I get it. I understand why electronic medical records are necessary. Documenting in this format is supposed to decrease medical errors and improve coordination of health care. I even prefer electronic documentation in most circumstances. Honestly, who wants to sit and hand write 30 detailed notes at the end of the day? It’s a great concept, except…..don’t we already spend too much time in front of a screen? Even before the implementation of the electronic record requirements, a study from the Council for Research Excellence in 2009 reported in the New York Times claimed that the average American spends over 8 hours per day in front of a screen! How much has that time increased with more of our personal and business interactions performed in front of the computer or mobile device almost 7 years later?
Despite the benefits of electronic documenting for overall improved coordination of health and documentation compliance, the fact is that extended screen time is simply not healthy. Here are 3 reasons why:
More prolonged sitting. After sitting all or most of the day the last thing your body needs is more sitting. However, it is unlikely that you have equipped your office with one of these cool treadmill desks. Sedentary activities promote cardiovascular disease, increases risk of obesity and consequential health problems associated with it, decreases aerobic capacity and much more. Of course there is a higher incidence of musculoskeletal pain in those who are more sedentary because the body is simply shutting down
More poor posturing. Proper posturing is just as important while using a computer as it is when working on patients do decrease risk of developing musculoskeletal dysfunction. Just as proper sitting postures are often lacking when delivering dental care, computer operating postures often leave much to be desired. If you are already experiencing neck/shoulder/back/wrist pain, your computer positioning may be a contributing factor that you have not considered. This is another area where those pesky muscle imbalances wreak havoc.
More visual stress. Eye strain is a problem for dental professionals. According to the American Optometric Association, extended time on computers can lead to a collection of symptoms which has been named “computer vision syndrome”. Symptoms include headaches, blurred vision and even neck and shoulder pain. Since eye strain is already common in dentistry due to the demands of accommodation and such, adding more activities which promote poor eye health is not ideal.
As it becomes more necessary to increase your screen time at work, it becomes even more necessary to change your lifestyle habits. Here are just a few tips on how to counteract some of the consequences of extended computer use:
Unplug: Spend time away from computers, phones, tablets and TV screens! You may be amazed at how difficult this may be at first, however, after a while, this will seem like a refreshing oasis of time. Reconnect with those things you once loved.
Move: Any way you want. Dance. Walk. Swim. Bike. Go to the gym. Play with your kids. Help a neighbor move. Clean the house! It doesn’t really matter what you do, just get going. This act alone has tremendous emotional and physical health benefits.
Eat Well: With an increase of sedentary activities, there is a decrease in calories burned and increase in fat deposited throughout the body. If you are not training to run a marathon, make sure you are not eating as though you are. Stick to a healthy diet with lots of fiber and water. Peristalsis tends to slow as we become more sedentary too, which can lead to bloating and other very uncomfortable things!
Educate yourself: Knowing your risk factors for developing pain and compromising your health is necessary so that you can learn how to overcome them. Use quality and reputable resources to start to make changes in your daily practice. OSHA has provided a free guide to setting up a proper workstation environment to improve posturing. This article is an excellent resource for you to assess your computer stations and help you to configure a station that makes long hours of documentation, business transactions, emailing, and even reading blogs more comfortable and safe for you.
It seems as though electronic documentation is here to stay. So it is of utmost importance that you learn how to protect your health from the devastating consequences that will result from hours of screen time.
As always: Be Healthy and Practice Safely!
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Low back pain is one of the most common musculoskeletal complaints in the world. Dental professionals are particularly prone to back pain as their posture is compromised throughout the day. Studies have shown over 90% of dentists deliver care in positions which can contribute to back pain. Sitting in awkward and uncomfortable positions for extended periods or just repeating the same posture over and over increases risk of injury to sensitive structures.
The mechanisms which result in generalized back pain and poor posturing are numerous and varied. That is because every body is different and everybody practices differently. This can make finding a solution to your specific back pain problematic.
There are common practices that have dominated dentistry which have been shown to contribute to low back pain. For example, sitting in your dental chair with your hips, knees and ankles all at 90 degrees. At some point, someone decided this was the most efficient way to deliver care while sitting and this idea has rooted itself into training programs and dental practices.
