Physiotherapy

Don’t break your back

It’s all too easy for doctors to neglect their own health. Physiotherapist Kam Sowman explains how to reduce the likelihood of being dogged by musculoskeletal problems.

A hospital doctor doesn’t work a typical 40 hour week – most work between 50 and 80 hours. Generally speaking, there are no scheduled breaks for coffee or lunch- instead these are taken when work allows. In common with other professionals, long hours mean many doctors have little time for sport and as a result there is a general trend towards them becoming less fit.

Combine these long hours, poor diet due to eating convenience foods and lack of exercise, with time spent sitting on the edge of patients beds, writing up case notes on the lap, being hunched over a computer looking for blood results, being bent over for ten minutes at a time while examining patients (or for even longer while performing surgical procedures) and you have a recipe for disaster.

Extremely Common

Musculoskeletal pain, as a result of poor posture and poor movement habits, is extremely common throughout society and doesn’t exclude medical professionals.

Billions of pounds are lost annually through absence from work and law suits due to musculoskeletal pain caused by a poor working environment. Health and safety legislation means that companies are now responsible for providing safe working environments. This includes manual handling recommendations and minimum legal requirements for seating and desks, collectively known as a work station. For many large corporations, a considerable amount of money is spent on work stations. However in most hospitals this is overlooked.

Ergonomics is a term used to describe the applied science of equipment design for the workplace, and is intended to maximise productivity by reducing operator fatigue and discomfort.

Legal Specifications

There are minimum legal specifications for chairs, desks and screens in the office environment are now adjustable, allowing for the great degree of variance between humans. Unfortunately this is not the case with most hospital workstations.

Poor sitting posture is a major cause of back and neck pain. With correct seating and good desk height, problems can be avoided. Most office desks are a standard height of 700-720mm. However most people, if seated at the correct chair height, require a desk between 750-800mm. It is therefore obvious that most people sit at a desk that is too low for them.

A designated working area for paper and computer work with, where possible, adjustable chair, desk and screen height would allow staff to sit in a more ergonomically correct posture and reduce posturally- generated pain.

Sound ergonomics are important, but are a waste of time without good postural control. Such control applies to not only to sitting but also to standing, bending over patients, carrying notes and performing surgical procedures.

Poor posture or poor movement habits- such as being stooped over patients- cause mechanical stress and strain on articular, myofascial, neuro-meningeal and connective tissues. Over time this causes cumulative micro trauma which leads to pain and pathology.

The ‘ideal postural alignment’ concept, pioneered by Kendall et al, occurs where the head, vertebral segments, pelvis and lower limbs are aligned in their correct anatomical position. ‘Ideal’ alignment is not always possible due to bony and soft tissue restriction, therefore ‘neutral alignment’, a mid range joint position is sought, where there is minimal support from the passive osteo-ligamentous system.

It is the deep postural muscles that are then responsible for maintaining alignment, posture and joint stability in weight bearing positions. Maintaining an ideal or neutral posture means less stress on joints and soft tissues and therefore less incidence of pain and pathology. Standing and sitting in neutral alignment needs to be learned and then practiced regularly until it becomes part of normal functioning.

Stooped Over

Improving work stations is one way to facilitate better posture and reduce pain , but other measures can help, too. Raising a patient’s bed height seems all too obvious but in many cases is overlooked. All too often doctors and other staff members are seen stooped over patients for long periods of time while conducting examinations.

By raising the bed and bending from the hips and not the spine, one can maintain a neutral spine alignment and drastically reduce the incidence of posturally – driven back pain.

Neck pain is another source of discomfort while at work and is also easily avoidable. Thinking about the posture you are in when taking a patients history can make a big difference.

Sitting slumped on the bed, twisting round to face the patient, is a very common scenario. Instead try to position yourself so that you sit in an upright, neutral posture, preferably in a chair facing the patient.

Try to avoid resting your notes on your knee and slumping over them; use a table or even write the notes up later on a suitable working surface. Writing slopes are extremely useful for bringing document up to the user to prevent excessive cervical flexion. These can be purchased in most furniture outlets.

Despite manual handling legislation, there are still instances when medical professionals are asked to lift items, whether this be moving heavy case notes around or examining a heavy leg belonging to a rather large prop forward.

It is important to try to carry or lift the object in question as close to the body as possible, in turn reducing the overall load on your spine. It may even be necessary to share the load between two people.

One final warning: absence of pain doesn’t necessarily mean that poor posture is not causing harm to tissues, which could lead to a painful condition in later years. And by that time it could be too late to do anything about it.

Kam Sowman is a chartered physiotherapist at health and Fitness Solutions

This was published in Hospital Doctor on 30th June 2005

AVOID MUSCULOSKELTAL PROBLEMS

• Try to use a desk to write up notes. Don’t be tempted to use your knee.
• When using a computer, always adjust your chair and, if possible, desk and screen height to suit you.
• Adjust patients’ bed heights when examining them to avoid having to stoop
• When taking a patients’ history, try to sit correctly in a chair and always turn your body, and not your neck, to face the patient
• Take care when lifting patients’ case notes- they can be heavy. Keep them close to your body to reduce the load on your spine. If you have to carry several files, make two trips.
• Take regular breaks from static positions and if you are bent over for long periods, straighten your spine every few minutes to prevent muscle fatigue and subsequent tissue damage.
• See a physiotherapist who specialises in treatment of neuromusculoskeletal injuries and has an understanding of muscle balance.

This was published in Hospital Doctor on 30th June 2005