Low back pain: Everyone’s getting it!

Have you ever had low back pain? Odds are, you have. Per the World Health Organization (WHO), 60 to 70 percent of people in high-income countries will have low back pain at least once in their lives. There are many causes for low back pain, so you should always consult with your doctor to make sure it’s nothing serious. That said, there are many things you can do to better understand your pain and work to relieve it.

To start, try to notice what caused or causes your pain and what your symptoms are. Your acute (sudden and short-lasting) low back pain could be linked to poor posture; sleeping oddly; or soreness that lingers after you do too much yardwork, pilates, or other intense activity. With low back pain from these causes, your back muscles might feel tight and tender to the touch. You could also have pain when you move in a certain way or stay in the same position for too long. You may have soreness in your hip or leg, decreased motion on one side, leg weakness with long periods of movement, or pain that affects your sleep. Your symptoms can be on one or both sides.

When you observe your symptoms, look out for any signs that mean you should seek medical care ASAP. These could be signs of something deeper than simple soreness, like nerve damage. Here are some red flags that may come with low back pain:

  • Numbness or tingling in your leg
  • Weakness in your leg that doesn’t come from prolonged movement
  • Your leg gives way while walking
  • Shooting, electric, or gnawing pain that goes down your leg
  • Pain that is constant and/or severe

Now for the best part: what to expect as you get better! Sometimes, back pain can go away on its own if you rest and avoid things that make your symptoms worse. Often, though, it takes special treatments to get better. These treatments include:

  • Using ice or heat
  • Putting on creams that numb your skin or reduce inflammation
  • Massage

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The key to getting better from low back pain is physical therapy (PT). PT exercises that address stretching and strength are the base of recovery. When you do your PT exercises, do them with focus and good form. Also, be sure to keep doing PT exercises, even when you start to feel less pain. Though you might not think you need to, you should complete the full course of treatment to avoid getting hurt again. You may also need to switch up the types of activities you do for the short or long term to reduce symptoms and prevent reinjury.

You might wonder how long it’s going to take to recover. This can vary: sometimes, it can be a day or two. When pain sticks around, your recovery could take a couple of weeks to a few months. This process includes using the treatments we mentioned above. With a more serious issue, it could take you more than six months to get better, and you might need surgery. Make sure to follow up with a doctor if you’re having low back pain that doesn’t go away.

You’re not alone if you’re having low back pain. Though your symptoms may make you feel annoyed or upset, there are many things you can do to reduce or cure your pain. Physical therapy is the base of these treatments, and it can help you prevent other back problems in the future.

Putting ACT into ACTion

Pain can take up a lot of space in your brain. Sometimes, you might even feel like the struggle to avoid pain takes over your life. If so, acceptance and commitment (ACT) might be a good approach for you. With ACT, you can learn to accept that you have pain, but that you don’t have to put your life on pause to manage it.

Here’s an ACT exercise that can help you observe your pain without letting it take over. Close your eyes and take a deep breath. Notice any physical sensations. You might notice pain or tightness, the fabric of your clothing on your skin, or maybe even a feeling of calm. Next, notice what you hear around you. Finally, notice your thoughts without judging them. You are not defined by your body, what you hear, or what you think. You can simply observe each of these without letting them take over who you are.

When you accept your pain and commit to your life, you can suffer a lot less. This approach isn’t magic; it doesn’t get rid of your pain, but it does help you avoid sadness or anger taking over your life. It’ll allow you to get back to things that make you happy, even when your muscles and joints aren’t 100% better.

Injury and Identity

How do you define yourself? Well, that’s a complex question. You might be defined by many things on paper: your name, your age, your job… but what matters most is how you see yourself, or your self-identity. Your self-identity is how you perceive your own traits and your place in the world.

