4.2 Postural Stress Issues: Upper Spine, with discussion of “Tech Neck”

Neck pain is a common complaint; it is reasonable to seek answers and how to deal with it. I share information and thoughts which hopefully will allow a better understanding of issues contributing to this condition, and offer realistic actions one can take to manage this.

As humans, we are different from most mammals because we have evolved such that our relatively heavy heads are balanced on top of our necks (not held out in front of our body).  However, human neck musculature is small compared to most other large-mammal species.

Postures that put one’s head out in front and/or forward of the body involve more muscle effort, which can generally be accommodated if that effort is not too long, or too strenuous.  Static (sustained) forward head carriage in humans is better tolerated when counter-balanced with (dynamic) head/neck/upper extremity motion. 

Muscle effort/action is required to maintain (erect) upper spine orientation; such action holds—suspends—upper extremities and shoulders against gravity. Lack of dynamic upper extremity activity (over years, decades) contributes to weakening of many of these muscle groups, making them less able to tolerate simple postural work.

I elected to include the contemporary term “tech neck” in this blog because it indeed describes a phenomenon I think is/has been present in many patients I have seen.  It is definitely a “syndrome”: a pattern of disagreeable symptoms with definite exam findings by palpation and/or range-of-motion testing (cervical region muscle tightness), along with chronological facts that are at least moderately associated with the symptoms and findings. 

A common assumption is that pain primarily stems from injury or “tissue damage” of some sort. This is only partly true. With neck pain, such “structural issues” can involve anatomical changes in cervical (upper spine) discs, which would contribute to degenerative changes in intervertebral joints associated with those discs.  

Most common is age-related disc degeneration, a condition we humans share with many other large, long-lived mammals. This can be quite variable between individuals—some people being genetically predisposed to developing more severe disc degeneration—with consequences being intervertebral joint hypertrophic (ligament thickening) changes.  This can result in low-level discomfort, causing variable degrees of localized muscle tightness.  In more severe cases of degeneration, nerve impingement can occur, such that surgical intervention deserves to be considered.

Sports injuries or peculiar trauma can cause disc and/or joint injury that heals, but over the course of years/decades undergoes accelerated changes of disc contraction and joint thickening, contributing to pain and arm symptoms.

What is now recognized are “functional issues” that contribute to pain, as described in the first several paragraphs. Tech Neck Syndrome is one prevalent example of neck pain presenting with significant cervical dysfunction/tightness, but without identifiable anatomical deformity/degeneration as a contributor.  X-rays do not reveal signs of disc or joint changes; with more severe tightness, straightening of the normal, relaxed bending of the cervical (upper spine) region may be seen. Sustained, seated posture (generally over the preceding 15-20 years) is strongly associated with this presentation. History of significant neck injury is rare.

The following factors can be important in addressing/understanding functional neck pain:

Younger patients can develop a robust myofascial (muscle and inelastic muscle covering) tightness in response to prolonged static postures. 

People who are constitutionally “flexible” (think: while standing—can bend forward and easily touch the floor) will generally have more pain in the presence of only mild myofascial tightness.

Prolonged cervical tightness can evolve into a constant “ache”, which when severe, can be associated with “headache”.  

Time spent seated in static posture is not structurally injurious, but is functionally demanding, with prolonged forward bending of the neck a definite contributor to developing this syndrome.

Development of an exaggerated/forward-bending upper thoracic spine (kyphosis) can disproportionately increase upper spinal muscle work; simple gravity then contributes to progression.

Strong and/or sustained cervical myofascial tightness can result in compression of nerves and/or blood vessels exiting the spine or transiting the neck area going to the extremities, leading to annoying arm and hand symptoms. If significant disc and/or joint changes are present, pain/tightness may occur involving a shoulder blade area.

People who perform routine moderate upper body/extremity activity are less limited by neck pain, or if they do develop such symptoms, treatment is usually effective and cursive /limited.

Ergonomics –and awareness—can allow a patient to perform “harm reduction” during their everyday life.

Examination—with the neck relaxed (lying on one’s back)—allows greater appreciation of the quality and severity of muscle tightness present, and whether nerve impingement might be involved.  Osteopathic manual treatment methods can then determine how reducible the tightness is.

Basic imaging (X-ray) is helpful in identifying the extent and degree of disc and joint changes present which may be contributors to pain.  MRI can provide more anatomical detail, but is best reserved for more severe neck pain with extremity symptoms, or pain episodes that have not improved despite reasonable treatment.

Tech Neck can have symptoms ranging from mildly disagreeable to moderately debilitating. It does not deserve to limit your life. This syndrome can be MANAGED, maybe resolved. Management involves recognition of these issues, then re-arranging one’s priorities to allow intermittent treatment, regular self-treatment (general or specific stretches), and establishment of a regular exercise routine.

Intervention with manual treatment (massage, chiropractic, osteopathic) can more quickly reduce intensity of tightness and modify residual tightness. It deserves to not be done too frequently, and avoid high-velocity treatments especially if an active disc syndrome is possible, or if a previous treatment caused increased pain for more than 2 days.  Reduction of myofascial tightness allows for easier introduction/initiation of an exercise regimen.

There are at least three factors involving patient-directed actions that are quite effective in successfully addressing Tech Neck: 

Awareness of—and respect for—ergonomics of posture, especially seated posture, whether at work, home, or while driving, can lessen static cervical region muscle work.  These were stated early in this discussion and deserve serious consideration.  Using a mirror to get a side view of yourself, taking a selfie while standing and/or seated, or viewing photos of yourself can be helpful in determining your posture.  Most physical therapists—and doctors of physical medicine like myself—have a lot to say about this.

The common modern work—and school and home—environment has transitioned away from dynamic and heavier use of extremities and torso, into time spent static (seated).  Over just 10 to 15 years, deconditioning of upper body and arm musculature occurs commonly in working adults in the U.S.  A regular exercise regimen that engages upper body, cervical area, and extremities with dynamic motion allows a reduction in “resting hypertonus” during static postures, reduces nerve compression/symptoms, and reduces deep cervical muscle fatigue.

Specific stretches (based on exam) can accurately address areas with more tightness/restriction. However, once improved, a regular stretching/movement regimen is an excellent antidote for preventing recurrences of this issue—either at one’s desk several times per day, or at home daily for 15 minutes.

Sincerely,

DrL