Stretching and Strength Training to Improve Postural Ergonomics and Endurance in the Operating Room

Abstract

Plastic surgeons report the highest prevalence of chronic musculoskeletal pain and fatigue among surgical subspecialties. Musculoskeletal pain impacts daily life, career longevity, and economic burden secondary to occupational injury. Poor postural awareness and ergonomic set up in the operating room represent the most common etiology.

Methods: A literature review was performed to highlight the ergonomic set-up, postural pitfalls, occupational injuries, and musculoskeletal pain in the operating room. An institutional survey was administered among resident and attending surgeons regarding musculoskeletal pain, posture, ergonomic education, and future improvements. Literature results, survey data, and intraoperative photographs were analyzed in collaboration with physical therapists and personal trainers.

Results: Survey results demonstrated that 97% of resident and attending respondents experienced musculoskeletal pain and 83% reported a lack of education in posture and ergonomics. The main postural pitfalls included head forward and flexed positioning, abduction and internal arm rotation, and kyphosis of the thoracic spine. The collaborators developed instructional videos to assess posture and biomechanics and demonstrate targeted stretching and strength exercises to address specific neck, back, and shoulder pain.

Conclusions: Poor posture is unavoidable in the operating room at times. These educational videos should be utilized for self-motivated and prophylactic conditioning outside of the operating room to maintain physical well-being throughout a career in plastic surgery. Future focus should be aimed at implementing dedicated ergonomic education and physical wellness programs early in surgical resident training.

Fig. 1.

Survey results: how often do musculoskeletal pains occur? N = 37 respondents.

Fig. 2.

Survey results: average time-to-onset of musculoskeletal pain after starting an operation? N = 36 respondents.

Fig. 3.

Survey results: rank the top 3 most painful anatomical areas during surgery. Green represents the number of respondents who ranked each area most painful. Yellow represents the number of respondents who ranked each area second most painful. Blue represents the number of respondents who ranked each area third most painful. N = 37 respondents.

Fig. 4.

Survey results: selected areas for individual postural improvement after watching the self-assessment video. N = 34 respondents.

Fig. 5.

Postural checklist anterior view: 1, head forward; 2, shoulders level; 3, neutral shoulder vs internal rotation; 4, equal spacing between arms and torso; 5, hips level; 6, knees and toes forward facing. Demonstration of poor posture (A) and proper posture (B).

Fig. 6.

Postural checklist lateral view: 1, head erect, chin parallel to floor; 2, ear, shoulder, hip, and ankle aligned in vertical plane; 3, natural cervical, thoracic, and lumbar curvature vs excessive kyphosis/lordosis; 4, neutral pelvis vs anterior/posterior pelvic tilt; 5, abdomen flat. Demonstration of poor posture (A) and proper posture (B).

Fig. 7.

Baseline strength and stretching prescription for problematic areas. (see Video 2 [Online] for points of performance for each exercise).

Fig. 8.

Demonstration of commonly seen flexed and rotated positioning of the trunk while operating.

Fig. 9.

Poor posture during microsurgery. Entire torso flexed forward with poor spinal and arm support. Head forward with lengthening of cervical flexors and strain to capitis muscles.

Fig. 10.

Intraoperative resident photographs. A, Incorporation of multiple surgeons into a large lymphedematous mass excision. Top left, kyphotic spine, forward and flexed head positioning. Top right, surgeon squatting at legs to achieve height, internally rotated and abducted arms. B, Use of lighted mammary retractor for pocket dissection causes shoulder strain, kyphotic spine, flexed head positioning for visualization.