As dental professionals, most of us have been taught, reminded, or even reprimanded about the care of our bodies while at work.
Posture, ergonomics, and equipment were topics likely reviewed in dental school and remain in the back of our minds as we practice. However, the responsibility to take care of our bodies while at or away from work is an individual choice, and we live with the consequences and rewards of our actions.
This article presents information for dentists about our body movements and how they relate to the work we do. We will look at how we should take care of our bodies and outline some practical techniques to help keep our body mechanics functioning optimally both in and out of the office.
The reality of practicing dentistry—pediatric dentistry, especially—is that even when our backs or necks ache, we still have to adjust the disto-lingual line angle on a wiggly 4-year-old, then crane our necks the very same day to show a parent caries on an upper second molar. Rinse, dry, repeat. Maybe in your practice these motions happen often, maybe they don’t. The reality is that even the most ideal posture and movements needed for dentistry and working with children aren’t always healthy and natural for our bodies.
How many of us choose to make time for exercises that help strengthen muscles that we abuse or neglect as dentists? How many of us have a physical therapist who has tailored an exercise program to keep us as healthy as possible? If that’s you, pat yourself on the back and stop reading now because you’re already on top of the situation. Or, keep reading, because you might find something new and useful here.
Just like an athlete who is expected to perform on the court or the field, we are expected to perform daily with the handpiece and mirror in hand. Whether you’ve been practicing for one year, ten years, or fifty years, we hope you find a take-away that improves your life, or at least encourages you to think about the merits of self-care and thoughtful exercise.
I (Graham) teamed up with my brother Mason, who just finished his Doctor of Physical Therapy, and who has coached me extensively on training programs and exercises to improve my body mechanics. We’ll talk about and demonstrate exercises that can mitigate the potential harmful effects of everyday work in dentistry. We discussed what this means for our bodies and created a framework, in the form of exercises and reminders, to improve and maintain healthy body mechanics. We hope you are able to put the following exercises to use in your life and daily practice and thereby reduce your risk of dentistry-related injury.*
*The following content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Section 1 —Mobility and Strengthening Exercises
1. Isometric retraction/elongation
Lie on your back without a pillow under your head (Step 1). Tuck your chin (see down arrow) in to press the back of your head flat on the floor (or into a bed) and pull yourself taller as if something attached to the top rear portion of your head is pulling (see right arrow) to elongate your neck (Step2). Return to the initial position and repeat. Perform this exercise for three (3) sets of 10 repetitions. This can also be performed while seated, such as against the headrest in a car on the way to/from work; however, for best results perform in a supine position.
The responsibility to take care of our bodies while at or away from work is an individual choice.
2. Thoracic extension mobility
Place a foam roller on the floor and lie on your back with your knees bent and the foam roller at the level of your shoulder blades. With your arms behind your head for support, lower your head and shoulders as close as you can to the floor until you feel a stretch behind your back. This can be performed segmentally by moving the placement of the foam roller 1–2 inches up and down the spine between the level of the shoulder blades down to the mid back. You can also work the foam roller up and down your back in smooth motions for a more massage-like effect. If your foam roller is below the level of your ribs, you’ve gone too far.
We live with the consequences and rewards of our actions.
3. Cat and dog stretch
Start on all fours with your back straight, hands under the shoulders and knees under the hips. To do the “dog stretch,” slowly inhale and let the belly fall toward the floor to arch the back downward and extend the head upward at the same time. Try to create as much of a “U” shape as possible between the pelvis and head (Step 1). To do the “cat stretch,” slowly exhale, round the back upward and tuck the chin to the chest (Step 2). Alternate between these two positions slowly. You should be feeling this motion as a “rolling” of the pelvis and as an arching of the spine in both “cat” and “dog” motions.
4. Thread the needle
Start in a four-point position with your hands directly under the shoulders and the knees under the hips. Keep your chin in, back straight and shoulders back. Using one arm to stabilize your body, raise the other arm off the floor and reach under the stabilizing arm as far as possible, rotating and rounding your upper back downward as you lower the shoulder of your moving arm (Step 1).Then retract your moving arm and reach vertically as far as possible (Step 2). This movement can be modified by placing a foam roller on the outside of your stabilizing hand and using the foam roller to facilitate the movement in the first picture below.
Change stabilizing hands and repeat with the other arm. Hold each end-range position for 1–2 seconds while continuing to breathe before reaching in the opposite direction.
Exercise reduces the chance of chronic pain.
5. Suboccipital release
Using athletic tape, fasten two tennis balls together so that they are firmly affixed next to each other. Place the balls underneath your neck at the base of your skull while lying on your back with your knees bent. Tuck a small hand towel between the tennis balls and your upper back to keep the balls from sliding. Hold this position for 10–15 seconds before re-adjusting. Experiment with different locations to find the one that provides the most relief.
