Dr. J. Ricky Singh explains how to prevent neck and back pain. We’ve all experienced discomfort in our neck or back. Spine specialists offer simple techniques that anyone can incorporate into their daily routines in order to keep their backs healthy and pain-free. Podcast This week, Faith Salie talks to Dr. Ricky Singh about the common causes of neck and back problems. Dr. Singh is a specialist in Sports Medicine, Pain Medicine, and Physical Medicine at Och Spine, NewYork Presbyterian and Weill Cornell Medicine. Dr. Singh gives advice on how people can reduce pain at home, whether it’s due to technology use or sports injuries. Episode Transcript Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie. We have all felt the nagging pains and aches, whether they are from a long exercise or hours spent hunched over a computer or phone. To learn how to prevent common neck and back problems, and how we can treat these at home, I spoke with Dr. Ricky Singh. He is a specialist in sports medicine and rehab medicine at Och Spine NewYork Presbyterian and Weill Cornell Medicine. Dr. Dr. Singh showed us some simple techniques that we can all use in our daily routines to keep backs healthy and pain-free. Faith: Hello, Dr. Singh. Thank you for joining us. Dr. Dr. Singh: Hello Faith, thank you so much for having me. Faith: We know that you have seen a wide variety of conditions in your time as a doctor. What are the most common complaints about back and neck that people bring to their doctor? Dr. Singh: 90% of the time, we see muscle spasm and disc bulge, you know postural stuff. Pre-pandemic I would say that I would see around 75% lower back pain. Um, these people hurt themselves playing sports, like golf or tennis, or lifting heavy objects. During the pandemic, I began to see more upper back and cervical pain. Patients who don’t usually have an ergonomic setup in their home were using their laptops on their beds or coffee tables, with their shoulders rounded and their necks going forward. We called it text neck or zoomneck, uh, mostly neck pain that can cause headaches and migraines. These are probably the two most common conditions. I continue to see. Faith As we emerge from the pandemic you’re seeing around 50-50? Dr. Singh: I see some Zoom Neck but I think lower back lumbar disk people are returning to sports. Pickleball and paddleball are gaining popularity, so I am seeing more injuries as well. Faith What does neck and spine pain tell us about neck health? Dr. Singh: Yeah, great question. You know, many of the symptoms we experience around our spine are mainly muscular, soft tissue. It’s not structural, like a herniation of a disc or a fracture. Or even arthritis. You know, we don’t have to see many patients who have back pain, because their muscles aren’t balanced. If we sit all day, our core is not engaged. The muscles stretch, the disc squeezes a little, and the body produces inflammatory cytokines and cells that cause pain. If we sit in these positions for long periods of time and develop overuse injuries, the pain will persist. If we change our behavior, do some exercises, get some cardio, and bring oxygen to these areas, most of the symptoms will disappear pretty quickly. You know, there are a lot athletes around here. I treated a lot marathon runners, triathletes and CrossFitters. I’ve learned that telling an athlete they’re weak won’t get me far. So I’ve changed my approach. I no longer say weak. I say that the balance is not optimal. Faith: Boom. Dr. Singh: I’m saying that you are super strong, and your quads are super strong in your Hamstrings. But your glute medias outside your hip muscles is not as strong as it should be. There’s a chance to correct this imbalance. The same thing applies to core. People think core is the six-pack. It’s only about 20%. It’s deep abdominal muscles. It’s the muscles of your pelvic floor. You know, like kegels. Your diaphragm and lower back are the targets. Superhumans or lotus position is recommended. The core is the foundation that connects your legs to your upper body. So working all those muscle groups is very important. Faith: How can a person tell if the pain they are experiencing is severe and permanent or just minor and short-lived? I think that when we have neck or back pain it feels like an urgent situation. Dr. Singh: Yep. I think that the most important factor is how debilitating this pain is. How much has the pain really affected your ability to function? I woke up with back pain today. I told you earlier that I was sitting in an economy seat on a flight over night before we began recording. Yeah. That’s not funny. Yeah. So I had some pain in my back today. I know it’s going to take a few days for this flare or cycle to pass. If you have neck or back pain that lasts for more than a couple of days, and it is affecting your ability to function, such as if you can’t dress yourself, change, or go to the toilet, then you should get checked out. Most neck and back issues will resolve within three months. You know, most, you’re talking about 85, 95%. Even those who persist longer, only 5 to 10% require any kind of intervention or spine surgery. Faith: This actually is very comforting. But I, I want to pause and think about something. But people want immediate relief. Three months can seem like a long period of time. Dr. Singh: Right. Right. Yes, that’s correct. Three months is a long time, especially if you are in pain. Even though I’ve experienced pain, 24 or 48-hours seems like a long time when you’re unable to do the things that you want to, it all depends on the severity and level of pain. The other thing I forgot to mention was the neurologic symptoms. Then you should get checked out. Do you feel a weakness in your grip or hands? Are you experiencing tingling or pins-and-needles in your arms, legs or feet? Do you have problems with your bowels or bladder? These are all reasons to see a doctor sooner. But, again, this is only a small minority of patients who experience these symptoms. Faith What can people do to relieve neck and lower back pain? Dr. Singh: Neck Pain is not just neck. There’s a good reason why you