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Dr. Bethany Valachi, PT, DPT, MS, CEAS is DPR’s ergonomics editor and author of the book,“Practice Dentistry Pain-Free” and clinical instructor of ergonomics at OHSU School of Dentistry in Portland, Ore. She is also the author of the evidence-based "Online Dental Ergonomic & Wellness System for Dental Professionals." A physical therapist who has worked exclusively with dental professionals for more than 15 years, she is recognized internationally as an expert in dental ergonomics, and has been invited to lecture at more than 300 conferences worldwide. She has published more than 50 articles in peer-reviewed dental journals and has developed patient positioning and exercise DVDs specifically for dental professionals. Bethany offers free newsletters, articles, videos and product reviews on her website at www.posturedontics.com and can be reached at email@example.com.
Neck pain is a common problem plaguing dental professionals, but taking these five steps can help.
Neck pain is the most prevalent musculoskeletal complaint among dentists. The interventions are numerous, and it can be a daunting task to figure out exactly where to start.
Try these five strategies to put yourself on the road to wellness.
1. Good declination angle
Since bending the neck forward greater than 20 degrees while working is significantly associated with neck pain, loupes with an excellent declination angle are your first and foremost ergonomic safeguard against neck pain. I have found only one style of loupe that consistently keeps all operators within this safe head posture. This style is a vertically adjustable flip-up loupe, which provides a very steep declination angle (Fig. 1).
When properly adjusted and positioned low in relation to the pupil, this loupe easily enables dentists to work with less than 20 degrees of neck flexion. Weight is no longer an issue with flip-ups, as there are ultra-lightweight flip-up loupes on the market today that rival the weight of through-the-lens loupes. For a list of recommended flip-up loupes, please visit www.posturedontics.com/equipment-recommendations.
2. Postural correction exercise
Rounded shoulders (slouching posture) can exacerbate neck pain. The position of the shoulders in this forward position places great strain on the trapezius muscle, which attaches to the cervical vertebrae. This exercise retrains the shoulder girdle muscles to develop healthy, neutral shoulder posture that will reduce neck strain. It can easily be performed chairside with gloves on (Figs. 2a, 2b and 2c).
3. Support the cervical curve
The natural curve of your neck is constantly pulled into a flattened position during the delivery of dental care. The loss of this curvature can result in a myriad of musculoskeletal problems, and to restore the cervical curve, you will likely need the help of a licensed healthcare practitioner. Therefore, it makes sense to do everything you can to prevent flattening by supporting and reinforcing your cervical curve.
Use of a neck support cushion at night will greatly aid in preserving your natural cervical curve. These come in a variety of shapes and sizes. Contoured memory foam pillows will support side-sleeping and back-sleeping postures, but discourage stomach sleeping, which is the worst position for the health of your neck. Another method to support the cervical curve is by inserting a round, cylindrical cervical roll into your pillowcase (Fig. 3). When considering pillow type, studies show that buckwheat hull pillows may be the best for chronic neck pain, while feather pillows should be discouraged.
4. Use arm support
Simply the weight of the arms hanging dependently at your sides can be enough to set off neck pain for some dentists. In consultations, I perform a test to determine if, indeed, armrests would be beneficial. Armrests also provide a constant reminder where neutral, relaxed shoulder posture is. This is helpful, since many dentists operate with their arms lifted away from their sides without realizing it. Many operator stools can be retrofitted with armrests. Contact your manufacturer to inquire if this may be a possibility.
5. Self-treat your trigger points
Studies show that the upper trapezius muscles are the most responsive muscles in the human body to emotional stress. Managing your stress response can prevent accumulation of tension in the upper trapezius muscles that results in neck pain.
You can also self-treat these painful trigger points yourself using a trigger point tool (Fig. 4). A treatment protocol that research shows to be most effective includes moist heat, trigger point treatment and stretching. For more information on this highly effective treatment technique, please visit http://bit.ly/TreatTriggerPoints.
Dr. Valachi’s doctorate research focused on neck pain in dental professionals. For information on the two most effective therapies to permanently resolve neck pain, please e-mail firstname.lastname@example.org.