Physical toll of the OR - recommendations?

[YellowTurtle]

I'm a second year and I have been going back and forth whether I want to do surgery. When I'm in the OR, for the first 2ish hours I'm really enjoying it, but then my feet and back start a terrible aching. Around hour 3/4 I'm dying to sit down, but have to stand through the pain. I also get migraines, but they are only triggered rarely (extreme stress/standing on aching feet for hours).

If it weren't for this pain in the OR, I could really see myself being a surgeon. I just don't want to have a career where I'm in pain all the time. I've heard about Danskos and a couple other brands of clogs, and Ted hose, but I don't know if those would be enough. I also don't want to be on NSAID's 24/7.

Has anyone else experienced this? If so - did you find anything that helped relieve the pain?

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[scoKraz4]

On my rotation I remember holding retractors in the same position for like 45 min, maneuvers in awkward positions, standing for hours on end, etc. My back would kill sometimes. But by the end of the rotation and doing surgeries over and over I got used to it and it wasn't that bad. I get migraines too and it helped to constantly snack. Would devour a couple snacks in between each surgery or whatever I had to do.

 

[typhoonegator]

A lot of people go through this. Your body isn't used to it, but that can change. Focus on good posture, and decide what type of shoes work for you. Some love Danskos, and others feel much better in something more padded. Also, you feel a lot different when you're engrossed in the case. I used to stand at football games for hours at a time without feeling achy, but in the OR I felt like crap because I was just standing there a lot of the time. For me, the aches and pains showed me how bored I was in the OR. Now I can stand in the ICU on rounds for hours and hours and I don't bat an eye.

 

[Psai]

Biggest thing IMHO is getting in shape.

Flexibility and core strength help a lot.

I actually like yoga now (don't judge me) - I'm super not flexible but it helps.

Workplace/occupational injuries are extremely common among surgeons, usually do to a combination of poor ergonomics in the OR (you'll notice a lot of surgeons who always hunch over or lean, etc) and poor health maintenance outside it.

Also they have these really nice OR mats these days. I got to stand on one for a long case a couple months ago and it was magical. Will be using one in practice when I finish residency.

pics

 

[bashwell]

I'm a second year and I have been going back and forth whether I want to do surgery. When I'm in the OR, for the first 2ish hours I'm really enjoying it, but then my feet and back start a terrible aching. Around hour 3/4 I'm dying to sit down, but have to stand through the pain. I also get migraines, but they are only triggered rarely (extreme stress/standing on aching feet for hours).

If it weren't for this pain in the OR, I could really see myself being a surgeon. I just don't want to have a career where I'm in pain all the time. I've heard about Danskos and a couple other brands of clogs, and Ted hose, but I don't know if those would be enough. I also don't want to be on NSAID's 24/7.

Has anyone else experienced this? If so - did you find anything that helped relieve the pain?

Maybe anesthesia instead...?

 

[Promethean]

Good shoes are CRITICAL.

I was ready to give up on my career and start investigating disability because of crippling foot and back pain, before I found shoes that worked for me. Like my feet felt like I'd lit them on fire about 2 hours into my shift, and even the morning after a shift, I would have trouble walking down the stairs from my bedroom. I hobbled around in pain most of the time, taking way more ibuprofen than I ought to have done just to get through the day.

Some people swear by Danskos, and I tried a couple of pairs only to find that they actually made it so much worse.

I found Anywear clogs. They are similar to Crocs, but they have an super cushy insert. A week in them and I was totally pain free. The insert wears out in 3 months or so, but can be bought for $10 separately. The shoes themselves are only $20-30/pair, compared to $100-200 for Danskos.

I'm not saying that these are the ultimate OR shoes for everyone. Some folks really do better in Danskos, and find that Anywear clogs are too soft for them. But if you are going to find out that a brand of shoes is wrong for you, might as well try the cheaper brand first.

A lot of people like compression socks, but I found that calf raises were better for me. Just do a few reps a few times an hour, as duty permits. Moving your calf muscles as much as you can keeps the blood moving. Lose bad habits ergonomic habits like locking your knees. That goes far.

 

[PL198]

or you could just wear normal tennis shoes like 99 % of people and not wear some disgusting shoe that probably isn't more comfortable than the typical shoe for people all over the world for any physical activity.

brb not reinventing the wheel

 

[njtrimed]

I'm a second year and I have been going back and forth whether I want to do surgery. When I'm in the OR, for the first 2ish hours I'm really enjoying it, but then my feet and back start a terrible aching. Around hour 3/4 I'm dying to sit down, but have to stand through the pain. I also get migraines, but they are only triggered rarely (extreme stress/standing on aching feet for hours).

