Written by Stephanie Lievense Cohn PT, DPT, OCS
Since the global pandemic of COVID-19 took off in March, many people have been working from home to slow the spread of the virus and avoid exposure. From the looks of things, this may be the case for quite awhile, if not permanently for some. I am treating many patients in the clinic who are still working from home and will be until at least the end of the year. I have noticed that many of them have experienced worsening symptoms not only due to absence from physical therapy during the shelter in place order, but because many changes to your body and mind come with working from home. Let’s get more specific and talk about how working from home can increase your jaw and neck pain.
This is the big one. As a society, we have TERRIBLE sitting posture – we are constantly hunched forward on our computers and phones, and nice squishy arm chairs and beds certainly don’t help us. When you work in an office, chances are you have a pretty good desk and chair setup (because your boss certainly doesn’t want you to be less productive due to neck pain…) and you can get up semi-frequently to chat with a coworker, get some coffee, make copies, etc.
Guess what? Unless you invested in a good desk and chair for your house, you’re stuck doing work at your dining room table, on your couch, in your bed, etc. These typically don’t make the best long-term work stations for your posture. If you’re anything like me, you enjoy sprawling out on the floor, sitting in a very flexed position in a big arm chair, and pretty much working everywhere that is awful for your posture.
How does poor posture affect your neck and jaw pain? Let’s start with a mini anatomy lesson. You have this kite-shaped muscle on your back called the trapezius (“traps”). The upper traps extend from the base of your skull, down your neck, and all the way out to your shoulders. They are responsible for shrugging your shoulders and assisting your shoulder blade in rotation when you raise your arm up past your shoulder. The middle traps are found between your shoulder blades, and these guys mainly work to squeeze your shoulder blades together. The lower traps extend from the bottoms of your shoulder blades a little further down your spine, and they are in charge of pulling the shoulder blades downward.
When you hunch forward, you stretch out the middle and lower traps. When muscles get stretched out, they can’t activate as effectively (bend your wrist backward and try to make a fist – nope!); this means that sitting in this hunched posture for too long can cause weakness and/or decreased endurance of these muscles. Also, in this position, your neck has to extend in order to keep your eyes level with your computer or phone screen. When your neck extends, your upper traps are doing a LOT of work. Your head is heavy, believe it or not! The upper traps can’t do all of this by themselves, and they will get very tight and even painful.
In terms of the TMJ, sitting in this flexed posture can actually increase the mobility of the jaw a bit too much due to increased pull from the muscles in the front of the neck. When you have too much mobility in your jaw, you can experience some painful popping and even dislocation of the little disc that lives in your TMJ. Ouch!
Those who are not used to working from home or who actually have more work to do now that they’re home will probably experience an increase in stress. We all handle stress differently but to name a few coping mechanisms that are more specific to neck and jaw pain, increased stress can result in abnormal breathing patterns and/or jaw clenching or teeth grinding.
Breathing correctly (yes, it’s a thing) involves the diaphragm, which sits under your rib cage. When you inhale, your belly should rise, followed by an expansion of the rib cage out to the sides. When you exhale, the diaphragm contracts so that the belly falls and the rib cage compresses. In some cases, stress and even pain can cause an abnormal breathing pattern which involves more use of the muscles in the front of the neck, collectively called the accessory muscles when it comes to breathing. These guys may assist in deep breaths, but they should not be pulling the entire workload at any time, especially at rest. If your stress response is shallow breathing or upper chest breathing with those accessory muscles, you may experience increased tightness in these muscles. The tight muscles can then develop trigger points which can refer dull, achy pain to parts of the face, neck, and jaw.
Clenching or grinding the teeth is another way that some may cope with stress. When you engage in these behaviors, you are overusing some of the jaw muscles, especially the masseter and temporalis. Similar to upper chest breathing, overuse of these muscles can cause painful trigger points to form in the muscles which may also refer pain to the face, neck, and jaw.
Loss of Normal Routine
This is probably what I hear the most from many of my patients who are working from home. When you have designated hours in your office, you can easily schedule things such as exercise, laundry, cooking meals, picking up the kids, etc. for before or after work or during your lunch hour. When working from home, boundaries and set hours may unfortunately be a bit blurred. This means that you may skip your usual morning yoga or PT home exercises (tisk tisk!) because you got pulled into a 7am conference call, when you normally don’t work until 9 am. Before you know it, the days start getting away from you and you’ve fallen out of your usual habit of 7am yoga or lunchtime PT exercises.
