Back Pain Relief for Dentists
Article by Mike Patellie, MS, PT, CEAS
Many dentists experience neck and back pain while working. Since dentists often find themselves stretched forward in prolonged positions, with arms outstretched, it is easy to understand why this happens. To help with posture related body problems that are associated with incorrect working postures, dentists are encouraged to use external lighting source, dental magnification loupes and ergonomic chairs with arm support. Dental magnification loupes (flip-up and TTL loupes), LED headlamps and properly designed dental chairs can considerably relax the back and neck muscles, improve ergonomics, increase much needed productive work hours. In addition, a proper stretching routine and regular exercise must also be incorporated into the dentist’s day. Healthy ergonomic habits will inhibit years of chronic and acute neck and back pain.
In the most common hunched over position, the anterior neck, chest and hip muscles become shortened and tight, essentially freezing the body in a flexed position with the muscles working in reduced capacities.
Poor working posture without dental loupes. Pelvis is twisted, anterior neck muscles shortened leading to neck and back injury.
Such body posture is common for dentists working without dental loupes or without adequate illumination.
The pelvis is also commonly twisted. Since the pelvis is the foundation of the spine, it forces the spine to over-compensate with drastic curves from the neck down to the lower back in order to correct the head’s position. If the pelvis begins to tilt forward, in part due to shortened or tight hip flexors and quadriceps, the curvature of the lower back is increased and the abdomen may begin to protrude.
Being able to perform self-myofascial release (SMR) using limited exercise equipment can assist with releasing muscle tension and aiding muscles in returning to their normal length. The exercises set forth below can help decrease lower back pain and increase core stability.
Myofascial release has been used for many years by practitioners to loosen soft tissues and increase one’s range of motion and flexibility, which then decreases pain and stiffness.
Imagine a dentist sitting in a chair in the same position for most of the day. His or her hips are at a 90-degree hip flexion, the trunk may be twisted or bent with the head leaning forward to see inside the oral cavity. If a dentist stays in this position for an extended period, muscles begin to shorten and tighten, leading to muscle weakness and pain. The longer the dentist goes without addressing the root problem of the pain, the more severe the ache becomes.
It is common for dentists to experience pain in localized areas, such as a “stiff neck”. This is also why some attempts to alleviate pain only where it is felt and underestimating the problem. The root of the problem, however, may lie in a group of muscles in the back, chest or hips that are foreshortened and overly tightened. Massaging your neck muscles may alleviate the pain temporarily, but will not result in a lasting fix, and before long the dentist is again experiencing the same symptoms.
The benefits of the following stretches and exercises are that they require very little extra equipment, can be done in small rooms (such as an office or at home) and, lastly, do not require an extensive time commitment. In fact, it is often better to break up the routines throughout the day instead of performing them all at once.
A simple 20-minute self-myofascial release and stretching routine, performed daily, is all that is needed to lengthen muscles that have been shortened due to a static working position. Adhering to this routine will decrease one’s pain and increase one’s range of motion and levels of muscle function.
These stretches work particularly well because they incorporate the dentist’s own body weight, and when performed on a foam roller or medicine ball, the muscles and tendons are stretched while applying pressure to an inflammation (or trigger point). Typically, pain is decreased in the sore spot within 30 seconds. As this routine is repeated over several weeks, those sore spots usually disappear altogether.
Daily Stretches
The Door Stretch: This simple stretch should be performed two to three times per day. Stand in a doorway with one arm raised out to the side at 90 degrees. Put the forearm on the back of the door’s jamb with the palm faced forward. Draw in at the belly and smoothly bring the same side leg forward until a slight stretch is felt in the chest and shoulder. Always keep your shoulders even and hold the stretch for 30 seconds. Now repeat with the other arm.
Scapular/Thoracic Stretch: Performed once or twice daily, lie on the floor with a foam roller behind the shoulder blades at a right angle to the length of your body. Cross your hands behind your head and place your feet flat on the ground, with knees bent. Now raise your hips off the floor and slowly roll the foam roller to the middle of your back. You can position the foam roller over any tender spots for 30 seconds.
