Fitness 101 for Dental Professionals: Secrets for Comfort and Career Longevity
What Causes Pain? There are usually many factors that lead to pain, rather than a single source. Poor flexibility and weak postural stabilizing muscles are common causes of pain. To work all day and maintain proper posture, we have to target specific muscles in the shoulder girdle and core. Mental stress can often manifest as muscular tension and cause neuro-muscular pain. Infrequent breaks, improper adjustment of equipment, and poor equipment can all cause problems.
The risk factor that causes the most trauma in dental professionalsâ€™ bodies is prolonged, static postures impacting the neck and shoulders as well as the upper and lower back. This is applicable to any bent forward position in or outside of the clinic. A study done by Kihara showed that two-thirds of work hours for a right-handed dentist are spent in these prolonged and awkward postures. This causes shorter and tighter muscles on one side of the back and longer, weaker muscles on the opposite side. After a period of time the spine is no longer held in neutral alignment, causing pain. Poor posture also causes disc degeneration. When standing there is 100% pressure on the lower discs, whereas sitting while leaning forward puts 275% pressure on those same discs.
Exercise as a Preventive Measure Ms. Valachi spoke of aerobic exercise, stretching and strengthening as the three important areas of fitness. Aerobic exercise uses oxygen to sustain a pulse rate for a prolonged period of time through rhythmic and regular joint movement. The goals are to improve the efficiency of your heart and lungs, develop functional capacity in the circulatory system, and most importantly for those of us in the dental field, to increase the blood flow to the working muscles, helping to heal microtrauma. Aerobic exercise alleviates muscular pain, prevents musculoskeletal dysfunction, improves circulation, healing and recovery time for the muscles, reduces stress, decreases risk of cardiovascular disease, increases longevity, and reduces body fat. The best aerobic exercise involves the upper trapezius muscle. This is a great way to stimulate that group of muscles and encourage blood flow to repair microtrauma without creating bulk. A common mistake, especially in men, is focusing on bench pressing to work this muscle, creating trigger points and additional pain. An ideal commitment to exercise would be four to five times a week for thirty minutes. Rapid walking while swinging the arms encourages cyclic muscular activation and may reduce low back
physical therapist, dental ergonomic consultant and author of the new book Practice Dentistry Pain-Free: Evidence Based Strategies to Prevent Pain and Extend Your Career, Bethany Valachi is the CEO of Posturdontics, a company that evaluates dental ergonomic products and provides researchbased dental ergonomic education. Ms. Valachi is also a clinical instructor of ergonomics at OSHU School of Dentistry in Portland, Oregon and has provided advice on dental ergonomics to numerous practicing clinicians and schools, including faculty training at NYU College of Dentistry. She is a member of the National Speakers Association and lectures nationally and internationally at dental meetings, schools, associations and study clubs. Additionally, Ms. Valachi is the ergonomic columnist for the journal Dental Economics, has published over 50 articles in dental journals, and has produced exercise videos specifically for dental professionals. Ms. Valachi began with a short story about her husband. During his second year of dental school, he experienced severe neck pain. He decided to take measures to improve his health and increase his career longevity by taking up bicycling. This actually worsened his neck pain. This is a common scenario for dental professionals because they are prone to muscle imbalances and microtrauma.
The Primary Risk Factor
Symposium 2009: Ms. Bethany Valachi
pain. Additionally, studies show that rapid walking reduces the risk of cardiovascular disease and may be even more beneficial than intense physical activity. Stretching is another activity that has numerous benefits. It reduces trigger point formation, provides nutrition to spinal discs and creates a relaxation response from the central nervous system. Stretching has also been proven to decrease pain and promote normal range of motion, thereby addressing muscle imbalances that may occur in the operatory. Stretching increases blood flow to the muscles. Many lengthy procedures require dental professionals to remain in awkward static positions for long periods of time, restricting blood flow. The longer muscles are without proper blood flow the more likely the rate of damage will exceed the body’s ability to repair itself. Ms. Valachi recommended chair side stretching as an activity to address microtraumas resulting from prolonged static postures. Strengthening is important for all dentists. The imbalance caused by holding the head forward and rounding the shoulders can cause the upper back muscles to weaken. If upper back muscles aren’t trained correctly they fatigue very easily, and other muscles are forced to take over, increasing upper back pain. The frontal neck and chest muscles can also become short, tight and painful. Some exercises that others find fun and easy can send dentists into a vicious pain cycle because of the positions they are in every day in the office. Strengthening exercises should be chosen not so much to increase actual strength but rather to increase the endurance of the muscles that support the spine.
Endurance training can prevent muscle fatigue. The two groups of muscles in the body are the postural muscles and the mover muscles. Postural muscles are closer to the spine, meant to contract for long periods of time and to stabilize the spine. The mover muscles are located further from the spine, and are made for movement, power and bursts of energy. Ms. Valachi recommends that dental professionals take part in an exercise program that is designed to improve endurance of the postural muscles. According to Lehto, lack of muscular strength is seldom a critical factor, even among female dentists.
