Transcription:
Back Health and Working From Home

Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.

Amanda Wilde (Host): Welcome to BayCare HealthChat. I'm Amanda Wilde. And I invite you to listen as we discuss back health and working from home. I'm joined today by Michael Venezia, Doctor of Osteopathy, specializing in Orthopedic and Spine surgery in the BayCare Health System. Dr. Venezia, thank you so much for your time today. Back pain is so common. Why is that?

Michael Venezia, DO (Guest): Thanks for having me on the podcast. Happy to be here. It's a great question. There's a lot of different causes of back pain itself. It's one of the most common complaints that we see in the medical field actually. And it's also the leading cause of workplace disability, which is kind of a staggering thing. And then as we've kind of moved into everyone working from home, I think we're, we're seeing a huge rise in back and neck pain in our practices, just because it's such a different environment that we're used to. And, you know, back pain has physical as well as mental components to it.

So, there's the stresses of life that we can't really do much about, tackling day to day. And then there's the physical component of back pain and back pain, as we all know is multi-factorial. It can be anywhere from musculoskeletal to obviously neurologic in its structures.

So, there's a lot of different causes of low back pain. But with regards to working from home, I think we moved to an environment that we weren't entirely prepared for. Having the proper posture is essential to take the stress off of your neck and your back.

And having these prolonged days where you're sitting in now non-ergonomic chairs, maybe you're sitting at your table, some people are sitting on their bed, sitting on a chair or a sofa, and it's just different and it's not what we're used to. And, your body needs motion and it needs to constantly be used.

And we've gone to this more sedentary lifestyle, I think in this, working from home environment. Where it's just so easy to be seated for a long period of time and lose track of time. I'm sure we've all done it. Sitting at home, doing charts and I forget about it and wake up with a little bit of a back pain myself.

Host: Where are you sitting right now?

Dr. Venezia: I'm unfortunately sitting on a sofa. What I just told you guys not to do. So, I probably should be working on my posture now and I'm glad we're not on Zoom.

Host: Well, I was wondering, is it posture? Is it hereditary? Is it mainly caused by injury? We were talking a bit about posture, but also is it simply inherent for human beings as we've evolved to walking up right?

Dr. Venezia: It's a great point. In fellowship, where I trained, one of the professors used to always say that life is a kyphosing event, which is kind of the curvature that top of our spine takes. And you can see that as we age, we get a little bit more hunched over, and there definitely is a hereditary component too, to back issues. But there's also, as we are adapting, from we're going back to standing upright and now we're adapting to leaning forward. And there was a couple of reasonably good papers that have come out over the last two years about the incidence of neck pain related to cell phone usage, because now we're looking down for everything, right?

Host: You were just talking about other parts of the body that are involved with back pain. Our necks, as we look down at our cell phones has changed our posture. There's always pelvic exercises and we're always thinking about our center and moving from our center. And if we don't there's problems there and then, leg pain is indicative in back pain. So, how does back pain cause leg pain and how do these things all interact with each other? I've also heard of sciatica. I don't really know what that is. Is that like nerve pain?

Dr. Venezia: Those are all great questions. So, our spine is a connected series of bones that travels from the bottom of the skull all the way down to our sacrum, which is kind of the largest bone of the spine that articulates with the pelvis. So it's all kind of one interconnected component. And the spine itself is a multitude of bones that protect the nervous structures, that supply our legs and our arms. And that's why, you know, you may get sent to the spine surgeon for leg pain when you're thinking, well, I don't, I don't have any back pain, but it's my leg that hurts. And that's a component of another back issue. And that's where sciatica comes in, where it's actually a collection of a multitude of nerve roots that are in the bottom of the spine, in the lumbar spine, that form the largest nerve in the body, which is the sciatic nerve.

And that does a lot of the processes in your leg, whether it functions for sensation and motor function of your legs. And when you hear people say sciatica, it's often a misnomer where they think they're diagnosed with sciatica where sciatica is more of a symptom, it's pain in that specific region of the body. And it's usually caused by a multitude of different things. It could be one of those nerve roots are being pinched from the spine itself. It could be the sciatic nerve is being pinched by muscle spasms. Or it could be some exterior entrapment somewhere outside of the spine itself. There's a multitude of things that can be causing your leg pain that all are potentially emanating from the spine, unfortunately,

Host: So the spine is actually the cause? Or do they feed each other?

Dr. Venezia: So, a lot of times the spine itself is the actual causative agent in what's causing your leg pain and that comes from external compression on some of these nerves that feed the leg itself. There's a lot of different things going on in the spine itself that could be contributing to your symptoms, but, especially when it comes to people that have back pain from non-traumatic things. When we think about injuries and in injuries more often you can see a herniated disc from a car accident or a slip and fall causing a compression fracture, things like that, but, low back pain and sciatica, or leg pain that occurs with that, that kind of occurs over time or with things like posture, unfortunately from being sedentary or from just, not using the correct muscles or just wear and tear of the spine, it's not an all or nothing event. These processes can occur over time.

