Sonographer Stretches for an ‘A’ Game

For our first blog we introduced the reality that there is an epidemic amount of sonographer pain and injury. Almost 90% of sonographers work and live daily with that pain and injury as a result of doing our jobs. That is an epidemic and sinful statistic. As fellow sonographers, we should be incensed that more is not being done to quell the enormous pain and injury that we suffer from.

Coach Rozy and I have the solution. In our first blog with the AIUM, we detailed and gave examples of lower body stretches and exercises that sonographers should do. The folks at the AIUM relayed that our post was very popular among sonographers. Some of the feedback that we received was that many that read our blog thought it was silly that we would suggest doing lower body work for sonographers that predominately suffer from upper body issues (neck, back, shoulders, etc…).

In our 2nd blog we explained why lower body stretches and exercises are also crucial to good sonographer health and pain-free imaging. My favorite story that Coach Rozy tells is about his time in the National Football League. A prominent quarterback in the league at the time was having pain in his shoulders, and main throwing arm. He couldn’t follow through properly on his pass mechanics due to the pain in his throwing shoulder. Not good, if you are a quarterback in the NFL and you can’t pass properly.

Rozy immediately zoned in and started working the shoulder, with little positive result. A few days later Rozy noticed that this quarterback was walking into the locker room with a limp. He hit him up and was told that he had taken a hard hit on his hip and that it had caused him hip pain. Immediately Rozy started working on the quarterback’s hip. A few days later, the hip was better. At this time the shoulder pain also stopped, and life was good. The problem wasn’t the shoulder. The problem was the hip. The hip injury translated into the shoulder. Fix the hip, fix the shoulder. That’s why when you look at sonographer pain and injury, you must look at the body as a whole, not just the area of pain and injury.

For our 3rd blog, we want to share why it is absolutely crucial that your work as a sonographer must be done at the very highest level on each and every patient that you work on. An article entitled, “Making a Difference as a Sonographer, 100% Every Person, Every Time” details my own personal battle with my wife’s diagnosis of breast cancer. As you will read, a breast ultrasound is the only test that caught my wife’s cancer. The cancer was caught early, which made her course miraculous, given such a diagnosis. Amazing things happened in Yankton, SD, the day that my wife had her ultrasound study that caught ‘something’. Enough ‘something’ that a biopsy was done, the cancer was found early, and the course for my wife was incredible.  As sonographers it is CRUCIAL that we be on our ‘A’ game for every person that we work on.

The following are a few simple, quick, easy stretches that can be easily done at work or home. Working the body as a whole is important.

Lying thoracic spine rotation

Start by lying on the ground on your side (either side). With your arms extended straight out at chest level pull your knees pulled up to your chest. The hips and knees should both be at 90 degrees. Work to have your ankles at 90°. You can use a mat, and for added comfort and support use a pillow.

To begin, keep the knees together (place a rolled-up towel or small ball between the knees if you need more support), move your top arm over your body and toward the floor on the opposite side. The objective is to get the arm and s
houlder blade touching the ground, not just the hand.

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All images courtesy of Doug Wuebben.

The goal is to do 2 sets of 8 reps on each side. Tip: You want the movement to come through the thoracic spine — not just the shoulder area.

Kneeling thoracic spine rotation

After completing the lying thoracic spine rotation, progress to the kneeling thoracic spine rotation exercise. This is a more progressive move and requires enhanced control over your posture, movement, and stability.

Begin in a 6-point (some say 4-point) position, on your hands and knees. Take one hand and put it on the base of the skull behind your head. It’s important to keep weight evenly distributed between the legs and your other arm.  Keep the bent arm locked in position. The elbow stays pointed toward the ground. Rotate your torso with motion going through the spine, ending so that the bent elbow is pointed up.  The movement should come through the back/spine — and not just the shoulder! Take the movement through as large a range of motion as possible.  The benefit comes from movement from the thoracic spine. Don’t use your shoulders or hips.

