We all used to get the occasional bothersome ‘neck niggle’... but then we’d work out at the gym or go for a swim, or simply distract ourselves at dinner with friends and by the next week we’d often have forgotten about it, and the ‘niggle’ was gone.
But this is a new season, the season of lockdowns and of big lifestyle changes. The ‘occasional niggle’ turned into a constant and debilitating discomfort, with the neck and shoulders feeling like a solid block after a day, or just a few hours, of work at your ‘home desk’ setup. Then out of the blue, one seemingly irrelevant movement of the neck leaves you stuck in pain, unable to turn your head any further. The straw that broke the camel’s back.
If you’re reading this, it’s likely that you are among the many of those experiencing this problem. In this blog we’ll try and clarify why neck pain has become such a prominent issue since the pandemic, how we reach the point that a straw can break a camel’s back, and, most importantly, what you can do to manage and prevent this from happening in the future. Stay tuned, keep reading and we will try and answer these questions.
A complex issue
You probably tried all forms of stretching… you’ve also been rolling your head throughout the day to get some movement whilst also keeping it as straight as possible to control your posture. This probably helped relieve some tension, but not for long. Back to the laptop and here we go again, slowly but surely everything stiffens once more. Your concentration loosens, frustration mounts and more stress adds on to perpetuate this vicious cycle.
The reason behind the ineffectiveness of stretches, regular movement or ‘posture’ control is that they are applied in isolation without taking into account the bigger picture of the biopsychosocial aspects of pain. There’s nothing magical about this picture, simply that it includes all the other factors that are responsible for causing and maintaining neck pain (the psychological and social) that go way beyond simply the tension in your neck muscles or the pressure on your discs (the biological). If we want to find long-lasting, sustainable solutions we need to start understanding the role of these factors within our environment, routines and habits, and accordingly make the necessary lifestyle adjustments.
Sitting at our laptops
But let's start with the obvious physical causes of neck pain. We all know it but we always forget: we have not evolved to sit in front of a screen for hours on end. We evolved to hunt, work the land, run from predators, mate, rest… (not necessarily in that order).
From an anatomical perspective, a fixed sitting position will naturally drive our shoulders and head forward as the head makes up 20% of our entire body weight. This is due to the position of our keyboards, mouses and screens that, coupled with the unrelenting force of gravity, produce a constant forward and downward pull. In reaction to this, our head needs to naturally tilt upwards, extending the neck, in order to keep our eyes on the screen.
The result of this action is an increase in the work that the small muscles below the skull (the suboccipital muscles), as well as the ones running at the back and front of your neck, need to do, and an increase in the natural curve of the neck (cervical lordosis). Muscles will tend to store more tension and tire faster, whilst the small facet joints of the cervical spine can get compressed, causing discomfort.
Our natural response to this discomfort is to move and try to avoid the painful positions so that, in normal conditions, our body repairs and adapts itself, and in a few days the pain is gone. But these are not normal conditions.
"Lots of scientific research has been trying to show which posture may lead to pain and which may prevent it. Despite the efforts, however, evidence is yet to demonstrate what good sitting posture is."
As the reality is that "the next posture is the best posture". In essence, research advises to have a variety of work set-ups, different postures, angles and stimuli for your body.
The role of stress
Stress and anxiety increase muscle tension and drive the perception of pain.
Contrary to common belief, stress isn’t just about feeling mentally drained. Stress is our response to anything that challenges the healthy mental and physical balance. It can be an approaching work deadline or an intense workout. Indeed, stress isn’t always about feeling restless, anxious and awful as we may feel amazing after the workout although the body is under stress (called eu-stress). In either case, stress is there to make us perform efficiently, bring us back to balance and dissipate once the job is done.
In our modern lives, however, stress invades every aspect of our daily routine. We have to deal with never ending work commitments, kids, partners, taxes all whilst trying to meet everyone’s high expectations of us. Simultaneously, our body is handling the strain from lack of regular movement, loss of sleep, over-snacking and staring at computer screens and so muscular tension builds and builds, as does our awareness of pain.
We learn to live with stress and to adapt so that it remains within manageable levels. Before the pandemic, coffee or tea breaks at the office were the perfect excuse to satisfy some physical and social needs. The commute to the office was the way to progressively detach from homelife, readying ourselves for the workday, whilst the journey back gave us the chance to ease ourselves into home again; each space maintained its own set of rules and symbols within our life. We would hardly skip the weekly workouts; we had certainties and plans for the weekend, whether it was escaping the city or socialising.
We can no longer rely on most of those small but essential routines. Coffee breaks have little meaning without social contact; home and work have blended into the same space; it is hard to motivate ourselves to exercise and social outlets are hardly present. We are lacking de-stressors and distractors. Thus, our focus is placed almost permanently on our aches and pains, which become more real and intense, muscles do not have their chance to relax and the following week this “vicious cycle” will repeat.
So, why is the pain still here?
Feeling some pain is fine. Actually, it is good for you! Pain is telling you to change position, to stretch, get active, do all of those things that are healthy for you. Basically, pain is protecting you. But sometimes it hangs around longer than it needs to, and long after anything needs to be protected. But why is?
We need to understand that pain is an experience that your brain decides to make you feel when it is under threat. It is a response to possible tissue damage to make you protect yourself. Your tight neck muscles or strained joints may send signals notifying your brain that things are not as great as they could be, and there might even be some degree of inflammation, but ultimately it is your brain that decides whether it’s relevant enough to have pain. Nine times out of ten, the same pain you are feeling now would only be a fraction of its intensity if you were sat on a beach googling ‘things to do on your holiday’ rather than being stuck at your desk, in mid-winter, in a pandemic.
Of the many factors that account for our experience of pain, we need to ask ourselves: How anxious am I about it? How are my general stress levels? How is my general physical and mental wellbeing? All this can have a profound impact in defining whether, and how intensely, you will feel pain.
We learn pain
Interestingly, our brain can also learn to experience pain simply by associating it with a particular activity or experience. When you feel the same pain over and over again, at the same desk, or during the same particular job, physical activity or stressful situation, then your brain learns that these environments are a threat and begins to predict pain in advance of it actually happening. This then leads to increased tissue sensitivity, muscles tightening, altered breathing - all the physiological events that happen during pain - but prior to any actual physical load on your body. This prediction of pain is real pain. There is no difference between this pain and actual ‘physical’ pain because all pain is real yet is simultaneously an emotion, an output of the brain not an input into the tissues.
Think about it, you can have discomfort in your neck for months, and a two-week warm holiday is all it takes to make it go away. You even survived a 6-hour flight without moving and.. without pain. Then on the flight home, as you start planning your work tasks, before you know it the same neck discomfort is back. Your brain is predicting how it will feel in a few days time and adapting accordingly, by making your tissues more sensitive and better able to detect the ensuing threat that not moving at your desk and being stressed out will bring.
To get out of this, we could just book the next flight back out to holiday-ville. Or we could actively unlearn pain: preempting the pain by getting up and moving before it starts hurting, making our next working position unpredictable, changing our desks around to remove any visual cues or memories of the last few weeks of pain, distracting ourselves from the pain but also understanding that our joints and muscles are generally healthy and not the only factor causing the pain.
To read more about our strategies for facing long-lasting neck discomfort, stay tuned for the next blog piece: “How to effectively manage your neck pain”