Long-duration sitting in the workplace is becoming more of a norm for a lot of occupations, as more jobs are moving towards computer use for work-related tasks. Because of this trend, it is vital to address sitting posture in the workplace and find ways to prevent job-related injuries associated with repetitive-sitting behaviors. Headaches are one complaint frequently associated with sitting jobs, secondary to the sustained postural habits which tend to place adverse stresses onto the structures surrounding the head and cervical spine. Cervicogenic headaches (neck headaches) are defined as referred pain perceived in any part of head caused by a painful structure in the musculoskeletal system innervated by cervical nerves. Pain associated with cervicogenic headaches have been attributed to impairments of joint, muscle, and neural structures of the upper three cervical joint regions.

When thinking of the action of sitting, one must realize the frequency, in our society, of sitting with all daily activities. After waking in the morning, we sit to use the bathroom prior to sitting to eat breakfast. We sit to drive prior to sitting at work for eight (or more) hours. During lunch, we sit to eat. We sit to drive home, prior to sitting to eat dinner and to socialize with our families. Then, we sit to watch television or to read, prior to heading to bed for the night. Many of those activities throughout the day are short-lived, with the exception of sitting at work. Therefore, if improvements are to be made in sitting habits, the first activity which needs correction would be with work, since more than one-half of the person’s waking hours are spent sitting at that job.

Poor sitting habits slouches your low back and excessively curves the thoracic spine back against the chair, rounding the shoulders forward. With the body essentially being a large kinetic chain, this rounding causes the lower neck to also round, bringing the head to a ‘looking down’ position. Since the floor is not where the computer is located, you poke the chin forward to bring the eyes back to a horizontal level, straining the upper cervical spine joints and shearing the mid-cervical spine joints. The neck stabilizing musculature is unable to function from this position, causing much of the superficial/large musculature around the neck to continuously contract to stabilize the head. The chest is unable to appropriately expand with breathing, forcing secondary musculature around the neck to be over-used for normal respiration. Joints, joint capsules, and ligaments in the upper cervical spine are stressed to extreme positions, and muscles in the back of the head are placed in a chronic, shortened position. Each of these problems can result in chronic neck headaches, but can be addressed and improved with physical therapy.

In physical therapy, your therapist will ask you detailed questions regarding the history, frequency, duration, location, and patterns of your headaches trying to identify a musculoskeletal nature to the headaches. Manual examination of the neck and head by a skilled, manual therapist helps identify the painful structures, and has been shown to be as effective as radiographically-controlled blocks at detecting symptomatic joints. Treatment will consist of manual therapy to the neck and thoracic spine to help improve joint mobility and excessive stress on various cervical joints. Retraining of neck musculature (i.e. learning to breathe without excessive muscular contractions, contracting the deep stabilizers of the front of the neck and improving diaphragmatic breathing and proper chest expansion) helps decrease chronic overuse of the large neck muscles. Core and scapular strengthening is also important as postural habits improve, since one needs to be strong enough to maintain postural correction once the optimal posture is identified. A detailed analysis of your work-station will also occur, to then help build your environment around the optimal posture for long-term improvements. The great thing is that even chronic neck headaches improve well with conservative therapy. Your physical therapist will help design a program to not only improve your headaches short-term, but also teach you ways of self-management for long-term gains. If you are suffering from a new-onset of headaches, or have chronic headaches, contact your physical therapist to have an evaluation and begin on the road towards recovery.