Reading: Has the Pandemic Been a Pain in Your Back? Literally!

Even before the pandemic, I worked from home, occasionally writing from a not-very-ergonomic armchair next to my fireplace, on a porch swing, or even while reclining on my bed. But in my pre-COVID days, I was often in motion, and my frequent bursts of activity balanced out my back-compromising work habits. Like many people, however, I spent a lot more time sitting at home over the past year — and paid the price with a persistent dull ache in my lower back. 

I’m not alone. According to a survey by the American Chiropractic Association, 92 percent of chiropractors said their clients reported more back and neck pain in the wake of public health recommendations to work from home, and doctors around the world have noted a rise in the number of patients complaining about musculoskeletal issues over the course of the pandemic. 

“Sitting in chairs all day is not really what the human body was meant to do,” says Carolyn Keeler, DO, assistant professor of physical medicine and rehabilitation at Duke University School of Medicine. CoveyClub recently consulted with Dr. Keeler about pandemic-related back pain: what causes it, what to do about it, and how to prevent it. 

CoveyClub: According to a recent report in The New York Times, doctors and chiropractors have experienced an uptick in patient visits due to back and neck pain over the course of the pandemic. Would you attribute this increase in patients with musculoskeletal complaints to poor work-at-home habits, a decrease in physical activity, increased stress, or a combination of all three? 

Dr. Keeler: All of these can contribute. First of all, offices make an effort to be ergonomically friendly, hopefully providing a comfortable office chair and an appropriately-sized desk with a computer set up so that you are sitting with 90 degrees from hips to elbows, and the monitor at eye level. But the home office setting is often makeshift, set up in the kitchen or dining room or even on a futon — not the most ideal.  

We do know there is a relationship between pain and stress, and certainly, more stress can exacerbate pain and can affect sleep. During the pandemic, people have had to be more flexible about when they work, maybe making themselves available during hours outside the normal work time, and perhaps having to work later in the day because of kids being home and the school situation. Working later into the evening can affect sleep. And if you aren’t following good sleep hygiene — like shutting down your computer an hour before bedtime — that can also affect the sleep-wake cycle. I really encourage people to try to get as much sleep as they can at this time, because sleep is restorative. The body needs it to recover. 

CoveyClub: Biologically speaking, how might stress exacerbate back or neck pain? 

Dr. Keeler: Stress definitely feeds into some of the pain pathways. Stress is central nervous system-mediated — it can amplify pain signals. And cortisol, the stress hormone, can affect inflammation. Cortisol fluctuates quite a bit during the day, and levels are highest in the morning. One of the ways to help regulate that — and keep the biorhythms in place — is by exercising in the morning. 

CoveyClub: And can decreased sleep and poor dietary choices — both often consequences of increased stress — also lead to increased inflammation in the back?

Dr. Keeler: Generally, in the 30s, 40s, and 50s, women begin to experience degenerative changes in the spine. What tends to happen is that there is a little bit of disc degeneration, and along with that we get a little bit of arthritis formation. By their 50s, women may also develop some bone spurs. The inflammation process can get triggered — whether due to stress or poor work-at-home habits — and can make underlying degenerative spine changes become painful.

Recovery from any damage to the system occurs at night. It’s the time for the body to repair itself. But because hormones can affect sleep, a lot of women around the time of perimenopause and menopause have more sleep issues. 

People often won’t see the connection between diet and back pain, but it all comes down to inflammation. Foods that are high on the glycemic index, unhealthy fats, highly-processed foods, and high-sugar foods, can all promote inflammation and are all things I encourage people to stay away from. I really encourage following an anti-inflammatory diet, including lots of brightly colored fruits and vegetables, whole grains, lots of spices, green tea, low fats. If you like sweets, choose dark chocolate, and if you drink, drink red wine. 

CoveyClub: Clearly, spending countless hours hunched over laptops and smartphones, working, Zooming or doom-scrolling for the latest pandemic news hasn’t done our backs any favors. What can women do differently? 

Dr. Keeler: Laptops are challenging because, in order to have your screen up at eye level, your keyboard is going to be up too high. Using a separate keyboard and having your laptop up on a book or books to raise the screen to eye level allows the head to be in a neutral position so that the neck isn’t hunched forward. And using a separate keyboard also allows arms to be in neutral position so your shoulders can relax as well. 

If you have an ergonomic chair, that’s great, but if you don’t have that available, just make sure your knees (and your hips) are generally in a 90-degree position. Utilizing a pillow — for example, placing one behind your low back — reminds you to keep your pelvis in a neutral position while you’re sitting, even if it doesn’t offer a lot of support. For most people, a balance of sitting and standing is a good idea, so that you’re not in any one position for too long. Work for, say, 45 minutes to an hour and then change positions.

CoveyClub: Are there certain exercises or stretches that can help alleviate back pain? 

Dr. Keeler: What happens with prolonged sitting is that our hip flexors get tight and our gluteal muscles get weaker. We want to correct that throughout the workday by having an alarm set and getting up periodically to do some hip stretches and leg raises. And stretching the upper body — retracting the shoulder blades, pulling them back together, and making sure you move your back out of the hunched position — is really crucial. One way to do this: Stand in the doorway with one arm in the goal post position, an arm at a time, to open up the chest muscles. Also, shoulder circles can be really helpful to make sure upper trapezius muscles are relaxed. That’s even something you can do while sitting or while on a Zoom call. 

CoveyClub: Will these recommendations also help prevent neck pain? 

Dr. Keeler: Keeping your laptop at eye level will help with neck pain. But even with computers set up properly, we’re still on our phones and tablets looking down. Be aware of how much you’re doing that and try to minimize it. Take a break from technology and go for a walk, so that the body is in an upright position and in motion, and your arms are swinging freely. And don’t look at your phone while walking. 

CoveyClub: Can physical therapy help undo the damage done during this protracted period of reduced activity and poor work habits? 

Dr. Keeler: I’m a strong proponent of PT. Even if you’re doing all of your exercises, there are subtle imbalances that can be present that you aren’t aware of. So, for example, if you’re exercising on the treadmill or elliptical and have been sitting all day, your posture might be off, causing you pain. Problems that are just due to overuse or postural issues are usually reversible with the proper type of therapeutic exercise — specifically focusing on core strengthening, pelvic stabilization, and posture.

CoveyClub: How do you know when back or neck pain is simply the result of poor ergonomic choices or too much inactivity vs. a sign of something more serious requiring medical treatment? When should you consult a back specialist? 

Dr. Keeler: Usually I tell people that if pain is present for longer than six weeks, it’s probably time to see the physical therapist or the doctor. The things that you definitely need to see a doctor for: Any sign of focal weakness or weakness in general in the arms or legs can signal a larger problem in the back or neck, like a disc herniation. Other red flags: Back pain that is worse at night, back pain that doesn’t go away no matter what position you are in, back pain associated with fevers, and any kind of loss of bowel or bladder control. Otherwise, in general, physical therapists are really skilled with being first line with back pain.

CoveyClub: Any other recommendations on how women can prevent back problems? 

Dr. Keeler: Exercise! It’s so important in middle age to do all the core strengthening exercises. If you never did them before, now’s the time to start. Focusing on posture is key to women in their forties and beyond. Also, working from home is an opportunity to have a bit of flexibility with your position. You can change your position throughout the day, which can be very helpful. If you have a higher table or shelf, you can move your laptop to a different level and stand while working. You can even lie down. And, again, I really stress the importance of  focusing on quality sleep. Everything you can do to help support your general health — adequate sleep, better diet, and regular exercise — is also going to directly or indirectly affect back pain.