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Ophthalmologists need to protect themselves from repetitive strain injury
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Repetitive strain injury, or RSI, is defined by Wikipedia as an “injury to the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained or awkward positions.” For us ophthalmologists, RSI is primarily caused by the final four words in that definition: “sustained or awkward positions.”
Our repetitive sustained and awkward positions are primarily those assumed when sitting down at the slit lamp examining a patient in the clinic or at the operating microscope doing microsurgery repeated hour after hour, day after day, week after week, year after year. Poor ergonomic positioning combined with a low level of physical fitness/flexibility are the primary causative factors. The solution is the opposite: good ergonomic positioning and a high level of physical fitness/flexibility. Good posture at the slit lamp and operating microscope in which one stretches upward and sits tall and vertical can be achieved with proper positioning and adjustment of the slit lamp, the operating microscope, the ophthalmologist’s chair and the patient’s chair or bed.
It is important to take the time necessary to achieve proper positioning of oneself and the patient during every patient encounter. This is a discipline that requires some time and effort but generates enormous rewards for the ophthalmologist and even the patient. Proper surgeon and patient positioning will not only enhance the ophthalmologist’s well-being but also, especially in the case of a surgical procedure, improve the surgeon’s dexterity and durability in regard to the number of cases that can be performed well without results impacting fatigue.
While prevention is always preferred over treatment, many of us will inevitably suffer some level of RSI. The classical initial treatment for any RSI is rest, ice, compression and elevation (RICE). Analgesics, especially a short course of an oral NSAID, can be helpful, being aware of the renal and gastrointestinal side effects of excess long-term NSAID use. Physical therapy and/or therapeutic exercise can serve for both prophylaxis and treatment.
The earliest findings of a potentially career-threatening RSI are usually sensory symptoms. This is because the motor nerves are surrounded on their surface by sensory neurons. Thus, we fortunately suffer symptoms such as tingling, numbness, discomfort and pain before we are handicapped by the potentially disabling motor nerve damage resulting in weakness or even paralysis. The wise ophthalmologist will respond to the onset of meaningful cervical or lower back symptoms resulting in dysesthesias in the upper or lower extremities, usually the hands or feet, well before the onset of the potentially disabling motor weakness signs, which include muscle atrophy in the mildest form and loss of function and even paralysis when severe.
I personally have found a combination of compulsive attention to good posture in both the clinic and operating room along with a daily morning exercise/stretching program has allowed me to survive 45 years of longer-than-average clinic and operating room work days. At an earlier age, when first troubled by lower back pain after long days in the operating room, I discovered the well-known author Pete Egoscue’s books and adopted many of his teachings on posture and exercise. While years of sports have taken a toll on my hip and knee joints, the teachings of Pete Egoscue have helped me preserve a healthy enough cervical and lumbar spine to continue the practice of medical and surgical ophthalmology comfortably into my seventh decade. I support the recommendations made in the accompanying cover story and also recommend acquiring one of Pete Egoscue’s many books as a source of useful information to both prevent and, if needed, treat RSI.
Disclosure: Lindstrom reports no relevant financial disclosures.