Dealing with Work-From-Home Aches and Pains

It turns out that working from home during this pandemic can be a big pain in the neck …and the back …and the wrists. Your aching body may be telling you that your work-from-home situation isn’t working.  What can be done to ease those aches and pains -- or better yet, prevent them? Host Jonathan Fialkow M.D. explores practical solutions with his guest, Justin Thottam, D.O., a physiatrist with the Baptist Health Center for Spine Care, part of Miami Neuroscience Institute.

Suggested Resources:

Exercises for Relieving Text Neck

https://baptisthealth.net/baptist-health-news/exercises-relieving-text-neck-video/

#BaptistHealthy In Motion: Prevent Back Pain

https://studio.youtube.com/video/oajEk3YzcBU/edit

Back Pain: Prevention, Causes and Treatment

https://www.youtube.com/watch?v=wx-H-jtZehE

For more information about COVID-19 please visit BaptistHealth-coronavirus.com

Transcript

Announcer:

At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist Health Talk podcast, where our respected experts bring you timely, practical health and wellness information to improve your family's quality of life.

Announcer:

For many of us working from home during the pandemic is a pain in the neck. And the back. And the wrists. And the hips. If your aching body is telling you your work from home situation isn't working, we have some helpful tips on this episode of Baptist Health Talk.

Dr. Jonathan Fialkow:

Welcome back Baptist Health Talk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a practicing preventive cardiologist and lipidologist at the Miami Cardiac and Vascular Institute at Baptist Health South Florida, as well as chief population health officer at Baptist Health.

Dr. Jonathan Fialkow:

One of the goals of this podcast is to bring on experts to answer the kinds of health questions my colleagues and I are asked on a daily basis. The Coronavirus has brought major changes to the way we work and live. Working from home in less than ideal conditions has become a fact of life for many of us. And we're likely spending a lot more time on our sofa watching TV as well. The result, a lot of complaints about sore backs, stiff necks, painful wrists.

Dr. Jonathan Fialkow:

Studies have shown 60 to 75% of computer and office workers complain of some form of musculoskeletal discomfort. All of these are office jobs at desks and personal computers. This doesn't even include people who are working now on laptops on their couches. Today, we'll talk about some real life solutions to these issues with my guest, Dr. Justin lipid, a physiatrist with the Spine Center at the Miami Neuroscience Institute at Baptist Health South Florida.

Dr. Jonathan Fialkow:

Welcome to the podcast, Justin.

Dr. Justin Thottam:

Hi, Dr. Fialkow. Thank you so much for having me. I really appreciate. It's an honor to be here and I appreciate everyone having me as a guest today.

Dr. Jonathan Fialkow:

Well, again, we appreciate your time and please refer to me as Jonathan. This is very conversational and very informal.

Dr. Justin Thottam:

Hey, Jonathan.

Dr. Jonathan Fialkow:

Okay. Justin, we've had on one of our previous podcasts one of your colleagues, Dr. Ron Tolchin, who had a wonderful podcast with information about back pain in general. We're going to talk specifically more about posture and effects of the COVID working at home. But it always good to start off with what is a physiatrist. Explain to the public what your specialty really entails.

Dr. Justin Thottam:

So a physiatrist is a physician who treats a broad variety of medical conditions. So it can affect problems with the spine, with the brain, with nerves, joints, muscle ligaments, and other pathologies, the list goes on. We focus mostly on function to be specialized and we can specialize in multiple fields, including pain medicine, sports medicine, spinal cord injury, brain injury. And again, the list goes on. We work hand in hand with physical therapists, occupational therapists, speech therapists. And once again, the main function of us or the main goal of ours is to help a patient regain function. So decrease their symptoms, decrease their pain and increase their function.

Dr. Justin Thottam:

So when I see a patient come into my office, I evaluate them with a thorough history and physical, try to make a treatment plan and alleviate their symptoms. Eventually the goal is to get patients to do what they want to do. I love playing basketball myself, so I say this all the time, if I had an injury that I can't play basketball, or a physician told me I can't play basketball anymore, that would crush my soul. So my goal is to listen what the patient wants to do, whether it be taking care of the grandchildren, going back to work, playing sports with the hope that I can treat their symptoms and get them back to do what they want to do.

Dr. Jonathan Fialkow:

So I'm sure with that skill set and with that specialization you've been very busy, and as has the group prior to COVID, just based on normal life and aging and whatnot. What are you seeing now through COVID? What kind of injuries or complaints are you seeing more commonly that can be attributed towards the change in our lifestyle through this pandemic?

