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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.
How to alleviate two forms of hip pain plaguing dental professionals.
Hip pain among dental professionals can be due to a number of factors, however two common etiologies are: piriformis syndrome and osteoarthritis. Both conditions are more prevalent among women than men and occupations that involve prolonged sitting -such as dentistry - may place women at a higher risk for hip pain than other professions.
The piriformis muscle is responsible for externally rotating the hip and can easily become tight in the operatory when you sit for long periods of time straddling the patient chair. In about 20 percent of the population, the sciatic nerve runs through the piriformis muscle. In this population, when the muscle becomes tight, it can cause painful sciatica - shooting pain into the buttock and down the back of the leg. With true piriformis syndrome, segments of the piriformis muscle will be quite painful to palpation. Women are six times more prone to this problem than men.
Dental professionals who experience this symptom may consider self-treating the piriformis muscle. If the following interventions do not help resolve your sciatica, you should see a doctor as soon as possible because there are numerous neurological conditions that also cause sciatica.
The hip cartilage requires intermittent compression to stay healthy. Therefore, people in sedentary occupations (such as dentistry) requiring prolonged sitting tend to be predisposed to hip osteoarthritis. Other risk factors include middle age, previous hip injury, congenital hip dysplasia, obesity and leg-length discrepancy.
Treatment: Working with a skilled physical therapist, one of the most beneficial interventions is therapeutic mobilization. They may also recommend a shoe lift, use of a cane on affected side, avoiding stairs, ice or taping. A doctor may recommend NSAIDS for reducing inflammation and/or losing weight.
However, studies show that exercise has been shown to be more effective than any modalities such as TENS, E-stim, or acupuncture for treatment of osteoarthritis.
The old saying, “If you don’t move it, you’ll lose it,” is particularly applicable to people with osteoarthritis. Keeping the hips and knees moving, and the muscles around the joints strong, greatly contributes to protecting the joints and staving off additional damage caused by arthritis.
Good exercises include walking, swimming and cycling. The swimming pool must be warm because cold water is painful for osteoarthritis. Strength training is also important, especially the hip abductors - weak muscles cause joint instability, which can further damage the hip joint. People with OA of the hip should avoid running, jogging, jumping rope and high impact aerobics.
Lie on your back. Cross the right leg over the left knee and grasp the right knee with the right hand, slowly pulling it toward the left shoulder, then pull the right ankle up toward the left hip with the left hand until you feel a good stretch in the buttocks. Don't pull too hard on the ankle as this may over-stretch the hip. Focus on relaxing the buttock muscles as you hold the stretch. As the muscle begins to relax, you may increase the stretch by gently pulling further on the ankle. Remember never to stretch in a painful range. Switch legs.
Hip abductor strengthening: Lie on your side, or use a medicine ball, with bottom knee bent. Straighten the top leg, roll the top hip slightly forward and lift the leg upward. Try to lift the leg slightly behind the hip, so the exercise will target the gluteus medius. Repeat 10 times, then switch legs.