We recommend the solutions to your spine problems

The Back and Neck Pain Epidemic During Work From Home

Mr. Abhilash (name changed), 28 years old IT professional working in Pune, came to Spine OPD at Sancheti Hospital because of nagging back pain for one week. He is an avid long-distance cyclist who easily cycles 100+ km per week. Since the COVID-19 pandemic, Abhilash has been suddenly forced to stop all cycle rides and shift to working from home.

Dr. Shailesh Hadgaonkar, Head of the Spine Unit at Sancheti Hospital shares,
"People are working from home, remaining seated for longer periods of time with poor posture and minimum breaks from work coupled with a lack of places to go out for exercise."

India has now completed 6 successful weeks under lockdown in the COVID pandemic. The lockdown has caused sudden and major lifestyle changes in terms of restrictions on people's movement, access to facilities, commuting to work as people are forced to remain inside and work from home.

Dr. Hadgaonkar adds, "We are finding a surge of young, active adults who are facing new back and neck problems due to inactivity and prolonged sitting as opposed to having lifted anything heavy or overexertion."

This restricted mobility has brought on a variety of health problems, new and old issues, with a vengeance.

The spectrum ranges from mild to severe psychological and/or physical ailments - depression, anxiety, dry eyes, digestive problems like constipation, worsening of diabetes and other comorbid conditions, neck and back pain.

Dr. Parag Sancheti, Chairman of India's premier orthopedic institute, Sancheti Hospital says, "This is just the tip of the iceberg. We need to accurately quantify the health problems but the challenge is people are unable to avail regular healthcare services due to the strict rules of the lockdown, except for emergency cases like fractures. Many are suffering without appropriate treatment”

Final-year resident at Sancheti Institute, Dr. Ishani Chaudhary devised a cross-sectional study with a detailed and practical questionnaire to find the factual evidence of incidence and prevalence of neck and back pain in India during the COVID lockdown. Dr. Ishani shares,“ We wanted to make appropriate use of technology to reach out to many many people in need as possible. We distributed Google forms through various mailing lists and popular platforms of Whatsapp, Facebook, Twitter, Instagram to preach to multitudes of people at their fingertips across many Indian cities."

ICEBERG - The gravity of the problem.

Spine problems no longer affect the elderly- The age range of participants in the study was 17- 68 years of years. 68.9% of new cases of neck and back pain were in the young age group between 20-30 years. Males and females were equally affected (50.3% male and 49.7% females).

Inactivity induced neck and back pain- The participants of the study came from a variety of professions with following profiles - 31.3 % sedentary work, 55.6% mild exertion,13.1% heavy work/ fieldwork (study included students, teachers, engineers, IT professionals government sector, hospitality, finance and banking, advertising and media, pharmaceuticals and research, real estate, architect and designers, fitness coaches and athletes.)

New cases of neck and back pain in the last 6 weeks of the lockdown(incidence) were noted below -

	Neck Pain	Mid Back Pain	Low Back Pain
New Cases (Incidence)	15.8%	14.7%	21.2%
Old Cases (Prevalence)	21.9%	17.9%	28.1%

The new-onset cases were mild to moderate in intensity affecting regular activity in 10.4% patients

Of the prevalent cases of spine problems up to 1 year from the lockdown, we found 5.3% of participants had diagnosed herniated lumbar discs or cervical spondylosis under treatment. Of the prevalent cases, participants have undergone investigations like (18.5%) Xray,(11.4%) MRI or (6.6%) CT scans to diagnose their spine problems with treatment options of pain block therapy(7.8%) and spine surgery(5.2%).

Treatment options tried by participants during lockdown were as below

New Cases	Self-medication	Physiotherapy	Teleconsultation	Visit Hospital/ emergency department
	22.4%	37.7%	4.3%	1.1%

TRENDS DURING LOCKDOWN

1. Majority of the workforce is couped up at home

A majority of 77.8 % of participants were working from home (working 6-14 hours) and 22.2 % reporting to the regular workplace

2. Poor posture with lack of timely breaks worsening the pain

Only 39.6 % are sitting ergonomic position in chairs with appropriate backrest and laptops at eye level with only 23.3% taking regular breaks every 20-30 mins while working. 60.4% others had adopted harmful postures while working like lounging on sofas or lying on beds coupled with 76.7% taking no or irregular breaks after prolonged hours.

