Positioning Yourself for Career Longevity

Optometrists spend all day providing the best quality eye care to patients. And even though the workday may not seem physically intensive, it can take its toll on the body. Musculoskeletal disorders (MSDs) are characterized by (often persistent) pain and limitations in mobility and dexterity, reducing one’s ability to work and participate in activities.¹ These conditions can arise from a combination of factors, including poor posture, repetitive movements, and prolonged periods spent in one position. Nonphysical influences, such as stress, can also contribute to the development of MSDs.² Symptoms of MSDs typically do not require surgical intervention. Instead, treatment options, such as physical, occupational, and chiropractic therapies, as well as exercise can help to alleviate and prevent symptoms.³

IDENTIFYING THE PROBLEM

Optometrists are at risk for several types of MSD, including neck pain, back pain, wrist pain, hand problems, and even eye strain. A study in Ophthalmology found that eye care practitioners had a higher prevalence of neck, hand/wrist, and lower back pain compared with family medicine physicians.⁴ In the study, eye care professionals reported specific occupational tasks, such as the use of the slit lamp, binocular indirect ophthalmoscopy (BIO), and refracting equipment to be contributory to their symptoms of MSDs.

Evaluating certain risk factors in the work environment is crucial. Ergonomic assessments have proven to be effective in reducing work-related injuries.⁵ However, best practices indicate that ergonomics should be addressed within the work environment early by a physical or occupational therapist, which is not always feasible.⁶ Below are several risk factors in the ophthalmic workplace that can easily be modified to prevent symptoms related to MSDs.

SLIT LAMP SLUMP

Use of the slit lamp involves positioning our head and neck to align with the microscope to properly evaluate ocular structures. Prolonged and potentially awkward positioning can result in muscle imbalances and postural changes, causing pain in the neck, shoulders, torso, and hands. Instead, the head, neck, and shoulders should be vertically aligned in a neutral posture to prevent MSDs.

Helpful Habits

A few positional adjustments can make all the difference in preventing MSDs developed at the slit lamp. Performing a “body scan” technique that includes ensuring both feet are flat on the floor, core muscles are engaged, shoulders are back, and neck is neutral and not hunched, can save both neck and back pain, as well as subsequent nerve issues through the arms and hands. Repetitive use of mindfulness-based body scan techniques can easily create permanent habits that lessen the likelihood of physical ailments.⁷

Although adopting these habits as a seasoned clinician can feel challenging, it will pay dividends to your physical health. To support this practice, develop a “mental checklist” to repeat when approaching physical tasks, such as “head, shoulders, knees, and toes,” to prompt proper body positioning.

EXAMINATION LANE

Many of us were taught the art of refraction using a manual phoropter. Improper positioning with twisted and distorted body positions to reach the dials can wreak havoc on the back, shoulders, elbows, and hands (Figure 1A). Not only that, but chronic, repetitive motions can lead to symptoms associated with MSDs.⁸ With the advent of the digital phoropter and digital acuity technology, some of these issues have been eliminated; however, awkward angles and positions can still occur, leading to issues over time.

Another exam lane consideration is the orientation of equipment in the room, which can create a situation where optometrists are in an awkward position when they are speaking with the patient and trying to type notes into the chart for efficiency.

Helpful Hint

Consider flexible workspaces with universal design strategies. These can include rolling, spinning stools, and sit-to-stand workstations for computer use that allow easier and faster transitions between computer and examination tasks.⁹ Also, think about exam chairs with more adjustable features (eg, seats that easily raise and lower, adjustable or removable armrests, and stools with a narrower footprint) to decrease the physical distance between you and your patient during examinations (Figure 1B). Neck strain often arises from moving your body closer to a patient, rather than moving them closer to you.

BIO EXAMINATIONS

The BIO examination is important in evaluating the ocular health of a patient. That said, while performing this examination, we tend to put ourselves in awkward positions to achieve and maintain a good view of the retina. Whether the procedure is performed with the patient in a supine or seated position, this positioning can result in unnecessary strain on our head, neck, shoulder, back, and hands.

Helpful Habits

BIO techniques are inherently stressful on the body due to the need for full wrist and elbow extension, and neck flexion motions. However, you can counteract these positions by performing some simple stretches throughout the day. In general, it’s important to move in the opposite motion of those you perform, including passive wrist extension (Figure 2), scapular retraction (Figure 3), shoulder extension (Figure 4), and neck extension (Figure 5) exercises.

COMPUTER USE

The era of electronic health records has become mainstream in every office. Although it does prove its effectiveness, it requires increased time at the computer. Improper posture at the computer can lead to neck, shoulder, and back strain (Figure 6A). Additionally, the use of the keyboard puts the hands and wrists at risk for fatigue and cramping after extended periods of use.

Helpful Hint

Ideally, computer positioning should include neutral shoulders with your upper arms resting at your side, neutral wrists and elbows bent at 90˚, and upright, unhunched posture. If seated, your hips and knees should also be bent to about 90˚, commonly called the 90-90-90 rule, as the elbows, hips, and knees are all bent to 90˚ (Figure 6B).¹⁰ Ditch the wrist rests, and ensure your wrists “float” above surfaces, rather than resting on them, as these can add additional nerve pressure on the wrists and lead to exacerbations of carpal tunnel symptoms. Additionally, the single most effective way to avoid MSD development is the use of physical adjustments from any position (eg, alter your position at least every 20 to 30 minutes).³

STRESS

A study by Dhimitri et al observed a positive correlation between stress levels and back, neck, and upper extremity musculoskeletal symptoms.² All optometrists deal with some stress when they are juggling multiple tasks while also providing optimal eye care. It is an occupational hazard. Fortunately, managing stress can lessen one’s physical symptoms.⁹

Helpful Hint

Mindfulness-based stress reduction programs are increasingly supported by literature, but often require a significant training time not accessible to many clinicians. A brief way to manage stress and decrease sympathetic nervous system activation is using 4-7-8 breathing: inhale for 4 seconds, hold for 7 seconds, exhale for 8 seconds, and repeat for six cycles. This strategy has been shown to decrease heart rate, anxiety, and stress and to aid in sleep.¹¹

GIVE IT A TRY

The development of MSD symptoms may not be obvious at first. However, improper positioning and chronic, repetitive movements can lead to devastating consequences. Prevention and early intervention are key to maintaining career longevity. Getting an ergonomic assessment of the work environment can be helpful in preventing MSD development and will allow optimal conditions so we may deliver the best patient care without negatively affecting our own health.