Exercise for the Surgeon: Part 4 of Counteracting the Effect Surgery Takes on the Surgeon
As the exercises become more advanced, it is imperative to always maintain good form. Form fatigue is a common source of injury and can decrease the effectiveness of the exercises. It is better to do fewer repetitions with correct form than more with incorrect form. If you experience pain during any of these exercises, it is best to stop instead of trying to push past the pain.
A strong posterior hip is necessary for good posture and the bridge is a great exercise to work towards achieving this. To perform this exercise:
- Seat yourself on the ground with a ball braced against your back (Figure 1).
- Keeping your heels in contact with the floor press into the floor with the feet elevating the hip into a bridged position (Figure 2).
- During the movement, ensure the spine remains neutral.
- The change in position should occur because of a hinge at the hip joint.
To ensure the posterior chain is recruited for the movement, the lift should occur with a “pulling” sensation of the feet instead of “pushing”. To conceptualize this, imagine if your feet were to suddenly slip. Would they slip toward your hip because of the tension in the muscles or away from the hip? If you are “pulling” they should slip toward the hip. The progression of the exercise will provide greater emphasis on this “pulling” or use a weight over your hip (Figure 3,4).
Another progression for the bridge is to perform a single leg bridge from a supine position, with the other leg gliding on a towel or slider.
- Lying supine on the floor (a surface where a towel would glide), position one leg bent and firmly planted close to the hip to bridge from (Figure 5).
- The other leg should be extended with the heel firmly pressed onto the towel.
- As you bridge, simultaneously drag the extended leg in to match the bridging leg in position at the end of the movement (Figure 6).
- The harder you press the dragging heel into the ground the more friction will be produced and the more tension in the posterior muscles there will be in the movement.
A regression (easier version) to the elevated bridge is the supine lying bridge. The movement is performed the same as the elevated bridge, with the absence of the ball. The start position is lying prone on the floor with both legs bent and firmly planted just below the hip (Figure 7). You will press and “pull” just as in the other bridging exercise, ending with the hips fully extended (Figure 8).
The Piriformis Stretch is a good compliment to the bridging exercise.
- Start in a quadruped position and lift one leg, crossing the knee to the other side of the opposite leg’s shin (Figure 9,10).
- Shift back, extending the crossed leg straight back behind you to start the stretch (Figure 11).
- The legs should remain crossed and the leg that was not crossed over should end up tucked under the torso as you slowly push back into the stretch.
- The closer the shin of the tucked leg becomes to being perpendicular to the spine, the more intense the stretch becomes.
Chicago Review Course in Neurological Surgery
Jan. 24-Feb. 3, 2019; Chicago
Richard Lende Winter Neurosurgery Conference
Feb. 1-5, 2019; Snowbird, Utah
2019 NASBS Annual Meeting
Feb. 15-17, 2019; Orlando, Fla.
12th Annual International Symposium on Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery
Feb. 22-24, 2019; Lake Buena Vista, Fla.
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