses on the role that exercise protocols play in preventing and treating acute and chronic muscle skeletal injuries.
Disclosure: The authors declare no conflicts of interest and do not have any financial disclosures.
It is common for office workers to sit on an office chair for prolonged periods without having the chance to walk or make any kind of movement with hands and/or legs that would activate large muscle groups. While sitting, office workers tend to lean forward or to slouch down in the chair. This partial immobilization can cause low-back pain or neck pain because static posture increases stress on the back, neck, shoulders, arms, and legs. In particular, sitting can add large amounts of pressure to the back muscles, spinal disks, and ligaments. With time, incorrect sitting posture can damage spinal structures and contribute to or worsen back and neck pain (2).
Chronic or recurrent neck pain can be severely devastating and also can be accompanied by upper-back pain, shoulder and scapula pain, and headaches. These symptoms, along with tight neck muscles and stiff joints, can make even the simplest daily activity painful for the office worker. Therefore, strength and conditioning professionals, athletic trainers, and physical therapists often come across ongoing or recurrent complaints of neck pain. William J. Hanney, DPT, ATC, CSCS, who is an instructor in the Physical Therapy program at the University of Central Florida and a staff physical therapist with the Florida Hospital Sports Medicine and Rehabilitation, says that the “neck is a remarkable mobile joint that acts as a crossroad for the trunk, upper extremities, and head. Therefore, fluent movement and orientation of the head and neck are required to position senses to our surroundings. For these mechanisms to work, considerable muscular and sensory control is necessary” (4).
As more and more office workers complain of neck pains and headaches affecting their functionality and effectiveness in daily activities and work, accommodations must be made for exercise and easy mobilization in the workplace.
For that reason, office workers need to incorporate an exercise program in their daily lives, during office hours, to cope with the symptoms of partial immobilization resulting from prolonged periods in the sitting position. They need to adopt appropriate sitting position and remain in that while typing on the computer, talking on the phone, or doing other tasks in their office position. But, first of all, they need to work on proper joint mobilization through stretching stressed muscles, strengthening weak muscles, and improving joint stability via proprioception exercises.
Therefore, the purpose of this article is to present an exercise program that is suitable to address neck pain symptoms and it is easy to apply in the workplace by office workers because it takes no special outfit or equipment. This exercise program involves strengthening, stretching, and proprioception exercises while instructing the office worker how to reposition his head and body so as to prevent the symptoms or cope with them.
DESCRIPTION OF THE PROBLEM
Jobs requiring the use of a computer input device and video display terminal often expose workers to awkward and sustained postures and repetitive motions of the upper extremities, which have been established as causes of work-related shoulder and neck pain (2).
In particular, office workers with neck pain usually demonstrate excessive and prolonged deep flexor muscle activity of the head while their range of motion at the neck joint is limited (5). They also may exhibit altered postural behaviors such as drift in and out of scapular protraction associated with different muscle activation in the diverse trapezius band, producing mechanical stresses and pain on sensitive cervicobrachial structures (11).
Studies also have shown that people with neck pain have demonstrated proprioception disturbances, position sense abnormalities, balance deficits, and altered eye movement control (9,10).
DEALING WITH THE PROBLEM
It has been proven by electromyography that the altered trapezius activity presented in individuals with neck pain compared with the trapezius activity of pain-free individuals can return to optimal muscle activity levels when the individuals follow some scapular postural correction exercise during typing tasks (11).
Moreover, it has been confirmed that exercises involving repeated specific contraction of craniocervical musculature, precise movement relocation practice, and eye-head coordination improved quality of cervical afferent input into the central nervous system and alleviated neck pain in chronic neck pain patients (6).
It is well established that the head repositioning (neutral position, as seen in Figure 1) is the only way to control this excessive and prolonged muscle activity of the head’s deep flexors or correct those inappropriate postural behaviors previously mentioned.
An exercise protocol like the one presented in the present article is meant to address all previously mentioned problems altogether. It is composed of diverse exercises that have been proven to be efficient in controlling neck pain symptoms by previous studies (1,4,8).
