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

Episode Transcript

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

We’ve all felt those nagging aches and pains, whether it’s from a long workout or all the hours hunched in front of the computer, or even your phone.

To get some tips on how to avoid common neck and back issues — and how we can treat them at home — I talked with Dr. Ricky Singh, a specialist in sports and rehab medicine at Och Spine at NewYork-Presbyterian and Weill Cornell Medicine.

Dr. Singh walked us through some simple techniques we can all apply to our everyday routines to keep our backs healthy and pain free.

Faith: Hello, Dr. Singh. Thank you for joining us.

Dr. Singh: Hi, Faith, thank you for having me.

Faith: Over the time that you’ve been practicing, we know you’ve seen all kinds of conditions. What are the most common back and neck complaints that people bring to their doctors?

Dr. Singh: Well, 90% of the time we see disc bulge and muscle spasm, you know, postural stuff. Pre-pandemic, I would say I would see about 75% lower back pain. Um, these are people who hurt themselves playing a sport, golf, tennis, things like that, someone who’s lifting up heavy objects, a parent or a grandparent lifting up their kids or grandkids injuring their lower back.

During the pandemic I started to see a lot more upper back and neck pain. So patients who typically don’t have an ergonomic setup at home, uh, they were using the laptop on their bed or on their coffee table, kind of hunched over, stooped their shoulders rounded, their neck going forward, and we’re getting a lot of neck pain.

So we were calling it, you know, text neck or zoom neck, um, mostly neck pain, sometimes causing headaches and migraines. But those are probably the biggest two conditions. I continue to see.

Faith: At this point, as we come out of the pandemic, you’re seeing about 50-50?

Dr. Singh: I still see some Zoom neck but I think the lower back lumbar disc people are getting back to sports. Pickleball and paddleball are picking up, so I’m seeing a lot more injuries from those sports as well.

Faith: What, what does neck and back pain tell us about neck and back health?

Dr. Singh: Yeah, great question. You know, a lot of symptoms around our spine are mostly muscular, you know, soft tissue. It’s not a structural issue with like a disc herniation or a fracture or even arthritis. So, you know, that’s why we don’t need to see most of the patients who suffer from an episode of back pain because the muscles are not balanced.

You know, we if we’re sitting all day, the core is not really engaged. So the muscles stretch, the disc can squeeze a little bit, and the body produces inflammatory cells and cytokines that cause pain. And if we chronically sit in these positions and we develope overuse injuries, then pain, you know, persists.

But if we change that behavior, work on our exercises, get some aerobics, bring some oxygen to those areas, uh, most of these symptoms wane pretty quickly.

You know, we see a lot of athletes here. I treat a lot of marathon runners, a lot of triathletes, lot of CrossFitters, and I quickly learned. Telling one of those athletes that they’re weak doesn’t get me very far. So I’ve kind of changed how I approach that. And I don’t say weak anymore. I say not optimally balanced.

Faith: Boom.

Dr. Singh: So I say you’re super strong and you’re quads super strong in your hamstrings, but you’re glute medias on the outside of your hip muscles are not as strong as they should be. So there’s an opportunity there to correct that balance. Same thing with core. Yeah, I mean, people think core is your six pack. That’s like 20% of it. It’s the deep muscles of the abdomen. It’s your pelvic floor, you know, squeezing those muscles like kegel exercises. It’s your diaphragm, your lower back, doing superhumans and lotus position. Core is your foundation that connects our legs to our upper body, so working all those muscles, very important.

Faith: How can someone know if what they’re feeling is severe and lasting or if it’s just minor and temporary? Because I feel like when any of us has neck or back pain, it just feels like an emergency.

Dr. Singh: Yep. I think the most important thing is how debilitating that pain is. How much has it really impacted your function? I woke up today with back pain. I just told you earlier, before we started recording, I was on a flight overnight sitting in an economy chair. Yeah. That’s not fun. Yeah. So I had some back pain today. And, and I know that with this cycle or flare, it’s probably gonna take a day or two to kind of get normal. And I would say if you’re experiencing back pain or neck pain that lasts more than a few days, that’s really getting in the way of your functionality, you know, you can’t change, you can’t get dressed, it’s tough to toilet, that is probably worth getting checked out. Most of all neck and back pain issues resolve within three months. Most, you know, 85, 95% of the people. And even those that persist longer than that, only five to 10% need anything like an intervention or a spine surgery.

Faith: This is very comforting actually. But I, I wanna pause on something. Three months though, when people want immediate relief, right? Three months can feel like a long time.

Dr. Singh: Right. Right. And that’s, yes. Three months does sound like a lot, especially when you’re in pain. Now I’ve been in pain, even 24 or 48 hours seems like a lot when you can’t do the things you want to do, but it’s all about the level of pain and the severity. And then the other thing I didn’t mention was neurologic symptoms. And that’s when you really want to get checked out. And, and what I mean by that is do you feel weakness in your hands or grip? Is there some tingling or pins and needles going on into your arms or into your legs or into your feet? Are you having issues with bowel or bladder? These are reasons to get seen, you know, sooner. But again, that’s just a minority of the patients that experience these symptoms.

Faith: What are some of the things that people can do safely to relieve neck and back pain for some of the most common complaints?

Dr. Singh: Neck pain isn’t just neck pain isn’t just neck pain. There’s a reason that you have neck pain. And part of the investigative process of seeing one of us or working with a physical therapist or chiropractor is to figure out what that pain is and then how to treat it. So we focus a lot on rehabilitation medicine, which is physical therapy, occupational therapy.