Dr. Justin Thottam:

So kind of like you introduced today. A lot of people complaining more back pain, neck pain, wrist issues, pain that goes into their legs, pain that goes into their arms. And it may be from just sitting for too long or not being as active. Because of the pandemic a lot of people, and rightfully so, have been quarantined. So they just been less activity.

Dr. Justin Thottam:

So not going to the office, not walking up the stairs, not walking around the office saying hello to people, not going grocery shopping, which is an exercise that we don't even think that we're doing. But walking through aisles of a grocery store is actually exercise, it's more activity than we're doing now I feel.

Dr. Justin Thottam:

So patients have come in and say, "Hey, listen, my pain started right around the pandemic started. And the pain has been so severe that every time I'm sitting at my desk, by the end of the day, the pain just gets worse and worse." And that's something that I've just been seeing a lot more now.

Dr. Jonathan Fialkow:

Is it attributable towards, because you brought up a couple of good points, is it attributable to not being as physically active in general or just sitting in one place? Meaning if you're home and you're not going out supermarket, there are things you can do at home rather than just sit in one place for a long period of time. So is it really a matter of not going out or just not even moving?

Dr. Justin Thottam:

I think it's the fact of not moving. When I brought up the grocery store, I mean that it's an exercise that we don't even think about that we're doing that's kind of cut out of our lives. But I think that when you're sitting on a desk on a computer and you're kind of focused on your work, you're doing what you have to do for your job, you don't realize you're sitting for hours at a time. And like you said, Dr. Tolchin had that podcast where he talked about patients who are sedentary for more than five hours a day have been shown that they've just had poor health when it comes to their back, their spine, even other issues, cardiac, pulmonary, all that stuff plays into the part.

Dr. Jonathan Fialkow:

So we'll go through as the conversation, hopefully quite a few tips and pointers that the listeners can can take from the conversation. But for this particular one, what is the recommendation? Just to get up every half an hour or 45 minutes and stretch or walk or get a glass of water. What would you say for the person who's busy in front of their computer all day to avoid that sedentary or that sitting in one place, COVID?

Dr. Justin Thottam:

Yes. So I think getting up and doing frequent breaks. So 45 minutes, I think, is a good time to maybe... One of my colleagues, Dr Melissa Guanche, had told me that she tells her patients to put an alarm on her phone every 45 minutes. So you get up, like you said, can grab a glass of water, get up and stretch, do some of the exercises that can be core strengthening. It can be stretching out the back. It could be Pilates or yoga. It can be just even neck exercises, like chin tucks, pectoralis stretches and even moving around the wrist. Those are all kind of things that you want to do every 45 minutes or so, so you're not sitting there for a prolonged period of time and causing these muscles to tighten up on you.

Dr. Jonathan Fialkow:

So you just mentioned a couple of stretches, for example, things people can do. We'll come back to that. But let's talk then a little bit about the kinds of ergonomics, speak a little bit towards what the concept of ergonomics is and how it is applied to people when they're sitting in one position and especially working on computers or desks or laptops or things like that.

Dr. Justin Thottam:

Right. So our spine is built in a way that we have curves and natural curves. And it's to make us more efficient and to spend less energy. So the more that we're on a computer, we're all guilty of it, we all start to slouch a little bit and lean forward, start to lean back in our chair. And those are all things that our body's telling us, "Hey, listen, try to move." Or, "Get up and try to stretch."

Dr. Justin Thottam:

When it comes to a chair, you may want to have a chair that has curves into it, so it can support the curves of your spine. Or you can use a lumbar support pillow to give you a reminder, "Hey, you need to curve your back and keep a correct posture."

Dr. Justin Thottam:

When you're in front of a computer, you want the screen to be about eye level or a little bit below your eye level. When you're sitting on the chair, you want to try to have the height so that your feet are on the ground. Some people actually have a foot pedal or a foot incline where they can rest their feet. And some of them actually move. So you can get the feet pumping while you're sitting there for those 45 minutes before your break and stretch out those muscles or increase your blood flow in and out of the legs.

Dr. Justin Thottam:

Armrest, you want it to be so that your shoulders aren't so stressed. Your mouse for the wrist, you want your mouse and keyboard to be so that your wrist is neutral, not too flexed or too extended.

