Does surgery hurt your back?

[baya]

Okay, so maybe this is a silly question.
I'm entering med school in the fall, and my only OR experience has been as the one on the table.

When I envision myself as possibly going into surgery, a lot of things about it sound great. (I loved my undergrad anatomy classes, like the idea of directly 'fixing' the problem', etc.)

But standing over a table for 3-7 hours? Doesn't that just kill your back? I usually find walking to be much easier on my back than standing. Is this just me, or is there an ergonomical surgical position, or is toughing out back pain just part of being a surgeon?

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[GMO2003]

standing over a table for 3-7 hours? Doesn't that just kill your back?

It actually eats away at your very desire to live as you ask yourself...wtf am I doing here? 🙄 👎

 

[phillymed]

Along the lines of that question...
how do people take their surgical career as they get older?
I mean, how long until the physicial demands of the job catch up with you?
This is asked in the context that everyone seems to think our generation will be working much longer, chave a few mutations in career, well past the age of 65.
I now some internests who practice past that age, but what about the cutters?

 

[Aloha Kid]

I know this vascular surgeon. Big guy. Pushing nearly 400 pounds. He has the staff lower the table and he sits on a stool for almost all of his procedures.

I also remember being in on a Whipple. At the 5 hour mark my feet and back were killing me. At the 7 hour mark, the attending surgeon was ready for the guy to die. It was just one bleed after another. The guy's abdominal cavity was a pool of blood with a million ties and clips. The surgeon was practically supporting himself by leaning over and throwing all his weight on this anesthesized patients body. Bad form, but when it hurts, it hurts. What else are you going to do?

 

[WingZero]

I don't know about long-term strategies, but I've been reminded numerous times while on surgical rotations when I'm closing to simply stand up straight with my shoulder blades pushed back. It sounds simple / silly, but as a student, the temptation is to lean forward and stick your face an within an inch of the wound so you get those subcuticular sutures just perfect when it's not necessary at all unless you're in need of new glasses. Things you learn / get accustomed to as a student have a nasty habit of persisting when you become a resident and attending... I've also been told that having strong abs helps out as this balances your back muscles during prolonged standing so start doing those crunches. The right pair of shoes never hurt either - the Dansko's are popular (I have a pair myself) but I find the soles to be way too hard for prolonged standing. I think I'll just settle for a comfortable pair of running shoes when I'm an intern this summer.

 

[praying4MD]

Just got off of 2 weeks doing a rotation on Cardiothoracic surgery where the minimum time i spent in an OR for one case was 6 hours. today it took 7 hours. the longest surgery i've been in was about 8-9 hours [very intense, rare, and complicated resection of recurring neuroblastoma on pediatric surgery.] the CT surgeries are more tiresome than that long one was. my back doesn't hurt so much as my feet and legs and knees. i swear to god i have claudication and am forming a DVT every day in the OR. 🙂 That, and our job as med students is to hold retractors and be pimped, so it makes the time that much longer....

BUT, having said that, i really, really like surgery. if you're doing stuff, or even seeing incredible things, it doesn't feel like that long sometimes. it's when you are in a painful position and being asked questions with words you've never heard before that the it gets to be too long for comfort. also, the nice thing is, that if you hold out for a long enough time each day, you are rewarded with getting to do stuff. over only 3 months of rotations, i have sometimes chosen the longer, yet cooler cases, because of the attendings/chiefs involved and it has paid off-- i have gotten to do the first incision [unheard of as a med student], sew fascia [ditto], and do quite a bit of subcuticulars [which every med student gets to do], but even on the midline sternotomies, which are all kind of a privilege as a med student. so i think it pays off in the end.... sometimes.

PS: funny, i just got told today, while doing the sub-q's on a midline sternotomy: "Stand up straight and fix your posture."

bottom line: if you like it, the pain is bearable, but still definitely existent.

