Back and Spine; Brain; COVID

Back pain relief at home: COVID-19 accelerates advances in video spine exams

Back and Spine; Brain; COVID

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The UT Southwestern Spine Center team has designed a video exam template that correlates a patient's ability to perform certain movements with a wide range of conditions.

Constant or persistent pain in the back, neck, or spine can take a major toll on your overall health, physical function and quality of life.

Care for that type of hindrance can't wait, even during the pandemic. So, in the spring, UT Southwestern's Spine Center expanded our telehealth program to deliver specialized spine care for patients without the need for a trip to the clinic.

Before the pandemic, we implemented video visits for patients living outside the Metroplex who needed non-emergency or pre- and post-operative care. Now we see any new and established patients by video for appointments that don't include imaging or procedures.

My colleagues and I have evolved our in-clinic spine exams into high-quality, effective video exam guidelines. For each physical test we do in the clinic – looking at the affected area, applying resistance, and testing sense of touch – we created simple at-home tests to omit the "in-person" aspect and still get the information we need.

We designed a video exam template that correlates a patient's ability to perform certain movements with a wide range of conditions. During your visit, the specialist will ask you to perform specific actions and, based on our findings and your health history, we can narrow down your diagnosis.

Video is a powerful, patient-centered tool that fits well with our spine care philosophy: It’s all about the patient's needs, and everything else comes second.

Research shows that patients who use video visits for spine care get more pain relief and feel more satisfied with their care than those get in-clinic care only. Not only are video visits convenient for patients with limited transportation or busy schedules, you may also be seen sooner than you could be for an in-person clinic visit.

How spine care video visits work

In your video visits, you'll get the same level of team-based care you'd receive in our clinics. Our process is set up to ensure that you, your primary care provider (PCP), and your specialist team can contribute to your care plan:

  • First, you'll see your PCP, who will order necessary tests and collect your health history.
  • Then, they'll securely send our spine team a referral along with your information via MyChart, our electronic medical record system (just like they would for an in-clinic appointment).
  • In your video visit, we'll talk you through any imaging or test results your PCP sent over, as well as discuss your medications and symptoms.
  • We'll get a visual physical exam by video – the capabilities are more comprehensive than you might expect!
  • Then we determine whether to try conservative therapies or recommend that we see you in person in the clinic.

We'll only as you to visit the clinic for the few aspects of care we can't do virtually, such as:

  • Getting MRIs, X-rays or other imaging exams
  • Treatment for postoperative complications, such as an infection
  • Spine tumor diagnosis
  • Pre-surgical examinations
  • Surgeries or in-office procedures

Please note: Certain spine-related symptoms indicate a medical emergency. Go to the emergency room immediately if you experience pain that radiates down your arms or legs, numbness in the groin area or sudden incontinence or weakness in the legs.

If you do need to come to the clinic, UT Southwestern has extensive safety precautions and protocols in place to reduce the risk of COVID-19 exposure.

Video visits for spine care: What to expect

Take a look at some of the functional areas we test. The way you respond and move in these tests can help us diagnose the cause of your pain or enhance your post-surgery care plan.

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Specialists will test your range of motion, asking you to turn your head in different directions and rate your pain.

Range of motion, strength, and weakness

Make a move: We’ll ask you to rate your pain during these movements and tell us when you've hit your limit:

  • Balance on your heels or toes
  • Bend forward or backward
  • Lift your arms above your head
  • Raise your legs while seated or lying down
  • Rotate or lift your shoulders
  • Show your shoes to the camera
  • Stand up or sit down
  • Turn your head in a certain direction
  • Twist your upper body

What we learn: Whether or how well you can perform these actions can give us clues about your muscle, tendon, ligament, and joint health:

  • Limited mobility or pain when raising your arms above your head might point to a rotator cuff injury
  • Sounds of strain or pain (such as grunting when you stand) can indicate arthritis, a muscle injury, or ergonomical issues
  • Neck numbness, tingling, or pain that replicates down the arm may be caused by cervical radiculopathy (a pinched nerve in the upper neck)

If you have trouble balancing on your heels or their toes, or if you've been tripping more often recently, you may have significant weakness in those bones, muscles, and tendons.

Your doctor may ask to look at the soles of your shoes. Wear and tear in the toe area, for example, can be a sign of drop foot – a symptom associated with stroke or nerve damage related to conditions such as diabetes or a herniated disc.

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Specialists will examine your form and gait, asking you to sit, stand and take a few steps to assess your pain.

Form and gait

Make a move: Depending on your symptoms, your doctor may ask you to do the following motions:

  • Sit or stand up tall
  • Take a few steps away from the camera
  • Turn and walk back toward the camera
  • Jog in place, jump, or other sports-related movements

What we learn: It’s helpful to get a baseline evaluation of the symmetry of your shoulders, hips, or spine while you are still and in motion. We're looking for limping, foot dragging, or other abnormal movement patterns that can negatively impact balance and symmetry. These issues can be a result of muscle, tendon, or bone injuries, but can also be due to neuropathy or nerve pain.

Holding your body in unnatural positions can cause pain in seemingly unrelated places over time. For example, limping on your left ankle can cause pain in your right hip due to overcompensating for weight and balance distribution.

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The exam will also look at any swelling in your feet, ankles, or legs.

Swelling and sensation

Make a move: If you’re experiencing numbness or pain, we’ll ask you to show us where. Then, your doctor may ask you to:

  • Aim the camera at your feet, ankles, or hands to assess swelling
  • Touch an area of your legs or arms with a finger, paperclip, or toothpick

What we learn: Swelling can indicate a joint, tendon, or muscle problem, whereas numbness or feeling pins and needles can indicate a nerve problem. We may ask you to touch certain areas of your arms or legs and report any differences in sensation. A family member can help, if needed – we'll teach you both what problems to watch for and how to check for lost sensation.

The future of virtual spine care

I am a true believer in face-to-face interaction and care, which will always be important and will never go away. But video visits have proven to be tremendously valuable and will continue to be, even after we’ve returned to a sense of normalcy post-pandemic.

I expect virtual visit technology to continue improving over the next decade. Researchers are developing digital technologies to further optimize virtual care:

  • 3D motion capture technology to more accurately measure a patient's gait in their home
  • More sensitive motion sensors to monitor a patient's progress during and after physical therapy (some centers already use this technology).
  • Precise range of motion sensors that automatically upload measurements to MyChart

Especially now, as we continue physical distancing and exploring adapted pathways during the pandemic, video visits open specialized spine care to more patients. The technology truly brings providers back to patient-centered care, reducing barriers that range from lack of transportation to busy home and work schedules.

While face-to-face human interaction is not the same over video, it's not lost. In fact, video visits give patients an opportunity to include more loved ones in appointments than we currently allow in the clinic due to COVID-19 protocols.

If back pain is affecting your quality of life, ask your doctor for a referral to the virtual spine care program at UT Southwestern. We’ll help you feel less pain and get back to your daily activities – with far fewer trips to the clinic.

To request a video visit for spinal care, call 214-645-8300 or request an appointment online.

How Virtual Care is Becoming the New House Call

This week on What to Know, Dr. John Warner discusses the evolution and future of virtual care with Alan Kramer, architect of UT Southwestern’s telemedicine strategy, and Dr. Suzanne Cole, an early adopter of video visits and Medical Director of Simmons Cancer Clinic at Richardson/Plano.