Do we even lift, bros?

Veronica Bessone, a biomechanist and biomedical engineer, and Sven Adamsen, a gastroenterologist, have conducted an online survey of their gastrointestinal endoscopist colleagues to learn more about musculoskeletal injuries (MSI) related to the practice of endoscopy [1].

They found that among 204 endoscopists and endoscopy nurses (78 % men, 81 % older than age 35 years), 53 % of them had at least one MSI. MSIs were more frequently located in the neck (23 %), shoulder (19 %) or thumb (19 %) and were more frequent in women (75% of women vs. 46.25 % of men). MSIs were also more frequent if participants did more than three procedures per day and/or spent more than three hours in the endoscopy room per day. Counterintuitively, having smaller hands was not associated with more frequent thumb or hand injury, but the sample size of endoscopists with small hands was also …small.

I have one comment.

Osteopenia and sarcopenia may develop with aging [2] [3]. In addition, sustained positions in work or leisure may lead to wear and tear on joints. If they are repeated, injuries compound and eventually are expressed as pain and “functio laesa” [4] [5]. What can we, as endoscopists, do about it?

• Avoid performing endoscopies. Not an option.

• Decrease the load on our thumbs and hands in general by changing the way we maneuver the scope. Invendo Medical and Aer-O-Scope have imagined a joystick- like handle for their colonoscopes, but unfortunately, their devices are not currently being used in practice [6] [7].

• Ergonomics training for optimal posture during procedures. An individualized ergonomic wellness approach for the practicing gastroenterologist recently has been proven extremely useful in reducing or resolving 63 % of 22 pain sites [8]. An ergonomic design for our endoscopy units will also help.

• Decrease load on spine, hips, and knees by achieving and maintaining a healthy body mass index (BMI). Although BMI values were not reported in the paper by Veronica and Sven [1] and although there was no statistical significance for height and weight intervals (p > 0.05), there is strong evidence that BMI > 25 kg/m² (overweight) or BMI < 18.5 kg/m² (underweight) is associated with higher frequency of MSI [9].

• Increase muscle mass, especially the so-called “core muscles,” so we may be able to maintain optimal posture [6]. Higher body fat percentage (above 22 %), lower muscle mass, and low physical fitness are all associated with risk of MSI [9] [10]. In the current paper [1], participants reported various types of physical activity, and their duration did not correlate with MSI. However, they reported mostly “cardio” physical activities, such as jogging (38 %), walking (33 %), cycling (32 %), and only about 23 % reported strength training. Although these activities are excellent for decreasing cardiovascular risk factors, they do not necessarily increase muscle mass and sometimes may predispose to injuries: Very frequent running on hard surfaces may increase the risk of knee osteoarthritis and 60 % of riders may develop neck and lower back pain [11] [12]. Strength training has been shown to improve back, neck, shoulder, and arm pain and decrease recurrence of low back pain [13] [14] [15]. Core stability exercises are more effective in decreasing low back pain and may improve physical function [16].

As we age, our bodies change. Some changes can be prevented, some changes can be slowed down a bit. Strength training may help and may also prevent us from getting injured. It is not a modern invention. Egyptian tombs show pictures of lifting bags filled with sand and stone swinging and throwing exercises [17].

Let’s prevent and slow down age-related changes by lifting some weights.

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Bessone V, Adamsen S. Gastrointestinal endoscopy and work-related injuries: An international survey. Endosc Int Open 2022; 10: E562-E569
• 2 Biino G, Casula L, de Terlizzi F. et al. Epidemiology of osteoporosis in an isolated Sardinian population by using quantitative ultrasound. Am J Epidemiol 2011; 174: 432-439
• 3 Lera L, Albala C, Sánchez H. et al. Prevalence of sarcopenia in community-dwelling Chilean elders according to an adapted version of the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. J Frailty Aging 2017; 6: 12-17
• 4 Safiri S, Kolahi A, Hoy D. et al. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ 2020; 368: m791
• 5 Ai-Min W, Lyn M, Xuanqi Z. et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Translat Med 2000; 8: 299
• 6 Sterile single-use endoscopy. Invendo Medical https://www.youtube.com/watch?v=GNUR5RyvlQU
• 7 Aer-o-scope colonoscope system. GI View Ltd https://www.youtube.com/watch?v=Z-_U8KtwUIE
• 8 Markwell SA, Garman KS, Vance IL. et al. Individualized ergonomic wellness approach for the practicing gastroenterologist (with video). Gastrointest Endosc 2021; 94: 248-259
• 9 Sammito S, Hadzic V, Karakolis T. et al. Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model. Mil Med Res 2021; 8: 66
• 10 Havenetidis K, Paxinos T, Kardaris D. et al. Prognostic potential of body composition indices in detecting risk of musculoskeletal injury in army officer cadet profiles. Phys Sportsmed 2017; 45: 114-119
• 11 Gessel T, Harrast MA. Running dose and risk of developing lower-extremity osteoarthritis. Curr Sports Med Rep 2019; 18: 201-209
• 12 Mellion MB. Common cycling injuries. Management and prevention. Sports Med 1991; 11: 52-70
• 13 Frutiger M, Borotkanics R. Systematic review and meta-analysis suggest strength training and workplace modifications may reduce neck pain in office workers. Pain Pract 2021; 21: 100-131
• 14 Calatayud J, Guzmán-González B, Andersen LL. et al. Effectiveness of a group-based progressive strength training in primary care to improve the recurrence of low back pain exacerbations and function: a randomised trial. Int J Environ Res Public Health 2020; 17: 8326
• 15 Ezzatvar Y, Calatayud J, Andersen LL. et al. Importance of frequency and intensity of strength training for reduced musculoskeletal pain in the back, neck-shoulder, and arm-hand among physical therapists. J Phys Act Health 2020; 17: 723-728
• 16 Wang XQ, Zheng JJ, Yu ZW. et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One 2012; 7: e52082
• 17 Dashish AA. Pharoachs first to organize sports competitions. https://see.news/pharaohs-1st-to-organize-sports-competitions/

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Artikel online veröffentlicht:
13. Mai 2022