GOALS OF THE EXERCISE PROTOCOL
Office workers can improve symptoms of chronic neck pain by completing the following exercise protocol (either prevent or cope with them). This exercise protocol is designed to help the office worker improve his or her head positioning and gradually attain appropriate head repositioning (neutral position as seen in Figure 1) through strengthening and stretching of the corresponding muscles and enhancing the proprioception ability of the neck muscles.
ADVANTAGES OF THE EXERCISE PROTOCOL
* Office workers can use this protocol while they are seated or standing without drawing attention to themselves!
* They can use the protocol in their office clothes (e.g., a tie or a suit is not an eliminating factor for adherence to the program).
* The protocol does not require any special equipment, so everybody can use it while seated even in the car waiting at the traffic lights.
* The exercises are easy to take up, following a brief instruction period with a specialist.
* After only a little practice, office workers are able to check themselves for proper execution and appropriate posture while working (without the help of the checklist proposed in the present article).
STEPS TO MAINTAIN PROPER UPPER-BODY STANDING POSITION WHILE EXERCISING
Before beginning this exercise protocol, subjects must train themselves to follow three basic steps to maintain proper upper-body standing position while exercising. These steps are:
Standing against a wall:
* First step, subjects must come to a pelvis tilt position to eliminate the lumbar extension (Figure 2) and hold this position for 10 seconds.
Check point: The lumbar spine should be flat and touching the wall
* Second step, while maintaining pelvis tilt, subjects must bring their shoulders in contact with the wall and hold this position for 10 seconds (8).
Check point: Shoulders should touch the wall and remain there.
* Third step, subjects must tuck their chin and finally lift their head while maintaining the chin tuck and the previous two positions (Figure 3).
Check point: They must lift their head like someone is tearing out their hair.
NOTE: Subjects always must remember to move air in and out of their lungs (7) and maintain proper posture while executing the exercise protocol.
Check point: Keep the mouth opened and relaxed so air can move in and out of the lungs in synchronization with the exercise easily.
DESCRIPTION OF THE EXERCISE PROTOCOL
While executing the following exercises from the upright standing position:
* Against a wall: Begin neck movements in all directions (flexion, extension, left and right rotations, and side flexion) while continuously holding the scapulas on the thoracic cage (the wall will help keep the proper scapula position). Make slow and controlled movements trying to reach full pain-free range of motion. Imagine the head bisected and divided into upper and lower halves at the point of the upper lip. Place the index and middle fingers on the upper portion of the lip as a guide to move the head back into a retracted position.
○ Flexion: Tuck the chin while lifting the top of your head. Return to the neutral position (Figures 4 and 5).
○ Extension: Lift the chin until the posterior head still touches the wall (Figure 6).
○ Left-right rotation: Try to touch the wall with the ear, left or right correspondingly. Stay in this position and depress the opposite shoulder (Figure 7).
○ Left-right flexion: Always touch the wall with the bottom half of the head. Stay in this position and depress the opposite shoulder.
Check point: Don’t forget to maintain pelvis tilt position and shoulders against the wall.
○ Against a wall: Place the index and middle fingers on the upper portion of the lip as a guide to move the head back into a retracted position. Begin horizontal movements of the head forward and backward (8). Think about keeping the head in the same horizontal plane (Figures 8 and 9).
Check point: Make small movements, pressing the wall with the head while returning backward (retraction).
* Against a wall: Cup the hands behind the neck. Stretch and extend the head upward and backward, obtaining external rotation of the shoulders (8). The major thoracic is stretched while the scapula remains close to the thoracic cage.
Check point: Keep elbows on the wall, “double chin.”
○ Free-standing position: Make shoulder rolls. While in proper standing position, with hands comfortably resting on the thighs, slowly move your shoulders in large circles, first in the forward direction and then backward (1,3,4) (Figures 10–13). The range should be broad but comfortable enough not to worsen pain symptoms. Shoulder rolls help to engage the cervicothoracic muscles and prepare them for activity. The purpose is to improve the contractility of these muscles and increase blood flow to the region. Therefore, the more repetitions subjects perform, the more benefits they get.
Check point: Slow movement and maintain the position for 2 to 3 seconds when achieving forward, upward, backward, and downward position of the range of motion.
