Danny Dinh

My treatment philosophy is guided by 2 core principles: 1. I optimize my patients' recovery time frame as much as possible. 2. I empower my patients to be as independent in their rehab as much as pos...

A Case Study on Neck Pain while Working from Home

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Danny Dinh
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Remote work and neck pain

Remote work brought many amazing advantages such as being able to save money on gas, save time on commuting and preparing, and being in the comfort of our home. However, staying active and changing positions often when working at a desk used to be much easier back in the office. Getting up from our desks to go to the water cooler to gossip with co-workers, heading to a meeting on another floor, and, walking to the office all ensured that we at least had a minimum of physical activity despite having a desk job.

    I believe that my seeing more patients with neck pain ever since they started working from home is linked to the decrease in physical activity the “at work” to “at home” shift brought.

Another relevant point is that the move from office to home also meant giving up our desks at the office. Moving from a corporate desk that has been made ergonomic to working from our kitchen sitting on a wooden chair would of course affect our comfort level.

    So am I trying to say that to get rid of your pain, you should go back to working in an office? Of course not! But you should be doubly conscious of trying to be more active during the day as well as adjusting your desk comfortably.

    This article will help illustrate these points and go through them in more detail with a case study and a few tips.

Case study

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A little bit before Christmas time, I had the chance to treat Ms. V. She had been suffering from neck pain for about a year and a half now, to the point where it was impacting her performance at work and her social life. She told me that the worst thing about the pain was its unpredictability: it started for no apparent reason and its intensity could vary day by day. She could go weeks at a time without feeling it, and whenever she thought that her neck was healed, it would come back hard. The pain would radiate from her neck all the way down to both her shoulder blades and she would feel as if her entire upper body was frozen stiff. 

    The only pattern she noticed was that she would feel more pain toward the end of her workday. Like many of us, she had been working from home since the start of the pandemic. Like many would have, she blamed her bad posture and home office setup for her pain. Unfortunately, even after shelling out a lot of cash for a desk and a chair that many would consider “ergonomic”, her pain did not abate. Instead of healing, however, the problem seemed to be getting worse: the episodes of pain were more frequent now, occurring almost every day.

    After 4 sessions in physio, Ms. V. claimed that she was “95% better” and was given a detailed plan of how to lower the chances of the problem recurring and what to do if the pain did ever come back.   

What happened? What was causing Ms. V.’s pain?

Like almost any pain that isn’t due to clear trauma, Ms. V’s pain was multifactorial. Some possible culprits we identified together included:

  • A major decrease in her physical activity levels since she started working from home due to the pandemic. Ms. V seldom practiced any sports, and so her daily hike up and down the hill leading up to her office was the main activity she did every day.
  • Sitting too straight aggravated her pain. By sitting for hours and hours in a singular straight posture and rarely deviating, Ms. V. was putting too much stress on her neck muscles. Ironically, the worsening of her episodes of pain also coincided with when she had resolved to sit straight all the time.

What was the solution?

As with any of my patients, my first evaluation with Ms. V was dedicated to a singular goal: understanding her pain. In the physical examination, we confirmed that sitting with a retracted head (super straight) were worsening her pain: after only 30s of sitting with her head completely tucked in (imagine a deep double chin) and her shoulder blades pulled back, she reported feeling the same pain that she usually only felt after a long day of work.

    The variability of Ms. V.’s pain as well as the intense stiffness she would feel in her neck whenever in pain also clued us in on a possible green flag condition. This would put her in the same category as another patient previously discussed on Paperminds, Mr. P (link to Lx article). In Ms. V.’s case, a green flag condition would be a cervical derangement, in which the theory posits that a space occupier would be the main cause of her pain. Due to its physical presence, it would justify why she’d feel like something was “stuck” in her neck as well as why the pain would vary so much.

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    Now, onto answering the actual question of how we actually reduced Ms. V.’s pain. Our plan consisted of four key components:

