Surina Bhola explains how you can ensure dentistry isn’t a pain in the back.

It is well versed in literature that dentists, amongst many other health professionals, are at highest risk of musculoskeletal problems. Much of this is due to the nature of our work, for example, sitting down for most of the day, looking down and hunching our shoulders, desperately trying to find that notorious MB2 canal. Being in a job with a large physical demand, at some point, with years of service, something will give. For many of us, it is our physical health.

Looking at current evidence, lower back pain has been observed in up to 70% of healthcare professionals (Cınar-Medeni, Elbasan and Duzgun, 2016). In a study conducted by Cinar-Medeni, over half of healthcare professionals with back pain had incorrect posture, and amongst physiotherapists, dieticians, nurses, and dentists, it was dentists and nurses who had a higher prevalence of lower back pain. In many cases, musculoskeletal pain has varied in its location in dentists, being prevalent in the neck, back, shoulder and wrist regions, again, mainly due to posture. Nevertheless, this has lead to over a third of dentists seeking medical help for their pain (2).

It has been suggested that workers with a physically demanding job are at an increased risk of not only muscle and back pain, but cardiovascular disease, mortality, sickness absence, as well as early retirement. Physically demanding tasks may include heavy lifting, prolonged standing, working with the hands lifted to the shoulder height or higher, working with a twisted back, and poor posture.

So what can we do about it? As dentists, we have already committed ourselves to a long, albeit fulfilling, mentally and physically challenging career. However, there are steps that all dentists can take, to prevent, reduce the chance of, and improve musculoskeletal pain and stress. This may allow dental professionals to remain productive for longer periods of time (Alavinia et al, 2009).

1. Stress management and relaxation exercises

Dentistry is one of the most stressful careers, whether it be financial pressures, high patient expectations, or difficult interactions. Relaxation techniques and exercises such as deep breathing, yoga, pilates, and gentle stretching, not only improve flexibility, leading to a reduction in muscle strain, but also provide an internal, mental relaxation.

Regular stressors can produce a state of chronic muscular contraction, which can lead to the increase in toxic ions, which may stimulate neural circuits to increase pain. Evidence has suggested that deep breathing and muscle relaxation exercises, especially during a stressful period, may help to improve this (Al Wassan et al, 2001).

2. Aerobic exercise

Aerobic exercises have been shown to improve or even prevent lower back pain. It has been recommended that a 30-minute cardiovascular programme, three times a week, is ideal for overall fitness. This includes an effective warm up. Lack of warm up may lead to muscle spasm or strain. This may include walking, swimming, or other forms of cardiovascular training.

3. Rest

If a dental professional has a particularly acute phase of back pain, it is recommended that the dentist take a break until the back pain has eased off. This applies to practising dentistry, as well as exercise.

Exercising or straining muscles that are already in severe pain may increase the risk of further tissue damage. Signs to see a health professional include sharp pains, numbness or tingling, indicating possible nerve or discal injuries.

4. Correct posture

Correct posture is key for any health professional, which includes no excessive twisting or bending at the waist, and to try and avoid a bent back, and hunched shoulders. Ideally dentists should position the patient to where their muscles do not feel strained, and the shoulders are down and relaxed, with the patient at approximately chest level.

Magnification, in the form of a microscope, or dental loupes is highly recommended by the author. It is also worth investing in a dental chair with an ergonomic design, as well as good lighting.

5. Resistance training

Resistance training, ie lifting weights, or working against resistance (bands and cables), is a very effective way of increasing strength, and reducing the chance of musculoskeletal pain. The evidence is plentiful in support of resistance training. Resistance training has been shown to:

  1. Improve glycaemic control in people with type 2 diabetes (Castaneda et al, 2002)
  2. Improve physical strength and capacity, leading to a reduction in musculoskeletal pain (Mekary et al, 2015; Andersen et al, 2010)
  3. Improve bone mineral density, especially in early post-menopausal women (Pruitt et al, 1992).

When beginning a resistance or weight training regime, it is always advisable to consult a health professional first, and to start off slowly, with lighter weights. The main aim of weight training should be to focus on maximal contraction of the muscle in question, and to focus less on the weight lifted, and more on the form of the exercise. This will lead to better strength gains, and reduce the chance of muscle pain and sprain.

When lifting, the evidence has shown that compound movements, ie the ones that work multiple muscle groups, are more effective for increasing overall strength (Gentil et al, 2013). The form implemented may also help improve day to day posture. Compound movements may include squats, deadlifts, pull ups, and rows, as opposed to isolated movements, such as bicep curls.

Dentists often sit down for long periods of time, which strains the back, the gluteus muscles, as well as the legs and the core. This will all be worked if compound movements such as squats are implemented.

In conclusion, musculoskeletal pain is a definite issue with a high risk, physically demanding career such as dentistry. With the introduction of stretching, relaxation techniques, correct posture, weight training, resistance and aerobic training, dentists can reduce the risk of chronic musculoskeletal pain, which for many dentists, can be debilitating.

References

Al Wassan KA, Almas K, Al Shethri SE and Al Qahtani M (2001) Back & neck problems among dentists and dental auxiliaries. J Contemp Dent Pract 2(3): 17-30

Alavinia SM, Van Den Berg TI, Van Duivenbooden C, Elders LA and Burdorf A (2009) Impact of work-related factors, lifestyle, and work ability on sickness absence among Dutch construction workers. Scand J Work Environ Health Sep 1: 325-33

Andersen LL, Christensen KB, Holtermann A, Poulsen OM, Sjøgaard G, Pedersen MT and Hansen EA (2010) Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial. Manual therapy Feb 28;15(1): 100-4

Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, Roubenoff R, Tucker KL and Nelson ME (2002) A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care Dec 1;25(12): 2335-41

Cınar-Medeni O, Elbasan B and Duzgun I (2016) Low back pain prevalence in healthcare professionals and identification of factors affecting low back pain J Back Musculoskelet Rehabil Nov 11(Preprint): 1-9

Gentil P, Soares SR, Pereira MC, Cunha RR, Martorelli SS, Martorelli AS and Bottaro M (2013) Effect of adding single-joint exercises to a multi-joint exercise resistance-training program on strength and hypertrophy in untrained subjects. Appl Physiol Nutr Metab Mar 18;38(3): 341-4

Mekary RA, Grøntved A, Despres JP, De Moura LP, Asgarzadeh M, Willett WC, Rimm EB, Giovannucci E and Hu FB (2015) Weight training, aerobic physical activities, and long‐term waist circumference change in men. Obesity  Feb 1;23(2): 461-7

Pruitt LA, Jackson RD, Bartels RL and Lehnhard HJ (1992) Weight‐training effects on bone mineral density in early postmenopausal women. J Bone Miner Res Feb 1;7(2): 179-85