It’s easy for sports or physical skills to become part of our self-identity. The better we become at a sport — such as lifting weights, CrossFit, running, football, or tennis — and the more we commit to it, the more likely we are to include it in our sense of self. Our physical skills can become a big part of how we see ourselves. As a result, getting injured can take a toll on our emotions, not just on our bodies. Anger, frustration, anxiety, and depression are common reactions. We begin to question who we are if we can’t lift weights, run, or play tennis. We might ask, “Where do I fit in now?”

No one wants to think about getting injured. That said, it is likely that we will have an injury at some point. It’s a good idea to think in advance about the emotions that might come with injury. Here are a few things you can do to prepare yourself:

  1. Find interests and social connections outside of sports. This might take some thought if you devote a lot of time to training. What pros do you see in making time for new interests now, before an injury forces you to do so?
  2. Think about other things you enjoy in life. You might not get the same boost from other things that you get at the finish line of a 10K run, but there are sure to be other things you enjoy. What else makes you feel fulfilled, proud, or content?
  3. See what you have to offer that isn’t linked to physical skills. How do you self-identify outside of your sport? How much more do you have to offer the world, beyond what you can do physically?

An introduction to ACT

Have you ever felt like your pain takes a lot of space in your brain? Or that the more you think about easing your pain, the more it takes away from other things in your life? If so, acceptance and commitment (ACT) might be a good approach for you. ACT comes from the idea that pain hurts, but it is the ongoing struggle with pain that causes people to suffer. With ACT, you can learn to accept that you have pain, but that you don’t have to put your life on pause to manage it.

The first step of ACT is to accept your pain. Most people spend a lot of effort trying to get rid of their pain. How much energy do you put into fighting negative thoughts and feelings about your pain? As odd as it sounds, mental attempts to “fix” your pain can cause more harm than good. Think of it this way: compare the force it takes to hold a beach ball underwater (i.e., fighting your pain) versus the energy it takes to let it go and allow it to float at the surface (i.e., accepting the sensation of pain in your body).

Beyond letting yourself accept pain, the ACT approach asks you to commit to taking actions that will get you the things you love. Take a moment to reflect on what gives your life meaning, whether it’s your health, relationships, career, or other things. Ongoing pain can cause you to lose touch with what you value. You might even try to avoid things that are important to you because you are focused on your pain. In ACT, it’s key to define your values and choose actions that move you to things that give your life meaning. When you focus on your values, you can keep doing what you care about — even when you’re having pain or have to adjust how you do things.

Running tips: Stay healthy and avoid getting hurt

The COVID-19 pandemic has changed daily routines for a lot of us. No longer do we leave the house to stop for coffee, drive the 40 minutes to work, or move about the office for meetings. While working from home has had many pros and cons, it has caused a lot of us to be less active throughout the day.

To make up for this lack of action and social time during the day, many people have turned to more intense workouts. Sales of remote fitness products, such as Peloton, Mirror, and Nordic Track, have boomed during the past year. Of all types of activity, running has seen a huge surge, with many people running to help their physical and mental health.

With more running comes more risk for injury. Before COVID-19, most of us had not prepared our muscles and joints to handle so much impact and mileage. Common running-related issues include shin splints, ankle sprains, plantar fasciitis, stress fractures, knee pain, and back pain. To avoid getting hurt, follow these tips:

  1. Maintain your shoes. Both miles and time affect your running shoes. Not only does the impact of running wear down your shoes, but the material of your shoes breaks down even if you’re not using them. We suggest you change your running shoes every 300 miles or every year, whichever comes first.
  2. Warm up and cool down. Going straight from the couch to a sprint is not a good idea. Try doing some light calf and quad stretching to loosen up your muscles. You can also start with a walk for the first few minutes, then ramp up to a jog, and then walk again at the end of your run. Warming up and cooling down protects your heart by making the change between resting and moving more gradual.
  3. Don’t tire yourself out too much. As you get tired, your form gets worse, which can cause injuries like sprained ankles. The “talk test” is one great way to measure if you’re overdoing it or not (i.e., would you be able to chat with a friend while running?) Another is the Karvonen heart rate formula, which can help keep you in a healthy heart rate zone during your exercise session.
  4. Avoid doing too many types of sports. Instead of jumping into hardcore circuits, biking, and running all at once, try sticking with one type of workout at first. Then, try adding in a second type once you have built up some strength. This will help you prep your body for the added stress of a new workout.
  5. Take days off. While many of us may want to come out of this year fitter than ever, working out every day can get you hurt. Take a break every other day, and make sure to take stock of how you’re feeling before you work out.
  6. When in doubt, seek someone out. If you have questions, don’t hesitate to reach out to a health care provider for guidance. Your routine may have changed a lot in 2020 and 2021, so it’s important to consult with an expert before you exercise. If there’s anything that COVID-19 has taught us, it’s that our health and safety should be top concerns.