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Do 2 sets of 8 reps on each side.

Psoas lunge

Most people consider proper lunge technique to include pushing the hips forward to stretch what they feel are the hip flexors and the psoas. The iliacus crossing the hip is what is stretched in the traditional lunge, but the psoas also crosses the hip and all lumbar joints.

The best way to stretch the psoas occurs when it is isolated with a lunge that includes lateral bending of the spine and twisting and extension motions. This is a great warm-up stretch before running or doing a lower body routine. Stretch and hold for 20 to 30 seconds. Repeat several times, both directions.

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Farmer’s walk

Another simple yet effective routine is what we call the farmer’s walk exercise. Pick one or two dumbbells and hold them by your sides. Then walk around your training area. Start by walking 25 yards or you can also time yourself, say for 30 seconds, to begin with.

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If you are a beginner, perform the farmer’s walk by carrying any object that has some weight to it. Increase the weight as you progress. The farmer’s walk is a simple yet effective leg-strengthening exercise that works your calves, quadriceps, and hamstrings. The core muscles that help support your spine also benefit. It also creates intra-abdominal pressure to prevent your spine from collapsing.

To vary this routine, hold the weights overhead, use only one weight, or hold one weight overhead and one at your side.

What stretches do you do? How do you improve your posture? Comment below or let us know on Twitter: @AIUM_Ultrasound.

 Doug Wuebben BA, AS, RDCS (Adult and Peds), FASE, is a registered echocardiographer and also a consultant, international presenter, and author of e-books in the areas of ergonomics, exercise and pain, and injury correction for sonographers. He has also been published on the topics of telemedicine and achieving lab accreditation.

Mark Roozen, M.Ed, CSCS,*D, NSCA-CPT, FNSCA, is a certified strength and conditioning specialist, a certified personal trainer, and a fellow of the National Strength and Conditioning Association (NSCA).

Wuebben and Roozen are co-founders of Live Pain Free — The Right Moves. They can be contacted at livepainfree4u@gmail.com.

 

Greater Trochanteric Pain Syndrome

In a study funded in part by AIUM’s Endowment for Education and Research, Jon Jacobson, MD, and his team from the University of Michigan set out to determine the effectiveness of percutaneous tendon eer_logo_textsidefor treatment of gluteal tendinosis. The full results of this study were recently published in the Journal of Ultrasound in Medicine.

Greater trochanteric pain syndrome is a condition that most commonly affects middle-aged and elderly women but can also affect younger, and more active, individuals. It has been shown that the underlying etiology for greater trochanteric pain syndrome is most commonly tendinosis or a tendon tear of the gluteus medius, gluteus minimus, or both at the greater trochanter and that tendon inflammation (or tendinitis) is not a major feature. This condition can be quite debilitating and often does not respond to conservative management.

Treatment of greater trochanteric pain syndrome should therefore include treatment of the underlying tendon condition. Ultrasound-guided percutaneous needle fenestration (or tenotomy) has been used to effectively treat underlying tendinosis and tendon tears, including tendons about the hip and pelvis. Similarly, autologous platelet-rich plasma (PRP), often combined with tendon fenestration, has been used throughout the body to treat tendinosis and tendon tears.

Although studies have shown patient improvement with PRP treatment, the true effectiveness of this treatment compared to other treatments remains uncertain. Although percutaneous ultrasound-guided tendon fenestration has been shown to be effective about the hip and pelvis, there are no data describing the use of PRP for treatment of gluteal tendons, and there is no study comparing the effectiveness of each treatment for gluteal tendinopathy. The purpose of this blinded prospective clinical trial was to compare ultrasound-guided tendon fenestration and PRP for treatment of gluteus tendinosis or partial-thickness tears in greater trochanteric pain syndrome.

