Neck Pain & Risk Factors
Risk: A situation involving exposure to danger.
When it comes to neck pain risk factors are the variables in our life that are associated with a greater likelihood of developing neck pain.
You might be surprised to know that hundreds of researchers around the world study neck pain and work to identify the risk factors for developing neck pain. They do this because neck pain places a massive burden on individuals around the world and this burden leads to many consequences. For instance in 2012, 25.5 million Americans missed work due to neck pain and averaged missing 11 and a half days during that time.
25 million people X 11 days = 275 Million Days Lost
275 Million Days / 365 Days in a Year = 753,424 Years
That’s a lot of lost time due to pain. If we are able to pinpoint the risk factors and then engage in activities to either combat those risk factors or decrease our activities that are seen as risk factors we would have less people develop neck pain and we would gain a ton of time to work do the activities we love and enjoy without having the annoying buzz of pain interfering with our daily lives.
Today we are going to review 5 research articles on the development of neck pain and leave you with some key takeaways to help reduce your risk of developing neck pain.
Here’s how this is going to go. I’m going to share with you the name of the study, who was in the study, and what the study determined, rather than doing a deep dive like I so badly want to. I think this short concise format will hopefully lead you to being able to read through this full blog before you notice your eyelids slowly starting to droop to a close.
Study 1: Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study.
Time & Population: 3 years among 1334 workers from 34 companies
What Was Done: Video recordings were taken of the individuals of the study looking at sitting position, neck flexion, and rotation. Neck pain was then assessed by having the individuals fill out a questionnaire.
Conclusion:
There is a significant positive association between prolonged sitting at work and neck pain, implying that there is an increased risk of neck pain for people who are working almost all day in a sitting position (more than 95% of the working time).
There is a positive trend for an association between neck pain and neck flexion at work, although not significant, suggesting that there is an increased risk of neck pain for people who are working with the neck flexed more than 20° for a major part of their working day. A low endurance time of the neck muscles seems to play an important part in the development of neck pain due to neck flexion at work.
No clear relation was found between neck rotation at work and neck pain.
Based on the results of this study, prevention of neck pain should focus on the reduction of time spent working in a sitting position and the promotion of more dynamic working postures.
Takeaway: Sitting at work for over 95% of the day requires a decent amount of neck strength. When we sit in a position where our neck is flexed forward greater than 20 degrees it puts more tension on the muscles of the neck that hold our head upright and those muscles fatigue faster and we feel pain. Some individuals can sit in a position where they are flexing their head forward over 20 degrees and it doesn’t cause pain, while others can sit in just a slightly forward position and they feel pain relatively quick. Sitting position isn’t the end all be all when it comes to neck pain but it can be a contributing factor and is something to watch if you find yourself in pain during work or after.
Study 2: Identifying risk factors for first-episode neck pain: A systematic review
Time & Population: Systematic review which is a type of research study that aims to collect and analyze all available evidence on a particular topic to answer a specific research question. This question was “What are the risk factors for a first episode of neck pain?”
What Was Done: A group of researchers looked through 3 databases searching for articles with the terms like "neck pain" and "first incidence" to find relevant articles. The risk factors identified in these articles were categorized as either physical or psychosocial and ranked based on their severity using a specific scale: below 1.0 (protective), 1.0-1.5 (minor risk), 1.5-2.0 (moderate risk), or above 2.0 (major risk). Out of 878 articles they found, only 10 met the criteria for inclusion in the study. Important to note is this study took out any article that wasn't related to first episode neck pain so the results are quite different from studies where neck pain has occurred more than once in a population.
Conclusion:
Risk factors with the largest effects for neck pain were psychosocial risk factors such as depressed mood, high perceived muscular tension, and perceived role conflict. Perceived role conflict is when an individual experiences incompatible demands or expectations within their role or between different roles they occupy. This can be as a parent, a worker, caregiver, etc.
Physical Risk Factors that were seen as moderate were; working in sustained or awkward positions and ability to adjust sitting position.
Protective factor, so factors that decreased the risk of developing neck pain were; higher endurance of the neck muscles and more leisure physical activities.
Takeaway: This study really points out the effects psychological stress can have on our pain levels. Our body has so much energy and resources it can utilize to keep us moving forward and throughout our day. When we are stressed our brain essentially becomes hyperaware of abnormal sensations and pain, this then increases our risk of developing pain. However this aspect of pain development is a nuanced topic and the exact mechanisms can be quite complex, involving multiple physiological systems and pathways and there are other studies that dive deeper into the role stress plays in the development of pain. This again is why I repeatedly talk about the importance of stress management and engaging in activities like yoga-nidra, meditation, and moving your body in a fun way.
Study 3: Contribution of biopsychosocial risk factors to nonspecific neck pain in office workers: A path analysis model.
Time & Population: One-year prospective cohort study involving 559 healthy office workers from four large-scale workplaces in Bangkok, Thailand.
