Many Clinicians Needlessly Work with Neck Pain

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ErgoPractice News – November 2016

How non-ergonomic loupes have caused an epidemic and how you can help stop it!

Aches and pains are hindering the quality of life. Many surgeons (92.3%) report work-related pains and about 20% of those surgeons eventually resort to surgery for treatment.1 Dentist and veterinarians are in a similar situation.2 Are traditionally designed, non-ergonomic loupes promoting poor working postures? A research article raising this question was published about 20 years ago: “Are your loupes posture breakers or posture makers?”3

Can the neck pain epidemic be stopped? The answer is yes if more clinicians are informed of how a poor working posture leads to pain and injury. You may see your colleagues working like the clinician in Figure 1a. Chances are they are experiencing chronic neck pain. Why do most clinicians not work like the clinician in Figure 1b? The main reason is that traditionally designed loupes, still used by many clinicians, were created to help users see better but did not consider ergonomic issues. Ergonomically designed loupes are available today and clinical ergonomics has become a widely discussed topic, but most loupe users have not be informed of the true requirements of ergonomic loupes. Why? Let us highlight a few common reasons:

Non-Ergonomic Postures are a Natural Behavior

When we look down on objects, we tend to tilt our heads rather than rotate our eyes. Ergonomic postures are learned behavior, like an effective tennis or golf swing. We may unknowingly work with non-ergonomic postures for many years without experiencing serious neck pain. Initially, working with non-ergonomic loupes will feel more natural than working with ergonomic loupes. Learning to work safely with ergonomic loupes is a short process but very beneficial in the long term.


Some clinicians self-diagnose their neck pain and attribute it to a sports injury or an auto accident or even a bad pillow. No wonder 20% of surgeons who report working pain are resorting to surgery for treatment – working posture was not even considered as a cause for their neck pain. Some clinicians believe that all loupes are basically the same and thus ergonomics is not an important factor in selecting loupes. Partially because many of their peers are using non-ergonomic loupes.

Missing Information

Many clinicians do not know that non-ergonomic loupes can cause poor neck posture which can contribute to chronic neck pain and injury.3 Many clinicians believe that their neck pain is just a part of the job.


Ergonomics has been promoted through continuing education courses, in programs at hospitals and dental schools, and in cover stories of trade magazines. In response, nearly every loupe company has added the word “ergonomic” to their marketing materials. Indeed, the use of loupes does allow the clinician to work farther away from their patient which reduces lower back pain. But loupes without proper viewing angles (called declination angles) can cause poor neck posture leading to chronic pain and injury.

Question: If all manufacturers claim their loupes are ergonomic, what can anyone do to test their claims? Some loupe providers will even misinform their customers by promising custom, ergonomic viewing angles and then deliver something different.4

Answer: If loupes force someone to tilt their head more than 20 degrees forward, they are not ergonomically designed for a safe and comfortable posture. The strain of supporting the head in this position can cause chronic neck pain and injury. A neck tilt angle can be easily measured.

The 20 Degree Test

It only takes one photo to get an estimate of the head tilt angle. Take a photo from the side with the subject looking down at a target through loupes, as in Figure 2. Be sure the user is sitting or standing up straight, with the spine balanced over the hips. Draw a vertical line directly up from the hip through the shoulder. Next, draw a second line through the center of the head until it intersects with the first line. This angle is the head tilt. A head tilt under 20 degrees is generally safe and over 20 degrees can be dangerous.

If you see your colleague working as in Figure2a, with a neck tilt that is far over 20 degrees, chances are they are needlessly suffering. You may not know because many choose to suffer in silence and not “complain.”

SurgiTel began to offer adjustable, ergonomic front-lens-mounted (FLM) loupes about 25 years ago. With continued research and development, we are now able to offer ergonomic through-the-lens (TTL) loupes with any custom viewing angle, allowing users to work in safety and comfort. We found many clinicians have been able to eliminate their neck pain by replacing non-ergonomically designed loupes with our SurgiTel ergonomic loupes.5,6

Please share this article with anyone who has told you about their neck pain, or who is working like clinician 2a and probably silently suffering! If you or your colleague can send me two photos, one of a neutral posture and one of a working posture with loupes, I can let you know the head tilt angle.

You can help your colleagues who may be suffering by simply sharing this information.

Feel free to contact me with any questions or any interesting stories to share. My e-mail is


  1. Chitnis, Deepak. “Operating with Pain: Surgeon Workplace Injury Underrecognized.” ACS Surgery News 01 Apr. 2016: 1+. Print.
  2. Valachi B, Practice Dentistry Pain-Free, Posturedontics Press, Portland, OR 2008,
  3. Rucker LM, Surgical telescopes: posture maker or posture breaker? In, Murphy D, ed, Ergonomics and the dental care worker. Am Public Health Assoc, Washington DC, 1998, 191-216
  4. Valachi, Bethany, PT, MS, CEAS. “Are Dental Loupes Improving or Worsening Your Neck Health?” Dental Products Report 01 Oct. 2016: 96+. Print.
  5. Darryl L Hatchett, SurgiTel Delivered the Magnification I Wanted Without the Pain, ErgoPractice News, June 2014.
  6. Amjad Ansari, SurgiTel’s Ergonomic Loupes Freed me from Neck Pain, ErgoPractice News, Feb 2015.
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