“Bones Says”….Take the Stand!

skeleton_MrBonesThe daily demands of being a health care professional are daunting. From managing patient loads and charts, to handling insurance claims and complaints, workday stressors abound. And don’t forget about the physical stress: standing for hours on end; white-coat with heavy, overstuffed pockets weighing around the neck; reading X-rays with your head in forward flexion; eating less-than-optimally and using M&M’s as energy supplements… the list abounds.

For many of us, the physical toll on our bodies is compounded by the impracticality of properly caring for our bodies in the precious (and likely tired) hours remaining to us after a long day at the clinic. If you’re like many other doctors, you are living in a body that you might barely recognize as your own!

Holistic Primary Care believes that we as physicians are most effective when we keep ourselves healthy and can model healthy living for our patients. To that end, we’re happy to introduce the “Bones Says” column, to help you restore your well-being while on the wards, in your office, or wherever it is you spend your time caring for others. We need to take care of the care-takers, too!

“Bones Says….” is adapted from its original home at living anatome, a website that helps medical students practice what they preach, by promoting conversations and curriculum concerning self-health. On the living anatome site, Bones represents voices from a variety of holistic healthcare fields (e.g. yoga, naturopathy, Pilates, energy management), giving students specific recommendations for how to ease the physical and emotional stressors of medical school.

Here at HPC, “Bones” will apply these same concepts to the context of your busy primary care practice. We hope that you find the recommendations relevant and helpful in making better use of your own body. We are, after all, living, breathing anatomy!

Bones says… Take the Stand!

What is The Stand?

Once again, you’re standing at a workstation in the hall, filling out the umpteenth patient chart, not bothering to sit because your next patient is waiting to be seen. You continue to stand during your patient’s HPI because you are going to shortly leave the room in a few minutes to go grab lab results from a nurse, or respond to a page while the patient changes. And while that empty stool in the corner beckons, you fear that sitting down might require more energy than it’s worth. So you suffer through tight thigh muscles, the ache in your knee joints, the stiffness of your lower back, and the exhaustion of your feet. You’re suffering from a clear case of “The Stand.”

How does “The Stand” affect my anatomy?

When standing for prolonged periods of time, the body is stressed and strained in several different ways, e.g. peripheral pooling of blood, excess load on joints (e.g. knee and hip), muscle strain (e.g. back). Additionally, chances are that you are not standing in proper alignment, thereby tightening and shortening some muscles, while elongating and weakening others.

Fidgeting, therefore, becomes the body’s natural defense against these postural stressors, re-distributing the load placed on your skeletal frame and soft tissue structures, as well as temporarily relieving the work of your supporting muscles.

What can I do to counteract its effects?

Don’t let standing for hours every day control you. Whether you intend to or not, you will inevitably fidget when standing for prolonged periods of time. So use this knowledge to consciously fidget to your advantage with these simple tips:

Relieve tension on your ankles and feet: Raise one foot and perform gentle ankle circles in one direction, for 5 full rotations. Reverse the direction of the circle for another 5 rounds. Then change feet. Don’t lose your balance: keep your lifted foot just an inch or two off the ground, or better yet, try keeping the tips of your toes on the ground while the foot circles!
Unlock your knees: Perform micro knee bends to take your knees out of a locked extension or hyperextension, and get your anterior thigh muscles (e.g. the quadriceps femoris group) working. Make sure that the depth of the bend is small (only a couple inches), even on both sides, and that your patellae remain parallel to each other.
Release your tight lower back: Tilt your pelvis anteriorly and posteriorly, rocking it forward and back in small motions. Keep your knees bent and, for bonus points, initiate the movement from the abdominal wall muscles.
Counter too much hip flexion: To counter the activity of your hip flexors in the micro-bends, engage your gluteus maximus muscles to isometrically strengthen your hip extensors. While standing in a neutral, even stance, squeeze both of your butt-cheeks, hold for 5 seconds and release. Perform 5-10 in a row.

And most importantly: No matter how athletically inclined you are, try these simple moves at home before you show them off in your work environment. They should be second-nature, so that you are still able to focus on the task at hand, and do not jeopardize anybody’s safety (especially your own!) by bending too far, losing your balance, etc.


Stephanie Pieczenik Marango, MD, RYT is a professional explorer of being human. She is a licensed physician in New York State, trained at the Mount Sinai School of Medicine in New York City, and California Pacific Medical Center in San Francisco. She is also a yoga teacher, certified by the Sivananda Ashram at the 300+ level. She merges the movement and medicine worlds as co-founder of Living Anatome, as co-Director of the Functional Anatomy for Movement and Injuries (FAMI) Workshop, and through Yoga Teacher Trainer programs.

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