I say, listen, we’re gonna start this treatment regimen with function — strengthening, stretching, and that’s physical therapy. If that doesn’t work, let’s go to level two, which is some type of medication. Is it a muscle relaxer? Is it an over-the-counter anti-inflammatory, um, things of that nature. I’m gonna give you a medication that’s not gonna fix you. It’s gonna help with your symptoms so that you can then go back to phase one, which is exercise.

Because if you’re in pain and I say, oh, you know, you just need physical therapy, you’re not gonna go to physical therapy because it’s hurting too much. So I use medications to bring down that pain, bring down that inflammation. And then say, now go fix the actual problem with physical therapy and exercise.

So usually most patients, 85% of the patients fall into those two categories, physical therapy and some type of medication temporarily. If those don’t work, then we elevate it and escalate it to a more interventional approach, which is injections. And again, I tell patients, Listen, I’m not gonna cure you with this injection. I’m not gonna cure you of your arthritis. But if I get rid of the pain associated with arthritis, you’re going go all the way back down to phase one again, which is exercise.

And every one of my patients knows that. The goal is always to get you back to exercise. And I just use some of these interventions, medications, injections, maybe surgery. Again, that’s, you know, 5% of the patients, all with the aim of functional improvement.

Faith: Okay, so, so while we’re talking about alleviating pain, I’ll ask very specifically: ice versus heat?

Dr. Singh: You know, the science is actually not clear which is actually better for you. Uh, and I tell patients that first, what makes you feel better faster? You know, is it sitting in a heating blanket and a heating pad? Does that speed it up? Go ahead and do that. But for most of the group who hasn’t really experienced one or the other, I’d say jump with cryo first.

Faith: Okay. And not alternate, right?

Dr. Singh: Alternating is great. I mean, I think that’s very important. Yeah. Contrast therapies where you’re doing a little bit of ice, a little bit of heat, that actually speeds up the recovery even faster. It’s time consuming, but contrast bats really helped with inflammation and then the heat for mobility.

Cold therapy is great for acute pain. You know, if, if you wake up and you have a crick in your neck or lower back pain, I would say go to ice first, stop the inflammatory process, because when your body sees something mechanically wrong or posturally wrong, it sends all these inflammatory cells to that site, you know, albeit to help repair issues there. But that comes with a lot of pain and stiffness. So throwing a bag of ice or frozen vegetables or something like that for 20 minutes is gonna help shut that inflammatory process off, help decrease the swelling in that area. It’s after that where heat can really help relax the muscles.

Faith: Would you describe some of the most important things that people can do for their neck and back health

Dr. Singh: Yeah. First is mobility. You know, I say this to almost every patient, mobility is medicine. We have to get you moving because if you don’t move, you’re not gonna bring blood flow and oxygen and nutrients to where they need to be. When we exercise, we take the pressure off that disc and that negative pressure sucks in all these nutrients and oxygen and good stuff. So if we do that all day, sitting and standing. Sitting and standing. So that motion is very helpful for the muscles and the structures around the spine. Same thing with our neck. If we’re sitting at a computer zooming all day and on virtual meetings, it’s very hard to maintain perfect ergonomic setup, but if you give yourself a check, OK, every 15 minutes or every time the phone rings, I need to get up off my chair and decompress my lower back. Mobility. Mobility is medicine. That’s the one thing that I stress the most with every patient. I ask them, how much are you walking?

Faith: I mean, it’s an easy thing to remind people. I also love this idea of the mere act of standing, or not sitting, provides nourishment for our back.

Dr. Singh: Absolutely. You know, that’s, that’s how you engage those muscles when you’re sitting. We’re not really using our core right now. And our disc and our spine is taking all of the forces. When you stand up, the forces around the spine minimize and the muscles engaged to support you. I share with patients and say, this is why your disc hurts. You’re sitting all day. Get up and get up and move around.

Faith: OK. That’s again, simple, relatively easy. Mobility is medicine. Get up and move around. What else? What else can we do for back health?

Dr. Singh: Core strengthening and upper back strengthening. I think these are kind of undervalued as well. You know, once we get the basic foundational motion in place and we’re saying, OK, you’re walking now, you’re walking 30 minutes, five times a week. If you can increase that to a more intense, vigorous exercise, you’re gonna get other benefits, like joint health and cardiovascular health. But at minimum, let’s talk about moving 150 minutes a week at baseline.

One of the best exercises that I go over with my elder adults is sit to stand. So just sitting to standing without using your hands. Being able to engage your core, engage your glutes, and stand up from a sitting position is a wonderful exercise to keep your foundational strength intact. And that actually predicts your ability to ambulate and to walk long term without an assist device, without a cane or a walker.

Faith: So, to whom should folks go if they have questions and, and wanna talk about their neck and back health with someone?

Dr. Singh: I think first and foremost, see your primary care doc. Most of the patients who—if you have experienced an acute episode—will probably be best served seeing a physical therapist. See a physical therapist, occupational therapist, try to see one of us. And then let us refer you out to, you know, a lot of these non-interventional options like chiropractic care, acupuncture and things like that. That’ll probably get you better fast.

Faith: Well, I am grateful for this conversation. Thank you so much, Dr. Singh.

Dr. Singh: Thank you, Faith. It was a pleasure.

Our thanks to 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 shared on this podcast solely reflect the expertise and experience of our guests. 

NewYork-Presbyterian is here to help you stay amazing at every stage of your life.