Spend a day at a typical veterinary clinic and by mid-afternoon you will see people rubbing their own lower backs, necks and shoulders with grimaces on their faces. A morning of lifting, restraining, typing, squatting and kneeling is taking its toll.
Everyone who enters the veterinary profession is told it will be physically demanding, but they may not realize the serious implications of these daily aches and pains. Musculoskeletal injuries or disorders may lead to decreased performance, workers compensation claims and even career changes. Understanding the importance of and implementing an ergonomics program is a critical part of reducing the risk veterinary employees face in the workplace.
Risky Business
According to the American Veterinary Medical Association, activities common in veterinary medicine that carry a high risk of musculoskeletal injury include awkward postures, high hand force, highly repetitive motions, repeated impact, moderate to high hand-arm vibration and heavy, frequent or awkward lifting. Tasks associated with these risks can be almost anything a veterinary professional does: restraining or lifting a large or uncooperative patient, performing or assisting in surgery, dental prophylaxis and extractions, or kneeling on the floor to accommodate a frightened animal. Veterinary administrative duties such as typing or talking on the phone can also result in strain and injury.
While all parts of the body can be affected by MSD (musculoskeletal disorders), the back, neck and shoulders are frequently noted as sources of pain for those working in veterinary medicine. Some ergonomic tips to alleviate the incidence of these symptoms include:
1. Maintain a neutral spine
This is the core ergonomic principle related to back, neck and shoulder pain. A neutral spine should contain three curves; one in each of the following areas: cervical, thoracic and lumbar spine. The cervical and lumbar spine should curve slightly inward, while the thoracic spine should mirror that curve in an outward fashion.
You should not work with your head tilted forward more than 15 degrees from upright or your torso hinged further than 20 degrees forward from the waist. Shoulders should never be “hunched,” meaning curled forward or held in tension toward the ears. Working on a surface that is the proper height—typically the height of the pelvis or higher—greatly increases the likelihood of maintaining a neutral spine position. Ideally, exam and surgical tables should be adjustable to the height of the individual using them.
Veterinary receptionists and administrative employees often spend a large portion of their day on the phone, which presents its own ergonomic risks to the cervical spine. As many calls require those answering them to take notes, a hands-free system is a good way to prevent neck strain from cradling a phone between one’s ear and shoulder.
2. Be mindful of seating
We put the most pressure on our spine by sitting, so it is best to avoid sitting for long periods when possible. When seated, be sure to sit facing whatever you are working with straight on, as sitting and twisting is the most stressful position for the spine. This means desks, dental and surgical tables, and other areas where employees are often seated should always be designed with room for an individual’s legs to fit comfortably under the work surface.
The ideal arm position for working while seated allows forearms to be parallel with the floor, elbows not elevated above forearms and upper arms to rest alongside the torso, maintaining the curve of the thoracic spine and relieving shoulder and wrist strain. An adjustable-height, ergonomically-designed seating surface (a saddle seat is often recommended) encourages proper posture and alleviates spinal and nerve compression. Ideally, alternate sitting and standing tasks to further reduce risk of injury.
3. Practice proper patient handling
Many injuries in veterinary practice occur when interacting with patients. The activity most associated with musculoskeletal risk is lifting large patients. Your practice should have clear guidelines as to what size patients require multi-person lifts. Additionally, patients in the weight range requiring two or more people to safely lift should be scheduled at times when proper staffing ensures this is possible.
When lifting any size patient, make sure you have safe footing, take a wide stance and keep your arms as close to your body as possible. Minimize the distance you carry a patient by encouraging conscious patients to stand rather than lie down before lifting them. And, if your work surface is adjustable, lower it before lifting the patient. For sedated or unresponsive animals, use a stretcher to stabilize the weight you are lifting.
Patient restraint is also physically demanding. As with lifting, hold the patient close to your body to brace against sudden movements. Since struggling patients are most likely to cause injury, consider sedation for stressful procedures such as radiographs and ultrasounds.
While we often choose to work on the floor as a way to make animals more comfortable, this frequently results in hunched postures and repetitive-use injuries from kneeling or squatting. The ergonomic recommendation is to place patients at the level of the pelvis or higher during physical examination, blood draws, vaccination and other routine procedures. If working on the floor is the best fit for your practice, provide anti-fatigue mats to kneel on and limit the number of floor-level appointments any given employee sees in a day by alternating with other qualified staff.
Employer Guidelines
Employers are responsible for the safety and welfare of their team. Fortunately, embracing this responsibility benefits everyone in the veterinary setting—including practice owners—by reducing workplace compensation claims, increasing employee satisfaction and improving productivity. The following are steps employers can take to establish and maintain an ergonomically-friendly veterinary work environment:
Provide ergonomic training: New employees at a veterinary practice should receive ergonomic training covering all daily duties. Training should be refreshed for all staff on a regular schedule determined by practice owners or managers. Visual reminders of proper postures and technique should be posted in work areas.
Invest in prevention: There are a number of products specifically designed to make a workplace ergonomically friendly, including seating, work surfaces/tables, specialized keyboards, braces and belts, and hand tools for surgery and dentistry. Practice owners or managers should stay well informed on the most effective products and make selections that fit employee needs. If a practice is being built or remodeled, an ergonomics consultant can be a useful resource for making design choices that reduce physical strain and injury.
Schedule thoughtfully: Scheduling greatly influences the physical stress put on veterinary employees. Try not to place large, physically-demanding patients back-to-back; for example, alternate small and large dogs, or dogs and cats. Make sure staffing meets demands when scheduling so team members are not coerced into performing tasks alone, compromising their safety. When scheduling multiple surgeries, alternate surgeons if possible. And, if a single surgeon is working, aim to provide a mix of procedures that do not require the same posture or movements. Finally, give enough breathing room in the schedule for staff to feel comfortable taking “micropauses”— breaks of 20 seconds every 20 to 40 minutes to change position, stretch or perform any movement that reduces fatigue.
Encourage team involvement: The Occupational Safety and Health Administration advocates for a participatory approach to ergonomics, meaning all team members are encouraged to provide regular feedback about their working conditions, including identifying problem areas and suggesting solutions. Staff should also feel safe reporting any physical concerns as early as possible. Employers should ask team members to evaluate any ergonomic changes made to the practice for effectiveness.
Veterinary work will never be easy, but understanding and implementing healthy ergonomic practices increases worker safety and career longevity. Ergonomic planning creates an environment where veterinary professionals are able to provide care to patients while being kinder to their own bodies, ultimately leading to a more sustainable and healthier future for veterinary medicine. +
Resources:
- Altier B. Comfort and Participatory Ergonomics in Veterinary Dentistry. DVM360. https://www.dvm360.com/view/comfort-and-participatory-ergonomics-veterinary-dentistry-proceedings-pdf. Published August 31, 2019. Accessed June 11, 2020.
- Ergonomics. Occupational Safety and Health Administration. https://www.osha.gov/SLTC/ergonomics/. Accessed July 1, 2020.
- Hawn R. Strains, Sprains, and Pain in Veterinary Professionals. Trends Magazine. June 2020:37-40.
- Veterinary Ergonomic Guidelines. American Veterinary Medical Association. https://www.avma.org/resources-tools/avma-policies/veterinary-ergonomic-guidelines. Accessed June 11, 2020.
- White SC. Ergonomics in veterinary medicine. Innovative Veterinary Care Journal. https://ivcjournal.com/ergonomics/. Published January 3, 2020. Accessed June 11, 2020.
