IT SHOULDN'T HURT Recognizing that health care is physically demanding is the first step toward staying injury-free.

When we think of healthcare-related ergonomics, one of the first things we think about is lifting and transporting patients. Those are very important considerations, but staying injury- and pain-free starts with the way you carry yourself.

During a recent visit to an outpatient facility, I found myself studying the staff around me. As a master trainer specializing in biomechanics, I couldn't help but notice — and begin to diagnose — what I was seeing. Many staff members seemed to have low back and hip issues, both the people who were on their feet almost the entire time and those sitting behind desks.

It was clear to me that the biggest issue for both groups was something I work on constantly with medical professionals: posture. Poor posture can lead to a host of problems, far more than you may realize. It's progressive and it's sneaky. I've treated people who had chronic headaches — headaches that resembled migraines — that were caused by bad posture.

How's your posture?

Try standing against a wall and see what touches. It should be the back of your head, the tip of your shoulder blades and your behind. If you need to do better, start with a proud chest, what I call a rooster's chest. Then squeeze the wings (shoulder blades) in your back. Your shoulders should go back and downward, helping your chest rise and your chin return to a neutral position.

Of course, if you've been slouching for years, it's going to be a tough habit to break. It helps to have someone remind you periodically, but you don't want a nagging mother telling you to stand up straight. So instead of attaching a negative connotation, ask a partner or co-worker to give you a thumbs-up every once in a while. It's a positive gesture that reminds you to stand up straight. And if you remind your partner to stand up straight, you remind yourself, too.

If you're sitting most of the day, you need to have a chair that promotes good posture. Little reminders can help there, too, like little notes on your computer — anything that triggers the memory and helps you change the pattern.

Be proud of the work you do. If you show that pride in the way you carry yourself, you may find that those annoying (and sometime debilitating) aches and pains in your lower back and elsewhere begin to subside.

FROM THE FLOOR UP
One Weekend, and Boom, OR was Ergonomically Up-to-Date

RIGHT HEIGHT A floor-mounted boom can be installed in a weekend.

When it became clear that a dedicated endourology room at Oregon Health Sciences University in Portland wasn't up to current ergonomic standards, the facility faced a painful decision.

"We could not afford to have that room down for 3 or 4 months to have it remodeled with standard [minimally invasive surgery] equipment," says Eugene Fuchs, MD, FACS, a professor of urology at OHSU. "Fortunately, one of our OR supervisors recalled seeing a display at an OR convention and proposed a different solution."

Instead of tearing the room apart and installing a ceiling boom, OHSU opted for a floor-mounted boom. What could have been a real pain in the neck turned out to be a relative breeze. "I literally operated Friday, and the following Monday the room was fully equipped and ready to go," says Dr. Fuchs. "And at a fraction of the cost, I might add."

Like a ceiling boom, the floor-mounted version has several arms that can be used to swing monitors into any position, allowing surgeons and staff to work with screens that are directly in front of them, instead of having to look up, down, left and right.

The payoff? "It's made my work a lot easier," says Dr. Fuchs. "At the end of the day, I don't seem to be as exhausted as I was when I was looking off to the side all the time."

— Jim Burger

Look up
Several years ago I worked with an ophthalmologist whose shoulder, neck and hip pain had him on the verge of early retirement. The source of all that pain was the way he was hunched over while looking into his microscope. We made several ergonomic changes to his work environment, the most important of which was switching to a microscope that let him sit up and look straight ahead. He's still practicing, pain-free, today.

Looking down can be debilitating, but it's increasingly common in our electronic age. We spend a lot of time looking down at phones, computers and, in the operating room, patients. All that bowing is creating chronic musculoskeletal issues, because the more you bend your head forward and down, the more stress you put on your spine. The impact is so dramatic that if you bend your head 60 degrees forward (envision a teenager reading a text message), it's like carrying a 60-pound weight on your shoulders. If your neck muscles can't take the weight, the burden falls to the shoulders and traces its way down your entire back. The curvature of your lower back may even change.

The key is to keep your head up. If you're reading a text message, move your eyes, not your head. If you can control the height of any visual, whether it's a computer or a monitor in an OR, do it. Ideally, you want it directly in front of you, so you're not looking down or sideways.

Stay loose
As minimally invasive surgery becomes smaller and more specialized, so do surgeons' movements. That can lead to fatigue, tightness and repetitive-motion injuries. Surgeons, as soon as they have an opportunity, need to release that tension — either between cases or during the case, if possible.

How? Lower your arms and roll your shoulders back in at least 5 repetitions of shrugs. If you can, have an assistant do a gentle squeeze of the elbows behind you to open the thoracic cage. That also puts your shoulders back in a neutral position and takes pressure off your neck. It also encourages deeper breaths, which help promote calm.

Core concern
As noted, transporting patients is one of the big ergonomic challenges in health care. Much has been written about it, and we all should know how important it is keep our feet apart and lift with our legs, not with our backs. Healthcare staff members are generally well trained in the proper protocol. But something extremely important is lacking from that protocol. Just as waiters need to have arm strength and shoulder stability, and just as those working on roofs all day need to have good balance, nurses and surgeons need core strength. And that requires at least a minimum amount of core exercise every week.

The core is the area between your chest and your knees. Every time you reach for a patient, you're in a compromised position if you don't have the abdominal strength to support your lumbar and thoracic areas. If you're a surgeon doing microscopic surgeries for hours at a time, you have to have a strong core to avoid endless aches and pains. Walking 4 miles a day and doing the elliptical at the gym are great for your circulatory system, but they don't stabilize your core. Here are 4 essential core-strengthening exercises for healthcare professionals.

• Squat. This is the most important, and it's simple. Sit in a chair and then stand up. Repeat. Make sure to tuck your feet underneath you, lead with your chest and stand straight up. Your weight should be on your heels. You'll feel it in your thighs, but keep doing it until you feel it in your glutes, too. That's how you know you've done enough.
• Plank. This is the push-up position, but on your forearms, instead of your palms. Hold your body as straight as you can. One minute or more is a good goal, but you may have to begin with 30 seconds.
• Lateral balance. On your hands and knees, raise your right arm in front of you and left leg behind you. They should be parallel to the ground and at the same height. Hold for 10 seconds, then alternate — left arm in front of you and right leg behind you.
• Rowing. You need a machine for this one. When you row, be sure to use your back muscles to pull your shoulders back, not just your elbows.

No time for sidelines
But what if you don't have time for exercise? I saw a sign in a dentist's office when I was very young. It said, "Only brush the teeth you want to keep." The same goes for exercise. Do you have time for an injury? A bad back takes more time and is much more inconvenient than the exercises you need to make sure you can keep up with the physical demands your work requires. And the older you get, the more you need to exercise. In your 20s and 30s, you can probably get away with a few workouts a month. But if you're in your 50s and don't exercise at least 3 times a week, you'll really feel the difference in energy, sleep quality and core strength. In your 60s, when everyone starts to feel aches and pains, the more active you are, the fewer aches and pains you'll have.