Workshop Intervention for Forward Head Posture in Office Workers
Background & Rationale
There is a rising health concern as our daily use of devices such as computers, laptops and phones are having a progressively greater influence on musculoskeletal conditions (Lee, Han, Cheon, Park, & Yong, 2015). In particular, prolonged device screen time has been shown to induce an extensive neck posture where the head protrudes forward, also known as forward head posture (FHP; Kang et al., 2012).
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FHP causes abnormal tension on neck and shoulder muscles and have multifaceted health implications (Harrison et al., 2003). FHP shifts the centre of gravity with where the head is positioned and increases the load on trapezius, sternocleidomastoid, temporal and suboccipital muscles (Lee, 2016). Persistent pressure on these upper and lower neck muscles predict tension neck syndrome, musculoskeletal dysfunction and permanent structural changes to the cervical spine (Lee, 2016). FHP-related neck pain also predicted stress and anxiety in young adults in a longitudinal study (Siivola et al., 2004). Those susceptible to FHP are at risk of long-term health implications.
FHP is thus an occupational hazard to office workers who primarily operate at their desks with computers. A survey revealed that Australian office workers spend on average 5.9 hours per day looking at computer screens (Lonergan Research, 2017, p. 5). Such exposure makes office workers prone to faulty sitting positions and sustained FHP. High FHP prevalence rates among office workers corroborate this. FHP has been reported to be present in 85.5% of academic office staff (Vakilie et al., 2016) and 61.3% out of 101 Iranian office workers (Nejati, Lotfian, Moezy, & Nejati, 2014). Additionally, studies indicated that sustained FHP and consequent curves in cervical and thoracic spine correlated with higher neck pain incidence for office workers (Cagnie, Danneels, Van Tiggelen, De Loose, & Cambier, 2007). While FHP has serious consequences, it may be reversible and preventable.
Various exercise interventions demonstrate that FHP is treatable. In a randomised, 10-week controlled trial of a home exercise program involving neck muscle strengthening and stretching regimes, there was a significant increase in the head’s vertical alignment and 3.7˚ increase in neck flexion (Harman, Hubley-Kozey, & Butler, 2005). 47% of participants reported noticing posture changes and showed a 40% subjective increase in FHP awareness. A meta-analysis of FHP exercises revealed that exercise interventions can significantly enhance the craniovertebral angle, which determines whether FHP is pathologic, by 4.5˚on average and moderately improve neck pain (Sheikhhoseini, Sharhrbanian, Sayyadi, & O’Sullivan, 2018). The researchers suggested that combined strengthening and stretching exercises for affected muscles may be more effective than others, and that FHP is reversible and preventable in at-risk or early onset individuals.
Despite being a fixable and preventable condition, FHP remains a common health epidemic amongst office workers. Researchers attribute this problem to the habitual nature of FHP that impede the conscious effort of correcting posture (Harman et al., 2005; Straker, O’Sullivan, Smith, & Perry, 2007). This is supported by findings that showed how awareness alone influenced postural alignment for control group participants in clinical trials (Harman et al., 2005). As explained by the Health Beliefs Model (HBM; Rosenstock, 1974), lack of awareness and knowledge of the above outcome expectations and perceived threats involved with FHP reduce likelihood of good neck posture.
Thus, our intervention aimed to raise office workers’ awareness of FHP and equip them to develop effective exercise habits to prevent and correct FHP. Our intervention targets all components of the HBM, self-efficacy and cue to action to optimize office workers’ chance of engaging in healthy neck posture. In light of the literature, we believe that a short, workplace-based, educational exercise workshop may help prevent and fix FHP and impact the long-term postural health and productivity of the at-risk population of office workers (Chen et al., 2018).
Our project was a 20-minute in-house workshop for office workers targeting FHP. We liaised with the managers of the UNSW Division of Philanthropy and organized a workshop session that would be held in a conference room within their city office with approximately 20-30 attendees who predominantly operate at their desks.
Our intervention involved three major components: education, follow-along exercise demonstrations and post-workshop measures. The workshop began with introductory remarks on FHP and a disclaimer to seek professional medical advice should the attendees have existing neck and shoulder pains. Then we demonstrated a series of easy step-by-step exercises that have been proven to target FHP (Anterior scalene and neck flexion stretches and chin-tuck exercise; Sheikhhoseini et al., 2018). Establishing the ease of performing these exercises heightened engagement and self-efficacy while reducing barriers. Attendees were then asked whether they thought the exercises were hard to do, and whether they could be easily completed during work. After, we delivered an educational pitch accompanied with presentation slides for visual aid. Participants were informed about what FHP is, its prevalence, risk factors, causes, symptoms and long-term implications, which aimed to increase awareness of perceived threats and outcome expectations. They were also educated about the muscle structures affected by FHP and were explained which exercises and regimens target and correct which specific muscle groups. Here, participants were led to follow along the McKenzie exercise demonstrations that take a more comprehensive approach to target overall neck posture (McKenzie, 1983). In the last segment of our pitch, we provided practical resources such as recommendations for workplace ergonomics and device applications such as ‘Straighten Up’ and ‘Text Neck’ that have diagnostic and correction exercise tools and periodical reminders for correcting neck posture (Australian Chiropractors Association, 2019; FHP - Text Neck Correction, 2019). Finally, we offered our attendees cards that would work as cues to action with the slogan ‘put your best foot forward, not your neck’ and infographics of two exercises completed during the workshop. Additional cue cards and workshop slides were also supplied for attendees who wished to inform their colleagues.
