How to prevent and treat musculoskeletal disorders.
If you have been in dentistry long enough you are familiar with the common occurrence of aches and pains of the body.
Musculoskeletal disorders are not the direct result of a single event or injury but develop over some time due to chronic use of repetitive, forceful, and awkward movements or postures. Areas that are affected include soft tissues of the body such as nerve tissue, connective tissue, tendons, and muscles. Symptoms of MSD include pain, swelling, burning, cramping, limited range of motion, muscle weakness, stiffness, tingling, and sometimes numbness. Contributing factors to pain in the dental field include poorly designed workstations, deficient equipment, poor work patterns, awkward positioning of operator/patient, repetitive work, neck flexion, upper arm abduction, and prolonged static postures. We can not eliminate the risk of MSD, but we can minimize the contribution of risk factors. In this article, I hope to provide you with information that you can take and apply to your practice to help prevent chronic pain and discomfort.
Ergonomics. A word that was ingrained into our brains during dental hygiene school, now we understand why!
Ergonomics is defined as a science of equipment design and workspaces focused on maximizing productivity by minimizing operator fatigue, discomfort, and injury.
Common risk factors include:
Poorly designed work stations that require the operator to reach beyond an arms-length to obtain equipment
Inadequate equipment such as dull instruments or old cavitron tips
Poor work habits such as contorting the body, not utilizing indirect vision, or failure to use correct clock positioning
Neck and shoulder pain due to a failure to remain in a neutral spinal position while working.
Reducing pinching force when holding instruments. Use a SOFT C grasp.
Decreasing the vibrations from ultrasonics and handpieces.
Organize your workspace to be ergo-friendly
Consistant neutral positioning
Common Musculoskeletal disorders in dentistry include:
Carpal tunnel Syndrome: Caused by medial nerve compression in the wrist. Symptoms are a lazy or clumsy hand with tingling. Treatments range from worksite ergonomic intervention, physical therapy, anti-inflammatory medications, to surgery.
Rotator cuff issues or thoracic outlet syndrome: Caused by inflammation of the rotator cuff soft tissues of shoulder or compressed nerves or blood supply passing to the arm. Treatment can range from worksite ergonomic intervention, physical therapy, to surgery.
Myofascial pain syndrome: Range of symptoms that can also produce pain in the upper body such a neck, shoulders, arms, or back. Treatment is the restoration of muscle function by strengthening and stretching.
Low-Back Pain is the number one cause of occupational disability in the field of dentistry. I can personally relate due to a previous compression fracture in L4. Sitting all day is not ideal for anyone. We work sitting in ops where a limited range of motion is emphasized and stabilization is needed. Sitting is indeed a dynamic activity.
Tips for improving posture and reducing muscular exhaustion:
Keep shoulder back, elbows lower than shoulders, and wrists even or slightly lower than elbows
Many professionals recommend mixing it up by alternating standing and sitting throughout the day
Take breaks during treatment to take a deep breath, stretch, and realign into neutral positioning
Use properly fitted loupes, light, and saddle stool
Keep the neck as vertical as possible by centering ears above the neck and shoulders this discourages the neck from tipping forward or to one side
Keep the shoulders balanced and as horizontal as possible.
Avoid hunching, twisting, lifting, sitting on one hip, or with one leg on the base of the chair
Lean forward at the waist when necessary, avoid bending the neck forward
Keep upper arms parallel with the torso elbows should be at waist level with a bend
Avoid angulation greater than 20 degrees abduction from the body
Keep forearms parallel to the floor, avoid closing it less than 60 degrees with the upper arm
Keep the thumb slightly higher than the pinky finger keeping the wrist in alignment with the forearm
Avoid bending wrist in an up and down motion
Seek out professional help when you first notice discomfort that is not going away
Five must-haves for combating MDS in dental hygiene:
A saddle stool from a reputable dental manufacturer. I like many of you found it hard to spend $800 on an operator chair for work. I have purchased three separate stools from Amazon. I finally after two years of back pain purchased a Queen Ann saddle stool from the crown seater company. Ya'll it's been a game-changer for my back comfort. https://www.crownseating.com/product/q-a-c-queen-anne-chair/ Keep in mind with any operator chair the ideal angulation for hips should be between 110-130 degrees. The hips should be slightly above the knees, keeping both feet flat on the floor. A saddle stool facilitates the opening of the hip angle and maintains the anteverted curve.
When proper magnification loupes and light are used the operator can see more clearly, with less effort, therefore improving the clinical experience. When the angle of declination is correct there is less effort to keep the neck straight. There is always a learning curve when introducing a new piece of equipment into your clinical practice, keep in mind that with an increase in magnification there will be a decrease in brightness and field size. I recommend a magnification between 2.0-2.5. Many companies offer prescription lenses for those who need them.
I find that sharp, lightweight, and wide-handled dental instruments are best for my fat fingers. They reduce the problem of over squeezing or pinching in my experience. Please keep your instruments SHARP to prevent long-term finger issues such as arthritis. My favorite instruments are the hu-friedy Harmony line and Paradise dental technology.
Know when it's time to seek professional help. Whether that is an ergonomic coach, physical therapist, massage therapist, or chiropractic care. Follow our friend Katrina at ergofitlife on Facebook https://www.facebook.com/ergofitlife/ for great professional tips on stretching and muscle conditioning to prevent injury. I see my chiropractor and massage therapist twice a month https://georgiaspinesports.com/ to keep my muscles relaxed and my hips in proper alignment.
I hope this information helps to keep you all aligned and comfortable at work and home.
Resources: Dental hygiene Applications to Clinical practice, R. Henry