6. Bird dog (leg lift/arm lift)
Get on your hands and knees (four-point position—see Step 1) with your knees directly under your hips and your hands directly under your shoulders. Beginning with the “cat and dog” stretch is a good way to warm up for this exercise, and to find the “neutral spine” position to best perform the “bird dog” movement.
With your back in a neutral position (slightly arched), keep your eyes focused on a point on the ground slightly in front of your hands. Tighten your abdominals in an attempt to pull your belly button upward toward your spine and maintain this contraction while continuing to breathe. Then, extend one leg behind, without moving your back or pelvis (Step 2). Next, extend the opposite arm in front while keeping your balance. Try to grab something far away in front of you with your hand and touch an imaginary wall far behind you with your foot instead of just lifting it up (Step 3). Lower your leg and arm back to the floor and repeat with the other leg and the opposite arm. Repeat this motion for 12–15 repetitions per side, up to three (3) sets per side.
The reality is that even the most ideal posture and movements needed for dentistry and working with children aren’t always healthy and natural for our bodies.
7. Dead bug
Lie on your back and place both knees and hips bent to 90 degrees and both arms pointed straight towards the ceiling (Step 1). This should feel like the inverse of the “bird dog” position mentioned earlier. Activate your abdominals by bringing your belly button downward toward your spine. Maintain steady breathing while you lower one leg straight and lower the opposite arm behind your head (Step 2). Just before you touch the floor, return the leg and arm to the starting position and repeat with the other leg and opposite arm, maintaining the abdominal contraction throughout the entire movement.
Section 2 — Thoracic Spine Mobility Exercises
1. Prostrate prayer pose to cobra pose
Start on all fours. Push your buttocks back toward your heels with your arms extended fully forward (Step 1). Then, transition into a cobra position by gradually moving your hips forward, keeping them close to the ground. Simultaneously raise your chest off the floor by pushing up with both arms to a fully extended position while keeping your legs flat on the floor surface (Step 2). Alternate between these two positions up to 15 times per session.
2. Thoracic spine mobility with stick – Type 1
Start in a standing position and hold a stick in front of you with palms up and your feet a shoulder-width apart as illustrated (Step 1). Rotate your trunk to one side (twist body R or L), raising your hand (on the side to which you are rotating) high overhead while reaching the opposite hand across the body but keeping that arm parallel to the floor. Do this while bending the trunk laterally to the side in the opposite direction of the raised hand (Step 2). Repeat the exercise, beginning this time by rotating (R or L) in the opposite direction as the first time. Perform this movement up to two (2) sets of 12 repetitions per session.
3. Thoracic spine mobility with stick – Type 2
Start in a standing position and hold a stick in front of you with palms up and your feet a shoulder-width apart as illustrated (Step 1). Rotate your trunk to one side (twist body R or L), lowering your hand fully on the side to which you are rotating while reaching the opposite hand across the body but keeping that arm parallel to the floor. Do this while bending the trunk laterally to the side in the same direction as the lowered hand (Step 2). Repeat the exercise, beginning this time by rotating (R or L) in the opposite direction as the first time. Perform this movement up to two (2) sets of 12 repetitions per session.
Dentists are at risk for musculoskeletal disorders such as neck and back pain, in part due to the postural and biomechanical requirements of the profession. While it can be difficult to maintain proper ergonomics in all aspects of clinical dentistry, reminding ourselves and our staff of its importance and holding ourselves accountable for our wellbeing at work is likely to improve both the longevity and comfort of our practice. Improving workplace ergonomics can play an important factor in the prevention of these pathologies, such as setting up treatment rooms to allow for maintaining upright standing posture or ensuring that stool heights are at a level to achieve upright seated posture during patient care.
Ergonomic evaluations can be performed by licensed physical therapists for individualized evaluations of workspaces.
Beyond the clinic, regular participation in exercise to maintain core musculature strength and global spinal mobility can reduce the risk of overuse injury from faulty body mechanics in the workplace. Achieving a balance of activity outside the office and an ergonomic workspace has been a personal and professional goal for both of us, and we hope that you can reap some of the benefits of finding a balance for yourself, wherever that may be.
Remember, the exercises listed in this article are intended to be used together as part of a wellness program. By addressing and strengthening the areas listed above, we have focused on the prevention of chronic workplace injuries most commonly reported by dentists. This article provides a framework designed for dentists to combat workplace overuse injuries by creating weekly habits of customized exercises, improving ergonomics in the workplace, and encouraging participation in recreational activities. It is not intended to treat any particular condition, and we encourage seeking the advice of a licensed physical therapist if you have any musculoskeletal conditions.
Most importantly—don’t forget to get out and enjoy regular physical activity! Increasing activity throughout the week and exercising some every day will significantly help to decrease the risk of injury associated with routine activity in the dental office.