Stability Ball Stretches/Exercises
Stretching
The Stability Stretch: Sit on a stability ball and slowly walk your feet forward. Now lie back on the ball, draping your body over the ball and extend your arms out to the side, allowing gravity to pull your arms down. Move your arms over the head. Hold for 30 to 45 seconds.
Bridging
Bridging: Lean back on the stability ball with your arms out straight in front and palms facing out. Draw in the abdomen and lift your trunk up slowly so that your arms and shoulders are parallel to the floor. Your body should be straight between your knees and shoulders. Squeeze your buttocks together and contract your abdomen, holding for three seconds and then slowly lower yourself back to the floor. Repeat 12 to 15 times.
lowering hips
Lowering Hips while Bridging: While sitting on the stability ball, walk your feet forward and lay back on the ball. Your head and shoulders should rest on the ball with the neck in a neutral position. Lower your hips slowly, pointing the tailbone toward the ball. Now lift the hips upwards toward the ceiling. The chest should also be lifted, with the shoulders, hips and knees forming a straight line. Hold for three seconds. Do not move your legs in or out. Keep the ball still. Repeat 12 to 15 times.
Scapular Retraction/Protraction: Lying on your back while draping your body over the stability ball, reach your arms toward the ceiling with palms facing in until your shoulder blades come off the ball. Keeping your arms straight, retract your shoulders toward the ball and pinch both shoulder blades together. Hold for three seconds. Repeat two sets of 10-12 repetitions.
Self-Myofascial Release
The following exercises and stretches can be done any time during the day or at home. For best results, break them up over the course of the day.
Pectoralis Muscles
Pectoralis Major and Minor: Place a medicine ball under your feet and lean on your arms. Roll the ball up and down, side to side, until you find the sore spot. Hold the position on the sore spot until tension is released (roughly 30 seconds). Repeat on other side.
Quadriceps: Lie prone on the floor with a foam roller on your thighs. Roll your legs up to the hips slowly and then back down to your knees. You can use your feet or upper body for support. Hold roller on any sore spots for 30 seconds.
Illiotibial Band: Lie on your side with the foam roller under your thigh. Keeping the bottom leg off the floor, roll from the hip to the knee on the lateral side of your thigh. Hold on any sore spots for 30 seconds. This exercise may be uncomfortable at first, so do it slowly. If you need assistance, bend the top leg and place the foot on the floor to decrease pressure on the illiotibial band.
latissimus dorsi
Latissimus Dorsi: Stand on the floor with your arms up above the head using a medicine ball. Move the ball up and down in front of you until you find a sore spot. Hold for 30 seconds. Repeat on the other side.
Tensor Fascia Latae: Lie with the foam roller under both thighs. Now place the foam roller just lateral to the anterior pelvic bone, halfway between where you had it for the quadriceps and illiotibial band exercises. Slowly roll the foam roller until you find a sore spot. Hold for 30 seconds. Repeat on the other side.
Illiopsoas: With a small medicine ball on the wall, lean into it while placing it on the anterior hip. Roll the ball in small circles until you find your sore spot. Hold for 30 seconds. Repeat on the other side.
Piriformis: Sit on a medicine ball with your arms placed just behind you, supporting some of your weight. Now cross the foot of one leg over the opposite knee and slowly roll on the posterior aspect of the crossed leg’s hip. Find your sore spot and hold for 30 seconds. Repeat on the other side.
Piriformis
These stretches and exercises are meant to be done daily. You may broke them up throughout the day. With a minimal investment of time, they can have a significant impact on your health and lead to a more pain-free practice.
*It is highly recommended that all individuals consult with a physician prior to beginning any active routine. All dental professionals should invest into quality dental loupes and headlights, either LED or fiber optic, to prevent or minimize body harm. Numerous studies indicate a consensus among leading professionals that dental and surgical loupes improve ergonomics.