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    Resolving upper back pain in dental professionals

    Solving the common problem of back pain in dentists requires identifying the correct cause first.

    Myofascial pain syndrome is a little recognized diagnosis, but one of the most common causes of upper back pain. After ruling out what would seem the least likely (but is actually one of the most common) cause of upper back pain — scalene trigger points — one can turn one’s attention to the more obvious players.

    These muscles are actually located in the same area as one feels pain: rhomboids, middle trapezius and lower trapezius. Symptoms of trigger points in these muscles include tightness, stiffness and ache in the shoulder blade or interscapular area. Pain is usually worst toward the end of the day. Sleep patterns can be disturbed, and bruxism is common. Of course, one should also rule out the non-musculoskeletal etiologies: gall bladder and pancreatic disease.

    Related article: How shoulder pain can cripple your dental career

    Recent research shows that these “stabilizing” muscles are hard-wired to your sympathetic nervous system, so they respond strongly to mental stress or anticipated stressful activities. When the fight or flight signal is received, they contract in anticipation of the life-threatening fight that (hopefully) never happens. The muscles are left in a contracted state and easily develop painful trigger points.

    Add to this the physical stresses on these muscles from the ongoing ergonomic challenges in the dental operatory, and you have the perfect storm for a vicious pain cycle: physical and mental strain from the job leading to muscles tensing, which leads to the development of trigger points, which leads to pain, which finally leads to mental stress! This is not your muscles being dysfunctional, but a normal physiologic response to stress whenever the muscle is sustained beyond its usefulness to a point of pain. Drs. Gerwin and Whyte Ferguson refer to this syndrome as SITS (sympathetic intrafusal tension syndrome) — a much more accurate descriptor than “chronic strain.”

    Rhomboid stretchRhomboid stretchThe medical approach to this syndrome is usually medicine (NSAIDS, anti-depressants, muscle relaxants) and rest. Unfortunately, this is often a band-aid approach since the underlying exacerbating factors are not being addressed.

    When incorporating interventions, remember the proper sequence for treating chronic pain. 

    Ergonomic interventions

    A common cause of lower trapezius trigger points is when the operator or assistant cannot get his or her knees under the patient chair and ends up leaning or bending forward over the length of his or her leg. If your knees cannot be positioned under the patient chair without lifting the arms out to the sides, operators should straddle or use runner-up or saddle-stool positioning to gain close proximity to the patient and preserve the best operating posture. Learning to control the occlusal plane to allow an upright posture is essential to a dentist’s career longevity.

    Continue to page 2 to see self-therapies...

    Dr. Bethany Valachi, PT, MS, CEAS
    Dr. Bethany Valachi, PT, DPT, MS, CEAS is DPR’s ergonomics editor and author of the book,“Practice Dentistry Pain-Free” and clinical ...


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