Its not been the best start to 2021 but we hope everyone’s been well and safe. It seems like home working is likely the new normal for most people.
Since the first lockdown’s lifted and being allowed to see patients in clinic, we have been seeing much more issues related to working from home.
The common theme we are hearing is less exercise, less movement, being stuck in small spaces, sub-optimal home working environements (think dining tables or small lap trays). These all can take its toll on our necks and backs.
On the upside, we find that most people do have a pretty good awareness of things like their postures and optimal home office set-ups.
We figured we would do a follow-up on this since home working is likely to continue and may even become the new normal.
We will be discussing a couple of different issues we have been seeing cropping up more often that’s related to home working and postures. We will then show a few things you can do to address and prevent this.
Most people have experienced headaches in some way or another – especially after sitting for a long time in front of the desk. There are many causes and subsequently different type of headache diagnosis.
The main headache diagnosis we’ve seen and treated is a specific type of headache known as cervicogenic headache (cervical = neck, genic= originating from).
This type of headache is a form of referred pain that comes from the neck – meaning that it’s caused by the neck but experienced elsewhere in the head.
This happens because the nerves of some neck structures share the same end-point as the nerves in the head. This confuses our brain which detects the pain as coming from the head.
*Note this is a simplified explanation of this phenomenon
Often, the headache will be felt along the back or side of the head and into the temple.
There is usually a vague sensation or tension in this “ram-horn” pattern (as seen the image above.) Some people also experience a pressure building up in the back of the eye.
Usually, you will notice these after sitting for a long time and feeling your neck/shoulder getting stiffer. Other times, you might feel these headaches coming on with certain neck movements.
You can often pinpoint what you are doing that seems to be triggering these headaches. This differs with some other types of headaches such as migraines which tend to feel quite sporadic.
A clear history taking often reveals that this is related to certain positions and/or prolonged sustained postures.
On assessment, we usually find stiff joints and very tense muscles – most often in the upper neck and sometimes down into the shoulders well. On palpation (physio-speak for digging our fingers as hard as we can into your muscles!), these areas will reproduce the same symptoms as well!
So any treatment will have to be targeted at this area. Try the exercise linked and listed below which all aim to address stiffness and muscle tension in this area.
Stiff shoulders are really common after sitting for too long, either at work or driving or similar. This mostly felt on the top or front of the shoulders and tends to be related to the many muscles around the shoulder.
Sometimes, you might experience pain travelling down the arm and/or fingers. This is most commonly described as a vague, odd sensation that might be accompanied with numbness/tingling.
You will find that these symptoms tend to come on with prolonged sitting with hunched shoulders. They tend to ease once you are up and moving relatively quickly. You might also notice this when sleeping at night, especially if this has been going on for a while!
If this sounds like you, chances are the nerve is involved!
Nerves in general like movement as this gets blood and oxygen to it. When they don’t get this, they tend to get quite grumpy – often caused by a lack of movement combined with certain postures that stresses the nerve.
There are a few different nerves running through the front of the shoulder which gets annoyed when we are hunched over our desks (see above image). So imagine if your shoulder are rounded for hours and weeks on-end without a break, mix that in with a lack of movement overall from lockdown and you get the recipe for an irritated nerve!
To help this get better, we need to start moving the nerve! We can do specific exercises to get the nerve moving and sliding nicely again (also known as nerve flossing or mobilisations).
Follow the instructions in the video for each specific nerve slider.
We also want to reduce the “stress” on the nerves by identifying the postures that tends to aggravate it – often related to shoulder hunched forwards! Scapula pull outs are great way to do this as we strengthen the muscles that help “open” up the front of the shoulder.
The running theme so far in this blog is about posture, especially when sitting! We’ll discuss a few things to help you work on this.
More likely than not, we will tend to sit in one these kinds of posture
See how in the above pictures, the neck and shoulder (yellow) tends to droop forward compared to the rest of the body (red). This position tends to stress the upper neck and shoulder.
Now compare that to this. Where the shoulders and neck are more in-line to the body compared to before. Less tension is placed on the neck and shoulders as a result.
Instead of looking to correct your shoulders and neck, start by getting a bit more upright at your lower back instead.
Compare the top and bottom images.
See how on the bottom image having a slightly more upright lower back position changes the position of the upper body? Try this out yourself! You will naturally find that your shoulders and neck are in a much better position and feel less tension through these areas.
If that still doesn’t help much, try squeezing your shoulder blades together gently. Follow up by doing the chin tuck exercise earlier, just about halfway and that gets your neck in a better position.
To be perfectly honest, working on posture is difficult, and really just plain boring. We often hear our patients saying that its really difficult to maintain the “good” posture for the whole day.
And this is something that’s been preached by countless people for a really long time.
So why does no one do it?
That’s because we are trying to create a whole new habit which is really difficult and takes a lot of effort to change. Our body also tends to default into the most comfortable positions – this isn’t bad, but everything in moderation.
Practically, what we recommend is to frequently change your posture – this prevents you from being stuck in position all the time. The is much easier for most people to achieve.
By frequently changing your postures (from hunched to upright and back), we break the cycle of being stuck in one position for too long! Over time, its gradually gets easier to keep upright for longer while allowing you to reap all the benefits in the meantime!
This, in our opinion, is a much more manageable way to build better posture – by gradually introducing it bit by bit!
So if you notice your neck or shoulders getting stiff or symptoms coming on, see if you are hunched over excessively (quite likely you are). Get yourself a bit upright for a bit and see how that changes your pain (most often it starts to settle).
Another easy way to help your posture is to incorporate movement “snacks” when you start to feel like you’re getting stiff – a minute every hour is an easy way to start! Any regular stretches for your neck and shoulder will help do. But here’s a simple routine to get you started – you can do this at while sitting so no excuses there!
We’ve come to the end of this blog! We hope everyone’s taken away something useful to help us to adapt to the new normal!
We remain open for face-to-face sessions as physiotherapy is considered an essential service. If you are struggling with any issues as a result from working from home, it can be beneficial to get yourself an individualised assessment and plan (including hands-on treatment) to figure out a way forward!
We are also running remote consultations – these can be really helpful if you are looking for an individualised home office assessment! We can subsequently advice you on the types of changes or modifications that might suit you. You can expect the same level of service as a face-to-face appointment, with a thorough assessment and an individualised treatment plan (minus the hands-on of course).
Written by Andrew Linn 🇸🇬