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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.
It’s no wonder that three out of four dentists and hygienists complain of neck pain. EMG studies show that the upper trapezius muscle is the most active muscle during the delivery of dental care, which can lead to the development of a painful condition called trapezius myalgia.
Symptoms include pain, spasms or tenderness in the upper trapezius muscle, most commonly in the non-dominant (mirror or retracting) arm.Trigger points in this muscle result in referred headaches behind the eye, into the temple and in back of the neck.
The upper trapezius muscles are responsible for elevating the shoulders and rotating the neck. Reaching forward in the operatory increases strain on the upper trapezius and neck muscles, which largely support the arm’s weight. In dentistry, trapezius myalgia is caused by static, prolonged elevation of the shoulders, mental stress, infrequent breaks, improper exercise and poor head posture.
Correct patient height. Position the height of the patient so your forearms are sloping only 10 degrees or so upward. Positioning higher than this often leads to shoulder elevation, especially when working between the eight and 11 o’clock positions. Also,
working with the shoulders on a tilted axis or the head turned to one side can also lead to worsening of upper trapezius pain. Operators with short torsos may find that when they position their knees under the patient head or backrest, they have to elevate their shoulders when working. This problem is best resolved with a saddle stool, which allows lower patient positioning.
Use ergonomic loupes. Excessive forward head posture is commonly observed in the operatory and strains the upper trapezius muscles. Loupes with a poor declination angle forces the operator to assume a forward head posture greater than 20 degrees-a posture that has been associated with neck pain. Vertically adjustable flip-up loupes will allow the most neutral, upright working postures
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Utilize armrests. Supporting the arm weight is especially important for trapezius myalgia sufferers. If you find it difficult to maneuver a chair with armrests around the patient, you may want to consider a unilateral armrest fixed to a counter. Dentists who operate with the left arm supported have been shown to have less pain than those who do not. These devices are available in a variety of heights and are especially useful since dentists and hygienists typically experience more pain in the non-dominant neck and shoulder.
Perform chairside stretches. Sustained, low-level contraction of the upper trapezius with few breaks greatly increases its susceptibility to ischemic pain. Without sufficient rest periods or dynamic movement, tension can accumulate in these muscles and, by the end of the day, you may be wearing your shoulders as “earrings” without realizing it. Frequently performing two specific chairside stretches can reduce the accumulation of tension and pain in these muscles. View the stretches here.
Manage your stress. High levels of emotional stress and working at complex, difficult tasks can elicit muscular contraction in the upper trapezius muscle. This type of subconscious muscular contraction in response to stress is called neuromuscular hypertension. If the stress response is not followed by dynamic muscular activity the blood pressure has no outlet and continues to rise. The statically contracted muscle becomes ischemic and painful while the blood pressure remains high. Therefore, stress management strategies that specifically target muscular-type pain are helpful in prevention.
Proper exercise. Training the upper trapezius muscle with heavy weight resistance is one of the most common exercise mistakes dental operators make (vertical rows, military presses, etc.). This can worsen the unique muscle imbalance to which dental professionals are already prone and cause neck pain. Rather, you should target the upper trapezius muscles with aerobic exercise (i.e. walking while swinging the arms, rowing, cross country skiing, etc.).
It is also important for dental professionals to learn how to self-treat and manage upper trapezius pain outside the operatory, which will be the topic of a future column.
About the author
DPR Ergonomics Editor Bethany Valachi, PT, MS, CEAS is author of the book, “Practice Dentistry Pain-Free: Evidence-based Strategies to Prevent Pain and Extend your Career” and clinical instructor of ergonomics at OHSU School of Dentistry in Portland, Ore. A physical therapist who has worked exclusively with dental professionals for over 15 years, she is recognized internationally as an expert in dental ergonomics and has been invited to lecture at over 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. She offers free newsletters, articles, videos and product reviews on her website at www.posturedontics.com. Bethany can be reached at email@example.com.