While greater strength may protect against overstrain in occupations where greater external forces are frequently applied, it does not seem to protect against symptoms caused by static postural positions. Specifically, the endurance of the girdle muscles helps prevent and alleviate pain in the neck and shoulders. Endurance training targets the deep postural stabilizing muscles with high repetition using a low weight or resistance and little recovery time. Strength training targets more superficial muscles to develop power, accomplished by low repetitions and high resistance. Ms. Valachi stressed that we should never begin building endurance until we are pain free. Easy tools to use include exercise bands for shoulder muscles and a gravity resistant ball for trunk muscles. Exercise should not cause pain, although mild soreness that lingers for an hour is normal.
Exercises for Dental Professionals Ms. Valachi reviewed a few basic exercises that can be used as staples in the dental profession. The first is called the pointer dog. Begin on all fours, and stretch out the right leg while reaching forward with the left arm, returning to all fours, and proceeding with the opposite side (left leg, right arm). This stabilizes many muscles, including neck and shoulders, transverse abdominals and spinal muscles. There are a variety of abdominal strengthening exercises for both the obliques and transverse abs. Anything with rotation is working the obliques, and anytime you pull the naval to spine the transverse abdominals are engaged. The doorway stretch is useful to make sure the chest muscles are released to prevent thoracic outlet syndrome. Standing, place forearms on the frame of a door (like signaling a touchdown) and lean forward. It’s helpful to have someone make sure posture and form are correct when practicing these exercises. Ms. Valachi pointed out that there are real differences between a Certified Athletic Trainer and a Personal Trainer. A Certified Athletic Trainer must have completed a Bachelor’s degree, a three part exam, keep up with continuing education, and be certified by a national agency. Personal Trainers are not required to complete any college education or
continuing education and a certification exam may or may not be required. Surprisingly, there are exercises that can actually worsen a dental professional’s health. For example, Pilates is commonly considered, but there are a few things to keep in mind. Any exercise that involves lifting the head off of the mat, pushing or pulling overhead against resistance and the “superman” exercise is not healthy for dentists. Pilates certification is not regulated in the US, and there is no requirement for any background or education in health sciences to be a Pilates instructor so it is a good idea to talk to the instructor to gain an understanding of his or her background. As dental professionals, we need to be careful not to over-strengthen the pectoral muscles. This can set off a pain cycle through muscle imbalance. The over-strengthening of the deltoids is also dangerous because it can damage the rotator cuff. Ms. Valachi advises that we avoid strengthening the upper trapezius muscles “like the plague” due to the pain it can cause.
Controlling Pain Chronic pain is common among dentists. It’s a result of years of awkward posturing, and it can often take weeks or months of work to see improvement. Ms. Valachi shared six points that can prevent and control this pain. First is to use ergonomics in the operatory. Addressing the cause of the problem is much more effective than treating the symptom alone. Number two is to pick the right healthcare professional. In school the average M.D. has only four hours of education in therapeutic rehab and in many cases we are relying on these general practitioners to diagnose and manage our pain. The treatments implemented can affect overall health and career longevity. It is important to become an advocate for our own musculoskeletal health. Third is to resolve trigger points. These are hyperirritable spots in skeletal muscles that are associated with a hypersensitive, palpable nodule in a taut band of muscle fibers. These spots are painful on compression and can often cause referred pain and tenderness as well as motor dysfunction. Fourth is to stretch and improve range of motion.
Number five is to strengthen stabilizing muscles. This is second to last because strengthening muscles with trigger points will usually set off additional pain. Sixth is to practice patience. Recovery and strengthening takes time, but in the end the payoff of being pain free is enormous.
Trigger Points Trigger points are not recognized by western medicine today because they are not quantifiable, measurable or observable. Many times people experiencing painful trigger points go from doctor to doctor and specialist to specialist seeking comfort and are told that there is nothing that can be done. This is a common occurrence among dental professionals. The three primary risk factors for developing trigger points are asymmetrical postures, mental stress and muscle ischemia. Trigger points can develop anywhere in skeletal muscles. A knot in the muscle is made up of many little contractions in the muscle fibers, causing the trigger point. The most common trigger point in dental teams is the upper trapezius in the lower neck. It causes a very bizarre headache behind the eyes that ibuprofen usually doesn’t cure. Trigger point therapy comes in many different forms. A therapist can stretch out the muscle and use a fluoro-methane vapor spray, a certified muscular neuro-therapist can perform trigger point release, a very well trained doctor can inject the area, deep stroking or massage can help or trigger points can be self-treated. Frequent, sometimes even daily intervention is often necessary to release trigger points so self-treatment is often the best option. To treat a trigger point on your own a small ball or a “Backnobber®” can be used. Find the pain, relax the arms, and apply firm pressure to the spot for five seconds. Gently roll over the spot for another five seconds and repeat the cycle for one minute. Gently stretch the area and repeat this process three to five times a day or until the pain is minimized.
Conclusion In closing, Ms. Valachi shared one of her favorite quotes from Will Rogers who said “You can always be on the right track, but if you just sit there you’re going to get run over.”