My Back Hurts…

Back pain is very common during medical training.   All doctors spend time leaning over beds …. some of us (e.g. surgeons) more than others.  Back pain for most physicians is about core fatigue.  When you lean over for any length of time you are supported by your core muscles.  When the core muscles begin to fatigue, you transfer the job of holding the position to your joints (spine, hips, knees) and the muscles of your back.  So – the most important way to prevent or get rid of back pain is core training.   Crunches alone won’t do it – they just work the muscles in one direction.  What causes our pain is twisting with bending over.  You need a set of exercises that strengthen your core in more than one direction.  A great way to strengthen your core (if you have time for the classes) is doing yoga, pilates, or tai chi.  But (assuming you don’t really have time for classes), commit to 5 minutes a day of core exercises and I bet you’ll see a difference.  Needless to say, we’re talking about “ordinary” back pain here.  If you have symptoms of radicular pain, weakness or paresthesias go see a doctor!!!

Here’s some urls with good illustrations of functional (i.e. all directions) core exercises

http://www.mayoclinic.com/health/core-strength/SM00047

http://sportsmedicine.about.com/od/bestabexercises/a/all_abs.htm

One other really important thing – make sure you use a good technique if you have to lift a patient (or any other heavy object) i.e. face the object (no twisting) and use your legs, not your back.   http://www.webmd.com/back-pain/lifting-properly-to-prevent-back-injury

For surgeons, you can do a few things in the operating room that will help.  This list is from an article I published last December (Am J Surg. 2009 Dec;198(6):742-7. PMID: 19969123)

All surgery

  • Set the table height at the level of the umbilicus of the tallest assistant/surgeon and use standing stools for all other personnel

Open surgery

  • For long cases that require torsion of the back (pelvic surgery, head and neck surgery), change positions often; raise or lower the bed slightly; switch sides; and stretch periodically

Laparoscopic surgery

  • Place the monitors so they are directly in front of the operating surgeon/assistant, the goal is to avoid any twisting of the neck for the surgeon or assistants
  • Place the monitors in laparoscopic surgery slightly below eye level (15° is best) to have a slight head-down gaze
  • Use enough standing stools to provide a large enough platform for foot pedals (2 deep, 2 wide if necessary)
  • Once the trocars are in place, lower the table (or add standing stools) so the operating surgeon has relaxed shoulders
  • Avoid positioning foot pedals so the surgeon has to stand on one foot; even better, switch to the most ergonomic possible hand control

You Can Exercise Even if You are on Call

One of the great fallacies about working out is that you need to “go somewhere” to work out.  This idea that working out is separate from the rest of your life is the main reason people don’t work out.  Be creative – there are lots of ways to work out that don’t require much and can be done in the hospital.  There are days on call and then there are days on call (everyone who has done it knows what I am talking about).  On the days that have a little “breathing room” here are some ways to work out while you are at work.

Cardio options

  1. Take the stairs instead of the elevator.  There are good data that 3 sessions of 10 minutes of cardio has the same result as a 30 minute cardio session.  Those 2-3 minute “sessions” of going from floor to floor will add up to 20-30 minutes easily by the end of the day.  Or, if you want to push it a bit, add a few flights (or minutes) here and there.  You can always find 10 minutes (or 20, if the day permits) and really climb the stairs.
  2. Take a jump rope to the hospital and keep it in the call room
  3. Find out if there is a stress test lab or PT area in the hospital that has stationary bikes or treadmills that you can use.
  4. Go for a walk.  If it’s safe, and your beeper and cell phone permit, walk outside the hospital.  If not, do “power rounds” on the floors for exercise (do the circuit of each floor, climb the stairs to the next floor and continue).
  5. Talk your program into paying for a used bike or treadmill.
  6. Commute to work on your feet or on a bicycle (more on that later…)

Strength training options

  1. Buy a set of stretch bands or inflatable (with water) dumbbells and throw them into your on-call bag.  You can get a good strength training workout with these.
  2. Cheap dumbbells are easy to find.  For $20-30, you can put a pair or two  in the call room or resident lounge.  See if there are other residents that want to go in with you to buy a complete set.  Of course, you will have to find a way to lock them up if, like most hospitals, things have a habit of walking away.
  3. Old fashion calesthenics (push-ups, squats, etc) will provide a good strength workout , too. You might consider one of the many popular DVD based programs that are making the rounds (no pun intended) at the moment.

Flexibility training

Stretching can be done anywhere, anytime.  Like weight training, there are some good tips that can be taught by a pro.  Make sure if you hire a personal trainer that you ask them to give you some tips about stretching, too.  There are also excellent books on stretching.  You might think about web based or DVD yoga sessions as another alternative.

The key concept here is that working out during call is doable – and will often help with fatigue, stress and the feeling of being overworked.  These “workouts” don’t have to be long – even 10 minutes will help.