Back problems in surgery

[agranulocytosis]

Relax mods, I'm not looking for treatment or anything.

I just realized today, while washing my dishes in the kitchen sink, that a surgical career might not be for me. My back started hurting after only 5 minutes of washing that I can only imagine all the leaning forward, the neck straining, standing for hours on end on complicated surgeries.

So, for all you residents and attendings, how much does surgery take a toll on your backs? Is it something that's inherently associated with the job? I've always liked the idea of working with my hands and fixing mechanical problems, but I don't want to mess up my back and have major problems later on in life.

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[Winged Scapula]

Relax mods, I'm not looking for treatment or anything.

I just realized today, while washing my dishes in the kitchen sink, that a surgical career might not be for me. My back started hurting after only 5 minutes of washing that I can only imagine all the leaning forward, the neck straining, standing for hours on end on complicated surgeries.

So, for all you residents and attendings, how much does surgery take a toll on your backs? Is it something that's inherently associated with the job? I've always liked the idea of working with my hands and fixing mechanical problems, but I don't want to mess up my back and have major problems later on in life.

I don't have any back problems in the OR..my feet, shoulders and neck hurt more (I have a tendency to hunch my shoulders a lot).

Before writing off a surgical career, you might consider what type of footwear you had on while washing those dishes. A good sock and shoe can go a long way toward making you more comfortable. Some swear by arch supports and of course, TED hose can make your legs feel a lot better.

There are other options...some fields have shorter procedures, and some even sit down a lot (hand, anything like microvascular where you are using the operating scope). If you haven't done your 3d year surgical rotation yet, you'll get a good idea about whether your back can handle it, although 5 minutes washing dishes isn't promising. Perhaps you shouldn't wash dishes anymore! 😀

 

[ESU_MD]

my back is showing signs of wear after five years of working at wierd table hieghts, etc..

my neck is almost gone from poor posture with loupes (and poor table height)

the only thing I can do is look forward to being an attending so I can set the table to my optic length, and afford a better hot-tub to soak in after work,

 

[Chronic Student]

I've been in surgery for over a decade now and it has most certainly taken a toll on my back. Lifting patients (especially the plus sizes and when there is not enough help) and as mentioned previously the akward positions.

I routinely lean over the patient doing spine case so that I can see over the spinous processes so that I can actually help the surgeon or have to contort to use the microscope. In neurosurgery good cases are just getting going in hours four and five. Not unusual to have ten hour cases.

As I write this I have probably herniated a disc in my neck, its in full spasm and I really hope its just a strain, but I don't think so.

Yes, it can be very hard on your body. As previously mentioned the right footwear is important, posture is important, the type of surgey you do as well as the length of your cases is important as well. Keeping your body toned and healthy is vitally important as well. My extra pounds have not helped me at all.

That having been said a lot has to do with genetics, previous accidents (whiplash, spondylosis) and just plain bad luck.

 

[Winged Scapula]

my back is showing signs of wear after five years of working at wierd table hieghts, etc..

my neck is almost gone from poor posture with loupes (and poor table height)

the only thing I can do is look forward to being an attending so I can set the table to my optic length, and afford a better hot-tub to soak in after work,

You're tall aren't you?

I spent my entire residency on steps, sometimes two (our Peds attendings were very tall...all of them). Only the PD was about my height (5'5"). My neck hurts from looking down a lot -poor loupe posture as well, but my gastrocs are buffed! 😀

Step up, step down, calf stretch...

 

[Pir8DeacDoc]

I'm 6'3" which is pretty much a pain in the *** when it comes to surgery. Obviously as a resident no one really cares what height I want the table set at. I try and work my back and abs at the gym on a fairly regular basis to try and maintain my core.

 

[ddmo]

I'm 6'3" which is pretty much a pain in the *** when it comes to surgery. Obviously as a resident no one really cares what height I want the table set at. I try and work my back and abs at the gym on a fairly regular basis to try and maintain my core.

