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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 firstname.lastname@example.org.
The exercises that work for the average person can be damaging to a dental professional’s health - but do you know which ones are dangerous?
As I have discussed in previous articles, dental professionals are prone to unique muscle imbalances and require corrective exercise to prevent pain and injury and ensure a long career. Certain exercises that aren’t a problem for the general public can throw dentists into the ‘vicious pain cycle.’
The research on exercise is constantly evolving. Let’s take a look at some interesting exercise facts that dentists may want to consider when selecting an exercise program.
A Swiss exercise ball is an effective exercise aid that decreases pain
Studies show that exercises performed on the Swiss ball elicit more muscle activity than when performed on a stable surface (Duncan 2009). Also, the exercise ball has been shown to be a very effective tool in rehabilitating low back pain (Marshall 2006). What’s more, the exercise ball is an inexpensive and easy way to perform effective workouts in the comfort of your own home.
Stretching improves strength
Believe it or not, it’s true - static stretching leads to better strength and endurance, which improves specific exercise performance, per a Louisiana State University study. Of course, stretching won’t take the place of resistance training or aerobics, but it does show benefits on a much smaller scale (Kokkonen, Nelson 2007). Having said that, whether performed before, during or after vigorous exercise, stretching does not appear to reduce post exercise soreness (Herbert, Noronha, et al. 2011).
Crossfit and injuries
Surprisingly, the rate of injuries in Crossfit is comparable to Olympic weightlifting, distance running, track and field, rugby or gymnastics (Meyer 2017; Montalvo 2017). In other words, this is not an appropriate exercise regimen for beginners!
For dentists who are prone to imbalances, several exercises must be removed for safety, including the deadlift, which is a ballistic move and requires a great deal of core stability and correct technique to be performed safely.
Pilates and low-back pain
A study of patients with chronic low-back pain found that the Pilates program did not improve functionality or pain levels any better than traditional lumbar stabilization exercises (Pereira, Obara 2011). In fact, many Pilates moves can actually worsen existing muscle imbalances in dental professionals, including lifting the head off the floor for long periods of time and reaching overhead to push/pull.
Exercise can prevent back and neck pain
In a study evaluating different preventive interventions for back and neck pain, (including ergonomics, lumbar supports, exercise and education), only specific exercises provided enough evidence to conclude that they are an effective preventive intervention (Linton, vanTulder 2001). Stabilizing exercises focused on improved muscular endurance is particularly protective against low back pain (McGill 2002).
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Tight hamstrings can flatten your back
In seated occupations such as dentistry, where you sit with the knees in a flexed position, tight hamstrings can actually flatten or reverse your low-back curvature. What can you do? Stretch your hamstrings - both chairside and at home (Stokes, Abery 1980).
• Extend one leg until knee is straight.
• Keep back straight and lift chest up.
• Pivot forward from the hips until you feel a stretch at the back of your thigh.
• Hold for 30-40 seconds.
Sit-ups may be damaging
Full sit-ups were a cornerstone of fitness regimens for decades in the 1960s-1980s. Luckily, the healthcare system ‘woke up’ and realized this prescription may be damaging the backs of many people - not improving their health. You are actually strengthening the hip flexor muscles during the last half of this exercise.
A healthier alternative is a partial crunch, where only the shoulder blades (or one shoulder blade) are lifted off the floor and briefly held. This produces plenty of resistance for the abdominal muscles without creating strain on the low back (McGill 2002).
Elastic band or dumbbells?
I’m often asked by male dentists if dumbbells give them a better workout than elastic bands. The answer is a resounding no. In fact, the muscle activation obtained by both are comparable (Andersen, Andersen 2010). So, feel free to mix it up for variety if you’d like. You should, however, progress from lighter resistance bands (yellow) to higher resistance bands (red) when the exercise feels too easy.
For more ways to balance your musculoskeletal health, check out Dr. Valachi's Home Exercise for Dental Professionals exercise program. Use code OTB2018 to receive a discount. Learn more here: http://bit.ly/HomeExerciseDentists.
Duncan M.Muscle activity of the upper and lower rectus abdominis during exercises performed on and off a Swiss ball. J Bodyw Mov Ther 2009;13(4):364-7.
Marshall PW, Murphy BA. Evaluation of functional and neuromuscular changes after exercise rehabilitation for low back pain using a Swiss ball: a pilot study. J Manipulative Physiol Ther. 2006;29(7):550-60.
Kokkonen J, Nelson AG, Eldredge C, Winchester JB. Chronic static stretching improves exercise performance.
Med Sci Sports Exerc. 2007;39(10):1825-31.
Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise.
Cochrane Database Syst Rev. 2011 Jul 6;(7).
Meyer J, Morrison J, Zuniga J. The Benefits and Risks of CrossFit: A Systematic Review. Workplace Health Saf. 2017 Mar 1.
Montalvo AM, Shaefer H, Rodriguez B, Li T, Epnere K, Myer GD. Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit. Journal of Sports Science and Medicine 2017;16:53-59.
Pereira LM, Obara K, Dias JM, Menacho MO, Guariglia DA, Schiavoni D, Pereira HM, Cardoso JR. Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: systematic review and meta-analysis. Clin Rehabil. 2012;26(1):10-20.
Linton S, van Tulder M. Preventive interventions for back and neck pain problems: what is the evidence? Spine 2001;26(7):778-87.
McGill S. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Human Kinetics, Champaign, IL. 2002.
Stokes I, Abery J. Influence of the hamstring muscles on lumbar spine curvature in sitting. Spine 1980:5(6):525-8.
Andersen L, Andersen C, Mortensen O, et al. Muscle activation and perceived loading during rehabilitation exercises: comparison of dumbbells and elastic resistance. Physical Therapy 2010; 90(4):538-50.