SAFETY SATURDAY: THE NECK

Wu-Tang Clan comin' at ya

Watch your step kid

Watch your step kid (protect ya neck kid)

 - Protect Ya Neck, by The Wu-Tang Clan 

Work of all kinds requires human focus and attention. Manual, technical, and informational work requires sustained visual focus and often sustained and prolonged postures. In addition to this, the arrangement of workstations, tasks and workspaces requires skilled workers and those who use machines or plant to use their arms as well. Work tasks that involve powered plant or control panels also require sustained visual focus as well as a narrow range of upper limb movements. Between human vision and the action of the upper limb, the human neck is responsible for stabilising the visual field and human vision on work information and in front of control panels and interactive assets like keyboards, panels, and wheels, as well as coordinating the actions of the upper limbs. Many muscles such as the levatores scapulae, scalenes, trapezii and the sternocleidomastoids bridge between the neck and the arms or originate from the neck and attach elsewhere in the body. The musculature of the neck is finely evolved to maintain the alignment and posture of the human head while also being able to execute a large number of movements - bending forward and backward, turning, twisting, tilting, and rotating through different axes allows a human worker to focus on different sources of information in their environment, attend to different tasks, and focus during manual handling or during skilled work involving the hands and the arms. For these reasons and others, the human neck is a source of concern for workplace health interventions. This does not consider trauma to the neck which, by virtue of the contents of the neck including the spine, cardinal arteries, trachea and oesophagus, may be traumatic or fatal depending on the effect. Damage to and fracture of the hard bony and jointed structures in the neck can be lethal or disabling if not managed. The human neck is essential yet vulnerable, so its sustainable protection from acute and chronic risks is necessary to protect the health of the worker.

Workplace injuries affecting the neck account for 1.7% of those injuries reported in the 2022-2023 period (Safe Work Australia, 2024), just under half as common as those injuries affecting the head as reported within the same period. This is broadly consistent with the proportion of injuries reported in in the 2009-2010 and 2013-2014 periods (SWA, 2016) and in other reporting periods (SWA, 2019). This is understandable given the neck is rarely under acute or significant load in the same way that the lower limbs, lower back, or upper limbs may be. Instead, the neck is typically placed under sustained, gradual, and accumulating strain as the consequence of being the anatomical intermediary between the head and the torso. Body stressing is one of the most common causes of workplace injuries, arising from sustained or acute stress applied to a region of the body that is sufficient to cause discomfort that may or may not be accompanied by structural damage (SWA, 2023). There is reasonable evidence to suggest that discomfort within the neck arises as a consequence of sustained posture which may be further aggravated where a worker may be experiencing psychological or specific occupational stress (da Costa & Vieira, 2010). The contribution of posture to the presentation of symptoms is understandable when considering the anatomy of the neck. The neck contains the bones of the neck whose primary functions are not merely mechanical weightbearing or articulation but also the protection of arteries, the trachea and oesophagus, as well as muscles and nerves. Prolonged postures without movement result in increased strain and pain, and the potential development of forward head postures (Diab & Moustafa, 2012) which may contribute to the development of neck-related nerve pain (Iyer & Kim, 2016) and headache (Elizagaray et. al., 2020). Sustained muscular engagement within the neck may irritate the nerves serving the arms and skull, causing discomfort (Bogduk, 2011). Additionally, with age, the bones of the neck may experience degenerative change, which in combination with stereotyped and repetitive work tasks can contribute to a worker’s experienced discomfort (Williams & Sambrook, 2011; Bunch, 2012). The effect of these changes may be further magnified with fatigue that accumulates and is experienced throughout the working day - the average Australian worker works 35 hours a week (Australian Bureau of Statistics, 2025), but must also travel to work by train, car, or by foot. Throughout working and recreational hours, a worker’s neck and cervical-postural muscles are under ongoing engagement, and when the neck becomes fatigued, discomfort often arises (Côté, 2014).

