Ask Us Anything About… Back Pain

Barbara Schindo – Good afternoon. And thank you for joining us here today. I’m Barbara Schindo. You are watching Ask Us Anything About Back Pain. So prior to the onset of the coronavirus pandemic, data showed that roughly one in six Americans were working either partially or totally from home. Since the onset of the pandemic and as it continues, many states are pushing for telecommuting. So we can only assume that a larger number of Americans are working from home. And that number continues to increase. The shift to remote work can be putting a strain on our backs as we’re working in different environments. We’re huddling around kitchen tables, we’re sitting on couches, working on coffee tables, or working at a quiet nook, you know, in our house, away from our typical office. And this is putting some strain on our backs. So joining us today to talk about back pain Dr. Tim Reiter. He is a neurosurgeon at Penn State Health, Milton S. Hershey Medical Center. Dr. Reiter, thanks so much for joining us today. So why don’t we talk about back pain? We welcome your comments and questions for Dr. Reiter. If you have a question about back pain, please just post it in the comment field below, below this video here, and we will get an answer for you. So, so Dr. Reiter, let’s start by talking about, you know, people are sitting as I mentioned, sitting on kitchen stools, sitting up at the, on the couch, not sitting in a typical office and a lot of people, anecdotally, you know, I’m hearing a lot of people complaining about back pain. Can you talk about, you know, why sitting in places like that for long periods of time might cause back pain?

Dr. Tim Reiter – Yeah. I mean, I think a lot of it’s with the mechanics and, you know, you need good mechanics while you’re sitting. You know, especially when you’re sitting up straight, which I should be doing now, but I don’t feel like it, you know, kind of engaging your core muscles, you’re strengthening them. I mean, I think it’s a combination of, like you said, it’s for fighting — I shouldn’t say fighting, but we’re competing with the other people in our house for the good workspaces. I know with my kids home from high school, you know, there’s a lot, everybody needs their own room. So we’re not in an optimal seating areas to do our work. And then also, I think we’re getting out of our usual routine as far as exercise, seeing that gyms are closed. So I think it’s important to not only try to find a good workspace, they’re also continuing with some type of exercise programs, so you’re continuing to strengthen your core muscles and staying in shape.

Barbara Schindo – Okay, so you answered this a little bit, but you can talk a little bit more expanding there. So, so for those of us that don’t have the abilities, I’m fortunate enough that I kind of have, I’m able to create my own office space. I have a desk, I have a chair, which has been helpful for me. But, you know, what do you recommend for people who might be experiencing back pain related to that? Is there anything they can do at home or a certain type of chair or seat you might recommend?

Dr. Tim Reiter So I agree getting that, you know, a good chair with good posture. So your two feet flat on the floor, you know, what your [inaudible] talks about sitting up right. And again, you know, kind of, engaging your core muscles when you sit up straight with good posture. Because I think that’ll help a lot. You know, it could be tough if there’s only one office in the house and you have two people working from home and your kids, so who’s going to get the office chair? I think you can, you know, use dining chairs and other chairs where you sit upright in them and try to stay away from, you know, reclining on the sofa or, you know, doing your, my kids are always doing their homework in bed. I think all that is not good for you. But, you know, it’s difficult though. I’m sure, just like all gym equipment’s, it’s almost impossible to find right now because everybody went out and bought a home gym, you know, I’m sure office chairs are hard to find too. So, it will probably take a little bit of creativity, but a lot of it just comes back to just good posture, you know, getting up and moving around every so often. Don’t try to sit there for three hours straight, maybe half an hour, get up and move around, make sure that you’re walking, you’re engaging the muscles in your legs. And then we are sitting kind of engaging your core muscles, sitting up straight, shoulders back every so often take a nice deep breath in, right. That’s good and relaxing. And, yeah. And like I said, the exercise I think is important too. I think the exercise is the most important thing.

Barbara Schindo – So speaking of, of exercise to help kind of relieve some of that back pain, is there any specific type of exercising that you would recommend?

Dr. Tim Reiter So it’s a core exercises. So yoga is very good. Pilates are good. You know, planks, sit ups, anything that works, the core muscles and kind of the proximal leg muscles. Lunges are good. You know, all those — and actually, they’re very good. All those exercises are good for your cardiovascular system too. So, and again I think for most people, as long as you stay within your normal exercise routine. So if you were going to the gym three times a week, try to work it out, work out at home three times a week, you just can’t, now that we’re out of that routine, we can’t forget parts of it. You have to stay in the routine you were in before.