If you have been diligently trying to maintain this difficult position of hips knees and ankles, then you have been exposing your back to unnecessary stress and discomfort. Making small changes to this posturing can help to lessen the effects experienced by your spine during and after prolonged treatments.
Here is a simple experiment for you to try:
Find a firm or semi firm chair. Your favorite recliner is not the best surface, even though I am sure it is the most comfortable!
Sit at the edge of the chair and drop your knees slightly towards the floor creating a 100-110 degree angle at the hips. What is happening to your low back? Did you notice you sat a little straighter and created a nice little curve in your low back. That curve, or lordosis, is a natural stress absorbing mechanism. It distributes the forces evenly throughout the spine.
Now sit back in the chair until your hips and knees approximate 90 degrees. What happened to your lordosis? Gone, right? As the pelvis tilts back, it straightens the spine, which reduces the lordosis.
The 90 degree position of the hips decreases the natural ability of the spine to properly distribute the forces you experience from sitting. Those forces don’t just disappear, they have to go somewhere, but where? When the curve of the spine has been neutralized, the forces are directed to the supporting structures, or muscles, ligaments and tendons. The lumbar musculature is overworked to stabilize the spine in this abnormal position while the abdominal musculature is underutilized. Being over and under worked both lead to the same result: weakness. If you are curious about how strong your own lower back is, refer to this earlier blog. As muscle groups perform tasks for which they are not equipped or designed, they begin to ache and cause pain.
Dental practitioners experiencing back pain should feel free to experiment a little with sitting/standing positions to find your optimal position. Working with your body’s natural features to absorb stress and protect itself will yield better results than trying to force it into an uncomfortable position for prolonged periods of time.
There is nothing so debilitating as chronic back pain. It will not simply go away. You must take action in your life and practice to ensure that you are protecting yourself so that you may a long and productive career. Simple strategies such as this can help.
Be Healthy and Practice Safely!
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“I stretch my neck all of the time.” Dr. Iminpain, DDS proudly declares.
“You do? That’s great! How long do you hold the stretch?” I feel a great sense of hope as our consulting session begins. Maybe he has picked up a valuable tool that we can work with to help reduce his neck pain. That feeling of hope fades quickly with is next statement.
“I’m not sure. Just until I feel that it doesn’t need it anymore.”
“Ok. Can you please show me what stretches you are performing?” It seems that he has not had proper training in stretching and I fear that he will soon abandon the practice when there are no results.
Now picture an otherwise distinguished professional man very awkwardly lifting his arm above his head at the same time rotating, twisting and bending his neck in some bizarre fashion that I am sure was a modified version of the infamous exorcism scene.
“Wow, that is some stretch,” I continue, already anticipating the answer to my next question. “How did you learn that one?”
“YouTube. There was an 'exercise expert' that claimed this would help with my neck pain.”
“Then maybe we should look at some proper stretching techniques that may be more effective for you.” And so our work begins.
Unfortunately, this is not an uncommon encounter to have with dental professionals with whom I work. They have the right idea, stretching is an integral part of overcoming musculoskeletal discomfort caused by assuming awkward positions throughout the day. It also seems like such a natural and easy undertaking. What is there to know about stretching? Turns out, a lot.
Stretching is a natural phenomenon. You experience the urge to stretch when your muscles require nutrients and your brain wants to improve circulation. Before you know it your arms are high above your head and your body is moving in all sorts of inexplicable directions rarely observed in a context other than on dancefloors at family weddings as you try to dance the funky chicken.
However, stretching for dental professionals for the purpose of pain relief is much different. It is not so natural. In fact, it has to be learned. It is a skill to be honed after much practice. The more you know how to anticipate your own body’s needs and how to incorporate stretching, the more effective the stretches will be for relieving pain. After spending time practicing and implementing key strategies, the body learns how a stretch should feel and it will start to seem more natural.
Just doing any stretch over and over is not the answer to improving your stretch mechanics. The old adage is very true when it comes to stretching: Practice doesn’t make perfect, perfect practice makes perfect.
