We expect a lot of our necks. Not only do they have to balance a bowling ball on our shoulders for 16 hours a day, but they tolerate the constant strain of our work and leisure activities, and safely protect the plumbing and wiring that connects the brain to the rest of the body. It’s a hard job and symptoms caused by neck dysfunction are common in general practice.
Firstly, what the biomechanics of the spine? The key element is that it works best when everything is in alignment. The cervical (neck) spine has a curve with the C shape facing backwards, the thoracic spine curves the other way, the lumbar spine reverses again and the sacrum yet again. The result is that perfect posture would mean the ear lobes are vertically above the “sit bones” when standing or sitting.
The sit bones are not the buttocks, but the ischial bones that we feel when sitting up straight on a hard seat. To test this, it is an interesting exercise to stand with one’s back and heels up against a wall and see if the back of the head is gently touching the wall or sitting out a few centimetres. Head forward posture may be due to thoracic spinal problems like osteoarthritis or osteoporosis, but more commonly it is a learnt postural problem due to computer and desk work, plus our recreational sitting positions.
I now see chronic head forward posture in all ages: kids due to time spent on devices, adults because of computer work and older people mostly from arthritis. This can cause headaches, sometimes very severe and mistaken for migraine, sometimes just an ill-defined discomfort and heady feeling. Dizziness can also occur.
In children, earache is not uncommonly due to a neck problem, though that generally comes as a surprise to both patient and parent. On the whole, I blame the digital age. I spend most of my day at a computer and almost everywhere I work as a locum has terrible ergonomics.
The correct height and seat plate position of the chair are critical. Especially for hot desking situations, where multiple people use the same workstation, it is important to be able to adjust the screen position and angle. Even moving the mouse to the non-dominant hand can balance out lateral tension in the neck.
Also, people doing repetitive tasks, such as assembly workers, need regular breaks to unravel the tension caused by holding the neck in the same position for a long time. Recreationally, people spend a lot of time with their spine in a complete C shape – pelvis pushed forward, upper back hunched over and neck flexed. We feel like we are relaxing, but the neck muscles are in a constant state of tension to hold that position.
Being aware of this and compensating with some extension exercises came make a big difference. For further advice, including postural correction and the importance of sleep position, I recommend Robin McKenzie’s excellent little book, . Or, of course, see a health professional.
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