• Practice Perfect

    Stress? Back Pain? Try Yoga Sequences That Are Tailored for Ophthalmology

    Written By: Mary Wade, Contributing Writer, interviewing Justin L. Gottlieb, MD, and Camille V. Palma, MD

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    Each day, ophthalmologists accumulate tension and stress as they lean toward the slit lamp, perform precision surgeries, and deal with patients’ complex concerns.

    Your job is putting you at risk for musculoskeletal strains that can limit—or even end—your career. Studies have repeatedly underscored just how widespread musculoskeletal disorders are among ophthalmologists. For example:

    • Vitreoretinal surgeons spend up to 75% of their time in moderate flex­ion during indirect procedures; this puts them at risk of spinal pain due to frequent ergonomically unacceptable posture.1
    • When the American Society of Oph­thalmic Plastic and Reconstructive Sur­gery (ASOPRS) distributed a survey via its listserv, 73% of the 130 respondents reported discomfort due to operating, and 9% had stopped operating due to pain or neck injury.2

    Yoga can help you to prolong your career. Camille V. Palma, MD, and Justin L. Gottlieb, MD, have found that yoga can reduce and relieve tension and stress. The two retina specialists practice yoga and breathing exercises regularly, both in the office and outside work. Dr. Palma is in private practice in the Chicago area and Dr. Gottlieb is a professor in the Department of Oph­thalmology and Visual Sciences at the University of Wisconsin, Madison.

    Yoga for Ophthalmologists

    Yoga simultaneously builds flexibility, strength, and balance. Add breathing exercises to reduce stress.

    Yoga in practice. Dr. Palma is also a certified yoga instructor (http://yogaeyedoc.com), and she has developed yoga sequences tailored to ophthalmol­ogists’ specific physical challenges and work schedules. Doing just one or two postures at a time can boost your phys­ical energy, she said. “You can release muscle tension and clear your mind to prepare for your next patient.”

    Benefits of some key yoga se­quences. Dr. Palma’s selection of yoga sequences includes the following:

    • Modified sun salutation decom­presses the lower back and hamstrings; mobilizes and strengthens the spine.
    • Forward fold with spinal twist, using chair or desk, mobilizes the spine; opens and releases tension in the shoul­ders and upper back.
    • Side bends to right and left mobilize the spine; lengthen and strengthen the obliques; and stretch the psoas.
    • Hand and wrist exercises increase the strength and mobility of the wrists and fingers; helps to prevent arthritis and carpal tunnel syndrome.

    Watch online. Dr. Palma demon­strates these sequences and others, including a warm-up sequence, during a short video (see above) that provides a safe and simple way to explore yoga. The sequences can be performed in the exam room in regular work clothes in 1-to 2-minute incre­ments, as needed, during your workday. Or you can do the entire 12-minute session when you arrive at the office or during break time.

    Yoga and Mid-Career Renewal

    While it is never too early in your career to incorporate yoga into your working day, Dr. Palma observes that mid-career ophthalmologists may be the most likely to need and benefit from the practice.

    Losing that spring in your step? When he turned 50, Dr. Gottlieb took up yoga at his health club. “Basically, I was looking for a way to feel better,” he said. “I’d played men’s soccer for years but was increasingly sore and worn out after games. I wanted exercise that offered fitness and energy. My wife suggested yoga.”

    How Dr. Gottlieb got started. Walk­ing into his first Yoga for Athletes class was a bit intimidating, but the teacher and fellow students were welcoming, not judgmental, he said. The teacher set an accepting, realistic tone. As Dr. Gottlieb’s core conditioning and energy level increased, he felt stronger and more comfortable at work and in daily life.

    Using yoga to unwind. Now, five years later, he goes to class after work several times a week. “I go to the same three classes weekly, and so also enjoy the benefits of a practice community,” Dr. Gottlieb said. “By the end of an early evening class, my workday stress is gone.”