Host: Well, everything's interconnected. It reminds me of that skeleton song, the leg bone's connected to and the knee bone, you know.

Dr. Venezia: That's exactly right.

Host: So everything's affecting everything else. And then as we age too, that's got to be a factor. I mean, osteoporosis, and then isn't there some kind of skeletal shrinkage over time as we age? So, that process also might affect our back?

Dr. Venezia: Yeah. So, I mean, osteoporosis can play a huge role in back issues. One of the main issues that it can cause is osteoporotic compression fractures of the spine. Unfortunately, it's something that I commonly see in my area of the world where people don't even have an injury per se. They just end up waking up one day with severe back pain and x-rays are taken and it shows that they have a fracture and how do you get a fracture without having an injury or falling off of the cliff or getting hit by a car. But unfortunately when your bones develop this weakening, they can break on just the weight of the body itself.

So, it definitely plays a role in skeletal health, maintaining strong bone structure and something that prevention is key here, you know, even as a surgeon, the biggest thing I tell these patients that they need to be focusing on is strengthening their bones, so this doesn't happen again.

Host: Well, how do we do that? How do we strengthen our bones?

Dr. Venezia: Unfortunately, it would be nice if it's as simple as the movie's taught us to just drink a bunch of milk, but, at some point, when you are truly an osteoporosis patient that's just not enough calcium and vitamin D. It isn't enough to supplement.

So that's when you should be talking to your primary care physician about adding an osteoporosis medication that helps actually build bone or prevent bone from being reabsorbed. These are important drugs that we've made lightspeed's of advancements in over the last decade or so, and, unfortunately a very common selection of drugs that we do use to help prevent these issues from happening.

Host: What else can we do to prevent getting into position where we have back and neck pain? How do I avoid that low back pain?

Dr. Venezia: Great question because everybody wants to avoid having to see me. Cause if you're seeing me, that means that things must be really bad. The biggest thing is, coming from a working from home standpoint is being cognizant of your environment, right? And to help prevent these issues from arising and, making sure to not be sedentary for three, four or five hours at a time, to schedule breaks where you're walking, stand up, we all have iPhones, right? You can set an alert, just to go out for a walk around the house or go out for around the neighborhood. Some of the best things that we can be doing is stretching exercises, exercises to strengthen the muscles in our back, as well as our core muscles, which is often an overlooked section of our body that really contributes to spine health because our core muscles themselves are actually the secondary stabilizers to our spine.

So, having a strong, functioning, almost sandwich of muscles, if you think about it, you have your muscles in your back, that run up and down your spine that need to be able to help keep you balanced, keep your posture well, and then you have the muscles in the front, your core muscles that kind of help balance those out.

Host: If you could recommend just one exercise to ease back pain or prevent it, what would that be?

Michael Venezia, DO (Guest): I recommend a few different ones, but anyone that can tolerate, even on your knees, a plank, which is an exercise you can do for core. I recommend doing those, as well as, on your back doing an exercise where you take your knees and you stretch your paraspinal muscles. Anything to help engage these muscles because we’re not using them as often as we should be, not in the correct manner, unfortunately, a lot of times using them in poor posture. And, as I’m leaning hunched over my laptop right now, doing exactly what I’m telling you, not to, we’re not engaging them, how they need to be engaged. So, those are some really important ones that I emphasize most of my patients to do.

Host: When I find myself hunching over, I tend to, when I see it, that I’m doing that, I tend to try to compensate by doing like the opposite move. Does that work? Instead of hunching over, you then maybe arch your spine or bring your shoulders down.

Dr. Venezia: I mean, I think that being aware of that is better than not, but I think sometimes we may overcompensate because we may actually hyper extend our neck and bring it back too much. But what that comes down to is looking at your environment and seeing what's going on around you, that's causing you to be hunched over and how to fix that, so it's less of you trying to compensate and it being more natural. So, ensuring your screen is not too far from your face, ensuring that you don't have to reach too far for your keyboard or your mouse or your writing device, whatever it may be. Making sure things are at eye level, so that you're not forced to overcompensate for what you're already trying to fix.

Host: You were talking about how sedentary we tend to be when we are working. Is there a certain way we should be sitting? Is there something we should be aware of the help us sit correctly? You were talking about having things at the right level, for example, which, like you said, a lot of people working at the table, the table is not really the right height. So, that is something we might be able to correct? Is there a posture that we should be in when we are sitting and working?

Dr. Venezia: Our bodies want to sit in our natural you call it an almost an S shaped curve that if you looked at our spine from the side, we have a sway in our back that's called lordosis. And then we have a kyphosis in the thoracic spine, which kind of hunches over, and then the cervical spine of the neck curves back. So it's kind of a slow sweeping S and you want to be able to support that. And actually it's things that we often overlook in an office environment where a lot of these chairs have been designed for that, with supports on the back of the pillows, in the lumbar region to help encourage that sway back. As well as, the distance we are. Your feet need to be on a flat surface. If you're, if you're reaching up or down or they're hunched over then that becomes an issue that, forces again, everything's connected, like you said, and the song taught us as kids, that if you're overextending in your legs, then it's going to stress your back out the way it shouldn't be.

