Expert insights for safer, sustainable practice

Endoscopy is a highly skilled yet physically demanding clinical specialty. With rising procedure volumes and prolonged static postures, musculoskeletal strain has become an increasingly recognized occupational risk. Ergonomics is therefore no longer a peripheral concern; it is central to clinician well-being, procedural performance, and long‑term sustainability in practice.

This Q&A features insights from Dr. Raj Rameshshanker, Consultant Gastroenterologist at Hillingdon Hospital, London, and Ms. Jo Kelly, physiotherapist, exploring common risks, everyday challenges, and practical strategies for improving ergonomic safety in endoscopy.

Q1: Why are endoscopists particularly at risk for musculoskeletal injuries compared to other clinicians?

Dr. Raj Rameshshanker: Endoscopy is physically demanding. It requires clinicians to stand for prolonged periods in static postures while maneuvering complex equipment. Combined with increasing procedure volumes and the time required for therapeutic interventions, this significantly elevates the risk of endoscopy-related injury.

Q2: How common are endoscopy-related musculoskeletal symptoms in practice?

Dr. Raj Rameshshanker: Endoscopy-related pain is very common. Published studies report musculoskeletal symptoms in approximately 50% to 90% of endoscopists, depending on the population studied and how symptoms are defined. From my own experience and discussions with colleagues, shoulder, neck, and back pain are among the most common complaints.

Q3: What are the most common ergonomic mistakes observed during procedures?

Ms. Jo Kelly: A frequent issue is failing to adjust the bed to the correct height. This often leads clinicians to lean forward, increasing strain on the lower back, upper back, and neck. It can also move the shoulders and arms out of a neutral position, requiring greater force and repetitive loading through the arms and hands. Over time, this contributes to overuse injuries in the elbows, wrists, and hands.

Q4: How important is posture during procedures, and what does good posture look like in endoscopy?

Ms. Jo Kelly: Posture is fundamental to preventing injury and supporting a long, sustainable career. Good ergonomic practice can influence not only professional longevity, but also quality of life outside of work. In practical terms, good posture in endoscopy means maintaining a neutral spine with a straight neck and back, keeping the feet comfortably apart for stability, and ensuring the shoulders and elbows remain in a relaxed, neutral position. The bed height should be set slightly below elbow level, typically within a range of 0 to 10 centimeters.

Q5: What are the early warning signs of strain that clinicians should not ignore?

Ms. Jo Kelly: Early signs include aching and fatigue during work. A key indicator is whether symptoms resolve within two hours after the last procedure. Ideally, clinicians should not begin the next list still feeling the effects of the previous day’s workload.

Q6: Do ergonomics impact procedural performance and patient outcomes?

Dr. Raj Rameshshanker: Absolutely. Ergonomics affects both clinician performance and patient outcomes. Discomfort or pain can limit a clinician’s ability to complete long procedure lists and may reduce concentration. If attention is diverted by physical strain, procedural performance may be affected, which can ultimately influence patient care.

Q7: What practical changes can be made to improve ergonomics in daily practice?

Dr. Raj Rameshshanker: We actively address ergonomics in our practice by optimizing monitor positioning, adjusting bed height, and using anti-fatigue mats and foot support. We also aim to avoid overly long procedure lists and ensure that there is sufficient recovery time between cases. In addition, we prioritize regular breaks, take a more thoughtful approach to scheduling workloads, and encourage ongoing discussion around ergonomic best practices and how to use new technological advancements to improve ergonomics in practice. These measures collectively help reduce strain and support long‑term musculoskeletal health.

Q8: What needs to change in training and the wider industry moving forward?

Dr. Raj Rameshshanker: Ergonomic awareness should be introduced from the very start of training. While technical skills, pathology recognition, and list management are already core components of education, ergonomics must also become a standard part of the curriculum. Although awareness is improving, adoption is still evolving, particularly across Europe. A more structured, top‑down approach is needed, including stronger integration into training programs, greater emphasis from professional societies, and equipment designed to promote natural movement, reduce repetitive strain, and accommodate clinicains of different hand and body sizes. Even with behavioral adjustments, system and device design play a critical role. Ergonomically optimized equipment can significantly improve outcomes for clinicians.

Conclusion

Ergonomics in endoscopy is no longer a secondary consideration; it is fundamental to sustainable clinical practice. As highlighted by Dr. Raj Rameshshanker and Ms. Jo Kelly, musculoskeletal strain is highly prevalent, often underrecognized, and closely linked to everyday factors such as posture, equipment positioning, workload, and procedure duration.

While simple behavioral adjustments, such as optimizing bed height, maintaining neutral posture, and incorporating structured breaks can significantly reduce strain, long‑term progress depends on broader system-level change. This includes embedding ergonomic principles into training, increasing awareness across clinical teams, and ensuring that equipment design actively supports the user.

Ultimately, protecting clinician well‑being is inseparable from delivering high-quality patient care. A comfortable, well-supported endoscopist is better equipped to maintain focus, precision, and efficiency. By aligning clinical skills with ergonomic best practices, the endoscopy community can move toward a safer, more resilient, and more sustainable future.

At PENTAX Medical, we believe clinician well‑being is an essential part of delivering high-quality patient care. Our flexible endoscopy solutions are designed with ergonomics in mind - from research and development through everyday clinical use - to support clinician comfort, procedural efficiency, and longevity in practice.