Dr. Jonathan Fialkow:

So this actually helps me quite a bit. I have my adult children who are staying at home. And my daughter's in her mid twenties, is constantly slouching on a couch working on her laptop. And then I have to give her a back rub at night. So now I can make my life a little easier by getting her a workstation. But it is real. I mean, it's a real component of it. And so then maybe again, as you just mentioned, these are things that would be considered good posture. Is this good work form, like you're saying, sitting with the eye level at the desktop and the 90 degrees for your elbows, and. Is that things that people should aspire to when they set up their home office?

Dr. Justin Thottam:

Yeah. That's exactly right. You want the good work form for that part of it. And then posture in general, when people are standing and walking, you want to keep your back upright, your shoulders back a little bit. A lot of people use braces to help with that part of it, lumbar support braces. But it's actually been shown that it doesn't really help patients in the sense it doesn't prevent injuries. One and two, it actually makes your core weaker because the braces is taking support that your muscles usually do. So for muscles when you don't use it, you lose it. So if those muscles of the core aren't keeping you up and the brace is doing that job, you end up losing those muscles or making it weaker essentially.

Dr. Jonathan Fialkow:

So the frequent breaks, not sitting in one place in one particular time, we'll talk about exercise in a second, but obviously being more active helps, changing your position. Your proper posture helps. Is there anything else people can do besides the positional? I guess the things we just mentioned are kind of things to help prevent the soreness and pain and the back injury. What about if someone has it already? Are there additional things they should do or is just go back to practicing these habits?

Dr. Justin Thottam:

Well, the additional things would be probably the exercises. I mean, essentially, like we said, if it's neck pain you want to talk about chin tucks and head presses. You want to do shoulder blade squeezes. And especially with being on the computer for a long time, we start to slouch and actually the muscles can start to contract or stay tight on you. So you want to do pectoralis stretches. You can do it on a frame of a door where you just put your arms on the door frames and then lean forward on it. And you stretch out those pecs.

Dr. Justin Thottam:

Sitting for a while you can get hip flection contractures or tightness. And you can stretch your hip flexors. When people are really in pain, especially if it's back, going down the legs, you really want to focus on the core strengthening. You can do yoga and Pilates. Those are all been shown that it's been helpful.

Dr. Justin Thottam:

The whole idea is that the lumbar spine and the cervical spine to the neck and the back are kind of a no man's land. It's only bone in that section. Everything else is muscle. So those muscles are weak, all the stress goes onto that spine. So that lumbar spine or that cervical spine. So the whole point of treatment, physical therapy and these exercises are to strengthen the muscles around the spine to take less stress off of it.

Dr. Jonathan Fialkow:

What about, is there a role for anti-inflammatories and pain relievers? Or where does that come into play when someone's in pain?

Dr. Justin Thottam:

So there's definitely a role. I mean, essentially when you think about back pain, a lot of it may be inflammatory. So that's where the anti inflammatories come into play. Acetaminophen or Tylenol also can be beneficial. It's good for pain, doesn't decrease inflammation but definitely good for pain.

Dr. Justin Thottam:

When you talk about the conservative, we already spoke about the stretches exercises. Also staying active, gyms are closed so it's hard for people to go to the gym. I understand that part of it, but even walking around your house or community is beneficial. Eating healthy, diet is a huge part of it. Losing weight can help decrease any back or neck pain.

Dr. Jonathan Fialkow:

So the confluence of all these things is also they're good stress relievers. So there's many benefits in helping us get through this pandemic with those recommendations. How about a warm bath at night?

Dr. Justin Thottam:

A warm bath can help. A massage from your significant other also helps.

Dr. Jonathan Fialkow:

Okay. I got to think outside the box a little bit, but.

Dr. Justin Thottam:

Yeah, exactly.

Dr. Jonathan Fialkow:

But going back to the original points. So you mentioned when you were discussing what especially physiatry is, returning people to function, you mentioned quite a bit pain as the driver. What are some of the other symptoms someone might have that might suggest they'd benefit physiatrist? We talk about tingling or other things that might bring someone to say, "Hey, I may benefit from physiatrist evaluation and treatment plan."

Dr. Justin Thottam:

Yeah. So pain is a big thing that we work with. Like you said, numbness and tingling can be a sign of nerve issue which we work up and manage. It can be joint dysfunction, not being able to move the knee as well as you'd like. Gait abnormalities, weakness is a huge thing that you should be coming and seeing a physiatrist for. And it may be back pain going down your leg with a foot drop or your foot isn't working as well as you want it to, is something that you should come and be evaluated for.

