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Occupational Hazards of Dentistry: Shoulder, Neck and Back PainDr. Martin Minrovic, PTFelicia Rather, PT, OCS
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Objectives
� List most common injuries related to the dental profession
� Recognize postural adaptations that can lead to pain and dysfunction
� Demonstrate exercises that can assist in correcting postural abnormalities correcting postural abnormalities
� Demonstrate understanding of the role of physical therapy in lower back, neck, and shoulder rehabilitation
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Prevalence of Musculoskeletal Disorders in Dentistry
� Back, neck, shoulder and arm pain is found in 81% of dental operators even after the techniques changed to seated four-handed dentistry and ergonomic equipment
� Changing to seated positions in dentistry did not change the frequency of pain, only the location
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change the frequency of pain, only the location
� The sitting position predisposes dental operators to back, neck, shoulder and arm pain
• Valachi and Valachi, 2003
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Postures Used in Dentistry
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Dentistry and Low Back Pain� Prolonged sitting postures have a negative effect on the
health of the intervertebral discs (Marras, WS, et al, 1995)
� Sitting in a forward flexed position causes increased pressure within the disc, possibly leading to disc herniation
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� The disc gets its nutrition through movement of fluid, which happens with movement of the body
� Other problems can occur in the joints of the spine as static sitting postures prevent movement of the joint fluid and reduce the lubrication of the joints
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Common Lumbar Spine Diagnoses
1.) Sciatica2.) Piriformis Syndrome3.) Lumbar DDD4.) Lumbar DJD/OA5.) Disc bulge/herniation6.) Sacroiliac Joint Dysfunction7.) Paraspinal Muscle Spasm
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The Spine
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Dentistry and Neck Pain
� Static seated postures in a rounded back position can lead to a forward head posture
� Forward head posture causes cervical muscle imbalances
� Dental operators frequently work with their heads rotated and sidebent, which can cause more
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rotated and sidebent, which can cause more muscle imbalances
� The overstretched muscles must still hold up the head, and these lengthened muscle contractions can lead to pain and development of trigger points
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Common Cervical Diagnoses
1. Cervical DDD2. Cervical DJD/OA3. Cervical Radiculopathy4. Cervical Disc Bulge/herniation4. Cervical Disc Bulge/herniation5. Muscle Spasm6. Postural Syndrome7. Thoracic Outlet Syndrome
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Neck Pain in Dentistry
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Neck Pain in Dentistry
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Sitting Posture and Back/Neck Pain
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Dentistry and Shoulder Pain
� Arm positions change the subacromial space
� There is 11 mm space available with the arm by the side; at 90 degrees elevation, it decreases to 6 mm
� There are 11 pain generating tissues in the subacromial space
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subacromial space
� Overuse of the rotator cuff along with poor arm positioning leads to impingement of the rotator cuff tendons
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Common Shoulder Pathology
� Tendonitis/tendonosis/tendonopathy� Rotator Cuff� Bicipital
� Impingement Syndrome
� Bursitis� Subacromial� Subacromial
� Rotator Cuff Tear
� Labrum
� Osteoarthritis (OA)� AC joint� Glenohumeral joint
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Dentistry and Shoulder Pain
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Tips for Reducing Strain to Your Body
� Neck/Back: Maintain an upright posture as much as possible, relax your shoulders, avoid prolonged sitting, take frequent breaks from sitting to allow your spine to move
� Shoulder: Reach overhead in a “thumbs-up” position
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position
� Maintain your overall health with proper diet and regular exercise (cardiovascular, strengthening, and flexibility)
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Postural Correction
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Preventative medicine
� Doorway stretches
� Scapular squeezes
� Upper Trapezius stretches
� Chin tucks
� Hamstring stretches
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� Hamstring stretches
� Standing backward bends
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Signs of Danger
� Neck: Pain that radiates into your shoulder blade or down your arm, especially if it limits your neck mobility or causes tingling in your fingers
� Back: Pain that radiates into your buttock or down your leg, especially if it causes tingling in your foot
� Shoulder: Sharp pain with movement of the shoulder,
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� Shoulder: Sharp pain with movement of the shoulder, aching in the shoulder joint at rest, or when you start to compensate with the other hand
� If pain is inhibiting your ability to sleep
� If pain worsens despite attempts at resting the area, use of ice, or OTC medications
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What Your Physical Therapist Can Do
� If your symptoms do not resolve you can have your doctor refer you to physical therapy
� We will do a thorough evaluation to determine the source of the pain, areas of tightness or weakness, functional limitations and other contributing factors
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contributing factors
� You may need more specialized treatment, manual techniques such as joint mobilization, and an individualized exercise program to fully address your symptoms
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Rehabilitation: Neck Pain
� Trigger point releases (ball in sock or against the wall, theracane, massage therapy)
� Nerve stretches
� Postural stretches (snow angels against wall or on foam roller, foam roller exercises, doorway chest stretches)
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chest stretches)
� Strengthening (scapular retraction/rowing, prone I/Y/T, deep neck flexor exercise)
� Stretches (cervical retraction, upper trapezius, levator scapula)
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� I’s -1
� Y’s- 2
� T’s- 3
Prone Hughston’s I, Y, T2 3
1 2 3
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Rehabilitation: Shoulder Pain
� Postural stretches (same as for the neck)
� Strengthening: scapular retraction/rowing, scaption, external rotation (ER), horizontal abduction, also prone I/Y/T as for the neck
� Stretching: doorway chest stretches, foam roller stretches
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stretches
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Rehabilitation: Low Back Pain
� Stretches: Hamstring, hip rotators, low back stretches (knees to chest, prone pressups)
� Strengthening: Core exercises such as abdominal bracing, planks, supermans, as well as hip/glute strengthening such as leg presses, chair squats, side stepping with resistance
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chair squats, side stepping with resistance
� Postural modification: Using a lumbar roll when sitting
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Ice or Heat?
� For an acute injury, ice will help decrease inflammation and swelling, and numb pain
� Heat helps bring circulation to an area and make the area relax and become more flexible, but it can make inflammation/swelling worse
� For neck and low back pain, you can try ice or
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� For neck and low back pain, you can try ice or heat and use the one that helps the most
� For shoulder pain, ice typically works the best because the shoulder problems usually have inflammation involved
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Any Questions?
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References
� Mechanisms leading to musculoskeletal disorders in dentistry. Valachi B, Valachi K
� JADA. 2003 Oct; 134: 1344-1350
� Biomechanical risk factors for occupationally
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� Biomechanical risk factors for occupationally related low back disorders. Marras WS, Lavender SA, Leurgans SE, Fathallah FA, Ferguson SA, Allread WG, Rajulu SL
� Ergonomics. 1995 Feb; 38(2):377-41
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Theracane
Available at:http://www.theracane.com/
http://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=theracane
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Foam Roll – typical size is 36in. long, 6 in. diameter
Available at:http://www.optp.com/AXIS-Black-Roller?cat_id=43
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Exercise ball – Typical size 65cm (Also available in 55cm and 75 cm)
Available at: Any store with sporting goods
http://www.optp.com/Gymnic-Classic-Plus-Exercise-Ball?cat_id=63
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“The Stick” – Available in multiple sizes (17-26in.) We typically use a 24in. Version
Available at:https://www.thestick.com/
http://www.amazon.com/The-Stick-Original-Massage/dp/B000YDO1NA/ref=sr_1_3?ie=UTF8&qid=1364562474&sr=8-3&keywords=the+stick