A conversation on how adjusting body positioning and building physical strength can help veterinary professionals manage the physical demands of patient care and reduce injury risk.
Kneeling for floor exams, holding awkward positions during dentals, restraining patients that won't stay still, and carrying sedated dogs on stretchers are routine parts of veterinary work, and each one strains the body. Aaron Shaw, OTR/L, CHT, CSCS, an occupational therapist and founder of Project Vetspan, says better positioning helps, but the step that does the most to reduce that strain is building physical strength outside of work.
In this Q&A drawn from the latest episode of The Resilient Vet: Mind and Body Strategies for Success, Shaw and cohost Jennifer Edwards, DVM, PCC, CPC, ELI-MP, a leadership coach, discuss how routine exam and dental postures load nerves and tendons, why pain has become accepted in veterinary culture, and why Shaw recommends a consistent strength training program as the first step toward reducing it.
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In this Q&A:
Editor's note: This Q&A has been edited and consolidated from an episode of The Resilient to better fit a written format while retaining the substance of the original conversation
Shaw: I recently had the privilege of speaking to 500 vet professionals at a conference, and I asked one question to start with: "How many of you regularly work in pain because of the physical demands of your job?" Every single person in the room raised their hand.
It was super awesome to be there and to have that many people giving their undivided attention to the stuff I talk about. But to ask that question and to have everybody raise their hand was sad in a sense. Misery loves company, I suppose. Everybody in there is kind of looking around, like, Yeah, we're all getting kind of beat up with work here.
I recognize that that's not a scientific survey, but when 500 people respond the exact same way, it may be worth paying attention to. Sadly, pain in vet med has become so common that it's really become accepted as just part of the job. But common doesn't mean that it's normal, and it certainly doesn't mean that it is inevitable.
Edwards: It's not a scientific study, but it's data for sure. The importance of 500 hands all going up for the same question is really not arguable. Was there any part of that that surprised you? Were you a little bit taken aback by how unanimous it was?
Shaw: I've been focusing specifically on veterinary medicine for the past couple years. Before that, I would have been completely baffled, and I still am, even though I sort of anticipate it at this point. I don't know if cringey is the right word for it, but it's heartbreaking, really, to see so many people who are at a conference because they're passionate about what they do. They love taking care of their patients, they're super smart people, super motivated people, and yet everybody raises their hand, basically saying they're getting beat up by the job that they love. It's a testament that something is wrong in the profession.
There's a hidden-in-plain-sight problem that is leading, I think, in no small part to people who change their roles in vet med because they can't tolerate the same work through the years. And even more sadly, I think some people have to leave the profession entirely because they can't do it.
I think it was surprising and heartbreaking, but because of my skill set, it was also encouraging. Before people totally break down and leave, I want to say, "Okay, wait a second. Give me a little bit of your time. Let me try to help you through this."
Edwards: There's a lot of physical professions out there. What is it about veterinary medicine that causes such a pervasive level of physical pain?
Shaw: First, for perspective, I have the luxury of being kind of an outsider looking in, with decades as an occupational therapist studying body mechanics and positioning and strength and conditioning. From the outside, it's plain to see: the static postures, the poor postures that are demanded of you to get into certain positions to do the work that's just everyday work. You talked about dentistry and doing physical exams, getting down, up, and off the floor multiple times. Then factor in that 9 times out of 10, you're dealing with another living being that doesn't always follow perfect commands. It's not like that Amazon box that you're going to bend down to. It's on you to make the situation as ideal as possible for you. The German shepherd may not be quite so content on staying perfectly still. [It] may want to wiggle out of the way.