Our workshop concluded with a summary of the facts and exercises presented, followed by a time of question-and-answer and feedback from the attendees. After, we held a debrief meeting to discuss our observations, outcomes and reflections on the overall experience of the intervention.
Our project had immediate outcomes on the variables of interest and likelihood in engaging in better neck posture or exercises that target FHP. This was measured by the number of attendees that took the cue to action cards that were provided as ‘optional’ resources. All attendees (16 total) took the cue cards and 16 additional cards were taken to be shared with their colleagues. More cue cards were made available at the office kitchenette. Further, several attendees took photographs of our information slides for future reference, and also requested that we provide the slides to be shared on the company intranet. We anticipate these resources to boost the office workers’ self-efficacy for correct neck posture and perhaps change the everyday dynamic for healthy behaviour within their workplace.
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It was also very clear that our participants were engaged with our workshop. All participants intently followed the exercise demonstrations and actively contributed to discussions facilitated throughout the workshop. The attendees’ feedback also evidenced surprisingly high and successful levels of interest, as they expressed ideas for regular meetings or designated times during work hours to perform the exercises in the office and to raise the importance of targeting FHP with upper management. Many commented on how easy and quick the exercises were to do and how they weren’t aware of FHP as a serious health problem of its own prior to our workshop. Overall, our intervention was very well received by our sample of office workers.
We anticipate the benefits of this project to extend beyond the immediate relief of neck pain and tension offered by our exercise components, or simply being aware of FHP and its long-term implications. We equipped the attendees with the necessary resources and knowledge that can effectively remind them to engage in FHP exercises and behaviours that foster good neck posture in a self-sustainable manner. We expect this to be achieved by the increased self-efficacy from the cue cards, device applications and the resources that will be shared on the office intranet. We also anticipate reaching a wider sample than those who were present through these post-workshop measures and resources. We hope the benefits of this project would stretch to changes in lifestyle habits and broadly, long-term musculoskeletal health.
The project was a valuable experience of witnessing the positive snowball effect that my actions could have on individuals’ long-term health and lifestyles. I was able to help make an actual impact to increase office workers’ awareness and self-efficacy to target FHP.
While the experience was enjoyable and rewarding, our team came across some logistical challenges. First, we realised the difficulty of designing an effective and ethical public health intervention. The amount of time and effort that cost to carry out this short-term project renewed my respect for health interventions. We also struggled during the initial recruitment phase, where there were delays in liaising with different offices. Personally, I was challenged by the high temperature of the conference room that elevated my anxiety, constant interruptions from attendees leaving or entering, and their consequent impact on the overall flow of our workshop.
Despite these obstacles, I was thoroughly surprised by the level of engagement and enthusiasm that the attendees exhibited. I expected some of the attendees to be unfocused or not engaging with the exercise demonstrations. However, all attendees were highly attentive, followed all exercise demonstrations and actively participated in discussions. I was also surprised by the wide age range of our attendees varying from their 20s to 50s, as well as the lack of male attendees compared to females. Their feedback on the professionalism of the workshop was also unexpected, as our team felt that we were slightly underprepared.
Overall, I believe our project aligned well with the current literature on FHP and methods to promote health behaviour. We devised our workshop to raise awareness of, prevent and fix FHP due to its habitual nature and implications that go easily unnoticed in everyday life. Hence, our workshop was for both at-risk and early onset individuals. The effectiveness of evidenced-based exercises on both prevention and treatment further reinforce our approach. We specifically targeted office workers, whose work demands place them at high risks of engaging in FHP. Thus, we aimed to address all perceived threat and outcomes to boost office workers’ ease of performing FHP correction exercises. To do so, we used a multidimensional approach in our educational exercise workshop that would maximise attendees’ engagement, resources, self-efficacy and interest about FHP. This enables a self-sustainable workshop that can extend influence on participants’ daily work lives, where they might be more vigilant and consciously aware when engaging in FHP. However, we were limited by a relatively small sample despite the high prevalence of FHP among office workers reported by the literature. Our project also did not address students, who are the other primary target population indicated by past research.
For future FHP projects, I would add more rehearsal schedules so that our workshop will be more prepared, effective and professional. I would also request a larger space and early advertisement to accommodate more attendees. Further, I would implement other measures to make the intervention even more self-sustainable. For instance, we could incorporate office announcements or dedicated exercise breaks. I could also design lock screens and infographic backgrounds to be used directly on the attendees’ computers and other devices. This resource-based approach could implicate a wide scale intervention that could be used in other offices or released to the general public. I would also run early intervention workshops in schools and universities where device-dependent work is increasing. Another would be to use cue to action infographics or exercise announcements on public transport vehicles, where indivdiuals spend majority of their travel times on their phones. I would also utilize social media to post daily FHP facts and start viral exercise challenges to increase public awareness and partner with wearable technology to track and remind posture correction for a more treatment-based future intervention
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