The importance of good posture in dentistry
James Tang explains why good posture is so important in the prevention of neck and back pain.
The spine has four natural curves when viewed from the side – cervical lordosis, thoracic kyphosis, lumbar lordosis and sacral kyphosis – and these curves are essential for shock absorption.
In the neutral position, the spine is mainly supported by the bony structures of the vertebrae resting on top of one another. When these curves become either exaggerated or flattened, the spine increasingly depends on muscles, ligaments and soft tissues to maintain its erect position – causing tension in these structures.
This leads to neck and lower back strain and formation of trigger points. Over time, this can lead to spinal disc injury.
Common postural deviations
This is also known as the lower crossed syndrome. It is characterised by specific patterns of muscle weakness and tightness that cross between the dorsal and ventral sides of the body.
There is tightness of the erector spinae and the hip flexor group of muscles. In addition, there is weakness of the glutes and the deep abdominal core muscles. The hamstrings are also usually tight.
These imbalances result in an anterior tilt of the pelvis, increased flexion of the hips and a compensatory hyperlordosis in the lumbar spine.
Generally speaking, this postural deviation is prevalent in those who sit for a prolonged period of time, such as dental professionals. Corrective exercises involve the activation of the deep core abdominal muscles alongside the glutes. You need to stretch the tight hip flexors.
Corrective exercises for hyperlordosis
Hip flexor stretches
Kneel with one knee on the floor and your other foot in front of you with the knee bent at a 90-degree angle. Push your hip forward and keep your back upright. Hold until the tension alleviates; then, take the stretch further once more until the tension subsides.
Activation of the transversus abdominis (TvA)
Due to years of misuse, eg sitting on a stable surface for a prolonged period of time, these core muscles are ‘switched off’.
The TvA is one of the muscles responsible for the forced expiration of air when we cough. The TvA provides a stable base within the centre of the body for activities that are more distal, such as heavy lifting or indeed working on patients.
With this in mind, it would be useful to be able to pinpoint the TvA and consciously activate it.
Teaching points: lie on your back with your knees bent at 90 degrees
Find a position two inches below the navel and two inches to either side. Press lightly on each side using the first two fingers of your hands and then cough. This is the location of the transversus abdominis. You should be able to feel the contraction under your fingers as the TvA fires.
Breathe out completely, try to draw your navel in as far as possible and tilt your pelvis up very slightly. You should feel the contraction of the TvA. Start breathing normally whilst maintaining the contraction of the TvA.
The aim of the exercise is to try and replicate the contraction felt whilst coughing but without actually coughing.
Glute activation exercises, eg glute bridge
Lie on the floor on your back. Bend your knees at a 90-degree angle. Contract or squeeze your glutes (you should be able to feel them tightening) to lift your hips and thighs off the floor. Form a straight line between your knees and shoulders, maintaining a neutral spine with your core engaged.
Hyperkyphosis (upper crossed syndrome)
For the upper body, dental professionals tend to bend forward, protracting their shoulders for a prolonged period predisposing to a hyperkyphosis and a forward head posture.
By holding the head and neck in an unbalanced forward position, the spine increasingly depends on soft tissues to maintain an upright position. For example, the upper trapezius and erector spinae must contract constantly to support the weight of the head in the forward posture, predisposing to the formation of trigger points in these muscles leading to the predictable referral pain patterns including tension neck syndrome characterised by headaches and chronic neck pain.
The pectorals are also tight. Those that are commonly weak include the deep cervical flexors, lower trapezius and rhomboids. If it has been determined that your neck pain is caused by muscle imbalances, this needs to be rectified by using the following corrective exercises.
Corrective exercises for hyperkyphosis
Doorway chest stretch – stand in an open doorway and place your hands on the inside door frame with your arms at shoulder level, holding them straight. Lean forward until you feel a stretch in your chest.
Examples of strengthening exercises for the middle trapezius and rhomboids: three to four sets of 12 repetitions.
Barbell bent-over row
Stand holding a barbell with an overhand grip, your hands slightly more than shoulder-width apart. Push your hips back and bend forward until your torso is almost parallel to the floor. Draw the bar towards your rib cage. Pause and then lower the bar. Maintain a slight bend in your knees throughout the movement.
Seated row with resistance band
Teaching points: sit up straight on the floor and tighten your core to avoid injuring your lower back. Wrap the band around your feet, bend your elbows and pull the band towards your body, at the same time squeezing your shoulder blades. Hold for a few seconds and slowly return to the starting position.
You can actually stretch your pectorals and strengthen your upper back with one simple exercise. You can easily do this regularly at work (for example, between seeing patients). Simply clasp your hands behind your back, retract your shoulders and squeeze your scapulae – hold this position for a few seconds before releasing.
Strengthening exercise for the deep neck flexors
Weaknesses of the deep neck flexors are commonly associated with neck pain (similar to weakness of the transversus abdominis being commonly associated with lower back pain). There are exercises that can be used to reactivate these muscles.
You can activate neck flexors with a simple head-nodding motion (chin tucks). For example, by moving the chin closer to your ‘Adam’s apple’.
Teaching points of chin tucks
Stand against a wall so that when you retract your head, it just touches the wall. Hold this position while breathing normally for 10 seconds and repeat the process 12–15 times. Progression – hold for longer as you become stronger.
Be aware, besides corrective exercises, it is imperative to develop good habits for your posture by improving your general work ergonomics. You should train your body so that you can recognise when you are adopting a poor posture. Correcting your posture may feel awkward initially because your body has adapted to sitting and standing in a particular way.
You are advised to engage an appropriate professional to give you advice and guidance to ensure that the correct activities are being selected for your particular situation.
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This article was first published in Orthodontic Practice magazine.