If it weren't for this pain in the OR, I could really see myself being a surgeon. I just don't want to have a career where I'm in pain all the time. I've heard about Danskos and a couple other brands of clogs, and Ted hose, but I don't know if those would be enough. I also don't want to be on NSAID's 24/7.

Has anyone else experienced this? If so - did you find anything that helped relieve the pain?

You'll get used to it, but it takes a while. I have worked in the OR for well over a decade and I honestly don't even get tired until I'm approaching 10-12 hours on my feet. Yet after only a few months on maternity leave, I was in agony for the first 4-6 weeks back at work. It takes getting used to, and it definitely helps to be in decent shape...or at least not overweight.

 

[deleted659912]

Like everyone else is saying, you'll probably get used to it. Slightly unrelated but when I started working as a server I had the most horrible body aches from carrying heavy trays and running around everywhere but now I can work a 10+ hour shifts with no problems.

 

[michiganpsych08]

@Promethean which style do you have in the anywears? I am looking to buy some per your recommendation. I was going to go with Danskos, but I wanted to give the ones you talked about a try first. You sound like me, I literally say all the time I wish they could just cut both my feet off because the pain is so unbearable!

 

[Promethean]

Most of the variation is in color/decoration and whether it has a backstrap or not. I mostly have gotten the plain black ones with back strap, but there was a sweat leopard print pair that I went for. I get lots of compliments on those.

One downside... they have no ventilation. That is a bonus if you work someplace that says that you can't have holes in your shoes... but I find them a little too sweaty without ANY airflow. So, I used a 15 blade disposable scalpel to make very small vent holes (about the size of small peanut) down near the sole on either side of the toes. Carefully placed, they didn't draw attention from the uniform police, and gave just enough air flow to keep my feet comfy. Be very careful if you do decide to do this... you can easily get too aggressive and cut too much. I wrecked one pair that way, before I got the technique down pat.

 

[dienekes88]

Exercise.

Good footwear. Everyone is different.

Posture. Stand up straight.

The other thing is compression stockings. Changed my life.

Biggest thing IMHO is getting in shape.

Flexibility and core strength help a lot.

I actually like yoga now (don't judge me) - I'm super not flexible but it helps.

Workplace/occupational injuries are extremely common among surgeons, usually do to a combination of poor ergonomics in the OR (you'll notice a lot of surgeons who always hunch over or lean, etc) and poor health maintenance outside it.

Also they have these really nice OR mats these days. I got to stand on one for a long case a couple months ago and it was magical. Will be using one in practice when I finish residency.

Unfortunately, I usually have to stand on a step. It wasn't as big a deal during general surgery cases, but for cardiac and thoracic I'm not tall enough.

 

[Smurfette]

Keep in mind that as a student, watching (often times from around an attending and resident, meaning you are the 2nd assistant) and retracting put you in different positions than actually being the person operating. While there's always going to be some awkward angles that you'd have to deal with as an attending, for the most part, the attending surgeon has the best view, determines table height, and stands at the best angle to do things. You may want to figure out if your back pain is due to how you are standing/leaning/retracting or if you just don't have the ability to stand for hours.

As far as your feet, you just need to find the right pair of shoes for you. Go to a quality shoe store and be willing to pay good money for a pair of shoes that will last a long time and keep you pain-free. If you know you tend to have bad knees/hips/flat feet/etc., a salesperson should be able to direct you to certain brands or styles that are most likely to be comfortable. Many surgeons have shoes in the OR that they've been using for years. If you don't become a surgeon, these shoes would still get you through long nights of call as a resident.

And compression stockings (light compression) really are helpful in longer cases or when on overnight call, especially if you are not used to prolonged standing.

 

[Hangry]

or you could just wear normal tennis shoes like 99 % of people and not wear some disgusting shoe that probably isn't more comfortable than the typical shoe for people all over the world for any physical activity.

brb not reinventing the wheel

If 99% of people spent 10 hrs a day standing in one place, your argument would make sense.

 

[Mad Jack]

I'm a second year and I have been going back and forth whether I want to do surgery. When I'm in the OR, for the first 2ish hours I'm really enjoying it, but then my feet and back start a terrible aching. Around hour 3/4 I'm dying to sit down, but have to stand through the pain. I also get migraines, but they are only triggered rarely (extreme stress/standing on aching feet for hours).

If it weren't for this pain in the OR, I could really see myself being a surgeon. I just don't want to have a career where I'm in pain all the time. I've heard about Danskos and a couple other brands of clogs, and Ted hose, but I don't know if those would be enough. I also don't want to be on NSAID's 24/7.

Has anyone else experienced this? If so - did you find anything that helped relieve the pain?

Why are you in the OR for that long as a second year, Gunner McGunnerson?

Danskos are great for the feet, but the back- you'll just have to do exercises for to strengthen.

