Prolonged use of computers during daily work and recreation is a growing cause of neck pain

For people who spend a great deal of time using computers, neck pain is a common problem.1,2 By computer, we include desktop, laptop, notebook personal computers, video display units and terminals, to include the use of keyboards and associated pointing devices like a mouse or trackball. Neck pain is pain experienced anywhere from the base of the skull at ear level to the upper part of the back or shoulders.

There has been great technological advances in computers along with an industrial shift to a more service oriented economy.3 This has led to more sedentary jobs4 as the downsizing of the number of employees is used to minimize losses in corporate profits and resulting increased demands in productivity for those who remain with a company and an increase in sick leave resulting from neck pain.5 This means more people use computers for work and recreation and we must find better ways of coping with neck pain associated with extended use of computers.

The computer helps a company minimize inefficiencies in the workplace by eliminating wasteful tasks as office workers no longer need to leave the desk to retrieve mail, copy or file documents.6 This streamlining and increase in productivity through elimination of inefficiencies related to specific tasks has some unfortunate consequences for the worker; there is a reduction in the number of breaks available from repetitive or static job tasks which help to restore health.5

The factors involved in neck pain are complicated and include physical, psychological, individual, and environmental sources.7 However, office workers and computer users experience the highest incidence of neck pain of all workers with a one year prevalence of neck pain ranging from 17.7% to 63%.3 The weekly prevalence of neck and shoulder pain in adolescents rose from 17 to 28% in the years 1989 through 1996, and is thought to be related to the increased sedentary nature of adolescents, including increased computer use. Additionally, psychosomatic symptoms during adolescence can predict neck pain in adulthood, setting the stage for these future workers before they even enter the workforce.8 Fatigue and sleep difficulties in adolescence are associated with a high prevalence of neck pain in adulthood.8 Frequent computer activities are a noted risk factor for adolescents using computers four to five hours per day,9 and with children being exposed to computer related activities at earlier ages, the consequences of neck pain in the future workforce deserves more attention.

Chronic neck pain patients use the health care system twice as often as the rest of the population.10 The estimated cost associated with work related musculoskeletal problems is projected to be between $45 and $54 billion annually.11

In addition to adolecsence factors described above, there are additional risk factors associated with neck pain. There is a clear relationship indicating workers with a prior history of neck, low back or upper extremity pain are more likely to experience neck pain.3 People with the most severe neck pain also are more likely to have other problems that significantly effect their health.12 The perception of neck muscle tension is an individual risk factor for neck pain and perceived muscular tension in the neck a few times a week had an higher incidence rate for neck pain, compared to those who did not perceive muscular tension.7 Often involved in trapezius myalgia, the upper trapezius muscles in computer workers with neck pain had less relative rest time during psychologically stressful tasks.13

There is nearly double the risk for developing neck pain for people who most of their day or sitting at work.14 Duration of computer use, frequency of breaks, method of keyboard operation, position of computer monitors, type and use of input devices are also associated with neck pain at work.15,16 Poor neck posture, where neck flexion is exaggerated (slumped forward) is noted when people use notebook and subnotebook computers.17 These increased neck flexion angles are associated with increased upper trapezius muscle activity and with neck and shoulder discomfort in office workers.18 Frequently sitting for a long time is associated with twice the chance of having neck pain.19 Workers who had light-load work were less likely to have neck pain when compared with having no-load work (sitting).20 Neck pain is twice as likely for those sitting in poor posture with the head in a flexed forward position.1 Remaining sedentary during leisure time (e.g., watching television) is associated with an increased prevalence of neck pain.8,21 Being physically active during leisure time is associated with almost twice the chance of not having neck pain.1

Taking minibreaks, or microbreaks of 30 seconds once every 20 to 40 minutes is an effective means to reduce neck pain at work and these short breaks have no adverse effect on worker productivity.22

A higher risk for work related neck pain is noted in people with higher mental stress,16,23, situations that demand the greatest job strain,3,22 shortage of personnel in the workplace,1 a lower amount of control over the job,24 and low supervisory support.3,22 Those with mental tiredness at the end of the day are twice as likely to experience work related neck pain.1

Having computer users engage in physical activity as part of their work day would be an appropriate prevention strategy.1 Encouraging leisure activities may be beneficial in sedentary workers.21 Physical activity facilitates both mechanical and metabolic processes that are healing for musculoskeletal tissues.25

Computer workstations should be arranged to maximize correct posture and reduce neck flexion with the use of document stands and screen height adjustments, appropriate chairs and supports.1,20 Providing ergonomic counseling has been shown to reduce neck pain in computer users26 and may be useful as a prevention strategy.

Providing docking stations and external keyboards for laptop computer users may have a preventive effect for neck pain. To help with prevention of work related neck pain, computer users and employers may use the computer user checklist and working with computers from the Health and Safety Executive.

Strength and endurance training of the neck muscles, which has been shown to decrease pain and disability in chronic neck pain may be helpful for computer users with neck pain.10 Computer users with neck pain had reduced activity of the cervical extensor muscles and higher activity in the upper trapezius, compared to workers without neck pain.27 Neck muscle exercises may be useful as a preventative and rehabilitative approach.

Employers may be able to reduce neck pain in the workplace by increasing the collective decision making of employees, and insuring that workers have support from superiors when making decisions.22

Additionally, therapies that endorse relaxation and aim to lower perceived muscular tension may be effective for reducing or eliminating neck pain for those workers who perceive muscular tension in the neck throughout the week.

