As students, we get the ergonomics lecture during the first year of dental school. But when it comes to beginning sim lab to do a crown prep, all that positioning tends to go right out the window. “I’ll work on my positioning once I get the actual dentistry down,” right? Then clinic starts and you will do anything to feel like you can actually see or to avoid indirect vision. Those future neck and back problems can get their start as early as dental school.
In a study done at UCSF, questionnaire responses indicated that 46-71% of the students of all four years experienced neck, shoulder, and/or back pain, with more than 70% reporting pain by their 3rd year. The general trend was a positive correlation between pain and years of schooling. So what gives?
The culprit of that pain than can become chronic 20 or 30 years down the road is not as much the awkward positions we contort our upper halves into, but the length of time we hold them in that position. It is known the PSP or prolonged static posture. Maintaining a hunched over and tilted upper body position for hours a day puts a lot of demand on the body’s muscles. It is harder to maintain static positions than dynamic movements (which could also help explain why wall-sits and planks are the worst). When the head, neck, and trunk are tilted to one side, as often done while working, the muscles in use on one side become shorter and stronger and the other side becomes lengthened and weakened. The overall effect is muscle imbalance with the shortened muscles getting poorer blood supply, too. The unequal tension on the spine can cause some serious pain. What was originally back and neck pain that occurred from time to time becomes more frequent, develops into a chronic pain, and ultimately a severe musculoskeletal disorder which can require surgery or early retirement!
Of course, dentists are going to have neck and back aches on occasion. It doesn’t mean you are doomed or your efforts at good ergonomics are failing. The art of operator positioning is tough and there are times where you just can’t satisfy your spine and your patient at the same time. However, there are some sobering statistics from studies researching this issue.
A study published in the British Dental Journal reported that nearly 30% of premature retirements of dentists surveyed were due to musculoskeletal disorders. In the ADA’s Health Screening Program of 2012, 56.4% of participating dentists had musculoskeletal symptoms with 61% of the currently practicing dental professionals reporting pain, tingling,or numbness regularly. (Visit the ADA website for the entire discussion.) A bit depressing? Yes, but all is not lost! While we cannot help that our profession causes non ideal body positioning, remember there are actions to take to counter the effects of prolonged static postures.
The idea that “proactive” measures are much better than “reactive” is something students hear roughly 500 times over 10 different courses, and it applies here! In addition, taking the time to do counter poses and breaks from PSP in your daily routine can make a world of difference. Here are some posture break exercises for countering those PSPs in office or at home:
Here are some quick stretches:
Also, adding physical activity to your daily routine, such as sports or yoga, can activate unused muscles or stretch out the tightened muscles. It is just another important reason why students need to stay active regularly. Putting down the books or lab work for an hour can actually help your career! And as many students may have heard when buying loupes, they do indeed help to improve posture. Keeping your focusing distance fixed prevents excessive bending and maintains a more neutral head and neck position.
Naturally, while focusing on supporting our families, friends, classmates and goals during dental school, it is easy to overlook the loyal support we depend on to make our careers possible, so remember… give back to your back!
~Kathryn Dickmann, Detroit Mercy ’17