Barbara Schindo – And we do have a question here. We have a question from Dawson. Dawson wants to know, you know, what about standing desks? Is that going to be helpful for back pain?

Dr. Tim Reiter I think it’s, especially with the standing desks that you can change your position in. I think they can be very helpful. I think you have to be a little careful with the standing desks that you’re standing all the way up and you’re not leaning forward and extending your neck. So again, you know, it’s a good thing, but you have to be sure that you’re still using good posture when you’re using that standing desk. So that’s an important takeaway whether you’re sitting or standing is making sure you’re sitting up straight, engaging your core, thinking about your posture, that’ll be helpful.

Barbara Schindo – Absolutely. [Inaudible],

Barbara Schindo – [Inaudible] I need to do myself.

>> Yeah.

[ Laughter ]

Dr. Tim Reiter I think though you might like people talk about meditation and taking a minute or two, just deep breath in, deep breath out. And then getting back to work, I think is very important.

Barbara Schindo – Mm-hm. Thank you very much. So you are watching Ask Us Anything About Back Pain with Dr Tim Reiter who’s a neurosurgeon at Penn State Health Milton S Hershey Medical Center. And we welcome your questions about back pain for Dr. Reiter. So if you have a question, please just insert that in the comment field below this post, and we will get that question answered. So I have one too, that’s kind of about a unique type of desk. What about, I’ve heard some folks say that they feel better if they sit on an exercise ball, you know, when they sit at their desk. And do you find that to be helpful? Again, I think that the reason the exercise ball is helpful is you have to sit up straight with good posture and engage the core muscles. So as long as you’re doing that on the exercise ball, I think it works very well. Personally, I don’t think I would use an exercise ball. I kind of like have a chair that I lean back into. But, you know, it just, you have to think about when you’re sitting there that — think about that position you’re in. And again, I think the taking breaks from sitting too. I think when you sit for an hour, hour and a half straight, I think that’s very, that can add the back pain, because again, you’re not getting up, moving around, engaging the muscles. So, I’m not against the exercise ball chair, but you know, as long as you just sit there with good posture.

Dr. Tim Reiter Okay, so let’s talk about — so, outside of just, you know, back pain because you sit for a long time, back pain could sometimes be a symptom of a larger problem or a more serious health problem. You know, what are some other symptoms, or what symptoms might mean that you have a back problem? So the kind of the red flag with just straight back pain would be back pain at night that wakes you up. And in that case, that could be something more serious. So you really should talk to your doctor about back pain at night that wakes you up. The normal kind of arthritic, mechanical back pain is worse with activity and actually if you lay down. It gets better because you’re no longer loading the back. There’s no weight on the back, so it feels a good bit better. That arthritic pain also gets better with activity. You know, like the engine’s cold in the morning so the car doesn’t run well, right. But as soon as the engine warms up, the car runs well, and that’s the same with us. You know, the joints are a little stiff in the morning and once you get a move in then they move easier and easier. So that’s the normal kind of back pain. As a neurosurgeon, we’re all about the nerves and the spinal cord, so we usually get involved when those are pinched or comp, you know, squeeze. And that, this is where you talk about shooting pain down the leg or shooting pain on the arm. So that’s consistent with pinched nerve or radiculopathy. And that would be something that I could help if, you know, if the nerve’s pinched sometimes a steroid injection can help, sometimes physical therapy can help or surgically, I can go in and open up and, you know, if there’s a disc herniation, I can take that out and unpinch the nerve root. And then the other thing would be the spinal cord, like up in the neck. If that’s pinched, that’s usually, there’s symptoms. You’d be clumsy and can’t walk. They’re pretty obvious symptoms. And that’s something I can treat also.

Barbara Schindo – Okay. One of the things you, you just mentioned there was, some signs of a pinched nerve. So how, so what is, what causes a pinched nerve, and what would that, how would that cause damage.?

