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Since the country went into lockdown in March many of us have been working from home, often at makeshift desk spaces and enduring increased screen time due to the endless schedule of Zoom meetings.

I’ve been back in the clinic just three weeks and there’s already a common theme starting to appear, as sedentary workers seek out physical therapy for newly acquired neck pain, tension headaches and shoulder and arm discomfort. I’m going to run through a few of the common symptoms, look at the potential causes and suggest how you can maximise the ergonomics of your home workspace with a few simple changes.

The Anatomy:

The neck is made up of the seven vertebrae of the cervical spine and surrounding 26 muscles that enable mobility and stability, not to mention the tendons and ligaments. The vertebrae surround and protect the spinal cord, where the top vertebra (C1, or Atlas) connects with and supports the skull, and the lowest vertebra (C7) sits just above the level of the shoulder blades and articulates with our thoracic spine. The cervical nerves supply sensation to the skull and scalp, as well as sensation and muscular control to the arms.

Our necks permit us a large range of flexibility and motion under normal circumstances, however it also allows a vulnerability to a number of physical forces; in this case when we subject our cervical spine to unusual positions while sitting and using our phones or computers.

Neck Pain:

Neck pain is fairly obvious; it’s when we notice localised pain around the neck and it can feel stiff, resulting in a limited range of movement. Trapped nerves can sometimes become an issue and pain can also radiate into the shoulders, jaw, temples, forehead and eyes, and base of skull.

Neck pain occurs when the soft tissues–muscles, fascia and tendons–supporting the cervical spine and weight of the head, become stiff after prolonged static postures, such as hours in front of a screen. If our desk set up means we have to lean forward or look down for long periods then the force on our neck increases.

While in a neutral position, the pressure on our neck is only around 5kg, as the direction of the force comes straight down the spine. But if you tilt your head forward, as you would look at a screen or laptop, then those forces increase dramatically as a study from 2014 (1) shows; if you were to look down at your phone at around 45°, the force your head puts on your neck increases up to three times as much. This requires a lot of extra work from your neck muscles, fascial system, tendons and ligaments, and in turn can tug at the skeletal organisation of your vertebrae.


Headaches commonly accompany neck pain. The tightness of the neck muscles pull at their attachment to the skull and they can be more prominent and disabling for people than the neck pain, and may be the main presenting symptom.

Headaches emerging from neck dysfunction often begin at the skull base, radiate up over the scalp and produce a pressure-like sensation over the entire head. Some headaches we feel behind our eyes and across the forehead, these can radiate from the sternocleidomastoid muscle (SCM); two large neck muscles inserting to the mastoid process of the skull, just behind the ears, and coming down to your collarbones.

Shoulder Pain:

We all have a large fan-shaped muscle either side of our spine that crosses a large surface area of our upper back, from the base of the skull, down the back of the neck, over the shoulders (where it attaches to part of the collar bone), along the superior and medial edges of our shoulder blade and to the spinous processes of the mid spine. Static contractions and prolonged static loads can lead to fatigue and/or aggravation of these important shoulder muscles.

Recent research suggests that there is a link between psychosocial factors and the occurrence of trapezius muscle pain; social issues such as lack of support from colleagues, mental stress at work and low influence (2), all of which can be exacerbated when we are working in isolation, without contact time and daily support from our colleagues.

Another common aggravator for the shoulders are the levator scapulae muscles that link the upper neck to the shoulder blades, their job is to elevate the shoulders and, I’m sure many of us have noticed, the shoulders can creep up to our ears when we’re involved in focused work at our desks, especially when the work is stressful or involves deadlines!

With both of the muscles above we tend to feel aches at the top of our shoulders, along the top of, and between, our shoulder blades and at the base of the shaft of the neck.

Arm and Hand Pain & TOS:

Sometimes our sedentary and work-related postural positions can result in numbness and/or pain down the arms, in the wrists and hands. Wrist and hand pain can be a carpal tunnel issue, but often it’s a pain symptom created further up the chain by a tightening of the muscles around the shoulders and neck that impinge on the blood supply and irritate the bundle of nerves (brachial plexus) that comes from the cervical spine and innervates the muscles of the arm. This is thoracic outlet syndrome (TOS) and can feel like a heavy, aching and fatigued sensation, as well as numbness in the hand and fingers.

Hands on physical therapy can certainly offer a lot by way of reducing soft tissue tensions and encouraging the body into a more efficient alignment. However, there are also some simple things you can do to maximise your home office set up.

Home office tips:

  • If you’re working with your laptop on a kitchen table or home desk it may be time to invest in a laptop stand to ensure your screen is at eye height when the head is lifted.

  • Check in with your working posture regularly to allow your head ribs and pelvis to stack on top of one another, with your chin gently tucked so the back of your neck stays long.

  • Some people find it helpful to set an alarm every 20/30 mins to get up and stretch their legs, grab some water or spend a couple of minutes stretching. Posture tends to deteriorate the longer we spend sitting or standing in a static position so changing your movement pattern regularly will prevent build ups of tension

  • When typing it’s easier on your shoulders if you allow your arms to hang next to your body. Think less zombie-like and more T-rex.

  • Ideally the wrists want to be hovering above your fingers so avoid resting your wrists on the table as it can contort your wrist and create RSI issues.