The physical demands are so unique. It's this combination of contorting the body into positions that are not efficient for muscular activation [or] for sustained positioning, [plus] the up and down off of a hard floor, kneeling and bending and twisting to the side. As I've said in some of these other episodes, and when I talk to clients, if I can take a picture of multiple positions in a clinic throughout the day, so many postures are actually provocative tests for nerve injury and tendon injury. When I put my therapist hat on, I'm like, Oh, you're doing a nerve tension test that's intentionally stressing your median nerve. That's not someplace where you want to hang out, but in order to do this exam or this dental, that's exactly what you're doing. You're going into the worst position, in a sense.
The challenge, of course, is that's just the job. If I'm going to coach somebody on body mechanics, or being safe and resilient and durable to bend down and pick up an Amazon box that's on the floor in front of them, it's pretty straightforward. Those ergonomic rules are out the window in vet med because the German shepherd is not a box. Then put [those positions, that duration, and the stresses of the job] into the clinical setting of next patient, next patient, next patient. Add on some emotional stress, the unavoidable stress of seeing animals in pain [and] euthanasia. Add some other stress because you've got pet parents who are coming in aggravated. All of these things are just this perfect recipe for pain.
Edwards: There's a level of unpredictability in what we're dealing with. Not only is it not predictable what a dog is going to do, particularly big, strong dogs, but it's constantly changing. I used to joke that sometimes I felt like I was playing a game of Twister. It sounds funny, but it's actually true, and that's the sad part about it. I used to have team members who would be in pain, and they'd be like, "Oh, I got it! I got the dog!" To what extent have people in the veterinary profession, regardless of role, accepted that pain is normal?
Shaw: That is a dangerous situation to be in. For what I can do, I feel like I'm walking around with a bullhorn [telling] anybody in veterinary medicine who will listen, "This is not normal. This is not sustainable." And dare I say it's inhumane to normalize that, not even from a clinic culture, but from an industry culture [standpoint], like it just is what it is.
I think people compensate sometimes by using it almost as a badge of honor: I can endure. I'm tired, I'm sore, I'll take it. So there gets to be this almost self-inflicted stress and physical discomfort from it, because that's the culture. And yet at the same time, there's at least a somewhat significant exodus from the field entirely of people who are broken, burnt out, and just beat down from it. It's a problem, and it is too normalized. But I'm here to say there's something else we can do about it. It doesn't have to be the norm.
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Edwards: I hear a lot about ergonomics, but I also hear about body mechanics. What is actually the difference?
Shaw: Ergonomics is really about matching the job demands to the person's physical ability. With good ergonomics, what's expected physically to do that underbelly exam, for example, matches the ability of the person who's doing it.
I know describing the movements of veterinary medicine without full-on video of me on all fours is harder, so let's use picking up a box. If there's a box on the floor, ergonomics would say, How do I position myself in relation to that box so I can pick it up with the least injury risk? I can either stand 3 feet away from this box and reach over and pick it up, or I can bring my feet right up to the box so it's closer to me and pick it up that way. The closer we are to something, the less demanding it is on our body if we're going to pick it up off the floor. Veterinary medicine aside, if it was a grocery bag or a box, we tend to do this naturally as we move. That's the concept of ergonomics: How can the environment help me, or how can I fit in with the environment well enough to succeed in the task I'm trying to do?
Body mechanics, on the other hand, is thinking about, as I move to pick up this box, do I bend at the waist, do I round my back, or do I contort myself sideways? You can think about this in vet med. If you're standing in one position and you reach across your body to grab your patient and move them across, that is where your physical mechanics change. You have the opportunity to think about ergonomics, [to] make sure I'm close to my patient before I pick them up, and to make sure I'm using good body mechanics as I'm picking them up, so I'm going to try to keep my spine erect. When you put those together, you're decreasing your risk of injury.
Edwards: Is focusing on ergonomics and body mechanics enough to mitigate the impact on the body?
Shaw: Absolutely not. Not even close, unfortunately, because you're not treating Amazon boxes, it turns out. It's far more complicated than that. The biggest risk I see is that people are, sad to say, too weak for the job, too deconditioned for the job. Dealing with a 50-pound animal is not easy, and dealing with that animal in all sorts of kneeling, half kneeling, bending, twisting, looking under bellies, and doing dentals is not easy. We can [apply] ergonomics to some of that and make it as efficient as possible. But to be clear, vet med will always be very difficult work, very physically demanding, even with textbook ergonomics.
