From Pain to Perfect As A Sonographer - How Movement Training Changed My Life, Part 2

Over the last 25 years there have been vast improvements in ultrasound equipment design with a heavy emphasis on sonographer ergonomics. The industry standards and practice have been geared toward improved ergonomic industry standards and practice, with the large emphasis on reducing sonographer pain and injury. The problem remains significant as the fact that a large percentage of sonographers still experience work related musculoskeletal strain disorders (WRMSD’s). As we have stated in our last article; up to 80% of sonographers scan in pain, while 20% of those folks have to leave the industry. They can no longer continue on as a sonographer. In less than 5 years of entering the sonography industry, a sonographer is going to experience the prevalent pain and injury of our profession. This problem not only affects the sonographer and their body, it is a huge drain on the company pocketbook. Some figures have shown that a failure to address sonographer pain and injury in the workplace can result in enormous value and lost revenue for the institution. It is an enormous problem.

My experience has been that technology is not the answer. There have been enormous gains made in improved ergonomic designed ultrasound machines. While I do not disagree that better equipment, better education, and more knowledge are all very important, these alone have not done enough to combat the problem. Many folks would argue that the problem is just as epidemic as it was 25 years ago; even with improved ergonomic design and awareness. That’s why my colleague and I feel so strongly about our ‘movement training’ education. You can take charge, be in control of your body, and allow it to do what you ask of it. You just have to be willing to do the right things the right way.

Sonography is a career and a profession where in the work environment demands that the body of the sonographer function at a high level in a variety of positions. You can’t do that if you are suffering from work related pain and injury. It is our belief that the improvements in the industry need to be three fold -

Our 3E Approach

Improvement in:

  1. Equipment (machines), in proper
  2. Ergonomics, and
  3. Exercise,

being incorporated have got to be looked at to remedy the enormous amount of sonographer pain and injury.

We view the THREE E’s as a 3 legged stool, with each ‘E’ being a leg of the stool. The stool will not work properly if you eliminate just one of the ‘E’s. You must incorporate all three to achieve ultimate success.

We believe there are several misconceptions prevalent in our world today, and we have been led to believe that more proper education on proper movement is a huge area that can and will be a key to navigate the problem.

Another fact for the sonongrapher in the normal work place setting is that it can be nearly impossible to follow basic ergonomic standards in every scanning situation. Patient size, room and equipment setup can make it impossible to squeeze ergonomic necessity into many of our daily scans. This result is improper body position, less than ideal body mechanics, with these contributing to the high percentage of sonographer pain and injury that dominate our industry.

To this day, and on every scan that I do, I attempt to follow proper ergonomics guidelines. We live in a chaotic environment where everything we do is not ‘cookie-cutter’ perfect. That’s why as sonographers we need and we must, be ready to respond to the chaotic situations and circumstances that our job throws at us. One of the limiting factors of our performance is our level of fitness. The roadblock for us lies in the capacity of our body. Willpower, focus and due diligence are great things to strive for, but they certainly will not prevent body pain and injury.

The great news is that our bodies are functional units and our bodies can do what we ask of it, with proper training and conditioning. You must keep your body in some form of health and fitness level to dramatically reduce an injury event. Having a working knowledge and some background in taking care of yourself and preparing the body to respond properly based on what you ask it to do; is vital. This starts with obtaining proper education and then implementing that education to your benefit.

We will now begin to cover basic movement patterns, ways to stabilize and mobilize certain areas while we lengthen and strengthen our body to help alleviate and prevent the epidemic of sonographer pain and injury. We will show very basic and simple exercises, that when done properly, can lead to combatting sonographer pain and injury.

Arm abduction

Ergonomic advice : It is important to adjust the height of the exam table as well as the chair you are sitting on.

Performance advice: A basic understanding of body movement and how the body moves both with individual components as well as a complete unit. This type of education will help you understand how the body moves individually as well as a unit, what the body stabilization process is, and also an understanding of how individuals can improve movement to increase performance. This is a must.

With lateral arm movement away from the midline of the body, it is imperative to look and have a basic understanding of shoulder articulation, abduction, adduction, transverse adduction, transverse flexion, and the different forms of rotation.

