Adapting to Change: UM Physiatrists’ Guide to Keeping the Cane Community Aligned & Pain Free

by Armando Alvarez MD MPH, Rosa Rodriguez MD, Laura Huang MD

Photo by Karolina Grabowska from Pexels

It’s a pain, both working from home and sometimes, the way we work from home. Poor posture may lead to back and neck stiffness, pain, and strains, also sometimes referred to generally as myofascial pain syndrome. Symptoms can range from a limited mild discomfort to a long lasting, persistent, searing and burning pain that limits your ability to move and focus on your work. A lot is changing and without a doubt social distancing and stay at home orders have led to significant shifts in how we work and attend school. Faculty, staff and students have been forced to reinvent and transition from the physical classroom and meeting spaces into virtual ones. Merriam-Webster defines ergonomics as ‘an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely.’ Working and learning from home, your efficient and safe ergonomic office or library set up may now be a couch or kitchen table. In the home office setting, the U community is also facing reduced physical activity and prolonged sitting, which are known to further exacerbate muscular imbalances and pain. As Physiatrists aka Physical Medicine and Rehabilitation (PM&R) specialists, we deal with functional disorders of muscles, nerves and bones and can be thought of as the MacGyver’s of adaptation. The purpose of our letter to you this is to make your life a little bit easier, healthier, and hopefully a little less painful.

Posture & Ergonomics

‘A good stance and posture reflect a proper state of mind.’ — Morihei Ueshiba

‘Good posture is the one most important thing anybody can do now to look better.’ — Helen Gurley Brown

Prolonged sitting, particularly with poor postural alignment, can contribute to stiffness of front body muscles (think front of your hips and chest muscles) and weakness of back body muscles (think glutes and muscles between the shoulder blades). Let’s call proper postural alignment of your head, neck, shoulders, spine, hips and legs ‘home base.’ Postural deviations from home base tend to be subtle but compounding in nature. You might not be aware of these subtle postural deviations until the pain hits you several days and many hours later.

The most ergonomic and evidence-based approach to sitting in front of a computer or laptop is with both feet flat on the floor about hips’ distance apart. The angle of your knees, hips and elbows should be 90°. Shoulders should be down and back, with a gentle downward tuck of your chin. Your gaze should fall to the midpoint of the screen.

If your feet don’t quite reach the floor, a small step stool or old textbooks can bring the floor up to you. If you’re lucky to have a counter or shelf around the right height for yourself, consider converting it to a standing desk.

A novel and unusual predicament that working, teaching, and learning from home provides is the essential and exclusive use of computer cameras or laptops for teleconferencing. Some may not even be aware that these technologically essential tools may be leading to increased pain. When cameras are positioned too high, neck pain may result secondary to extension strain (neck craning upwards from). Conversely, cameras positioned too low may cause pain from prolonged neck flexion (bending forward too much). Ideally, the camera would be about the level of your lower face. Books can be stacked under the laptop or camera to bring it to an ergonomic height. Utilizing a keyboard and mouse separate from the laptop may also be more comfortable for some individuals to minimize wrist or shoulder discomfort.

A chair with a firm seat and back support is preferred for spinal support. For low back support, a pillow or rolled up towel can be placed in the curve of your low back. Products such as lumbar support rolls and wedge cushions are also readily available for purchase online.

Physical Activity & Exercise

For those individuals who are teaching, keep in mind the prolonged sitting times of your students. Allowing a quick break after 15–30 minutes of lecture, given the unique circumstance of finagling with the computer camera, may alleviate some inattention stemming from an uncomfortable position or posture. These imbalances can cause significant back, shoulder and neck pain. Coupled with decreased physical activity, it can lead to a sore outcome and worsening pain, which leads to worsening productivity, more physical inactivity and worsening posture, a vicious and unrelenting cycle.

As Physiatrists, we like to approach problems holistically. We would feel remiss to give you tips on posture and pain without also mentioning physical activity and exercise. More and more data are emerging regarding the positive effects of physical activity and exercise on not only the body’s immune system, mental health, sleep, but also their role in reducing one’s overall risk of developing heart disease, cancer, obesity and dementia.

