These guys get neck pain and back pain!
I know, I once was the military Rehab Officer for London, and had the pleasure of looking after them and all the craziness that went with it. These so called great postures produced plenty of problems.
These guys don’t get neck pain.
We know because the reported incidents of neck related disorders in workers with a flexed neck posture is not particularly high compared to other issues and in fact other factors such as stress seem to be more of an issue. Maybe the modern world has more daily life stresses?
There are no documented notes from Monks who spent their life copying books by hand, saying my “bloody neck hurts”. They do say things like how cold it is and about the food! So they documented things but not about neck pain.
We do know that people get “sensitized” and then feel “pain” or other things due to altered interpretation. Some of this is due to believing that they are doing things “wrong” and will harm themselves. Are you sensitising anyone with your words? I used to say nocebic words like “keep you back straight”etc, when I believed what I was told. Then got shown a better more evidenced based way, and try and avoid it now.
Also maybe it is out “view” of how we should look. A slouched guardsman wouldn’t look alert, a laid back worker some view as not looking productive. But is that true or just a belief. Maybe this is a clue?
Maybe it is those peddling these thoughts that are responsible for freaking people out and maintaining discomfort or pain, and maybe it is in teh interest of the people saying this too. Alignment specialist and so on, some of the theory is built on sand and doesn’t allow for people being different.
Is there any evidence for old biomechanics beliefs?
Well what about neck shape? A Swiss study showed that habitual loss of neck lordosis for example, didn’t mean that subjects got neck pain. They just lost the lordosis.
What about feelings of fatigue? Is that just not being used t the position?…..we could argue we should train them to get used to it. We do this elsewhere, so why not? So text away progressively folk (just look where you are going please).
Why do we ask people to work their muscle to get stronger and then randomly select some exercises as not appropriate? like holding your head forward. There is plenty of flexion in pilates!
If you want a strange choice, how about the horrible plank hold for example. Makes everyone stiff and is an isometric load. Yet people do it without saying things like you will get “plank spine”. I see plenty of people in my physiotherapy practice and at the movement studio, who have become too stiff from doing plank and the old static “core” exercises. My movement reasoning doesn’t see a reason for this, unless you need to be that stiff and compressed. The guardsmen thought that, but we had less back pain with a spinal mobility and decompression exercise regime for them and that is why they do the marching routine when they need to move!
Some studies and people have said text neck exists. Famously the New York Surgeon, Dr. Hansraj, talked about load ( the famous bowling ball), of the head, being a load of 60 pounds in flexion, and causing tissue failure. He can’t produce the evidence and no one can reproduce the study. Seems he just said it !. But what an effect in the media.
Can the tissues fail …well, with difficulty… it takes a massive load to damage the neck structures. A Bristol research group showed that it took over 500 lbs to cause tissue damage to a flexed neck in cadavers. A bit more than the suggested limit.
Other studies often quoted, such as a Brazilian study in 2014, suggested text neck existed, but the methodology was shown to be flawed on deeper investigation. They only looked at people with pain.
An Iranian study of computer workers suggested work posture as the issue but failed to exclude work stress from its evaluation, So you cannot blame the posture. This is a common flaw in studies. Correlation does not mean causation. Of course google is not a reliable source for the answer either.
Where does this leave us?
Well, in a great place. We moved away from all that postural alignment and plumb line stuff years ago. We recognise that pain is a sum of many things in life so we can’t just blame structure and load.
So ignore the fear mongering and poor science and be reassured the neck and spine are robust. Don’t stay too long in one position, none of us like it and all get the urge to move. Don’t let someones false instructions or old paradigm of guidelines imprison your body.
We are movement people, so let’s get people moving in ALL directions and positions. Educate them to play with all directions, speeds and combinations. Educate them that there is no wrong posture and variety is the way forward. There are potential better strategies for some tasks and learn those skills to do them.
The evidence is strong for moving with neck pain and back pain especially. Indeed most issues with the human body we know should be moved.
As movement teachers you have plenty of good evidence based things to teach. It’s a harder path than using “common media beliefs”, but rewarding and honest.
We are in an era started over ten years ago of trying to overcome peoples fears with spinal and body issues. Don’t reinforce these but help people to reduce them and move fearlessly and joyfully.
Move them and reassure them.
Remember you should be giving people, Permission to Move.
Happy to chat over this one …………………..
The Healthy Neck workshop is a start
1. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head.
Surg Technol Int. 2014 Nov;25:277-9.
2. Przybyla AS, Skrzypiec D, Pollintine P, Dolan P, Adams MA. Strength of the cervical spine in compression and bending. Spine. 2007 Jul 1;32(15):1612-20.
3. Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. European Spine Journal. 2007;16(5):669-678. doi:10.1007/s00586-006-0254-1.
4. Kumagai G, Ono A, Numasawa T, et al. Association between roentgenographic findings of the cervical spine and neck symptoms in a Japanese community population. Journal of Orthopaedic Science. 2014;19(3):390-397. doi:10.1007/s00776-014-0549-8.
5. Richards KV, Beales DJ, Smith AJ, O’Sullivan PB, Straker LM. Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents. Phys Ther. 2016 Oct;96(10):1576-1587. Epub 2016 May 12.
6. Brink Y, Louw QA. A systematic review of the relationship between sitting and upper quadrant musculoskeletal pain in children and adolescents. Manual therapy. 2013;18(4):281-288.
7. Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis CA. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Physical therapy.1992;72(6):425-431.
8. Ruivo RM, Pezarat-Correia P, Carita AI. Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain. Brazilian Journal of Physical Therapy. 2014;18(4):364-371. doi:10.1590/bjpt-rbf.2014.0027.
9. Nejati P, Lotfian S, Moezy A, Moezy A, Nejati M. The Relationship of Forward Head Posture and Rounded Shoulders with Neck Pain in Iranian Office Workers. Medical Journal of the Islamic Republic of Iran. 2014;28:26.