The Potential Value of Preventative Physical Therapy for Surgeons

Facial Plastic Surgery in Cincinnati, Ohio

The Potential Value of Preventative Physical Therapy for Surgeons

Dr. Jeffrey Harmon

“Do you want the bed up?” I heard these words frequently from the circulating nurse and anesthesiologist in the operating room during residency. I heard them rarely, not surprisingly, from my attending physician. It was an expression of concern for my back and neck because I looked so unnatural and uncomfortable operating as a new resident. I almost always replied that I would like the bed raised. However, I initially felt awkward asking. I was usually taller than the attending surgeon and staff. I knew they would need to adjust to accommodate me. It took time, but I grew increasingly comfortable and assertive requesting ergonomic adjustments that were less stressful on my neck and back. I have been interested in the topic since. The following blog post is a summary of what I have learned from research, experience, and conversation with professionals. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck.

Surgery is Physically Demanding Work

Head and neck surgery is physically demanding, often because of the variety of positioning required to perform the multitude of procedures. Facial plastic surgery, the subspecialty I was fellowship-trained – and am double board-certified - in, requires standing and sitting, the back and neck flexed at multiple angles, throughout a single procedure. Endoscopic sinus surgery involves often-uncomfortable positioning of the arms at an angle to the trunk to be able to see the monitor, which shows the sinus anatomy the instruments are navigating. These instruments can be heavy as well, resulting in additional strain. Surgery of the larynx, otherwise known as the “voice box,” requires the use of microsurgical instruments and precise movements on a fulcrum from the end of the long instrument to the wrist. Head and neck cancer surgery involves hours-long procedures with the head often weighed down by a headlight and a microscope attached to glasses, called loupes. As a result, the risk of developing work-related musculoskeletal disorders is high.

In fact, work-related musculoskeletal disorders may be as prevalent among surgeons as some industrial tradesmen, including masons and electricians. A review of the literature (1) demonstrates a twelve-month prevalence of pain in the following locations in surgeons and interventional physicians:

● Neck – 60%

● Shoulder – 52%

● Back – 49%

● Upper Extremity – 39%

Regarding head and neck surgery, between 47.4% and 97% of have reported musculoskeletal symptoms in the literature, with back and neck pain being the most frequently cited locations (2). Pain tends to begin early in residency and persists, likely because there is not only little training but little understanding of good ergonomics in residency programs. As a result, 23% to 84% of head and neck surgeons report seeking medical treatment, which includes physical therapy, medications, massage, and/or acupuncture (2). Unfortunately, 2.4% to 28% report requiring surgery, 16% require time away from work, and 2% are forced to stop work or retire early due to work-related musculoskeletal disorders (3).

Work-related musculoskeletal disorders are a prevalent and severe problem among surgeons and interventional physicians resulting in significant morbidity and lost time. What can be done to prevent and treat it?

The following information is what I have learned from my conversations with Physical Therapists (PTs) who I know and who I have been treated by for the purpose of preventing musculoskeletal injury. While I want to emphasize that I am not a trained, licensed physical therapist – and, therefore, the following information should be considered educational only – I do believe prevention is the optimal approach to the above problems in surgery and would advise any surgeon with musculoskeletal problems or who has concerns they will develop them to consider evaluation by a licensed, qualified PT.

Physical Therapists Explain Why Physical Therapy Can be Beneficial for Surgeon Musculoskeletal Health

Between 85.7% and 93.6% of head and neck surgeons have reported improvements in musculoskeletal symptoms with physical therapy (2). Physical therapists can be utilized both preventatively and therapeutically. According to my physical therapy colleagues, the initial evaluation includes:

Identifying areas of muscle and joint restriction
Assessing strength and endurance in sustained positioning or with repetitive movements.

The body is accustomed to taking the path of least resistance, which often results in pressure on the joints. This can be a source of injury and pain, because joints are not able to tolerate static load over time in the same way our muscle can. Therefore, the most important thing for physician surgeons to develop is improved positional awareness to choose positions with the least strain. It is for that reason that I started Reformer Pilates, both to strengthen muscles that stabilize my spine, but also to strengthen and activate those muscles I was instructed I will need to position myself in the least stressful way possible.

Physical Therapists Explain Why Movement During Surgery is Important for Surgeon Musculoskeletal Health

Some physical therapists will argue that no single position should be considered necessarily “bad” or “good.” Positioning depends on the individual and the work demands on them. However, the general problem comes from maintaining one position for too long. Neck and trunk flexion as well as flexion and abduction of the shoulders create higher force and increased muscle strain. This positioning is common during surgery. To that extent, “micropauses” of 20 seconds or more – or short breaks in general – are advised by some physical therapists to reduce joint and muscle strain.

Physical Therapists Argue Strategic Movement Before, Between and After Surgery is Important for Surgeon Musculoskeletal Health

Some physical therapists will argue that what we do before, between, and after surgery is important as well. For example, building muscle strength and flexibility beyond the range of motion of the activity performed – in this instance, surgery – is important to reduce the risk of injury. In fact, many professional athletes adhere to this strategy in basketball and other sports.

Other Common Preventative Strategies May be Less Helpful

The feedback I have received from physical therapists is that biofeedback devices – those devices that are often worn on the back and send signals with changes in posture – are generally not effective absent other interventions as described above. One colleague explained that, while biofeedback devices can be used for training, they are less effective with daily use, primarily because they can take attention away from the task at hand (i.e., surgery). However, every individual needs to make the decision for themselves whether the above is indeed true for them.

I was very interested in the feedback I received on postural chairs; chairs meant to force improvement in posture. I have colleagues who use these chairs during surgery. I was informed that, while postural chairs can be good to provide breaks for your body, they should not be a primary intervention. These chairs can reduce the usage of muscles whose strength is important to maintain good posture and, therefore, protect your musculoskeletal system. Again, however, the use of postural chairs and biofeedback devices should be a personal choice made in consultation with a licensed, qualified physical therapist.

Trust Your Face to a Double Board-Certified Facial Plastic Surgeon

It is important to seek a fellowship-trained, double board-certified specialist in plastic surgery of the face and neck when you have concerns about your face or neck.

Why Choose Dr. Harmon

The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good.
Dr. Harmon is a double board-certified facial plastic surgeon
Dr. Harmon values making patients feel welcomed, listened to, and respected.
Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology.
Dr. Harmon earned his medical degree from the University of Cincinnati.
Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati.
Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City.

Request a Consultation

Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon’s credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching “plastic surgery near me.” Get in touch with us to learn more.

Contact Us

References

This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.