Hopefully you’ve seen this poster at the office (and if you haven’t – where ya been??) and it provoked some thinking about your own posture. When it comes to posture, we all have room for improvement. I generally see people for one of two reasons: trauma (rare), or repetitive motion injuries (nearly everyone). Now, however, I’m seeing many new and established patients for the same repetitive motion: they’ve gone from an ergonomic work situation with a fancy chair and standup desk to a makeshift desk at their kitchen table or worse, their sofa (if that’s you, please read on and then make an appointment :). Posture is so important and integral to care that I even have new patients sign a contract to audit their daily postures. It’s a small, actionable change that speeds healing drastically (and can impede progress if changes are not made).
What is Tech Neck?
The posture seen in the picture on the right is called a forward head carriage and it’s problematic for a number of reasons. But first, how does one get that way? Certainly texting, but also reading, studying, computer work, driving, eye strain and caring for little ones. Most of us do at least one of those things daily. The image on the left displays a “perfect” posture – the earlobe is vertical to the middle of the shoulder. For every inch that the earlobe shifts forward, 18 pounds of pressure are placed on the area between the neck and upper back (called the cervicothoracic junction or CT spine). Add this to the 8-10 pounds of the average human head, and that delicate area of the spine is now carrying 30 lbs (1inch forward), 50 pounds (2 inches forward) or 70 pounds of pressure (3 inches forward). If you’ve ever noticed a bump in someone’s spine at that area – it didn’t get there overnight! That’s what increased pressure looks like over the course of years.
Additionally, when the spine shifts forward, it loses it’s natural curve of 35-45 degrees (called a lordosis). This translates weight from the tough, bony back of the spine to the front of the spine where the discs live. The discs are meant to absorb pressure and keep the bones in your neck from touching each other. When they are forced to carry extra weight they do one of two things: they physically move out of that space (called a disc bulge or herniation depending on size and severity) or they disappear at a faster rate. The former usually happens to young, plump discs and the latter happens to aging spines. The discs tend to get drier and smaller naturally as we age, and this rapidly accelerates that process. Once the bones begin touching, arthritis ensues. Have I painted a picture?? It’s not a good scene!
Finally, when the head is shifted forward, the spine can no longer adequately do it’s job; it’s structurally unstable. This causes the muscles to engage to about ten times their capacity. This is often what brings people in – tight muscles that they can’t seem to find relief from. Left untreated, there are both disc, arthritic and neurological repercussions (think numbness/tingling/pain/weakness into the upper extremities).
What to do about it?
The most preventive action to take is to improve your postures. Mentally check off the items below:
- TEXTING. Bring your phone up to eye level, not your head and neck down to your phone.
- COMPUTERS. See below for a how to on desk ergonomics, but you should be looking straight ahead or up to 10 degrees up. If you have two screens, have them placed equidistant left and right.
- PILLOWS. You’re sleeping on your back, right?? Your pillow should be supporting your neck but not causing any flexion (or chin tucking). Down pillows need replacing yearly; a contour or memory foam pillow can last two to three years.
- KIDS. Ahh, mother’s neck (dads get it, too)! This is a tough one and with babies often non-negotiable but try to do extension exercises. Be ambidextrous with carriers, bags, children, etc.
Not just a shameless plug! Getting adjusted lines up your spine, takes pressure off the discs and nerves and provides pain relief. Soft tissue work restores your muscles and improves range of motion and biomechanics.
This one is two fold: increasing the cervical curve (which counteracts the unavoidable daily postures and also puts the weight of the head back where it’s supposed to be) and re-stabilizing your upper body, which sets the foundation for the head and neck.
Increase Your Curve
- Pettibon cervical fulcrum – this is the dense foam fulcrum you may have used in the office. It is passive, easy to incorporate and redistributes the weight of the head.
- Cervical posture pump – this is the pump you may have used in the office as well. It is the more evidence based tool of the two; pre and post MRIs have shown disc material resorbing into the disc space. Pretty rad!
Note: both of these tools are designed to be used daily.
Increase Your Stability
In addition to all our forward postures, many people and workout programs emphasize the chest (pushups, burpees, chest press, yoga chatarangas). I recommend cutting out at least half of that and replacing with upper back strengtheners. These are postural muscles that are often very weak and deconditioned. There are two ways I like to strengthen them.
- Goalposts. Lay face down. Bring your elbows to 90 degrees, like a goal post. Lift your arms up 2-3 inches and squeeze between your shoulder blades. From there, pulse upwards and then down towards your hips. Repeat 50x.
- Door Squeezes. Position yourself with your back to the edge of an open door. Take your arms out to your sides and initiate a contraction from the space between your shoulder blades. Initially you may need to move your hands posteriorly but over time they should not move at all. Once you can hold that contraction, you may do this exercise without the door. Make little circles backwards. Start with 30 seconds and work up to 3 minutes.
- Finally – stretch your chest. Position yourself next to a doorway. Bend your elbow ninety degrees and lift your elbow to shoulder height. Press your forearm along the doorway. Keeping your hips square, rotate away from your arm. Hold 20 seconds and repeat on the other side.