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Consultant spine surgeon: Movement is key to avoiding back pain in the remote working era

Derek Cawley says the change in our work habits and bad home office setups have contributed greatly to an increase in back pain.

Derek Cawley

THE RECENT PUBLIC health emergency has forced many of us to change our working environments and to remain at home.

I conducted a recent survey in conjunction with the Irish Society of Chartered Physiotherapists of over 80 physiotherapists where we found that at least half experienced an increase in people attending with back and neck pain, directly as a result of the recent changes in work practices.

Physiotherapists reported back pain increases in 34% of cases, neck pain in 19% and both back and neck pain in 47%. Furthermore, top reasons cited for why this is happening included prolonged immobility/lack of exercise in 70% compared with poor ergonomics/ sitting incorrectly in 25% and pre-existing muscle weakness in 6% (Figure 1).

BACK STUFF Figure 1: Reasons for why over half of physiotherapists are seeing increased patients presenting with neck and back pain. Source: Images with permission from “Spinal Anatomy: Modern Concepts”, Ed JM Vital, Derek Cawley, Springer 2020.

Many occupations have used both technology and connectivity to work while remotely accessing the workplace, colleagues and clients. Most will not miss the daily commute, and the efficiencies of a home office mean less lost time around the working day.

Continuous lack of movement

Yet again, the sedentary lifestyle creeps farther into our human existence. In particular, we spend even more of our time sitting. Typically, one in five office workers reports an episode of neck or back pain within one year.

We know that immobility increases the likelihood of modern-day disorders like diabetes, obesity, cancers and heart disease. However, the recent past has seen an upsurge in back and neck pain presentations to clinics where working from home has subsidised habits in terms of poor posture and lack of exercise.  

A normal healthy lumbar spine (lower back) should have a small arch, keeping us upright when standing. This arch relaxes during sitting, called lumbar flexion, which places more pressure on the intervertebral discs.

The discs in the lower back are the largest as they carry the most weight. Excess weight, therefore, puts the disc at increased risk. Body fat cells also contain pro-inflammatory chemicals or cytokines that irritate tissues causing pain. Exercise on the other hand promotes anti-inflammatory cytokines that reduce inflammation and pain. 

The spinal column of bones critically needs its supporting structures to maintain spinal health. All of these structures, including bones, discs, ligaments and muscles become weak if not regularly used.

image2 Figure 2: As the erect spine goes from standing to sitting, the pelvis rotates forward and the spine flexes, placing more pressure on the discs. Source: Images with permission from “Spinal Anatomy: Modern Concepts”, Ed JM Vital, Derek Cawley, Springer 2020.

Prolonged sitting allows the pelvis to gently slide forward into a slouch, further stooping the back (See Figure 2). Furthermore, because the lower and middle spine is tilted forward, the neck has to work harder to keep the head upright with resulting neck pain. 

However, bad posture or slouching, while considered bad for us, are not definitively proven to cause back pain. In contrast, a lack of exercise is definitely linked to back pain and other health problems as mentioned. As part of this, stretching promotes movement and elasticity of the passive tissues. 

Ergonomic office design

The home office must be optimised to promote a healthy workplace. This particularly applies to workers who spend long hours at a desk, on a video call, typing or using a mouse.

An entire industry has developed based on optimising workstation ergonomics. Important well-known aspects of correct seating include achieving proper desk, seat and screen height, and elbow, wrist and lumbar supports.

At the very least, a small support cushion placed behind the lower back allows maintenance of the arch of your spine while sitting. Consider a gym ball which you can swap for the office chair intermittently during the day which allows for a gentle core workout, but can also function as an excellent aide to further exercises.

A standing desk has an adjustable height to allow work while standing up. If taking a business call that does not require a screen presentation or visual information, this may be an opportunity to put on the headphones and spend the meeting while going for a walk. 

Movement is key

Cycling is an exercise that is often very suitable for patients with a bad back, particularly a recumbent exercise bike or even an office bike! However, this may not be the answer for someone who is better off stretching out after spending extended time in a hunched position.

While office ergonomics are important, research would show that it is the practice of moving, stretching and walking where possible that makes the greatest gains in maintaining spinal health.

Therefore it is worth getting up out of your chair at least every hour, placing your hands in the small of your lower back, pushing the hips forwards and lean back as far as you can a few times to reset the natural curve of your spine.

image3 Source: Images with permission from “Spinal Anatomy: Modern Concepts”, Ed JM Vital, Derek Cawley, Springer 2020.

After work, simple strengthening exercises that are well known include the “Superman” and the “Plank”:

The Superman – Kneel on your hands and knees, engage your lower abdominals and raise and straighten both your right leg and left arm. Hold for 15 seconds, then switch around and repeat this 5 times. 

The Plank – lie face down, bring your elbows under your shoulders, keep your back straight and rise up onto your elbows and toes (or elbows and knees which is easier). Hold for 15 seconds; repeat 5 times.

Frequently, a minor back injury is blamed as the cause of the spine problem, and often prompts a visit to a doctor or physiotherapist but it is more likely to be the most recent symptom in a culmination of postural habits and muscle imbalance.

There is no universal agreement on how to manage back pain. Hence why we have so many passive interventions like acupuncture, injections, massage and medication.

None are perfect as a single treatment as they each address only one factor and not issues like sleep, diet, fitness levels or even stress management. But there is a broad consensus in approaching back pain, which starts with having your doctor or physiotherapist rule out serious causes for your back.

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Once that’s done, avoid bed rest and gradually return to daily activity levels. For the majority with lower levels of disability, a large body of treatment is not needed, and following a simple activity or an exercise programme is sufficient. 

With higher levels of disability, it may require input from multiple disciplines. A chronic back pain sufferer may look into attending a spinal specialist to achieve further insights into their back pain, undergoing x-rays or MRI scans and potentially requiring injections or surgery. However, the concepts of regular gentle back exercises apply to us all.  

Mr Derek Cawley is a spine surgeon at the Mater Private Hospital and chairs the PatientLine committee as part of the European Spine Society. For further details, visit www.thespineacademy.ie.

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