Back and neck pain continue to plague dental professionals, so it’s always worth a reminder of the importance of preventive care. Consistently over many years, over a third of the amount we pay in claims to dentists are for musculoskeletal issues, which in 2015 approached £1.5 million.

Dental professionals commonly experience musculoskeletal back and neck pain and discomfort, in some cases even starting at dental school before following them throughout their careers. But this needn’t be the case. With awareness, focus and your own preventive care plan, you could be pain free for life.

The issueDr Jimmy Tang CES, MBA, BDS, LDS RCS, dentist and corrective exercise specialist said “What you may not know is that most of these disorders are a result of poor posture leading to muscle imbalances where certain muscles are lengthened/stretched or shortened/tightened. In both cases, the muscles are weakened and dysfunctional. These weakened muscles are more susceptible to damage, fatigue and injury. For instance, muscles that are tight and stiff can restrict blood circulation, resulting in increased muscle fatigue and impeding the muscle repair process.”

He continued “So what are the causes of muscle imbalances? The most common cause among dentists is poor and prolonged static posture. This is because the muscles adapt to the positions that you put them in and the longer you hold them in a certain position, the more muscle adaptation occurs. Tissues can therefore become adaptively shortened or

lengthened. Furthermore, tight muscles can inhibit the function of their counterparts.

“For instance, if you sit for a prolonged period of time, your hip flexors (responsible for hip flexion, bringing your legs forward) become tight and the opposing glute muscles (antagonist) become stretched. The gluteal muscles are important in hip stabilisation and extension (moving your legs back, i.e. every time you walk or run). When the glutes are not able to function properly, other helper muscles (synergists) take over, e.g. the piriformis, erector spinae, quadratus lumborum, hamstring and latissimus dorsi – this is known as synergistic dominance where the helper muscles (synergist) take over the role of the prime movers (agonist). Unfortunately, these synergists are not as efficient as the agonists and, over time, this can lead to dysfunctional movement patterns and the development of trigger points in the synergist muscles, resulting in musculoskeletal lower back pain.

“Of course, this is just a simplistic overview of what can happen as a result of prolonged sitting. It is even more complicated if you sit with a poor posture; for example, if you slouch, you may end up with a posterior pelvic tilt with lengthened back muscles and tight abdominals (stretched erector spinae and tight rectus abdominis). Conversely, if you sit with an excessive lumber extension, you may

Pain in the neckdevelop an anterior pelvic tilt with shortened and tight back muscles (erector spinae) and stretched core and abdominals (rectus abdominis and transversus abdominis).”

Dental studentsWith students starting their clinics in earlier academic years these days, and more cases of referrals to occupational health at a younger age, it is important that there is a

greater focus on good posture and preventive care from dental school to ensure that they implement good habits into their routine at a young age.

A paper in the BDJ in September this year looked at the musculoskeletal neck and back pain in undergraduates at a London dental school. They found that 79% of

students experienced back pain with over 40% of those experiencing it for more than 30 days in the past year. Additionally these problems were experienced by students of all clinical years, not just those in their final year. Lower back pain was the most common source of the problem and was reported by many to be the worst hit area. Over 50% of respondents indicated that they used daily stretching to try to combat the issues, but this was only common practice where they experienced pain rather than as an active preventive approach.

Over 50% of respondents indicated that they used daily stretching to try to combat the issues, but this was only common practice where they experienced pain rather than as an active preventive approach.

Members’ Newsletter Issue 8 Summer/Autumn 2016

8 Dentists’ Provident

The National Academy of Sports Medicine (NASM) recommends the following four distinct phases in the management of lower back pain:

• Inhibitory phase – inhibit the activity of overactive or tight muscles by using self-myofascial release of trigger points

• Lengthening phase – once these overactive muscles have been inhibited, they need to be stretched. Muscles that are typically shortened as a result of prolonged sitting are hamstrings, hip flexors and the piriformis

• Activate phase – activation of underactive muscles such as the gluteus maximus and medius. An example of an activation exercise for the gluteus maximus is the glute bridge

• Integration phase – functional exercises involving the use of dynamic total body exercises to enhance functional capacity. These include exercises that focus on the synergistic function of the body’s stabilisation and mobilisation muscles. This involves low load and controlled movement in an ideal posture

Dr Jimmy Tang, CES, MBA, BDS, LDS RCS BiographyGeneral dental practitioner. NASM Corrective Exercise Specialist with special interest in postural dysfunction and lower back problems. Level 3 Personal Trainer (REP registration no R1045463). L3 Sports massage therapist.

PreventionFollowing NASM’s advice, we can see that daily stretching and strengthening of the important muscle groups is vital to help prevent back pain, following the use of foam rollers and massage balls. Activating your weak muscles such as with exercises like bridges that strengthen your glutes and hamstrings are also vital. Activities like Pilates, yoga and the Alexander Technique could all be useful additions as well as any other preventive techniques that may work for you. Just make sure you consult a medical professional before starting any new exercise regime to prevent new issues occurring or old problems resurfacing.

Dr Tang also warns “If you suffer from repeated episodes of back pain with no means of relief, apart from paying attention to your musculatures, you may need to have your ankle alignments assessed as well. If you are flat footed, this may have contributed to the recurrence of your back pain.”

Dr Tang finishes by saying “It is not enough to just treat the acute episode of pain because without intervention, active trigger points simply turn latent and can be reactivated with the slightest twist and turn.”

So beware and remember – it’s never too late to reverse the symptoms of minor niggles and prevent bigger issues occurring in the future.

References available on request.

Members’ Newsletter Issue 8 Summer/Autumn 2016

Dentists’ Provident 9