In The Physio Fix, a physiotherapist from the Singapore General Hospital shares practical exercises to improve mobility, and ease aches and pains.
Changing out of a sweaty T-shirt after a walk so I don’t catch a chill. Eating fruit for a more balanced diet. Moving my neck once in a while when I’m working at the computer so I don’t get “tech neck”.
These take almost no effort, yet I find them strangely difficult to do — and end up paying the price. My neck, for example, is constantly stiff and sore from the long hours I spend at the computer, or slouched in bed scrolling on my phone without a break. I suffer from “tech neck”, a term used to describe neck pain, stiffness and upper back discomfort caused by a prolonged forward-bending posture while using computers, smartphones and tablets. Neck pain has become more common, says Associate Professor Joseph Thambiah, head of division and senior consultant at the University Spine Centre in the department of orthopaedic surgery at the National University Hospital. The most common cause, he says, is sedentary work at a computer. Age-related degeneration of the spine, known as cervical spondylosis, can make the pain worse. Computer screens, especially laptops, are often not ergonomically positioned at eye level, he adds, and people work on them for long periods without taking a break. This places tremendous stress on the intervertebral discs and the joints at the back of the spine.To make matters worse, in between computer work, many people are hunched over their mobile phones for long periods. This increases the pressure on the discs in the neck, and leads to muscle fatigue and pain. Over time, the repeated strain can accelerate wear and tear in the discs and joints. Those who work from home may be at greater risk because the tables and chairs they use for computer work are often not ergonomically designed, he adds. Prof Thambiah says most of the neck pain cases he sees are posture-related, though age-related degeneration can also play a role in older adults. There can be more sinister causes of neck pain, including cancer or infection, but these are rare, he adds. At the University Spine Centre, patients with neck pain usually provide a history of their symptoms and undergo a physical examination along with an X-ray. MRI scans are often not required. Treatment is usually conservative, involving painkillers, anti-inflammatory medication and muscle relaxants. Patients may also be referred for physiotherapy.“The key thing for them to understand is that they ought to continue with their exercises even if there is no pain,” he says. “Few of them go on to develop long-term disabling pain.” That said, there are signs that neck pain could be more serious. These include pain that disturbs sleep at night, pain or numbness radiating down the arms, weakness in the limbs, difficulty using chopsticks or buttoning shirts, and an unsteady gait. These symptoms could indicate that nerves may be affected.“Taking breaks from the computer every 20 to 30 minutes and doing the provided neck exercises are key,” he says.The single most powerful way to prevent tech neck is to take regular movement breaks every 30 minutes or so, says senior principal physiotherapist Philip Cheong from the Singapore General Hospital. “Don’t stay in one position for too long,” he says. “The key is regular movement and small adjustments. Take micro breaks.” During these breaks, do simple exercises such as rotating your neck from left to right in a controlled movement, rolling your shoulders backwards and shoulder shrugs. Dr Cheong says that most of the neck pain he sees is mechanical in nature, meaning that it is related to how joints, muscles and soft tissues are loaded over time. The cause is usually multifactorial. Besides prolonged desk work and screen use, stress-related muscle tension, weak neck and upper back muscles and poor sleep quality can all contribute. “In most cases, it is due to cumulative strain rather than a single incident,” he says. Tech neck develops when the head is held forward for prolonged periods, such as when looking down at a mobile device. This position increases the mechanical load on the cervical spine and surrounding muscles. The average adult head weighs about 5 kg. When it is positioned directly over the spine in a neutral posture, the muscles and joints of the neck support that load efficiently, notes Dr Cheong. But as the head tilts forward – known as neck flexion – the load on the neck increases. To counteract gravity, the neck muscles have to work much harder. At about 60 degrees of flexion, a common angle when looking down at a phone, the load on the neck can reach around 27kg. “Over time, sustained loading can lead to stiffness, fatigue and pain,” he says.