The 1960s were a glorious time for our country. Social activism flourished, music was as political as Washington DC, and fashion was….well…interesting. In this era of giant collars, long haired hippies and Janis Joplin, established traditions were challenged and change was procured. Not all changes were as dramatic as the civil rights victories, but many of those subtle changes still dictate the way you practice dentistry today.
In the 1960s dentistry welcomed a new way to practice known today as four handed assisted dentistry. With this new, more efficient practice method, dentists could take a load off and sit down. This was novel to dentistry as prior to that, most dental procedures were performed while standing. Standing long hours while performing dental work was not easy on the body. Dental professionals, like most professions requiring prolonged standing, reported significant lower back, leg and feet pain. Sitting down seemed like an answer to a prayer from an aching body.
Over 40 years later, we are discovering that sitting has it’s own set of vices for the body. Despite the innovation in chairs, office design and other environmental factors, development of musculoskeletal disorders is something with which dental professionals continue to struggle. Not only that, new research indicates that sitting down for extended periods of time may actually be as harmful as smoking, at least in terms of cardiovascular health.
Evidence shows that alternating between sitting and standing positions to deliver care is best practice when it comes to maintaining healthy stresses placed on your body. Some dental professionals find standing to be uncomfortable and can increase back pain so they avoid it.
A good amount of ergonomic research has been dedicated to understanding why people experience back pain with prolonged standing. You can take a look at these articles (1,2,3) to see the results of some of these studies.
These studies and others indicate that if the sequence of activation of the muscles supporting the spine is altered, individuals are at a higher risk of developing lumbar pain, than in subjects where the muscle are recruited in a more normalized fashioned.
What does this mean for you?
Altered muscle recruitment can be the result of several factors. However, in this particular case, typically the problem arises because of lack of strength. Some muscle groups are not strong enough to support the load and recruit other muscle groups for assistance. The other muscle groups are not adequately designed for the task and become fatigued quickly. Fatigue is a major contributor to pain in dentistry. See my blog Muscle Fatigue and Dentistry: A Painful Combination to find out more about this phenomenon.
Of particular interest in the cited studies was the recruitment of hip muscles, or gluteus medius to be specific. This muscle is responsible for stabilizing the pelvis, among other things. One interventional study demonstrated a significant decrease in activation of this muscle after the participants exercised the muscle to fatigue.
That makes sense. You know how it is when you are exhausted and resting. The last thing you want to do is help your neighbor shovel out a hole in his yard. The same is true for these muscles. Once they are fatigued, they are not easily activated again. Their get up and go, got up and went.
The ineffective recruitment of the gluteus medius muscle turns out to be a good thing. According to the research, when these muscles are not recruited, there is less risk of developing back pain while standing. Since we know these muscles are not recruited after they have been exercised, the next logical question is….how do I exercise these hip muscles properly so that I have less risk of developing back pain?
Great question, I am glad you asked. Take a look at this video for an effective exercise that you can do in your home or office to not only strengthen, but also fatigue the gluteus medius muscles to improve the proper activation of postural muscles.
Next it is important to consider, how to reduce the general load or stress on the muscles and other structures implicated in causing back pain in the first place? The load on the primary muscle group can vary greatly depending on your posture. When you assume an optimal posture, you minimize the stress placed upon the muscles, ligaments and all other underlying structures. Therefore, it seems to follow, that muscle recruitment may, again, have a chance to return to normalized pattern.
All of that may be too much information. What you really want to know is how you can stand to work and still maintain proper posturing?
In a recent podcast I discuss optimal standing positioning to reduce neck and shoulder pain. The same principles are true with regard to lumbar or back pain. Make sure to listen to the podcast for all of the details, but here are the highlights.
1. Operator (that’s you) should be positioned between the 11:00-1:00 position 80% of the time. Not to the side.
2. Use loupes to decrease the amount of forward head flexion.
3. Arms should be close to side with elbows bent at 90 dg.
In addition to these guidelines, you also need to make sure you:
1. Distribute your weight evenly through both legs. Standing with uneven weight distribution affects the muscle activation pattern resulting in imbalances and pain.
2. Activate your abdominals frequently. You can do this by sucking in your stomach as though you are trying to put on a tight pair of pants. Please make sure you are still able to breathe when you do this! No one wants to see you passed out on the floor.
3. Avoid repetitive or prolonged twisting at the waist. Although some twisting may be necessary, position your instruments, patient and self in such a way as to minimize this movement.
Although the 60s brought about the current trend to deliver care in a seated position, remember, the healthiest way to practice dentistry is a combination of both sitting and standing. By applying these interventions, you will improve your body’s muscle activation pattern and reduce your risk for developing back pain while performing procedures in a standing position.
Join me for the Healthy Solutions for Dental Professionals podcast to discover more strategies for a healthy practice and extended career.
Be Healthy and Practice Safely!