The physiological role of the neck is to stabilise the visual field of the eyes and to support hand-eye coordination (Treleaven, 2017). Individuals with chronic neck pain display slower hand and foot reaction times as well as impaired hand-eye coordination (Sittikraipong et. al., 2020). This is owing to the neck’s ability to assist in stabilising gaze when focusing on tasks (Richter & Forsman, 2011) as well as the fact that muscles that attach to the shoulderblades also attach to the neck. The neck balances the engagement of the eyes, the arms, the torso, and the shoulders (Smith et. al., 2019). When the upper limbs fatigue, neck postural muscles become more engaged to stabilise the head to compensate (Côté, 2014). Equally, when the eyes become fatigued as a consequence of sustained visual attention that results in strain, muscles in the neck reposition the head to compensate for vision shortfalls (Richter, 2014). The incidence of eye strain resulting in visual fatigue increases in those occupations requiring sustained visual attention, such as computerised and technical work, those occupations requiring attention for more than eight hours such as longhaul trucking, or those that require intense focus such as dentistry or fine machining (Thorud et. al., 2012; Souchet et. al., 2022). Neck pain is an identified symptom of eye strain that occurs outside of the skull (Kaur et. al., 2022). Neck pain may also occur in workers who need to move their heads and arms repeatedly and quickly, owing to the dynamism, repetition, or specificity of their tasks (Lomond et. al., 2010). The neck can become irritated from sustained movements, repetitive movements, and awkward movements. Pain in the neck can give rise to upper limb, jaw, headache, and visual symptoms. Protecting workers from occupational, environmental, and organisational factors that may increase the risk of an individual developing neck pain requires the consideration of work-design and individual factors. There is inconsistent substantiation for the effectiveness of physical and organisational ergonomic interventions in the management of neck pain (Driessen et. al., 2010) owing to the breadth of potential interventions that may be performed against the diversity of factors that may incite postural and occupational neck pain, while strengthening (O’Riordan et. al., 2014) in combination with cognitive therapy (Cox et. al., 2019) and stabilisation training have been found to be more effective. 

Strategies that are effective in the management of neck pain arising from visual fatigue include those that may be used to ameliorate digital and focused eye strain as a whole, such as individual and workplace education and the implementation of workplace accommodation and safety design to minimise the incidence of worker visual discomfort (Coles-Brennan et. al., 2019), the management of workspace and task-specific lighting (Sheppard & Wolffsohn, 2018) and the management of occupational and organisational stress may be effective in the management of neck discomfort arising from occupational factors (Nixon et. al., 2011). Given that the neck is responsible for managing strain between the head and the arms, minimising the postural and loadbearing strain experienced by these respective structures is a potential point of intervention. Ideally, the worker will not be using their head for loadbearing so minimising strain through the arms through task rotation and load management can control the effect of shiftlong accumulative fatigue (Motabar & Nimbarte, 2021). When considering fatiguability of the neck as a consequence of sustained visual focus, decreasing visual load through positioning of screens, appropriate sizing of texts and orientation of viewports as well as the arrangement of keyboards, mice, and touchpads to curate the ecosystem of occupational engagement may be used (Nimbarte et. al., 2013; Guo et. al., 2024). Where possible, postural breaks should be considered so as to minimise the exposure of workers to stereotyped and sustained postures, either for breaks, work reallocation, or for other occupational tasks (Nakphet et. al., 2014; Sarker et. al., 2021; Koch et. al., 2024). However, the institution of work breaks should be undertaken so that interruptions imposed by breaks do not add to cognitive burdens or other distractions from workers. Further to this, the management of breaks and work schedules may be made more flexible through consultation with workers, which may be undertaken as part of a broader strategy of collaborative work design and organisation (SWA, 2015).

The human visual field is an incredible thing - being able to perceive depth, direction, speed, and infer other properties such as relative size and mass based on quick reasoning. Technical, skilled, and manual work requires appreciation of information on screens, diagrams and in IDEs, the use of interactive devices like keyboards and controls, and hand-eye coordination of powered and unpowered tools. As technological advances improve human control over the external and worked environment, so too is the articulation of the man-machine interface made more complex by virtue of the sophistication of those machines. Despite this advancement, human biology is slow to evolve and so must be accounted for, with respect to its capacities, limitations, and tolerances. Protection of worker wellbeing during and outside of occupational engagement requires consideration of the areas and concentrations of strain within different regions of the human body, and the neck is no exception. The human neck connects the skull and its precious contents with the human torso and limbs, coordinating between both and commanding the latter, both on the jobsite and off. Bridging the skull and the torso between the girdle of the upper limbs, the neck is under strain and engagement from the first to the last waking moments, supporting coordination, action, and attention in technologised, mechanised, and energised environments as well as in relaxed surrounds. 

None of this information constitutes medical, legal, occupational health and safety, best guidance, standard, or other guidance, instruction, or prescription. 

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