NOTE: Repeat this exercise at a pain-free range as many times as comfortable at the beginning and at the end of the exercise protocol.
Sitting Position Proposed to Be Maintained While Working
* Slowly roll the pelvis forward to create a normal lumbar lordosis.
* Lift the sternum, so the shoulders fall back into a neutral position.
* Tuck the chin as if making a double chin and lift the head while maintaining the chin tuck. Relax to a resting comfortable position. This final position should always be maintained during static sitting activities as typing on the computer, talking on the phone, and so on (Figure 1).
Exercises for Proprioception Enhancement
When a subject achieves the appropriate head positioning and proper sitting position, it is time to work for proprioception improvement using eye-head coordination exercises as follows:
A soft pillow is needed to put it on top of the head.
* From the appropriate sitting position in front of the office desk, begin neck movements in all directions (flexion, extension, left and right rotation, and side flexion). Remember to hold the appropriate head position and proper sitting position (the chair helps to keep the proper sitting position, with shoulders touching the back of the chair). Make slow and controlled movements, trying to reach as much range of motion as possible, but always ensure that the pillow stays on the head. Try to follow the movement with your eyes.
* Repeat the same exercise with eyes closed.
We recommend the entire 5- to 10-minute protocol be repeated every 2 or 3 hours at the workplace. Gradually, subjects will realize which of the exercises previously mentioned help them feel better, and they can repeat them as frequent as they want, with no fear of any injury. The success of the program in reducing symptoms is proportional to the commitment of the employee to completing the exercises.
CONDENSED VERSION AND BOTTOM LINE
* Head repositioning of the office worker is critical to prevent or cope with the symptoms of chronic neck pain.
* The exercise program suggested can be used by office workers easily and effectively every 2 or 3 hours while in the workplace.
* An important factor as to the exercise’s effectiveness is to maintain proper upper-body standing position while exercising: Come to a pelvis tilt, bring your shoulders in contact with the wall, tuck your chin, and lift your head. Breathe normally.
* Four exercises from standing position aim to enhance range of motion and muscle strengthening of the neck.
* The frequent use of this exercise program prepares the office worker to adopt the appropriate sitting position while working.
* Improving proprioception ability while working is important for the effects of this exercise protocol to start becoming more and more positive.
Special thanks to George Nikolopoulos for his assistance in editing this article.
1. Andersen LL, Jorgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjogaard GA. Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc
. 2008; 40: 983–90.
2. Bernard BP, ed. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back
. Atlanta (GA): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 1997.
3. Blangsted AK, Sogaard K, Hansen EA, Hannerz H, Sjogaard G. One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. Scand J Work Environ Health
. 2008; 34: 55–65.
4. Hanney WJ, Zbaraschuk KS, Yi CJ, Klausner SH, Wawrzyniak L. Neck pain: exercise and training considerations. Strength Condition J
. 2011; 33 (3): 104–10.
5. Johnston V, Jull G, Souvlis T, Jimmieson NL. Neck movement and muscle activity characteristics in female office workers with neck pain. Spine
. 2008; 33 (5): 555–63.
6. Jull G, Falla D, Treleaven J, Hodges P, Vicenzino B. Retraining cervical joint position sense: the effect of two exercise regimes. J Orthop Res
. 2007; 25 (3): 404–12.
7. Latey P. Updating the principles of the Pilates method — part 2. J Bodyw Mov Ther
. 2002; 6: 94–101.
8. Rota E, Evangelista A, Ciccone G, et al Effectiveness of an educational and physical program in reducing accompanying symptoms in subjects with head and neck pain: a workplace controlled trial. J Headache Pain
. 2011; 12: 339–45.
9. Revel M, Andre-Deshays C, Minguet M. Cervicocephalic kinesthetic sensibility in patients with cervical pain. Arch Phys Med Rehab
. 1991; 72: 288–291.
10. Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med
. 2003; 35: 36–43.
11. Wegner S, Jull G, O’Leary S, Johnston V. The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain. Manual Therapy
. 2010; 15 (6): 562–6.
Keywords:© 2014 American College of Sports Medicine.
Therapeutic Training; Sitting Position; Head Repositioning; Chronic Pain; Prevention