I've worked with some people [where] we role-play how they move their body. There's always a few pointers, but [it's] not always terrible, and it's still so physically demanding for them. We realize that the next piece to really make a difference is you have to be physically stronger. You have to have more physical stamina, because a 50-pound dog is a 50-pound dog. If you're somebody who has difficulty picking up 20 pounds, that's going to be super risky for you to be working with that animal.
If, on the other hand, you have a strength training program outside of work, and you're pretty accustomed to moving around 50 pounds, or even 55 or 60 pounds, then when you get into work and you're dealing with that 50-pound patient, you already know that is well within your capacity because you've trained your body to do that. I think that's still a little bit foreign to think about sometimes, because for a lot of the people that I work with, the most physically demanding thing that they ever do is at work. They don't do enough outside of work, so the toughest thing that they pick up or push or pull in these unusual positions is at work. Every day it's kind of like, Cross your fingers. I hope I can do this. This is going to be tough, but I'm going to push on through and see what I can do.
When there is this mismatch, that's what leads to injury. It's tissue overload. Human side or vet med side, we go back in time to our studies and understand that those aches and pains are signs that we've exceeded the tissue's capacity. You're going to get these little pain signals. If you're getting those signals, that means you are asking more of your body than it's prepared to give. And as you mentioned a little bit earlier, the workspace is unpredictable, and you may not always have the luxury of [saying], "Let me put the box down." Sometimes once you're in the thick of it, you can't stop, and that's the risk.
Edwards: That's a safety issue from multiple standpoints. It could be a 120-pound dog that all of a sudden jerks or turns to bite, and you've got to increase your restraint. I remember times we had a 200-pound dog sedated for surgery, and we had to move that dog on a stretcher. A lot of practices don't have gurneys. I think they should, but not everybody has that. So we would have 4 people, each on a corner of a stretcher. Nobody was lifting the 200 pounds, but think about the little handle at the corner. Your hands are together, so your shoulders are not in the proper position to have your strength. And I remember a friend of mine who didn't get hurt at work, but she bent down to get something out of her dishwasher and threw out her back. Sometimes it's that slow accumulation that we may not even know is happening. If someone listening feels a lot of pain after work, what would you recommend they do differently so they can head this off before it gets really bad?
Shaw: The number one thing people can do is to have a consistent strength training program. It'll move the needle more than any other thing that I could list off. Certainly ergonomics. Position yourself as well as you can in the work environment. Absolutely do those things. Eating well, sleeping well, all of these things that I love to talk about are great. But the more physical strength that you have, the benefits touch all of those. You can get away with imperfect reaching and postures when you have a strong body, from head to toe.
Yoga is good, walking is good, mobility is good. Do all the other stuff that's good. But to be clear, when the 4 of you are picking up this 200-pound dog, it's not about how well you can do a downward dog, or even a plank for that matter, or how far you can walk. It is straight up risky, and it is strength that is going to get you through that. And as you said, there's the risk for the person getting hurt, but there are also patient handling risks involved in this too.
If you're interested in learning more, you can go to my website, projectvetspan.com, and there's a button to join a newsletter I have called the Durable Vet Brief. I send out exercise tips, and I actually have a free 3-week training program just for vet professionals. If you don't know where to start, that may be one place to go. If you need more of the personal trainer vibe, where you need somebody standing in front of you [showing you] what to do, go to your local gym and see if there's a personal trainer you can connect with to get some guidance. And of course, feel free to reach out to me. I do a lot of coaching with vets and techs who are trying to do the right thing to be durable.
You can reach out to Shaw at info@projectvetspan.com and Edwards at jennifer@drjenniferedwards.com.