Dr. Jonathan Fialkow:

Appreciate that. And then a few more questions. So if someone now is forced to work at home, and again, it's obviously been some time. We talked about proper posture and stuff like that. Where would you tell them it's best to set up their work at home? I mean, we kind of alluded to it, not slouching on the couch, but speak a little bit towards, someone's going to come in and say, "I'm going to start working at home. How should I begin to do things?" Speak a little bit what you'd recommend in terms of their home office setup ideally.

Dr. Justin Thottam:

Right. So obviously if you're working a computer, I mean, I've been working from home as well, so. You try to set it up in an office room ideally if you can, where you have a desk and materials around you. You don't want things on the other side of the room where you have to get up and grab it and twist and turn to try to get things. The couch is comfortable but not the best for your posture, especially when you have a computer on top of you, laptop, tablets. You want something with more structure essentially, or more support, so you're not tiring out muscles and keeping your body in a strenuous position for too long.

Dr. Jonathan Fialkow:

And I think that's why we wanted to reiterate those points. Now what about when they're not working but they're at home. Because now's a lot more binge watching of TV and other sedentary lifestyles. Any recommendations for some good habits to develop when you're not specifically in front of a computer doing work, but you're doing other home bound stuff?

Dr. Justin Thottam:

Yeah. It all comes down, you want to make sure that your posture is correct. I mean, we're all on our phones, we're binge watching all that stuff. So you start to slouch and you forget about your posture. Two things. One is, remember your posture and two, try to stay active too. So what I've done is, it may not be the safest thing to be honest, but I watch a show while I'm walking or while I'm doing some activity. So you want to make sure that you're not tripping and falling over things, or on a treadmill you're not falling. But at the same time it may be beneficial. You want to try keep it at eye level so your neck isn't isn't slouched. And-

Dr. Jonathan Fialkow:

We always see the people, especially when we're out more, and they're all looking down on their phones as they're walking for units of time, crossing streets. And obviously that can lead to some of these neck injuries and these back injuries as well.

Dr. Justin Thottam:

Right. And then also if you're not paying attention something could hit you, so another thing.

Dr. Jonathan Fialkow:

Right, right. It does happen. It does happen.

Dr. Justin Thottam:

Right. Right.

Dr. Jonathan Fialkow:

Well really this is great information. And we talked about little things people can do like set the alarm every 45 minutes and go get a glass of water or get up and do something. Because just sitting one place is bad. We talked about stretching, you mentioned a couple of stretches and we could provide some links in our program notes towards what those stretches specifically are and how they could be followed, whether it's shoulder shrugs or the chin tucks or the things, the wrists and stuff. I think it really does make a difference. And I think that's great.

Dr. Jonathan Fialkow:

Ergonomics about setting up your office, other lifestyle components, exercising and eating well and of course getting a good night's sleep. Anything else you'd like to let the listeners know based on things you're seeing, specific concerns regarding the pandemic and the working at home processes. Anything further that you want to address?

Dr. Justin Thottam:

I think one thing I forgot to say is that with the risks, especially with a lot of patients that are on computers a lot, we see that they develop carpal tunnel. So that's also something to keep into mind. You can buy braces at your local drug store. And that may be beneficial, especially if you're getting the numbness in the hand and you just start shaking it off. That may be a sign that it's carpal tunnel. So before you-

Dr. Jonathan Fialkow:

Very valid.

Dr. Justin Thottam:

Right. So you want to see a physician for that. But at the same time if, hey, you don't have time right now and you're in pain, try the brace. It may be beneficial for you.

Dr. Jonathan Fialkow:

And it doesn't happen overnight. So it's a repetitive injury. So you certainly have time to prevent it. If you're not currently experiencing that, make sure you have the right posture.

Dr. Justin Thottam:

That's a hundred percent correct.

Dr. Jonathan Fialkow:

That's great. So I really appreciate your time and your expertise, Dr. Justin Thottam at the Miami Neuroscience Institute, the Spine Center. Great information. And hopefully we can all have better posture, as I'm sitting up right now in my chair, as we're having the conversation. And again, I'm going to have to talk to my daughter when I get home.

Dr. Jonathan Fialkow:

But to our listeners, again, as always, any thoughts or comments or any ideas or future topic recommendations, write to us at baptisthealthtalk@baptisthealth.net. We hope to have some program notes that should be supporting some of the conversation topics we had today. And thank you to all our listeners. Stay safe and stay home.

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