A surgeon’s pain: why are they so beat up?

Posted on July 16, 2018

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(Last Updated On: July 23, 2018)

This is a three part series:

 

Why are surgeons so beat up?

I’m a personal trainer. Imagine you come into the gym to meet me for a workout. I hand you one of those light, pink dumbbells. I say “Hold your arm out to your side.”

“Ok, good. I’ll be back in eight hours.”

You’re going to think “screw this guy.” Obviously, that’s not going to feel great on your shoulder.

This is the primary reason surgeons are so beat up. They hold their body in a given position, or move their body in and out of the same positions, for long periods of time. You’re leaning over, you’re twisting your neck, you’re looking down, you’re having to hold your arm up,

for hours and hours.

Hell, just stand in place, with perfect posture. Even that will start to hurt at some point.

“procedural physicians do indeed appear to be at higher risk than nonprocedural physicians. For example,  endourologists reported more hand and wrist problems than psychiatrists, otolaryngologists experience impingement syndrome more frequently than endocrinologists, vaginal surgeons reported a higher rate of work-related musculoskeletal disorders compared with primary care physicians, and Kitzmann et al reported a higher prevalence of neck, back, and upper extremity pain among ophthalmologists compared with family medicine physicians.”

Source.

Pretty simple here. Primary care doctors don’t perform many procedures in an awkward position, on a routine basis. Sure, they might lean over trying to clear a wax filled ear, but they don’t do that 15 hours per week. There is a lot more variety than say, an orthopedic surgeon who does five knee scopes a week. Or an endodontist who does a root canal every two hours.

 

Repetitive motion isn’t the only concern

An under appreciated factor with surgeons is the intensity of practice. This can be hard to grasp for everyday people who haven’t been in an operating room, or for some procedural doctors who don’t incur higher intensity work, but many procedures require a fair amount of force. I’ve personally seen one orthopedic surgeon tighten an ACL graft with an enormous grunt to insure it was tight. I’ve seen another literally pull out a saw, like a carpenter, to reorient a patella. The last time I needed a crown, I nearly reflexively punched the dentist due to how hard they pushed to get it in place. When you’re doing that on an hourly basis, it adds up.

This is no different than how running is harder on the knees than walking. While surgeons primarily operate at a walking intensity, unlike say, a computer programmer who has a lot of repetitive motion concerns too, surgeons also throw some running (higher intensity) in the mix. Meanwhile, a computer programmer isn’t banging their keyboard every hour.

(I’d also add here I’m not sure how much surgeons themselves realize the physicality of their work. The orthopedic surgeons I’ve talked with don’t think much of it. Nor do dentists. After all, it’s become routine, and compared to the force it takes to tear an ACL, it is quite different. Nonetheless, it’s much more physical than say, your typical desk worker.)

 

Why is the problem getting worse?

As we went over in part 1, the prevalence of musculoskeletal issues is increasing for surgeons. There are population characteristics to consider here, such as doctors are getting older, but let’s also consider environmental changes.

As we said, surgeons lean over a lot. Not just during surgery either!

Furthermore, 30 years ago, they didn’t go into their office, and their home, to do this:

Surgeons are notorious for carpal tunnel issues. It’s only recently they used their hands for surgery and for office work, and for leisure. It’s only recently they look down while practicing and while checking in on their family and while entertaining themselves:

 

Thirty years ago, exercise wasn’t as well appreciated as it is now. In one sense, the enhanced appreciation is great. Exercise has the potential to at least partially counteract enumerable ailments.

However, the downside is if you don’t know what you’re doing when you exercise, you leave room to compound your already existing musculoskeletal problems. After all, a surgery most of us are familiar with is one for a physical activity concern. For instance, you might think you’re doing your knees and low back a favor by riding the bike, because it’s low impact, but doesn’t this look familiar?

If you’re a surgeon who likes cycling, then you’re leaning over while getting ready for surgery, while doing surgery, while doing paperwork from surgery, and while exercising. Talk about repetitive motion!

That’s what we’ll explore in,

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