 

[Hangry]

Keep in mind that as a student, watching (often times from around an attending and resident, meaning you are the 2nd assistant) and retracting put you in different positions than actually being the person operating. While there's always going to be some awkward angles that you'd have to deal with as an attending, for the most part, the attending surgeon has the best view, determines table height, and stands at the best angle to do things. You may want to figure out if your back pain is due to how you are standing/leaning/retracting or if you just don't have the ability to stand for hours.

As far as your feet, you just need to find the right pair of shoes for you. Go to a quality shoe store and be willing to pay good money for a pair of shoes that will last a long time and keep you pain-free. If you know you tend to have bad knees/hips/flat feet/etc., a salesperson should be able to direct you to certain brands or styles that are most likely to be comfortable. Many surgeons have shoes in the OR that they've been using for years. If you don't become a surgeon, these shoes would still get you through long nights of call as a resident.

And compression stockings (light compression) really are helpful in longer cases or when on overnight call, especially if you are not used to prolonged standing.

Exactly this. Can't wait until I'm the attending and can set the table height.

And another +1 for the compression stockings. They work incredibly well for the long surgeries and call nights. Although nothing will make you feel older than comparing and contrasting favorite brands of compression stockings with your 68 yr old peds attending

 

[Hangry]

Why are you in the OR for that long as a second year, Gunner McGunnerson?

Danskos are great for the feet, but the back- you'll just have to do exercises for to strengthen.

He's seen the light early! I loved scrubbing in for whipples as a second year when I had a day off.

I've found that danskos help my back too, but it could just be because they force me to improve my posture.

 

[Mad Jack]

He's seen the light early! I loved scrubbing in for whipples as a second year when I had a day off.

I've found that danskos help my back too, but it could just be because they force me to improve my posture.

At first they seemed to help my L-spine, but as time went on, I actually think they were neutral to detrimental (I wore them for almost six years). They're the only things I ever wore that ever made my feet stop hurting though.

And scrubbing in for Whipples whenever you had a day off? Where the hell were you that you found so many fortunate pancreatic cancer patients lol. I worked at a huuuuuge hospital (>1,500 beds) and we rarely saw a Whipple because most people just weren't eligible for it.

 

[Hangry]

At first they seemed to help my L-spine, but as time went on, I actually think they were neutral to detrimental (I wore them for almost six years). They're the only things I ever wore that ever made my feet stop hurting though.

And scrubbing in for Whipples whenever you had a day off? Where the hell were you that you found so many fortunate pancreatic cancer patients lol. I worked at a huuuuuge hospital (>1,500 beds) and we rarely saw a Whipple because most people just weren't eligible for it.

Haha it wasn't that many whipples. Other pancreas whacks too that took similar hours that my second year brain classified in the same category. Trying to stay somewhat anonymous here or I'd tell you where.

 

[Mad Jack]

We do 150ish per year. It's a pretty common procedure at high volume referral centers.

Usually a second year isn't shadowing specific procedures, they're shadowing specific physicians. That's why I was like, "wut, so many Whipples." You may do 150 Whipples/yr, but they probably weren't by the same dude by a long shot.

And by "rare" I meant I'd see one maybe once a week, and I only saw the ones that were in bad shape. We probably had a lot more than that, but I didn't work the SICU enough to deal with every Whipple we came by.

 

[Reckoner]

Why are you in the OR for that long as a second year, Gunner McGunnerson?

Second years at 1.5 year pre-clinical schools have been on the wards for about a month. Second years at Duke are already halfway through their core clerkships!

 

[tiedyeddog]

You get used to it after while. Also, as others have said trying different shoes like clogs might help. Sanitas/danskos really seemed to help me with some if the lower back pain I was having when I first started out.

 

[WingedOx]

Biggest thing IMHO is getting in shape.

Flexibility and core strength help a lot.

I actually like yoga now (don't judge me) - I'm super not flexible but it helps.

Workplace/occupational injuries are extremely common among surgeons, usually do to a combination of poor ergonomics in the OR (you'll notice a lot of surgeons who always hunch over or lean, etc) and poor health maintenance outside it.

Also they have these really nice OR mats these days. I got to stand on one for a long case a couple months ago and it was magical. Will be using one in practice when I finish residency.

sigh... it's almost sad how out of shape I was during M3 year. If I had my current level of fitness and strength back then perhaps I'd be an Ortho Brah today.

/I have these thoughts then I remember I like getting to work at 8AM like a normal person.

 

[PL198]

If 99% of people spent 10 hrs a day standing in one place, your argument would make sense.

No I mean 99 % of people in surgery wear tennis shoes. but whatever try to reinvent the wheel with some ugly POS that you can't wear anywhere else becaues you think it's more comfortable but really does nothing a decent pair of nikes wouldn't.

