A physical therapist's perspective on COVID and injury prevention

New restrictions begin this Wednesday, November 18th. Instead of bumming out, we see the next four weeks as an opportunity to establish new, healthy habits around working from home and training solo.

One of our favorite local physical therapists and RRCA certified run coach, Anna Komer, gives us her perspective and the science behind it, as well as a few injury-prevention techniques for those working from home. Connect with her at her downtown Portland clinic, Bridgetown Physical Therapy.

The COVID-19 pandemic has shell shocked our typical day-to-day routines. Due to these disruptions, many people are finding it hard to maintain regular physical activity.

Working from home has its perks, but what we are seeing is that the amount of total movement each day has dropped. The temptation is to put high value on getting in that 30-60 minutes of exercise each day, but doing so undervalues the importance of getting up and moving multiple times per day. Though we support healthy adults shooting for 60 minutes of exercise daily, we see the most success in terms of long-term health outcomes with those that make movement a lifestyle. Previously, this could have been a mid-morning walk for coffee or perhaps a bike commute into work. With COVID-19 keeping most of us home, these natural outlets have dwindled. So how do we suggest increasing exercise motivation and adherence, as well as total movement throughout the day to keep an active, healthy lifestyle?

Be thoughtful and deliberate about your movement. 

  • We recommend planning exercise in advance. Work with a physical therapist (PT) or a coach to help you figure out when and how much to exercise, so that you know what to do and how much movement is appropriate on a daily basis. You might even consider joining Fleet Feet's Winter Warriors program as a way to hold yourself accountable and get at least three walks or runs in each week!
  • We also suggest setting an alarm every 30 minutes on your phone to get up and walk. This can be as simple as a quick lap around the house or even equate to a short walk out the door to get some fresh air. Movement and breaking up static activity is absolutely key to overall health and well-being, as well as injury prevention.
  • Consider starting your morning with a 10-minute warm-up routine. We recommend doing this 2-3 times per day. To design the best routine for you, we suggest working with a PT or a personal trainer as well. Basic components of the program should include moving your body in all directions to maintain flexibility in your joints and muscles and fight the impact of sitting at a desk all day. A quick glimpse into a mobility routine could be: neck circles (clockwise/counterclockwise), shoulder rolls (forward/backward), cat-cow, child’s pose, downdog, bodyweight lunges, and snow angels with your arms out to the side (optionally performed on a foam roller).


Incorporate snow angels on a foam roller as a part of your mobility routine.


Cat/cow is also a great exercise to incorporate into your mobility routine.

  • Be open to changing it up. Make sure that you find activities that you enjoy to break up the monotony. We are seeing a lot of difficulty with adherence to previously-enjoyed activities. Use what is available to youi.e: virtual classes, cycling, bands, weights, and/or your legs for a brisk walk. Create a routine with a mix of things that you enjoy and do not overdo any particular activity to ensure you maintain interest. Changing it up can also apply to your position throughout the day. Though getting up and walking is incredibly helpful, there are more options for you to offload your body including modifying your work station. If you have a standing desk...great! But, don’t stand all day. There is not one position that will keep you healthy. It is all about variety. It is good to switch your sit to stand setup every few hours if this is an option. If you have multiple monitors setup, make sure that you are not always turning your head to one direction. Adjust your positioning or your monitor's position to minimize repetitive stress on the body. Variety is the spice of life.

 

What are common ‘Work from Home’ injuries and how do you prevent them?

  • Foot pain: We recommend alternating a shoe with a small amount of cushion underneath it and a barefoot position throughout the day with attention to how your foot is positioned. We have seen an increased frequency of foot pain due to things as simple as hardwood floors putting increased pressure on the balls of the feet. Consider a house shoe or a recovery shoe to protect your foot from the change of being in a shoe all day previously and now on a hard floor that you have not adjusted to. That said, it is also healthy to practice barefoot conditions with attention to your ‘foot posture’. Practice short duration windows to start (i.e: 15 min) in a barefoot condition in your house while focusing on lifting your arch up without curling your toes (see below). Practice this 3x/day and progress by slowly increasing the time on your feet with maintaining your arch height.

  • Cervical pain: Have an ergonomic assessment performed. Did you know that your work may cover this? You may even already have an ergonomic specialist that works for your company. Physical therapists can also help with this! Make sure your gaze is forward and not constantly turning towards one side. Ensure that your elbows are at a right angle whether you are sitting or standing. Your neck should be in a neutral position with your shoulders back. Also, pay attention to your phone utilization. Did you know if you look down at your phone the human head that typically weighs 8 lbs can weigh >30 lbs with the pull of gravity? Try to keep the phone at eye height to reduce stress on the neck joints and muscles.


Posture for neck in chair with L shape (making sure chin is behind L and shoulders are rolled back) to relieve and prevent cervical pain.

  • Low back pain: See abovehave an ergonomic assessment! If you are sitting, make sure that your contact point is the sit bones and not your tailbone or your pubic bone. You should be stacked on top of your sit bones and feel that your spine is in a neutral position. Use the back support of the chair and consider using a lumbar support (can use a towel rolled up long ways) at the base of your spine. Sitting on the edge of the chair can make your hip flexors very tight, especially if your feet do not touch the ground. Your hips and knees should be at roughly a 90-degree angle, and you may require a small stool under feet to achieve this if your chair is too large. If you are standing, make sure your weight is equally distributed over both legs. Do not lean over one leg; this will most certainly lead to hip pain down the line. Make sure that the front of your hips do not touch the desk while your torso is slightly reclined. This also puts increased pressure on the hips and the back. Standing can be a big change for people, so consider changing to a seated position if you find yourself having a hard time holding a neutral standing position. Last but not least, avoid crossing your legs. It is very hard to correct as we tend to have strongly embedded patterns, but with attention to this you will likely notice a strong preference towards a certain side that sits on top. This can increase hip pain, create tension on your ITB band, increase knee pain, and reduce lower body blood flow. You can try a small ball or towel roll between your legs to prevent you from crossing. Remember, it takes three weeks to achieve a new habit!


Posture for lower body with chair (without L shape hand position). Use a towel to support your low back in neutral spinal alignment. Hips/knees at 90 degree angles. 

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