Neck Pain and Posture

Among orthopedic problems, the prevalence of neck pain is second only to low back pain. Like low back pain, neck pain can arise from trauma, such as motor vehicle accidents, or from micro-trauma. Micro-trauma entails lower level stresses over a relatively long period of time. Postural stress is perhaps the best example of micro-trauma and is an underlying factor in a significant proportion of neck pain complaints seen in physical therapy practice.

So how does poor posture cause neck pain?

First, the ideal static head and neck posture is ideal for a reason. When a person sits or stands with the head aligned over the shoulder girdle – whereby the earlobe is positioned directly over the lateral tip of the shoulder when looking straight ahead – a balanced position is achieved. (This assumes good shoulder girdle and trunk position). This posture is most efficient in terms of energy expenditure, and it places the lowest amount of stress on the cervical joints.

The most common postural impairment of the head and neck is referred to as the forward head posture. When people are engaged in tasks that require relatively static postures of the head and neck, such as viewing a computer monitor, the natural tendency is to project the head as close as possible to the task at hand. The position that the neck adopts when doing so is called cervical protraction. The further the head moves relative to the shoulder, the greater the torque produced on the neck by the weight of the head. This torque would move the neck into flexion (the head would tip forward) unless counteracted by contraction of the posterior neck muscles.

Prolonged cervical protraction produces, among other things, increased force demands on the posterior neck muscles, shortening of the anterior neck muscles, elongation of cervical spine ligaments, and increased compression stress on the cervical joints.  All or some of these effects can lead to neck pain, and/or headaches.

If this type of postural stress becomes chronic, the body responds through physiological adaptations that can lead to movement impairments such as decreased range of joint motion and muscle length and strength deficits. When people then develop neck pain, in addition to directing treatment toward the symptoms, it is very important that the movement and postural impairments are addressed.

If you have neck pain that may be related to your posture, try increasing your postural awareness and improving your head/neck alignment. If you cannot control symptoms through self-correction, see your physical therapist.

Marcia Miller Spoto, PT, DC, OCS