Exercise for the Surgeon: Counteracting the Effect Surgery Takes on the Surgeon: Part 2
As the exercises become more advanced, it is 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 less 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.
RETRACTIONS AND LAT STRETCH
Strengthening the retractor muscles of the scapula will help to combat the mal effects of long surgeries and time spent at the desk. It is best to perform this exercise standing to encourage the intermuscular coordination with the abdomen and discourage the posterior tilt of the hip, which often occurs when seated.
Using a dual cable machine position the pulleys so that they are shoulder height and grab the cables so that they are crossed in front of you and gripped with a supine hold (i.e. grab the right cable with the left hand and the left cable with the right hand)(Figure 1,2). Center yourself on the machine and with a maintained straight arm horizontally abduct the shoulders and retract the shoulder blades (Figure 3,4). The scapular action is the primary goal of the movement. It is important to start from a protracted position and work into a retracted one as the shoulders are horizontally abducted for each repetition. A common mistake is to try and maintain a retracted shoulder blade after the first repetition for all remaining repetitions. This goes against the natural glenohumeral rhythm of the shoulder girdle and can cause injury or impingement.
If impingement or injury is already of concern a regression to the movement is to take the angle of movement at a downward angle (Figure 5,6,7,8). This regression is advised for cases of neck injury or shoulder impingement as it encourages the depression of the scapula and increases spacing in the shoulder joint, decreasing the likelihood of impingement.
Performing the movement with free weights is a progression that has the added benefit of increased trunk activation and intermuscular coordination. This is performed by hinging at the hip and horizontally abducting the shoulder in the same fashion with a dumbbell grasped in each hand (Figure 9,10,11,12). The consideration for this one to be performed properly is the spine’s orientation to gravity. The spine must be close to perpendicular to gravity or the movement will encourage the elevation of the scapula decreasing its effectiveness on improving posture.
The Lat Stretch is a good compliment to the retraction of the scapula. This is performed best with a circular band looped around a high anchor point. Place a hand in the tag end of the band so the back of the hand is in contact with the loop, then grab the band so that the material is in the “V” of the hand between the thumb and index finger (Figure 13,14). Stretch the band back so there is tension in the material and take a deep lunge backward with the banded-side leg planting the knee on the ground. Lean forward so the spine is in-line with the direction of pull of the band allowing the tensioned band to stretch your Lat (Figure 15,16).
An alternative if no band is available is to find a door frame or tall fixed post that you can grab hold of easily. Stand so that the post or frame is to your side lined up with your hip (Figure 17,18). Stagger your stance so that the inside leg is forward and outside leg is rearward. Brace the inside hand against the post or frame at waist height so that it can press away from the post or frame. Reach over the head with the outside hand and grab onto the post or frame firmly, gripped with the thumb down (Figure 19). Press with the inside hand pushing your hips away from the post or frame until you feel a stretch in the Lat.
This is Part 2 of a series.
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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