3. Trending during the lockdown

We compared the number of hours for the following before and during the lockdown - activity, sitting, use of backlit screens, sleep hours, housework, and sleep. There was a fall in the frequency of exercise done in the week. The percentage of people not exercising at all in the week increased by 47.45%. 63.7% report an increase in household work. The following are the trends noted.

	Avg Before Lockdown	Avg During Lockdown	Trends
Sitting(other than work)	2-4 hours	4-6 hours	Increased
Exercises (per week)	4-6 days	2-4 days	Decreased
Mobile use (Other than for Work)	1-3 hours	3-5 hours	Increased
Laptop Use (Other than for work )	2-4 hours	4-6 hours	Increased
Watching TV	1-3 hours	3-5 hours	Increased
Sleeping	6-8hours	7-10 hours	Increased
Household work	2-4 hours	3-6 hours	Increased

4. 50% of participants also reported feeling monotonous lethargic, directionless, and demotivated with 37.5% of people reported an increase in anxiety and stress. 45.2% complained of the altered sleep cycle-

difficulty falling asleep, sleeping, and waking up late. Participants also reported weight gain and indigestion problems.

SOLUTION

We recommend the following solutions to your spine problems

Image source: Reddit.com

A. Posture-

How to maintain an appropriate ergonomic posture while working

Select a chair that supports your hips and knees to bend at a 90-100 degree angle with feet flat on the ground. Use books under the laptop or pillows under you to adjust to the appropriate height.
The chair should have a backrest that supports your lower back to maintain normal lordosis (curve) and armrest that keeps forearms parallel to the ground.
Keep the head and neck centered over shoulders relaxed and rolled back. Avoid Text Neck ( point 5 )
Maintain the top of the laptop/ computer screen at your eye level.
Avoid text neck

Strictly avoid slouching or lounging on sofas and beds while working.
20-20-20 rule - Apply a timer to adjust your posture every 20 mins by getting get up and walking around and sitting down as per the guidelines mentioned above. Along with this, focus at an object approximately 20 feet away and blink for 20 seconds.
While doing household chores, maintain the spine curve and bend from the knees during lifting objects, sweeping floors as below

B. Exercise: We recommend the following spine strengthening formula - 1.lower back + 2.neck with proper form ( see images ) as follows to maintain a flexible and pain-free spine -

Hold each position for 5-10 seconds(as per comfort)
Do 10 repetitions of each exercise. Complete 5 exercises for lower back + neck each
Repeat in 1-3 sets (As per comfort)
10-15 mins every day
Minimum once a day for 4-5 days a week
Twice a day ( morning and evening ) more beneficial
Do In-chair specific exercises during breaks from work every 20-30 mins to prevent stiffness.

a. Lower back exercises. -

b. Neck exercises -

c. Exercises while working -

If you have a treadmill or stationary bicycle in the house, use those for getting your regular dose of cardio.

2. Sunlight and supplements - The most underdiagnosed and undertreated deficiency in India is that of Vitamin D with a very high prevalence through various regions and age groups ranging from 70-90% (Ritu et al). Vitamin D is made in the human body with sunlight exposure to the skin. The lockdown forces us to be completely indoors leading to worsening of vitamin D deficiency. Daily 10-15 mins of sunlight exposure in your windows/balconies/terraces are essential. If your existing levels of Vitamin D are low, oral supplements for Vitamin D along with other essential vitamins after checking your vitamin level profile as per your local doctor is required.

3. Meditation and Breathing exercises- Mindfulness practiced through the meditation of personal choice along with breathing exercises for as little as 5 mins per day can work wonders on keeping calm demeanor and mood.

4. Do's & Don'ts -

Don'ts	Do's
1. Do NOT self-medicate for pain	1.Use Teleconsultation for appropriate advice.
2. Do NOT overexert by copying exercises online/ apps without appropriate fitness levels and warm-up	2. Consult Orthopedic/ Spine surgeon if your back/ spine pain persists for 4 weeks. Do appropriately supervised physiotherapy.