I first started dental assisting when my stepfather needed help in the office. I was happy to learn something new and to work with him and the patients. It was also good way to earn a little extra money while I was in college. I returned to assisting when I graduated and moved away and wanted to start an actual career. I learned many things my two stints as an assistant. First of all, dentistry is HARD PHYSICAL and MENTAL WORK. I have a great respect for the people who are able to practice in the field. Secondly, dentistry was not for me!
Since then, I have found my passion in physical therapy. After years of working with patients who suffer from work related musculoskeletal disorders and exploring best treatment options, I have wanted to return to dentistry in a new way. To use my expertise to help those of you that have lasted much longer than I did. Here, I want to specifically address neck pain. To do that, I’ll share with you four basic principles about neck pain. Knowing these principles is the first step to managing both acute and chronic pain. Management is essential because pain doesn't just place your livelihood in danger, it diminishes the quality of life you have outside of your work. And that is just not acceptable.
Neck pain is not isolated to those who practice dentistry. Even though it is difficult to measure, research has suggested the prevalence of neck pain in the general population to be as high as 62%. It is more common in women than men and also is reported more in persons with mentally and physically stressful career.
Although the causes of neck pain in the general population are very different than those reporting neck pain in the dental field, it's important to keep in mind that dental professionals are not the only sufferers. Why does that matter? Since people not working in the dental field can have neck pain for various reasons, those that are working in this profession can have neck pain for those same reasons. They may also experience the neck pain because their work requires prolonged compromised postural positions. So, dental professionals are at risk of neck pain because they are in the general population and because of the working postures required. That is a double whammy!
Research is chocked full of statistics confirming this is the case. Countless studies indicate neck pain is among the top complaints of dental professionals, especially hygienists. The take home message is that if you are working in dentistry you are likely to have neck pain and you are certainly not alone.
Appreciating the complexity of neck pain is important if you want to manage it. It is multifactorial and challenging to treat in the general population. It can be even more difficult in the dental population because of the double whammy that was mentioned above.
Why are the postures adopted by dental professionals so harmful? I'll do my best to give you the short answer. The working theory that most of us that study the work related disorders of the musculoskeletal system subscribe to is that the prolonged posturing of dental professionals places them at high risk of neck pain. These positions have the potential to weaken specific muscle groups. The weakened muscle groups are not able to provide the scaffolding to support or force required to move the underlying structures. Some groups of muscles that are weakened are stuck in a shortened state and do not allow for proper movement of the structures. So, basically, you have an undersupported and hypomobile cervical spine. This is literally a disaster waiting to happen.
Sounds simple, right? If left untreated, these weaknesses can morph into muscle imbalances. As muscle imbalances are reinforced through continued habits, the person is at risk of damaging the underlying structures. Once those structures (vertebrae, discs, ligaments, nerves) are injured, the muscles will then respond in a different manner. The only way they know how. They will contract or shut down. This contraction (or muscle shortening) leads to hypomobility, which in turn, leads to weakened muscles. This encourages even more imbalance and so the cycle continues.
The source of most cervical pain is not the underlying structural deficits, but rather the reaction of the muscles that support the structure. To be clear, the structural deficits can include disc herniations, nerve impingement and mechanical malfunctions. The reaction of the muscular system is also a major (if not sole) contributor of the reduced range of motion and other impairments associated with cervical pain. The delicate balance of the muscle system must be restored so that it can provide the necessary support to the structures.
To add more complexity, consider that shoulder and upper thoracic musculoskeletal impairments can also announce themselves as neck pain. Of course there are referral patterns from other systems, such as the cardiovascular system, referring pain to the jaw, upper back and neck regions and the respiratory system that can add to stresses on certain musculature in the cervical region.
If you have had neck pain and tried strategies that did not work, it is most likely because the you did not address the source of the pain. The complexity of neck pain lies in discovering the actual source of the pain. Then, if it is muscular in nature, in full or in part, the cycle of imbalance must be interrupted.
Throughout my blog posts, I will certainly discuss particular muscle imbalances in more detail. Suffice it to say, although there are clear patterns, every person has a unique circumstance that can contribute to neck pain. Individualized evaluation for all of the possibilities is ideal.
The bad news is that neck pain, once experienced, is likely to return. This is certainly the case if you are not able to identify the cause and contributing factors. It may ease for a bit, only to return with the slightest turn of the head. The reality is that neck pain does not go away quietly and it does not stay away for long.
Unfortunately, this is too well known by those that suffer from neck pain. Dealing with it is an arduous process. Too often the first remedy for this chronic pain is medication. Research confirms that dentists often use medication for pain management and are at risk for over medicating themselves. This is understandable as neck pain in dentistry does not only mean a bad day at the office, but also the risk of not being able to perform your duties and losing your career. Pain killers and muscle relaxers serve to mask pain or change the activation level of muscles. They do not address the complex nature of the underlying problem. Instead, chronic use of medication is an acceptance of the pain and resignation to live with it. There are other interventions out there. And many of them have been tried to little or no avail for some dental professionals.
Ergonomically designed products and procedures can help to reduce many of the postural and work related stresses that contribute to the development of neck pain. But these strategies are passive. Passive interventions alone will rarely be able to fix existing problems, but instead are great for prevention and maintenance. It is similar to parking a beautiful new Mercedes in your driveway, only to have it hit by a baseball and cause a dent. Now you park your car in the garage. Parking in the garage may avoid further damage, but that alone does not fix the dent! Active measures are required to remedy that.
Active interventions, such as specialized exercise programs can help correct the imbalances. The best interventions involve specific training for the muscles and underlying skeletal system. Simple stretching is not enough to correct the problem, although it is necessary. And not all exercises should be about strengthening. So, if you have tried exercises and they have not worked, you probably have not been given a properly specific program that is training the system in the most effective manner. If you have tried exercises and they do work, but once the pain is gone you decide to slack off, the pain will return. That is part of the chronicity. The exercises will only be effective as long as they are performed.
Just as the actual sources of neck pain are individualized, so should the interventions be. Not everything works for everyone. However, no matter what pain management measure or measures you choose, it is important to recognize that this will require life-long management. Not just momentary relief.
Let's end with the good news!! Most of the time the sources of neck pain are identifiable and even manageable! Isn't that wonderful???!!! Once the source of the pain is identified, you can learn how to manage it. You are in control of your own destiny. Let me say that again. YOU are in control.
Interventions only work if you are consistent and responsible. That goes for ergonomic tools, exercise programs, stress management techniques, medication regimes and any other host of “cures” that are proposed. Most cases require more than one strategy to reduce neck pain.
Don’t give up. Seek out the proper professionals to assist you. Remember, your neck pain is not going to go away by itself, but it is manageable. Your career is worth the investment if your time and resources to take care of yourself. Hey, let's forget about the career, your LIFE is worth it!!
Be Healthy and Practice Safely!
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