You're just in the wrong field... should have done ortho.

 

[Kubed]

Hmm, I'm 6'2" but I would have to say that my head hurts more than my back when I'm working with a shorter attending. Monday I worked with a 5'5" attending and hit my head on the lamps at least three times.

 

[Blade28]

Er...for how long were you washing dishes?

 

[tussy]

I'm 5'5" and 120 lbs, and i used to find that my back, neck and shoulders killed after a day in the OR. Then last year i was in the lab and doing microsurgery hunched over a microscope and i developed the worst sciatica you could imagine, so i'm sure i have a herniated disk.

IN the past 6 months i joined a good gym and got a personal trainer. I've been doing lots of work on my back and core and have noticed a huge difference. I don't hurt after an OR and i haven't had sciatica at all.

I do go for massages every now and hten when i strain something. I refuse to help lift heavy patients (not worth ruining my career when there are nursing attendants/orderlys to do that work).

Good shoes also help. Lots of residents get orthotics and find they really help. I find Danskos fit my feet perfectly, and they give me an extra 1.5 " that helps with the height issues.

good luck.

 

[DrDawg]

I'm 5'5" and 120 lbs, and i used to find that my back, neck and shoulders killed after a day in the OR. Then last year i was in the lab and doing microsurgery hunched over a microscope and i developed the worst sciatica you could imagine, so i'm sure i have a herniated disk.

IN the past 6 months i joined a good gym and got a personal trainer. I've been doing lots of work on my back and core and have noticed a huge difference. I don't hurt after an OR and i haven't had sciatica at all.

I do go for massages every now and hten when i strain something. I refuse to help lift heavy patients (not worth ruining my career when there are nursing attendants/orderlys to do that work).

Good shoes also help. Lots of residents get orthotics and find they really help. I find Danskos fit my feet perfectly, and they give me an extra 1.5 " that helps with the height issues.

good luck.

I herniated a lumbar disk in 8th grade. Never had surgery just RX'D it with PT. I also carry all my stree in my back. Comfortable shoes are a must. I had orthotics but stopped wearing them in residency because they fit poorly into my clogs. I had them designed for my running shoes. Once a month I get a massage, and this does wonders for me. Its also important to have a good matress at home, most in the call rooms suck.

 

[PediBoneDoc]

back pain .... ahh yes ....

being in one of the specialties that wears a headlight, loupes, and lead, i know this pain well.

i there is no way of avoiding the pain. the question is will it be short lived? most of the pain after a long case is just plain old mechanical back pain from poor posture. wether it is adjusting the table height, getting better loupes, or a lighter headlight, you will eventually figure out what works for you. i think the neck pain is more of an issue. for back pain, we can brace you (like the soft drink delivery men/women), but for neck pain, we can't. the neck probably causes surgeons more issues. heaven forbid you get a cervical disc and have radiculopathy, it could be career ending.

in general the pain most get is from fatigue. when i am in the marathon 12 hr front/back spine, my whole body just hurts. the best way of preventing this (for the low back) is core strengthening. along with good posture with adjusting the table and paying attention to your positions during surgery.

as much as residents like to blame the attenfings for their poor positions (table height etc), residents and medical students tend to be their worst enemy. i watch them close incisions like the are standing on their head or hunched over like their hiding candy from their sibblings. i have to remind them to either lower the table and sit or raise the table. (see that is not my choice because i am not scrubbed)

 

[Pir8DeacDoc]

You're just in the wrong field... should have done ortho.

I look a lot more like an ortho resident than an ENT resident.

 

[agranulocytosis]

Just earlier today I shadowed an orthopod and he told me he quit doing procedures after his back gave out after only 2 years of performing spine procedures. Ironic, isn't it? And as someone already said, trauma surgery doesn't do much good with all the lifting of really heavy patients.

Are there any regulations to the amount of time docs can perform on surgeries? I think maybe there should be a study done on the amount of time it takes being in certain positions before wear and tear really becomes an issue. Perhaps this can alleviate some of those problems?

