In order to find pictures to demonstrate surgical posture, I went again to Google images to find some pictures of spaying and neutering, and came across several with surgeons in what appeared to be uncomfortable and ergonomically risky postures. Here are a couple of photos that I found:
https://images.app.goo.gl/7Fhew62NGyxoGRe96
https://images.app.goo.gl/QmP7Mmq6uqSUKyGh7
Both of these pictures show trainee surgeons leaning over their patients with about a 90 degree neck angle, bent waists, and elevated shoulders. We can’t know if these surgeons are using their bodies in this way because of the way their surgery room is set up, or because of habit, apprehension, or unawareness of their posture– or all of the above. Maybe these are brief positions during the surgery – but if these postures are sustained through a surgery day, these individuals are likely to experience some pain as a result.
In small animal surgery, we can achieve a fairly neutral posture except for our neck position. A neutral neck position would involve flexion of less than 10 degrees, but for a surgeon it is often 20-30 degrees. In this picture, I have a neck angle approaching 40 degrees.
It may not be possible to avoid extreme neck flexion in this work, and the important thing will be getting out of this posture between surgeries to allow those muscles to release and stretch. Turning your neck to each side, rolling your head, extending your neck, and shrugging your shoulders are all ways to release the tension in the muscles around your neck.
Other surgical postures to watch out for can be twisted or asymmetrical postures. If a surgeon maintains an asymmetrical or twisted posture, that can lead to uneven muscle use and strain and discomfort at the end of the day.
However, varying position during the surgery day is a good thing. If this surgeon balances the twist in one direction over time with a twist in the other direction, then she may not experience strain from the posture.
In this case, this surgeon might be more comfortable with a foot stool to rest her foot on, rather than using her weight-bearing foot as a footrest.
Another important thing you can do for yourself is to move during the surgery day. Between surgeries, take a few seconds to change your position. Roll your neck and shoulders, stretch. walk a few steps.
A study on human surgeons (abstract here) showed that taking a 20 second break every 20 minutes can increase your comfort and decrease fatigue after a day of surgery, and it can sustain your surgical performance and accuracy better through the surgery day. (If you can get access to the article, it’s a fun read not just for the scientific finding but also for the authors’ wry humor).
We are fortunate in spay neuter that we have short-enough surgery times that we can use the end of each surgery as a cue to move a little. We aren’t doing hours-long surgeries where we would need to set an alarm to remind us to move (although if you are someone who does long-duration surgeries, setting an alarm could be a good way to remind yourself to take your 20-second stretch break). So take a moment when you switch from one surgery to the next, to break the muscular tension that you hold during surgery.
We don’t necessarily think of or talk about spay neuter surgery as a sport or an activity that requires physical fitness or work hardening, but it does. As you do this work, your ligaments adapt, if you give them the recovery time they need between use.
- Ligaments adapt to exercise and use by increasing size, strength, and collagen content (given adequate rest and recovery time between uses)
- Surgeons in regular work may have greater resilience due to this tissue adaptation
- New HQHVSN surgeons (or those returning from an extended break such as a maternity leave) will not have the ligament strength and may be at greater risk for hand/ wrist injury and discomfort.
- Consider having a lighter schedule for new/ returning surgeons to allow their bodies to become conditioned to the work. Gradual increases in work hours, rather than starting off with a full-time schedule, may be more likely to lead to well-adapted ligaments rather than injury and strain.
For a much more in-depth discussion of ligament physiology, check out Ligaments: A source of musculoskeletal disorders. If this link isn’t available (it is not from the original publisher’s site), you can find other versions posted on Google Scholar.
Solomonow M. Ligaments: a source of musculoskeletal disorders. Journal of bodywork and movement therapies 2009;13:136-154.
Finally, physical activity outside of work is important to reducing physical discomfort while at work.
- Physical activity outside of work is known to be associated with lower prevalence of pain
- Surgeons who are physically active experience less fatigue due to work
- For people experiencing low back pain, maintaining daily activities as much as possible is associated with quicker recovery from symptoms
- Staying physically fit, maintaining friendships outside of work, eating well, and maintaining a work-life balance are all ways to reduce work-related musculoskeletal discomfort and stress.
There are not specific activities or exercises that research says are “best” – and it will likely vary between individuals– the key is simply being active and moving.
I hope this series of posts about surgical ergonomics has given you some ideas of how you might improve your own comfort during surgery. Remember that taking videos or photos of yourself during surgery can be a great way to understand what you are doing with your body, and to start to make improvements.
Let me know what works and what doesn’t work for you, and make comments with questions and with your own experiences of surgical ergonomics.
This is incredibly, spectacularly helpful and should be taught in every vet school, I don’t recall anything but the most perfunctory “don’t have bad ergonomics while you do surgery” instruction 15 years ago. In addition to every symptom and pain mentioned on this site I’ve experienced severe ulnar nerve entrapment, where at the end of a long day with lots of big dogs spays I can’t feel my pinky or ring fingers on both hands. My Physician says I will need to have surgery to continue to be able to do surgery. My solution so far has been to cut back severely on large dog spays, and I am thinking of transitioning to cat only spay/neuter as it is just so much less destructive to the body.
Also, do you have a position (no pun intended) on sitting? I am a stander, I have tried sitting and just can’t do it. Older DVMs have told me I have to learn to sit to do surgery or my surgical career is almost over. Dr. Bushby mentioned during his webinar on the updated guidelines that a vet he knows alternated sitting and standing. I’ve been thinking of getting a sit/stand stool, but they are kinda pricey.