For best results, try to spread your physical activity throughout your day. We recommend taking breaks every 20–30 minutes or at the very least, every 60 minutes. Try to avoid going to the kitchen and snacking often! If you must snack, go for fresh or unprocessed foods that are rich in fiber. Staying hydrated, maintaining a consistent sleep schedule, and regular stress reduction practices are also key components in to your overall wellness. At the bottom, we will give you some recommendations for exercises and wellness tips to integrate into your daily practice!

Multiple organizations, including the American Heart Association, American Cancer Society and the American College of Sports Medicine recommend that every adult get 150 minutes per week of moderate intensity exercise. 150 minutes may sound like a lot, but divided over 5 days, is only 30 minutes per day!

Moderate intensity exercise = ability to talk but not sing while performing the exercise.

Get creative, there are numerous online resources, depending on your interests. Regular exercise is about finding something you enjoy doing and will do consistently.

Telecommuting and the changes that it brings can be difficult, but by adapting together, we can achieve great things and make this time the best we can. We are all in this together!

A sample home body weight exercise routine:

Warm-Up (Total 5 minutes)

1) Jumping Jacks (30–45 seconds with 15 second break). Modification: step one foot to the side at a time.

Alternating with:

2) Running or walking in place (30–45 seconds with 15 second break)

Work out

1) Mountain climbers x 30 seconds

2) Bodyweight squats x10 reps (modification can be made by sitting and standing from a chair)

3) Pushups x10 reps (modification can be made with knees on the floor)

4) Shoulder circles x 30 seconds: hold your arms by your side, lift them to look like an airplane and perform circles in a forward direction. Not hard enough? Hold a water bottle in each hand. After 30 second rest break, repeat for 30 seconds with circles in a backwards direction.

5) Plank x 30 seconds: start in pushup position and then place your forearms down on the ground while maintaining the same leg position, squeeze in your belly and breathe while holding (modification can be made by putting your knees on the ground)

This circuit can be done 3x through with breaks as necessary.

If appropriate, a walk around your neighborhood while practicing social distancing is a good and safe way to get yourself moving. These healthy breaks will set you up for long term success!

During your breaks, consider these stretches:

• Overhead side stretch: where you stand tall and interlock your fingers above your head. With arms directly overhead, lean to the left and you should feel a stretch down your right torso, repeat on the right side so there is a stretch on the left. This can also be modified by staying seated and performing the same actions.
• Chest stretch: interlock fingers behind your low back and lift your palms up and away from your body.
• Twisting Trunk stretch: reach your right hand in front of your body and place it on your left hip, then reach your left hand behind your back and try to place it on the right hip, then finally turn your head to look behind you. This will allow you to twist your body to the left. Repeat on opposite side. Can be performed sitting or standing.
• Hamstring stretch: place your heel, one at a time, on an elevated surface like a bench or stool, and gently hinge forward from your hips until you feel a stretch in the back of your thigh.
• Quadriceps stretch: while standing on the left leg, bend the right knee and hold the right ankle with your hand and bring your heel as close as you can to your glute, this will stretch the front of your thigh. Repeat with opposite leg.
• Calf stretch: place both hands on a wall and stand with your right foot close to the wall with the knee bent to 20–30°, then place your left foot about 2–3 away from the wall and straighten the leg. You should feel a gentle and comfortable stretch in the backside of the left leg. Repeat with opposite leg.
• Try to do each stretch 3 times and hold each one for 30 seconds.
• Movements should be slow and controlled.
• Take slow deep breaths with each movement.
• Stretching can cause some pain initially, especially if you are stiff. This should improve as you continue to stretch. Please discontinue the movement if it is causing excessive discomfort.
• For additional or alternative stretches, you can do an online search of the stretch names above.

Armando is a PGY-3 resident, Rosa is a PGY-4 resident, and Dr. Huang is an attending physician at the University of Miami in Florida.

Questions or comments? Email us at: a.alvarez1818@med.miami.edu or Tweet us at @mandoalvarezpmr