“Hurt” isn’t always “harm”

Pain is hard on your body and your mind. It can limit the things you can do in daily life, which might make you angry, annoyed, anxious, or depressed. To treat pain, you may need to work not only on your physical health, but also on your mental health. Even though pain isn’t just “in your head,” most people find that using their minds to manage pain is key to getting better.

The first step to honing your mental skills is to be aware of the tie between emotions and pain. Just like pain has an effect on how you think, how you think has an effect on your pain. For one, when you expect something to hurt, it often hurts you more. You might also feel more intense pain when you are already upset.

Fear is one emotion that can have a strong effect on pain. If you feel pain when you move a certain way, you might fear that you are doing harm. Then, you can become more fearful of moving, which can cause you more pain. Soon enough, you’re afraid to move at all, even if it would be good for you!

If there’s one thing about the mind-body link that can help you recover, it’s learning to split “hurt” from “harm.” Feeling a little pain when you move doesn’t mean that you’re doing harm to yourself. Once you realize this, you can keep pushing forward with your recovery. The more you keep yourself on track, the less pain you should have… and the more relief you’ll feel that you’re getting back out there.

Pacing yourself: How to keep moving when times are tough

It’s common for humans to avoid things that make us feel bad, and pain is no different. When moving makes you feel pain, you might want to stop moving. The more you avoid movement, the more you’re afraid of it — and soon enough, you don’t want to move at all. This lack of activity can actually make your pain worse, reduce your muscle strength, and make it harder for you to do certain motions. Once you’re stuck in this cycle (fear of movement, avoiding movement, and worse pain), it can be hard to get out of it.

To prevent this cycle of pain and fear, you can try an approach called pacing. Pacing is the balance between movement and rest. When you pace yourself, you won’t overdo it when you’re feeling good and underdo it when you’re not feeling great. Here are some ways you can pace yourself in physical tasks you want to do:

  1. Break tasks into smaller parts, with rests in between.

Do your tasks with frequent rest breaks. In the long run, you will be able to get more things done if you don’t do too much at one time.

  1. Work at a slower, less intense pace.

Slower ways of movement, like walking instead of running, can keep you from overdoing it when you’re feeling good. Going slower doesn’t mean that you’re not working hard; rather, you’re taking better care of yourself.

  1. Switch tasks often.

Instead of doing the same task for long periods of time, switch it up. Get up from your desk after some time to give your neck, back, and arms a rest. Instead, try doing something that requires you to stand.

  1. Use different parts of your body throughout the day.

If you’ve been using one part of your body for a physical task, move to actions that use a different body part every once in a while. This will keep you from putting too much stress on one area.

Now that you’ve learned about pacing, take some time to reflect. Have you ever over- or underdone it with exercise? If so, how did that make you feel? How do you catch yourself doing too much or too little, and what will you do if it happens again? What are one or two ways you could try pacing this week?

While pacing might mean you adjust the way you move about, you can still feel good as you achieve things each day. You can apply these tactics to your chores, hobbies, and physical therapy exercises.

Working from home: Tips for a safe at-home work environment

In the Age of COVID-19, working remotely has become commonplace among office workers.  While it certainly comes with its perks – lack of a commute, flexible schedules, increased quality time with our families (questionable if this is a perk for some of us, I’m sure) – there are also some real risks to general health and wellness with our new normal. 

