Prevention of Musculoskeletal Disorders
“How much longer will I be able to practice?”
Does pain from your neck, back, shoulder, or arm cause you concern for the viability of your career? Do numbness and tingling in your hands limit your dexterity and professional skills? You are not the only one! Eighty percent of dental clinicians suffer from pain associated with musculoskeletal disorders caused by their work, according to research. By their senior year, 70% of dental students suffer from the same conditions. The pain alone is difficult, but these health issues can have a much greater impact. They can negatively affect the longevity of a career, financial health, and the overall quality of life. Research also shows that dentists have the earliest retirement age of any doctor. They retire 29.5% earlier than desired.
THE PROBLEM
Throughout the years that I have worked with dental professionals, it has become apparent to me that specific repetitive movement patterns were very common and universal. These repetitive movement patterns, if ignored, can cause cumulative physiological damage that can lead to a career-ending injury. This is very similar to what can happen with a professional athlete. Rigorous physical strains and repetitive movements lead to muscle imbalances, postural dysfunction, and compensatory movement patterns. Overused muscles fatigue, while underused muscles fail to properly support the spine and extremities. Sitting in the same position for extended periods of time, and moving into and out of the same position in the same manner, creates asymmetries and imbalances. These often lead to developmental spinal scoliosis, vertical axis misalignment (inability to find and stay in center), shoulder elevation syndrome, and pelvic obliquity. If muscle imbalances and compensatory movement patterns already exist, general exercise programs can be detrimental, tending to reinforce imbalances and faulty movement patterning. Without focused and specific movement re-education, strong and overused muscles and systems are further strengthened while neglected muscles remain weak. Movements are inefficient and energy requirements increase. Not only is the impact felt in the work environment, but then pain and fatigue often limit one’s ability to pursue recreational interests and quality free time. These are the patterns and complaints I continued to encounter in my rehabilitation practice. Certain techniques that I developed started to address these conditions and decrease pain, dramatically improving quality of life for dental professionals.
THE SOLUTION
First and foremost, clinicians must become aware of the postures and positions into which they are placing themselves on a daily basis. Pain is not just an unavoidable consequence of either the aging process or being a dental professional. Biomechanical re-education must be introduced, taking into consideration occupational, recreational, and daily activities. Oppositional movement patterns must be created to counteract imbalances and repetitive positions.
One common example of the need for oppositional movement is the dental professional who routinely sits in the operatory with legs abducted and externally rotated. Muscular tightness on one side of the hip develops, paired with long and weak muscles on the opposite side. Uneven joint loading can lead to early onset of hip degeneration. The hip joint exerts a large influence on the pelvis and spine as well as the ability to maintain body symmetry. This same professional might then go to the golf course or tennis court on a day off. Both sports require internal rotation range of motion in the hip for optimal performance and injury prevention. Without proper hip rotation, other areas will attempt to compensate. A painful spine or hip may be attributed to the game, but the cause may be much broader and needs to be addressed in all environments. Once aware of this issue, the dental professional can utilize a movement into internal rotation and adduction. Introduced at an appropriate frequency, this can begin to create balance and range of motion in any environment and for any activity.
To reduce pain and provide optimal function, the spine must move in segmentation, muscles must be recruited properly, and correct breathing patterns must exist. Proper spinal segmental mobility is crucial for reducing back pain and stiffness. The segmental design of the spine serves to absorb shock and distribute forces, both gravity and ground reaction. Imbalances in movement lead to hypermobility of segments paired with adjacent hypomobility. This causes shearing forces and uneven load on intervertebral discs. I commonly see losses of lumbar flexion and thoracic extension. Without proper thoracic extension, the cervical spine compensates with an increasing lordosis, compressing the tissues, nerves, and discs. Compression causes pain. Segmental spinal mobility needs to be restored for efficiency of movement and pain relief. The Body Praxis program has developed specific movements to properly restore segmental mobility of the spine. Once learned properly, the dental professional can perform these movements in the home or office to restore and maintain optimal mobility of the spine.
Sitting: Active Versus Static
One contributing factor to pelvic and low back pain is the rigid and static nature of a traditional dental stool, resulting in sustained mechanical tissue loading and restrictive posture. The prolonged postural loading of the spine, while sitting without natural movement or mobilization of the spine, can increase pain and stiffness. Inhibition of the deep core musculature is paired with overuse of superficial hip and back muscles, leading to fatigue and pain. In contrast, an active sitting system allows equal resistance in 360° of movement. Forward spine flexion and pelvic rotation are minimized in work postures. Natural movement and spine mobilization, not forced, fixed rotation, are allowed as you work and address the patient. Deep core, postural muscles (the marathon runners of the body) engage and support the body as intended. This eliminates overuse of superficial musculature (the body’s sprinters) so that they can be engaged when they are needed, without strain or fatigue. This improves posture, core stability, and circulation. One such stool is the DynaCor 9400 Dynamic Seating System (Brewer Company). The Body Praxis program incorporates seated exercises on a stability ball to increase pelvic mobility and realignment, lumbar spine mobility, postural awareness, and core strength.
CLOSING COMMENTS
I have worked with many dental professionals during the last 20 years. They say, “I don’t know how much longer I will be able to practice.” They have invested an enormous amount of time, money, and education into their careers. Unfortunately, the demands of the profession have taken a toll, and they practice in pain. This led me to design the Body Praxis dental ergonomic program. I have found that most dental professionals continue to practice in pain despite other interventions. This is because they are unaware of the true causes of pain and that a solution even exists. A vital component to restoring function and alleviating pain, which other interventions lack, is an awareness and understanding of the process that created the conditions as well as the steps that can be taken that can lead to a return to health. It is not only about what you do in the operatory, but how you want to live the rest of your life!
Mr. Williamson, a personal trainer and nationally recognized Pilates practitioner, developed the Body Praxis system after successfully rehabilitating numerous dentists from the pain associated with musculoskeletal disorders. He has been involved in the fitness and rehabilitation industry for more than 25 years. An active member of the American College of Sports Medicine and the Pilates Method Alliance (PMA), he is certified by the American Council on Exercise and Senior Fitness Association. A PMA-certified Pilates rehabilitation practitioner and teacher, he trained at the University of Miami and Long Island University. He earned a bachelor of science in biomechanics from the Alternative Medicines Research Institute (Canada). He has served on the board of the Alternative Therapies at the Erie County Medical Center and was a steering committee member of the 50-Plus Fitness Campaign at Degraff Memorial Hospital. He was a guest speaker at the First Alternative and Complimentary Therapies conference held at the State University of New York at Buffalo and is a regular speaker at the Buffalo Mitochondrial Disease Foundation. He is the owner of Body Praxis, which offers an exclusive structural redevelopment and wellness program to address the serious musculoskeletal disorders that affect many dental team members. He can be reached at (716) 639-0200 or via the website bodypraxis.com.
Disclosure: Mr. Williamson is a consultant to Brewer Company. He receives compensation for travel but did not receive compensation for writing this article. Mr. Williamson is the owner of Body Praxis, Ltd.
