Bill Klaproth (Host): This is an AAOMS On the Go
podcast. I'm Bill Klaproth and with me is Dr. Julie Chavez, an AAOMS fellow, as
we talk about work-related pain and the benefits of ergonomics for oral and
maxillofacial surgeons. Dr. Chavez, welcome.

Dr. Julie Chavez: Hi, Bill. Thank you for having me.

Host: You bet. It's great to talk with you. So, let me
ask you this, how did you develop an interest in ergonomics? And why is it
important for oral and maxillofacial surgeons in particular?

Dr. Julie Chavez: Well, I had and continue to have some
issues, some musculoskeletal problems myself. And in working through those
issues, I developed a keen interest in it and also an interest in how we don't
get much training in that throughout all of our residency or even prior to that
in dental school, and seeing that as a big learning knowledge gap and hopeful
that I can help remedy that in some point in time.

Host: So Julie, you mentioned that you have had and
continue to have some issues. Can you tell us what musculoskeletal issues
you're facing?

Dr. Julie Chavez: For me, I had developed some shoulder
issues. And for right-handed surgery, we're holding a retractor in our left
hand almost constantly, and I've developed some limited mobility and some
issues in my shoulder. And I knew it was coming from the work and trying to
improve my posture and things. But then, I developed some numbness in my
fingers on my left hand, on my ring and pinky finger. And then, through our
training we do a lot of neurosurgery and so we know that this can be coming
from the neck and the cervical vertebrae. So, it was very worrisome. And of
course, I was very afraid that this was going to progress or potentially
prevent me from practicing. So, I did everything in my capability to
rehabilitate with my trainer, who thankfully I have had a really great trainer,
Chuck Turner, for almost 10 years now. He helped me a lot, massage, stretching.
So, I really got interested in this and I was able to really help myself and
rehabilitate. It's always there nagging. But that's been my experience more
than back pain and some neck. But the studies show and our study shows that
mostly shoulder, neck, back is the highest risk areas for us.

Host: So, you talk with a lot of other OMSs. This sounds
like it's something that's common in the industry, would that be right?

Dr. Julie Chavez: Yes. I think unfortunately extremely
common.

Host: So, there's a survey that was done of the
Minnesota Society of Oral and Maxillofacial Surgeons, and can you share with us
any things you learned specifically about ergonomics?

Dr. Julie Chavez: In my journey, it spurred me to
investigate. I had many colleagues that were experiencing similar problems and
I've had former partners that have had to retire because of musculoskeletal
issues. So, we have several meetings, COVID kind of derailed it a little bit,
but, you know, often seeing a lot of colleagues at meetings. I had met some
occupational health students that were obtaining their PhD in occupational
health. So, they helped me develop this survey that was basically a 14-question
survey, and I distributed that to colleagues and residents at meetings over
about a year period. And it asks questions such as: "Are you currently
experiencing pain? And if yes, where?" "Do you attribute this pain to
your career?" "Have you missed work because of this?" So, some
of those kind of questions, and it was really quite alarming that 47% of the
survey participants, and we ended up having about 75, 47% said they were
currently experiencing pain and most prevalent at 38% was shoulder like myself,
then neck 37% and lower back at 31%. So, that information too spurred me
further to think it seems crazy that we don't get any training in this.

And with the help of the occupational health students and then
Jim Swift, who was my director and mentor going through residency and my
trainer, Chuck, we wrote a paper on using the data that we collected. And I'm
hopeful it's been accepted for publication in a journal called WORK, which is
an occupational health journal. And I think it was in September we got accepted
and it should be within the year. So hopefully, any month now, it'll be coming
out. But it does go through those findings and some other findings too.

And with my work with Chuck, as I was a client of his for many
years, I found out that he did some work in corporate settings. And he's very
fitness-oriented, but he's really in incredible shape, but he's that kind of
person that is focused on the six-pack abs and really focused on functional
movement and a lot of stretching. So, he's very good at what he does, and I
think some people had recognized that he's really motivational. So, he was
going to these corporate settings where people were either factory, working on
the floor or sitting at a desk for long periods of time. And he would go in
and, for the factory workers, every 45 minutes for five minutes, you know, he'd
pop up on the screen and he was going through some of these fitness strategies,
mainly stretching and to avoid these repetitive motion injuries. And so as I
was having my issue and talking with him about that, I thought, "Well, we
need something like that for surgeons." So, that's really kind of how the
light bulb went on and how I pursued it.

Host: Yeah. Well, some people may be shocked at those
statistics you gave us. So given the physical nature of the profession, is it
inevitable then that OMSs will develop neck or back or shoulder injuries?

Dr. Julie Chavez: I believe it's preventable. And I
think that it's multifactorial. I think if there's good training with
ergonomics, which is basically being aware of your posture and your body
position while you're doing this. It is a quite physical job. I think that
would be number one, is understanding the ergonomic principles that we need to
withstand the work that we're doing and then, the fitness strategies to promote
strength. I think it's really about strength and stretching and you don't have
to be a fitness nut to benefit. And most of these exercises are very simple and
straightforward. So, I think a combination of those two could prevent a lot of
these musculoskeletal problems, which are the top cause of people becoming
disabled and not being able to practice, and it's across the healthcare of
surgeons. Dentists, number one, are highest risk of musculoskeletal disorders
followed by surgeons. And when we were looking at research, I found, well,
there's surgeons and lots of different types of surgeons. Really, there's not
much specific data out there on oral maxillofacial surgeons. But I think as a
dentist who's specializing in surgery, we're probably at the top of the chain
to be highest risk for those problems. But the statistics that we saw is really
pretty in line with a lot of the other research out there in other surgical
specialties. And, you know, there's oncologic surgeons, there was a lot of
OB-GYN, there's really a lot of research out there on many surgical
specialties. And at some level, I think we're all doing similar type of work
and contorting ourselves in these positions. And yeah, it's a big problem, I
think.