    How Dr. Gottlieb uses yoga at work. Dr. Gottlieb asked his teacher to rec­ommend practices to use at work. She recommended standing (or seated) forward bending, with long, slow inhales and exhales. Dr. Gottlieb added that the breathing aspect is key to releasing tension. He uses this practice often between surgeries and after seeing especially complex patients.

    Standing Spinal Twist
    STANDING SPINAL TWIST. Start by placing your right forearm or, if you are a beginner, right hand on a chair. Bend your right knee and keep your left leg straight. Keep your left hip above your left heel. Lengthen through your spine and stretch the left arm up toward the ceiling. Hold for two breaths, then bring your arm down. Repeat using the other side of your body.

    Start Now

    “I’d encourage ophthalmologists at any career stage to explore yoga and related mind-body exercises,” said Dr. Gottlieb. “If you can, start during your fellowship or residency. Make it a part of your life.”

    How to find a good studio and teacher. Dr. Gottlieb offered two key recommendations for ophthalmologists who want to explore yoga:

    • Find a teacher who offers variations appropriate for beginners and encour­ages you to make the practice your own.
    • Look for a class geared to people with a range of abilities, rather than to 20-something dancer-

    Dr. Palma added these suggestions:

    • Ask your friends and colleagues for recommendations. Online reviews may also be useful.
    • Check for free or discounted classes for new students. Most studios offer this option.
    • If you dislike your first class, don’t get discouraged. Try a different studio or teacher next time.
    • Let the teacher know if you’re a beginner, and always note any musculoskeletal issues you’re having.
    • Good teachers give verbal cues for proper alignment in the postures and offer variations for different ability levels.

    Find the yoga style that works for you. There are several styles of yoga, ranging from more athletic forms, such as Vinyasa, to forms with a slower, gentler pace, such as Hatha and Yin. Dr. Gottlieb now prefers “flow-style” hot yoga, in which students move rhyth­mically from one posture to the next in a heated studio. This style stimu­lates your cardiovascular response and increases flexibility by warming your muscles, he said.

    Incorporating yoga into your working day. To build a yoga habit, Dr. Palma recommends picking a regular practice time and sticking with it for at least 30 consecutive workdays. “Continuing for 90 days is even more potent for expe­riencing the benefits.” And in the OR, commit to doing at least one posture between each case, she added.

    Never push yourself beyond your physical capabilities. Yoga is about honoring your body. If you find your­self in a class that’s too advanced, or if you feel pain in any posture, remember that it is always OK to stop and rest. (Child’s pose, also known as Balasana, can be calming and restful, for exam­ple.) Starting small and building grad­ually are key. Be kind and patient with yourself as you discover what works for you, and acknowledge and celebrate each step along the way.

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    Read “Glaucoma and Exercise” (Clin­ical Update, March) for advice on yoga poses that glaucoma patients might need to modify or skip altogether. For more wellness suggestions, including additional yoga and ergonomics tips, visit aao.org/wellness.

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    1 Shaw C et al. Can J Ophthalmol. 2017;52(3):302-307.

    2 Sivak-Callcott et al. Ophthalmic Plast Reconstr Surg. 2011;27(1):28-32.

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    Dr. Palma is a retina specialist in private practice in the Chicago area. Financial disclosures: None.

    Dr. Gottlieb is a professor in the Department of Ophthalmology and Visual Sciences at the University of Wisconsin–Madison. Financial disclosures: None.

    Posture, Ergonomics, and Aerobic Exercise

    Take time at the slit lamp and operating scope to set yourself up properly. Each time you sit down, intentionally check and adjust your posture. Eventu­ally your body will automatically find a neutral spinal alignment. Yoga practice can help you to develop better body awareness.

    Stand when you work, as often as possible. Many clinics have adjustable screens and keyboards, so you can stand to use the computer. Inexpensive standing desks can be purchased online. Move more, sit less.

    Complement yoga with aerobic exercise. Yoga and other mind-body practices can be balanced with some form of aerobic exercise. Thirty minutes of brisk walking (at a pace that raises your heart rate) several times a week is possible for almost everyone.

    For more tips, see aao.org/member-services/individual-wellness.