Neck pain in the exam room and how to alleviate it

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Optometry is a profession where we sacrifice ourselves while serving others.

Repetitive motion and posture may be major risks for neck and back pain. If you feel the pain, know you are not alone. A recent study showed ophthalmologists and optometrists have reported a higher prevalence of neck, hand/wrist, and lower back pain than family medicine physicians.¹ Studies show 70 to 82 percent of eye care providers report neck and back pain.^1,2

The number of patient encounters per day can vary depending on the practice. Some ODs may see 15 patients per day, while other ODs may max out at 40+. Neck pain may be difficult to manage when using repetitive motions with poor posture, shoulders slumped forward, neck forward, and arms held up multiple times per day.

Previously from Dr. O'Dell: How I am embracing the medical model in optometry

Somedays may be worse than others depending on how many children or handicapped patients an OD may see. These patients can be a challenge to serve causing an OD’s contortion to be worse during the exam process.

Work-related musculoskeletal disorders may be a pain in the neck and lead to reduced time in the office, chronic pain, and headaches. If you are experiencing pain, it is important to address it to prevent further injury.

Here are three common exams that may give ODs a pain in the neck, how to avoid tech neck, and tips to combat the pain.

1. Refracting

While refracting patients, ODs must often reach above their bodies to change lenses on the phoropter. The “Which is better, one or two” procedure may cause stress on the shoulders and neck. Trial frame refracting also creates strain and stress on the area because both hands are needed to refract and manipulate the lenses.

Solutions

• Electronic refracting. Switching to electronic refracting may reduce the stress and strain on the neck and shoulders by eliminating the need to reach forward and above the midline while changing lenses.

Related: How ODs can ease the pain of patient referrals

• Alternating between right- and left-handed rooms. Set your exam rooms up to place your equipment on different sides of the room to utilize your right and left hands. This allows you to work from both sides of your body throughout the day minimizing stress.

2. Slit lamp exam

During slit lamp examinations, it is easy to adjust the height of the slit lamp to the patient. This creates unneeded stress on the OD’s neck, which may cause hyperextension. Fundus examinations at the slit lamp may also be taxing on the neck muscles as ODs manipulate the lens for good focus while adjusting the position of the slit lamp illumination.

Solution

• Position yourself first, then move the patient to you. Be sure to keep your neck from hyperextending by pulling your chin to your chest as you set up the exam.

3. Binocular indirect ophthalmoscopy (BIO)

Depending on how you perform a peripheral retinal exam, the exam can cause work-related injury especially if it is performed with the patient in a seated position. When performing this procedure, the OD is working with her hands above her head to achieve good peripheral retinal views. This exam may also require stooping and stretching.

Related: Process key to pain management

Solution

• Patient positioning. It is best to lie the patient back and have the patient move his head to allow for better peripheral views.

Combating tech neck

In our personal time, many of us are guilty of using digital devices such as smart phones, Fitbits, and Apple watches. Tech neck is the act of holding your head flexed and forward while looking down at your device. Tech neck puts your cervical spine in a tenuous position.

Solutions

• Set time limits on a task: Take breaks for about three minutes for every 20 minutes you are using a device. During this time change your posture and move around.

• Reposition: If you are too busy to know when repositioning is needed, set a reminder.

• Eye level: When using a digital device or phone, keep it at eye level to minimize neck flexing and forward positioning.

Aerobic exercise to alleviate pain

Cardio exercise may increase blood flow to the muscles of the neck and upper back to help loosen muscles and increase range of motion. It is recommended to have 30 minutes of cardio exercise daily. Cardio releases mood enhancing endorphins that further improve neck pain.

References

1.  Al-Marwani Al-Juhani M, Khandekar R, Al-Harby M, Al-Hassan A, Edward DP. Neck and upper back pain among eye care professionals. Occup Med (Lond). 2015 Dec;65(9):753-7.

2. Long J, Naduvilath TJ, Hao LE, Li A, Ng W, Yip W, Stapleton F. Risk factors for physical discomfort in Australian optometrists. Optom Vis Sci. 2011 Feb;88(2):317-26.

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