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AANS Neurosurgeon | Volume 26, Number 1, 2017


Exercise for the Surgeon: Counteracting the Effect Surgery Takes on the Surgeon

Surgeons often work in a kyphotic posture. We explore a series of exercises that focus on maintaining good posture to counteract this occupational hazard.

As surgeons, we spend much time in a kyphotic posture. Culprits include standing over a surgical site. In time, these poor habits lead to permanent changes in our posture and contributes to acute and chronic pain. Ironically, we direct patients to maintain good posture, as well as strengthen the core and upper back, but do not heed our own advice. Developing a consistent and effective exercise program can help to counteract one of the occupational hazards we face as surgeons – poor posture.

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Prone Extension

  • Lay prone on the floor with arms and legs stretched out as far as possible. (Fig. 1, 2)
  • Activate extension of the spine to lift the limbs off the ground as high as possible without a flexion of the knee or elbow. (Fig. 3, 4)
  • Key: Keep extension in the thoracic spine and lumbar not the cervical spine

HINT: Shoulder impingement can make this movement harder to perform. 

  • If you can assume the starting position pain free but cannot lift the limbs bilaterally, an alternative is a contralateral lift of the lower and upper limb. (Fig. 5, 6)
  • If you cannot comfortably assume the starting position, begin with hands by the hip and lift with an external rotation of the shoulder to encourage a retraction of the shoulder blades. (Fig. 7, 8)

Fig. 1 Dr. Neal demonstrates exercises, with the help of trainer lijhKevin Oelschlaeger.

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8


Pectoralis Stretch

Pairing this movement with a pectoralis (PEC) stretch is highly recommended. This stretch is best performed using a suspension trainer, but can be performed on a fixed structure, like a doorway.

  • Using the suspension trainer, position yourself facing away from the anchor point with your arms outstretched and slightly higher than shoulder-height.
  • Walk yourself out slowly until you begin to feel a stretch and assume a staggered stance.

KEY: A staggered stance allows you to lean into the stretch and control the intensity. (Fig. 9)

If a suspension trainer is not available, a doorway will suffice.

  • Place both arms on the frame of the doorway with the elbows slightly higher than shoulder-height.
  • Assume a staggered stance and lean into the stretch. (Fig. 10, 11)

HINT: If you cannot comfortably assume the stretch position with both arms up, a single-arm pec stretch can be performed as long as the same side leg is forward in the staggered stance. (Fig. 12, 13)

Fig. 9

Fig. 10

Fig. 11

Fig. 12

Fig. 13




Spine World Summit
Jan. 26, 2018 - Jan. 27, 2018; Hong Kong

6th Ottawa Neurosurgery Review Course
Feb. 3, 2018 - Feb. 10, 2018; Ottawa, ON Canada

Winter Clinics for Cranial and Spinal Surgery
Feb. 25, 2018 - Mar. 1, 2018; Snowmass Village, Colo.

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