Good posture, ergonomics and exercise key to long career for ophthalmologists
The three repetitive strain injury syndromes that shorten ophthalmic surgeon careers are cervical spine disorder, lumbar spine disorder and thoracic outlet syndrome. Wikipedia provides a nice overview for the interested reader.
In a year, the typical ophthalmologist examines 5,000 to 6,000 patients at a slit lamp, some more than once during an examination, and sits behind an operating microscope 500 to 600 times for 10 to 60 minutes, depending on surgical case complexity. This is repetitive stress, and repetitive strain injury (RSI) is common in ophthalmologists.
It is critical to know the early symptoms and signs of RSI. They include tingling in the hands or feet, discomfort with an aching/pulsing pain, and then numbness, finger or toe weakness and eventually nerve death and muscle atrophy. One of the easiest objective tests for the ophthalmologist is grip strength, which is reduced in RSI.
A few personal thoughts after surviving 50 years as a busy ophthalmic clinician and surgeon. First, good posture is critical and widely neglected. Take the time required during every examination and surgery to reduce the stress on your neck, back, arms and legs. The critical action to prevent RSI for the ophthalmologist is to compulsively require good posture during patient examination and surgery.
Second, ergonomics, in which the environment is modified to reduce RSI, is equally important. For the ophthalmologist, a solid chair during examination and surgery with a large sitting platform and a straight back support is preferred. The ophthalmologist should sit up straight when examining a patient’s eye through the slit lamp or operating microscope and ideally look straight ahead without having to significantly bend the cervical or lumbar spine. There must be adequate room under the operating table for comfortable foot positions to operate the phacoemulsification pedal and operating microscope controls. This requires the surgeon to adjust their chair and slit lamp or operating microscope to their ideal level and then adjust the patient chair or operating table to the proper height. This takes a little time and is often neglected as we bend down to adapt to different-sized patients rather than compulsively maintaining good posture and bringing the patient to us.
Be aware of the early symptoms of RSI, and if you start to notice tingling of your hands or feet and muscle aching at the end of the day, you are on your way to trouble that could end your career. So, please, do not ignore it — change something.
I have two toes on my right foot that are permanently numb from ophthalmic RSI strain at L5-S1 of my lumbar spine from years of awkward phacoemulsification pedal placement. Fortunately, I have no permanent muscle or motor nerve damage. It took 25 years of a busy practice with poor posture and poor ergonomics to permanently damage the superficial sensory nerves to the fourth and fifth toes on my right foot. A lifetime of athletics, including decades of weight training, probably protected me some, but I heeded this early sign and made changes. I compulsively improved my examining and surgery posture and ergonomics. I also added the third critical protective factor: appropriate exercise and stretching.
I did some research, read widely and consulted with some quality MD pain management and spine surgeon colleagues. They suggested that I transition from classical strength-focused weight training to other forms of exercise and stretching and that doing so would not only enhance my career as an ophthalmologist but allow me to continue to enjoy my then-preferred sports of tennis, golf, skiing, hunting and fishing.
For the past 25 years, I have completed a 30- to 45-minute morning workout every day, rain or shine, which I can do at home or anywhere in the world while traveling. It requires no equipment and is based on books written by Pete Egoscue, the Royal Canadian Air Force Exercise Plan and a set of isometrics. For the interested reader, books detailing these exercise plans are inexpensive and available on Amazon. I stopped strength-focused heavy weight training. I stopped running and switched to walking. If there is inclement weather, I climb and descend 10 flights of stairs, one flight at a time, which can also be done anywhere in the world. Pilates, yoga, a personal trainer at a health club, regular therapeutic massage, an incline sit-up bench, well-managed weight training with lower weights and high repetitions, and a myriad of other programs can be equally effective, but with my unpredictable and long days in the clinic and OR along with significant travel, I found none of them sustainable. My workout program must be first thing in the morning before I start my day, or it just does not happen. So, I get up 30 to 45 minutes earlier every day than required and work out in my bathroom and bedroom, no special equipment required. That exercise regimen along with good posture and ergonomics in the clinic and operating room have allowed me to enjoy and sustain a 50-year productive career as a high-volume clinician and surgeon.
While a lifetime of RSI in sports starting at age 4, including football, hockey, baseball, softball, water and snow skiing, tennis, low-rep heavy weight strength training and running, damaged my hip and knee joints to the extent they required replacement surgery, my neck, back, hands and feet remain pain-free thanks to care in posture and ergonomics at the office and a daily exercise plan, allowing me a long and satisfying career.
RSI is a meaningful risk for we ophthalmologists and has ended many careers. I hope a few of the ideas discussed in the accompanying cover story and this commentary are helpful, as we will need every healthy and productive ophthalmologist we can find to meet the exploding demand for eye care projected for the next decades.