  1. Identifying directional preference: we discovered during our first appointment that repeated cervical flexions would help relieve Ms. V. 's symptoms and would also allow her to move her neck in other directions with less pain and more range of motion. In our second session, she also reported that after doing this exercise throughout the day, she noticed a lot less neck pain at the end of her workday. Manual therapy procedures performed during our sessions served to replicate the flexion forces that gave her relief.
  2. Adopting a habit to change position often: Every two hours, Ms. V. ‘s phone would ring and she would do 2 things: perform 10 repetitions of the directional preference exercise and slightly readjust her posture at her desk. This ensured that she never forgot to do her exercise and also prevented her from staying in a super retracted and straight posture the entire day.
  3. Raising her activity levels: On our 3rd session, once we were both certain that Ms. V.’s improvements were long-lasting and that the decrease in pain she felt between our 1st and 2nd sessions was not just a coincidence of the variability of the pain, we devised an exercise program together. Since she used to be an amateur bodybuilder but had stopped working out at the gyms due to the pandemic, we tried a few bodyweight exercises and other exercises using resistance bands since her husband had some at home.
  4. Regular phone conversations: A very frustrating thing for many patients is when improvements made during a physio session are not replicated at home. Ms. V. wanted to feel independent and in control of her pain, so we found an exercise that helped decrease her pain that she could do at home by herself. To make sure that everything was going according to plan, we would schedule a phone call once per week in-between physio sessions. During that call, I would check how the exercise was doing and troubleshoot if anything needed to be changed in our exercise plan.

If society says that slouching is bad, but sitting too straight made Ms. V. worse, what am I supposed to do?

    Everybody’s spine is different and prefers different positions. There are only two key things when it comes to adapting your workstation:

  1. Your default position, ie: the position you will be staying in the most, should be comfortable for you. The image on the right is the most popular “ergonomic” default position for most people. However, use it more as a starting point and a suggestion for your desk posture! If sitting like the guy in the image makes you feel tense or uncomfortable, make some adjustments! For example, raise or lower your armrests so that your shoulders feel relaxed while you’re using your keyboard, and modify the height of your monitor (or laptop screen) so that your neck feels comfortable during long work sessions.
  2. Move move move! You don’t need to do anything drastic that would disrupt your workflow and prevent you from meeting your work deadlines. This is easier said than done, so here are some suggestions to help you be more active while working from home or in an office.
Use this as a starting point for your default posture<br>
Use this as a starting point for your default posture

Let’s steal a trick from the optometrists’ playbook: the 20-20-20 rule, which states that every 20 minutes, you should look at something 20 feet away for 20 seconds. Let’s add another 20: every 20 minutes, move or change positions for 20 seconds. Some examples of exercises to do in those 20 seconds: standing up and stretching your neck, looking at the ceiling and stretching your arms, or simply getting up from the chair and sitting back down a couple of times.

If possible, invest in an electronic standing desk. This makes changing positions even easier. At a press of a button, you could switch from sitting to working in a standing position. Alternate between sitting and standing as you see fit.

Other practical workplace accessories to keep you active include an exercise ball chair to replace your current office chair, a desk treadmill (if you have a standing desk), and a desk cycle.

It’s all about load management

Proper posture, as well as preventing common sports injuries, all come down to load management. We can hurt our joints doing almost anything: sitting straight, sitting slouched, playing any sports, running too fast to catch the bus…

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    But this does not mean that any of these activities are “bad” and that we should avoid them! It all comes down to load management. Load management is the act of controlling how much stress we put our body through by modifying our activity levels and taking breaks whenever necessary.

    Improper load management is like trying to keep our fists tightly clenched all day long. Give it a few minutes and our hands and forearms will start getting tired and may even start to hurt. If we simply shake our hands and take breaks from time to time, we’ll be able to get back into clenching our fists without feeling pain. 

    To bring this pain to the main topic of this article, neck pain, and posture, the points made in the previous sections - to be comfortable when sitting and to change positions frequently - emphasize proper load management of our spine when sitting at our desks for long periods of time.

Moving forward

If any of the information or stories in this article speaks to you, feel free to check out my profile to read more of my articles or to book a 1-hour private room evaluation with me.

If you’d like to discuss any of the points raised in this article in more detail, I would love to speak to you. You can contact me by email at dannydinh.physio@gmail.com or by phone at 438-801-0417. I currently offer free no-strings-attached 15-minute phone call sessions to discuss how I can best assist you.

Further reading

Here are some suggestions of articles I have written recently, organized by topics.

An in-depth explanation of my physiotherapy philosophy: Part 1, Part 2

Neck pain: a case study, answering common questions from patients

Low back pain & sciatica: case study 1, case study 2

Knee pain: case study 1

Shoulder pain: case study 1

An explanation of referred pain

Why choose telerehabilitation

7 reasons why I love my profession

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Disclaimer: All stories published on paperminds are educational in nature and do not represent medical advice. Stories are not a substitute for an assessment by a licensed health professional. You can book a professional directly via paperminds to get a more accurate picture of your problem.

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