Essential Steps to Prevent Pain & Ensure Your Career Longevity
By Dr. Bethany Valachi
Pain is not a necessary by-product of dentistry–you can reduce or eliminate your pain with evidence-based interventions. Effectively resolving work-related pain in dentistry requires correctly identifying the risk factors, and then targeting those risk factors with specific, evidence-based interventions. Due to the multi-factorial nature of work-related pain, rarely does a single intervention (i.e. purchasing a new set of loupes, strength training) permanently resolve pain issues.
It is also important to know the proper sequence in which to implement the interventions. Here are my 6 Keys to Wellness in Dentistry to help you work with less pain, improve your quality of life and extend your career.
STEP 1. ‘Ergonomize’ your operatory. It is all too common to observe dental professionals spending money on chiropractic adjustments, personal trainers or expensive gadgets, only to return to the operatory environment that likely caused the pain problem in the first place! It is no surprise that the pain syndrome usually returns, and round and round it goes… So, first and foremost, you need to resolve ergonomic problems in your operatory.
Important questions to ask include:
- How can I easily & economically ‘ergonomize’ my operatory layout?
- How should I adjust the levers on my operator stool to optimize my spinal health?
- Is my loupe declination angle improving or hurting the health of my neck?
- Is my stool cylinder the correct height?
- Is the seat depth of my stool promoting lumbar health?
- Is my saddle stool correctly adjusted?
- How can I ergonomize patient chairs with ‘wide wings’ that cause forward leaning postures?
- Was the working distance on my loupes correctly measured?
- Is the overhead light positioned correctly to best prevent shadowing?
- Do my gloves fit properly?
- What is the best clock position to treat my patients?
For example, one of the most common ergonomic mistakes I observe is TTL loupes with a poor declination angle that forces the operator into an unsafe forward head posture and causes neck pain. I have found that there is only one style of loupe on the market that consistently keeps all operators in a safe head posture, which is a vertically adjustable flip-up style loupe. However, before you invest in ergonomic equipment, it is helpful to know which stools, loupes, instruments, gloves and chairs will benefit your health and not make it worse! I have created a proprietary list of the equipment that I frequently utilize in my in-office consultations here.
STEP 2. Pick the right healthcare professional. If you have had persistent chronic pain for longer than six to eight weeks, you should probably consult a healthcare professional. So who is the ‘right’ healthcare professional? The first person most of us turn to when we are in pain is our primary care medical physicians. While physicians receive a tremendous amount of training in medical school, their schooling in therapeutic rehabilitation is quite limited. Yet many PCPs are making treatment decisions that can profoundly (and often negatively) impact your musculoskeletal health and career longevity. Consider requesting a referral to one of the following healthcare professionals for chronic pain problems. Keep in mind that because one of the primary causes of pain in dentistry is muscle imbalance, a chiropractic adjustment rarely permanently resolves the issue.
PHYSICAL THERAPIST. Physical therapists work to regain normal movement and function of the body through use of various modalities, hands-on techniques and exercises.
CERTIFIED HAND THERAPIST. If you suspect your problem originates in the hand, wrist or arm you may want to request a referral to this specialist.
TRIGGER POINT THERAPIST. Many therapists call themselves trigger point therapist, but have not completed Dr. Travell’s extensive myofascial pain treatment education.
STEP 3. Resolve your trigger points. Major trigger points should be resolved before any strengthening exercise is attempted. Painful trigger points are common among dental operators due to body asymmetry, poor postures, poor body mechanics, repetitive movement, lack of movement, sustained muscle contraction and mental stress. Unfortunately, trigger points are often overlooked in traditional Western medicine and patients are sent from specialist to specialist with no resolution to their pain.
Among dentists and hygienists, trigger points occur in numerous muscles—far too many to discuss in this brief report. In the operatory, trigger points can develop from improper positioning, poorly adjusted scopes and a myriad of other ergonomic pitfalls, and require special operatory modifications. If allowed to persist untreated, trigger points can cause a myriad of musculoskeletal pain and dysfunctions. It is important to relieve trigger points as soon as possible to restore nutrient flow to the muscle, prevent muscle imbalances and prevent compression on nerves. There are various methods to treat trigger points, however due to costs, time constraints or convenience, self-treatment is often the most practical and economical consideration. Utilizing the Backnobber, a trigger point self-treatment tool, is a good first-step to resolving trigger points.
STEP 4. Develop Good Flexibility. Chairside stretching will help you regain full range of motion and prepare you for strengthening. Overstretching muscles with active trigger points may cause micro-tearing of muscle, which is why stretching is recommended after trigger point treatment. Since dental professionals are prone to muscle imbalances, it is important to ensure you are targeting the correct muscles with your stretching. Rather than stretching muscles that are already elongated, focus on the muscles that tend to become short, tight and ischemic. Chairside stretching is an important strategy to perform throughout the workday to prevent microtrauma and muscle imbalances, especially for men, who are more prone to musculoskeletal injury due to poor flexibility than women. Stretching is especially important after prolonged static postures, and even more so if awkward positions were assumed.
STEP 5. Strengthen Specific Stabilizing Muscles. Studies show that dentists with better endurance of the back and shoulder girdle muscles have less musculoskeletal pain.
However, if you over-strengthen muscles with trigger points, your pain may worsen, which if why this is the 5th step in our sequence. Consider waiting till the area is pain-free to begin strengthening.
Because of their vulnerability to muscle imbalances, all strengthening exercise is not necessarily good exercise for dental professionals. Some of the worst pain problems I have seen resulted from a dental professional who followed a ‘generic’ exercise program designed by a personal trainer at their gym. The exercise needs of dental professionals are very specific, and while certain key muscle groups should be targeted, others should be very cautiously approached or eliminated altogether in an exercise regimen.
Numerous studies support endurance exercise over strength training for dental professionals. In dentistry, it is imperative to have proximal stability–when these postural “stabilizer” muscles become fatigued, not only can the operator slump into less than optimal posture, but the “mover” muscles are called upon to perform a stabilizing task for which they are not designed, (a.k.a., muscle substitution). Muscle imbalances can develop that cause painful trigger points and muscle spasms to develop in the inappropriately used muscle. Also, joints may not move normally due to the abnormal muscular tension, causing pre-mature degeneration of joint surfaces and inflammation of the muscles or tendons. Over time, weak postural stabilizing muscles in dental professionals may ultimately lead to a CTD.
Ensuring a pain-free career involves addressing numerous risk factors. Remember, that implementing only one risk factor (i.e. purchasing a new stool, seeing a physical therapist, or doing only chairside stretching) rarely resolves pain completely. Take the time to further educate yourself on each step of the above sequence utilizing the many resources on this website, and you’ll find yourself feeling less pain, more energy, less fatigued, and increasing your productivity!
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