Individualized ergonomic wellness approach for the practicing gastroenterologist (with video).

Journal Article (Journal Article)

Background and aims

The prevalence and burden of ergonomic-related musculoskeletal injury are well established in the literature, but data are scarce on techniques that can be used to avoid injury. This pilot study aimed to develop a new method of endoscopist wellness assessment. The technique presented here is an intervention by a physical therapist assessing ergonomic position and posturing during endoscopy to create an individualized wellness plan.


Volunteer endoscopists were identified in a single ambulatory surgical center. Demographics, previous injury, current pain, and posture were evaluated. A comprehensive assessment was developed by the physical therapist while observing endoscopists performing at least 2 colonoscopies and while working at their computer workspace. The detailed personalized wellness program included recommendations for individualized exercises, static and dynamic posture re-education during and between procedures, optimization of procedure suite setup, pain education, and an opportunity for follow-up 1-on-1 sessions with the physical therapist. Endoscopists were later interviewed regarding their perception of and compliance with the wellness plan. Specific outcomes evaluated included changes in musculoskeletal pain, acceptance, and incorporation of wellness recommendations and procedure suite alterations into clinical practice.


As we developed this new method of endoscopic wellness assessment, 8 endoscopists representing a wide range of ages and clinical experience were assessed. Twenty-two pain sites were identified among 5 subjects, with back and neck pain the most common pain sites. A variety of ergonomic inefficiencies and suboptimal movement patterns was observed, resulting in highly variant wellness plans. By the end of the study, 63% of pain sites were reduced in intensity or resolved, whereas 32% of pain sites were unchanged and 4% increased in intensity. Seven of 8 participants found the pictures depicting their posture that supported their movement analysis helpful, and 3 participants requested reassessment by the physical therapist. All participants reported static and dynamic postural education and procedure suite setup recommendations to be impactful to their ergonomic performance.


Ergonomic assessment and instruction by a physical therapist was well received and resulted in improvement of musculoskeletal complaints among a cohort of endoscopists reporting baseline pain associated with performing endoscopy. In addition, this intervention provided ergonomic education that can be carried forward throughout their professional endoscopic career. We believe that ongoing individualized assessment and optimization of ergonomics is necessary because generalized wellness programs or even modifications to endoscopic equipment would not target all the unique ergonomic challenges faced by each physician. Ergonomic programs using the new method presented here could potentially contribute to career longevity, decrease burnout, reduce lost days of work, and, most importantly, reduce pain and fatigue among practitioners.

Full Text

Duke Authors

Cited Authors

  • Markwell, SA; Garman, KS; Vance, IL; Patel, A; Teitelman, M

Published Date

  • August 2021

Published In

Volume / Issue

  • 94 / 2

Start / End Page

  • 248 - 259.e2

PubMed ID

  • 33561486

Electronic International Standard Serial Number (EISSN)

  • 1097-6779

International Standard Serial Number (ISSN)

  • 0016-5107

Digital Object Identifier (DOI)

  • 10.1016/j.gie.2021.01.045


  • eng