In dentistry, we know that the mouth isn’t just a one tooth job. We don’t see a broken molar, stick a filling in and call it a day. We place the restoration, incorporate anatomy and check the occlusion. Why? Balance is essential to the mouth. A high or unbalanced restoration can lead to a variety of other problems including the possibility of tooth loss if not handled. The mouth is no different than the body when it comes to balance.
Remember that song in grammar school… “the knee bone’s connected to the thigh bone, the thigh bone’s connected to the hip bone…” and so on? Funny thing, it’s TRUE!! Everything in the body is connected in a delicate balancing act and when something is thrown off, the rest of the body compensates to make things work. The problem we face is that balance being thrown off early, often and for long periods of time. It’s the reason why one in four dental professionals collect disability benefits long before the age of retirement (https://www.insurance.ada.org/ada-insurance-plans/disability-insurance.aspx).
Here’s how it works. We start by sitting the patient back/down too far and our chair too high. We just want to see INTO the mouth for pete sake!?! Then we bend over at the hip, crane our head to the side and down, raise one arm up and over to get into the mouth. Once inside, we hold it there while we work in pretty much that same position for anywhere between 20 min to an hour or more. We stand, roll our head back, pull the shoulders back and press our hands on the lower back and try to push it back the way it all was when we woke up. We get 2 minutes of blissful relief and start it all over on the next patient. Sound about right? This cascade of a biomechanical nightmare is why we hurt at the end of the day.
The nightmare begins before you even walked into the office. It started by not providing a solid foundation upon which the body was capable of drawing the strength necessary to do the job in the first place. Dentistry is a labor intensive job of small, repetitive movements under forced control. It takes great strength to do this and not create microtraumas at the cellular level that, with time, turn into outwardly identifiable pain.
Good working posture is created with A) intention and mindfulness of working practices and B) musculature to support the body including the hips, spine, shoulders and neck. Let’s go back to that song… Starting from the ground up, the quads, hamstrings and glutes support posture by relieving the low back muscles in the task of holding the lumbar spine in neutral position. The psoas muscles are often shortened, which act to pull the lower spine forward so stretching the psoas/hip flexors is very important in relieving lower back pain. Next, the spine is more supported by the core (abs) than anything else. That doesn’t mean do a thousand sit-ups a day. It means developing a strong core in a variety of exercises that work all 4 sets of abdominal muscles. It also means reducing the pull moving outward against your center of gravity (eh hem) will greatly effect your back pain. A strong back and shoulder girdle are two areas that are vital to a pain free career in dentistry. Keep them strong to help to fight the hunchback effect we see in so many dental professionals. Last, but not least is the neck. That poor thing is used and abused day long, take a minute to strengthen and stretch it. Luckily, the movements used are done simultaneously!
What it looks like when we employ a strong body that is properly and regularly stretched with sound ergonomic practices and strategies is feet flat on the floor, thighs at about 110*, back upright, shoulders relaxed with elbows in at the sides and head tilted no more than 10* forward. That clinician goes home feeling good because the muscles required to maintain good posture are working in a balanced fashion.
Workplace pain is almost never singular in causality because it stems from a vast potential of sources. Ergonomic practices and strategies, strength training, stretching and foam rolling all play a profound role in posture and a pain free dental career. They all work together to perform the delicate balancing act of developing a solid foundation used for providing patients with the care they need and the clinician with a body they can retire from and still enjoy!
Katrina Klein RDH, CPT, CEAS