“Lack of movement, not taking regular breaks and elevated stress or anxiety levels are also important contributing factors,” he says. This may explain why some people appear to escape tech neck despite spending long hours on their devices. Factors such as general physical condition, muscle endurance and stress levels can make a difference. Children and teenagers, for instance, tend to recover more quickly, especially if they stay physically active and move around a lot. In older adults, neck pain may occur more easily because muscles, tendons and joints may recover more slowly and tolerate sustained load less well than in younger individuals. Physiotherapy addresses both the physical and non-physical contributors to neck pain. This includes strengthening the muscles of the neck, shoulders and upper back, exercises to keep them mobile, and educating patients on ergonomics.When we are stressed or anxious, the sympathetic nervous system becomes more active and triggers the body’s “fight-or-flight” response. This can make the neck and shoulder muscles stay slightly tense even when we are at rest. “At the same time, people may adopt more guarded postures and reduce natural movement,” he says. All this can contribute to neck discomfort or make existing symptoms worse. He gives the analogy of clenching your fist. “If you make a fist and hold it tightly for a short time, you will feel that it is not an issue. Now, keep your fist clenched for several minutes. You will notice that the muscles will start to fatigue and the hand may start to ache. It is similar for our neck and shoulder muscles.” Physiotherapy can also help people manage stress and anxiety through breathing techniques, relaxation strategies and lifestyle adjustments. Dr Cheong notes that shoulder, neck and upper back pain are highly interconnected. “The neck does not function in isolation,” he says. It relies heavily on the shoulder girdle and thoracic spine for support. Weakness or stiffness in the upper back and shoulder muscles often increases the load on the cervical spine. Strengthening these areas and improving mobility can frequently reduce neck strain. As for whether there is an ideal way to hold your phone to prevent neck pain, Dr Cheong says that from a biomechanical point of view, bringing the phone closer to eye level reduces the force on the neck. But this creates another problem – strain on the arms, shoulders and wrists. “There really isn’t a perfect way to look at our phones,” he says. “The more important factor is not staying in one position for too long.”Sumiko Tan doing a neck rotation exercise to improve blood circulation to the neck and upper back, which helps to relax the neck and ease stiffness.2. Slowly turn your head to the left in a controlled, smooth movement. Rotate as far as is comfortable. You should feel a gentle stretch, not pain. Hold for 2–3 seconds.4. Slowly turn your head to the right in the same controlled manner. Hold for 2–3 seconds. Return to the starting position. This is one repetition. Repeat. This exercise improves blood circulation to the neck and upper back, which helps to relax the neck and ease stiffness.Move slowly and gently. Don’t jerk or swing your head.If you have a history of neck injury, slipped disc or chronic neck pain, check with a doctor first.Sumiko Tan doing a shoulder roll exercise to improve blood circulation to the neck and upper back, reducing stiffness.1. Stand with feet shoulder-width apart. Keep your back straight and your arms relaxed by your sides.3. Gently roll your shoulders backwards in a big circle.This exercise improves blood circulation to the neck and upper back, reducing stiffness. Rolling backwards helps to reverse the effects of hunching forward, for example, when we look at our mobile phones.Avoid fast or jerky movements. Movements should be gentle and controlled.Stop if you feel sharp pain, numbness or discomfort.Sumiko Tan doing a shoulder shrug exercise to relieve tension in the upper trapezius muscles and improve blood circulation in the neck and shoulders.1. Stand with feet shoulder-width apart. Place a resistance band under both feet and hold one end of the band in each hand. There should be some tension in the band. Let your arms hang naturally by your sides. 2. Slowly raise both shoulders towards your ears, as high as you can go. There's no need to hold the position. Keep your arms straight and avoid bending your elbows. 3. In a slow, controlled movement, lower your shoulders back down. Don't drop your shoulders abruptly. This is one repetition. Repeat. This exercise relieves tension in the upper trapezius muscles and improves blood circulation in the neck and shoulders. It enhances shoulder stability and supports better neck control, helping to maintain proper posture during prolonged desk work.Don’t roll your shoulders. The movement is a controlled lift straight up and down.Stop if you feel sharp pain, tingling or numbness.Sumiko Tan doing a low row exercise to help stabilise the scapular muscles in the back. It reverses rounded shoulders and reduces strain on the neck.1. Secure a resistance band to a sturdy object like a metal gate. It should be at waist height. Stand with feet shoulder-width apart and look forward. Hold one end of the band in each hand. Thumbs should be facing up. Keep your arms straight in front of you. The band should be slightly taut. 2. Pull your hands towards your waist, driving elbows straight back, in a rowing movement. Squeeze your shoulder blades together for 1 second at the end of the movement. 3. Extend your arms forward slowly. Maintain a neutral spine throughout. This is one repetition. Repeat. This exercise helps stabilise the scapular muscles in the back. It reverses rounded shoulders and reduces strain on the neck.Keep your back straight and don’t arch or round it.If you have an existing neck or shoulder injury, check with a doctor first.
SINGAPORE GENERAL HOSPITAL PHYSIOTHERAPY BALANCE SHOULDER MOBILITY NECK PAIN EXERCISE INTERACTIVE GRAPHICS ST DISCOVER
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