Ergonomics for Cleft Providers — Sage Perspectives Blog

BY Usama Hamdan, MD, FICS; Jose Antonio Garcia, MD, MPH; Wassim Najjar, MD

When we think about superheroes, we often envision invincible, impervious-to-harm individuals with superpowers beyond imagination. Yet, outside the pages of comic books and movies, real-life heroes work diligently to make this world a better place. They may not wear capes or wield extraordinary abilities, but their superpower lies in their determination to transform people's lives. Some of them wear uniforms and fight crime, while some others have the power to create smiles.

Among these remarkable real-life heroes are the physicians, surgeons, therapists, dentists, and nurses dedicated to cleft lip and palate care who, unlike our comic book counterparts, are not immune to our efforts’ toll. In our paper "Ergonomics for Cleft Providers: A Brief Communication", we shed light on an often-overlooked aspect of this noble work—the challenges we face in maintaining our own well-being while dedicating our lives to the well-being of others.

After decades of experience as a surgeon, I have come to understand that, while tireless passion fuels our work, we must recognize our vulnerability to physical strain and discomfort. This issue resonates with countless experiences of colleagues, which have compelled me to act toward ensuring that all providers are not just equipped to transform lives, but also to protect their own well-being.

Work-related musculoskeletal (MSK) disorders are a leading cause of pain and morbidity among cleft care providers, impacting not just their professional lives but also interfering with their personal time. For instance, more than 80% of surgeons report significant pain while operating, and an astonishing 9.2% will terminate their career prematurely due to MSK morbidities and discomfort.

To address this issue, the American College of Surgeons has proposed ergonomics and strength training as viable solutions. But what is “ergonomics”? From the Greek ergon (work or labor) & nomos (natural laws), this term refers to the optimization of MSK performance in accordance with human anatomy and physiology.

Yet, cleft care providers face various ergonomic challenges. Firstly, the natural aging process impacts our balance, endurance, flexibility, and strength, which leads to a gradually increasing need for proactive measures to counteract these effects. Secondly, workplace mechanisms may not cater to maintaining an appropriate posture during practice, requiring adjustments and improvements to protect our postural health. Lastly, the interplay between poor habits at work and outside can create a vicious cycle of morbidity if not addressed promptly.

To overcome these ergonomic challenges, we propose three simple pillars: "Avoid, Adopt, and Advance." As can be seen in Figure 1 and Figure 2, by actively avoiding back-breaking positions, adopting better posture not only at work but also in daily activities, and advancing time utilization for exercise and stretching, cleft care providers can seamlessly improve and protect their MSK health and overall wellbeing.

**Figure 1. Back & Neck breaking positions during cleft surgery, using regular loupes.**

**Figure 2. Posture recommendations during cleft surgery using prism loupes.**

Aside from a good posture, implementing strength training is a vital step in safeguarding our most valuable asset as health care providers—ourselves. The American Heart Association recommends 150 minutes of moderate-intensity heart-pumping activity a week (3), which can be achieved through a simple 20-minute daily workout. Furthermore, as is illustrated in Figure 3, Figure 4, & Figure 5, by adopting a comprehensive routine that includes stretching, core training, weight training, and aerobic exercises, we can maximize our physical performance and reduce our risk of injury during surgery.

**Figure 3. Proposed stretching routine.**
***Begin with a thorough 5–10-minute stretching session to warm up muscles and increase flexibility.***

**Figure 4. Proposed core training routine**
***Follow this with a 10-minute core training session to strengthen abs and back muscles.***

**Figure 5. Proposed weight training routine**
Move on to weight training to target specific muscle groups and improve overall strength (To avoid muscle fatigue, allow 48 hours between workouts for the same muscle groups). Finish the routine with aerobic exercises, which can help to improve cardiovascular health and promote fat burning.

Additionally, taking microbreaks (lasting 1.5 to 2 minutes) during surgery introduces a paradigm shift in the OR that can significantly contribute to our overall well-being. Incorporating short breaks every 20-40 minutes has shown to lead to physical gains, reduced fatigue, and enhanced mental focus and communication among team members. Furthermore, these breaks do not compromise efficiency, but instead, improve patient outcomes and overall performance.

Finally, educating health care professionals about the importance of ergonomics is paramount in promoting healthy work practices and overall job performance by prioritizing their well-being. By integrating ergonomic workshops and sessions in surgical meetings, attendees gain valuable insights into maintaining proper posture, using equipment correctly, and preventing injuries.

In the end, just as we pursue innovative techniques to improve our patients’ outcomes and transform their lives, let us remember that we, too, have the power to transform our own. My aim is to ensure that we stand tall in our mission to create new smiles—today, tomorrow, and for years to come.