Dr. Tim Reiter So pinched nerve, can be caused a lot of different things. Probably the most common thing people think about would be a disc herniation. So a little piece of the disc breaks out from that central core. So like a little jelly comes out of the donut. It goes into the spinal canal within the spinal canal, it pinches the nerve. So that’s probably the most common thing, what we think about. It can also be caused by just bone spurs. So, you know, with arthritis, the bone kind of overgrows a little bit, the disc bulges out in that bone spur can kind of encroach upon the tunnel where the nerve root goes through. So that can pinch a nerve also, and then sometimes it’s just, because the spine is a dynamic structure. The nerves come out between the bones, you know, just kind of moving wrong, your spine twists in a funny way, pinches a nerve. But then when it comes back to where it should be, the nerves no longer pinched. So, you know, there’s all different things that can pinch a nerve. Some of them we can fix, some of them you don’t need to fix. The nerve just has to calm down. And, you know, in that last example where the nerve gets pinched, but when the spine goes back into normal alignment, it’s not pinched anymore. That’s something that an epidural steroid injection can be very helpful for.

Barbara Schindo – Okay, thank you. We will get back to it to that type of pain. Another question I had about a pinched nerve, too, but before we do that, we do have another question from one of our viewers here, her name is Gabrielle. And she has a question, which we can, her question specifically is about nurses, but I think we can kind of expand this to a larger population. Just, you know, how can you prevent back pain when you’re doing awkward maneuvers, like boosting heavy patients, skincare. You know, something like that, but I think we can kind of broaden that out to anybody who has a big part of their job is, is lifting heavy things or moving heavy things. You know, how can we help prevent back pain for things like that?

Dr. Tim Reiter Yeah. I think that’s a good point,. You know, I see, you’ll see people with these herniations that give the story that they were lifting something in an awkward manner. So, I mean, I think as much as you can, you want to kind of be straight on, you know, not leaning over to pick something up. I mean, this isn’t always possible, but you know, the better the lifting mechanics, that you practice, the less chance you’ll have it at developing a problem. So, you know, kind of lift with your legs, the stuff we always talk about and talk about, you know, you hug the weight, you try to lift with your legs. You try not to lean forward when you’re picking something up. I think, you know, going back to the exercise part, if you have very strong core muscles to begin with, then I think you have a less of a chance of developing something. Because the core muscles are going to kind of protect the spine even in that awkward position. But you know, I think we just have to really think about when we’re picking something up heavy, and especially a nerve thing, if you’re rushed, and you know, there’s something really serious going on, it’s harder to do this, but sometimes if you have a moment to do it, take, think a minute before you do it. So you can try to optimize your mechanics when you lift something.

Barbara Schindo – Okay. Thank you. So I want to get back to talking a little bit more about radicular pain and the pinched nerve that you had mentioned. Can, I guess this is kind of a broader question too, but sitting for a long time cause something like that? Like can sitting for a long time in the wrong position cause any serious problems that people should be aware of?

Dr. Tim Reiter I have definitely had patients come in and complain about maybe their parent was in the hospital or they’re on a really long flight. And after that develop arm pain or leg pain, and had a disc herniation. You know, I think again, I think they say maybe they fell asleep in a funny position with their neck down and, and, you know, it’s always seems like there’s some, something in addition to just sitting. They were sitting in some awkward position that that caused it. There is some literature out there that shows that if you look at the pressure within the disc itself, in the lumbar spine, in the low back, the pressure is highest when we’re sitting. So sitting definitely stresses the spine more than other positions. So, you know, I think it is important to try to have good posture and engage the core muscles. You know it’s okay to sit in a recliner and relax every so often. But, you know, especially if you’re doing work or something where you’re concentrating, try to be in a mechanically, try to optimize your position.

Barbara Schindo – Okay. Thank you. Again, you’re watching, Ask Us Anything About Back Pain with Dr Tim Reiter, neurosurgeon at Penn State Health Milton S Hershey Medical Center. We welcome your questions for Dr. Reiter whether you’re watching this in the live broadcast, or if you’re watching a playback, you can insert your question in the comment field below this video here. And we will get an answer for you, whether it’s live or on playback. Either way is fine. So, I wanted to go back to the standing desk question or if someone’s going to use a standing desk, do you recommend a time period for that they should be standing and then maybe taking a break. Like should they, is it okay to stand all day if you want to do that, or should you take a break and sit down?

Dr. Tim Reiter So I end up standing a lot in the OR so, but no, I think again, it’s just moving around. So I think if you’re going to be standing there doing work, usually talk to patients about kind of 15 minutes, maybe up to a half an hour postoperatively where you want to just move around and change your position. So I think I would say the same thing here. I mean, optimally, you know, I wouldn’t work more than half an hour before I kind of moved around. You know, just for general health, just moving the legs and, again, taking a deep breath. You know, I think that’s a good rule, but can’t say I have any data to support it, but I’d say about a half hour.