And then, you know, thinking about things like your screen. The recommendation from a lot of therapists and stuff that have done work on this have said that they don't want your screen any more than an arm's length. So you're not straining and then you start having issues with your eyes.

But you're also not too close to where you end up leaning forward. It's important to kind of think of your entire environment and it's sometimes it, it may be required to augment your environment to make it more comfortable.

Host: Yeah, maybe we should all have a checklist of things that we need to have in our environment to help us with our posture.

Dr. Venezia: That's a great idea. You're onto something I think.

Host: So, what would those things be?

Dr. Venezia: Yeah, I would say ensure that your chair is properly set up, at the right height. Like we talked about feet flat on the ground. So, make sure as you're going through a checklist, you got to check your chair and make sure it looks okay. And then, I would say, make sure your screen and what you're doing in front of you is set up appropriately.

So we talked about keeping it no more than an arm's length away. Having some ergonomic things set up like a keyboard and mouse that are within arm's reach. And I think really from a surgeon standpoint on top of posture and the most important things you can be doing is, not sitting. So, every couple hours, make sure there's a reminder there to get up and go for a quick walk.

Do a stretch, take five minutes out of your day and mobilize those joints. Cause if you think about it, the back itself, each level that connects has two little joints on each side that are no different than a knee or a hip it's just, their range of motion is different, but they have cartilage and they're fed by synovial fluid and that fluid in there needs motion to continue to bathe that area with nutrients. So, our bodies rely on motion. We're creatures that crave it. But as we become more sedentary, we have to be more cognizant of being able to still stay active and still keep moving.

Host: When you are working from home, if you're in a situation, maybe you're on Zooms or you can't get up. Are there exercises you can do while seated to sort of put some of those fluids in motion?

Dr. Venezia: Yeah. I think I remember always going on the airplane and they talk about doing some calf stretches and heel raises and things like that while you're seated to avoid things like a blood clot while flying. And I think some of that stuff can come into play as well, too. You are still a little bit limited to what you can do in a seated position. But there are actually, I know that there's some companies that are selling little recumbent cycling machines that you can put under your desk and you can actually cycle while sitting at a chair, you know, so there's definitely some options to do. I think that, it may be getting a little bit challenging to really provide enough value. But anything that you're doing that shows you're kind of thinking about that is going to help keep this from happening.

Host: Yeah, that's a different kind of multitasking, isn't it? You specialize in orthopedic and spine surgery. And you said people don't really want to see you because by the time they've seen you, the situation is, come to needing surgery. When do we find ourselves in that situation? What do you see in your patients that makes them need to come to a spine surgeon?

Dr. Venezia: I do see a lot of people with just back pain and in all reality, the amount of people that need spine surgery is very low, thankfully. But typically, in my patient population, I see a lot of back pain, obviously, a lot of leg and arm pain from associated problems in the neck and low back. And a lot of these problems that have been ongoing for long periods of time that have not improved with conservative treatment, or, if I'm seeing them for the first time, that still need a lot of conservative treatment to see if we can get this better without surgery. Things like physical therapy and injections and, anti-inflammatories that we can use to help with their symptoms. But, I see the whole gamut. I see a lot of deformity patients that have malalignments of their spine and things like that, that unfortunately, are surgical patients.

Host: So, there are issues you can correct through surgery?

Dr. Venezia: Oh, yes, of course. Spine surgery is great for the people that really need it. It has very good outcomes and I think we're just getting better by the year with our understanding and our thoughtfulness and more minimally invasive type procedures that not only can be tissue sparing, which is important, but we've gotten so much better with technology and the ability to target specific levels.

And instead of having to do a large surgery, we can do something that's small and tailored towards the patient and using a combination of injections and things to target what their actual pain generator is. And that's the most challenging thing I think in spine surgery itself is what is the actual pain generator that's causing this person to have such a problem. And if we can figure that out, then we can have a tailored solution for that patient that's less invasive, that gets them out of the hospital faster and gets them out of pain faster.

Host: But before we get there, hopefully I'm hearing motion, motion, motion, and muscular health and environment and medication if needed.

Dr. Venezia: I couldn't say it any better. Yes, I think the, you know, motion, I tell my patients all the time, is the key to all of this. I put almost all of my patients into physical therapy and the goals of the therapists have been laid out to them. They need to provide these people with home exercise plans that they can execute on their own because that's the key to preventing this from getting worse or needing surgery in the future.

Host: Dr. Venezia. Thank you so much. I'm ready for us to take a big stretch and maybe walk around a bit.

Dr. Venezia: Thank you so much for having me on. It was, great and I had a great time.

Host: And that wraps up this episode of BayCare HealthChat. Head over to our website at BayCare.org for more information, and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts. For more health tips and updates, follow us on your social channels.

If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. I'm Amanda Wilde. Thanks for listening and stay well.