Training body movement is the ultimate goal. Training just muscle will not accomplish our intended results. You cannot have success in achieving a pain free work existence if you only improve movement in one plane of motion. Our bodies function in many planes of motion. The goal is to be able to perform in a variety of body planes and motions. This will allow us to do our job and remain pain and injury free to perform our work at a high level.

Solution :: Band High Row: Hold onto a resistance band with both palms facing down (figure A), pull the band toward the head and abduct the elbows as you row. When at the end of the movement, the elbows should be high. The movement should be controlled (finish each repetition as shown in figure B). Return to the beginning and do for a total of 10 times or 10 repetitions. It is easy to increase difficulty, simply step back slightly, as this will increase the tension of the band. Another solution is to increase the number of repetitions or sets performed.

Solution: The Corner Stretch: Go to any open corner in a room. Stand upright but having feet staggered (one slightly in front of the other) , place your elbows at shoulder height. Put elbows and palms of the hands on the wall and lean forward, this creates a stretch in the front chest and shoulder area (figures C and D). Hold this position for 15 to 20 seconds and then release. Complete this two to three times per workout!

Go beyond your normal reach

Ergonomic tip: Get as close to your patient as possible.

Performance tip: Much of our job is spent reaching. We want to put ourselves in the best position possible to decrease work intensity and fatigue. This will reduce fatigue and the injury that comes with fatigue. You need to align yourself in the best way possible to reduce fatigue and injury.

To better assist yourself day to day, you must develop strength not only in your shoulders, but the back as well. You must increase the stability and support that the muscles of the shoulders and back can give, while maintaining both mobility and flexibility in those muscle groups. The two moves below demonstrate that where you find yourself in situations of needing to reach beyond 12 inches.

Solution: Band Shoulder Retraction. Grab and hold onto a resistance band with palms facing down (as shown) and arms extended. The subject is shown overreaching slightly forward (figure E). From this position maintain your arms straight, pull the shoulder blades back while simultaneously trying to pinch them together (figure F). Hold in this spot for a two-count and then repeat for 10 repetitions. You want to maintain an upright posture while completing this exercise. It’s very easy to increase or decrease the band resistance. Simply step forward or backward to increase or decrease the difficulty.

Solution: Standing Wall Stretch. Place your palms down and about an arms-length away from the wall, look down at the ground and place the hips back away from wall. Put an acceptable pressure on the hands. (figures G and H). This should allow you to feel a good stretch on the back of the arms, upper back, and shoulders. Hold for 15 to 20 seconds and then release. Repeat two to three times per session.

Be sure to visit for the next article in this series.

From Pain to Perfect As A Sonographer - How Movement Training Changed My Life, Part 1

From Pain to Perfect As A Sonographer - How Movement Training Changed My Life, Part 3

Doug Wuebben BA, AS, RDCS (Adult and Peds) FASE is a registered cardiac sonographer who performs adult and pediatric echocardiograms. Doug is also a consultant and International Speaker on keeping Sonographers and Others doing their jobs at a high level.

Mark “Coach Rozy” Roozen M.Ed, CSCS,*D, NSCA-CPT, FTSAC, FNSCA Mark has his Masters Degree in HPERD, with emphasis in Exercise Physiology. He is a Certified Strength and Conditioning Specialist (CSCS,*D), a Certified Personal Trainer (NSCA-CPT) a Facilitator for Tactical Strength and Conditioning (FTSAC) and a Fellow of the National Strength and Conditioning Association (FNSCA). He has been in the Strength, Conditioning and Performance field for over 30 years.

Mark is also Owner and CEO of COACH ROZY, LLC, his company that does performance training, a radio show, writes a column in the local newspaper and oversees his speaking and writing. He is also Co-Founder of LIVE PAIN FREE with Doug, which works with groups, teams and corporation to help their staff and employees achieve peak levels of performance.

His other business is 911 Tactical Performance where they work with First Responders; fire, police and military to help BE FIT FOR DUTY - FIT FOR LIFE.

They can be reached to

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