-Dr. Bethany Valachi-
Those who know me well may think I advocate a saddle stool because I am an equestrian! However the beneficial biomechanics behind a saddle stool in the operatory cannot be overlooked.
Saddle-style stools are becoming increasingly popular in dentistry—and for good reason. The benefits of this positioning are numerous, and research supports the positive impact on the musculoskeletal system. For those unfamiliar with saddle-style stools, they may seem unconventional, if not radical, compared to traditional flat operator stools. However, with the prevalence of back pain in dentistry unwavering over the past 50 years (around 65%), the recognition for new, alternative methods for sitting and preventing back pain are gaining increased recognition.
A saddle style stool promotes a neutral pelvic position, which supports the spine’s 3 natural curves in a balanced posture. The thighs slope steeply (45°) downward, so the seated position is halfway between sitting and standing (think ‘supported standing’). The resultant benefits to the musculoskeletal system and from an ergonomic standpoint when compared with conventional style seating are numerous.
- The stool places you in a ‘tripod’ position with the hips slightly flexed and abducted (spread apart), which is the most stabilize position for the hip joint.
- Dentists with short torsos who find they have to lift their arms to the sides when working, can easily lower the patient when seated on a saddle stool, allowing more relaxed neck and shoulder musculature.
- It is easier to maintain neutral spinal posture, since you are halfway between standing & sitting.
- It is easier to gain close proximity to the patient when the thighs are steeply sloping downward, which minimizes excessive forward reaching.
- Moving the stool is easier, since it utilizes the larger thigh muscles instead of the calf muscles.
- Since it places the pelvis in a neutral position, the lumbar curve is more easily maintained, minimizing the need for backrest support.
- When the lumbar curve is present, it facilitates a more neutral head posture. Conversely, when the lumbar curve flattens, the head moves forward!
- Its low profile makes the saddle stool ideal to access the 12:00 position in small, confined operatories.
Fig. 1 Left: a true saddle stool. Right: a hybrid saddle stool
Selection of saddle stools. There are 2 styles of saddle stools on the market that allow this optimal ergonomic positioning. A true saddle stool (left) and a saddle-style stool (right). One of these stools will be more appropriate for you than the other depending upon your lumbar curvature (hyperlordotic, hypolordotic or neutral) gender, lumbar disc health and height.
If you are considering a true saddle stool, select a saddle stool that is the right contour for your pelvis. A saddle that is too narrow for your pelvis can cause compression and be uncomfortable. Likewise, a saddle that is too wide for a smaller operator can cause uncomfortable splaying of the hips. Men should consider either a highly padded style saddle or a split seat saddle stool to decrease compression on the peritoneal area, or opt for the saddle-style stool to avoid compression altogether.
The hybrid saddle stool has a flat triangle-shaped seat that keeps the pelvis in a neutral position, while the thighs slope steeply downward. This is a nice option for dentists who want to avoid compression in the genital area, yet glean the benefits of saddle stool positioning. I believe backrests are beneficial on saddle stools when used in dentistry. However the backrest must be the correct shape and size to properly support the lumbar spine.
Adjustment of saddle stools. In general, operators should adjust the height of the saddle stool so thighs angle downward at about a 45 degree angle. The seat tilt adjustment will depend upon the lumbar curvature and disc health of the operator. For many operators, the saddle seat is best left in a flat position.
Dr. Bethany Valachi, PT, DPT, MS, CEAS
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