Staying active and keeping up with your PT homework is very important for mobility, flexibility, strength, endurance, and emotional and mental well-being. When we get away from these healthy habits, we’ll see consequences that may include increased pain. Your PT has prescribed you certain exercises for a reason, and if they are not performed at the correct frequency and dosage, you may experience a relapse in your condition.
At this point I’ve told you the things that can go wrong when you work from home, specifically when it comes to neck and jaw pain. Now what should you do to stop it or, even better, prevent it?
Invest in an ergonomically correct workstation
You may have to spend some money here….but your health is worth it, especially if working from home is a long term plan for you! Here is a checklist for a proper ergonomic setup:
- Feet resting flat on the floor
- Knees and hips bent at 90 degrees
- Natural curve in the low back with support
- Forearms resting on the desk with elbows bent at 90 degrees
- Shoulders relaxed in their natural position
- Computer screen at eye level
- Ears stacked over shoulders
Pro tip: don’t sit on a physio ball. This was a fad for a while, as people claimed that it would help your posture and improve your core strength at the same time. This is fake news – you’ll just get tired from holding that position, and sure enough all of the big muscles that are not designed to be on as long as the core muscles will kick in and make you feel more tight. You can also fall off of them quite easily which will absolutely increase your pain.
We all get in the zone sometimes, and before we know it, three hours have flown by and our bodies feel like garbage. Set an alarm on your phone to remind you to periodically get up, stretch, and walk around. These time intervals need to work for you – it can be every 30 minutes, every 5 minutes, whatever is doable. Breaks are a great time to do PT exercises, too!
Mindfulness involves being present in the moment. It involves being aware of what your body is feeling, your emotions, and what you need in this moment. Many times, habits such as clenching the teeth and shallow breathing occur because we are not aware of what’s going on in our own bodies at any given time. When you take your break, also take a moment to be mindful. What feels tight? Do you have any pain? Are you thirsty? Obviously it’s tough to think about these things when we’re up to our necks in work, so this just reinforces the importance of taking a break. Are you clenching your teeth? Take a moment to relax your jaw and really feel the difference. Is your chest rising and falling as you breathe? Place your hand on your belly and try to push it into your hand as you inhale, and bring it away from your hand as you exhale. The more you practice these little things on your breaks, the more easily they will become second nature while you are working or distracted.
Establish boundaries and prioritize
Easier said than done, right? As I mentioned earlier, your office hours pre-COVID may have been 9-5; however, now that you work in the same place as you eat, sleep, and play, it’s hard to separate your office from your home. Try using the quadrant system when prioritizing your day – I can tell you firsthand as a physical therapist and a former clinic director that this system works!
Quadrant I (urgent and important): These are fires. These need to be addressed ASAP. Examples include angry customers, your child’s nosebleed, and an actual fire in your house.
Quadrant II (important but not urgent): These are your top priorities if you don’t have any fires to put out. You want to avoid these creeping into Quadrant I. Examples include grocery shopping, routine doctor’s appointments, and usual work duties such as reports or boss/coworker business emails.
Quadrant III (urgent but not important): These may FEEL important because of the urgency conveyed, but they can actually wait. Examples include breaking up your children’s screaming match, someone calling you to donate to your former college, and any phone calls or emails that do not relate to work or your health. This is a good quadrant to ask yourself: “If I don’t attend to this now, what’s the worst that will happen?” If the worst outcome is really not that bad, then it can wait.
Quadrant IV (not urgent and not important): This is what I call the time wasting quadrant. These should not get your attention until your other quadrants have been taken care of. Examples include checking social media for leisure, online shopping, and hair/nail appointments (sorry, ladies!).
To recap, working from home can result in changes in posture, ergonomics, stress, and normal routine. These changes can result in overuse of certain muscles that attach or refer pain to the neck and jaw, as well as underuse of key muscles that are important for posture and shoulder mobility and reduce stress on the neck and jaw.
If you are working from home and experience an aggravation in or new onset of these symptoms, don’t hesitate to reach out to us here at Motion Stability. Neck and jaw pain can have various origins depending on the person, and our therapists have extensive experience in diagnosing and treating these issues.