What Was Done: Participants filled out a questionnaire and had a physical exam to collect various types of data. Every month afterward, researchers checked in to record any occurrence of neck pain. They used a regression model to see which factors could predict the onset of neck pain. Then, a path analysis was done to look at how these factors were directly or indirectly related to neck pain.
Conclusion:
Gender, history of neck pain, monitor height, and perceived muscular tension were associated with onset neck pain.
Factors that influence perceived muscular tension were history of neck pain, followed by gender, and monitor height.
Takeaway: This study similarly to both study 1 and 2 found that perceived muscular tension plays a role in our development of neck pain along with the position of our computer screen(monitor) when it is at the level of the eyes or below. These are two things we can modify, we can raise the height of our monitor to be at eye level or above which will help keep us in a more upright position helping to decrease our risk of feeling muscular tension. Again our position isn’t the end all be all. In this study of 559 office workers only 28% developed neck pain, and while that is a lot and the the factors that led to neck pain were statistically significant, there were individuals in this study that had the monitors below eye level and did not develop pain. However, that leaning forward position is going to put more strain on the muscles of the posterior neck and if those muscles don’t have high endurance than they’re more likely to develop pain.
Study 4: Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents
Time & Population: 1,108 17-year-old Australian adolescents over a 3 year period.
What Was Done: Utilizing a 2-dimensional photographic postural assessment in a sitting position, researchers aimed to identify clusters of neck posture and their association with biopsychosocial factors and neck pain. Additionally, height, weight, lifestyle, and psychological factors were assessed via questionnaires. They grouped the 1,108 individuals into 4 groups.
Conclusion:
This study found that the frequency and level of neck pain was consistent across all 4 groups.
There was not increased pain in the more slumped postures typically seen in other studies.
Depression was found to be more common in Cluster 3, the slumped sitting position.
22% of all individuals in the study had persistent neck pain, sitting made the pain worse but it was not related to a specific position.
Takeaway: My key takeaway for this study, and it’s backed up by the two studies that they cite, is that when under the age of 17 sitting posture doesn’t seem to make a huge difference when it comes to neck pain. However, sitting position in this study was found to be related to depression, which has been thoroughly seen as a risk factor for the development of neck pain. While there wasn’t a statistically significant relationship between neck pain and specific sitting position, sitting did cause an increase in neck pain in individuals with neck pain.
Study 5: Psychosocial, Physical, and Neurophysiological Risk Factors for Chronic Neck
Time & Population: The study was conducted over a year on 171 office workers (135 females, 36 males) who were within the first three months of starting a new job.
What Was Done: A group of researchers took these individuals through a thorough baseline evaluation done to categorize risk factors into psychosocial, physical, and neurophysiological domains. Participants completed monthly online surveys over the year to track the development of chronic interfering neck pain, defined by a Neck Disability Index score of 5 or more for 3 or more months. Statistical Analysis was done to identify the significant predictors within the three risk factor domains of: psychosocial, physical, and neurophysiological.
Conclusion:
Depressed mood was a significant risk factor for developing chronic interfering neck pain.
Greater neck strength (cervical extensor endurance) and leisure activity were protective against the development of chronic neck pain.
21% of healthy office workers in this study developed chronic interfering neck pain that limited their activities for a period of 3 or more months.
Takeaway: Another study showing the large effect our mental health has on our perception of pain. This study which had a relatively low number of individuals reporting depression still found a significant relationship between depression and the development of neck pain. In fact there was a 3 fold increased risk of developing chronic neck pain in the individuals who had a self-rating of low or depressed mood. One thing often lost in the literature is the relationship between mood and pain. Does low rating of mood increase the risk for pain, or does pain lead to a depressed mood. This study highlights that for this sub-group of the population an increased risk of developing chronic interfering neck pain in those with depressed mood. On top of that this study also found that the strength (endurance) of our neck muscles play a significant role in decreasing our risk of developing neck pain.
Final Breakdown: Neck Pain & Risk Factors
After reviewing these 5 articles we can come to a few conclusions.
First our mental health plays a large role when it comes to pain, especially the development of neck pain. Across nearly all of these studies depression was significantly related to the development of neck pain whether it was first time neck pain or chronic pain. Second, if a muscle is weak its more likely to fatigue and fatigue especially in an area where there are dozens of pain sensitive structures like the neck is going to lead to pain. A stronger neck, specifically endurance of the neck is going to help protect against developing neck pain. Physical activity and leisure activity are also protective effects for the development of neck pain. Lastly, if we place our body in a position that puts more stress on certain muscles then it’s likely those muscles are going to fatigue and we are going to feel muscle tightness and that tightness can develop into pain. If you work at a desk all day try and get up every 30 minutes and do a little walk, calf raises, jumping jacks and if 20 minutes doesn’t work just do it when you can. Whether that’s just once in an entire work day or every few hours. More movement is better and something is better than nothing. Lastly, monitor height. If you work at a computer try and place the middle of your screen at or above eye level.
As always I hope you enjoyed this blog and as always feel free to reach out to me at drcoffman@optimizecolumbus.com.
-Dr. Jake
References