 

[tripod]

Back when I was a student, and i sutured with my face inches away from the wound, an attending used to say:
"hey, why is your face so @#$@'in close? Can you not see it or do you like the smell?"

For me, the pains of body functions aren't felt until the end of the case because of all the adrenaline pumping through me during the middle.. Usually during the closing is when my stomach starts gurgling and I start having to cross my legs and kinda dance in place. Then your mind realizes "Oh ****e, I was hungry 4 hours ago and have had to take a piss for the last 3."

 

[m3shocker]

MS2 here- also interested in surgery with a couple of Q's:

are there any particular muscle groups that surgeons focus on when working out- to possibly increase stamina?

Also, besides back pains, what about neck pains? I would think there is no way avoiding the excessive strain on the neck (ie, no exercises for it) during surgeries

 

[njbmd]

MS2 here- also interested in surgery with a couple of Q's:

are there any particular muscle groups that surgeons focus on when working out- to possibly increase stamina?

Also, besides back pains, what about neck pains? I would think there is no way avoiding the excessive strain on the neck (ie, no exercises for it) during surgeries

Hi there,
I am at the end of my PGY-2 year. This year I have generally spent 12 hours or so operating on the rotations where I have not been covering an ICU. To avoid neck strain, I make sure that the table is at the proper height for me. All of our attendings adjust the table to the residents height. Since I am tall, this is generally not a problem. My shorter colleagues will stand on a step or two.

I work abs on every workout. I also do cardio (even if it's running the steps) as much as possible (good stress relief). I spend most of my money on my feet with a weekly pedicure, TED hose, Boston Birkenstocks (for operating) and cowboy boots for ward work. I also sleep on a Temperpedic mattress at home. Again, I love my comforts when I am not working.

Other than the above, I generally don't have any aches or pains unless I do something stupid like fall asleep at the nurses station.

njbmd 😀

 

[kinetic]

Other than the above, I generally don't have any aches or pains unless I do something stupid like fall asleep at the nurses station.

What does this mean? When I read it, I envisioned you slumped over at the nurses station while the nurses and secretaries administered karate chops to your prone body. (They were also yelling "Hiii-yah!", but that's sorta irrelevant.)

 

[kinetic]

I spend most of my money on my feet with a weekly pedicure ...

Sorry to make fun of you twice in a row, but I gotta ask: how does the pedicure decrease body aches? 😀

 

[kinetic]

When I was doing my surgical rotation in med school, my lower legs and feet would always ache big time at the end of the day. I'd be sorta OK until I got home and took off my shoes and got off my feet ...then, it was like, "let the throbbing ...BEGIN!!!" Everyone I have ever mentioned this to has given me a weird look. I've tried doing orthostatic contractions, but you usually are too busy and focused to be doing this for any amount of time. People always say, "it's your shoes - get better arch support." Whatever. I dunno. (This post has helped nobody, so back to envisioning njbmd's well-pedicured body receiving random karate chops at the nurse's station.)

 

[jakstat33]

A pedicure???!

 

[Rony]

For whatever it's worth, there was a post not too long ago about various shoes that would make your head spin...Dansko's vs. Plogs vs. 'Stocks...etc...
Has anyone seen an "OR accessory mattress"??...I don't care who you are, standing on rigid, flat concrete for hours on end is going to hurt eventually, this baby is a rectangular piece of soft, shock absorbent "carpet" for lack of a better description that's supposedly more comfortable (I tried standing on it for several minutes at the end of the case after my attending walked out)

 

[supercut]

I'm finishing my intern year. Not often that I'm scrubbed on long cases, but sometimes it happens (or several shorter cases back to back)

I've had back pain for as long as I can remember. Good shoes help a little, but not much. My back hurts with prolonged standing. SO it hurts in the OR. If I'm holding retractors, it seems to hurt more (acutally I notice it more) If I'm actively involved in the case, I dont notice it. Also, rank has its privleges, so as I move up the chain of command is is more likely that I will be able to sit during non OR team activites (when there aren't enough chairs for the entire team)

Bottom line...If I'm standing for 4 hours, my back will hurt. As I progress in surgical residency, I will be more involved in those long cases and notice the pain less becasue I love what I'm doing. However, if I had a career of 4 hour medicine rounds, I would notice the pain more because I'd be bored silly and hate it.