Importantly, the potential for adverse effects of engaging in prolonged exposure to computer work at a young age should be addressed.

1. Cagnie B, Danneels L, Van Tiggelen D, De Loose V, Cambier D. Individual and work related risk factors for neck pain among office workers: a cross sectional study. Eur Spine J 2007; 16(5):679–86.	15. Johnston V, Souvlis T, Jimmieson NL, Jull G. Associations between individual and workplace risk factors for selfreported neck pain and disability among female office workers. Appl Ergon 2007; Epub ahead of print, PMID:17761137.
2. Stupar M, Shearer H, Cote P, et al. Prevalence and factors associated with neck pain in office workers. In: Proceedings of the World Congress on Neck Pain; 2008 Jan 20–22; Los Angeles. Toronto: Canadian Institute For the Relief of Pain and Disability; 2008. p. 154.	16. Korhonen T, Ketola R, Toivonen R, Luukkonen R, Hakkanen M, Viikari-Juntura E. Work and related individual predictors for incident neck pain among office employees working with video display units. Occup Environ Med 2003, 60, 475–482.
3. Cote P, van der Velde G, Cassidy JD, et al. The Burden and Determinants of Neck Pain in Workers: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008; 33(4s):S60-S74.	17. David G, Woods V, Li G, Buckle P. The development of the Quick Exposure Check (QEC) for assessing exposure to risk factors for work-related musculoskeletal disorders. Appl Ergon 2008; 39:57–69.
4. Ratzlaff CR, Gillies JH, Koehoorn MW. Work-related repetitive strain injury and leisure-time physical activity. Arthritis Rheum 2007; 57(3):495–500.	18. Szeto GP, Straker LM, O’Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work – 1: Neck and shoulder muscle recruitment patterns. Man Ther 2005; 10:270–280.
5. Wells R, Mathiassen SE, Medbo L, Winkel J. Time – a key issue for musculoskeletal health and manufacturing. Appl Ergon 2007; 38:733–744.	19. Barbe MF, Barr AE. Inflammation and the pathophysiology of work-related musculoskeletal disorders. Brain Behav Immun 2006; 20(5):423–429.
6. Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren A. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary. Spine 2008; 33(4s):S5-S7.	20. Tsauo J, Jang Y, Du C, Liang H. Incidence and risk factors of neck discomfort: A 6-month sedentary-worker cohort study. J Occup Rehabil 2007; 17:171–179.
7. Wahlstrom J, Hagberg M, Toomingas A, Tornqvist EW. Perceived muscular tension, job strain, physical exposure, and associations with neck pain among VDU users; a prospective cohort study. Occup Environ Med 2004; 61:523–528.	21. Hildebrandt VH, Bongers PM, Dul J, Van Dijk FJ, Kemper HC. The relationship between leisure time, physical activities and musculoskeletal symptoms and disability in worker populations. Int Arch Occup Environ Health 2000; 73:507–518.
8. Siivola SM, Levoska S, Latvala K, Hoskio E, Vanharanta H, Keinanen-Kiukaanniemi S. Predictive factors for neck and should pain: a longitudinal study in young adults. Spine 2004; 29(15):1662–1669.	22. Menzel NN. Psychosocial factors in musculoskeletal disorders. Crit Care Nurs Clin North Am 2007; 19:145–153.
9. Hakala PT, Rimpela AH, Saarni LA, Salminen JJ. Frequent computer-related activities increase the risk of neck–shoulder and low back pain in adolescents. Eur J Public Health 2006; 16(5):536–541.	23. National Institute for Occupational Safety and Health. NIOSH publications on video display terminals. 3rd ed. Cincinnati: U.S. Department of Health and Human Services; 1999.
10. Ylinen J, Takala E, Nykanen M, et al. Active neck muscle training in the treatment of chronic neck pain in women: A randomized controlled trial. JAMA 2003; 289(19):2509–2516.	24. Carroll L, Hogg-Johnson S, Cote P, et al. Course and Prognostic Factors for Neck Pain in Workers: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008; 33(4S):S93-S100.
11. Denis D, St-Vincent M, Imbeau D, Jette C, Nastasia I. Intervention practices in musculoskeletal disorder prevention: A critical literature review. Appl Ergon 2008; 39:1–14	25. Ratzlaff CR, Gillies JH, Koehoorn MW. Work-related repetitive strain injury and leisure-time physical activity. Arthritis Rheum 2007; 57(3):495–500.
12. Cote P, Cassidy JD, Carroll L. The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 2000; 25:1109–17.	26. Voerman GE, Sandsjo L, Vollenbroek-Hutten MM, Larsman P, Kadefors R, Hermens HJ. Effect of ambulant myofeedback training and ergonomic counselling in female computer workers with work-related neck shoulder complaints: A randomized controlled trial. J Occup Rehabil 2007; 17:137–152.
13. Thorn S, Sogaard K, Kallenberg LA, et al. Trapezius muscle rest time during standardised computer work – a comparison of female computer users with and without self-reported neck/shoulder complaints. J Electromyogr Kinesiol 2007; 17:420–427.	27. Szeto GP, Straker LM, O’Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work – 2: Neck and shoulder kinematics. Man Ther 2005; 10:281–291.
14. Ariëns GA, Bongers PM, Douwes M, et al. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study. Occup Environ Med 2001; 58:200–207.