Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Joint protection program for the neck

Maureen R Gecht-Silver, OTD, MPH, OTR/L
Alison M Duncombe, PT, DPT, OCS, FAAOMPT
Section Editor
Zacharia Isaac, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


The management of neck pain includes active treatment, rehabilitation, and joint protection. A joint protection program for the neck is indicated for patients with a rheumatologic disorder involving the neck to help prevent recurrent sprains and strains that add to inflammation and degeneration [1]. In addition, it is fundamental in preventive joint care.

The principles and guidelines for joint protection programs for the neck will be reviewed here. An overview of joint protection and the evaluation and treatment of neck pain are discussed separately. (See "Overview of joint protection" and "Evaluation of the patient with neck pain and cervical spine disorders" and "Treatment of neck pain".)


The following principles are the foundation of patient education in joint protection and are applicable to joint protection for the neck:

Respect pain

Distribute the load over stronger joints and/or larger surface areas

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Jul 18, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Sheon RP, Orr PM. A joint protection guide for rheumatic disorders. Appendix B. In: Soft Tissue Rheumatic Pain: Recognition, Management, Prevention, 3rd, Sheon RP, Moskowitz RW, Goldberg VM (Eds), Williams & Wilkins, Baltimore 1996.
  2. McLean L. The effect of postural correction on muscle activation amplitudes recorded from the cervicobrachial region. J Electromyogr Kinesiol 2005; 15:527.
  3. Gerr F, Marcus M, Monteilh C, et al. A randomised controlled trial of postural interventions for prevention of musculoskeletal symptoms among computer users. Occup Environ Med 2005; 62:478.
  4. Wright A, Mayer TG, Gatchel RJ. Outcomes of disabling cervical spine disorders in compensation injuries. A prospective comparison to tertiary rehabilitation response for chronic lumbar spinal disorders. Spine (Phila Pa 1976) 1999; 24:178.
  5. Rempel DM, Krause N, Goldberg R, et al. A randomised controlled trial evaluating the effects of two workstation interventions on upper body pain and incident musculoskeletal disorders among computer operators. Occup Environ Med 2006; 63:300.
  6. Miguez SA, Hallbeck MS, Vink P. Participatory ergonomics and new work: reducing neck complaints in assembling. Work 2012; 41 Suppl 1:5108.
  7. Korhonen T, Ketola R, Toivonen R, et al. Work related and individual predictors for incident neck pain among office employees working with video display units. Occup Environ Med 2003; 60:475.
  8. Hannan LM, Monteilh CP, Gerr F, et al. Job strain and risk of musculoskeletal symptoms among a prospective cohort of occupational computer users. Scand J Work Environ Health 2005; 31:375.
  9. Shikdar AA, Al-Kindi MA. Office ergonomics: deficiencies in computer workstation design. Int J Occup Saf Ergon 2007; 13:215.
  10. Xie Y, Szeto G, Dai J. Prevalence and risk factors associated with musculoskeletal complaints among users of mobile handheld devices: A systematic review. Appl Ergon 2017; 59:132.
  11. Lee S, Kang H, Shin G. Head flexion angle while using a smartphone. Ergonomics 2015; 58:220.
  12. Vasavada AN, Nevins DD, Monda SM, et al. Gravitational demand on the neck musculature during tablet computer use. Ergonomics 2015; 58:990.
  13. Gustafsson E. Ergonomic recommendations when texting on mobile phones. Work 2012; 41 Suppl 1:5705.
  14. Gupta A, Ankola AV, Hebbal M. Dental ergonomics to combat musculoskeletal disorders: a review. Int J Occup Saf Ergon 2013; 19:561.
  15. Gupta A, Bhat M, Mohammed T, et al. Ergonomics in dentistry. Int J Clin Pediatr Dent 2014; 7:30.
  16. Mclean L, Tingley M, Scott RN, Rickards J. Computer terminal work and the benefit of microbreaks. Appl Ergon 2001; 32:225.
  17. Klussmann A, Gebhardt H, Liebers F, Rieger MA. Musculoskeletal symptoms of the upper extremities and the neck: a cross-sectional study on prevalence and symptom-predicting factors at visual display terminal (VDT) workstations. BMC Musculoskelet Disord 2008; 9:96.
  18. Husemann B, Von Mach CY, Borsotto D, et al. Comparisons of musculoskeletal complaints and data entry between a sitting and a sit-stand workstation paradigm. Hum Factors 2009; 51:310.
  19. Kay TM, Gross A, Goldsmith CH, et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev 2012; :CD004250.
  20. Ylinen J, Takala EP, Nykänen M, et al. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA 2003; 289:2509.
  21. Miller J, Gross A, D'Sylva J, et al. Manual therapy and exercise for neck pain: a systematic review. Man Ther 2010; 15:334.
  22. Lowe BD, Dick RB. Workplace exercise for control of occupational neck/shoulder disorders: a review of prospective studies. Environ Health Insights 2014; 8:75.
  23. Malińska M, Bugajska J. The influence of occupational and non-occupational factors on the prevalence of musculoskeletal complaints in users of portable computers. Int J Occup Saf Ergon 2010; 16:337.
  24. Harrington CB, Feuerstein M. Workstyle in office workers: ergonomic and psychological reactivity to work demands. J Occup Environ Med 2010; 52:375.
  25. Carroll LJ, Hogg-Johnson S, Côté 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 (Phila Pa 1976) 2008; 33:S93.
  26. Ball JM, Cagle P, Johnson BE, et al. Spinal extension exercises prevent natural progression of kyphosis. Osteoporos Int 2009; 20:481.
  27. Stuke LE, Nirula R, Gentilello LM, Shafi S. Protection against head injuries should not be optional: a case for mandatory installation of side-curtain air bags. Am J Surg 2010; 200:496.
  28. Viano DC. Seat design principles to reduce neck injuries in rear impacts. Traffic Inj Prev 2008; 9:552.