Tech neck

What "tech neck" actually is

"Tech neck" is the catch-all name for the neck pain, shoulder tightness, and headaches that come from hours a day looking down at phones, laptops and tablets. It isn't a new condition — it's just a new cause for a very old pattern: the head sitting forward of the shoulders, and the muscles of the neck and upper back trying to hold it there.

Here in Nelson, most of the patients I see with it tell a version of the same story. In 2020 they set up a laptop on the kitchen table because they suddenly had to work from home, told themselves it was temporary, and never quite went back to a proper desk. The temporary setup became the permanent one. Five years of looking down at a screen that was never meant to be looked at all day — that's what walks into my office.

It isn't only bad setups, though. I see plenty of people with decent ergonomics — good chair, monitor at the right height — who still develop it, simply because the body wasn't designed to hold any single shape for eight or ten hours a day. So if you've done everything "right" and your neck still aches, you're not doing it wrong. The pattern is more about time held still than about one bad piece of furniture.

The ache usually starts between the shoulder blades, moves up into the base of the skull, and turns into a headache by mid-afternoon. By the time someone books an appointment, it has often been going on for months. The good news — and I want to say this early, because people arrive convinced this is just how their neck is now — is that this pattern responds well. It's a learned posture, and learned postures can be unlearned.

The bowling ball problem

Your head weighs about ten to twelve pounds — roughly the weight of a bowling ball. Held directly over the shoulders, that weight is supported by the bones. Tilted forward, it's supported by muscle.

The engineering is unkind here. For every inch the head drifts forward, the load on the neck roughly doubles. A head poked six inches in front of the shoulders — the position of someone reading a laptop screen — is the muscular equivalent of holding a forty-pound weight at arm's length all day.

"If you held a bowling ball straight over your head, you could do it for a while. Now try holding the same ball at arm's length. That's the difference between good alignment and tech neck."

How the body compensates

The body is good at finding ways to hold a difficult position — it just isn't free. Over time, the compensation pattern becomes the problem:

• Suboccipitals lock on. The small muscles at the base of the skull tighten to keep the head from falling further forward. They are a common source of tension headaches.
• Upper traps and levator scapulae shorten. The shoulders creep up toward the ears. Most people don't notice until someone points it out.
• Deep neck flexors go offline. The muscles in the front of the neck that should be holding the head up gradually stop firing, which puts more load on the back of the neck, which tightens further — a loop.
• The upper thoracic loses motion. The mid-back stiffens in a rounded position. Once that happens, the neck has to do the extension the upper back can't.

Treating the neck in isolation, when this much else is involved, tends not to hold. The neck feels better for a day or two and then returns to the same pattern.

What treatment looks like

Most of what I do with tech neck is find the restriction that is actually sustaining the posture, rather than chasing the tight muscles that are a symptom of it. In practice that usually means working into the upper thoracic, the first ribs, and the fascia around the base of the skull — and giving the deep neck flexors a chance to come back online.

But releasing the tight front is only half the job, and it's the half people expect. Tech neck is a lopsided pattern: the head pokes forward, the shoulders round in, the chest and the front of the neck tighten and shorten — while the muscles on the back that are supposed to hold you upright get stretched out, lengthened, and weak. Stretch the front all you like; if nothing is strong enough to hold you in the new position, you drift right back. So a big part of the work, in the clinic and at home, is strengthening the weak side rather than only stretching the tight side. Three muscle groups in particular need waking up and building:

• The mid-trapezius — the muscle between the shoulder blades that draws them back and down. When it's strong, your shoulders sit back where they belong instead of creeping forward.
• The deep neck flexors — the deep muscles at the front of the neck that gently tuck the chin and hold your head back over your shoulders, where the bones can carry its weight instead of the muscles.
• The posterior rotator cuff — the muscles at the back of the shoulder that rotate the arm outward and pull the shoulder back, undoing the rounded-in slump.

Strengthen those three, and the body finally has something to hold the upright position with. The tight chest and neck can let go because they're no longer the only thing keeping you propped up. That's the balance: release what's short and overworked, build what's long and weak. It's the same principle behind most of what I do — the goal isn't to relax everything, it's to even out the tug-of-war.

It's slow, precise work, but it's genuinely fixable, and you don't have to do it alone. Most people feel looser and clearer after the very first session. Lasting change for a pattern that's been building for years usually takes four to six, and we build the home strengthening in alongside the hands-on work so the gains hold between visits.

Between sessions

Treatment only goes so far if you return to the same desk, screen height, and ten-hour day that caused the problem in the first place. A few things I ask most patients to do:

• Raise the monitor so the top of the screen is at eye level. A stack of books works.
• External keyboard and mouse, so the laptop can go up without the hands going up with it.
• Every thirty minutes, stand, walk, and look at something further than three feet away for a minute.
• A small, boring chin-tuck drill against a wall, done daily. Two minutes. It wakes up the deep neck flexors better than any stretch.
• Gentle shoulder-blade squeezes — drawing the blades back and down — to start rebuilding the mid-trapezius. A few easy sets through the day matter more than one hard one.
• A light external-rotation exercise for the back of the shoulder, the kind done with a resistance band or a small weight, to strengthen the rear rotator cuff. I'll show you the version that fits where you're at — we don't load it until the movement is clean.

The pattern here is the same one I'll keep coming back to: stretch and release the tight front, but strengthen the weak back, because that's what actually holds the change. The goal isn't perfect posture. The goal is movement variety — not holding the same shape for eight hours — plus enough strength in the right places that upright feels easy instead of effortful. The body can handle almost anything except being asked to be still in one position forever, and once it's strong enough to hold itself well, tech neck stops being a daily fight.

In health, Eli Mead, D.O.M.P.