A Weill Cornell Medicine Doc on Aiding COVID-Era Back Pain

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By Beth Saulnier

Like physicians everywhere, Weill Cornell Medicine’s Jaspal Ricky Singh has seen his patients affected by the COVID-19 pandemic—but as a specialist in back pain and sports medicine, he’s treating the harmful side effects of pandemic-era lifestyle changes rather than the disease itself. Singh, an associate professor of clinical rehabilitation medicine at the Medical College who sees patients at its Center for Comprehensive Spine Care in Manhattan, talked with Cornellians about how COVID restrictions and telework have sparked a mini-epidemic of upper back pain—and offers tips for staying healthy.

How big a problem has back pain been during the pandemic?

Pre-COVID, what we would see at the center were mostly lower back issues— mainly caused by sitting too much, but sometimes by activities like tennis or golf. With COVID, we’ve been seeing a lot of neck and upper back pain, headaches, and migraines related to poor workspace ergonomics—out of proportion with what I’ve seen in the last 15 years.

Before, neck and upper back pain were 20% of my practice; now they’re 60%. People are using their laptop at home, putting it on a coffee table, working on the bed. How many people—especially in Manhattan—have a home office or even a dining table? Not very many. So posture was affected, putting a lot of stress on muscles between the shoulder blades.

Have there been problems related to people working out at home—for example, doing exercise videos without supervision?

It’s interesting—I also started doing YouTube workout videos that have a lot of impact and plyometrics that our joints and tendons used to absorb when we were in our 20s and 30s, and I got a lot of injuries. That motivated me to create safe home exercise programs based on age, from your 30s to your 80s, and I wrote a blog on the best home exercises without equipment. You can do things like “sit to stand”: sitting on your couch, then standing up and sitting back down 20 times without using your hands. It’s great for the core and the lower body.

The younger people are the ones who’ve been working from home. The older generation, we’ve seen more pain related to inactivity and muscle disuse.

Are you worried that people coming back from COVID restrictions will overdo it, exercise-wise?

We’re telling patients, just like we advise athletes for return to play: don’t go from zero to 60. Go very, very slow. Wherever you were before, cut that volume and intensity in half and start there, then increase it by 10% per week. And before you know it—within about a month—you’ll be back to where you were.

Is there a basic regimen of back stretches you could recommend?

It’s tough, because not all back pain is treated the same. In older adults who’ve got spinal stenosis [a narrowing of the spinal canal that can cause pain and other problems], I’d probably want them to do forward folding and touch their toes—whereas in a young person who has a disc herniation, that’s going to make them hurt more.

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But by and large, one thing that’s safe for everyone to do is stretch their hip flexors. If I’m sitting, my hips are at 90 degrees to my waist and the hip flexor muscle is shortened, and it gets tight with prolonged sitting. I also recommend keeping the back neutral: sitting up tall and keeping the lungs open, the shoulder blades back and down, and the head back so your ears are in line with your shoulders.

Given that some people will continue working remotely, what are best practices for a back-friendly home office?

Try to optimize your home workspace through some type of ergonomic evaluation. We have put out educational videos with tips on what to do at home with limited equipment; how to adjust your monitor, laptop, and seat; what to put behind the small of your back, like a pillow or a towel, to minimize stress. And move while you’re working: every 20 or 30 minutes, get up, decompress your spine, and stretch your neck and lower back.

Overall, do you have concerns about a hybrid approach to office work?

I actually don’t mind it, because you’re changing your environment and positions; it’s probably good for your spine to get a little variety. Once you get into a routine, you stop building muscle, because your body has accommodated to the stresses. But try to be mindful of the time spent in bad postures at home. Using some of those tips—moving a lot, changing positions throughout the workday, and modifying monitor height, keyboard height, and back support—will prevent injuries long term.

It’s probably good for your spine to get a little variety.

How do you feel about standing desks?

When you sit you put a lot of stress on your discs, which are soft, jelly-like structures between the bones of your spine. So people thought, “Let’s minimize that stress by switching to a standing desk”—but constant standing puts stress on other places like the joints, lower muscles, hips, ankles, and knees.

It’s healthiest to change positions many times throughout the workday, for example by using a workstation that can change from sitting to standing. That range of motion to the spine creates what’s called diffusion, where energy, oxygen, and nutrients come into the muscles and discs. I also tell patients, “Sit while you’re working, and every time you get a phone call, use that as a cue to stand up.”

What general guidance could you give as life starts to return to normal?

The American Heart Association, the American College of Sports Medicine—everyone recommends 150 minutes a week of moderate-intensity exercise, which basically means an intensity where you cannot have a regular conversation. Do that for thirty minutes five times a week, and add some resistance to your routine.

You don’t need a gym or sophisticated equipment; you can use a can of soup, something to put some stress on the joints and bones. That’s what builds stability and strength. As I tell my patients, “Mobility is medicine.” The best way to stay out of my office is to stay active, safely.

Top image: Illustration by Cornell University.

Published October 5, 2021

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Comments

1. 

   Liz

   23 Nov, 2021

   I’ve personally suffered from an exacerbation of an existing back issue during COVID and the best I can figure is that I’m not walking nearly as much as I did when I traveled for work. I wonder if that’s an issue for others, too.

   Reply

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