Barbara Schindo – And would you say the same for people sitting? If you work in an office where you sit at your desk from eight to five, would you recommend once every 30 minutes take a quick walk, or get up and move around?

Dr. Tim Reiter – I would, absolutely. Just at least stand up. Yeah. Take a deep breath.

Barbara Schindo – Okay. Is there anything, you know, that I had missed asking you that you think is important to add?

Dr. Tim Reiter – I don’t think so. Again, I think, especially if back pain lasts, you know, if you have back pain and it’s lasted over a month, I think you should talk to your physician about it. You know, it’s not getting better with doing some exercises. And we talked a little bit about the night-time back pain that wakes you up. You need to talk to your physician. And, again, you know, pinched nerves are usually pretty miserable. So you know that that’s something to talk to your physician about. And with the pinched nerve, it can be pain, it can be numbness or tingling, anything the nerve does, you can have that type of symptoms. So.

Barbara Schindo – Okay. And Dr Reiter, you know, for anybody who’s watching this, who’s thinking that’s me, I’ve been having back pain for a long time. What kind of advice would you give them? Should they call the Spine Center, you’re at Penn state health? Or what would you recommend?

Dr. Tim Reiter – I think it’s best to start with your primary physician, just so they’re kind of on board and know what you’re doing. I think it’s, again, this is fine to call the spine center and talk to us. And we’ll also communicate with primary physician. You know, I think the initial workup usually consists of just physical therapy, some x-rays and then seeing if this is again something that should go away with just some conservative care. If the symptoms are severe, then I would call sooner. I mean, if you’re really bad leg pain and you can’t sleep at night, absolutely. You know, that’s when you need to call your primary physician or the spine center to be seen sooner. And then, you know, symptoms like weakness, or the hands are clumsy, or you’re really having trouble walking where you need a cane or something just to get anywhere, that those are things that, you know, you need to get a hold of somebody soon. And then those are things that if you call our schedulers in the spine center, tell them that and they know to get you in a sooner appointment.

Barbara Schindo – That is very helpful, and so if you’re calling for an appointment, or calling to ask any questions, just be clear about what it is your symptoms and what you need, and we can help you with that. So we do have another question here from a viewer, and this is Gabrielle again asking, do you agree with chiropractic care or should patients see physical therapist for back pain or both?

Dr. Tim Reiter – I have very good experience with chiropractors. We actually have a chiropractic group who comes to some of our conferences. And adds a lot to the conversation. I think there, again, there’s certain, I think, there’s certain problems that need more urgent care. And I think chiropractors are very good at recognizing their problems and getting those patients to surgeons if needed. So I think chiropractors do very good work, and we actually, I will send people to a chiropractor sometimes, too. So we work well with them.

Barbara Schindo – Oh, good. So they can, that you can be a part of a comprehensive care to help people who are who are suffering from back pain. And it looks like Holly commented too that that a chiropractor has helped her when she had back pain working from home. So I just have one more question for you. Dr. Reiter that I just thought of here that I, before we wrap up. If you, before I was able to put this, I have an office, I have a desk but before I was doing that, I was working at a coffee table, and I did, you know, my back was hurting. Would you recommend what about maybe putting ice or a heating pad on the back? Was that, is that recommended or do you feel like that helpful or not.

Dr. Tim Reiter – So, usually acute pain, you use ice. So if something just happened for the last day or two, and the back really is bothering you, or you lifted something you shouldn’t have the day before, then ice for the first 24 to 48 hours is probably what works best. If it’s more chronic condition and more arthritic, and when you first get up in the morning, the back’s real sore and hurts, but as you move, it loosens up then it’s kind of like the cold engine. So you just want to put heat on that. So more chronic conditions are heat. But if you injure your back, for the first 24 to 48 hours, it’s ice.

Barbara Schindo – Okay. That is really good to know because I think I was doing that backwards [chuckle] if I have body pain I reach for the heating pad. So I very much appreciate that personally. So, Dr. Reiter, thank you so much for joining us, this has been, this has been very helpful. This is important information to have, so we appreciate your time. And for those of you watching we appreciate you joining us. And if anybody’s watching this on playback, and you have a question for Dr. Reiter, please feel free to put it in the comment field below the post, and we will get an answer to you within the coming days. So thanks very much for watching, and thank you very much Dr. Reiter for your time.

Dr. Tim Reiter – You’re welcome.