When it comes to work related pain, we tend to forget the contributing factors that are not work related. There are ways that we can be exacerbating pain at work of which we are unaware. Below is a description of some everyday activities that may be intensifying pain that you experience at work.
Prolonged positioning is not relegated to dental postures. In fact, when the body is forced to stay in any position for long periods of time, physiological consequences occur and the body will begin to send signals to the brain demanding a change of position. For more on this process click here.
Spending hours in the driver’s seat requires the body to be in static state for long periods of time which can decrease circulation to the spinal musculature and lower extremities. Since increased circulation is required to heal tissue that may have been damaged throughout your day of dentistry, it is easy to appreciate how long (especially stressful) drives may actually contribute to musculoskeletal pain.
Using a Computer
As electronic documentation is now a requirement in healthcare, workers are spending more time in front of computer screens. Use of computers may ease some of the burden of organizing our documentation, however, it has significant negative impacts on our health.
As with the driving, any prolonged positioning will eventually create tissue damage and pain. Unfortunately, with computer usage, the body is often even more compromised than with driving. Poor computer station set up at work can certainly contribute to any pain that is experienced. Here is a link to help you learn what an ergonomically sound computer station may look like for you.
But computers are not just found in our working environment. Indeed, they are part of our lives. We stream videos, communicate with long lost friends, edit pictures, take classes, and even write fascinating blogs with a few strokes of the keys. The body is mostly static, again, reducing the flow of vital nutrients to the areas that need it the most.
Minimizing time on the computer at home gives your body time to recover and lets the healing process begin. I always recommend my patients use a timer in order to accomplish this. The seduction of the screen can be difficult to escape. A timer reminds you just how much screen time you have had. A 10-15 minute break every 45 minutes will do wonders.
Recently, this article brought to light a phenomenon that every smart phone and tablet user should know. It is a warning about the rise of spinal musculature pain due to cell phone usage. I am certain by now that you can guess the mechanism by which pain is caused, but it bears repeating.
Prolonged unnatural postural positioning is placing abnormal stresses on your body. This positioning is benign when held momentarily, after all, our necks are supposed to move that way. Yet, if you are suffering from pain while you are working, maintaining this awkward positioning will futher compromise spinal alignment.
What the article fails to mention is another problem that has come to the forefront about cell phone and tablet usage, which is premature osteoarthritis of the small joints of the hand. That bit of information is essential for dental professionals to consider, as precise and pain free control of the hand is your livelihood.
So, do we stop texting or using our tablets? Ideally, yes! But that is not going to happen, so let’s consider the alternatives.
*Hold your phone straight out in front of you. The goal is to decrease the amount of forward bend in the neck.
*Activate your abdomen when using the phone. This act alone will improve your posture.
*Alternate finger usage to scroll or control your phone. Not using the same finger all the time to diminish the damage done to one finger.
*Limit time. Don’t type long emails or read books on your device. Save that for when you are able to position yourself properly in front of a computer.
Muscles need proper fuel to work at optimal levels. Top athletes understand how integral the relationship between nutrition and muscle performance is. They spend much of their lives learning about good nutrition and benefit greatly from it.
Although it is probably not your goal at this point in life to win an Olympic medal, the basic principles of good nutrition are just as important for you as they are for top athletes. It is imperative that you feed your body the fuel that it requires for your muscles to perform the demanding tasks of dentistry.
Nutritional needs vary by individuals and it is beyond the scope of this blog to provide detailed descriptions of such. However, I am confident that most of us know how to make healthy choices when it comes to our foods. I am not so confident that there is an appreciation for the immediate consequences of those choices.
Food provides energy. If you skip breakfast, you have decided to begin your day with an energy deficit. That deficit only increases as muscles begin to use a tremendous amount of energy to maintain positions for long periods of time. If there is not adequate nutrition provided to the cells, they are not able to metabolize properly to provide the necessary reactions for energy. Tired cells make up tired muscles. Tired muscles are a major source of pain and dysfunction for dental professionals.
Don’t skip breakfast and make sure that you are taking time to enjoy healthy snacks throughout the day.
Carrying Heavy Purses and Fat Wallets
Last, but certainly not least is a topic that I have found people extremely resistant to change. Women who carry heavy purses or bags on a consistent basis and men who put their wallets in their back pockets.
Ladies first. We know that our purses and bags are really extensions of who we are. We carry everything that everyone MAY need. Tissues, phones, papers, cards, money, everyone’s medical histories, lipsticks, the kitchen sink…..the list is endless. The problem is that we typically carry our purses or bags over the same shoulder. As we do this, we are putting significant amount of stress on sensitive tissues below the surface. Heavy bags can lead to back and neck pain. If you are in the dental profession, you are already stressing these tissues, and carrying extra weight is the best way to make sure that your condition gets worse.
Lighten up. Carry with you only the essentials. By essentials, I mean things that you will be using on that day. I have found the best strategy in which to accomplish this is to make yourself carry a smaller purse/bag.
If you do need to carry a laptop or other heavy bag, make sure you are switching it from side to side. This will give stressed tissue time to recover.
Now, for the men. I’m not sure who started the fad of men carrying their wallets in their back pockets, but you can certainly thank him for being a contributing source of your neck/low back pain. Sitting on a wallet compromises the alignment of your spine and creates muscle imbalances which can ultimately lead to pain. Move the wallet into your front pocket before you sit down. And, like the ladies, you also need to lighten up. Only carry what you need to carry for the day.