For many of us, our work life balance is blending together – a personal example: I am writing this blog at 12 AM because I can’t find a more productive time while balancing homeschooling, cooking, and meetings.  Behavioral disorders are on the rise as a result – the risks for increased stress, depression, insomnia have all increased during the pandemic

Weight gain is another common theme of this pandemic. A recent poll by WebMD found over 50% of respondents reporting gaining 1-5 lbs., with another 25% gaining 10 lbs or more.  Much of this weight gain can be tied to several factors: increased alcohol intake, stress eating, lack of activity.  Whatever the cause, the changes to our homelife is placing increased stress on our bodies in ways that could have long lasting effects. Added weight places greater strain on our heart and cardiovascular systems.  It makes it more difficult for us to fight off infections (particularly concerning given the current state of affairs) and can strain our muscles and joints, leading to greater risk for injury (low back and neck pain are most common).

To make matters worse, for many of us working from home comes the plight of poor ergonomics.  Pre-Covid, most of us had a decent office chair, a desk, and a workstation with a relatively good ergonomic set-up. Now many of us are working on the couch or at the kitchen table, slumped over our laptops for hours on end.  While short term, these postural abnormalities are fleeting, without the distraction of co-workers to chat with down the hall or the need to step into a meeting, we’re spending longer periods of time in those poor postural positions. This can cause major structural changes to our spinal alignment, and lead to long term pain and discomfort if left unchecked.

Here are some simple ways that you can minimize your risks:

  1. Set personal time on your work calendar
    You’re not likely to miss that work meeting, because most of us link greater importance to our work calendars than any personal one.  Place boundaries on your time, and sprinkle in some “You time” throughout the day
  2. Set reminders on your computer to get up and move around every 30 minutes
    It’s easy for us to lose track of time when we get involved.  With many of us working from home now from the couch or the kitchen table, our necks and back are at greater risk for injury.  Using your work computer to set audible reminders to get up and move every 30 minutes will reduce your risk of injury related to poor posture.
  3. Connect with your team
    Make sure to connect with your colleagues and friends. An easy way to do this is to build social time into your work meetings, where you talk about non work topics. Adding a face to the interaction can help overcome some of the isolation you may feel during this pandemic.
  4. Use household items to augment your workstation
    Sitting on a soft couch, try placing a baking sheet or tray under the cushion to provide more support.  Improve your sitting angle by rolling up a towel and placing it behind your lower back or under the edge of your bottom.  Mirror your laptop to the TV screen so you can maintain your neck in better alignment.  If you’re at the kitchen table, grab a chair with armrests and roll a towel behind your back.  Consider placing an extra cushion on top of the seat to raise you up to a more optimal sitting position and plugging in your laptop to an old computer monitor that is raised up to eye level to limit slouching.
  5. Take a walk
    You risk for covid is lowest during the day in open spaces. During one of your midday work breaks (see item 1 from above) get outside and take in the fresh air now that summer has arrived. It will help your mind and your heart!

Health Plans and Employers ‘Muscle Up’: Virtual Care Delivers Safe, Effective MSK Recovery

During the COVID-19 global health emergency, people are avoiding hospitals and other health care facilities because they’re concerned about being exposed to the virus. In fact, a recent Sage Growth/Black Book research survey found that 33% of respondents feel unsafe going to their doctor’s office and 41% feel unsafe going to a hospital. While that reticence may help hospitals avoid being overwhelmed, it’s absolutely not helping the people who’ve chosen to delay getting the care they need. How big is the issue? A recent Morning Consult-American College of Emergency Physicians poll found that nearly a third (29%) of survey respondents said they had avoided or delayed seeking medical care due to concerns about contracting the virus.