I guess I'll just have to wait and see how my surgery rotation turns out.

 

[Winged Scapula]

Just earlier today I shadowed an orthopod and he told me he quit doing procedures after his back gave out after only 2 years of performing spine procedures. Ironic, isn't it? And as someone already said, trauma surgery doesn't do much good with all the lifting of really heavy patients.

Well trauma surgeons don't necessarily operate much nor do they necessarily have to be the ones moving the patient around. If you have a bad back, that doesn't mean you need to rule it out as a career...especially since you won't be in the OR often as a trauma surgeon.

Are there any regulations to the amount of time docs can perform on surgeries?

There are no regulations for attending surgeons like there are for airline pilots, although there may be de facto restrictions simply because ORs don't generally run after hours and on weekends except for emergency cases. But if you can the OR to staff a room for you to do an elective case after hours, most people wouldn't stop you unless it was obvious you were impaired.

I think maybe there should be a study done on the amount of time it takes being in certain positions before wear and tear really becomes an issue. Perhaps this can alleviate some of those problems?

Surely someone in Occ med has done this already.

I guess I'll just have to wait and see how my surgery rotation turns out.

Sounds like a good plan.

 

[deleted77919]

Personally I've dreamed of a future OR where everyone is lying down on tables suspended from the ceiling. You'd be face down, with your face poking through a little hole (ala massage table). You could move the table you are lying down on up or down, side to side, and back and forth using joysticks. This would help prevent the old "what height do we set the patients table at since the attending is 4'7" and the resident is 6'9" issue. You could even have surgical trays suspended below the table.

 

[maxheadroom]

Are there any regulations to the amount of time docs can perform on surgeries? I think maybe there should be a study done on the amount of time it takes being in certain positions before wear and tear really becomes an issue. Perhaps this can alleviate some of those problems?

I guess I'll just have to wait and see how my surgery rotation turns out.

So you'd propose that surgeons become shift workers? "Sorry Mr Smith, but we could only put on two of your four amputated fingers -- Dr. Agranulocytosis hit his time limit and had to go for his mandatory massage therapy session."

Five years in, I have a few lessons:

1. Wear good shoes. I don't enter the OR without my Dansko clogs. They're much better than the best athletic shoes. Try on lots of different fancy, European footwear until you find the shoes that you can stand in all day and night. Don't be afraid to shell out the $120 per pair. Good shoes will especially help low back pain.

2. Learn good posture. When you get measured for your loupes, make sure that the angle is conducive to keeping your neck neutral.

3. Don't wear your loupes when you don't need them.

4. Avoid headlights. I've learned that there are very few cases that require a headlight. For me, it's pretty much a cleft palate or a pharyngeal flap. Beyond that, I'll just adjust the OR lights.

5. Good posture. Really. It's that important.

6. Adjust the table. Sometimes you can't (attending preference), but anytime it's up to you, put the table at the height that makes you comfortable.

7. Core strengthening exercises. If your back and abs are strong, they'll support you when you're in an awkward position.

8. Really make sure you practice good posture.

Back and neck pain are part of the job description for a surgeon. You'll find ways to help moderate it, but there will be times where surgery will beat up your body. Every medical specialty has its downsides. Internists have the combination of nerdiness and boredom. Cardiologists have that whole a$$hole thing. Surgeons beat up their bodies and work long hours.

 

[Blade28]

Every medical specialty has its downsides. Internists have the combination of nerdiness and boredom. Cardiologists have that whole a$$hole thing. Surgeons beat up their bodies and work long hours.

👍 👍

 

[DoctorMunchkin]

I don't own a pair, but I hear great things about some shoes called Z-coils. A friend of mine had bad plantar fasciitis and these really helped her. They claim to help feet, knees, hips and backs. They are pricey, but everyone who has a pair raves about them.

