Rachel Simpkins, a Parker University Lab Coordinator and Instructor of Diagnostic Cardiac Sonography, is also a student in the Bachelor of Science in Integrative Health program. She recently completed her Capstone project focusing on various musculoskeletal issues often faced by sonographers. As new sonographers enter this exciting field, it is essential for them to understand all the potential treatment options available to them, such as chiropractic, massage, Pilates, occupational therapy, etc. Check it out!
Sonography is the practice of scanning patients using sound waves to visualize patient anatomy and disease processes. Sonographers work to find the information physicians need to diagnose patients with a various symptoms. Not only do these professionals need to understand and be able to understand the physiology of the organ they are scanning, but they also have to manipulate their bodies into positions that cause pain to gain these specific images. Integrative healthcare areas have been proven to help patients in pain, but which of these areas most benefit the pain of the sonographer?
The Beginning
Musculoskeletal issues have long been an issue for practicing sonographers. These pains were first reported in a public forum in 1985 and have been discussed throughout the workday in hospitals, clinics, and doctor’s offices daily (Society of Diagnostic Medical Sonography, n.d.). Sonographers, unfortunately, are used to living in pain. We now call them Work-Related Musculoskeletal Disorders (WRMD)s.
First called “Sonographer’s Shoulder,” these disorders can affect muscles, nerves, ligaments, and tendons (Murphy, 2017). These WRMDs happen due to the repetitive nature of sonography maneuvers needed to complete a diagnostic examination. Over time, these small tears and strenuous activity take a big toll on the sonographer and their ability to function in their career. According to the statistics, 80-95% of sonographers experience work-related pain. 90% experience pain for more than half of their careers and 20% of sonographers sustain a career-ending work-related injury (Morrison, n.d.).
An explanation of WRMDs as they relate to sonographers is due to several reasons. The length of a proper exam can last anywhere from 15 minutes to 1 hour and 15 minutes. While the sonographer is scanning, pressure must be applied to the probe and sustained for the entire duration of the exam. This isometric positioning causes an immense amount of strain on arm muscles, tendons, and ligaments. Another factor is the increase in portable exams. These exams are ordered to be completed at the bedside for patient comfort. While this is a wonderful addition to patient-centered healthcare, it takes a toll on the sonographer, who is now dealing with a much larger bed and machines to work around. When scanning in a more ergonomic area, such as an outpatient room, the technologists can maneuver and gain some use of ergonomics. In the patient’s hospital room, this is much more of a challenge even after transporting the ultrasound machine to this location.
There have been improvements made in sonographer comfort. These have come from machine companies and workstation equipment manufacturers, but not all sites have the luxury of this equipment. There are still too many scanning areas that go without daily. Also, technological changes in workflow have given way to an increase in digital patient charts and files, and the added strain of more computer work and the issues that come along with it. Staff shortages due to injuries and insufficient rest periods between exams, push the sonographer’s exposure to these musculoskeletal disorders even further (Murphy, 2017).
Treatment
Usually, sonographers or the public will seek out the advice of their general practitioner. Most of the treatment options include warm compresses and some form of painkillers ranging from ibuprofen to muscle relaxers. The problem is that this form of treatment may work for a short amount of time, but not for the chronic pain of daily scanning. Ibuprofen by itself should never be taken for an extended period and definitely not daily. So, what other treatment options does a practicing sonographer have?
Integrative healthcare has helped many individuals in many professions to become pain-free in their daily lives. Could some of these alternative medicine methods help the pain of a sonographer as well? There are various types of this form of medicine.
Chiropractic care has been praised by many of its patients for the relief of back and shoulder pain. Cervical spine manipulation can offer much relief from the daily strains of sonography work. The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) created a guide to provide recommendations for musculoskeletal injuries in adults in the outpatient setting. This guidance is based on the current best available evidence about the benefits and harms of pharmacologic and non-pharmacologic care for MSK injuries. This guide found that joint manipulation therapy reduced patient pain for less than 2 hours after treatment (Qaseem et al., 2020).
This source of pain relief appears to be effective, but only for an allotted amount of time. While this is a better option health-wise than NSAIDs, it still lacks the need for chronic pain relief of the working sonographer.
Massage therapy is another alternative medicine area that has been shown to affect the structure and function of the musculoskeletal system by promoting a relaxation response, decrease in muscle tension, and decreased muscle (Engen et al., 2010). Researchers at the Mayo Clinic established a study questioning the effects of chair massage on muscular discomfort in cardiac sonographers. Fifteen participants engaged in a 30-minute massage once weekly for 10 weeks. The pilot study found that the groups that participated in the massage therapy found an improvement in the relief of work-related pain but indicated that further research of more participants over a longer period of time was needed to unequivocally come to a conclusion regarding these forms of alternative medicine (Engen et al., 2010). This seems to be a promising pain-relieving option, but the amount of time after the massage, that a sonographer is pain-free, would be more a testament to the effectiveness of massage for sonographers.
