Why sitting makes your neck hurt
The head weighs about five kilograms, and in a neutral position that load is spread evenly. Every centimetre it moves forwards – with the monitor set too low, or a phone in your hand – increases the work the neck muscles have to do. Those muscles are strong in themselves; the problem is that they have to work without a break for hours.
On top of that comes thoracic stiffness. When the upper back between the shoulder blades loses mobility, the neck takes over its job. That is why, with neck pain, we regularly work a level lower down as well, even though nothing usually hurts there.
It is also worth remembering that the neck muscles respond to stress. Long-standing mental tension holds the shoulder girdle slightly raised all day – and although this is not a medical cause in the classic sense, in practice it often explains why the symptoms keep returning despite a well set-up desk.
When the pain radiates into the arm
Pain travelling into the shoulder and arm can be a sign of nerve root irritation in the cervical spine, but just as often it comes from trigger points in the muscles of the neck and shoulder girdle. Telling them apart rests on testing sensation, strength and reflexes, and on nerve tension tests. Sometimes the source turns out to be the shoulder joint itself – in which case we move on to assessing shoulder pain.
What the treatment looks like
The first part of the work is reducing tension and regaining mobility. We use joint mobilisation, soft tissue techniques and, for stubborn trigger points, dry needling. Turning your head more freely is often noticeable after the first visit, but on its own that effect does not last.
What makes it last is the second part: exercise. The deep neck flexors and the muscles that position the scapula are trained briefly but regularly – a few minutes a day over several weeks. It is the least spectacular and the most important part of the whole process.
What you can change from tomorrow
The most effective change is not a new chair, but breaks. Standing up every 30–40 minutes and doing a few movements of the head and shoulders in the opposite direction to the one you hold at the desk does more than most ergonomic equipment. It is worth raising the monitor so that the top edge of the screen is at eye level. The rest – choosing exercises and working out where your pain really comes from – we sort out at the visit. If the symptoms have lasted more than two or three weeks, or keep coming back, there is no point waiting for them to pass on their own – the assessment takes about fifteen minutes and usually points straight to what needs working on.