A lot of gaming chairs include headrests, but many office chairs don't. Do I need a headrest to have an ergonomic setup?
Probably not, but it's worth talking about why you probably don't need a headrest.
Your cervical spine, which supports your head, has a lordotic curve just like your lumbar spine (see my advice about lumbar support). That curve goes slightly inwards, towards the front of your body. A lot of gamers and those who use their cell phones with poor posture can develop what’s called forward head posture, also sometimes called “text neck”, in which the head is pushed further forward than the shoulders.
Caitlin McGee is a physical therapist with a background in neuroscience and exercise/sport science. She is the co-owner and performance and esports medicine director of 1HP, a company that provides health and performance services to esports players, teams, and organizations. She has been working in esports medicine for six years.
Not all forward head posture is problematic! For some people, it’s the result of normal anatomical variations in their upper cervical vertebrae. For other people, though, it’s the result of poor postural habits, weakened muscles, and compensations from other muscles. Most commonly, the deep neck flexor muscles are shortened, tightened, and weakened, while the larger sternocleidomastoid muscle on either side of the neck works overtime to provide the stability that those muscles should.
Many of the gaming chairs currently on the market come with a large detachable pillow for the headrest. Just like the pillow for the lumbar spine, this pillow is often too large for safe, comfortable use and can actually cause worse posture, rather than better.
That’s not to say a headrest is always a bad choice! It can be useful if you’re gaming for long periods, either as an external cue to remind you to keep your head back against it or as a surface to rest against. But it’s also entirely possible to have that good, upright posture of your back and neck without a headrest.
To see if your neck, with headrest or without, is sinking into that forward head posture while you play, have someone take a picture of you directly from the side. Then, compare the position of your ears to the position of your shoulders and collarbones. Are your ears sitting right over your shoulders? If so, great! You’re in a nice, neutral head position. Are your ears sitting over your collarbones, or even further forward than that? You’re starting to sink into a little bit of forward head posture, and you might need to work on your deep neck flexor muscle endurance.
As with everything else about your setup, your headrest (or lack of one) should work to support you in good, comfortable postures. Sometimes, that means you'll need more support; sometimes, that means you’ll need less. You don’t have to have a headrest for good posture, but you do need good posture to make the best use of a headrest.