 

[tiedyeddog]

No I mean 99 % of people in surgery wear tennis shoes. but whatever try to reinvent the wheel with some ugly POS that you can't wear anywhere else becaues you think it's more comfortable but really does nothing a decent pair of nikes wouldn't.

eh, in my department I would say only 1/4th to 1/5th of people wear just regular tennis shoes. Most people wear either Birki's, Calzuro, Sanitas, or jungle mocs with the remainders being tennis shoes. The advantage of Calzuro's, Birki's, Sanitas are a mixture of the hard sole and forced high arch, along with the fact that they are more water impervious than plain tennis shoes. If course my speciality requires longer periods of standing without rest than other specialties so perhaps that has something to do with it.

I have to ask, have you used any other shoe then I tennis shoe in the OR?

 

[bc65]

Another major reason for back pain and fatigue is not having the table at the correct height. Ideally, the table should be set for the tallest person and the shorter ones should use step stools. When you're the med student, or the intern, your needs in this are are often overlooked. That's another reason that with time and seniority, the pain will decrease.

 

[Slack3r]

eh, in my department I would say only 1/4th to 1/5th of people wear just regular tennis shoes. Most people wear either Birki's, Calzuro, Sanitas, or jungle mocs with the remainders being tennis shoes. The advantage of Calzuro's, Birki's, Sanitas are a mixture of the hard sole and forced high arch, along with the fact that they are more water impervious than plain tennis shoes. If course my speciality requires longer periods of standing without rest than other specialties so perhaps that has something to do with it.

I have to ask, have you used any other shoe then I tennis shoe in the OR?

I'm pretty sure the guy spouting off about the best OR shoes is a preclinical med student. Go figure.

 

[frosted_flake]

Good shoes are CRITICAL.

I was ready to give up on my career and start investigating disability because of crippling foot and back pain, before I found shoes that worked for me. Like my feet felt like I'd lit them on fire about 2 hours into my shift, and even the morning after a shift, I would have trouble walking down the stairs from my bedroom. I hobbled around in pain most of the time, taking way more ibuprofen than I ought to have done just to get through the day.

Some people swear by Danskos, and I tried a couple of pairs only to find that they actually made it so much worse.

I found Anywear clogs. They are similar to Crocs, but they have an super cushy insert. A week in them and I was totally pain free. The insert wears out in 3 months or so, but can be bought for $10 separately. The shoes themselves are only $20-30/pair, compared to $100-200 for Danskos.

I'm not saying that these are the ultimate OR shoes for everyone. Some folks really do better in Danskos, and find that Anywear clogs are too soft for them. But if you are going to find out that a brand of shoes is wrong for you, might as well try the cheaper brand first.

A lot of people like compression socks, but I found that calf raises were better for me. Just do a few reps a few times an hour, as duty permits. Moving your calf muscles as much as you can keeps the blood moving. Lose bad habits ergonomic habits like locking your knees. That goes far.

I just bought 2 pairs... so cheap and super cute! I love soft cushy shoes.....

 

[Hangry]

No I mean 99 % of people in surgery wear tennis shoes. but whatever try to reinvent the wheel with some ugly POS that you can't wear anywhere else becaues you think it's more comfortable but really does nothing a decent pair of nikes wouldn't.

 

[Winged Scapula]

Excellent advice from my colleagues above and I don't have much to add except to corroborate with these three words:

Bikram hot yoga

 

[MediCane2006]

No I mean 99 % of people in surgery wear tennis shoes. but whatever try to reinvent the wheel with some ugly POS that you can't wear anywhere else becaues you think it's more comfortable but really does nothing a decent pair of nikes wouldn't.

Yeah, just FYI tennis/running/athletic shoes don't have enough support for a long OR day, which is why most docs don't wear them.

Personally I love Danskos/Sanitas, mostly for the arch support and durability. But as some of the surgeons in here have said, posture has a lot more to do with OR fatigue than anything else. I see a lot of students (and surgeons) slumping, hunching, or otherwise using poor body mechanics and that will REALLY catch up to you. I had a couple attendings early in my training who really emphasized this and helped me build good habits, and i try to remind my students and junior residents whenever I can. Stand up straight!

 

[WingedOx]

Excellent advice from my colleagues above and I don't have much to add except to corroborate with these three words:

Bikram hot yoga

A few residents in my class were really into Bikram yoga a few years ago. The place they did it was next door to the place where you could get a "toxin-removing colonic flush"

 

[qw098]

pics

pics or it didn't happen bru

 

[PhysicianOnFIRE]

Another vote for anesthesia. I like the OR but couldn't stand to be scrubbed in for any length of time. I still do sterile procedures, but most of them take less than ten minutes. I prefer anesthesia for other reasons too, but I would get real "antsy" after awhile scrubbed in to cases as a student; just can't sit still for that long.