By Timothy J. Caruso, PT, MBA, MS, CEAS, Cert. MDT
Dentistry has come a long way over the last 150 years. The evolution of anesthesia, dental techniques, materials, equipment, and approaches has come a long way from standing up with a pair of pliers and a can of ether.
Pain appears to be an accepted part of the dental profession, and its incidence is worsening. The patients are pain free but how about the dental staff? Our ultimate career goals are to be efficient and effective and healthy. However, these goals can be impacted by the presence of mechanical neck and low back pain. Daily discomfort continues to be tolerated day in and day out.
Evidence from the Scandinavian literature as early as the 1950s reports complaints of neck, shoulder and low back pain within the dental profession (Seyffarth). Eccles and Powell reported in 1967 that the practice of dentistry leads to excessive fatigue and to certain occupational illnesses and disabilities. Although dental practice transitioned from standing postures to sitting postures for most patient care tasks in the mid-1960s, a decrease in the prevalence of reported discomfort has not been reported (Rundcrantz BL). Kilpatrick observed, “Whether in ancient times or today, one observes a common physical profile, an unnatural body form reflecting degrees of contortion & distortion which range from moderate to extreme … a great deal has changed & improved in the art & science of dentistry over the centuries, but little has changed in the manner of work” (Kilpatrick).
Orthopedic research has shown that 70 to 80% of the population will experience transient neck or low back pain during the course of their lives (Spratt, Kelsey). Studies have found that 23% to 79% have symptoms that persist or recur (Toroptsova, Croft, Carey, van den Hoogen). A majority of dentists and hygienists have musculoskeletal complaints related to the back and neck (Oberg, Murphy). The prevalence of neck pain and lower back pain was reported at 52% and 58%, respectively, in the ADA News in June 2010, with similar findings reported in the ADA member survey in 2007.
The work of dentistry relies a great deal on the upper body in the operatory, particularly the musculature of the shoulder. Shoulder muscles are largely responsible for the dynamic stability and joint motion of the glenohumeral joint. When the shoulder muscles fatigue, joint mechanics become altered, thus possibly leading to pathologies such as tendonitis, impingement, and even subluxations or dislocations (McQuade et al). According to Escamilla et al, if normal scapular movements are disrupted by abnormal scapular muscle firing patterns, weakness, fatigue, or injury, the shoulder complex functions less efficiency and injury risk increases (Escamilla et al). Prolonged sitting in a slouched seated position, also increases the intradiscal pressure of the lumbar spine increased significantly (Anderssen, et al).
Pain in the dental practice can result from prolonged atypical posturing and further complicated by deconditioning. The cumulative effects of abnormal stresses and strains on the clinician have been well documented in the literature…. So, what can clinicians do? Is it possible for dental professionals to counteract the ill-effects of their profession on their bodies by participating in a regular exercise routine?
Research has shown that participation in a regular exercise program has a multitude of beneficial effects: improved blood flow; increased level of endorphins and encephalins in the blood stream which are known to relax the body; better muscle and joint function with improved relaxation; more restful sleep patterns; improved level of alertness during waking hours to name a few (Mayo clinic, CDC).
More specifically, there are several exercises in the literature that exhibit high to very high activity from the rotator cuff, deltoids and scapular muscles of the shoulder. These include prone horizontal abduction and abduction with external rotation; prone flexion; lifts & chops (D1 and D2 diagonal patterns) as well as a variety of weight-bearing upper extremity exercises, according to Escamilla. This program is designed to strengthen those areas most relied on by the dental professional. The challenge then becomes integrating such an exercise routine into an extremely busy clinic schedule.
For years, dental professionals have been constrained by the limitations of their own work environment and the negative effect on their bodies while paying a high price physically. The concept of caring for our most important instrument, our body, is invaluable and often ignored. Regular exercise has been shown to improve postural endurance and decrease the cumulative trauma that ultimately results in pain. However, given a busy clinical schedule, how can the clinician incorporate regular exercise into his/her routine? By adding some exercise as a regular part of your life, can one counteract the ill-effects of the profession on your body? If you are going to invest the time in a regular exercise routine, where should you start?
This program is designed for the busy dental professional to strengthen those muscular areas that are most stressed and fatigued by the practice of dentistry. Additionally, dentistry for the most part is a “seated profession.” If one must sit to work, why not work to sit? Dynamic sitting on a therapy ball has been shown to improve one’s working posture and spinal alignment, facilitate improved balance and continuous body movement & muscle function while working, increase surface contact of weight bearing structures as well as improving weight distribution while sitting (Mayo Clinic, Sochaniwsky, Dieter Breithecker, Bauman).
The rationale for use of the ball for sitting is based on the potential for increasing the neuromuscular demand required to maintain sufficient control of the spine and whole body motion (Desai & Marshall, 2010). As human beings, we spend a significant amount of time sitting. A 2009 issue of Women’s Health reported the results of a poll conducted by the Institute for Medicine and Public Health. The authors identified that the average American spends a little over 56 hours of the week sitting (Women’s Health November 2009). Several other studies have shown that prolonged sitting throughout the day may even increase your risk of morbidity and mortality (Levine, Patel).
Movement, can be a beneficial part of the working day (Yancey). As a chosen work position, we often sit in a fixed, frequently slouched posture for any number of hours during the working day. There are many seating alternatives available for the dental professional.
One option is dynamic sitting on the Evolution chair by Posture Perfect Solutions, which provides us with a unique alternative to typical sitting. The Evolution chair provides an opportunity to actively “participate” in the act of sitting, and while this may not be a good fit for all practitioners, it is yet another option to consider. Dynamic sitting allows us to avoid the habitual slouched sitting posture that our mothers always warned us about. We are continuously moving, adjusting and repositioning ourselves throughout the day thus counteracting our typical “holding patterns” of poor posture and perhaps saving our lives!
Efficiency, effectiveness and career longevity may be positively impacted by the fitness of the operator and their choice of seating. So when considering career longevity with the hope of making it to the end of your career in great shape, get on the ball!
Note: if pain persists beyond several weeks' time, seek out professional help.
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Timothy Caruso is a practicing Physical Therapist who has focused his professional expertise in the areas of manual therapy, orthopedics and neuromusculoskeletal disorders. He is a member of the ADA’s Ergonomic and Disability Support Advisory Committee and has worked extensively with the dental community since 1988. email@example.com (630) 628-8176.