We designed a study in which patients with symptoms of greater trochanteric pain syndrome and ultrasound findings of gluteal tendinosis or a partial tear (<50% depth) were blinded and treated with ultrasound-guided fenestration or autologous PRP injection of the abnormal tendon. Pain scores were recorded at baseline, week 1, and week 2 after treatment. Retrospective clinic record review assessed patient symptoms.

To break this down a little further, the study group consisted of 30 patients (24 female), of whom 50% were treated with fenestration and 50% were treated with PRP. The gluteus medius was treated in 73% and 67% in the fenestration and PRP groups, respectively. Tendinosis was present in all patients. In the fenestration group, mean pain scores were 32.4 at baseline, 16.8 at time point 1, and 15.2 at time point 2. In the PRP group, mean pain scores were 31.4 at baseline, 25.5 at time point 1, and 19.4 at time point 2. Retrospective follow-up showed significant pain score improvement from baseline to time points 1 and 2 (P < .0001) but no difference between treatment groups (P = .1623). There was 71% and 79% improvement at 92 days (mean) in the fenestration and PRP groups, respectively, with no significant difference between the treatments (P >.99).

These results led us to conclude that both ultrasound-guided tendon fenestration and PRP injection are effective for treatment of gluteal tendinosis, showing symptom improvement in both treatment groups.

What is your experience with treating greater trochanteric pain syndrome? Are you familiar with the Endowment for Education and Research?  Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Jon A. Jacobson, MD, is Professor of Radiology, Director of the Division of Musculoskeletal Radiology, Assistant Medical Director of Northville Health Center, and Medical Director of Taubman Radiology within the University of Michigan Health System.

3 Stretches All Sonographers Should Do

Have you ever thought about how you stand? Or how you hold a transducer? Or how you position yourself over your patient? Incorrect positioning in any form could increase your risk of pain and injury. Here are three easy exercises sonographers can do—even on the job—to reduce anterior pelvic tilt.

  1. 90/90 Hip Flexor Stretch
    On a mat, kneel down with the front leg up, with the knee at 90 degrees, the back leg is on the ground, but also bent at 90 degrees.  Make sure to tightening up the Hip flexorabdominal area. Then move your hips forward, maintaining shoulders back. You are looking for a stretch in front of the hip.You will feel the stretch in the front of your hip and the thigh. You are looking for a light stretch. You are not trying to rip the muscle apart. Hold that for about 20 to 30 seconds twice on each side, first the right leg, then the left. Alternate back and forth for the two sets.
  1. Side Lying Quad Stretch
    Lying on your side, reach back and grab the foot of the top leg with the same arm as the leg you are bending (i.e., right hand grabs right foot). As you grab the foot, bring the heel towards the butt. The key here is not to just pull the heel to the butt, but bring the thigh back a little bit in order to intensify the stretch in the front of the thigh and the front of the hip.stretch 2Think: Hold for 20 seconds as a light stretch and do it twice on each side alternating. Right leg first, then roll to the other side and do the left leg. Repeat.
  1. Deep Squat Stretch
    Stand up tall with a wider stance than shoulder width. From that position, squat down with hips below the knees. In the bottom position, place the elbows between the squatknees and then push the knees out with the elbows. You are looking for a stretch in the inner thigh and hips.This position and pressure will end up changing the position in the lower back and in the pelvis from an anterior tilt to a posterior tilt.  Doing just like the other stretches: 20- to 30-second hold, twice.

No matter what your occupation, a certain level of stretching and regular exercise will help reduce your risk of injury. This is especially true for sonographers. Please consult your physician (even if you are one) before beginning an exercise program.

What stretches do you do? How do you improve your posture? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Doug Wuebben BA, AS, RDCS (Adult and Pediatric) is a registered echocardiographer and also a consultant, national presenter, and author of e-books in the areas of ergonomics, exercise and pain, and injury correction for sonographers.

Mark Roozen M.ed, CSCS*D, NSCA-CPT, FNSCA, is a strength and performance coach and also the owner and president of Performance Edge Training Systems (PETS).