Half of American adults (127 million people) are estimated to be living with musculoskeletal (MSK) disorders. For them, the impact of delaying or going without care is significant and includes:

  • Living with ongoing pain, which in turn has the potential to increase use of and reliance on opioid medications
  • An increase in dysfunction that results in an inability to perform daily activities or work
  • A progression of the disease’s severity that may increase the likelihood of surgery or permanent disability

Before the pandemic struck, people with MSK disorders could access care safely and fairly easily. But even pre-pandemic, there was a significant unmet need for this care. Insurers typically pay for a limited number of physical therapy visits. If the person’s condition hasn’t improved, he or she needs to get approval for another limited number of visits, which can be time-consuming and frustrating. In addition, completing even this limited course of therapy can be challenging for many people who need to take time off work or secure childcare and travel to the location where their therapy is provided.

“I think it’s fair to say that the advent of telehealth has been just completely accelerated… there’s absolutely no going back.”
– Seema Verma, CMS administrator

A better way, now and moving forward

For the foreseeable future as the pandemic continues without an approved vaccine, people need a safe new way to access MSK care. And even if the pandemic can be contained, not everyone will feel comfortable returning to health care facilities, especially those who are more vulnerable and at risk from the virus, like people over 65 and those with underlying chronic health conditions. There’s also likely to be a backlog of people in need of care, which may make it a lot more difficult to get an appointment with an orthopedist or physical therapist, further delaying access to care.

The solution, for both the current situation and the future, is making quality MSK care available on patients’ terms—safely, outside a health care facility, when and where it’s most convenient. Telehealth can provide that solution in both the short and long term.

CMS Administrator Seema Verma

CMS Administrator Seema Verma (courtesy of Wikimedia Commons)

The time is right for telehealth to expand its reach. Medicare has relaxed its guidelines on the type of telehealth services it covers and enhanced its coverage through the summer, and many commercial insurers are following suit. And it’s likely these coverage enhancements will continue in some form indefinitely. Even CMS administrator Seema Verma has gone on the record saying, “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

Along with better coverage and reimbursement for telehealth, patients are also embracing virtual access to care. At the end of March, the Wall Street Journal reported a marked increase in telehealth visits by Medicare patients, from 100,000 per week to 300,000 per week. A Sage Growth/Black Book research survey also highlights patients’ growing desire for and acceptance of telehealth services. Of survey respondents, 48% are seeking more digital health solutions to manage their health and well-being and more than two-thirds (69%) of respondents want their provider to offer more telehealth visits as an alternative to office visits even after the pandemic ends.

But not all telehealth or digital solutions will deliver what people with MSK disorders truly need. Beyond ease of access from the safety of home, people need to receive care on an episode basis, not on a limited visit basis, so that they can receive care as long as it takes to recover. They need clinically validated assessments and recovery pathways, and access to personalized exercise plans overseen by physical therapists and coaches.

The good news is that RecoveryOne has already created this new model of care and is delivering on-demand, clinically validated MSK recovery care to people across the country. A growing number of insurers and employers are including this new resource in the benefits they offer, opening access for hundreds of thousands of those who will need this care long after the pandemic ends. After delivering millions of sessions, we’ve proven that this model can improve outcomes by up to 54%, reduce the need for surgery, lower costs for patients, payers, and employers—while earning a patient satisfaction rate of over 88%.

The essential role of health plans and employers in the safe delivery of care

But even as more health plans and employers make coverage for telehealth an integral part of their benefit offerings, there’s more work to be done to keep people safer during and after the height of the pandemic. They need to move from passively offering new virtual MSK solutions to taking proactive steps to identify and engage those who most need this care.

That means mining their own databases to identify those who’ve been pre-certified for MSK surgery, who have an existing MSK disorder that has gone untreated, and those prescribed opioid medications for pain related to MSK disorders. Plan administrators can connect these populations with virtual MSK services, helping them avoid unnecessary visits to healthcare facilities where they risk exposure to COVID-19.

Health plans and self-insured employers cannot afford to be passive, communicating the availability of telehealth coverage on a one and done basis. We all need to be proactive partners in the effort to keep people safer in this new world by encouraging the appropriate use of remote care.