Host: So, you were talking about prevention. What are
some things OMSs can do or change to avoid discomfort or prevent injury?

Dr. Julie Chavez: With the ergonomic piece, I think just
understanding some simple ergonomic principles can go a long way as far as
posture. And basically as humans, no matter what kind of work you're doing, you
would like to try to avoid having your spine bent greater than 30 degrees off
the vertical in a forward back motion or side to side. And the same thing with
the neck, you know, as the more we have it bent over, that's going to put you
at higher risk. The longer time you spend in that position, greater than 30
degrees, the higher risk you're going to become. And as far as shoulders go,
keeping your shoulders down and your arms in close to your body helps relieve a
lot of the stress that your shoulders can take. And then, wrist angle, I think
we're not as high risk as maybe some people, general dentists or people like
hygienists. But the angle that your wrist makes, your hand to your arm, you
should not close that down greater than 105 degrees. So, I've given some
lectures and I made a slide that is called ergonomics for dummies, and it
basically just says 30 degrees, 30 degrees, and greater than 105. And I think
the principles are simple because for somebody that's six-foot-five versus
myself who's five-foot-five, you know, positioning of patients and tables and
it's going to be different. But if you can keep those principles in mind,
that's really the goal.

Host: Yeah. And how about standing? Is there anything
that we should know about standing? You mentioned posture earlier, and is there
any fitness strategies an OMS can utilize?

Dr. Julie Chavez: So, I think for standing, I do think
it can be more beneficial. Most oral maxillofacial surgeons stand during their
procedures as opposed to general dentists or other dental specialists that are
sitting most of the time. And even though the OMSs in our survey, we did report
back pain, lower back pain at 31%, but the literature for general dentists and
other dental specialists is showing that they are affected by back pain at
about 70% incidence and mainly lower back pain. So, the standing may afford
some protection to the lower back and the lower back with the posture. A lot of
it has to do with core strength and core exercises, and thinking about those
things as you're operating. And I think things in my practice, what I try to do
is when things are going well and I feel like we're sailing along, then I try
to really think about my posture and ergonomics. And of course, when you're
struggling or things aren't going great, then you're just doing what you got to
do to get the job done.

I think the core strengthening exercises and Chuck and I have
developed a project called the Sustainable Surgeon Project, and there's a
website and also social media, Instagram, but we have a lot of videos through
the website or through YouTube that have some of these simple strengthening
exercises targeted at strengthening the upper back to combat the hunched over
position, so strengthening the back. We're all stronger no matter what you do,
sitting at a desk or whatever, we're all stronger in the front than the back.
And so, a lot of that strategy is the core and strengthening of those back and
neck muscles.

Host: Yeah. So, it sounds like it's not inevitable that
OMSs will develop neck or back injuries or shoulder injuries, especially if
they pay attention to ergonomics. And what you said earlier, make sure your
shoulders are down to the body, watch your wrist angle, proper standing
techniques. And then if you employ fitness strategies, it sounds like you can
keep these types of injuries at bay then.

Dr. Julie Chavez: I am a firm believer that if you have
that education and are doing those exercises, I think that you would've a much
better chance of having a musculoskeletal disorder-free career.

Host: Which is what we're looking for. So, are there
additional resources and tools available to surgeons, Julie?

Dr. Julie Chavez: Well, people can go to our website, so
it's called The Sustainable Surgeon Project and the YouTube site or Instagram.
And so, we've got a lot of videos up there.

And I just came across a paper that the American College of
Surgeons put out about three years ago. So, they developed a task force for
ergonomics and these kind of fitness strategies. And I think the impetus was
for general surgery when they went to doing a lot of robotic and laparoscopic
procedures, they were experiencing a much higher incidence of these
musculoskeletal disorders. So, that is out there too on the internet. So, it's
American College of Surgeons and it's got a nice synopsis. A lot of it is
targeted to laparoscopic and robotic procedures that we don't do that type of
work much, but I think is still helpful.

Host: Right. So, you called it the Sustainable Surgeon
Project, is that correct?

Dr. Julie Chavez: Yes.

Host: And what is the URL for that?

Dr. Julie Chavez: Yeah. Sustainablesurgeonproject.com.

Host: Got it. Sustainablesurgeonproject.com. Well, this
has been great, Julie. Thank you so much for your time. As we wrap up, is there
anything you'd like to add?

Dr. Julie Chavez: Well, I think that I love the career,
the oral surgery career. I think everyone would agree, every day is
interesting, never the same. But I do think that we need to be more in the
mindset of almost like an athlete, that you're going to go to game day every
day, and you need to prepare for that. It doesn't take a lot of preparation,
but it does have to be sustained. And you have to drink the Kool-Aid to benefit
and not wait until you're developing an injury. And I'm hopeful that I can be
instrumental in maybe developing some curriculum that could be implemented for
residency and even earlier so that the earlier you know that this is a
possibility and have the fundamentals, I think it would go a long way to
preventing some of these problems.

Bill Klaproth (Host): Well, Dr. Chavez. That was
wonderful. Thank you so much for your time. I love how you put that every day
is game day and we've got to be prepared and through your help in work. We
certainly will be more prepared. So thank you again, Dr. Chavez. We appreciate
it.

Host: And for more information and the full podcast
library, please visit aaoms.org. That's A-A-O-M-S.org. And if you enjoy the
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don't miss an episode. Thanks for listening.