I'm sure working out would help. I do work out some, but I really don't know any back specific exercies or if I need to focus more on back or abs.

Ain't no way I'm going to quit surgery over back pain. I basically just deal with it because I love to operate. I caught one attending here lying on the floor in the OR while anesthesia put the pt to sleep. I image I'll be doing that some too as I progress through residiency.

Oh, yeah, and I'm older too. Started med school at 38.

 

[Energon]

Oh, yeah, and I'm older too. Started med school at 38.

Good on ya mate!

 

[tubbs]

what about back belts? i know that 2 of the 3 surgical residents that i hung around with last summer used back belts. do you guys use them? which ones do you recomend?

 

[Square Pants]

I actually saw a pedi surg that had a latex form fitted back mould. It was moulded to his back specifically, and it went from about the beginning of the sacral spine up to the level of the scapula. It was strapped in place across the chest. It forced him to stand perfectly straight and I think it supported his lower back too. The scrub nurses seemed to know just how to fit him into it.

 

[kinetic]

I use a full body cast, which is molded anew each day. Smelly!

 

[LTbulldogs]

Would it be that wrong to have a chair in the OR??

 

[tubbs]

sitting is actually more stressful on your back than standing.

 

[baya]

sitting is actually more stressful on your back than standing.

why do you say that?
My experience has been the opposite.
It probably just varies with the individual.

 

[tubbs]

i guess too much of standing or sitting isn't good for anyone. but i've definitly read somewhere that sitting is more stressful on the lower back than standing...i'm not sure what the specific mechanisms are in terms of physics. anyways, there are chairs now designed to lower the stress. they're quite different. these "chairs" actually get you to kneel on a lower pad, taking off some weight off your butt, and allowing you to have a straighter back.

 

[dr.evil]

When I was in med school I thought all of these things that have been posted. I worried about my back and my feet. Now at the end of my 2nd year of residency, I really can't remember one time when my back hurt. I always manipulate the table to my height which is a huge help. I have rarely had to hold a retractor for more than 5 minutes so that has gone away (I held one in med school for nearly 3 hours and my entire arm went numb. weird feeling). My feet have been tired a few times but I alternate feet and shift my weight during long cases. About the first 5 times I wore my loupes, my neck was so sore I could barely turn it from side to side. Just like any other workout, that went away with time. I guess it's just like anything else you do, at first, it's a little painful but you do it a few million times and your body adjusts to it. Working out regularly (or as regularly as you can) is a huge help.

 

[LTbulldogs]

i guess too much of standing or sitting isn't good for anyone. but i've definitly read somewhere that sitting is more stressful on the lower back than standing...i'm not sure what the specific mechanisms are in terms of physics. anyways, there are chairs now designed to lower the stress. they're quite different. these "chairs" actually get you to kneel on a lower pad, taking off some weight off your butt, and allowing you to have a straighter back.

I've seen one of those chairs. Do surgeons actually use them?...they look comfortable. One of the major reasons for me not wanting to do surgery is that I dont want to be on me feet for 5 hours at a time.

 

[Sophie]

When I was doing my surgical rotation in med school, my lower legs and feet would always ache big time at the end of the day. I'd be sorta OK until I got home and took off my shoes and got off my feet ...then, it was like, "let the throbbing ...BEGIN!!!" Everyone I have ever mentioned this to has given me a weird look. I've tried doing orthostatic contractions, but you usually are too busy and focused to be doing this for any amount of time. People always say, "it's your shoes - get better arch support." Whatever. I dunno. (This post has helped nobody, so back to envisioning njbmd's well-pedicured body receiving random karate chops at the nurse's station.)

