Protect Your Moneymaker! by Katrina Klein

Certain stretches and exercises can help strengthen the muscles you need most as a dental professional

by Katrina Klein, RDH, CEAS, CPT

As professionals working in a dental office, we know all about pain: pain in the neck, pain in the lower back, in the hips, shoulders, wrists, hands … the list goes on. We knew about the consequences of “tech neck” before there were technical devices to crane our necks over! Most dental professionals are dedicated people who want to help others—even at the cost of their own health, it turns out.

Musculoskeletal disorders are the accumulation of microtraumas experienced on cellular levels that, over time, result in injury of connective tissues and everything they support.1 They manifest themselves through nerve impingement, skeletal deformation and degradation, muscle atrophy and, of course, pain. They’re sneaky, peeping Tom career-enders that come on gradually until one day we find ourselves stretched out on a surgical table—the types of injuries that can result in costly workers’ compensation claims. Thirty percent of all dental workers’ compensation injuries involve issues with the musculoskeletal system and connective tissue.2 That number represents an alarming number of injuries—not just the ones that result in surgeries but also the vast majority that never get reported, are suffered through and ultimately end careers. They must be stopped.

Ultimately, prevention is up to the operator. We need to learn and, more importantly, use proper ergonomics and prevention techniques when practicing dentistry. We need to invest in ourselves and those we employ for the betterment of career longevity, pain-free practicing and improved patient care (not to mention the blissful side effect of overall increased productivity).

It all starts with prevention
Prevention comes in many forms, but at the end of the day, it’s all focused on avoiding what OSHA deems the “5 Big Risk Factors”3:

• Awkward posture
• Force
• Repetition
• Contact stress
• Vibration

The practice of chairside dentistry (dentist, hygienist or assistant) employs all of these risk factors on a daily basis. There are preventive measures that can be taken long before a patient ever sits in the chair—using ergonomic equipment such as thick-handled instruments, ultrasonic scalers, saddle stools, ergonomically designed operatories, loupes and headlights; and taking frequent and encouraged stretch breaks, to name a few.

What happens once we get chairside has as much of a bearing on how we feel at the end of the day as the equipment we use. Maneuvering the patient position to our needs, keeping both feet on the floor and sitting upright are a few ways to actively practice sound ergonomics to prevent MSDs.

There is another form of prevention that has been long overlooked when preparing to practice dentistry as a career. That prevention comes in the form of taking care of the instrument that we use day in day out and depend on to be reliable every day: our bodies. The musculoskeletal system that we demand athletic performance from for eight-plus hours a day.

We can help prevent much of the injury and subsequent pain experienced by dental practitioners by preparing our bodies, and thus protecting them, with the strength they need for our demands. Would we administer anesthetic without making sure we had a handpiece or scalers to perform the scheduled treatment? No. Preparation starts long before we walk into the office. It starts with what we did out of the office to prepare ourselves for the work at hand.

Stretch and Strengthen
Just as there are fairly predictable areas that are prone to injury when practicing, there are also specific areas that need specific stretching and strengthening to combat muscle fatigue and injury.4 The lower back, for example, is the most complained-about pain, followed closely by the neck and shoulders. Muscles kept in chronically static, awkward positions consequently develop dysfunctional neuromuscular patterns that create a cascade of problems throughout the body.

Specific stretches and strength training exercises can and should be done to create the strong foundation that we need. Stretching the chest, the front of the shoulders and the hip flexors along with foam rolling daily can be a major source of relief. Here’s how to start.

The muscles: Consider the anatomy of the chest and shoulders. The origins of these muscles are on the sternum, ribs and clavicle and insert into the humerus and scapula (arm/shoulder). When upper body posture is hunched over or forward, as is often the case in dentistry, these muscles become shortened and tight. They need frequent stretching to avoid musculoskeletal changes that manifest (visually) as rolled shoulders or hunchback, and can lead to nerve impingement, constricted circulation, muscle atrophy and dysfunction.

The movement: One easy way to stretch them is to find a corner and walk into it, as demonstrated in Figs. 1 and 2. A corner allows the muscles to get into optimal position (outside of neutral) to obtain a stretch. The key to this stretch is to try to stretch the chest or shoulder muscles for 45–60 seconds, while maintaining scapular retraction and depression during the stretch. A stretch should be only to the point of discomfort, not pain!

The muscles: Another muscle that is chronically tight and shortened during dentistry, because of all the leaning in, is the psoas, or hip flexor, complex. The psoas originates at the base of thoracic and the lumbar vertebrae, travels in front of the hip and inserts into the medial part of the top of the femur. It essentially connects the back bones to the leg bones (as the kindergarten song goes) and primarily functions to flex the hip, like a hinge, bringing the legs toward the body. When sitting is a primary position during the day—chairside, at a desk or even driving—the psoas shortens and becomes tight as it pulls the lumbar spine inward. This is why our lower backs hurt after a long day.

The movement: Stretching the psoas not only helps to release muscle tension but also feels really good! Stretching the psoas is as simple as hingeing in the opposite direction. This can done by bending backward while pushing the hips forward with the hands—or, to achieve a deeper stretch, lie on the ground and stretch as demonstrated in Fig. 3.

I love analogies, so another way to think of it is that stretching is equivalent to brushing in respect that it feels good, we see fairly immediate results and it treats the problem. Resistance training is like fluoride because it functions to prevent trouble but doesn’t necessarily feel great. (No one likes that sticky, waxy film, just like not everyone likes the “burn” at the gym.) We need both the treatment and the prevention, in addition to the other factors that play into injury prevention in the dental workplace.

The muscles: When it comes to resistance training, dental professionals want to focus on strengthening posture muscles. The midback, shoulders, glutes and core all build muscle for support, and are the key to building a balanced foundation of good posture for most dental professionals.

The movement: One exercise that should be part of every dental professional’s workout is rows. Rows focus on strengthening the lower trapezius, rhomboid major and latissimus dorsi muscles, which are our major weaknesses because they’re constantly being lengthened and overused. The more we build these specific muscles, the better we can sit upright in proper neutral spine and prevent injury. Seated rows are a great example, as demonstrated in Figs. 4a and 4b.

To get the most out of this movement:

• Keep an arch in the thoracic spine (midback at the base of the shoulder).
• Pull the weight toward the belly button.
• Use controlled movements—don’t rock or use momentum.
• Retract and depress the scapula throughout the movement—shoulder blades back and down.

Conclusion
Ergonomics is probably the most undervalued part of our training and the most underutilized part of our everyday work. Yet using sound ergonomic practices can yield insurmountable results in both comfort and productivity. Ergonomics assessments can be done to evaluate how you practice. A set of trained eyes can be the difference between working in pain and not. There are answers. There are strategies. There are solutions!

At the end of the day, we are prevention experts. We live, eat and breathe prevention, and it’s time we look inward and protect our most valuable asset, because a healthy, pain-free body leads to a full and active life after dentistry.

References
1. U.S. Department of Labor Occupational Safety and Health Administration,
https://www.osha.gov/SLTC/ergonomics
2. Disability Statistics for Dentists: https://ddsdi.com/disability-statistics
3. Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health: https://www.cdc.gov/niosh/topics/ergonomics/ergoprimer/step1.html
4. Harvard Health Publishing, Harvard Medical School:
https://www.health.harvard.edu/staying-healthy/the-importance-of-stretching