have neck pain. It’s part of the process to determine what is causing your neck pain and then to find out how to treat it. We focus a great deal on rehabilitation medicine which includes physical therapy and occupational therapy. I tell them, “Listen, we’re going to start this treatment regimen by strengthening and stretching. That’s physical therapy.” If that doesn’t help, we’ll move on to the second level, which is medication. Is it a relaxant? Is it a non-prescription anti-inflammatory? I’m going to give you a medicine that won’t fix you. It will help you with your symptoms, so that you can go back to the first phase of exercise. You won’t go to physical treatment if you are in pain. So I use medication to reduce the pain and inflammation. Then, you can tell them to fix the problem with physical therapy or exercise. So, most patients, about 85%, fall into these two categories: temporary medication and physical therapy. If these don’t work we escalate to a more interventional method, which is injections. I tell my patients again: Listen, this injection is not going to cure you. I won’t cure you of arthritis. If I can get rid of your arthritis pain, you will have to go back to the first phase, which is exercise. Every one of my patients is aware of this. The goal is to get you back into exercise. I use only some of these interventions: medications, injections or surgery. This is 5% of patients. Faith Okay so, while we’re discussing pain relief, I’ll ask you very specifically: ice or heat? Dr. Dr. Singh: It’s not really clear which is better for you. Uh, I tell my patients, first, what helps you feel better? Is it using a heating pad and a blanket? Does it speed up? Do it. For those who haven’t had the opportunity to experience either, I would recommend starting with cryo. Faith: Okay. And not alternative, right? Dr. Singh: Alternating is fantastic. I mean, that’s important. Yeah. Contrast therapies, where you do a little ice and a little heat, actually speed up recovery. It is time-consuming, but contrast bats helped with inflammation. The heat was then used to help with mobility. Cold therapy is excellent for acute pain. If you wake up with a crick or pain in your lower back or neck, I recommend using ice to stop the inflammation process. When your body detects something mechanically or posturally incorrect, it sends inflammatory cells there to repair the problem. This can cause a lot more pain and stiffness. Throwing a bag of frozen vegetables, ice, or something similar for 20 minutes will help stop the inflammatory process and reduce swelling. After that, heat can help relax the muscles. Faith : What are some of the most important health-related activities that people can engage in to maintain their neck and back? Dr. Singh: Yeah. First, mobility. Mobility is medicine, I tell almost all my patients. We need to get you moving, because if you stay still, you won’t be able to bring oxygen and nutrients where they are needed. Exercise relieves the pressure on that disc, and that negative pressure draws in nutrients, oxygen and other good stuff. If we do this all day, standing and sitting. Sitting and standing. This motion is good for the muscles and structures surrounding the spine. The same goes for our neck. It’s hard to maintain a perfect ergonomic setup if we’re sitting in front of a computer all day, zooming and having virtual meetings. But if you check yourself, you can say, “OK, every 15 minutes, or every time the telephone rings, I have to get up and decompress my lower spine.” Mobility. Mobility is medicine. It’s what I emphasize most to every patient. I ask, “How much are you walking?” Faith: It’s easy to remind people. I love the idea that standing up or not sitting down can nourish our back. Dr. Singh: Absolutely. You know, you can engage these muscles while you are sitting. We’re not using our core at all right now. Our disc and spine are taking all the forces. When you stand, the forces around your spine are reduced and muscles are activated to support you. I tell patients that this is why their disc hurts. You’re sitting all day. Move around and get up. Again, it’s simple and relatively easy. Mobility is medicine. Move around. What else? What else can be done to improve back health? Dr. Dr. Singh: Core strengthening, upper back strengthening. These are also undervalued, I believe. You know, we can start with the basics and say, “OK, you are walking now. You’re walking for 30 minutes, 5 times a week.” If you can increase the intensity of your exercise to a vigorous, intense workout, you will get additional benefits like joint health and cardiovascular fitness. Let’s start with 150 minutes of movement per week. Sit to stand is one of the best exercises I do with my older adults. Just sitting to standing, without using your arms. It is important to maintain your foundational strength by being able to stand up from a seated position, while engaging your core and glutes. This is a good indicator of your ability to walk without an assistive device, such as a cane or walking stick. Faith So who should people go to if they have any questions or want to talk about their neck health and back? Dr. Singh: I would recommend that you first see your primary care doctor. If you’ve had an acute episode, it is likely that the majority of patients will benefit from seeing a physical therapy. Try to see a physical therapist or occupational therapist. Let us then refer you to non-interventional treatments like chiropractic care, or acupuncture, and other things. This will probably help you get better quickly. Faith: I am grateful to have had this conversation. Dr. Singh, thank you so much. Dr. Dr. It was a great pleasure. We would like to thank Dr. Ricky Singh. Health Matters is a production of NewYork-Presbyterian. For more stories of science, care, and wellness visit healthmatters.nyp.org. The views expressed on this podcast are solely the opinions and experiences of our guests. NewYork Presbyterian is here to help keep you amazing at every stage in your life. Read more Health Matters Subscribe on At a Glance Featured Expert Share this Story Recommended Reading