Doctor Doctor

Surgeons are well known for their fine motor skills. However, standing in theatre for long periods- whilst maintaining finicky postures is hard work, and requires more gross stability from the outer extremities. It is common for a physician to experience musculoskeletal pain with his/her craft. A recent surgeon of mine has received many compliments on his improvements in postural stability whilst consulting and in theatre. Recent compliments have sparked interest in strength training among other surgeons- leading to myself and other colleagues seeing more surgeons in the clinic wanting to improve his/her musculoskeletal pain.

Now, in no way am I a hero here. Managing musculoskeletal pain suits my own finicky personality; nor is a complex algorithm required. Taking a sound clinical history along with a good understanding of contemporary pain science goes a long way! What I want discuss is utilising time under tension (TUT) with surgeons- along with other age cohorts when prescribing strength exercises. Keeping this blog anecdotal. TUT can be described as: time taking to complete a single repetition. With any exercise, one has to withstand forces great enough to complete each lift. Surgeons are required (as mentioned) to maintain gross stability, sometimes hours on end. Movements such as: deadlifts, bent over rows, KB front squats, kneeling fitball roll outs and seated rows in hip flexion. Are all great movements to introduce TUT into ones exercise regime. Using a TUT of: 5-1-2 for a deadlift for example, for a set of 5 repetitions equates to a total set volume of 40 seconds. Now 40 seconds does not seem like much. However, if you include 5 sets, now you have 3.33 minuets for the exercise alone. Add two to three more exercises that were aforementioned- you then have 10 minuets of TUT! Next would be prescribing a safe adequate load that doesn’t mess with his/her loading mechanics. O’Sullivan & colleagues (2014) systematic review on heavy slow resistance training is a neat read and complimentary. Lastly, gradually increasing TUT and load improves gross motor control- which is especially helpful in theatre and in the everyday contexts, while also strengthening neuromotor pathways (which anecdotally) is one of the biggest winners in improving gross motor tone- reducing the “stiffness” that is often subjectively reported. Through brain plasticity: the brain learns how to turn on, and turn off tone.. winning! Turning off tone can be a surgeons omen..

As always: consult with your GP and exercise physiologist/scientist to be cleared to move with safety.

James 👨🏼‍⚕️🧠🏋🏼‍♂️💪🏼


Living large is a term typically used for one living a life that is extravagant. Extravagant can be synonymous to large portion sizes and long periods at the desk or television- you get the idea. Recent epidemiological statistics agree: that Australians are living an extravagant lifestyle that is not worth bragging about. One in two Australians have a current chronic medical condition at even given time. There are eight noteworthy chronic conditions according to public health experts- which are: cancer, cardiovascular disease, mental health conditions, arthritis, back pain and problems, chronic obstructive pulmonary disease, asthma and diabetes. You may have noticed that I have highlighted six out of the eight chronic conditions- as empirically I like to cluster the aforementioned affecting each other at some capacity such as: back pain reducing mobility, which increases sedentary behavior- and thus increasing insulin resistance. Each chronic condition is a blog on it’s own. So, as I always like to spark a few gamma waves that may entice you to deconstruct your own confirmation bias’s- that the highlighted chronic conditions are not just treatable beyond pharmacology, but are preventable and curable by moving more- whether it is a bit more huff-and puffing (aerobic activity), or applying forces against gravity (lifting weights, spending time in the garden). One in four Australians have a chronic condition- with mental illness and coronary artery disease being among the most common. What is most saddening, is that 87% of deaths are accounted for by a chronic condition. Socrates famous dictum: “The unexamined life is not worth living” is provoked by living a life that is deep in thought,  is rational and logic and has a touch of agape (unabiding love). If I replaced ‘unexamined’ with “unhealthy”, one would hopefully agree with me- that “A unhealthy life is not worth living”. Here I come back to the metaphor of living large. Why not commit to your own dictum of living a healthy life, that is provoked by moving well and regularly, following evidence based food guidelines, seeing your GP for regular check ups, embracing your default mode network by finding time to be creative and playful, and lastly- maintain strong social ties, which we know decreases ones risk of cardiovascular diseases and metal illness.


James 🙂

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