Working seated: neck, shoulder and back pain and what to do

Eight hours at the computer, seated meetings, the car or public transport on the way home and, in the evening, the sofa. At the end of the day, the neck is stiff, the shoulders rise to the ears and the lower back protests. It is one of the most common complaints of those who work in an office or from home.

The usual answer is “correct your posture”. But research tells a more interesting story: the main problem is not so much the position you are in, it is the time you spend in it without changing.

Why working seated hurts

Immobility is the main suspect

The body is made to move. When we stay in the same position for a long time, some muscles (such as the trapezius, which links the neck to the shoulders) maintain a slight but continuous contraction for hours. This low, sustained load, without breaks, is associated with fatigue, stiffness and muscle pain. Joints and discs also like variation in load.

And posture?

For decades, back pain was blamed on sitting “crooked”. Today we know the relationship is weaker than was thought. A review of systematic reviews found no consistent evidence that specific spinal postures, including sitting posture, cause low back pain (Swain and colleagues, 2020). People with very different postures have similar rates of pain.

This does not mean that posture does not matter. Spending hours with the head pushed forward to read a screen that is small or too low increases the strain on the neck muscles. But the solution is not to “sit up straight” by force for eight hours, which is also tiring. It is to vary your position.

Other factors that weigh in

• Stress and pressure at work: associated with more muscle tension and more neck and shoulder pain. Many people raise their shoulders and clench their teeth without realising.
• Little physical activity outside work: weaker, less conditioned muscles tolerate sustained load less well.
• Insufficient sleep: lowers pain tolerance.
• Mobile phone: adds more hours of flexed neck to those at the computer.
• History of previous pain: those who have had episodes are more likely to repeat them.

Sedentary behaviour: not just pain

Spending many hours seated is also associated with higher cardiovascular and metabolic risk. The World Health Organization recommends reducing sitting time, replacing it with activity of any intensity, and achieving 150 to 300 minutes of moderate activity a week (Bull and colleagues, 2020). Moving more is good for the back and for everything else.

Ergonomics: adjustments worth making

Ergonomics is not a cure, but it reduces unnecessary strain. Reviews of ergonomic interventions on their own show modest, inconsistent effects on pain, which reinforces the idea that they work best combined with movement and exercise. Even so, some simple adjustments make a difference to comfort:

• Screen: the top at eye level or slightly below, about an arm's length away. If you use a laptop for many hours, a stand and an external keyboard and mouse avoid a flexed neck.
• Chair: feet flat on the floor (or on a footrest), knees roughly at hip height, comfortable lumbar support.
• Arms: elbows close to the body, shoulders relaxed, forearms supported. If the shoulders rise to reach the keyboard, the desk is too high or the chair too low.
• Mouse and keyboard: close, so as not to overreach.
• Phone: earpiece or speaker instead of wedging the phone between shoulder and ear.
• Lighting and vision: reflections and small print make you tilt your head forward. So do out-of-date glasses.

Standing desks: do they help?

Height-adjustable desks reduce sitting time at work, according to a Cochrane review, by about one to two hours a day in the short term (Shrestha and colleagues, 2018). The effect on pain is less clear. And standing for a long time is tiring too. The value lies in alternating: seated, standing, walking.

What works best: movement and exercise

Frequent breaks

The most useful rule of thumb: stand up or change position every 30 to 45 minutes, even if only for a minute or two. Ideas that fit into a working day:

• Taking calls standing up or while walking.
• Getting water often (and drinking it).
• Using the printer or the toilet on another floor.
• Holding short meetings standing or walking.
• Setting a discreet alarm, if you forget.

Strength exercise: little time, good results

The most consistent studies in this area come from trials with office workers. In a Danish trial of women with chronic trapezius pain, specific strength training for the neck and shoulders clearly reduced pain, more than general cycling exercise (Andersen and colleagues, 2008). In another trial, of office workers with frequent pain, just 2 minutes a day of exercise with a resistance band reduced neck and shoulder pain, and 12 minutes a day was not much better (Andersen and colleagues, 2011). Systematic reviews confirm that workplace exercise, especially strengthening, reduces neck pain in office workers (Chen and colleagues, 2018).

A simple routine (with an exercise band, 2 to 10 minutes, almost every day):

• Lateral arm raise: standing on the band, raise the arms out to the side to shoulder height. 10 to 15 repetitions.
• Row: band fixed in front, pull the elbows back, bringing the shoulder blades together. 10 to 15 repetitions.
• Weighted shrugs: band under the feet, raise the shoulders towards the ears and lower slowly. 10 to 15 repetitions.
• Chin tuck: sitting, draw the chin back (“make a double chin”), hold for 5 seconds. 10 repetitions.

Effort should be moderate and without sharp pain. If you have an injury, severe pain or another health problem, ask a physiotherapist for guidance.

Stretching and mobility

Stretches feel good and help you feel less stiffness, although the evidence for pain is weaker than for strengthening. Rolling the shoulders, gently tilting the head to each side, opening the chest with the hands behind the back and stretching the spine during breaks are good options.

Outside work

Walking, swimming, cycling, strength training at the gym: any regular physical activity helps the back and health in general. The ideal is to choose something you enjoy, so that you keep it up.

Massage: where it fits in

Massage relieves pain and muscle tension in the neck and shoulders in the short term. A Cochrane review found immediate or short-term benefits, but with low-quality evidence and no demonstrated long-term effect (Patel and colleagues, 2012). In a trial on chronic neck pain, 60-minute sessions, two to three times a week for four weeks, were more effective than shorter or less frequent sessions (Sherman and colleagues, 2014).

In practice, massage works well as:

• Relief in phases of more tension or pain.
• A bridge back to moving: with less pain, it is easier to do the exercises.
• A moment of decompression from stress, which also contributes to tension.

What it does not do: replace movement and exercise. If the cause (hours without breaks, little activity, stress) persists, the tension returns.

For those who work seated, a massage focused on the neck, shoulders, the area between the shoulder blades and the lower back, or a combined massage, is usually the most useful choice. See Relaxing or deep tissue massage: which to choose.

When to see a doctor

Most of these pains are muscular and benign. Seek medical assessment if you have the signs below.

Call 112 for chest pain, pain in the left arm or jaw with shortness of breath, sweating or feeling unwell, or for sudden weakness on one side of the body, difficulty speaking or drooping of one side of the mouth. If in doubt, call SNS 24 (808 24 24 24).

At Luxmed Clinic

At Luxmed Clinic, in Algés, massages for those who work seated, carried out by a massage therapist, focus on the areas that suffer most from the computer: neck, shoulders, back and lower back. We begin by understanding your routine and where you feel tension, and adjust the technique and pressure to you.

Massage is a wellbeing complement and does not replace medical assessment or treatment. Results vary from person to person.

Frequently asked questions