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Taking Care of Your Back During the COVID-19 Crisis

Working from home was once considered a luxury for only about seven percent of the population. Due to COVID-19, many of us are now conducting all business at home, whether we like it or not. In addition to spending more hours on our electronic devices since March, and less time at the gym, it’s no wonder back and neck issues are on the rise.

Tiffany G. Perry, M.D. has been an assistant professor, neurosurgery at Cedars-Sinai Spine Center for the past five years. In the Neurosurgery Pavilion on San Vicente Boulevard, Dr. Perry treats a myriad of issues from chronic back pain to pinched nerves, carpal tunnel syndrome and disc disorders among others.

Since the COVID-19 shutdown, Perry has noticed a lot of degenerative conditions and incidental findings that have come to the forefront. “Patients are coming in for these ergonomic issues related to home-work stations, or maybe they have not been able to go to the gym and do their normal yoga or Pilates regiment,” she told the Courier. “They are having to transition and figure all of that out along with home-schooling.”

Some of the challenges include no room for a workstation in the home or the children taking up all the desks. It’s easy to end up stuck at the kitchen table or on the couch. “This is obviously not optimal for a grown-up trying to take care of their back,” said Perry.

This first thing Perry recommends is a sit and stand workstation that will help to combat neck or low back issues. “It just helps to shift your body’s dynamic throughout the day,” she said. “When you stand from a sitting position, you can feel how your lumbar spine goes into more of a curve and you can feel that ‘C’ shape in the small of your back, called lumbar lordosis,” said Perry.  Conversely, if you sit down, you will feel that goes away. “The IAR or instantaneous axis rotation shifts your body’s focal point of load-bearing access.”

If you’re sitting all day, that function is not being exercised. “We need to load our spine in different ways throughout the day,” cautioned Perry. “If you don’t, you are apt to be more susceptible to a disc herniation, develop deformation or acerbate joint pain in the low back. It’s not just about sitting or standing all day, but about having dynamics in the workstation,” she added.

Quick fixes include setting up a high bar area or stack of books at home so you can stand while working on your laptop. “You just have to think outside the box when you’re at home since it’s not healthy to sit all day,” said Perry.

She noted that the COVID-19 crisis is causing an increase in stress, due to financial matters, home schooling and working from home.

“The physical manifestation of these stressors include muscular tension, neck pain and/or lower back pain as our lives continue to be altered by this pandemic.  While we may not be able to do much to alter the stressors at this point, identification of how and where your body demonstrates stress is key to treating it, whether with massage, yoga, meditation or other exercise,” she said.

Perry advised to use what would otherwise be commute time as exercise or meditation time. Take advantage of not sitting in traffic to perform a 15-minute stretching routine or take an exercize class via Zoom.

For one patient who is a novelist, Perry was concerned about the posture of writing for eight-hour stretches. “I told him to set his alarm for every 30 minutes to check his posture or commit to shoulder rolls and shrugs. This is really important because we carry our tension in our trapezius muscles which can lead to pain and tension headaches,” Perry said.

Perry also advised against getting into strange positions with your legs folded. “I tell patients to imagine having a string attached to the top of your head like a marionette, and dangling from that position, that is the alignment your body should be at. The crown of the head is up and shoulders over the hips is how you should be sitting. If you’re standing, shoulders over the hips, hips over the knees, knees over the feet.”

For injury prevention, stay away from sitting on a bar stool or hard floor. “Develop an area where you feel safe and it’s good for your neck, low back and overall posture,” she said. Sitting on a yoga ball is also highly recommended, as this engages the core and lower back muscles.

With many people experiencing back issues for the first time, it’s important not to dismiss the discomfort. “If the pain gets to the point where it’s debilitating, then it’s time to seek medical attention,” she advised.

Cedars-Sinai internal medicine specialist Christopher Fitzgerald, M.D., finds that back issues can sometimes be difficult to diagnose over video. However, video does let Fitzgerald quickly see someone’s ergonomic set-up, whether they are looking up or down at the screen. Both are not good practices and could be the culprit behind back issues.

For better back hygiene, Fitzgerald recommends adjusting your computer screen to eye level. Hips and back should be at a 90-degree angle with shoulders and back in an “L” shape, knees and hips level.  Also, make sure your feet are touching the floor.  Arms should also be in an ‘L” shape. And for better wrist support, use a rolling mouse.

“Less than six weeks it’s an acute, sudden problem, but if it’s two to three months, it’s most likely a chronic condition. Ninety percent of what I’ve been seeing has been acute,” he confirms. “Most [cases] will get better in the two to six-week mark if you adjust the problem. We recommend RICE – rest, ice, compression and elevation.”

Fitzgerald also uses the American Academy of Orthopedics Society handouts as a great resource for at-home solutions. If the issue is not getting better after RICE, physical therapy may be needed. If it doesn’t get better after six sessions, or the pain increases, then Fitzgerald recommends contacting a specialist or orthopedic surgeon. An injection into the tendon to calm it down is another option.

As a specialist in the advancement of spinal health, artificial disc replacement and motion preservation for more than 30 years, Todd H. Lanman’s Beverly Hills practice is affiliated with Cedars-Sinai Medical Center and UCLA Medical Center.

Lanman’s practice has seen an increase in calls about back and neck pain since the COVID-19 crisis began. He attributes this to increased usage of electronic devices for virtual meetings, and the fact that gyms are closed, and patients are unable to carry out their general exercise routines to promote better health.

He also noted the effects of stress during this time.

“Patients that I have seen during the COVID pandemic have been affected by psychological distress related to the crisis. Lessened physical movement and being trapped indoors for long periods of time have increased and worsened pain of the low back and neck. Symptoms tend to magnify and become more intense when we suffer from emotional anxiety, which we are currently seeing related to the Coronavirus pandemic, lockdowns, and our inability to function in our normal daily routines. This has become a factor in amplifying the pain in the low back and neck areas and has impeded a patient’s ability to focus on anything other than their pain.”

Lanman recommends that patients work on some exercises at home, to build and maintain good core strength of their abdominal and back muscles, as well as practice postural refinement techniques while working on home computer systems. “Those techniques combined with some elements of core strengthening would be the best for patients, in order to prevent further progression of neck or back issues.” And, since it appears that we will be working from home for a while, that is also good advice to avoid chronic issues and potential surgery.

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