Unfortunately I can't offer anything constructive about this, but I can definitely relate. I get lower leg aches big time whenever I've been standing for too long. The longest time I've ever stood in one place is 4 hours, and that was serious hell afterwards, so I'm pretty worried about 7-8 hour surgeries. I think it's due to poor circulation (at least, my case is, not sure about yours), because the pain is accompanied by varicose veins, and lightheadedness (plus that squeamish feeling that precedes or accompanies lightheadedness where you just feel like you have to move).

Has anyone had any of these problems? Any known cures? I mentioned this to my doctor, but all she could suggest was more exercise and support pantyhose.

 

[unregistered]

Would it be that wrong to have a chair in the OR??

Not if you do ENT or Optho. 😀

 

[DoctorDoom]

I've seen one of those chairs. Do surgeons actually use them?...they look comfortable. One of the major reasons for me not wanting to do surgery is that I dont want to be on me feet for 5 hours at a time.

Not in general surgery... usually on your feet the whole day. Except for some vascular procedures.

You'll learn to position the table and your self properly... back pain was never a problem for me... or leg pain or anything else... just lucky I guess.

 

[Retinamark]

Would it be that wrong to have a chair in the OR??

I don't think so. For ophthal, there is no choice - it would be almost impossible to operate standing up, without f*cking things up.

Although as I'm often reminded by the ortho guys "If you need to sit down to operate, you need to sit down to pee". 😀

 

[Premedtomed]

What about swimming especially doing the backstroke? What do you guys thinK?

 

[ears]

I think it would be very difficult to operate while doing the backstroke. (Though I haven't seen any published RCT's proving the issue one way or the other...)

 

[Premedtomed]

I think it would be very difficult to operate while doing the backstroke. (Though I haven't seen any published RCT's proving the issue one way or the other...)

very funny

 

[aboo-ali-sina]

Not in general surgery... usually on your feet the whole day. Except for some vascular procedures.

You'll learn to position the table and your self properly... back pain was never a problem for me... or leg pain or anything else... just lucky I guess.

Also in Cardio thoracic, they use the chairs to sit on while taking down the IMA for CABG. I've also seen during transplants, at one center, they would have the new heart beating on pump with the cross clamp off for 30 min before they would start to ween from CPB so after they finished some of the "clean up work" (i.e. chest tubes and hemostasis) they would sit until the 30 min was up

 

[kinetic]

Also in Cardio thoracic, they use the chairs to sit on while taking down the IMA for CABG. I've also seen during transplants, at one center, they would have the new heart beating on pump with the cross clamp off for 30 min before they would start to ween from CPB so after they finished some of the "clean up work" (i.e. chest tubes and hemostasis) they would sit until the 30 min was up

What? A 30 minute break?!

*beats them mercilessly for being so weak*

Take that! And that! And that!



Once in medical school, I flexed my knee because my leg was aching. My upper body did not move at all, but the general surgeon saw the movement out of the corner of his eye. He was a really nice guy, but for some reason he spaszed out about this. He just looked at me and said, "stop that ...and don't ever do that again." And he shook his head (in disgust?) before continuing with the operation.

 

[Vukken99]

 

[Runtita]

A pedicure???!

I would venture to say that the pedicure is not only a spirit-lifter but can make your feel/lower legs feel great- especially if you go to a spa with the heavenly foot jacuzzis!

 

[Partialdoctor]

One of my attendings wears a back brace in the OR each day and swears by it. I've been thinking about getting one for under my scrubs, because my back KILLS me on longer cases.

I have found that eating a power bar and taking 600-800mg of ibuprofen pretty much helps, but if I did the latter too often I think it would land me in ulcer-land. 😉

PD

 

[kinetic]

I have found that eating a power bar and taking 600-800mg of ibuprofen pretty much helps, but if I did the latter too often I think it would land me in ulcer-land. 😉

PD

So would doing the former.