In the journey of finding pain relief, another integrative heath option was noticed. Occupational therapy involves helping a patient to improve multiple areas in their life, including physical conditions, to increase the performance of their daily activities. These can include activity analysis, adaptive equipment, environmental modifications, assistive technology, therapeutic exercise, and patient education and training (Anonymous, 2023). For many, these changes that are taught to them can help the patient overcome obstacles in their daily lives. In sonography, a list of stretches is taught and meant to be utilized at the beginning and end of a shift or when the sonographer is in pain. Added to this are recommendations for ergonomic scanning. With evaluation from an occupational therapist or assistant, sonographers can position themselves when scanning to reduce the risk of injury. Some published stretches include the overhead reach, thumbs back reach, and head to shoulder reach (Roozen and Wuebben, 2022). A systematic review by Tater and Truluck (2017) of the literature was performed to determine whether sonographers taught to use proper body mechanics, stretching, and/or therapeutic techniques experience less pain. The results suggest that education workshops and stretching techniques have the potential to benefit sonographers. Sonographers who incorporate stretching into the workday may experience a reduction in pain.
Unfortunately, occupational therapy practitioners are commonly overlooked in the research and development of comprehensive pain management teams compared with fellow non-pharmacological providers (Reeves et al., 2022). This can be said for most of the alternative medical care that is available.
Yet another helpful tool in our quest may be Pilates. This form of muscle-strengthening focuses on core muscles. It is a low-intensity type of workout that promotes flexibility, posture, and mobility. Pilates classes can help keep the body in alignment. Your body alignment determines how evenly your head, shoulders, spine, hips, knees, and ankles line up with one another. In a properly aligned body, your bones are evenly positioned across your body, helping your joints and muscles work freely and properly. A misaligned body puts extreme pressure on the muscles, joints, and ligaments in your spine and other areas, forcing them to work in overdrive to support your everyday movement. This can lead to chronic pain, headaches, general stiffness, reduced mobility, and several other problems that could severely impact your everyday life (Circle Health Group, 2024). Having a stronger core can inadvertently set the sonographer up with better ergonomic positions to use when scanning.
Chiropractic care, massage therapy, occupational therapy, and Pilates all provide a degree of pain relief from sonography work. As to what works best, that may be a very individual choice. The evidence leans more in favor of occupational therapy stretches with a solid Pilates base since those are to be utilized daily throughout the workday. Knowing this, the repetition of the practice may be what is more important. If it were possible to get adjusted or have a massage daily, instead of once per week, it could produce the same results. That frequency is, unfortunately, just not possible.
Finding and utilizing the correct integrative health area for the sonographer, with the frequency that is right for their workload, would produce the best outcome. In pursuing a sonographer’s pain-free scanning, may the best complementary alternative medicine prevail!
References
Anonymous. (2023, October 25). St. Catherine University. https://otaonline.stkate.edu/blog/6-occupational-therapy-interventions/
Circle Health Group. (2024, January 17). Why you should take up Pilates in 2024. https://www.circlehealthgroup.co.uk/health-matters/exercise-and-fitness/pilates
Engen, D. J., Wahner-Roedler, D. L., Nadolny, A. M., Persinger, C. M., Oh, J. K., Spittell, P. C., Loehrer, L. L., Cha, S. S., & Bauer, B. A. (2010). The effect of chair massage on muscular discomfort in cardiac sonographers: a pilot study.BMC complementary and alternative medicine,10, 50. https://doi.org/10.1186/1472-6882-10-50
Morrison, B. (n.d.). Work Related Musculoskeletal Disorders in Sonographers [PowerPoint slides]. College of Medicine, University of Maryland. https://www.hagerstowncc.edu/sites/default/files/documents/17-coned-cardiac17-musculoskeletal-disorders.pdf
Murphey, S. (2017). Work related musculoskeletal disorders in Sonography. Journal of Diagnostic Medical Sonography, 33(5), 354–369. https://doi.org/10.1177/8756479317726767
Reeves, L., Sako, M., Malloy, J., Goldstein, A., & Bennett, K. (2022, May 2). Role of occupational therapy in comprehensive integrative pain management. Aota.org. https://www.aota.org/practice/practice-essentials/quality/quality-resources/role-of-ot-pain-management
Roozen, M., & Wuebben, D. (2022, October 1). Reach for Relief: Eliminating Neck and Shoulder Pain. Cardioserv. https://www.cardioserv.net/sonographers-the-pain-factor/
Society of Diagnostic Medical Sonography. Work Related Musculoskeletal Disorders. (n.d.). https://www.sdms.org/resources/careers/work-related-musculoskeletal-disorders
Tator, C. F., & Truluck, C. (2017). Musculoskeletal pain relief in sonographers: A systematic review of the effects of therapeutic techniques. Journal of Diagnostic Medical Sonography, 33(5), 420–426. https://doi.org/10.1177/8756479317721673
Qaseem, A., McLean, R. M., O’Gurek, D., Batur, P., Lin, K., & Kansagara, D. L. (2020). Nonpharmacologic and pharmacologic management of acute pain from non–low back, musculoskeletal injuries in adults: A clinical guideline from the American College of Physicians and American Academy of Family Physicians. Annals of Internal Medicine, 173(9), 739–748. https://doi.org/10.7326/m19-3602
