Working From Home? Top Tips to Avoid Aches and Pains!
The COVID-19 virus continues to affect us even as we enter the second year of the pandemic. One of the major changes that a lot of us has had to deal with is the concept of “Working From Home” (WFH).
In my orthopaedic and sports medicine practice, I have seen an increasing number of patients who complain of symptoms that uncannily seem to stem from WFH practices. Let me share some of my experiences in this article.
“Doc, my neck is painful and stiff. Sometimes, I even get pain running down my arm!”
Ms Y is in the banking industry and has been on WFH for most days of the week since the Circuit Breaker last year. In the last 2 months, she has been having a gnawing left sided neck pain that she had earlier dismissed as a simple neck strain. However, the pain had gotten worse and appeared to be becoming more frequent. She also began to feel tingling and numbness in her left upper arm and forearm.
It became clear to me that Ms Y had been spending uninterrupted hours at her desk at home, working on her laptop and staring at the screen. Previously, when she was working in the office, Ms Y would take more breaks. For example, these breaks included going out for lunch or moving to another room for meetings (instead of having “virtual” WFH meetings).
In Miss Y’s case, this had gradually resulted in her neck muscles becoming tight with tension. In severe cases, prolonged poor posture can lead to a degenerated neck (cervical) spine. When the nerves become “pinched” in severe cases, sensations such as pins and needles, numbness or a deep pain can occur. A magnetic resonance imaging (MRI) scan was subsequently performed on Ms Y, which showed a degenerated cervical spine with nerve impingement.
I was able to convince Ms Y to correct her poor posture and improve the ergonomics of her workstation. That helped her to reduce the frequency and duration of pain. She was also disciplined in making the effort to regularly move and stretch her neck while working. I suggested for her to set a timer alarm to remind her to take heed of her posture and to move around. This helps to distribute the load stresses and prevent severe pain from setting in.
In addition, I referred her to a physiotherapist who was able to relieve her neck ache and upper limb symptoms with a combination of manual therapy, stretching and strengthening exercises. Ms Y’s symptoms progressively resolved over a month with the above measures.
Miss Y’s case is not considered severe. Less commonly, in more severe cases, invasive procedures such as nerve block injections and surgery may be beneficial and therefore, may be recommended by the doctor.
“My low back pain is killing me! I can’t sit for long!”
One month ago, Ms J, who is in the Information Technology industry, limped into my consultation room clutching her right lower back. She had earlier emailed me in the middle of the night, requesting for an early medical appointment to relieve her severe low back pain and shooting pain down her right leg. Ms J was not even able to sit down for the consultation. I took her medical history while she was standing as she could not sit without pain worsening over her back and leg.
Hers was a typical condition of a low back (lumbar) slipped disc resulting in a “pinched” nerve. A year ago, she had actually recovered from similar symptoms resulting from a tennis injury. However, the last few months of WFH had her sitting for many hours in front of a computer, engrossed in “virtual meetings”. Prolonged sitting places a constant huge amount of weight on the lower back and had inadvertently caused her symptoms to flare up.
I was prepared to admit her into hospital for bed rest and stronger painkillers, but she was determined to go home as she has young children to look after. Thankfully, she gradually recovered with physiotherapy, medication and a renewed diligence in checking her posture regularly as well as taking frequent stretching breaks. Ms J is fortunate to have recovered well as she had recognised quickly the severity of her condition and sought early medical opinion.
“Dr Ong, my shoulder is painful and becoming stiff, I don’t remember injuring it.”
“Hi Doc Ong, my shoulder has been painful for about 2 months and it’s especially worse when I try to pull up my pants. It’s also getting a bit stiffer and I can only wash my hair with the other arm,” said Mr K, a lawyer, when he came into my consultation room pointing to his right shoulder.
Upon further queries, I learnt that Mr K had only recently started home exercise fitness routines after he was encouraged to WFH. “Too busy to look for a gym outside and it is more time efficient to work up a sweat at home!” Mr K reasoned. Mr K’s home exercise routine consisted of a high intensity series of push-ups, sit-ups, planks and jumping jacks.
After a thorough physical examination and MRI scan, I confirmed a diagnosis of a rotator cuff tendon tear with resulting frozen shoulder (adhesive capsulitis). The rotator cuff is a group of muscles and tendons that controls movement of the shoulder joint. It can be injured when a person undergoes vigorous upper limb movement exercises. This is especially more common if training is not progressive, or if a patient is older and had developed a degenerative bone spur. This bony prominence then causes pinching and rubbing of the muscle tendon, resulting in a tear. A rotator cuff tendon tear can be very painful and may lead to a person moving his shoulder less. Over time, the shoulder can be scarred and “frozen” stiff.
Mr K had an unsuccessful spell with physiotherapy, but subsequently recovered successfully after a key-hole arthroscopic shoulder surgery to repair the tear and release the frozen shoulder.
The learning point in this case study is that while the original intention is to stay fit in an unprecedented time of social distancing, it will be safer to step up training in a progressive manner. This refers to both the frequency and intensity of the exercises. Emphasis also needs to be placed on correct technique and sometimes, a training coach will be helpful.
“Doc, I have been cooped up at home for WFH so I decided to take up running regularly. But now my knee hurts!”
Like so many people who have been on WFH, Ms Q, an accountant, has been feeling stifled from being stuck at home for so many days of the week. She admitted that she has never been much into exercise, but decided that now is a good time to get into shape and at the same time, get some fresh air. Hence, she started jogging 15 minutes once a week. This soon became 30 minutes three times a week.
When I examined her, she had a swollen knee with painful bending and straightening of the knee. She was also unable to squat or kneel normally due to the pain. An MRI scan was performed which showed a small tear of the meniscus as well as injury to the cartilage of the knee. The meniscus is a C-shaped soft tissue structure in the knee that acts as a shock absorber. It cushions the impact on the knee when running or jumping, hence protecting the internal structures.
As the damage to the meniscus and cartilage was minimal, Ms Q was able to recover fully with rest, anti-inflammatory medication and the help of a physiotherapist. This was done by strengthening the supporting knee muscles as well as improving Ms Q’s running form. She has now gone back to jogging, but at a more manageable pace.
If the meniscus or cartilage injury had been more severe, there might have been a need for key-hole (minimally invasive) arthroscopic surgery to repair the damage. This procedure, which can be a day procedure, has been shown to have consistently good results.
Having a jog around the estate after being cooped up at home is a wonderful way to keep fit and destress. However, Ms Q’s example is a lesson to all of us that any new exercise needs proper preparation and sufficient timeline.