New habits are not easy to create. Research has shown that it can take up to 66 days to form a new habit. Understanding the ramifications of not changing these detrimental daily activities is the first step. The next step is the hardest, which is for you to do the work you need to do to provide your body with every advantage to be healthy. When others in your office are complaining about how badly their back hurts and you see a fat wallet in their back pocket, you will be happy that you read this blog and made changes!
As a therapist, there is nothing more disturbing than to have a patient/client sit in my office and say these words, "I've had PT in the past, but it didn't help." Those words are typically spoken by people who feel forced into physical therapy by their doctor (or insurance company) before surgery or when no one else in their medical circle has been able to address the problem. I know immediately that I my efforts will have to be almost Herculean to combat the notion that physical therapy is a waste of his/her time.
I have the same conviction when I often read about dental professionals who have "tried" therapy and who have not been able to find relief and leave disheartened.
If you have tried physical therapy before for your aches and pains associated with dentistry but it "didn't help" or "only helped for a short time", please allow me to share some insight that I have gained throughout my practice.
1. All physical therapy is not the same.
Physical therapists are a very diverse group of practitioners with a broad range of, interests and knowledge. The interests of any one particular physical therapist will absolutely effect your treatment.
If you work with a therapist that has received advanced training or board certification in manual therapy, most likely, you will receive passive modalities (massage, joint mobilizations, fascial releases, etc.). Exercise may or may not be as crucial to that therapist.
If you work with a therapist that has a background in orthopaedics, you may not receive any passive modalities, but instead have a very heavy exercise program designed specifically to address dysfunction.
Some therapists will use electrical stimulation religiously, others see it as a waste of time. Some will use ultrasound, while others proclaim that research does not support it. Some will only choose to treat the area that is problematic, and yet others want to treat things that may seem unrelated, but ultimately could lead to the source of the pain. One physical therapist may insist that the Mckenzie method is the only appropriate way to treat patients, yet his neighbor may argue that Paris' strategies have better results. I could drone on, but I think you get the picture.
So, just because one approach in physical therapy didn't work, don't assume that all physical therapy is ineffective. Those strategies were not well suited for you. There are other strategies that will help you.
2. Exercise is not effective if it is not performed.
There was a study done to determine the compliance of patients with home exercise programs provided by physical therapists. It revealed that only 35% of patients were actively performing the home exercises prescribed by their physical therapist. Interestingly, especially for dental professionals, the more educated you are, the less likely you are to be compliant with your program.
Physical therapists are somewhat to fault here. There are sometimes unrealistic time and resource expectations placed on patients. Home programs should be specific and education provided on how to implement the exercises in a meaningful way.
In other other words, you shouldn't have to carve out 2 hours of your day dedicated to exercising so that you can manage your back pain. The exercises should also be interesting and challenging so that you can stay motivated to perform them. Guidance on when and how to progress is key so that you can change things up and not get bored. Joining a gym should not be a requirement to maintain gains found in therapy. It is unrealistic and frankly poor program design.
However.....consistency with an exercise program is key to achieve and maintain the desired result. A physical program does not just manage pain, but decreases stress and improves your overall health and vitality. Unfortunately, the last two are rarely motivators compared to pain. Ultimately, you are the one in control and you have to equate the exercise prescription with pain prevention/management. It is the exact same mentality you need to achieve with compliance of medication. It is your body and your responsibility.
3. Ergonomic considerations are paramount.
As dental practitioners, it is not a question of if you will encounter awkward prolonged positioning, but rather when and for how long. The frequency and duration of compromised postures depends on so many variables including chairs, positioning of patient/equipment/computers, use of loupes, lighting, practicing four handed dentistry, cell phone usage, etc.........The list is seemingly endless.
If a physical therapist tells you that you need to just change the way your sitting and does not offer any real strategies that you can apply, please leave and find another therapist. Find one who understands what you do for a living. You will save yourself a lot of time and money. That therapist may very well be able to improve your pain level in a perfect situation, but your profession demands that your body is able to handle less than ideal circumstances. You need an expert that will help you learn to perform your tasks pain free.
Ergonomic changes may need to be occur before you will get long term relief. Exploration of all of the variables that can contribute to your pain should be a significant part of your therapy plan. In fact, I will argue that it is one of the most important. This alone has been the driving factor for me to enter into the workplaces and actually observe the set up and workings of dental professionals. You may not want your therapist in your office, but perhaps you can provide video or pictures.
You may consider an certified ergonomic specialist. They are typically physical therapists and occupational therapists. Distinguishing designations are CEAS and BCPE. Although physical therapists are trained in general body mechanics and should always take into account these factors, someone that has received specialized training will be more focused on your work space and how it relates to your problems.
Remember, the first point: Not all physical therapy is the same.
So, if you have "tried PT" and it "didn't work", it is important that you know why. Resigning yourself to live and work in pain is not necessary. Take time to seek out the treatment that is best suited for you.
Physical therapy is a wonderful tool and should be sought out often for those in pain. It is non-invasive with highly skilled interventions and very specific and individualized plans to improve your impairments and decrease pain levels.
If you still have questions or concerns about why physical therapy may not have worked for you, let me know. Join the discussion on the forum page and check back often or feel free to email me directly.