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    Trigger points and low back pain in dentistry

    What are trigger points, and how can you avoid the pain they can cause?

    As a dental professional, you have probably already experienced trigger points, whether you know it or not!

    A trigger point is a group of muscle fibers that are in a constant state of contraction. It feels like a hard knot, and when pressed upon may be painful locally or refer pain to a distant part of the body. Trigger points may be active (painful) or latent (causing stiffness and restricting range of motion). Because they are caused by prolonged muscle contraction, postural asymmetry and mental stress, it is easy to see why trigger points are so common among dental professionals.

    Related article: 5 steps to a pain-free dental career

    If allowed to persist untreated, some trigger points can cause compression on nerves and contribute to syndromes such as thoracic outlet syndrome or pronator teres syndrome (a carpal tunnel-type pain). Trigger points are often the cause behind “mysterious” pain syndromes that elude Western medicine practitioners.

    The postural demands of delivering dental care predispose dental operators to trigger points in some muscles more than others. These muscles tend to become tight, short, weak and can refer pain to specific areas in the body. One of these muscles that is especially problematic in dentistry is the iliopsoas muscle. Trigger points that develop here can lead to low back pain and also pain in the upper buttocks and anterior thigh.

    Fig. 1Fig. 1The iliopsoas (pronounced ilio-so´-az) muscle is constantly activated when sitting actively (not resting on a backrest) in dentistry, which is a majority of the time for most operators. Located very deep on the front of the hip, this muscle functions to flex the hip, abduct the thigh outward and laterally rotate the leg, as is often seen among operators who “straddle” the patient chair in operatories. Iliopsoas trigger points are especially aggravated by prolonged sitting with the hips acutely flexed — 90 degrees or more (i.e., on a non-tilting seat pan).

    Trigger point pain in this muscle is referred to the low back (Fig. 1) and sometimes the upper buttocks and anterior thigh. Pain is also common when walking and relieved when lying down and flexing the hip. Trigger points in this muscle can cause improper posture, which aggravates other muscles, leading to trigger point development in them. 

    Identifying tightness in the hip flexor muscle requires a special test (the “Thomas Test”), performed by a physical therapist or similar healthcare practitioner. There would be palpable tightness and pain in the muscle as well. The quadratus lumborum muscle should also be assessed for involvement, as these two muscles are often partners in crime. Effective treatment of trigger points is essential and should be performed by a healthcare practitioner trained in trigger point therapy or having a CNMT (certified neuromuscular therapist) designation. 

    Up next: How to prevent trigger points

    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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