407activities, ergonomic intervention has been shown to provide 89% improvement in
symptoms. Ergonomic intervention includes maintaining a light touch and neutral
wrist position. The keyboard should be placed at a distance of at least 5 inches from
the edge of the desk. The chair height should be adjusted so that the keyboard is at
elbow height and the shoulders relaxed to avoid upper extremity strain [ 160 ].
Dictation and use of voice recognition software are other options that can decrease
the amount of typing required.
Regular Exercise
Exercise is important to reduce the risk of occupational injury. A study by Sivak-
Callcott et al. suggests that surgeons who exercise an average of 5 h per week are
less likely to experience pain or spinal disorders that result in the need to modify
operating practice, when compared to surgeons who exercise less [ 29 ]. Core-
strengthening exercises can prevent pain with standing while operating. Tse and
colleagues found that those who received trunk muscle training for 6 weeks experi-
enced significantly less discomfort and fewer errors during laparoscopic simulation
than those who did not train [ 164 ]. Strength training is often accompanied by tran-
sient muscular soreness especially when beginning a new program; however, the
long-term benefits of strength training appear to outweigh the initial increase in
discomfort. A 10-week training program consisting of 20 min of trapezius-focused
exercises 3 days a week was shown to significantly reduce neck discomfort in
women with chronic neck pain [ 165 ]. General fitness training, such as bicycling,
swimming, and performing other aerobic exercises, has been shown to increase the
pain threshold transiently for about 2 h in non-exercised muscles and has also been
shown to result in a reduction of the use of medications for back pain [ 165 , 166 ].
Stretching is important to improve flexibility and range of motion and increase
circulation to improve or prevent musculoskeletal injuries [ 144 , 157 ]. Stretching
exercises should be performed following a brief (<10 min) cardio warm-up three
times a week. Static stretches should be maintained for 20–30 s with three repeti-
tions to promote elongation of the muscle and other soft tissues. Dynamic stretching
involves repeated movements which gradually increase in movement size and range
of motion. Dynamic stretching and static stretching with a warm-up reduce muscu-
lar injuries [ 157 ].
Ergonomics for the Surgeon Educator
A lack of adherence to ergonomic principles in the operating room increases the risk
of musculoskeletal discomfort [ 10 , 14 , 83 , 97 ]. This may be especially true for resi-
dents who, while focusing on the operative procedure, pay less attention to ergo-
nomic conditions including their own posture. If an occupational injury occurs,
surgical training may be prolonged, directly affecting a resident’s career as well as
22 Surgical Ergonomics