  • Keep the keyboard close to the edge to the table, if you need to take notes on paper have a note pad to the side rather than a space for you to write on between you and the keyboard.

  • Ideally, having your feet flat on the floor with your hips and knees at 90 degrees, and your back against the back support of your chair, will help the pelvis and spine feel supported and balanced, which your shoulders and neck will appreciate.

1 Hansraj, K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int25(25), 277-9.

2  Burton AK. Back injury and work loss: biomechanical and psychosocial influences. Spine. 1997 Nov 1;22(21):2575-80.

Amy Moffat, August 2020

Updated: Aug 4, 2019

Over the last few weeks I've been absorbing Bessel Van der Kolk's insightful book, 'The Body Keeps The Score'.

The scope of the book covers human stories, scientific research and his own personal experiences of treating people suffering with trauma to explore the use of talk therapies, drugs and newer approaches such as yoga, massage, neurofeedback and psychomotor therapy to understand how body and brain operate after traumatic experiences and how our stories, emotional scars and histories can be re-shaped and re-observed to live happier and more fulfilled lives.

In the book Van der Kolk notes that mainstream medicine is firmly dedicated to bettering life through chemistry, but with this the fact that we can change our own physiology and inner equilibrium, by means other than drugs, is rarely considered. Within this perspective four fundamental truths are overlooked:

  1. Our capacity to heal one another, as well as restoring relationships and community is central to restoring well-being.

  2. Language is power; being able to communicate our experiences helps us define what we know, helps us find common sense and meaning and therefore helps us change.

  3. We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through simple activities such as breathing, movement and touch.

  4. We can change social conditions and create positive environments in which children and adults can thrive

Van der Kolk notes that, "When we ignore these quintessential dimensions of humanity, we deprive people of ways to heal from trauma and restore their autonomy".

I highly recommend this book to anyone interested in the power of mind and body, in addressing traumatic experiences from their own lives and to those working with individuals or groups in any dimension, whether in bodywork, leading workshops, in community projects or providing health treatments. It's a real page turner!

Amy Moffat, May 2019

The ways in which we use (or don't use) our bodies shapes our physique. Most of us spend a few hours a day at a desk in front of a screen, or peering down at our phones, putting our neck and upper-back muscles to work. Movement comes through the ways in which we commute to work or in short bursts of cardio or weight workouts that we cram into our week, or if we're lucky through mindful movement systems such as Pilates, Gyrotonic or Yoga.

Commonly I see limited range of movement (ROM) through the thoracic spine, the twelve vertebrae in the mid-section of our backs, whether through limitations in extension (opening up the chest and bending backwards), lateral flexion (bending to the side), in rotation (twisting through the thoracic) and in flexion (bending forwards).

Spinal mobility back pain

If we develop stiffness in the upper back, common sense tells us that the areas above and below—the neck and lower back—will have to compensate to achieve functional ROM. This is why pain symptoms in the neck and shoulders, as well as the lower back, benefit from being treated holistically along the spine, not simply spending time on the area of pain but examining where the pain problem initiates.

I find in my clinic that improving the ROM in the thoracic spine, through careful soft tissue manipulation —utilising combinations of myofascial release, trigger point therapy and massage— as well as mobility exercises, can really alleviate and improve pain conditions up and down the spinal column, as well as elsewhere in the body.

Although the following examples of research I am about to reference are more directed towards orthopaedic manipulation, they show the importance of focusing on releasing the thoracic spine when treating neck and shoulder pain. Based on personal experience I believe this manipulation can be as effective in the form of soft tissues release techniques as mentioned above and/or mobilisation exercises in movement programs such as Pilates. In a 2009 the study, 'The Immediate Effects of Thoracic Spine and Rib Manipulation on Subjects with Primary Complaints of Shoulder Pain' showed that those participating enjoyed post-treatment effects of a 51% reduction in shoulder pain and a corresponding increase in shoulder range of motion after a series of thoracic spinal manipulation techniques.

Another 2009 study, 'Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial', showed that those with mechanical neck pain who were treated with thoracic spine thrust manipulation once a week for three consecutive weeks experienced greater pain improvement scores at the final treatment session, as well at the two and four week follow-up periods, than those in the comparison group who received electro-thermal therapy for five treatment sessions.

This small selection of research gives us an insight into the benefits of improving mobility at this crucial area of the spine when addressing a large group of neck and shoulder complaints.

upper back pain shoulder

When presented with pain patterns such as carpal tunnel syndrome, piriformis syndrome, TMJ dysfunction (jaw pain), headaches or migraines and more, I always address upper spine mobility to get a sense of how the person moves and attempt to improve any spinal dysfunctions, as well as treat the particular pain region directly.

Other important factors to consider when treating the thoracic spine are stress levels and the breath. Our rib cage, and therefore the thoracic spine, will have to work differently in stressful situations compared to non-stressful situations due to the change in breathing in fight or flight mode. Breath work can therefore be another important aspect in improving spinal mobility and therefore a network of other related pain issues as mentioned.

So, if you've been to see me with chronic migraines, hip pain or tightness in the jaw you now know why I spend a decent amount of time investigating your spine!

Amy Moffat, Nov 2018

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