 

[MossPoh]

I'm 6'5" and just have chronic back pain in general. Years of drumline, powerlifting, and sports left me in a bad position. (Evidently your body isn't designed to hang 50+ pounds off your shoulders and march around for 4 or 5 hours at a time). I always wondered how surgeons handled it...I know one ortho guy that had to quit surgery because of the back pain.

The best remedy is always preventative measures. As mentioned earlier, creating a strong core helps a lot. As lame as you may feel when you are there, yoga really helps too. I'd trust these people on the shoes...I can't comment. Also, refrain from heavy squats with the powerlifting technique if you can. 😉 My back is demolished from that.

 

[Pir8DeacDoc]

I don't own a pair, but I hear great things about some shoes called Z-coils. A friend of mine had bad plantar fasciitis and these really helped her. They claim to help feet, knees, hips and backs. They are pricey, but everyone who has a pair raves about them.

Did you happen to check these out before you posted this?? I'd rather be crippled with back pain than wear these things. I can't even imagine keeping a straight face and wearing them.

 

[DoctorMunchkin]

Did you happen to check these out before you posted this?? I'd rather be crippled with back pain than wear these things. I can't even imagine keeping a straight face and wearing them.

Yeah, I know. They aren't any better looking in person. There are a couple pair that have the heel covered, but again, still not cool.
I would like it noted, that I never said they were stylish. Just said people say they work. I don't think any one would laugh at you (to your face).🙂

 

[Winged Scapula]

I worked with an older Plastic Surgeon in Princeton who wore those. I thought they were ridiculous as well, but he swore by them. I'd forgotten what they were called...I had a lot of fun telling him they made him look a little "light in the loafers!"

PS. I'm breaking in a new pair of Merrells today...we'll see if they are more comfortable than my New Balance. I tried the Danskos and can't say I thought they were any better.

 

[Kubed]

Anyone have any input on shoes for those of us with Fred Flintstone like feet (read: wide)? I tired on a few pairs of danskos the other day and it seems they only come in medium width sizes.

... and as it feels like I only chime in to say something about my freakish physical attributes (spoke up on the giant hand/foot thread) I'll add this to the list in honor of KC: I can wing my scapula.

 

[smq123]

Anyone have any input on shoes for those of us with Fred Flintstone like feet (read: wide)? I tired on a few pairs of danskos the other day and it seems they only come in medium width sizes.

Don't use Danskos - one of the students who was with me on my last rotation said that Danskos killed his wide feet. Also, stay away from Crocs. He said that he tried Crocs during OB (obviously, this pair didn't have those stupid holes on top), and he almost had to crawl out of the hospital at the end of the day.

My friend swears by PLOGS. He says that they're much better than Danskos.

 

[supercut]

I left a surgery residency after 3 years for a variety of reasons, one of which was that I felt I was sacrficing my well being. I'm pretty tall for a girl (6').
I had back pain all the time. Danskos were horrible for my very narrow, high arch feet. I wore regular atheltic shoes with custom inserts. (and, btw, several times after getting a brand new pair wound up getting them trashed by operating on an exsanguinating, blood flowing onto the floor, pt.) I tried to go to the gym but either didn't have time or energy. Most of our shorter attendings were pretty good about adjusting the table to the resident height and standing on stools. So that wasn't it. I never figured out what to do to keep my back from hurting.

I haven't been in the OR since July. My back almost never hurts anymore. So it is something to consider. A lot of people will tolerate it though, if they like what they are doing enough. I'll never forget intern year walking into the OR for a vascular case and finding the attending lying supine on the floor off to the side becuase his back was hurting so bad. He got when I started shaving the pt.

 

[Simppu]

A very good topic. My wife (ENT resident) had some bad backproblems earlier. But it solved with good footware, paying attention to posture and regular fysiotherapy and gym. I too had some problems, mostly related to bad posture. Today I had to assist in a 4 hour back-killer-fem-pop, had to work in a ****ty posture. The senior surgeon was sitting, but I couldn't. It's going to be an intresting evening trying to get this lumbar pain to ease. 😡

J