Since there are hundreds of stretches available, the goal of this blog is not to introduce you to all of them. Instead, the intent is to provide fundamental principles of stretching which should be applied to all stretches so that they may be effective. For specific stretches, you can visit my website here, or check out Bethany Valachi’s book Practice Dentistry Pain Free. No matter which stretch you choose that is appropriate for you, these principles apply.
1. Form is everything.
Specific and purposeful stretching is necessary to lengthen muscles which have been shortened and are contributing to pain. Of course, this lengthening will only happen if you stretch the correct muscle. Improper form misdirects the force of the stretch to other muscles and structures thus not lengthening the muscle fibers of problematic tissue and leaving you frustrated.
Don’t give up!
Proper form is not always easy to achieve in the beginning. Not only that, but it also may change from day to day. The body is a fickle world that is dynamic and responds to the internal and external environment. These things affect what is going on with the muscle fibers. So form may have to change so that you are getting the fibers in need of the stretch at that moment.
Key: Know your anatomy and your body. Check out this cool site that can help you pinpoint the muscles which need the stretch. Once you know your problem areas, you can then find the stretch that is right for you. Remember, if you are not feeling the stretch in the offending muscle, your form probably needs a little tweaking. Don’t be afraid to wiggle a little until you learn which position is the right one for you in that stretch.
2. Stretches are active!
After you have learned what to stretch, you now need to know how to stretch. Proper stretching requires your presence. In other words, you have to pay attention to what you are doing. Stretching will not be nearly as effective if you simply “assume the position”. Staying focused and active in the stretch allows the natural forces to elongate to muscle fibers effectively. Yoga can work because it requires awareness of the body and a gentle challenge to “move deeper into a pose”. It may not be practical to break out your Downward Facing Dog yoga pose in your office, however, it is possible to apply the same principles of yoga to all stretches.
Key: Once you have found the right positioning, use your breath to guide you deeper into a stretch. Every few breaths try to gently push yourself a little further into the stretch. Stretching SHOULD NOT HURT. So be careful. If you are very restricted, you may find that your body simply does not want to go further. That is ok. Stay in a position where you are able to feel the stretch with a slight discomfort. If the discomfort eases, then try to find it again by pushing yourself a little more.
3. Use the correct dosage.
Stretches take time. There are no shortcuts. In my practice and consultations, I routinely recommend 1 minute hold times once per day. That is a long time to hold a stretch, but see why this time is so important by watching Nikos , the developer of a technique called microstretching, explained here. He recommends performing the 3 sixty second stretches once per day. This frequency of stretching can be time consuming if more than one muscle group is troublesome. Not only that, but when delivering dental care, the muscles you have stretched are returned to their shortened and contracted positions often.
Key: Perform the 1 minute stretch per muscle group in the mornings after a warm shower. When you have brief breaks in care, incorporate “mini” stretches. These “mini” stretches should last from 30-45 seconds. This does not allow for time to stretch the muscle/tendon junction for an extended period of time, but it does allow for a general lengthening of all of the muscle fibers.
4. Be consistent!
Stretch every single day! No need to explain this. Make the time and just do it!
Key: Integrate stretching into your morning routines and practice. Create a habit and encourage others around you to do the same. It is much easier to start something new if you have a support system.
Stretching is an instinctive part of our daily lives. Proper stretching can leave you feeling invigorated, refreshed and pain free. Use these resources and guidelines to perfect your stretching techniques so that you can begin to experience the benefits.
As always, stay healthy and practice safely!
B. Valachi, Practice Dentistry Pain Free: Evidence Based Strategies to Prevent Pain and Extend Your Career, Portland: Posturedontics Press, 2008.
N. Apostolopous, "Micro Stretching," MicroStretching.com, Vancouver , 2008.
"Healthline," Healthline Networks, [Online]. Available: http://www.healthline.com/human-body-maps/. [Accessed 5 November 2015].
mahalodotcom, "YouTube," 3 June 2010. [Online]. Available: https://youtu.be/w43eUOjHkpA. [Accessed 6 November 2015].
.="J. Benedict, "Healthy Solutions for Dental Professionals," February 2015. [Online]. Available: www.jbenedictdpt.weebly.com. [Accessed 4 November 2015].